Facial Plastic Surgery Questions and Answers: Part 10

Question: Unhappy with side profile after rhinoplasty – will I need a revision?
Answer: It’s important to wait at least a year before contemplating undergoing a revision surgery To allow full healing to occur before embarking on a another procedure. If you were talking about this very small Residual dorsal hump, that would involve shaving down a millimeter of extra bone and cartilage.

Question: Alternatives to quinolone antibiotic for post facelift prophylaxis? 
Answer: In our practice, there’s no reason to do post facelift prophylaxis, since we give antibiotics during the procedure itself. It’s very rare to have an infection after a facelift procedure list or some underlying immune issue or you’re a smoker.

Question: Why did one doctor tell me my nose was too thin to perform a rhinoplasty and another say it’s okay?
Answer: It is best to go on consultations with at least 3 very experienced rhinoplasty surgeons to get 3 expert opinion on your nose, since rhinoplasty is the most difficult operation to perform correctly in the entire field of cosmetic surgery. Digital computer imaging would also be helpful to understand what can be accomplished with your nose upon your facial features.

Question: Will this help my turkey neck?
Answer: Congratulations on your 130 pound weight loss once you get to your goal weight. Since you are 55 years old, and having had a significant deflation in your neck, you’re going to need a lower face and neck lift procedure to properly rejuvenate this area.

Question: Am I a good candidate for rhinoplasty?
Answer: the photographs demonstrate an overly projecting nose, and an under projecting chin. A closed rhinoplasty approach can accomplish decreasing the overall projection of the nose, shaving down the dorsal hump, refinement of the bulbous nasal tip, and narrowing the bridge line with all the incisions placed on the inside of the nose. No external incisions are required. Placement of the chin implant is performed through a small incision underneath the chin to augment the chin forward. Augmenting your chin forward will make her nose look more in proportion, especially from the side profile.

Question: Recovery Comparison. How would you rate recovery of a neck lift and any other procedure to address the jowls?
Answer: The 1 very limited photograph demonstrates jowls, and significant fat deposits in the neck. A lower face and neck lift is going to be required. In our practice, we place drains underneath the skin in the neck for the first 48 hours. Most patients take a few medium strength Vicodin pain pills first few nights to help them get to sleep. Anticipate 2 weeks of visible bruising and swelling. Full healing takes 4-6 months.

Question: Follow-up question: Regarding first consult for lower eye blepharoplasty. Thoughts?
Answer: In our practice, we definitely do not perform fat injections to cheeks for a variety of reasons. If you are trying to augment the cheeks, use fillers placed in the office setting, or cheek implants for permanent augmentation. A simple transconjunctival lower blepharoplasty can accomplish improvement to rejuvenate your lower eyelids.

Question: What kind of rhinoplasty would be best suited for my nose?
Answer: The photographs demonstrate anoverly projecting nose and an under projecting chin. A closed rhinoplasty approach can accomplish shaving down the hump decreasing the overall projection and reducing the bulbous nasal tip with all the incisions placed on the inside of the nose. Consider placement of a chin implant to augment the chin forward for better facial balance and proportions, especially from the side profile. Augmenting your chin forward will make her nose looks smaller.

Question: Is a platysmaplasty necessary?
Answer: The Photographs demonstrate fat deposits located above AND below the platysma muscle. Liposuction will be only minimally effective, since it is only removing the fat above the platysma muscle. A surgical neck lift with a platysma plasty is required when fat is removed from underneath the platysma muscle.

Considering rhinoplasty for broken nose.
Answer: A rhinoplasty is performed to straighten the crooked nose and is done for cosmetic purposes. A septoplasty is performed in the back of the nose to improve airflow dynamics only. Both procedures can be performed simultaneously under one anesthesia with one recovery period. In our practice, we performed this surgery in a Medicare certified outpatient surgery center under general anesthesia administered by board certified physician anesthesiologists for patient safety and comfort.

Facial Plastic Surgery Questions and Answers: Part 9

Question: I was told I need an eyelid surgery and blepharoplasty. Should I use an ocular surgeon?
Answer: Much more information is needed, such as a full set of facial photographs from all angles looking straight into the camera( Not smiling) and why were told you needed eyelid surgery? Cosmetic or functional purposes?? Plastic surgeons, facial plastic surgeons and oculoplastic surgeons all perform eyelid surgery depending upon what you need. Regarding jowls, facial aging and considering a facelift, that should be performed by a facial plastic surgeon.

Question: Nasal wall is very high. Can this be fixed and how?
Answer: Your nasal sidewalls are very wide, especially on your right side. Low lateral osteotomies should be able to accomplish improvement in this area. Since it’s a revision rhinoplasty, an in-person examination is usually required because this is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery.

Question: Facial massage/exercise after facelift. What is and isn’t safe to do and when?
Answer: In our practice, we allow patients to start exercising at two weeks after the procedure. Regarding facial massaging, it’s probably best to wait at least 3 to 4 weeks. Also important to post a full set of facial photographs to make sure you’re a candidate for the procedure.

Question: What can help me achieve a balanced profile?
Answer: The side profile photograph demonstrates a recessive chin, so consider placement of a small chin implant which can be performed under local anesthesia as an outpatient procedure.

