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Facial Plastic Surgery Questions and Answers: Part 1

Question: Am I a good candidate for a lip lift and rhinoplasty? 
Answer: In our practice, we do not recommend a lip lift procedure due to very poor scarring we have seen with this operation performed elsewhere. A full set of facial photographs from all angles are required to make a determination what needs to be performed on your nose for a rhinoplasty procedure. A closed rhinoplasty approached can accomplish shaving down the dorsal hump, straightening the nose, and accomplishing refinement of the tip and the bridge line. You also appeared have some degree of facial asymmetry, so your nose will not be a perfectly straight.

Question: Are there any procedures besides a chin implant and rhinoplasty that could improve my appearance? 
Answer: The photographs demonstrate an overly projecting nose and an under projecting chin. A closed rhinoplasty can accomplish straightening the nose, shaving down the dorsal hump, and reducing the projection. Consider placement of a 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.

Question: Septorhinoplasty: What has the surgeon done wrong? What can I do about it? 
Answer: Its best to wait at least a year before embarking and another procedure because is important to allow full healing first. After a year, you can have your plastic surgeon or a small piece of cartilage from your nose, and place it in that area to fill in the small depression.

Question: Would I be a good candidate for just a tip rhinoplasty? 
Answer: Performing only a tip rhinoplasty will leave the nose unbalanced. Reducing the nasal tip cartilages  will give more of a supra tip break, which will make the dorsal hump appear appear larger. Also important to determine the thickness of the skin in the tip of your nose which may prevent refinement anyway. Based on the photographs presented, it will be best to perform a full rhinoplasty which can be done with closed approach with all the incisions placed on the inside of the nose.

Question: Rhinoplasty for a bulbous nose, one nostril appears larger or more to the side? 
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, narrowing the bridge line, and reducing the overall projection of the nose and reduce the hanging columella. All the incisions are placed on the inside of the nose and there’s no external incisions or painful packing required. Thick skin in the tip of the nose is going to prevent refinement in that area, so it’s important have realistic expectations. Digital computer imaging of your nose upon your facial features would also be helpful to understand what can be accomplished with the procedure.

Question: Is this a realistic outcome for rhinoplasty? 
Answer: Yes, the digitally altered photograph does appear realistic. It is possible to narrow the bridge line and refine the nasal tip with a closed rhinoplasty approach. This involves placement of incisions only on the inside of the nose. No external incisions are required and no painful packing is required.

Question: Had a closed rhinoplasty 10 years ago for hump removal only. Would a nasal tip refinement help achieve a less bulbous nose?
Answer: Revision rhinoplasty is much more difficult than a primary rhinoplasty due to the fact that there’s been previous alterations to the normal anatomy, thick skin present, and scar tissue. A formal in-person examination is going to be required. There also appears to be hanging columella, a prominent nasal spine, and a polybeak and a bulbous nasal tip Cartilages. A full revision rhinoplasty is going to be required to ensure that all of the components of the nose are balanced with themselves, and the entire new nose is balanced with the patient’s facial features in a three-dimensional fashion.

Question: Revision rhinoplasty help, what can I do?
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty, therefore an In-person examination is going to be required to make a determination about how best to proceed. Copies of the operative report will be helpful for your next surgeon. Also important to know how much cartilage is left over on the inside of the nose for potential grafting purposes. If the tip of your nose droops dynamically when smiling, then it is important to release the depressor septi ligament. Osteotomies are required to straighten the crooked nasal bones, and cartilage grafting techniques are performed if the upper lateral cartilages are concave. An internal evaluation of the nose going to be required to make a determination about what is causing nasal obstruction issues.

Question: Can I have my nasal hump rasped under local anesthesia? 
Answer: No, you have a fairly large hump, which is composed of both bone and cartilage. Once you take the hump down, you’ll be left with an open roof, flat top nasal deformity. Osteotomies placed in the nasal bones are then necessary to close the open roof and to give you a natural nose. That’s the reason a cast is placed across the bridge of nose just to hold the nasal bones in their new and more narrow position after the hump removal itself. In our practice, Rhinoplasty procedures are performed under general anesthesia by a board certified physician anesthesiologist for patient safety and comfort.

Question: What can I do to improve my face proportions? 
Answer: A full set a facial photographs from all angles are required to make a determination about your nose and your chin. A closed rhinoplasty can accomplish making the entire nose smaller and less projecting. All the incisions are placed on the inside of the nose. No external incisions are required. When there’s a recessive chin profile present, then consider placement of a chin implant to augment the chin forward which helps with facial balance and proportions, especially from the side profile with respect to the overly projecting nose.

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