Facial Plastic Surgery Questions and Answers: Part 05

Question: Brow bone reduction, rhinoplasty, mini facelift/cheek lift – are these edits achievable?
Answer: You’re not a candidate for a facelift or a brow lift, since you’re still very young. The amount of change or trying to obtain with a brow bone reduction is not worth it. Regarding your nose, it is possible to improve your side profile, however the nose is a three dimensional structure, therefore a full set of current pictures are required to make a determination about how best to proceed. A closed revision rhinoplasty can accomplish your goals with all the incisions placed on the inside of the nose. Digital computer imaging done by a rhinoplasty specialist would also be helpful to understand what can be accomplished with your nose upon your facial features.

Question: What can I do to correct asymmetry, shadowing and a slight bump on my nose?
Answer: From the photographs presented, your best off leaving well enough alone. There is no perfect nose, so it’s important to have realistic expectations. You would only consider performing a fourth rhinoplasty if there were very significant issues going on, which there is not. It would be too risky to perform a fourth rhinoplasty.

Question: Considering procedures to alter my chin – Would filler, liposuction, or an implant deliver the best results?
Answer: Your photos demonstrate several issues going on. You have a recessive Chin profile, so consider placement of the small chin implant to augment your chin forward for better facial balance and proportions, and for better structural support for all the soft tissues in your neck. Liposuction can only accomplish removal of the fat deposits above the platysma muscle, which will only give you minimal results. A surgical neck lift is required to remove the significant fat deposits below the muscle which also includes a platysma plasty to improve the jawline. No skin removal is required. A one inch incision underneath your chin is required for placement of the chin implant and the necklift procedure. The procedures performed under general anesthesia as an outpatient procedure.

Question: Would liposuction be effective for my double chin?
Answer: It’s difficult to tell from the limited photographs, however if the fat deposits are located above the platysma muscle, simple liposuction can accomplish improvement of your jawline and double chin. If the fat is located below the platysma muscle, then a neck lift with the platysma plasty will be required. No skin removal is required at age 30. 

Question: Should I get an open rhinoplasty, closed rhinoplasty or non surgical rhinoplasty for my dorsal hump?
Answer: A closed rhinoplasty approach can accomplish achieving down the dorsal hump, which is composed of both bone and cartilage. All the incisions are placed on the inside of the nose. No external incisions are required. This will offer permanent reduction to the hump itself. We do not recommend fillers placed in the nose for a variety of reasons.

Question: Are there alternative ways to reduce the cartilage at the tip of my nose?
Answer: A closed rhinoplasty approach can accomplish reduction of the nasal tip cartilages with suture techniques and a conservative cartilage removal. All the incisions are placed on the inside of the nose. No external incisions are required and no painful packing is required either. Anticipate A cast applied across the bridge of the nose for one week, and two weeks of visible bruising and swelling. 

Question: Difference between platysmaplasty with 1 incision under chin v/s necklift with (3 incisions over ears and chin)?
Answer: A full set of facial photographs are required to make a determination if your candidate for a neck lift procedure. In our practice, a neck lift procedure usually involves three small incisions which allow access into the neck. The two incisions behind the ears are only about half an inch which allow liposuction of the jawline. A 1 inch incision underneath the chin allows for open liposuction of the neck, and surgical removal of fat deposits underneath the platysma muscle in addition to a platysma plasty. No skin removal is needed. 

Question: I’d like a second opinion: My nose shape appears has changed since my primary, is this permanent, and can it be fixed?
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty, therefore an in-person examination is going to be required. The fullness along the bridge line can be caused from residual cartilage, or thick skin. Steroid shots will only be effective for thick skin with scar tissue and edema, while a revision rhinoplasty is required if there’s excess cartilage left behind.

Question: Revision rhinoplasty: are my expectations realistic?
Answer: Much more information is needed, such as a full set of facial photographs, and a copy of the operative report to find out what you have done in the past. Do you need a revision septoplasty, some other functional breathing surgery, and is this a primary rhinoplasty or a revision rhinoplasty? Look for a double board certified ENT/facial plastic surgeon with extensive experience with rhinoplasty, since this procedure is one of the most difficult operations to perform correctly in the entire field of cosmetic surgery. Is also important know how much cartilage is left over on the inside of your nose for grafting purposes, since you will need to spreader grafts placed in the mid-portion of your nose where your upper lateral cartilages are concave.

Question: Can Botox be used for non-surgical rhinoplasty?
Answer: Botox is used to treat wrinkles in the forehead and crows feet. Fillers are used for nonsurgical rhinoplasty, which we do not recommend for a variety of reasons. If you have a dorsal hump, it must be removed with a surgical rhinoplasty, since the hump itself is composed of both bone and cartilage.


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