The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 4

Question: Can I have rhinoplasty under general anesthesia with TMJ?
Answer: Yes, it’s certainly possible to undergo a rhinoplasty with TMJ. In our practice, we do not intubate patients, rather we use an LMA.

Question: I’m just wondering what kind of rhinoplasty I’d be a good candidate for?
Answer: The one limited photograph demonstrates an overly projecting nose and under projecting chin. A closed rhinoplasty approach can accomplish decreasing the overall projection of the nose, shaving down the dorsal hump, and reducing the hanging columella. All the incisions are placed on the inside of the nose, and there’s no external incisions required. Consider placement of a chin implant to augment the chin forward for better facial balance and proportions, especially with respect to the overly projecting nose from the side profile. Rhinoplasty is a very difficult endeavor, so choose your surgeon wisely based on extensive experience.

Question: Which procedure would help me achieve more projection and definition in the chin and jaw area?
Answer: Consider placement of a chin implant to augment your recessive manageable. In our practice, chin implants are placed through a small incision underneath the chin under local anesthesia, which takes about 30 minutes. If there’s excess fat in the neck, consider liposuction.

Question: Is it important to have a Board Certified Plastic Surgeon? 
Answer: Yes, indeed, it is important to make sure that your surgeon is board-certified in plastic surgery, or facial plastic surgery. It’s also very important to study your prospective surgeon’s before and after facelift photo gallery to make sure that it is extensive with lots of natural results.

Question: Lower facelift with chin implant or genioplasty?
Answer: Much more information is as needed such as a full set of facial photographs, your age, your height and weight to make a determination about how best to proceed. The goal of a chin implant is to augment the chin forward. The goal of a facelift is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove fat deposits in the neck located above and below the platysma muscle itself.

Question: I am in my early 40s. Neck lift, RF Microneedling, or other suggestions?
Answer: The photograph from the side profile demonstrates a recessive chin profile for which a Chin implant can improve the projection of the chin itself. The fat deposits in the neck appear to be located above and below the platysma muscle, therefore a necklift would be required. Both procedures can be performed simultaneously.

Question: Is it cheaper to get a dorsal hump reduction while I’m getting a septoplasty?
Answer: A septoplasty and a rhinoplasty are two completely separate surgical procedures, and both can be performed under one anesthesia with one recovery period. The rhinoplasty procedure is much more complicated than the septoplasty procedure, and takes much longer to perform. Anticipate paying for the entire cosmetic component of yourself while the functional breathing components can be billed to the patient’s medical insurance once medical necessity has been documented, and preauthorization has occurred. Anticipate co-pays and deductibles associated with your medical insurance as well.

Question: After a sliding genioplasty is it necessary to get plates/screws removed before going for a chin implant?
Answer: No, it is not necessary to remove plates and screws from prior surgery in order to undergo a chin implant. The Chin implant can be placed directly over the screws and through submental approach under local anesthesia as an outpatient procedure.

Question: Does jowl fat support the mid-cheek?
Answer: During a facelift procedure the Jowls a re-suspended in the mid face/ cheek area. If you’re trying to augment the midface by adding volume, then consider ceek implants.

Question: Do I need upper and lower blepharoplasty, please?
Answer: From the one limited photograph, it appears that you have significant asymmetry between your left side and right side. Your left upper lid is more hooded than your right, so a conservative skin only left upper blepharoplasty can make left eyelid Look more like your right. You also have fat bags on your left lower lid, and a left-sided trans-conjunctival lower blepharoplasty can make your left eyelid Look more like you’re right lower lid.

Question: Can you advise on how to fix my nose as I’m really insecure because one side is bigger/longer?
Answer: More information is needed such as a full set of facial photographs from all angles to make a determination about how best to proceed, since the nose is a three dimensional structure, and rhinoplasty is performed in all three dimensions. A closed rhinoplasty approach can accomplish narrowing the bridge line and straightening the nose from the frontal view.

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