Question: How can I fix my nose tip?
Answer: Much more information is needed, such as a full set of facial photographs from all angles that are in focus, in addition to a copy of the operative report to find out what was accomplished in the first procedure. It’s important to wait at least one year before embarking on another procedure.

Question: Will there be any long term effects if I drink alcohol after rhinoplasty?
Answer: No, drinking alcohol 2 1/2 weeks after a rhinoplasty will not affect upon the results of your rhinoplasty procedure. Just keep it in moderation.

Question: Kybella post submental lipo?
Answer: Unfortunately, your provider didn’t explain to you that there are two compartments of fat in the neck, and they are located both above and below the platysma muscle. Liposuction can only accomplish removal of the fat deposits above the muscle. Kybella Will be totally ineffective. You still have residual fat deposits below your platysma muscle, which is going to require a neck lift procedure to remove that fat in addition to a platysma plasty to significantly improve your jawline. No skin removal is required, and this can be performed through a 1 inch incision underneath your chin. You also have a recessive chin profile which makes the sub platysmal fat more apparent. Consider placement of a small chin implant to augment your chin forward for better facial balance and proportions, and will also give better structural support for the soft tissues in the neck.

Question: Horrible rhinoplasty results/complications. How can this be improved?
Answer: Revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery. Besides, a deviated septum, there are several other issues on the inside of the nose it can cause nasal obstruction, so an in- person consultation is probably going to be required. Choose your second surgeon wisely based on extensive experience producing natural results. Digital computer imaging would also be helpful to understand what can be accomplished with your nose upon your facial features.

Question: What would you recommend to fix my side profile?
Answer: The side profile photograph demonstrates an overly projecting nose with a dorsal hump, and a recessive chin profile. A closed rhinoplasty approach can accomplish shaving down the dorsal hump, refining the nasal tip and narrowing the bridge line with all the incisions placed on the inside of the nose. No external incisions are required and no painful packing is required either. Consider placement of a chin implant to augment the chin forward for better facial balance and proportions, especially with respect to the nose from the side profile. A small Silastic chin implant can be placed through an incision underneath the chin simultaneously. This allows one anesthesia with one recovery for both procedures. Digital computer imaging would also be helpful to understand what can be accomplished with both procedures upon your facial features.

Question: Would I benefit from a rhinoplasty?
Answer: A closed rhinoplasty procedure can accomplish reduction of the bulbous nasal tip, narrowing The bridge line and placement of spreader grafts in the midportion of the nose where it is pinched. All of this can be performed with the closed rhinoplasty approach with all the incisions placed on the inside of the nose. Thick skin in the tip of the nose is going to prevent refinement in that area, and this must be determined at the time of consultation.

Facial Plastic Surgery Questions and Answers: Part 8

Question: Can I achieve my desired look with a rhinoplasty alone?
Answer: Yes, a closed rhinoplasty approach can accomplish improvement of the bulbous nasal tip, and shaving down the dorsal hump and reducing the overall projection and those with all the incisions placed on the inside of the nose. You appear to have thick skin, so be prepared for a few steroid shots to the Nasal tip to reduce swelling in that area after the surgery.

Question: Is radix augmentation necessary for dorsal hump removal if you have a low radix?
Answer: In our practice, the far majority of people do not need radix augmentation. We rarely use this grafting technique as long as the radix is in an acceptable position. Digital computer imaging of your nose upon your facial features would be helpful to understand what can be accomplished with a closed rhinoplasty.

Question: What’s the best course of action to treat my platysmal bands?
Answer: Consider a lower face and neck lift procedure with a corset platysma-plasty, and a myotomy of the actual platysmal bands themselves. It’s also best to get Botox placed in the platysmal bands about a week before the surgery so that the bands do not grow back together after the myotomy. A lower face and neck lift will accomplish tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fat deposits in the neck with liposuction, in addition to the platysma plasty to significantly improve your jawline.

Question: Do I need a sliding genioplasty?
Answer: A sliding genioplasty as performed by an oral surgeon under general anesthesia in a hospital setting with an overnight stay, and is much more invasive and expensive than a simple chin implant. A sliding genioplasty is usually performed when the teeth are significantly out of alignment. It is not performed in conjunction with a rhinoplasty. Chin implants are placed through a small incision underneath the chin under local anesthesia which usually takes about 30 minutes. You can perform a chin implant with a rhinoplasty under general anesthesia as an outpatient procedure. For many examples of this combination, please see the link below.

Question: Should I get a chin implant or jaw surgery to move my mandible forward and (hopefully) define my jaw? Or jaw implants?
Answer: Jaw surgery is performed by an oral surgeon under general anesthesia in a hospital with an overnight stay and is much more invasive. It usually done with the teeth are significantly out alignment. Placement of a chin implant can be performed under local anesthesia which takes approximately 30 minutes. In our practice we placed the implant through a small incision underneath the chin under local anesthesia as an outpatient procedure. The fat compartments in your neck are located both above and below the platysma muscle, therefore a neck lift will be required to remove both compartments of fat in addition to a platysma-plasty to significantly improve the jawline.

