Facial Plastic Surgery Questions and Answers: Part 9

Question: What doctor should I chose, I am debating between a new or old surgeon?
Answer: Rhinoplasty is the most difficult operation to perform correctly in the entire field of cosmetic surgery, so it’s imperative to choose a plastic surgeon based on extensive experience. It takes a decade of experience and over 1000 noses to become very consistent with this operation. A closed rhinoplasty approach can accomplish shaving down the dorsal hump, refinement of the nasal tip cartilages, narrowing the nasal bones and placement of spreader graphs in the mid-portion of the nose where the bridge line is pinched. The spreader grafts will be a very important component to prevent further collapse in that area after the hump removal. Digital computer imaging would be helpful to understand what can be accomplished with your nose upon your facial features.

Question: Do I need alar base reduction?
Answer: Alar base reduction is performed to narrow wide nostrils. This can be performed as part of the rhinoplasty procedure under general anesthesia, or as a standalone procedure under local anesthesia. A closed rhinoplasty approach can accomplish reduction of the bulbous nasal tip, narrowing the bridge line, and shaving down the dorsal hump with all of the incisions placed on the inside of the nose. Digital computer imaging would be helpful to understand what can be accomplished with your nose upon your facial features. Rhinoplasty is a very difficult endeavor, so choose your surgeon wisely based on extensive experience.

Question: Can my tip be lifted up under local anesthesia?
Answer: In our practice, we perform all rhinoplasty procedures under general anesthesia for patient safety and comfort. Board-certified physician anesthesiologists perform the anesthesia. There way too many nerve endings in nose to try to accomplish this under local anesthesia. It will be extremely painful to try to get your nose numbed up in order to do the surgery. A full set of facial photographs from all angles are going to be required to make a determination about how best to proceed. At a minimum, going to want to reduce the overall projection of the nose, reduce the hanging columella, and slightly lift the tip. A full closed rhinoplasty is going to be required.

Question: I would like to get a Rhinoplasty revision and a face lift. Should I do the rhinoplasty first?
Answer: A revision rhinoplasty and a facelift can be performed together under one anesthesia which allows for one recovery period. There’s no reason to have two separate surgeries with two separate recovery periods. A full set of facial photographs from all angles are going to be required to make a determination about being a candidate for both procedures. Revision rhinoplasty is one of the most difficult operations to perform correctly in the entire cosmetic surgery, so it is very important to choose your surgeon based on extensive experience.

Question: I had open rhinoplasty two years ago and overall very happy with result. Revision needed?
Answer: The photographs demonstrate a hanging columella. The caudal nasal septum behind the columella appears crooked as well. A revision closed rhinoplasty can accomplish reduction of the hanging columella and straightening the caudal septum. This is performed under general anesthesia for patient safety and comfort, not in the office.

Question: Is there limits to how small you can make your nose? And will I have a piggy nose if I correct my droopy tip?
Answer: Yes, there are limits to how small you make a nose based on your current nasal anatomy. It is very important that all of the components of the nose balance with themselves, and the entire new nose balances with the patient’s facial features in a three-dimensional fashion. Revision Rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so it’s important to choose your surgeon based on extensive experience. A Closed rhinoplasty approach can accomplish lifting the droopy tip, and narrowing the bridge line. Releasing the depressor septi ligament will prevent the tip from drooping dynamically when smiling. An alar-plasty can accomplish narrowing wide nostrils. A full set of facial photographs from all angles are going to be required to make a determination about how best to proceed. Digital computer imaging would also be helpful in the communication process to see visually what you’re trying to accomplish. 

Question: What procedure do I need to achieve slimmer jawline? Liposuction?
Answer: A full set of facial photographs from all angles are required to make a determination about how best to proceed. Liposuction can accomplish permanent removal of fat deposits above the platysma muscle.A Surgical necklift is going to be required remove fat deposits underneath the platysma muscle, which also includes a platysma plastic procedure. No skin removal is required in patients less than 50 years of age. 

Question: Can someone with keloid prone skin get a nose job and cheek bone implants? Tattoos?
Answer: Yes, it is certainly possible to undergo a closed rhinoplasty procedure whereby all the incisions are placed on the inside of the nose which prevents keloid formation. Look for someone who specializes in closed rhinoplasty, not open rhinoplasty. In our Practice, we place cheek implants through an intraoral approach above the teeth in the gum line, which also completely eliminates keloid formation. 

Question: Multiple surgeries: rhinoplasty, nuss procedure and umbilicoplasty. When should I do them and in what order?
Answer: Rhinoplasty is 1 of the most difficult operations to perform in the entire field of cosmetic surgery, so it is very important to find someone who specializes in that procedure. Digital computer imaging of your nose upon your facial features would also be helpful in the communication process as to what we are trying to accomplish. It does not matter which order these 3 surgeries are done, but it is very important finding the right surgeon for each procedure.

Question: Do you ever have patients who go back and forth with the decision to undergo rhinoplasty?
Answer: Yes, occasionally we do have patient see go back and forth about making their decision to undergo a rhinoplasty procedure. We usually offer those patients an additional consultation to sort through the indecisive issues so that they understand they are making the right decision at the right time to undergo a rhinoplasty procedure.


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    The Seattle Cosmetic Surgery Center

    Seattle, Wa. 98104

    206-624-6200

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