Facial Plastic Surgery Questions and Answers: Part 09

Question: How can my nose shape be improved? Do I have a deviated septum?
Answer: A closed rhinoplasty approach can accomplish straightening the nose, narrowing and straightening the bridge line, refining the nasal tip, and shaving down the dorsal hump with all of the incisions placed on the inside of the nose. You will also require spreader grafts placed in the midportion of the nose where it is pinched and asymmetrical. A thorough internal examination of the nose going to be required to make the diagnosis of a deviated nasal septum.

Question: Could a revision actually fix any of these issues and what exactly needs to be done?
Answer: A revision rhinoplasty can give some improvement to the nose, but there will be no perfect result. It is very important to know how much cartilage is left over on the inside of your nose for grafting purposes, since you will need a cartilage graft placed on the left side of your nose where it is indented. The hanging columella can be reduced and the tip lifted on the nose. 

Question: What would be the best procedures for getting rid of the fat under my chin and getting a better jaw line?
Answer: Much more information is needed, such as your age, and a full set of facial and neck photographs from all angles. Also important to determine if the fat deposits are above the Platysma muscle, then liposuction can accomplish removal. If the fat deposits are below the platysma muscle, then a neck lift with a platysma- plasty is going to be required. If you over 50, a lower face and neck lift is going to be required. 

Question: Is it necessary to prep the thick oily skin for rhinoplasty?
Answer: No, there is no preoperative preparation for thick oily skin prior to a rhinoplasty. When patients have thick skin in the tip of the nose, but usually require several steroid went within the first few months after the procedure to manage the soft tissue envelope over the cartilaginous framework of the nose. This reduces scar tissue and fluid retention in the tip of the nose. 

Question: Coronal vs Endoscopic brow lift?
Answer: In our practice, we usually perform a coronal brow lift due to the fact there are significant limitations with the endoscopic lift. With the coronal approach, the goals are to either raise or lower the hairline, soften the horizontal and vertical lines in the forehead, adjust eyebrow asymmetry and simultaneously raise the eyebrows to the desired position. When there is significant dermal atrophy between the eyebrows, fascia grafts are placed.

Question: Remove cheek filler before facelift?
Answer: Filler does not have to be reversed prior to a facelift procedure. To make a determination about being a candidate for a facelift, a full set of facial photographs from all angles are needed. Most women at age 40 do not need a facelift. The majority of the facelifts performed in our practice are patients in their 50s, 60s and 70s.

Question: Mens Closed Rhinoplasty: am I a candidate given the tip ptosis and dorsal hump?
Answer: A closed rhinoplasty approach can certainly address removal of the hump and lift the nasal tip in addition osteotomies and placement of spreader grafts, if needed. All incisions are placed on the inside of the nose. For many examples, please see our closed rhinoplasty photo gallery.

Question: What can I do to shave my nose down?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump which is composed of both bone and cartilage. Osteotomy’s placed in the nasal bones are going to be required to narrow the bridgeline and the upper two thirds of the nose . All all the incisions are placed on the inside of the nose with a closed rhinoplasty.

Question: Droopy eyelids. Will blepharoplasty be my best option?
Answer: The photographs demonstrate droopy upper eyelids which are touching your eyelashes, and you appear to be excellent candidate for upper blepharoplasty procedure. This can be performed under local anesthesia or general anesthesia depending upon your desires. We would not recommend laser treatment to your eyelids.

Question: Would rhinoplasty be able to solve as much as I’d like?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, lifting and refining the nasal tip, and narrowing the entire bridge line. Also important to release the depressor septi ligament which dynamically pulls the dip down when smiling. All this can be done with one procedure with all the incisions placed on the inside of the nose. No external incisions are required, no painful packing is required either.

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