Question: Rhinoplasty advice to make my nose look more feminine and not so bulbous, wide and long?
Answer: A closed rhinoplasty approach can accomplish refinement of the nasal tip, shaving down the dorsal hump, decreasing the overall projection of the nose and narrowing the bridgeline. All of the incisions are placed on the inside of the nose, and no external incisions are required. No painful packing is required either. Open rhinoplasty involves placement of an external incision across the columella. An alar-plasty is performed when there are wide nostrils present from the base view. Digital computer imaging would be helpful to understand what can be accomplished with your nose upon her facial features. If you have thick skin in the tip of the nose, this may prevent refinement in that area, so it is important to have realistic expectations.

Question: What should I get done to my nose to remove the bone off the sides?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, straightening the nose and significantly narrowing the nasal bones where they are excessively wide. All the incisions are placed on the inside of the nose. Medial and low lateral osteotomies placed in the nasal bones accomplish narrowing and straightening the nose itself.

Question: Is it my chin or my jaws that are receded, would sliding genioplasty grant me a big improvement?
Answer: The limited photographs demonstrated a recessive chin profile for which a chin implant can improve. If your teeth are significantly out of alignment, then consider a sliding genioplasty performed by an oral surgeon in a hospital setting with an overnight stay. Chin implants are placed under local anesthesia as an outpatient procedure through a small incision underneath the chin.

Question: Is 56 too old for a mini MACS lift?
Answer: Mini lifts give mini results and therefore we rarely perform them. A full set of facial photographs from all angles with your chin in a neutral position with your hair pulled back are going to be required to make a determination about being a candidate for a lower face and neck lift procedure at age 56. The goal of a lower face and neck lift is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove fat deposits in the neck with liposuction in addition to a platysma plasty.

Question: Can change in this morph be achieved?
Answer: The photographs are rather limited, however the morphed photos do appear realistic. It is important to understand the nose is a 3-dimensional structure, and rhinoplasty is performed in all 3 dimensions. Rather than relying on morphing, look at your prospective surgeon’s before and after photo Gallery and make sure that it is extensive with results that you like.

Facial Plastic Surgery Questions and Answers: Part 7

Question: I would like tips for an improved jaw line/chin. What are my options?
Answer: The Photographs are rather limited, and more information is needed such as your age, and this status of the skin tone in your neck. From the photographs, there is fat deposits located both above and below the platysma muscle in the neck so at a minimum, you are going to need a neck lift with a platysma plasty to significantly improve the jawline. If your skin tone is poor, then you will need a lower face and neck lift to tighten loose and inelastic skin in the neck itself. 

Question: Do I need a revision rhinoplasty?
Answer: Since it is only been 4 months since her rhinoplasty procedure, its best to wait at least a year before embarking on another procedure to allow full healing before revising your nose. Rhinoplasty and revision rhinoplasty or the most difficult operations to perform correctly in the entire field of cosmetic surgery.

Question: I just want the loose skin removed due to my 50 pound weight loss. Can the skin just be trimmed for a tighter look?
Answer: First of all, congratulations on the weight loss. Since the face and the neck had been deflated with the significant weight loss, you are going to have significant loose skin and muscles. A lower face and neck lift is going to be required to tighten loose facial and neck skin, tighten the 2 muscle cords in your neck, and remove any residual fatty deposits with liposuction in the neck as well. A skin only face neck would not last very long, so it is important to tighten the muscles and fascia underneath the loose skin.

Question: Would Morpheus8 be a good option for my turkey neck?
Answer: Since you lost a significant amount of weight, you have deflated the skin in your neck and have significant skin laxity. In addition, you also have residual fat deposits in the neck which can be located both above and below the platysma muscle in your neck. A surgical neck lift with skin tightening most likely going to be required to address all of your issues. Noninvasive treatments are not going to accomplish very much at this point.

Question: What are my options for minimizing the appearance of double chin and dent when smiling?
Answer: From the photographs presented, you have a recessive chin and fat deposits in the neck. Consider placement of a small chin implant and liposuction to remove the fat deposits above your platysma muscle. If the fat deposits are located below the platysma muscle, you’ll need a neck lift procedure with a platysma -plasty to significantly improve the jawline.

Question: Stage IV vs V Deep Plane Facelift?
Answer: From the photographs presented, you’re good candidate for a lower face and neck lift procedure. In our practice that accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the Jowls, and removing residual fat deposits in the neck which also includes a platysma plasty. You also have a recessive chin present, so Consider placement of a chin implant to augment your chin for better facial balance and proportions, and a better jawline.

Question: Ocularplastic surgeon versus general plastic surgeon for upper & lower blepharoplasty?
Answer: In our practice for over 30 years, we’ve never heard of a blepharoplasty causing decreased vision. If anything, a functional blepharoplasty increases a peripheral vision by removal of excess hooded skin. It’s very important to go to A surgeon who has lots of experience performing blepharoplasty. Study your perspective surgeon’s before and after eyelid photo gallery to make sure that it is extensive with Lots of results that you like and they look natural.

Question: Is my hyoid bone too low for chin liposuction?
Answer: Your hyoid bone is irrelevant. It’s very important to understand if there are two compartments of fat, and they’re located both above and below the platysma muscle in your neck. The majority of your fat deposits are located below the muscle, which will require a neck lift procedure with a platysma plasty to significantly improve the jawline. Liposuction alone will only remove the fat deposits above the muscle, which will be an incomplete removal.

