Facial Plastic Surgery Questions and Answers: Part 10

Question: Endoscopic (trichophytic) browlift, any advantage to having this done under general anesthesia? 
Answer: In our practice, we perform all brow lift procedures under general anesthesia monitored by a board-certified physician anesthesiologist for patient safety and comfort. We also perform mostly coronal approach brow lift procedures which can not only raise the eyebrows, but a address asymmetries, and soften both of horizontal and vertical frown lines in addition to raising or lowering the hairline.

Question: Is it possible to get alar wedge excision to reduce the flare?
Answer: To make a determination about whether your candidate for an alar wedge excision, a set of photos looking up your nostrils will be necessary, especially since you already had some type of alar-plasty already. If you are a candidate, the procedure can be performed under local anesthesia as an outpatient procedure.

Question: Can I get a chin implant if I have a chin dimple, and want to keep it?
Answer: Chin implants are placed directly over the bone, and placed much deeper underneath the skin. Your dimple is located in the dermis, and Therefore you will be able to keep your dimple after placement of a chin implant.

Question: What would I need to have done to get a super slim nose or a pointy tip?
Answer: From the photographs presented you have very thick skin in the tip of the nose itself, so don’t expect significant improvement in that area. An alar plasty can accomplish narrowing your wide Nostrils. A closed rhinoplasty approach can accomplish narrowing the entire bridge line with osteotomy’s. Digital computer imaging by a rhinoplasty expert would be helpful to understand what can be accomplished with the procedure upon your facial features. 

Question: Can a revision rhinoplasty be closed?
Answer: Yes indeed, a revision rhinoplasty can be performed through the closed approach with all the incisions placed on the inside of the nose. No external incisions are required. It’s important to wait at least one year after your procedure. It would also be helpful to get a copy of the operative report to find out what was performed in the first procedure. In our practice, we only perform Closed rhinoplasty for both primary and revision rhinoplasty procedures. The thick skin in the tip of your nose Will prevent refinement in the tip area itself.

Question: MACS or SMAS lift – which procedure is best for me? 54 y/o, recent weight loss
Answer: In our practice, we perform a high SMAS lower face and neck lift procedure which accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing the fat deposits in your neck which also includes a platysma plasty to significantly improve the jawline. Most of your aging in these photographs is in your neck, so make sure your facelift surgeon addresses your neck specifically. Consider placement of a small chin implant for the recessive chin profile which will give you better bony structural support for the soft tissues in the neck.

Question: Which procedure should I consider to minimize the frontalis muscle after fat grafting?
Answer: More information is needed such as a full set of facial photographs at rest determine the height of your eyebrows in relation to your eyelids to see if you’re even a candidate for a forehead lift. A coronal approach forehead lift can accomplish softening the frontalis Wrinkles only in the central two thirds of the forehead. The outer forehead wrinkles from the frontalis cannot be surgically adjusted over the tail of the eyebrow, therefore Botox would be required for those wrinkles. It will be impossible to remove the fat injections that you had done in the forehead. 

Question: Unhappy with my side profile, which procedures would help me achieve a more balanced look?
Answer: Your side profile demonstrates a recessive chin profile, so consider placement of a small Chin implant to augment your chin forward for better facial balance and proportions. The implant is placed through a small incision underneath the chin under local anesthesia which takes about 30 minutes as an outpatient procedure. It’s also reversible if you don’t like it.

Question: Would a sliding genioplasty be worth it for my case?
Answer: A full set of facial photographs, not x-rays are more important to make a determination about how best to proceed. A sliding genioplasty is performed by an oral surgeon under general anesthesia in the hospital setting with an overnight stay, and is much more invasive, and can be performed under local anesthesia which takes about 30 minutes. 

Question: which procedure would help correct the appearance of drooping and flaring nostrils when I smile?
Answer: An Alar-plasty addresses narrowing wide nostrils by removal of a small wedge of skin at the base of the nostrils themselves. That reduces them statically. Releasing the ligaments underneaththe ala can reduce the dynamic flaring by about 40 to 50%. To prevent the nasal tip from drooping down dynamically when smiling, it’s important to release the depressor septi ligament. Both of these maneuvers can be performed under local or general anesthesia. Choose your rhinoplasty specialist wisely based on extensive experience.

Leave a Reply

Your email address will not be published. Required fields are marked *

    Contact Dr. William Portuese