The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 06

Question: Am I a good candidate for lower eyelid surgery?
Answer: From the one very limited photo, there does appear to be herniated fat in the lower lids. A full set of eyelid and facial photographs are going to be required to make a better determination. When the fat bags are present in the lower lids, a transconjunctival approach on the inside of the lower lid can accomplish removal. This is performed under a brief general anesthesia as an outpatient procedure.

Question: My nose was broken in a car accident and has healed a bit crooked. How much is it too straighten it? How much downtime?
Answer: To straighten the nose requires osteotomies placed in the nasal bones to straighten them, a cartilage spreader graft placed underneath the concave upper lateral cartilage in the midportion of the nose, and asymmetric tip plastic surgery, if the nasal tip itself is crooked. The procedure is performed under general anesthesia as an outpatient procedure. Anticipate the cast placed on the nose for 1 week, and visible bruising and swelling for 2 weeks. Our current price list is located on the link below.

Question: Do I need a neck lift? Or jaw surgery?
Answer: A full set of facial photographs from all angles in a chin neutral position are going to be required to make a determination about how best to proceed. Liposuction can accomplish removal of fat deposits in the neck.

Question: Which surgery would I need?
Answer: From the one limited frontal photograph, you do not appear to have ptosis. Your left eyebrow is lower than your right, and therefore you have an extra pleat of skin on your left upper lid, which can be removed under local anesthesia is an outpatient procedure. This will make your left upper eyelid platform look similar to your right.

Question: Is it possible to make the chin a little wider without implants/filler?
Answer: Filler placed in the chin is going to only give you a very temporary augmentation. Consider placement of a small chin implant which can give additional width. One such implant is called the pre-Jowl implant, manufactured by Implantech. Its place thru a small submental incision under local anesthesia as an outpatient procedure. The only other option is to perform osteotomy to the jawbone, which would be much more invasive under general anesthesia.

Question: Should I get a chin implant or sliding genioplasty?
Answer: A sliding genioplasty is performed by an oral surgeon in a hospital setting with an overnight stay, and is more invasive. It’s usually performed when the teeth are significantly out of alignment. For purely cosmetic purposes, a chin implant can be inserted under local anesthesia in the office setting, which takes about a half an hour, and it’s less invasive.

Question: Fixing the tip – concerned about breathing problems following the procedure.
Answer: You’re not gonna be able to undergo a tip-only rhinoplasty procedure, you must undergo a full rhinoplasty to ensure that the entire components of the nose are balanced with each other in a three dimensional fashion. A closed rhinoplasty approach is less invasive, and involves reduction of the bulbous nasal tip, lifting the nasal tip and shaving down the dorsal hump that you have. Also important to release the depressor septi ligament, which dynamically pulls the tip downward when smiling. When patients have severe anxiety, you’re gonna be much better off having this procedure done under general anesthesia. A steroid shot on the inside of the nose will help reduce the amount of swelling on the inside of the nose from the rhinoplasty, so that you can still have some airflow in the postoperative recovery.

Question: I have Raynaud’s Syndrome (bad circulation), am I at risk for necrosis after a rhinoplasty?
Answer: Consider performing a rhinoplasty with the closed rhinoplasty technique, which does not cut through the columella, and would significantly reduce the chances of any issues with healing.

Question: Rhinoplasty after Septoplasty? 
Answer: It certainly acceptable to undergo a rhinoplasty after a septoplasty, and it would be a primary procedure, since you’ve never had a rhinoplasty in the past. Not a revision rhinoplasty. The important issue is to know how much cartilage is left over on the inside of your nose for grafting purpose, especially the most common type of graft that we use is called a spreader graft. If there’s no cartilage left inside your nose, then ear cartilage may be necessary.

Question: Should I travel for an ethnic rhinoplasty, or stay local & would you still consider my nose to have Asian features?
Answer: You should definitely stay within the United States and find a rhinoplasty specialist that you can trust, since you have very thick skin in the tip of your nose, and you’re probably going to require a few steroid shots after the procedure to reduce swelling in the tip. The bridge of the nose can be built up, the bridge line narrowed and your tip lifted slightly. Wide nostrils can be narrowed with an alar plasty. Don’t expect a lot of refinement in the nasal tip due to the thick skin in that area.

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Plastic Surgery Center

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