Question: Why cheek implants vs. fat grafting or fillers? Or why not? 
Answer: Cheek implants offer very predictable augmentation which is permanent. The implants can be placed thru an intra oral approach under either local or general anesthesia. Fillers are all temporary, and fat grafting is very inconsistent, just like you’ve experienced.

Question: Would I benefit from a rhinoplasty or alarplasty?
Answer: An alar-plasty accomplishes narrowing wide nostrils. A closed rhinoplasty can address narrowing of the bulbous nasal tip. Osteotomy’s of the nasal bones accomplish narrowing the entire bridge line. Digital computer imaging of your nose would be helpful to understand what can be accomplished.

Facial Plastic Surgery Questions and Answers: Part 6

Question: Do I need a second chin lipo or jaw surgery?
Answer: To make a determination about being a candidate for a chin implant, you should probably have the current filler reversed to Make a determination about where your mandible really is. It’s important to understand that there are two compartments of the neck, and they’re located both above and below the platysma muscle itself. Liposuction can only accomplish removal of the fat deposits above the muscle. The residual fat deposits in your neck are most likely located below the platysma muscle, which requires a necklift procedure and a platysma- plasty to significantly improve your jaw line.

Question: What would be the best treatment for sagging neck and face jowls? Tightening that skin up and improving the texture of skin? 
Answer: A lower face and neck lift accomplishes tightening loose facial and neck skin, tightening a loose facial and neck muscles, lifting the jowls, and removing fat deposits in the neck along with a platysma plasty to significantly improve the jaw line. Choose your facelift specialist wisely based on extensive experience producing natural results.

Question: Lower face and neck deep plane face lift vs full face and neck?
Answer: If you have had radiation to your neck, you would not be a candidate for any type of neck work in our practice due to the poor healing after the radiation itself. If that’s the case, then you should just perform a facelift without any neck surgery. You can also consider doing your upper eyelids as well, but only if they’ve are bothering you. It does not appear that you need a brow lift.

Question: Aging in the lower face. Should I get a SMAS, mid-face or lower facelift?
Answer: At age 42, your skin tone of the neck should be acceptable, therefore no skin tightening/facelift is required. A surgical neck lift can accomplish removal of the fat deposits located above and below your platysma muscle in the neck which also includes a platysma-plasty.

Question: Considering rhinoplasty- what recommendations do you have to improve my nose?
Answer: The photographs demonstrate a significantly over projecting nose, and a mild recessive chin. The recessive chin makes your nose looked bigger than it really is, therefore consider placement of a small chin implant to augment the chin forward for better facial balance and proportions, especially with respect to the projection of the nose from the side profile. A closed rhinoplasty approach can accomplish reduction of the projection of the nose, shaving down the dorsal hump, and refining the nasal tip and narrowing the bridge line with all of the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Digital computer imaging of your nose and your chin would be helpful to understand what can be accomplished with either one or both procedures.

Question: My cheeks and jaw line have become droopy. Mini face lift, thread lift, or fillers?
Answer: In our practice, we do not perform thread lifts because of very temporary at best. We also do not perform a mini lift since they give mini results and do not last that long either. A well performed lower face and neck lift accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing the fat in the neck along with a platysma-plasty. When the mid face and cheeks are flat, then consider placement of cheek implants to give a permanent augmentation to the cheeks rather than having to go in for fillers every few months.

Question: Rhinoplasty: are there in office fixes that can be done to the nose post rhinoplasty to fix the lower third and tip?
Answer: The Photographs are rather limited, however it appears that you have an overly projecting nose and an under projecting chin. its best to wait at least 1 year before undergoing another nasal surgery, but that will need to be performed under general anesthesia, not in-office. In the meantime, you can follow-up with your operative surgeon for steroid shots to be placed in the supratip area of the nose to reduce swelling in that area. Even with a revision rhinoplasty, the nose can only be de-projected a few millimeters. Consider placement of a chin implant augment the chin forward for better facial balance and proportions, especially with respect to the projection of the nose from the side profile.

Question: Will my face benefit from a chin implant?
Answer: The Photographs are rather limited, but it does appear that there is a recessive chin profile for which a chin implant can improve your face. Chin implants augment your current anatomy, however it does not give you a pointy chin. Chin implants are manufactured in a large array of thicknesses, sizes, and shapes. In our practice we placed chin implants through a small incision underneath the chin under local anesthesia as an outpatient procedure.

Question: I’m having surgery for a crossbite/underbite. Can I have a rhinoplasty during the same surgery? price?
Answer: If you are having both upper and lower jaw surgery, this is going to be performed by plastic  surgeon under general anesthesia in the hospital setting with an overnight stay. Best to have that performed first. A rhinoplasty should not be included with that type of surgery. Rhinoplasty is also performed under general anesthesia, but as an outpatient procedure.

Question: Is it possible to get an ethnic/closed rhinoplasty without raising my bridge?
Answer: yes, a closed rhinoplasty approach can accomplish refinement of the nasal tip and narrowing the entire bridge line. To narrow wide nostrils going to require an alar-plasty.

