Nose Job Surgery at The Seattle Rhinoplasty Center The Seattle Rhinoplasty Center, board-certified,plastic surgeon

Facial Plastic Surgery Questions and Answers: Part 8

Question: Skin sagging or volume loss? Plus pronounced nasolabial folds and perioral mounds?
Answer: At age 23, you do not have loose skin. Your side profile photographs demonstrate a recessive chin, because your mandible bone never grew far enough forward. Consider placement of a chin implant to augment your chin forward for better facial balance and proportions. Placement of a chin implant can be done under local anesthesia as an outpatient procedure, which takes about a half an hour.

Question: Rhinoplasty for dorsal hump removal – are the results immediate?
Answer: Removal of the dorsal hump immediately causes multiple issues which are an open roof deformity and a hanging columella. Medial and lateral Osteotomies placed in the nasal bones are required to close the open roof created from the hump removal itself. Trimming back to excess hanging columella will also usually be required. Spreader grafts are usually required to prevent the upper lateral cartilages from collapsing inwards after the hump removal as well. Full healing after a rhinoplasty takes one year, so the results are not immediate. A callus might form 6 to 10 months after the surgery, if it’s going to happen.

Question: Lifting children after rhinoplasty – Any restrictions?
Answer: For the first two weeks after rhinoplasty surgery, it’s best you probably don’t lift more than 20 or 30 pounds and refrain from any type of exercise which would get your heart rate and blood pressure going, which could potentially give you a nosebleed. It’s also very important to make sure when you pick your children up to keep their head down lower than your nose so they don’t headbutt your nose after the rhinoplasty.

Question: Double Chin? Jowls? How to resolve?
Answer: The photographs presented are inadequate in order to make a determination about what is the correct surgical procedure for you. A full set of facial photographs from all angles when you’re not smiling are going to be required. Fat deposits located above the platysma muscle in the neck can be addressed with liposuction, however, fat deposits located below the platysma muscle require a surgical neck lift, which also includes a platysma plasty to significantly improve the jawline.

Question: 30 y/o, 21 BMI, can liposuction improve the contour of my neckline?
Answer: Liposuction can accomplish some improvement of your jawline, but if you’re looking to get the results in the after photo, you’re going to need a neck lift procedure to remove any fat deposits below the platysma muscle, in addition to a platysma plasty to significantly improve your jawline.

Question: I think I have a very large implant – how can this be treated?
Answer: It’s important to know what size, shape, and type of implant you have placed to make a determination about how best to proceed. If you currently have a large implant, potentially this could be downsized to a size small or medium. A full set of facial photographs from all angles are also required to make a determination, since the chin, the implant and the augmentation are all three-dimensional.

Question: Dr said I wouldn’t be happy with result – should I get a second opinion?
Answer: From the two photographs presented, you do appear to have a significant pre-Jowl sulcus on both sides of your chin. A side profile photograph is going to be required to make a determination about which type of implant you’re need, and what you’re trying to accomplish. If you’re only looking for width to fill in the pre-jowl sulcus, then consider a pre-Jowl implant. If you’re looking for filling in the sulcus in addition to augmentation of your chin forward, then consider a a standard chin implant. There are many different sizes and shapes of these implants, and they can even be custom carved when necessary for unique anatomy. Placement of a chin implant can be performed under local anesthesia as an outpatient procedure, which takes about 30 minutes.

Question: 23, 183cm and 64kg, how can I achieve this side profile?
Answer: The before photograph demonstrates a recessive chin, and fat deposits located mostly below the platysma muscle in your neck. Consider placement of a chin implant to augment your chin forward for better structural support for the soft tissues in your neck, and a surgical neck lift, which involves removal of the fat deposit above the muscle with liposuction, and surgical extraction of the fat deposit below the muscle, which also includes a platysma plasty to significantly improve the jawline.

Question: Am I a candidate for chin liposuction or will it need more intense surgery?
Answer: The photographs are really inadequate in order to make a determination about how best to proceed. Please post another set of full face and neck photographs from all angles to make that determination. The limited photographs appear to show a recessive chin profile for which a Chin implant can improve along with fat deposits located above and below the platysma muscle in the neck. A neck lift procedure can accomplish removal of fat deposits above and below the platysma muscle in addition to a platysma plasty to significantly improve the jawline.

Question: Lower facelift + closed rhinoplasty + tummy tuck – Okay to go to the same surgeon and do these together? 
Answer: Trying to perform all three of those surgeries at one time is probably a bit too much, but it’s also important to ask your plastic surgeon how long of time it’s going to take to accomplish all three procedures. You may not be a candidate for outpatient surgery, and might have to be admitted to a hospital. Probably best to do the closed rhinoplasty and lower face neck lift as one surgical procedure, wait about a month and then you can undergo the tummy tuck procedure. In our practice, a lower face and neck lift with a closed rhinoplasty would take about 3 1/2 hours under general anesthesia. Closed rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty specialist wisely, based on extensive experience producing natural results.

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