The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 08

Question: How do plastic surgeons fix a bulbous nose and it more narrow?
Answer: The Bulbous nasal tip to be reduced with a conservative amount of cartilage removed from the lower lateral cartilages in the nasal tip. When there is a significant wide nasal tip cartilages, then suture techniques are used to narrow the tip cartilages. Thick skin in the tip of the nose is going to prevent refinement in that area, so that must be sorted out prior to the plastic surgery. It is important have realistic expectations when thick skin is present. If he your nose droops dynamically when smiling, then it is important to release the depressor septi ligament which pulls the tip down dynamically. A septoplasty is performed for improvement of breathing, and can be performed at the same time as a rhinoplasty procedure.

Question: Is there any way to address difficulty breathing through my nose after rhinoplasty?
Answer: A thorough internal examination of the nose is going to be required to make a determination about what is causing the breathing difficulty. There are many issues on the inside of the nose that can cause breathing difficulties such as a deviated nasal septum, turbinate hypertrophy, allergies, chronic sinusitis and valve collapse. It would also be important to have a copy of the operative report to understand what was accomplished in the first nasal surgery procedure you had done.

Question: I dislike one side of my nose but I’m okay with the other. Should I opt for rhinoplasty?
Answer: The Reason that you have different 3/4 profiles because your nose is crooked from the front. You will automatically have a long side and a short side. A closed rhinoplasty approach can improve the straightness of your nose, decreased the overall projection, and make the nose better balanced. There is no perfect nose, just improvement.

Question: Suggestion on procedure to improve my eyes?
Answer: The Photographs demonstrate what is called dermatochalasis, and an upper blepharoplasty improve the look of your eyelids. This procedure can be performed under local anesthesia as an outpatient procedure.

Question: Am I a good candidate for a brow lift?
Answer: A brow lift can accomplish raising eyebrows and rejuvenating the upper one third of the face when there’s low eyebrows present. Also important to soften the coordinator muscles which create scowling and the 11’s between the eyebrows.

Question: Do sutures hold the platysma in place until muscles are fully healed?
Answer: Yes, platysma plasty sutures hold the platysma muscle in place once the neck shin has been tightened, and fat deposits are removed from both above and below the platysma muscle itself.

Question: Best surgical approach to make my nose smaller around the bottom?
Answer: A full set of facial photographs from all angles are are required to make a determination, since the nose is a three-dimensional structure. An alar plasty is performed to narrow wide nostrils. Conservative cartilage removal is performed to narrow a bulbous nasal tip. Osteotomies placed in the nasal bones narrow the bridge line. All of this can be accomplished with the closed rhinoplasty approach, with all of the incisions placed on the inside.

Question: Why is my nose so warped? Is it possible to completely straighten it?
Answer: First of all, you have significant facial asymmetry demonstrated in the one limited photograph, therefore your nose is going to have some asymmetries as well in addition to the trauma that you have received. A rhinoplasty procedure can accomplish improvement of your nose, but it won’t be perfect. There is no perfect nose. A cosmetic rhinoplasty can help straighten it out, however if you have a deviated septum causing nasal obstruction, you may need a septoplasty as well.

Question: What will work for this neck?
Answer: From the photographs presented, you have extensive inelastic skin in the neck in addition to fat deposits located both above and below the platysma muscle. Minimally invasive techniques will be a waste of time and money. You’re going to need a lower face and neck lift procedure which accomplishes tightening loose facial and neck skin, tightening and loose facial and neck muscles, removing fat deposits located both above and below the platysma muscle, and lifting the jowls. Choose your face/necklift surgeon wisely based on extensive experience producing natural results.

Question: Is this as good as I should expect from my neck lift, facelift and blepharoplasty? Do I need a revision?
Answer: You should wait at least one year after your primary facelift before considering undergoing a revision. From the limited photographs, it does appear that you have continued jowls, residual fat deposits in your neck, and loose and inelastic skin in your neck itself. The fat deposits in your neck may be located below the platysma muscle.

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