The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 07

Question: Should I get a septoplasty when I’m getting my rhinoplasty?
Answer: Most of the time when there is a crooked nose, there is a deviated septum present. A septoplasty is only performed to improve airflow dynamics, and will not change the shape of the nose. A rhinoplasty is performed to change the shape of the nose. If your deviated septum is blocking airflow, that meets medical necessity and can be billed to the patient’s medical insurance after preauthorization has occurred. It is always best to perform a septoplasty at the same time as a rhinoplasty which allows one anesthesia with one recovery period. If you do not address the significant deviated septum, your breathing could get worse when the nose is made smaller.

Question: I’m 37 and my eyes are aging me. Could upper and lower eyelid surgery help the appearance of this area?
Answer: From the photos presented, your upper eyelids are certainly showing some excess skin which is touching your eyelashes and you are great candidate for an upper blepharoplasty. Regarding the lower lids, there does not appear to be any fat bags in the lower lids. A conservative pinch technique of excess skin at rest( not when smiling) can accomplish improvement in that area. This incision Is located directly at the mascara line and is closed with tissue glue. Upper eyelid surgery can be performed under local or general anesthesia as an outpatient procedure.

Question: Flared nostrils after primary rhinoplasty. Can this be fixed in a revision?
Answer: The photographs demonstrate a combination of a hanging columella, and alar retraction. To reduce the hanging columella requires a columella -plasty to remove excess skin and cartilage in that area. Bringing the nostril rims downward involves harvesting a composite graft from the ear and placing on the inside of the nostril rims which brings the nostril rims down for better alar-columellar balance.

Question: 29M, recessive chin, would a genioplasty work here?
Answer: A genioplasty is usually performed by an oral surgeon when the teeth are significantly out of alignment. For cosmetic purposes, consider placement of a chin implant to augment your chin forward for better facial balance and proportions. Placement of a chin implant can be performed under local anesthesia, which takes about a half an hour. You also appear to have fat deposits in your neck, which is normal when patients have a recessive chin. It’s important to understand that there are two compartments of fat in the neck, and they’re located above and below the platysma muscle. Liposuction can only accomplish removal of fat deposits above the muscle, while a surgical neck lift is required to remove fat deposits below the platysma muscle, which also includes a platysma plasty to significantly improve the jawline. A better set of facial photographs from all angles are going to be required to make a determination about how best to proceed.

Question: Deep plane SMAS – how does the SMAS get reattached?
Answer: In our practice, the SMAS is lifted off the underlying structures, such as the parotid gland, and is then tightened in a more superior and posterior position with a moderate amount of tension. We use permanent nylon stitches, which are inert. In addition to tightening the SMAS, the goal of a facelift is to tighten, loose facial and neck skin, tighten loose facial and neck muscles, remove fat deposits located both above and below the platysma muscle in your neck, which also includes a platysma plasty to significantly improve the jawline.

Question: 48, sagging lower face, could a mini facelift fix my jowls?
Answer: A full set of facial photographs from all angles are required to make a determination about the proper surgical procedure for you based on your age. In our practice, 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 jowls, and remove fat deposits located both above and below the platysma muscle in your neck, which also includes a platysma plasty to significantly improve the jawline.

Question: What do you see wrong with my nose? And can it be fixed?
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty, therefore a full set of unadulterated photographs from all angles are going to be required to make a determination about how best to proceed with your nose. Copies of the operative reports would be helpful. Also important to know if there is any cartilage left over on the inside the nose for potential grafting purposes, if necessary. Also important to have realistic expectations on what can AND cannot be accomplished.

Question: Should I be worried about scar tissue after rhinoplasty?
Answer: A closed rhinoplasty approach can avoid the external scar which occurs with open rhinoplasty. When patients have thick skin in the nasal tip, steroid shots are also beneficial to reduce the edema and scar tissue in that location.

Question: Am I a good candidate for rhinoplasty mainly for the bump which is visual from my side profile?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, refining the nasal tip, and narrowing the bridge line with all of the incisions placed on the inside of the nose. No painful packing is required and no external incisions are required either.

Question: What do you recommend to fix my badly crooked nose?
Answer: A closed rhinoplasty approach and accomplished straightening the nose with all the incisions placed on the inside of it. No external incisions are required, and no painful packing is required either. Osteotomies placed in the nasal bones can accomplish straightening and narrowing them. A spreader graft composed of the patient’s own cartilage would be required to be placed on the concave side. The dorsal hump can also be shaved down and the tip refined as well. Also important to evaluate the internal portion of the nose in case there is a deviated septum present from the broken nose itself.

The Seattle

Plastic Surgery Center

About.

Award Winning Highly Rated & Reviewed plastic surgeon Dr & medical clinic serving Seattle Wa 98104, King County, Bellevue, Kirkland, and Surrounding Areas. We offer a variety of surgical procedures and non surgical treatments for enhancement and rejuvenation.

Reach Us.

Copyright © 2022. The Seattle Plastic Surgery Center. All rights reserved.