The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 9

Question: I am hearing that a lot of facelifts don’t last past 5 years. Is this true?
Answer: In our practice, that’s not true. We perform a high SMAS, comprehensive lower face and neck lift procedure, which accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fat deposits above and below the platysma muscle in the neck, in addition to a platysma plasty to significantly improve the jawline. We typically revise our own facelift patients between 10 and 20 years after their initial Face and neck lift. You may be referring to as to what a mini lift can accomplish, which gives only mini results. Study your prospective surgeon’s before and after facelift photo gallery.

Question: Would filler on the side of my nose help me achieve mere symmetry?
Answer: In our practice, we would not recommend fillers placed in the nose, since they’re only temporary, and can have significant complications such as skin necrosis. On the left side of your nose, you have a collapsed upper lateral cartilage and an outward deviation of your left nasal bone. You also have a hanging columella. A revision rhinoplasty can accomplish adjustments to all those areas which would it would include trimming back the excess skin and cartilage creating the crooked and hanging columella, placement of a spreader graft underneath the collapsed upper lateral cartilage on your left side, and a left-sided low osteotomy. All of us can be done with the closed rhinoplasty approach. All of the incisions are placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Please look at #7 in our Rhinoplasty photo gallery link below, who had the very identical issues that you do.

Question: Dent in nose after surgery. Should I go for revision with another surgeon?
Answer: It’s important to wait at least one year before embarking on another surgery. A full set of facial photographs from all angles are required to make a determination about how best to proceed, since you’ve only posted one angle, and the nose is a three-dimensional structure. Also important to know how much cartilage is left over on the inside of your nose, since you may need a cartilage graft in that depressed area. Best to obtain a copy of the operative report find out how much cartilage is still left over on the inside of your nose for grafting purposes.

Question: Do people who have lipo of lower neck have good results usually?
Answer: It’s very important to understand that liposuction can only accomplish removal of the fat deposits above the platysma muscle, while a surgical neck lift is required to remove the fat deposits frequently found below the muscle. Please post a full set of facial and neck photographs from all angles to make a determination about how best to proceed.

Question: Nose widens when I smile, options?
Answer: How much more information is needed, such as a full set of facial photographs from all angles with excellent lighting, and frontal photos both smiling and relaxed. An up the nostril photo would also be helpful.

Question: Does insurance cover a rhinoplasty under these conditions?
Answer: Functional nasal surgery such as a deviated septum or turbinate hypertrophy related allergies can be billed to the patient’s medical insurance once medical necessity has been documented, and pre-authorization with your medical insurance has occurred. Also anticipate co-pays and deductibles. Functional nasal surgery only improves breathing in the back of the nose. A rhinoplasty is performed for cosmetic purposes and must be paid for by the patient. Both functional and cosmetic nasal surgery can be performed together under one anesthesia with one recovery period.

Question: What procedure do I need? Preferably non surgical.
Answer: The side profile photograph demonstrates a recessive chin profile, along with fat deposits above and below the platysma muscle in the neck. Consider placement of a chin implant to augment the Chin forward for better facial balance and proportions. A surgical neck lift accomplishes removal of the fat deposits above and below the platysma muscle which also includes A platysma-plasty. Both procedures can be performed together under one anesthesia one recovery period.

Question: My nose is getting crooked. Can it be fixed with a nonsurgical rhinoplasty?
Answer: There are twisted nasal bones and a concave upper lateral cartilage in the mid portion of my nose in addition to a twisted nasal tip. A surgical revision rhinoplasty can accomplish straightening the nose. In our practice, we do not recommend fillers placed in the nose for a variety of reasons. It’s also important to know how much cartilage is left over on the inside of the nose for grafting purposes.

Question: Asymmetrical nose dome & deviated septum. What are my options?
Answer: The asymmetry of your nasal tip is related to normal facial asymmetry. The amount of asymmetry in your tip is not worth the risk of trying to adjust that so slight of an asymmetry. There is no perfect nose, since there’s a left half and the right half of the nose and they’re both different. A deviated septum is repaired with a procedure called a septoplasty. A rhinoplasty can accomplish shaving down the dorsal hump. For many examples in our current price list, see the link below.

Question: Can an Alarplasty decrease the size of my nose?
Answer: Yes, indeed, an alar plasty involves removing a small wedge of skin, typically about a quarter of an inch from the base of each nostril, and narrowing the base of your nostrils. This procedure can be performed under local anesthesia as an outpatient procedure.

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Plastic Surgery Center

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