Facial Plastic Surgery Questions and Answers: Part 06

Question: What are the chances of having another callus develop after a revision rhinoplasty to correct it?
Answer: Much more information is needed, such as a full set of facial photographs and an in-person examination to make a determination about what’s causing the callous formation. If there’s a small bony or cartilaginous hump, this can be simply filed down with the revision rhinoplasty procedure.

Question: If my nose is narrow in the front, will hump removal with nothing else done make the front view wider?
Answer: Yes, when there’s a narrow nose present when the hump is removed, the remaining nasal bones are too wide relative to the rest of the nose. Osteotomy’s are then required to close the open roof deformity created from the hump removal itself. In addition, spreader grafts are placed underneath the concave upper-lateral cartilages which will also add additional width, and are very important to prevent further collapsing inward of those narrow nasal cartilages. 

Question: Revision rhinoplasty on a fractured nose?
Answer: A revision rhinoplasty can certainly straighten the crooked nose after it’s been fractured. Much more information is needed such as a copy of your previous operative report and the x-ray or CAT scan that you had performed to make the diagnosis of the nasal fracture.

Question: Would a revision help nose tip, as it seems a little full & columella hangs?
Answer: The fullness in your nasal tip can be improved with steroid shots when there’s thick skin and scar tissue present. The hanging columella must be surgically improved the remove redundant skin and cartilage in that area.

Question: Thick under eye folds when smiling – what can I do to correct this?
Answer: The primary goal for lower eyelid surgery is to remove the fat bags creating the puffy look which is evident only in your third photograph. When there’s excess skin at rest (not when smiling), then the excess skin can be removed with a pinch technique. In our practice, we close that incision with tissue glue.

Question: Botox before or after endoscopic brow lift – which order is more beneficial for healing and results?
Answer: In our practice, we do not perform an endoscopic brow lift for a variety of reasons. The coronal approach gives much better, and long-lasting results. With the coronal approach, you can adjust the hairline upwards or downwards, improve asymmetry of the eyebrows, and soften both the corrugator and frontalis muscles which helps with both horizontal and vertical expression lines in the forehead. Botox is usually not required after the surgery if the muscles have been correctly softened during the surgical procedure. 

Question: F, 24, 5’1”, 105lbs, what can I do to fix my uneven eyelid?
Answer: A very conservative skin only pinch removal of excess skin can get rid of the excess pleat on your right eyelid. This can be performed under local anesthesia.

Question: Does it matter what day of the week or time to schedule plastic surgery?
Answer: In our practice, we perform facelift procedures earlier in the week, and not on a Friday afternoon. There’s lots of follow-up care for the first four days after the procedure.

Question: Can I achieve a more natural nose with fat injections alone or should I consider other options?
Answer: Fat injections don’t work very well in the nose. The photos are rather limited, but it appears that you have wide nasal bones and a hanging columella, along with a few irregularities your tip. Those issues can be improved with a closed revision rhinoplasty procedure.

Question: Not happy with my rhinoplasty results 2 years post op. What needs to be done?
Answer: A revision rhinoplasty can accomplished lifting your nasal tip, narrowing the bridge line and dependent upon how thick your skin is, you may get some improvement in the nasal tip. It’s also important to release the depressor septi ligament which dynamically pulls your tip downward when smiling. When you check in with your operative surgeon, ask about steroid shots to reduce the thickness and swelling in your nasal tip. 

Question: Would a rhinoplasty help me achieve a more feminine nose and minimize the appearance of bumps on the side?
Answer: From the front profile,What you’re seeing is wide nasal bones, narrow upper lateral cartilages, and wide tip cartilages. A closed rhinoplasty approach can accomplish getting rid of your “bumps” by narrowing the nasal bones, placement of spreader grafts to widen the Concave upper lateral cartilages, and refinement of the bulbous nasal tip. All of the incisions are placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Choose your rhinoplasty specialist very widely based on extensive experience.

Question: Which procedure would help minimize the appearance of wrinkles in the general eye area?
Answer: Consider an upper blepharoplasty procedure to get rid of the extra Hooded skin on the upper eyelids. With respect to the lower lids, you could have a conservative “pinch” performed for the extra skin. In our practice, that might be approximately one eighth of an inch skin excision. You may require laser treatment to get rid of all the fine lines. Botox is performed for crows feet.

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