Facial Plastic Surgery Questions and Answers: Part 09

Question: Am I a good candidate for rhinoplasty. I would look so much better with a smaller nose?
Answer: A closed rhinoplasty approach can accomplish making yournose smaller and more refined. This can be accomplished by shaving down the dorsal hump, decreasing the overall projection of the nose, and refining the bulbous nasal tip in addition to narrowing the bridge from the frontal view. All the incisions are placed on the inside of the nose. No external incisions are required and no painful packing is required. Digital computer imaging would be helpful to understand what can be accomplished with your nose upon your facial features.

Question: Am I a good candidate for a deep plane facelift?
Answer: The goal of upper eyelid surgery is to remove mostly excess skin and a small amount of fat on the inner corners of the upper eyelids. The goal of lower eyelid surgery is to remove the fat bags through trans-conjunctival approach on the inside of the lower lids. In our practice we do not recommend a deep plane facelift due to higher risk of facial nerve damage. We perform a high-SMAS lower face and neck lift. This procedure accomplishes lifting the jowls, tightening loose facial and neck skin, tightening loose facial and neck muscles, and removing fat deposits in the neck which also includes a platysma plasty. It is very important to look natural after all of these procedures.

Question: Do I need a revision? How long must I wait?
Answer: It is best to wait until at least 9 or 10 months before undergoing a revision to straighten the crooked nose. Any tip related surgeries should wait at least a year. This will allow pretty much full healing so that any other issues can be addressed all the same time. Straightening the crooked nose requires osteotomies placed in the nasal bones, and usually a spreader graft placed underneath the concave upper lateral cartilage.

Question: What options are available for hollow, sunken eyes?
Answer: More information is needed, such as any surgical history for a blepharoplasty or eyebrow lift. Fat grafting may be of some benefit to give more fullness to your upper lids.

Question: Still a double chin after chin lipo. Should more fat have been removed?
Answer: More information is needed, such as a full set of postoperative facial and neck photographs after your 20 pound weight loss to see if you’re still a candidate for any further surgery. It’s also important to understand that there are two compartments of fat in the neck, and they’re located both above and below the platysma muscle. Liposuction alone can only accomplish removal of the fat deposits above the muscle, while a surgical neck lift is required to remove fat deposits below the muscle, which also includes a platysma-plasty.

Question: Age 33, do I need a neck lift?
Answer: It is very difficult to tell from the photographs presented, but a neck lift in our practice involves removal of fat deposits above and below the platysma muscle, in addition to a platysma plasty to significantly improve the jawline. At age 33, you do not need a facelift.

Question: Does Kybella cause scar tissue?
Answer: The short answer is yes. The limited photographs demonstrate fat deposits below the platysma muscle in the neck. Simple liposuction and Kybella cannot address those fat deposits. A surgical neck lift is required to remove fat deposits below the platysma muscle which also includes a platysma plasty. No skin removal is required.

Question: What would need to be done to achieve a look that suits my face and give me an natural, unoperated look?
Answer: The Nose is a 3-dimensional structure, therefore a full set of facial photographs from all angles are going be required. Revision rhinoplasty is one of the most difficult operations to perform correctly in the entire field of cosmetic surgery. From the 1 limited photograph, there appears to be an inverted V deformity which will require low lateral osteotomies and spreader graft placement underneath the concave upper lateral cartilage in the midportion of the nose. It is very important to know how much cartilage is left over on the inside of the nose for grafting purposes.

Question: I’d like a second opinion: Can close osteotomy be done only on one side of the nose?
Answer: Yes, it is certainly possible to undergo one-sided osteotomy through a closed rhinoplasty approach. Probably best to wait several more months to allow full healing to make sure there is no other nuances that need to be addressed since you are only 1 month after the surgery.

Question: What is the likelihood of skin sag and tissue pocket after removal of a 7 year small, silicone chin implant?
Answer: It certainly possible to remove the chin implant 7 years after you had it placed, and there should not be any issues regarding bone remodeling. The soft tissues on your chin should just go back to where they were prior to the implant placement. Removal of the implant can be performed under a local or general anesthesia.

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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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