Facial Plastic Surgery Questions and Answers: Part 5

Question: Would I be wasting a surgeon’s time trying to see if insurance would cover a blepharoplasty?
Answer: Medical Insurance companies admitting very difficult to get reimbursed for this procedure any longer. A skin only upper blepharoplasty can be performed under local anesthesia to help reduce costs.

Question: Would dermal fillers or a facelift be the right choice to get rid of sagging jowls?
Answer: More information is needed such as a full set of facial and neck photographs from all angles to make a determination about being a candidate for a facelift procedure. The goal of the lower face and neck lift is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove the fat deposits in the neck with liposuction which also includes a platysma-plasty. Fillers are very temporary and can offer some augmentation in certain areas that are soft tissue deficient. Temporary Fillers are not substitute for a face and neck lift surgical procedure.

Question: What would you suggest for my double chin and jowls (5’6 and 135lbs)?
Answer: The Photographs demonstrate a recessive chin profile and fat deposits located above AND below the platysma muscle in the neck. Consider placement of a small chin implant to augment the chin forward for better facial balance and proportions. A neck lift procedure can accomplish fat removal in the neck with liposuction above the platysma muscle and surgical removal of the fat below the muscle which also includes a platysma-plasty to significantly improve the jawline once the fat has been removed from the neck itself.

Question: Late 30s – can I have a third or will my nose be even worse?
Answer: There’s definitely some improvement that can be made regarding your nose, but it’s imperative to choose a rhinoplasty specialist based on extensive experience. Your nose will never be perfect, just improvements. A full set of facial photographs from all angles would also be helpful to understand your current anatomy. You appear to have alar retraction on your left nostril which requires a composite graft from the ear to improve.

Question: Would a chin implant or genioplasty help improve the appearance of my jaw?
Answer: Placement of a chin implant can be performed under local anesthesia to cosmetically augment your chin mostly forward, but you will also get some lateral width as well. This procedure usually takes about 30 minutes, and will not affect the way your teeth fit together. A Genioplasty is performed by an oral surgeon when your teeth are significantly out of alignment.

Question: Lower facelift in March 2023 – do I need a facelift revision?
Answer: Much more information is needed, such as a full set of facial photographs from all angles to make a determination about how best to proceed. A Copy of the operative report would also be helpful to find out what type of facelift you’ve had in the past. Also best to wait at least one year to allow for full healing before embarking on another procedure. It’s also important to understand that a facelift will not remove wrinkles around the mouth.

Question: Why do some surgeons only offer general anesthesia for rhinoplasty & what are the advantages of each method?
Answer: Since rhinoplasty involves multiple different injections in the nose to get the nose numb prior to surgery, and the fact that there are there is lots of nerve endings, it’s very difficult to get the nose even numbed up for the rhinoplasty procedure. Both medial and lateral osteotomies are placed in the nasal bones are also performed, and most patients don’t want have conscious awareness of procedure that maneuver bro of breaking the nasal bones during the rhinoplasty procedure. It’s also very important have a controlled airway so that you’re not aspirating blood down into the lungs if you’re sedated while you are not breathing on your own under sedation.

Rhinoplasty, Septoplasty and Turbinate reduction.
A closed rhinoplasty approach can accomplish making the entire nose smaller which includes shaving down the dorsal hump, decreasing the projection, refining the nasal tip, and narrow bridge line with all of the incisions placed on the inside of the nose. Septoplasty and turbinate reduction are performed internally for breathing difficulties. Digital computer imaging of your nose upon your facial features would be helpful to understand what can be accomplished with a closed rhinoplasty.

Question: 50 years old female, is the 5 layer neck lift something new or not commonly done?
Answer: We have never heard of a five layer necklift. A full set of facial photographs from all angles are required to make a determination about the proper procedure for you. At age 50, you’re probably a candidate for a lower face and neck lift which accomplishes tightening lose facial and neck skin, tightening a loose facial and neck muscles, lifting the jowls, and removing the fat deposits in the neck itself which are located both above and below the platysma muscle. This also includes a platysma plasty to significantly improve the jawline.

Question: I have a weak jaw line. Would a neck lift help? Or would I need jaw implant?
Answer: From the limited photograph, you have a recessive Chin which would require a small chin implant to augment your mandible bone forward to give better structural support for the soft tissues in the neck, and improve your jawline. The reason liposuction did not work for you is because you have fat deposits located underneath the platysma muscle in your neck. A necklift procedure with a platysma plasty with significantly improve your jawline by removing that compartment fat below the muscle. No skin removal is required.

Facial Plastic Surgery Questions and Answers: Part 4

Question: I was told a mini facelift combined with Profound would give me good results?
Answer: From the photographs presented, a lower face and neck lift is going to be required to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove any fatty deposits of neck with liposuction. Minimally invasive devices will not accomplish any of these goals.

Question: Do I have an inverted v, open roof deformity, and polybeak from side? Do I need a revision with a graft?
Answer: Its very difficult to tell from the photographs, but you most likely have an open roof deformity and an inverted V deformity as well along with a poly-beak. The polybeak can be the result of excess cartilage or thick skin and scar tissue. Each 1 of those issues are treated differently. It is very important to know how much cartilage is left over on the inside of her nose for potential grafting purposes, since the inverted V deformity will require osteotomies and then spreader graft placement underneath the concave upper lateral cartilages in the mid portion of the nose.

