The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 10

Question: I have a deviated septum. Would I need septoplasty or rhinoplasty to fix the crookedness?
Answer: A deviated septum can only be determined by a thorough internal examination of the nose, and a septoplasty is only perform for medical necessity to improve air flow dynamics. A septoplasty will not straighten the crooked nose. To straighten the crooked nose requires a cosmetic rhinoplasty. Both procedures can be performed together under one anesthesia with one recovery period.

Question: Which procedures would balance my features the most effectively?
Answer: The side profile photographs demonstrate an overly projecting nose and an under projecting Chin. Consider a rhinoplasty to shave down the dorsal hump, and placement of the chin implant to augment the chin forward for better facial balance and proportions.

Question: What would I benefit from? Chin lipo, chin implant, etc.
Answer: The photographs demonstrate a small amount fat deposits in the neck and recessive chin profile. Consider placement of a chin implant to augment the chin forward, and simple liposuction to remove the fat deposits in the neck. Both procedures can be performed under local anesthesia as an outpatient procedure.

Question: Is it possible I have a deviated septum?
Answer: The diagnosis of a deviated septum can only be made by an internal examination of the nose. The photograph demonstrates a crooked nose for which a cosmetic rhinoplasty can improve. A septoplasty is performed to improve air flow dynamics in the back of the nose once medical necessity has been documented after a physical examination. Both a septoplasty and a rhinoplasty can be performed together under one anesthesia with one recovery period.

Question: I’m interested in chin/neck lipo. Will the fat grow back shortly after?
Answer: Once the fat cells have been removed, they will not come back after liposuction. This procedure can be performed under local anesthesia.

Question: Did my surgeon ruin my nose? What are my options?
Answer: You have multiple complicated issues going on with your nose currently. Make sure you obtain a copy of your operative report for the plastic surgeon, since it’s very important to know how much cartilage is left over on the inside of your nose for grafting purposes. To reduce the ski slope, you’re going to require a graft of cartilage across the bridge of the nose. You will also require osteotomies to narrow the nasal bones, and spreader grafts placed underneath the concave upper lateral cartilages creating the inverted V deformity. A composite graft harvested from the ear placed inside the right nostril help with asymmetry, but your nostrils will never be symmetrical.

Question: Deep plane incision – what is the best option?
Answer: An intra oral incision for a facelift is not necessary. Facelift incisions are typically placed both in front and behind the ears. There are many different types of facelift procedures, so it’s difficult for the consumer to understand the minute variabilities. Study your perspective surgeon’s before and after facelift photo gallery to make sure that it is extensive with results that you like, and the results look natural.

Question: Does lipo of neck and jawline always use microcannulas?
Answer: Much more information is needed, such as your age, and a full set of facial and neck photographs to make a determination about how best to proceed. It’s also important to understand that there are two compartment of fat in the neck, and they are located both above and below the platysma muscle itself. Liposuction can only accomplish removal of the fat deposits above the muscle, while a surgical neck lift is required to remove the fat deposits below the muscle, which also includes a platysma plasty to significantly improve the jawline.

Question: Would a mini facelift help correct lines, laxity and wrinkles?
Answer: Much more information is needed, such as your age and a full set of facial and neck photographs at repose, not when smiling. Mini lifts will give mini results and are usually not worth it.

Question: Is my nose tip well enough supported to avoid drooping and other questions?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, and then osteotomy’s will be necessary to be performed in the nasal bones to close the open roof created from the hump removal itself. You may also require spreader grafts to prevent the upper lateral cartilages from collapsing inward. Minimal if any tip surgery needs to be performed. Give some consideration to a small chin implant to augment the recessive chin forward for better facial balance, especially with respect to the nose from the side profile.

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