The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 1

Question: Will a facelift help minimize the appearance of wrinkles on the cheeks?
Answer: To properly evaluate your face, a full set of facial photograph from all angles are required. A surgical face and neck lift accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting in the jowls, and removing any fat deposits in the neck which also includes a platysma plasty to significantly improve the jawline. A surgical facelift improves all these issues at repose, but dynamically, your contracting your smile muscles and will still have some degree of wrinkles present even after a facelift procedure.

Question: Should I do chin lipo too or just filler?
Answer: The photographs demonstrate fat deposits in the neck, located both above, and below your platysma muscle, in addition to a recessive mandible. Consider placement of a chin implant to augment your chin forward for better facial balance and proportions. Liposuction can only accomplish removal of the fat deposits above your muscle, which will only be partially effective. Surgical extraction of the fat deposits below the muscle will most likely be needed in addition to a platysma plasty to significantly improve your jawline.

Question: Am I a candidate for eyelid surgery?
Answer: You have low eyebrows which are creating the hooded look on your upper lids. Consider a brow lift procedure to raise the eyebrows and lift your lower lids off your eyelashes.

Question: Any recommendations to improve my jowls?
Answer: Your side profile photographs demonstrate jowls, inelastic skin in the neck, and fat deposits in the neck as well. A lower face and neck lift procedure can accomplish tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing the fat compartments in the neck in addition to a platysma plasty, which will significantly improve your jawline. Consider placement of a small chin implant to augment your chin forward, which will also help with the prominent pre-jowl sulcus that you have just in front of your jowls.

Question: Can a doctor choose the placement of a chin implant? 
Answer: No, all chin implants placed in a very specific position underneath the periosteum of the mandible directly at the lower leading edge of the mandible bone itself. The only variable component of Chin implant placement is the size of the implant.

Question: When is a standalone neck lift appropriate? 
Answer: In our practice, a standalone neck lift is performed on patients less than 50 years of age who do not have a skin tone issue. We’re simply removing fat deposits located both above and below the platysma muscle which also includes a platysma plasty. Most patients over 50 years of age are going to have some degree of inelasticity of the skin, which is going to require a lower face and neck lift to tighten loose facial and neck skin.

Question: Blepharoplasty quandary. How does a surgeon determine the amount of filler to be used?
Answer: In our practice, we simply remove the herniated fat bags in the lower lids through a trans- conjunctival approach on the inside of the lower eyelids. Some patients over 50 years of age requires pinch of skin when there’s extra skin present which is located on the outside of the lower lid directly underneath the eyelash line. For long list of reasons, we do not recommend fat injections to the eyelids or fillers in that area.

Question: Am I a candidate for a nose job?
Answer: A closed rhinoplasty approach can accomplish refinement and slightly lifting of your nasal tip, shaving down the dorsal hump, and narrowing your bridge line with all of the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Digital computer imaging would be helpful in the education process to understand what can be accomplished. Rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so choose your surgeon wisely, based on extensive experience.

Question: Fess surgery with septoplasty. How common is empty nose syndrome?
Answer: Empty nose syndrome usually is created by over resection of the inferior turbinates, or resection of the middle turbinate. It is Not caused from endoscopic sinus surgery, or from a septoplasty.

Question: Scar tissue? Cartilage? Not sure what’s inside my nostril, do I need full surgery to fix it?
Answer: From the photographs presented, it looks like you either have a caudal septal deviation to your left side, or the foot plate of the lower lateral cartilage is overriding the caudal septum. This can be improved with a closed columella plasty under local anesthesia as an outpatient procedure.

The Seattle

Plastic Surgery Center


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