Question: Should I consider neck lift after no result from Facetite and Morpheus8 (late 20s)?
Answer: The Photographs demonstrate a process of the chin profile, and fat deposits located both above and below the platysma muscle in the neck itself. Noninvasive procedures simply will not help with these issues. Consider placement of a chin implant to augment the chin forward. A neck lift procedure involves removal of fat above the muscle with liposuction, and surgical extraction of the fat below the muscle along with a platysma-plasty. Also best make sure that your BMI is less than 30 before undergoing this procedure.

Question: Why don’t doctors recommend a cheek or mid face lift?
Answer: It’s because the Face does not descend vertically with the aging process, like the lateral face does. The mid face shrinks with volume loss, therefore we place cheek implants in the cheeks to restore that lost volume. There are many different complications can occur with a midface lift, that’s why we never recommend them.

Question: Recessive chin and fat cheeks – SMAS face/necklift and/or genioplasty?
Answer: Even though you’ve had a chin implant, you still have a recessive chin, so consider placement of a larger chin implant. You also have significant fat deposits in your neck, located both above and below the platysma muscle. You will also require a neck lift procedure to remove both fat compartments in the neck, in addition to a platysma – plasty. At age 35, your skin tone should be acceptable, and skin removal should not be required. You should also have a BMI of less than 32 before undergoing any of these facial and neck procedures.

Question: Badly botched 8 years ago. Is this fixable?
Answer: Much more information is needed, such as a full set of facial photographs of your nose from all angles, and even a copy of the operative report. The nose is a three-dimensional structure, and rhinoplasty is performed in all three dimensions. Revision rhinoplasty is more difficult than a primary rhinoplasty, so it’s imperative to have realistic expectations. It appears from the one very limited photograph that you had anosteotomy placed too high on the left nasal bone resulting in that line. Low lateral osteotomy’s should be able to improve your issue, but that will be determined at the time of a physical examination. 

Question: Am I candidate for bleph or ptosis surgery? I’ve always been like that I’m 33.
Answer: The Photographs are rather limited, but it does appear that you have excess skin on the upper lids for which a cosmetic upper blepharoplasty can improve. There does not appear to be ptosis from these photographs, but that may need to be determined at the time of examination.

Question: If I suspect an untreated broken nose (10 years) is causing discomfort/breathing issues, what steps should I take?
Answer: Trauma to the nose can cause a variety of issues such as a displaced nasal fracture, a dislocation of the upper lateral cartilages, and a deviated septum. A septoplasty is performed to straighten a deviated septum on the inside of the nose to improve airflow. A rhinoplasty is considered cosmetic which can accomplish shaving down the dorsal hump, straightening the bridge line, and placement of spreader grafts underneath the concave upper lateral cartilages in the midportion of the nose. A closed rhinoplasty approach can accomplish all this with incisions completely placed on the inside of the nose. No external incisions are required. 

Question: What treatment would be best to address double chin (Kybella, Smartlipo or VASER) yet not breaking the bank?
Answer: Its difficult to tell photographs, but you most likely have fat deposits located both above and below the platysma muscle. Liposuction can accomplish removal of fat deposits above the muscle, while a surgical neck lift with the platysma plasty is required to address that deposits below the platysma muscle. Kybella cannot remove the fat deposits below the muscle.

Question: What is causing my upper eyelids to be droopy? Would I need surgery or are there less invasive options?
Answer: The picture demonstrates excess skin on the upper eyelids known as dermatochalasis. The skin appears to be resting on your eyelashes, therefore you are great candidate for upper eyelid blepharoplasty. This procedure takes about 30 minutes and involves removing excess skin on the upper eyelids to rejuvenate them. The procedure can be performed under local anesthesia or general anesthesia.

 

Facial Plastic Surgery Questions and Answers: Part 3

Question: Should I get a chin implant?
Answer: The limited photograph demonstrates a recessive chin profile for which a chin implant can augment forward for better facial balance and proportions. In our practice for over 25 years, we have used Implantech brand of solid silicone chin implants with an excellent success rate. The implants are placed through a small incision underneath the chin under local anesthesia as an outpatient procedure.

Question: Why does my nose look like this? Is it possible maxilla & mandible will go back way it was?
Answer: You have a slight dorsal hump, and a significant hanging columella. A closed rhinoplasty approach can address these two issues with all of the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Digital computer imaging of your nose would be helpful to understand what can be accomplished with the procedure.

Question: Looking at lower face and sunspots – Best procedure for me?
Answer: To rejuvenate the lower face, consider a lower face and neck lift. In our practice, this procedure accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fat deposits in the neck which also includes a platysma- plasty to significantly improve the jawline. We no longer perform Chemical peels since there are much better alternatives today. The wrinkles on your upper and lower lips can be treated with dermabrasion or laser resurfacing. The sunspots are treated by dermatologists in the office setting.

Question: Do I have to dissolve filler in my nose before rhinoplasty?
Answer: Placement of filler in the nose distorts the anatomy of the nose itself, so it’s best to dissolve the filler several weeks ahead of time. Rhinoplasty is a procedure that is performed in millimeters, so it’s best to go in to the procedure with your normal anatomy, not an artificial anatomy.

