The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 3

Question: Will the leftover filler affect the rhinoplasty since it is a closed rhinoplasty?
Answer: The filler placed in the nose after nine months will probably not affect the results of your rhinoplasty procedure. If you think there’s still a significant amount leftover in your nose, then have it reversed by the person who placed it there in first place. A closed rhinoplasty just means all the incisions are placed on the inside of the nose.

Question: Can my insurance cover my Septorinoplasty?
Answer: The short answer to your question is you need to look at the specific exclusions on your insurance plan, such as cosmetic surgery. Your prospective rhinoplasty surgeon will need to see you in person and submit for medical necessity and pre-authorization with whatever medical insurance company that you have. You could also have In-network, or out of network benefits. You will also have to responsible to pay for the co-pays and deductibles.

Question: Would a chin implant give me more facial symmetry and balance?
Answer: Yes, indeed, a chin implant would give you better facial balance, and proportions, from mostly the side profile, but some frontal improvement as well. Chin implants can be placed under local anesthesia through a small incision underneath the chin which takes about 30 minutes.

Question: Can I achieve refinement with medium thick skin?
Answer: When performing a rhinoplasty, it’s impossible to thin down your thick skin. A conservative amount of cartilage can be removed from your bulbous nasal tip, shaving down the dorsal hump, and narrowing the bridge line with all of the incisions placed on the inside of the nose. This is called closed rhinoplasty. No painful packing is require either. You’ll most likely require several follow ups for steroid shots to reduce the the excessive swelling that occurs with thick skin in the supratip part of the nose.

Question: Good candidate for chin implant?
Answer: You are a good candidate for a chin implant, which can be done under local anesthesia, as an outpatient procedure which takes about 30 minutes. If your teeth are significantly out of alignment, then you can consider performing a sliding genioplasty by a oral surgeon under general anesthesia in a hospital setting with an overnight stay in the hospital.

Question: I’m considering a lower blepharoplasty, but I chew nicotine gum. Is this a problem?
Answer: It would probably be best to stay off the nicotine gum, at least a few days before and after a lower blepharoplasty procedure to ensure optimum healing. Nicotine restricts blood vessels and blood supply to tissues.

Question: I have extra cartilage protruding in one nostril. Can this be corrected in office under local anesthesia?
Answer: From the photographs, this is most likely the foot plate of your cartilage called the lower lateral cartilage. It might also be a slight caudal septal deviation. In any event, this cartilage can be removed under local anesthesia with one small incision placed on the inside of the nostril. No open rhinoplasty is required.

Question: Can I get Chin Filler with Chin Implant?
Answer: Chin implants are manufactured in a large array of both sizes and shapes, which is determined by your plastic surgeon prior to the surgery itself. Digital computer imaging can also be performed to give you an idea what your new result might look like. You should not need filler after it placement of a chin implant, but it would be acceptable to undergo filler placement underneath the dermis if ever needed.

Question: How common is entropion after lower blepharoplasty done from outside the eyelid?
Answer: In our practice for over 30 years, we remove all fat through the inside of the lower lid, which is the gold standard to prevent ectropion. If there’s loose and extra skin present on the lower lids, then we make an incision just underneath the eyelashes only remove a small pinch of the skin itself. The reason for the incision on the inside, and the incision on the outside is to prevent any disruption of the lower eyelid muscle, which can cause an ectropion.

Question: Do I need a neck lift? Is there another procedure that would tighten this skin?
Answer: You’re going to require a lower face and neck lift to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove the residual fat compartments in the neck, along with a platysma plasty to significantly improve the jawline. In our practice, a neck lift alone does not remove excess skin, which is your biggest problem. The crepey neck skin is due to the deflation of your neck tissues from the significant weight loss.

The Seattle

Plastic Surgery Center


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