The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 2

Question: Am I a revision rhinoplasty candidate?
Answer: Best to wait at least one year before undergoing a revision rhinoplasty. A closed rhinoplasty approach can accomplish straightening the nose and reducing the hanging columella present. All of the incisions are placed on the inside of the nose. No external incisions are required. Also important to know if there is any cartilage left over on the inside of your nose for grafting purposes since you may need a spreader graft placed on the concave side. Steroid shots can help with swelling in the nasal tip.

Question: If my “dissolvable” sutures were rejected/spit during a previous surgery. Should I be concerned about this recurring?
Answer: In our practice, we use dissolvable stitches that fall out of the nose of 5 to 7 days after the procedure. We also perform closed rhinoplasty with all the incisions placed on the inside of the nose. No external incisions are required.

Question: Low platelets. Could I still be a candidate for rhinoplasty?
Answer: In our practice, we have performed rhinoplasty on patients with a platelet count of hundred thousand, and they did fine. You should get clearance from your hematologist and discuss it with your plastic surgeon and anesthesiologist.

Question: When getting otoplasty, is It possible to choose how far the ears are pinned back on the day of surgery?
Answer: Communication with your surgeon is of the utmost importance. Tell them exactly what you’re trying to accomplish, since they are performing your surgery. In our practice, we usually have to slightly over correct the ears and then they tend to drift outwards over the first month or so. We also perform this procedure under local anesthesia as an outpatient procedure.

Question: What type of rhino do you recommend to address narrowing of wide bone, overprotection, drooping tip, tip refinement?
Answer: The side profile photographs demonstrate an overly projecting nose, and an under projecting chin. A closed rhinoplasty approach can accomplish narrowing wide nasal bones, reduction of the hanging columella, refinement of the nasal tip, and shaving down the dorsal hump with all the incisions placed on the inside of the nose. No external incisions are required. No painful packing is required either. Consider placement of a chin implant to augment the chin forward for better facial balance and proportions from the side profile, especially with respect to the projection of the nose.

Question: Would having upper and lower lid surgery help with bags/darkness under eyes?
Answer: The photograph demonstrates herniated fat in the lower lids for which a lower eyelid surgery can certainly improve. The fat is removed through a trans conjunctival approach on the inside of the lower lids. If there’s excess skin at rest (not when smiling) then a pinch of extra skin at the eyelash line can be performed to tighten the lower lids. In our practice, this incision is closed with tissue glue. No stitches are required.

Question: What kind of procedure would help to get rid of my double chin and give a more defined jaw line?
Answer: From the one limited photograph, there appears to be a recessive chin profile and fat deposits in the neck located both above and below the platysma muscle. Consider placement of a Chin implant to augment chin forward, and a neck lift to remove fat deposits located above and below the muscle in addition to a platysma- plasty which was significantly improve the jawline.

Question: What is the best treatment for my double chin/ neck area?
Answer: The photographs demonstrate fat deposits in the neck and a recessive chin profile. Consider placement of a chin implant to Augment the chin forward. Liposuction alone can accomplish removal of the fat deposits on top of the platysma muscle. A neck lift surgery is required to remove fat deposits below the platysma muscle which also includes a platysma-plasty.

Question: Do I need Lateral or full endoscopic brow lift? Or blepho?
Answer: From the limited photographs, it appears that the rows are low, and a brow lift could certainly be beneficial. There are pros and cons related to endoscopic lift versus a coronal lift.

Question: Am I a good candidate for a rhinoplasty and a fox eye thread lift?
Answer: It’s important to have specific goals in mind on what you’re trying to accomplish with your nose. A closed rhinoplasty approach can accomplish narrowing the bridge line and refining the nasal tip with all incisions placed on the inside of the nose. No external incisions are required. Digital computer imaging would be helpful to understand what can be accomplished with your nose upon your facial features. We would definitely not recommend performing any procedures to your beautiful eyes.

The Seattle

Plastic Surgery Center


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.

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