Question: What procedures would balance my side profile?
Answer: The photograph from the side profile demonstrates a recessive chin, and fat deposits in the neck located both above and below the platysma muscle in the neck. Consider placement of a chin implant to augment the chin forward for better facial balance and proportions. A neck lift procedure can accomplish removal of the fat deposits above the muscle with liposuction, and surgical extraction of the fat deposits below the muscle which also includes a platysma-plasty to significantly improve the jawline.

Question: 46 contemplating a neck lift, any suggestions?
Answer: The limited photographs demonstrate platysmal bands in the neck, with loose and inelastic skin in the neck. A neck lift procedure can accomplish tightening the neck bands, and removal of fat deposits in the neck with liposuction. A lower face and neck lift is required if the skin tone is very loose and there is lots of excess skin in the neck itself.

Question: What is the best scarless option for lifting the cheeks? 37 y/o
Answer: Consider placement of cheek implants placed through the mouth to augment your flat cheeks and maxilla. No external incisions are required.

Question: I’m 5’6, 34 and 143lbs. I have some jowling and a double chin. Chin/jaw lipo?
Answer: From the photographs presented, you do not have any jowls. It’s also very important to understand there are two compartments of fat in the neck, and they are located both above and below the platysma muscle in your neck. Liposuction can only accomplish removal of the fat deposits above the platysma muscle, which will be ineffective for you. You have a significant fat compartment below the platysma muscle, which is going to require a neck lift procedure with a platysma-plasty to significantly improve your jawline. This can be performed under a brief general anesthesia with one incision underneath the chin. Your skin tone should be just fine at age 34, so no skin removal is required and you’re not a candidate for a mini- facelift.

Question: Lipodissolve before surgery? 
Answer: Probably best to undergo the functional surgery first, heal up from that, and then consider undergoing any type of cosmetic procedure. A full set of facial and neck photographs are required to make a bet the best determination for what is the appropriate procedure for you. It’s also very important to understand that there are two compartments of fat in the neck, and they are located both above and below the platysma muscle in your neck. Liposuction can only remove the fat compartment above the muscle, while a surgical neck lift is required to remove the compartment fat below the muscle. This also includes a platysma plasty to significantly improve the jawline.

Question: Is it safe to combine a facelift and brow lift with liposuction? 43 year old healthy male who is fit physically.
Answer: In our practice, a male facelift and brow lift would take approximately 5 hours of surgery/ anesthesia time. Adding body liposuction would add additional hours depending upon what you’re try to accomplish. It’s probably best to separate your facial work from the body work and have them done separately, since this is done as an outpatient surgical procedure, not inpatient at a hospital. Please post full set of facial photograph to make a determination about being a candidate for both the facelift and brow lift procedures.

Facial Plastic Surgery Questions and Answers: Part 2

Question: Seeking a more balanced profile, chin or nose first? Do I have any jaw issues? 
Answer: From your description, it sounds as though you have an overly projecting nose, and an under projecting chin. A full set of facial photographs from all angles are required to make a determination about how best to proceed with two surgical procedures. In our practice, we frequently perform a rhinoplasty to shave down the dorsal hump simultaneously with placement of a small chin implant to augment the chin forward for a better facial balance and proportions. If you have a recessive chin, that makes the nose look bigger than it really is. Digital computer imaging of your both your nose and your chin would be helpful to understand what can be accomplished with both procedures. If you’re looking to only perform the chin implant, that can be done under local anesthesia as an outpatient procedure, which takes about 30 minutes. Rhinoplasty requires general anesthesia.

Question: Facelift after tightening procedures? 
Answer: The previous non-invasive treatments that you have will have no effect moving forward performing a lower face and neck lift procedure. Study your prospective surgeon’s before and after facelift photo gallery to make sure that the results look very natural.

Question: Facelift did not fix/ tighten my jowls – I look exactly the same after facelift. What can I do to fix this?
Answer: A full set of facial and neck photographs from all angles are required to make a determination about how best to proceed. You’re gonna need to wait at least one year after the primary facelift before embarking on another procedure to allow full healing first. Your incisions are still very fresh, and you have significant edema behind your ears. your next plastic surgeon they want to see a copy of the operative report as well.

Question: Should I wait for fillers and Botox to dissolve before having a facelift and a neck lift?
Answer: Botox and fillers will have no effect on a lower face and neck lift procedure, So it is very acceptable to undergo a surgical treatment you are interested in performing.

Question: When the nose bone is shaved down during rhinoplasty, how do you get out the shavings?
Answer: The dorsal hump is composed of both bone and cartilage. The cartilage is cut with a knife, and the bone is cut with a osteotome. A small amount of rasping is done to smooth out the edges. Any other residual debris is also removed with the rasp.

Question: Kybella and Coolsculpting or neck lift to get rid of my double chin?
Answer: The photographs demonstrate fat deposits above and below the platysma muscle in the neck. Liposuction can only accomplish removal of some of the fat deposits above the muscle, while a surgical neck lift is required to remove the fat deposits below the platysma muscle. A platysma plasty is also required after the sub- platysmal fat deposits are removed, which will also significantly improve the jawline. Noninvasive treatments are simply ineffective.

