Facial Plastic Surgery Questions and Answers: Part 10

Question: Is it worthwhile to pursue a revision rhinoplasty for facial balancing and profile improvement?
Answer: The photographs demonstrate a recessive chin which makes your nose look more projecting than it really is. The short Chin also gives poor structural support for the soft tissues in the neck. Strongly consider placement of a chin implant. The Side profile photographs also demonstrate fat deposits above and below the platysma muscle in the neck, therefore a neck lift procedure is going to be required to remove both compartments a fat, in addition to the platysma-plasty which will significantly improve the jawline. Both procedures can be performed together under one anesthesia with one recovery period.

Question: I’m 46 years old with deep nasolabial folds and marionette lines along with deep angry 11’s and sagging neck. Advice?
Answer: The photographs demonstrate a recessive chin profile and significant fat deposits in the neck located both above and below the platysma muscle in the neck. Consider placement of a chin implant to augment the chin forward, and a neck lift to remove fat deposits above and below the muscle which also includes a platysma- plasty. Botox would be best for the 11’s between your eyebrows.

Question: What kind of chin implant for my face?
Answer: In our practice for over 25 years we have used Implantech brand of solid silicone chin implants with an excellent success rate. We also use the Mittleman pre-jowl chin implant usually size small or medium. When their significant recession demonstrated in the photographs, size medium would probably be the appropriate size.

Question: Can rhinoplasty realistically fix the asymmetrical “squished”/bulbous look of my nose?
Answer: The photographs demonstrated an inverted upper lateral cartilage on the patients left side. A spreader graft placement of the patient’s own cartilage can accomplish improving the asymmetry and giving a straighter appearance to the nose. There is no perfect nose, only improvements, so it’s very important and realistic expectations. The height of the nostrils will not change.

Question: 6-year-old woman, looks like I’m frowning. Starting to get jowls and neck looks like a turkey. How do I treat this?
Answer: From the limited photographs, it appears that you have significant facial changes of aging for which a lower face and neck lift can significantly improve. The goal of a lower face and neck lift is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the gels, and remove fat deposits in the neck which also includes a platysma-plasty.

Question: Unusually low quote for submental liposuction from a board certified PS in Chicago – should I be concerned?
Answer: From the one very limited photograph, it shows that you have a very recessive chin profile and you’re going to have significant fat deposits above and below the platysma muscle in the neck. Liposuction will basically be ineffective, since most of the fat in your neck is probably located below the platysma muscle. A neck lift procedure can accomplish removal of both deposits of fat above and below the platysma muscle which also includes a platysma-plasty to significantly improve the jawline. No skin removal is required. Consider placement of a chin implant to augment the chin forward which will give better structural support for the soft tissues in the neck as well. Both procedures can be performed together under one anesthesia with one recovery period.

Question: Recommendations for laxed face jowls and double chin?
Answer: The limited photographs demonstrate a recessive chin, and a prominent pre-Jowl sulcus which makes your jowls look relatively bigger than they really are. Consider placement of a chin implant to augment the mandible forward and fill in the pre-Jowl sulcus. Liposuction can accomplish removal of fat deposits above the platysma muscle in the neck, howeverit also appears that you may have fat deposits below the platysma muscle which will require a neck lift with the platysma-plasty to significantly improve the jawline. More photos would be needed to make that determination.

Question: What is the likely cause of my eyelid asymmetry and how can it be balanced?
Answer: Everyone has some degree of eyelid asymmetry due to the embryologic development of the face from both the left and right half. A conservative skin only upper blepharoplasty can accomplish improvement of the asymmetry. This can be performed under local anesthesia as an outpatient procedure.

Question: Jowls, jawline, skin pigmentation, enlarged pores, fine lines, etc. —what do suggest?
Answer: Much more information such as a full set of facial/neck photographs from all angles with your hair pulled back to make a determination about being a candidate for a lower face and neck lift procedure. The goal of a facelift lift the jowls, tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove any fatty deposits in the neck to improve the jawline. Skin pigmentation is usually treated with laser treatments.

Question: What’s the recovery for a secondary rhinoplasty that is just inserting rim graft?
Answer: From what you’re describing, there appears to be two specific areas which is considered more of a touchup, so there should be significantly less swelling than a full revision rhinoplasty.


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    Seattle Nose Surgeon ®
    William Portuese MD
    Joseph Shvidler MD

    Seattle, Washington 98104

    (206) 624-6200

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