Facial Plastic Surgery Questions and Answers: Part 03

Question:  Rhinoplasty: are there in office fixes that can be done to the nose post rhinoplasty to fix the lower third and tip?
Answer: The Photographs are rather limited, however it appears that you have an overly projecting nose and an under projecting chin. its best to wait at least 1 year before undergoing another nasal surgery, but that will need to be performed under general anesthesia, not in-office. In the meantime, you can follow-up with your operative surgeon for steroid shots to be placed in the supratip area of the nose to reduce swelling in that area. Even with a revision rhinoplasty, the nose can only be de-projected a few millimeters. Consider placement of a chin implant augment the chin forward for better facial balance and proportions, especially with respect to the projection of the nose from the side profile.

Question: Will my face benefit from a chin implant?
Answer: The Photographs are rather limited, but it does appear that there is a recessive chin profile for which a chin implant can improve your face. Chin implants augment your current anatomy, however it does not give you a pointy chin. Chin implants are manufactured in a large array of thicknesses, sizes, and shapes. In our practice we placed chin implants through a small incision underneath the chin under local anesthesia as an outpatient procedure.

Question: Aging in the lower face. Should I get a SMAS, mid-face or lower facelift?
Answer: At age 42, your skin tone of the neck should be acceptable, therefore no skin tightening/facelift is required. A surgical neck lift can accomplish removal of the fat deposits located above and below your platysma muscle in the neck which also includes a platysma-plasty.

Question: I have a weak jaw line. Would a neck lift help? Or would I need jaw implant?
Answer: From the limited photograph, you have a recessive Chin which would require a small chin implant to augment your mandible bone forward to give better structural support for the soft tissues in the neck, and improve your jawline. The reason liposuction did not work for you is because you have fat deposits located underneath the platysma muscle in your neck. A necklift procedure with a platysma plasty with significantly improve your jawline by removing that compartment fat below the muscle. No skin removal is required.

Question: Do I need a second chin lipo or jaw surgery?
Answer: To make a determination about being a candidate for a chin implant, you should probably have the current filler reversed to Make a determination about where your mandible really is. It’s important to understand that there are two compartments of the neck, and they’re located both above and below the platysma muscle itself. Liposuction can only accomplish removal of the fat deposits above the muscle. The residual fat deposits in your neck are most likely located below the platysma muscle, which requires a necklift procedure and a platysma- plasty to significantly improve your jaw line.

Question: What would be the best treatment for sagging neck and face jowls? Tightening that skin up and improving the texture of skin?
Answer: A lower face and neck lift accomplishes tightening loose facial and neck skin, tightening a loose facial and neck muscles, lifting the jowls, and removing fat deposits in the neck along with a platysma plasty to significantly improve the jaw line. Choose your facelift specialist wisely based on extensive experience producing natural results.

Question: Lower face and neck deep plane face lift vs full face and neck?
Answer: If you have had radiation to your neck, you would not be a candidate for any type of neck work in our practice due to the poor healing after the radiation itself. If that’s the case, then you should just perform a facelift without any neck surgery. You can also consider doing your upper eyelids as well, but only if they’ve are bothering you. It does not appear that you need a brow lift.

Question: Considering rhinoplasty- what recommendations do you have to improve my nose?
Answer: The photographs demonstrate a significantly over projecting nose, and a mild recessive chin. The recessive chin makes your nose looked bigger than it really is, therefore consider placement of a small chin implant to augment the chin forward for better facial balance and proportions, especially with respect to the projection of the nose from the side profile. A closed rhinoplasty approach can accomplish reduction of the projection of the nose, shaving down the dorsal hump, and refining the nasal tip and narrowing the bridge line with all of the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Digital computer imaging of your nose and your chin would be helpful to understand what can be accomplished with either one or both procedures.

Question: My cheeks and jaw line have become droopy. Mini face lift, thread lift, or fillers?
Answer: In our practice, we do not perform thread lifts because of very temporary at best. We also do not perform a mini lift since they give mini results and do not last that long either. A well performed lower face and neck lift accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing the fat in the neck along with a platysma-plasty. When the mid face and cheeks are flat, then consider placement of cheek implants to give a permanent augmentation to the cheeks rather than having to go in for fillers every few months.

Question: I’m having surgery for a crossbite/underbite. Can I have a rhinoplasty during the same surgery? price?
Answer: If you are having both upper and lower jaw surgery, this is going to be performed by oral surgeon under general anesthesia in the hospital setting with an overnight stay. Best to have that performed first. A rhinoplasty should not be included with that type of surgery. Rhinoplasty is also performed under general anesthesia, but as an outpatient procedure.

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    The Seattle Rhinoplasty Center

    Seattle Nose Surgeon ®
    William Portuese MD
    Joseph Shvidler MD

    Seattle, Washington 98104

    (206) 624-6200

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