Question: Would I be a suitable candidate for chin implants?
Answer: The side profile photograph demonstrates a recessive chin for which a chin implant can improve. Chin implants are manufactured in a large array of thicknesses, sizes, and shapes. In our practice, we place Chin implants through a small incision underneath the chin under local anesthesia as an outpatient procedure which takes about 30 minutes.

Question: What can be done to fix uneven nostrils?
Answer: From the limited photographs, there appears to be an overly rotated nose, and a crooked caudal septum along with a hanging columella. This can be improved with a closed rhinoplasty approach with all incisions placed on the inside of the nose.

Question: Could my nose be improved by fillers or surgery?
Answer: More information is needed, such as a full set of facial photographs from all angles to make a determination about how best to proceed, since the nose is a 3-dimensional structure, and rhinoplasty is performed in all 3 dimensions. Unfortunately, these photographs are inadequate to make a determination. We do not recommend fillers placed in the nose for a variety of reasons. 

Question: What can be done to improve my side profile?
Answer: The photographs demonstrate an overly projecting nose with a dorsal hump, and a recessive chin profile. Consider a closed rhinoplasty approach to decrease the projection of the nose and shave down the dorsal hump. All the incisions are placed on the inside of the nose. No external incisions are required, and no painful packing is required either. To augment the chin forward requires placement of a small chin implant which will help with facial balance and proportions, especially from the side profile with respect to the overly projecting nose.

Facial Plastic Surgery Questions and Answers: Part 1

Question: What can I do to improve my profile? Should I do something to my nose?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump and reduction of the hanging columella and narrowing the bridge line with all of the incisions placed on the inside of the nose. No external incisions are required. Digital computer imaging would be helpful to understand what can be accomplished with your nose upon your facial features.

Question: What’s the difference between closed and open rhinoplasty and which works best for me if I want a big difference?
Answer: With closed rhinoplasty, all the incisions are placed completely on the inside of the nose. With open rhinoplasty there is a visible scar placed across the columella. You should be able to get a great result with either approach. Also consider placement of a chin implant to augment your chin forward for better facial balance and proportions, especially from the side profile with respect to the overly projecting nose.

Question: Can I get my bulbous nose and sinus surgery together?
Answer: yes, a cosmetic rhinoplasty, and functional endoscopic sinus surgery can be performed together under 1 anesthesia with one recovery period. Seek out a double board-certified ENT/facial plastic surgeon who can perform both procedures simultaneously.

Question: Will a nose job drastically change my face?
Answer: The side profile photograph demonstrates an overly projecting nose with a droopy tip. A closed rhinoplasty approach can accomplished decreasing the overall projection of the nose, shaving down the dorsal hump, and lifting the nasal tip slightly. It is very important to give a very natural appearing nose so that it does not look like it has been a rhinoplasty has been performed. The changes from the front will be very minimal, however the side profile changes will be moderate. Best to perform digital computer imaging from different angles to understand what can and cannot be accomplished with your nose.

Question: Will chin implant be beneficial if my top and bottom lip slightly don’t line up from profile view?
Answer: From the side profile photograph, you have a significant recessive chin profile for which a chin implant can certainly improve. Placement of a chin implant can be done as an outpatient procedure under local anesthesia. We make a small incision under the chin to insert implant. Digital computer imaging would also be helpful to understand what a new Chin might look like upon your facial features.

Question: Is it possible to place a graft to fix nostril flare?
Answer:You have a combination of alar retraction, a hanging columella, and A mild polybeak. All these can be addressed with a closed rhinoplasty approach with all the incisions placed on the inside of the nose. That alar retraction is best treated with the composite graft harvested from the ear.

Question: What should I do for my chin?
Answer: You have a recessive chin due to the fact that your mandible bone never grew far enough forward. If your teeth are significantly out of alignment, then you can consider a genioplasty performed by an oral surgeon under general anesthesia at a hospital setting with an overnight stay at the hospital. If you’re looking for a simple cosmetic improvement, then consider placement of a Chin implant to augment your chin forward for better facial balance, and proportions. Chin implants can be placed under local anesthesia through a small incision underneath the chin, which takes about 30 minutes in the office setting.

Question: Chin implant replacement after 35 years?
Answer: It is certainly possible to remove the old implant and insert a new chin implant. This time we would take the old one out and put the new one in through a small incision underneath your chin, and not go through the mouth again. This procedure can be performed under local anesthesia as an outpatient procedure which would take about 30 minutes.

Question: Want to get my nose done?
Answer: It’s very important to have specific goals in mind on exactly what you’re trying to accomplish with cosmetic rhinoplasty. The side profile shows that you have a slight dorsal hump and a slight hanging columella, which can be improved. The front profile demonstrates a bulbous nasal tip, which can be reduced, however if you have thick skin present, the amount of reduction will be limited. Digital computer, imaging of your nose upon your facial features would also be helpful.

Question: Would a septoplasty straighten my nose or only fix breathing problems?
Answer: A septoplasty will only fix breathing problems in the back of your nose as a result of the fracture. If you’re looking to straighten your nose, you’re going to need a cosmetic rhinoplasty. Both procedures can be done simultaneously under one Anesthesia with one recovery period. Rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so choose your surgeon wisely based on extensive experience.