The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 01

Question: Is 61 years old too old for a rhinoplasty? 
Answer: No, 61 years old is not too old for a rhinoplasty procedure, as long as you’re in excellent health to undergo general anesthesia. Digital computer imaging would be helpful to understand what can be accomplished with your nose upon your facial features.

Question: Can deviated septum surgery help with excessive widening while smiling?
Answer: No, a deviated septum is performed in the back of the nose for airflow improvement. An alar plasty is performed to narrow wide nostrils statically. Releasing of the lateral Alar ligament can help with the dynamic flaring when smiling. All of these can be performed together under one Anesthesia with one recovery.

Question: Can alar retraction be repaired without major surgery?
Answer: From the limited photographs presented, you have a combination of alar retraction, and a hanging columella. Both of those can be addressed under local anesthesia, but you better have some intestinal fortitude to get those areas numb in order to undergo the plastic surgery, since there is a lot of nerve endings in that area. Once the area is numb, it’s pretty straightforward to reduce the hanging columella and place composite skin grafts from the ear. In our practice, we have done both of these procedures under local anesthesia on some individuals, but the majority of patients prefer general anesthesia.

Question: Which type of Lift can reshape/raise a hairline and fix brow sagging and eye hooding after a brow bone contour?
Answer: A full set of facial photographs from all angles are required to make a determination if you are even a candidate for eyebrow lift procedure. If you have already had a coronal approach, then a brow lift would be through the pre-existing incision which will raise the hairline.

Question: Is it plausible to have a revision on my chin lipo?
Answer: From the before photographs it is quite evident that you have fat deposits located above AND below the platysma muscle. Liposuction cannot remove those deposits located below the muscle. Liposuction can only remove the deposits above the platysma muscle, so consider a neck lift to surgically extract the fat underneath the platysma muscle in addition to a platysma plasty to significantly improve the jawline. No skin removal is required.

Question: How successful are revision Septoplasty surgeries for pain and obstruction?
Answer: If you are had a septoplasty, your septum is most likely not the problem. A septoplasty is only performed for nasal obstruction symptoms. Consider obtaining a CAT scan of your sinuses.

Question: Can I get a nose job without the nostrils becoming larger if we turn up the nose (Barbie look)?
Answer: It is important not to over rotate the tip upwards so that you looked right up were nostrils. When the nostrils are excessively wide, ad alar-plasty is performed.

Question: Can the bridge of my nose be lowered?
Answer: yes, a closed rhinoplasty approach can accomplish decreasing the high bridge only a few millimeters and decreasing the overall projection of the nose. Most of the shortening of your nose would be accomplished by reduction of the hanging columella. A septoplasty can be performed at the same time to improve airflow dynamics out of your nose.

Question: How do I get a more defined neck and jawline?
Answer: Much more information is needed, such as a full set of facial and neck photographs from all angles, and your age and the status of the skin tone in your neck. In our practice, a neck lift procedure accomplishes removal of fat deposits above and below the platysma muscle in addition to a platysma-plasty. No skin removal is required.

Question: Upper, lower blepharoplasty, brow-lift? Which combination do I need?
Answer: he 1 Limited photograph demonstrates adequate brow position even though your raising them to lift upper eyelid skin skin. Performing a brow lift will make you look very surprised, since your eyebrow position is higher than normal. A brow lift is only performed for patients who have low set eyebrows. An upper blepharoplasty procedure can accomplish removal of the hooded skin touching your eyelashes, while a trans-conjunctival approach lower eyelid surgery can accomplish removal of the fat pad bags creating the puffy look. The incision is located completely on the inside of the lower lids. After you have performed the eyelid surgery, then consider Botox in your forehead for the horizontal lines.

Question: Am I a chin liposuction candidate? I weigh 120 pounds and I am 5’3 but I have a pocket of fat under my chin.
Answer: From the one very limited photograph, it appears that you only have a small amount of fat in the neck, and simple liposuction should be able to improve your neck.

The Seattle

Plastic Surgery Center


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