Facial Plastic Surgery Questions and Answers: Part 5

Question: Am I a good candidate for a rhinoplasty?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, refining the nasal tip cartilages, and decreasing the overall projection of the nose, narrowing the bridge line and reducing the hanging and crooked columella. 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 of your nose upon your facial features would be helpful to understand what can be accomplished.

Question: Can I have a facelift now after I had 4 syringes of Voluma to my cheeks and jowls 1 and 1/2 years ago?
Answer: Since the fillers were placed a year and a half ago, there’s probably not much left and will not affect the results from a lower face and neck lift procedure. The goal of this type of surgery is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove the fat deposits in the neck which also include includes a platysma-plasty.

Question: Is it possible for any kind of procedure to only make incisions behind the ear & under chin?
Answer: In our practice and neck lift procedure does not remove any skin since those three incisions are rather limited. A next lift only removes excess fat compartments in the neck above and below the platysma muscle and a platysma plasty. When there is significant laxity in the neck, a lower face and neck lift is going to be required to remove that significant amount of skin. A large Z-plasty across the front of your neck Will because cosmedically unacceptable.

Question: Should you do skin boosters before a deep plane facelift?
Answer: Skin boosters will not have any affect with the results of your facelift. Best not to cause any scar tissue in the interim. It’s important to understand that facelift procedures involve tightening loose facial and neck skin, tightening loose facial and neck muscles, removing fat deposits in the neck above and below the platysma muscle, lifting the jowls, and also performing a platysma plasty to significantly improve your jawline. Skin boosters will have no effect.

Question: Over 10 months post op – will my bulbous nose correct itself with more time?
Answer: At 10 months, you’re fairly close to the final healing. The bump along your bridge line is probably not gonna go away and will need a little touch up procedure to rasp that down. With respect to your bulbous nasal tip, it really depends upon what techniques were used, and the thickness of your skin in the nasal tip itself. Thick skin in the nasal tip will limit how much refinement can be accomplished.

Question: How would I go about correcting a bulbous tip?
Answer: From the side profile photographs, you have an overly projecting nose, and an under projecting chin. The under projection of your chin makes your nose look bigger than it really is. Consider a closed rhinoplasty, along with a chin implant for better facial balance and proportions. A closed rhinoplasty can accomplish shaving down the dorsal hump, decreasing the projection of the nose, and refinement of the bulbous nasal tip with all of the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Placement of a chin implant can be performed at the same time as the rhinoplasty, or separately under local anesthesia. In our practice, we place the implant through a small incision underneath the chin. Choose your rhinoplasty specialist wisely based on extensive experience, since rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery.

Question: Fullness under chin after lower neck & face lift 9 months ago, what’s needed to correct?
Answer: You have multiple issues going on after your previous lower face and neck lift which include residual fat deposits underneath the platysma muscle in your neck, platysma cords, excess neck skin, and most likely prominent sub maxillary salivary glands. Make sure your plastic surgeon is comfortable addressing all of those issues.

Question: Lower face help?!
Answer: The only surgical procedure that would help would be a small chin implant placed under local anesthesia as an outpatient procedure. It would give you more augmentation of your chin forward, a moderate amount of width, and a small amount of vertical height. This procedure can be performed under local anesthesia and takes about a half an hour. You could also go back to your injector and have the filler reversed in your cheeks.

Question: Should I get a revision?
Answer: Your nose is significantly smaller and less projecting than your prior surgery. The only issue a revision rhinoplasty would accomplish is to give you more of a feminized profile and shave down the residual dorsal hump.

Question: Rhinoplasty for facial balance?
Answer: A closed rhinoplasty approach can accomplish making your nose more symmetrical, shaving down the dorsal hump, which is more prominent on your right side, decreasing the overall projection of the nose, and refining the nasal tip, with all of the incisions placed on the inside of the nose. No external incisions are required and no painful packing is required either. You also have a recessive Chin profile which makes your nose look bigger than it really is. Consider placement of a chin implant to augment your chin forward for a better facial balance and proportions. Both procedures can be performed together, under one general anesthesia, or the chin implant can be performed as a standalone procedure under local anesthesia. Digital computer imaging of both procedures would be helpful in the education process.


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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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