Facial Plastic Surgery Questions and Answers: Part 3

Question: What kind of changes to my nose would flatter my face?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, refinement of the nasal tip, and narrowing the bridge line. An alar-plasty accomplishes narrowing wide nostrils, but that does not appear to be needed based on the limited photographs. Thick skin in the tip of the nose is going to prevent refinement in that area, so it is important to have realistic expectations. Rhinoplasty is a very difficult endeavor, so choose your plastic surgeon wisely based on extensive experience.

Question: Chin Implant: Should it be sutured to the chin?
Answer: In our practice, we place chin implants directly over the bone and into pocket underneath the periosteum. We also placed one dissolvable suture centrally to hold the implant in place. Once the pocket heals around the implant, it is very rare for the implant to ever shift or move.

Question: Would an eyebrow lift help my tired eyes?
Answer: Much more information is needed, such as a full set of facial photographs looking directly into the camera to make a determination about the need for an upper blepharoplasty, ptosis repair, or browlift. From the two limited photographs, it does not appear that a browlift would be necessary.

Question: What method provides more predictability and precision in revision rhinoplasty: external or internal osteonomies?
Answer: In our practice for over 25 years, we have performed endonasal closed rhinoplasty with all incisions placed on the inside of the nose. This also includes both medial and lateral osteotomies. This totally prevents an external incision and offers a very predictable result. Most important is what is accomplished with placement of the cuts in the nasal bones, not where the incision is made to do it. With either technique, the procedure is done by feel, not by sight since the surgeon cannot actually see the nasal bones themselves directly.

Question: Does someone with high nostrils always have a hanging columella?
Answer: Alar retraction and hanging columella are 2 completely separate issues. They are most commonly associated with a previous rhinoplasty. Each 1 is treated differently.

Question: Is it possible to have a secondary facelift under local anesthesia?
Answer: In our practice, we perform most face/necklift procedures under general anesthesia for patient safety and comfort. Board certified physician anesthesiologist administer the anesthesia. Trying to perform the entire face and neck lift under local anesthesia can be very difficult and painful for 3 hour procedure.

Question: How complex would a rhinoplasty for my nose be? I attached pictures of my nose now and the desired result.
Answer: Rhinoplasty is 1 of the most difficult operations to perform correctly in the entire field of cosmetic surgery, so it is imperative to choose your surgeon wisely based on extensive experience. A full set of facial photographs from all angles are going to be required to make a determination about how best to proceed. The dorsal hump can certainly be shaved down, and the tip lifted very slightly. Osteotomies placed in the nasal bones will be required to close the open roof deformity created from the hump removal, and spreader grafts will probably need to be placed in the midportion of the nose to prevent the upper lateral cartilages from collapsing inward. Digital computer imaging would be helpful to understand what can and cannot be accomplished with your nose upon your facial features. This would be a routine rhinoplasty, not a complex rhinoplasty for an experienced surgeon.

Question: Is it worth it to get a revision rhinoplasty? My nose is severely deviated.
Answer: Your Nose is not severely deviated, but there is a small area of fullness in the supra tip area which can be related to thick skin or excess cartilage. Thick skin is best reduced with steroid shots, while a revision rhinoplasty can accomplish removal of residual cartilage in that area in addition to reduction of the hanging columella. A septoplasty is performed in the back of the nose only to improve air flow dynamics, and will have no bearing on the look of the nose. Both procedures can be performed together when necessary.

Question: Crooked tip – Should I get a 2nd opinion for revision rhinoplasty?
Answer: A full set of unadulterated photographs are going be required to make a determination about straightening the Crooked nose. To straighten crooked nasal bones require osteotomies placed in the nasal bones to straighten them, a spreader graft composed of the patient’s own cartilage in the midportion of the concave upper lateral cartilage, and cartilage removal and cartilage grafting techniques in the nasal tip cartilages to straighten the nasal tip. Revision rhinoplasty for the crooked nose deformity is a difficult procedure to perform correctly in the entire field of cosmetic surgery, so it is important to choose a surgeon based on extensive experience. 

Question: How can I correct a droopy nose tip?
Answer: A closed rhinoplasty approach can accomplish correcting the drooping nasal tip by lifting the nasal tip cartilages, and shaving down the dorsal hump. It is also important to release the depressor septi ligament which pulls the tip down dynamically when smiling.


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