Facial Plastic Surgery Questions and Answers: Part 08

Question: When the nasal tip of a nose is lifted will asymmetrical tip cartilage be less obvious?
Answer: A full set of nasal photographs from all angles without your sunglasses on would be required to make a determination about how best to proceed, since the nose is a three-dimensional structure, and rhinoplasty is performed in all three dimensions. If you have a symmetrical tip cartilages, those need to be addressed with either grafting techniques or suture techniques. Simply lifting the tip of the nose is not going to address asymmetries. Digital computer imaging of your nose would also be helpful to understand what can be accomplished with your nose upon your facial features. 

Question: Full rhinoplasty under local anesthesia (pill sedation) only in the US?
Answer: It’s a bad idea did try to undergo a full rhinoplasty under local anesthesia. Patient simply will not be able to tolerate this because it will be too painful. We tried it to 35 years ago and patients could not tolerate it . There are lots and lots of nerve endings and blood vessels in the nose, you will not be able to tolerate the injections just to get your nose numb. You also not be able to tolerate the 4 osteotomies placed in the nasal bones and resetting(breaking) the new nasal bones into a more narrow position. In addition it’s also important to have protective airway to prevent blood from going down the Lungs during the procedure. In our practice, we have a board certified physician anesthesiologists perform general anesthesia for patient safety and comfort. 

Question: Would a mini neck lift fix this loose skin after weight loss?
Answer: A mini necklift will give mini results, and will not address your concerns. Consider a lower face and neck lift which will accomplish 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 to significantly improve the jawline.

Question: Would filler fix my profile or would I be better off trying Kybella?
Answer: From the limited photographs, there appears to be fat deposits located above and below the platysma muscle in the neck. Liposuction can only remove the fat deposits above the muscle which will be an incomplete removal. A surgical neck lift procedure can accomplish removal of the fat deposits above and below the platysma muscle which also includes a platysma plasty to significantly improve the jawline. The procedure does not remove any extra skin, and there is only 3 small access incisions to accomplish improvement. The procedure is performed under general anesthesia as an outpatient procedure.

Question: Chin Implant after Mandibular Advancement? 
Answer: Yes indeed, it’s certainly possible to undergo a chin implant after mandibular advancement. A full set of facial photographs from all angles are required to make a determination if your candidate for the procedure, and determine how recessive your mandible currently is. Chin implants can be placed under local anesthesia as an outpatient procedure which takes about 30 minutes. Bone remodeling occurs around the implant, but it’s never been an issue in over 30 years in practice.

Question: Neck lift/double chin again?
Answer: From the limited photographs, you have multiple issues going on. These include excess skin in your neck, fat deposits both above and below the platysma muscle in your neck, and a recessive Chin. To address all these issues at age 49, it’s going to require a lower face and neck lift which accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, along with removing both compartments of fat in the neck which includes a platysma plasty to significantly improve the jawline. Consider placement of a chin implant at the same time to give better structural support for the soft tissues in your neck. 

Question: Does this look like an open roof deformity 6 months post-op?
Answer: It’s been very difficult to tell from the photographs if you have an open roof deformity. Best to wait at least a year before contemplating revision rhinoplasty. If you have an open roof deformity, medial and lateral osteotomy’s will be required. The supratip area just above your nasal tip cartilages is slightly concave, and may require a small cartilage graft as well.

Question: Would a neck lift also target my jowls? 
Answer: Much more information is needed, such as your age and a full set of facial photographs from all angles with your hair pulled back over your ears to make a determination about the best procedure for you. In our practice, a necklift does not address jowls(only the neck), therefore a lower face and neck lift is the proper procedure to address rejuvenation of the face and Neck including lifting the jowls. 

Question: Can I reduce dorsal bump without general anesthesia?
Answer: Your digitally Altered photographs demonstrate a full rhinoplasty, which is going to require General anesthesia for patient safety and comfort. Once the dorsal hump has been removed, osteotomy’s are then mandatory to Close the open roof created from the hump removal itself. There are way too many nerve endings in the nose you try To attempt this under local anesthesia. In our surgery center, we use board-certified physician anesthesiologists who perform the general anesthesia. It’s also important have a protected airway so that blood does not get down in the lungs during the procedure. The procedure takes usually about an hour. 

Question: Would rhinoplasty provide a good result for my nose? What would the outcome look like?
Answer: First of all, you have a very nice nose to start with and your nose would only require a few minor changes. From the frontal view, your nasal bones and bridge line can be narrowed, and the bulbous nasal tip refined somewhat. Thick skin in the tip of the nose will prevent refinement in that area. The nose can also be improved on the crookedness, but not perfect, since there is no perfect nose. Your side profile and three-quarter profiles look Great, so no changes are required there. Digital computer imaging would be helpful to understand what can be accomplished. A closed rhinoplasty approach can accomplish your goals. All incisions are placed on the inside of the nose, and no painful packing is required either. 

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