The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 2

Question: 8 years post-op rhinoplasty for dorsal hump – is shrinking bulbous tip possible?
Answer: A full set of facial photographs from all angles and a copy of your operative report would be helpful to understand what was accomplished in the first procedure. The digital images that you presented are possible with a revision rhinoplasty procedure. You’re going to require cartilage grafting techniques to build up the area area on the bridge above the tip, that is slightly depressed. To prevent the tip of your nose from drooping down dynamically when your smile requires releasing of the depressor septi ligament. It’s important to know how much cartilage is left over on the inside of your nose for grafting purposes. Revision rhinoplasty is very difficult, so choose your surgeon wisely based on extensive experience.

Question: Facelift surgery is scheduled for 5:00 p.m. – is this normal? 
Answer: That does sound rather abnormal for outpatient elective cosmetic surgery. In our practice, we don’t schedule any long surgical procedures after 2 PM.

Question: Is septoplasty the right surgery for my nose?
Answer: A septoplasty is performed in the back of nose and only improves air flow. It will not change the shape of the nose. A cosmetic rhinoplasty can accomplish straightening the crooked nose, and shaving down the dorsal hump. Both procedures can be performed simultaneously, but expect to pay for the cosmetic component yourself. Functional breathing surgery such as a septoplasty can be billed to the patient’s medical insurance once a thorough internal examination the nose has been performed to determine medical necessity and then preauthorization with your medical insurance has occurred several weeks prior to the surgery.

Question: Do I need a lower facelift or would Ultherapy and fat transfer for the under eye and fillers work?
Answer: The photographs demonstrate a recessive chin for which a chin implant can certainly improve. Placement of the chin implant can accomplish augmenting the mandible forward for better structural support for the soft tissues in the neck. A lower face and neck lift can be performed simultaneously and can accomplish lifting the jowls, tightening loose facial and neck skin, tightening loose facial and neck muscles, and removal of the small amount of fat deposits in the neck.

Question: I’ve always wanted to get my nose done and would like to hear from professionals what will suit me best?
Answer: Digital computer imaging of your nose upon your facial features would be helpful understand what Can and cannot be accomplished. In our practice, we perform closed rhinoplasty which avoids any external incisions. Rhinoplasty is a very difficult endeavor, so choose your surgeon wisely based on extensive experience.

Question: Can you do a revision rhino without op reports from 1st? Is it possible to have a positive revision outcome in this situation?
Answer: Operative reports are helpful but not necessary. Revision rhinoplasty is one of the most difficult operations to perform correctly in the entire field of cosmetic surgery, so choose your surgeon wisely based on extensive rhinoplasty and Revision rhinoplasty experience.

Question: Can alarplasty be done? How far can nostrils be reduced in length and shortened?
Answer: Alar plasty only reduces the width of the base of the nostrils. It is impossible to reduce the length of the nostrils. A full set of Facial and nasal pictures are required to make a determination about how best to proceed.

Question: What is wrong with my nose? What is the specific rhinoplasty procedure that I would have to do to make it better?
Answer: The pictures are rather limited, however does appear that there’s a Crooked nose present in the frontal photograph. Consider a closed rhinoplasty to straightenThe bridge line with osteotomy’s, placement of a spreader graft to the concave side, and refinement of the nasal tip and shaving down the dorsal hump. All the incisions are placed on the inside of the nose. No painful packing is required.

Question: Would chin liposuction help my chin area?
Answer: More information is needed, such as your age, and BMI. After the fat has been removed from the neck, then a lower face and neck lift procedure may be required. In addition, you have fat deposits located above and below the platysma muscle in the neck, which must be removed at the same time.

Question: Unsatisfactory results from mini facelift, 2nd opinion please?
Answer: Mini facelift give many results, and this is just about what you would expect from a mini lift. In our practice, a lower face and neck lift procedure accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fat deposits in the neck along with a platysma plasty to significantly improve the jawline. Nasolabial folds will not be improved with a facelift.

The Seattle

Plastic Surgery Center


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