The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 03

Question: How do I get jaw definition – do I need a mandible implant?
Answer: More information is needed, such as your age and the amount of extra skin in your neck. As long as your skin tone is acceptable, then you can undergo a neck lift procedure which accomplishes removal of the fat deposits above and below the platysma muscle in the neck along with it platysmal-plasty. No skin removal is required with a neck lift procedure. No chin implant is required due to the fact of the projection of your mandible is fine. If you have loose and inelastic skin in the neck, then a lower face and neck lift is required to tighten loose and inelastic skin.

Question: Is the issue with my face from volume loss or sagging tissue?
Answer: You have both sagging tissues in your face and neck most likely related to the significant weight loss, and you have volume loss in the cheek area from the buccal fat pad removal. A lower face and neck lift with fat grafting to the cheeks would be your best solution.

Question: How safe are cartilage rim grafts?
Answer: Alar rim grafts are placed thru a very small incision ion the inside of the nose, so there is very little scarring. We use lateral crural strut grafts much more often than alar rim grafts to prevent collapse of the alar rim.

Question: Do I need lipo or a chin lift?
Answer: The limited photographs demonstrate a recessive chin for which a chin implant can improve. You also have fat deposits located above and below the platysma muscle in the neck. Liposuction will be ineffective ,since you can only remove a small amount of fat located above the muscle. Most of the fat deposits are located below the muscle which is going to require a neck lift procedure with a platysma plasty.

Question: Help! What happened to my face & neck? Can it be fixed?
Answer: Since it is only been 4 months unsatisfactory after your facelift, it is probably best to wait a full year before marking of another revision procedure to address the laxity of the skin in the neck, the platysmal cords in the neck, and the residual fat deposits in the neck along with the scar contracture and banding present. Anticipate a full lower face and neck lift. Choose your second Surgeon very wisely based on extensive experience.

Question: Would you recommend a chin augmentation or orthodontic jaw surgery to improve my profile view and overall appearance?
Answer: Orthodontic surgery is also known as a sliding genioplasty and is performed by an oral surgeon under general anesthesia in a hospital setting with an overnight stay. It is much more invasive, and is usually performed when the teeth are significantly out of alignment. Placement of a chin implant can be performed under local anesthesia and takes about 30 minutes to cosmetically augment your chin for better facial balance and proportions.

Question: I would like a more Barbie shape nose structure. Do I need a nose job?
Answer: It is important to perform a natural appearing rhinoplasty procedure so that you do not look like a Barbie doll. A closed rhinoplasty approach can accomplish refinement of the nasal tip, lifting the nasal tip, shaving down the dorsal hump, and reducing the hanging columella with all the incisions placed on the inside of the nose. Digital computer imaging of your nose upon your facial features would be helpful to understand what can and cannot be accomplished with a rhinoplasty, and yet look natural. Also important to release the depressor septi ligament which pulls the tip down when you smile. Thick skin in the tip of the nose will prevent refinement in that area, so it is important to have realistic expectations.

Question: Do I have a receding chin or protruding lips? Advice?
Answer: The limited photograph demonstrates a receding chin for which a chin implant can improve. Placement of the chin implant can be performed under local anesthesia as an outpatient procedure.

Question: Is there anything specific that can be done to fix an indent on my nose following a rhino/septoplasty?
Answer: If you are talking about the indentation in the soft tissue triangle just to the right of your nasal tip cartilage, that area can be filled in with a morselized cartilage graft harvested from the nose.

Question: Should I dissolve nose filler before having a rhinoplasty?
Answer: The filler has artificially inflated your anatomy, so it’s always best have it reversed, since rhinoplasty procedure is performed in millimeters.

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Plastic Surgery Center

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