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Facial Plastic Surgery Questions and Answers: Part 2

Question: Self-conscious about wide nose – What can be done to improve this? 
Answer: A closed rhinoplasty approach can accomplish refinement of your nasal tip cartilages and narrowing the bridge line with all of the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either.

Question: What is the best option for my weak chin: Chin implant?
Answer: When patients have a recessive mandible and chin profile, consider placement of a chin implant which is exactly designed for that very issue. Chin implants are manufactured in a large array of thicknesses, sizes, and shapes, which must be determined at the time of the examination. In our practice, we place the implants under local anesthesia through a small incision underneath the chin. Chin implants offer a permanent augmentation, versus injectables which are temporary. In our practice for over 25 years, we have used Implantech brand of solid silicone chin implants with an excellent success rate.

Question: Cost and complication of rhinoplasty to reduce the size of a bulbous tip & dorsal hump and fix a deviated septum? 
Answer: A closed Rhinoplasty approach can accomplish straightening the nose, narrowing the bridge line, shaving down the dorsal hump, and refining the bulbous nasal tip. All the incisions are placed on the inside of the nose. There’s no external incisions and no painful packing. A septoplasty is a functionally medically related procedure performed for a deviated septum when there’s airflow blockage. A septoplasty is usually billed the patient medical insurance, while cosmetic rhinoplasty must be paid for by the patient. Both functional and cosmetic surgery can be performed at one time under one anesthesia with one recovery period.

Question: Would I have better profile harmony with a rhinoplasty, genioplasty, or both? 
Answer: The side profile photograph demonstrates an overly projecting nose, and an under projecting chin. A closed rhinoplasty procedure Can accomplish shaving down the dorsal hump, and narrowing the bridge line with all the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required. Placement of a chin implant accomplishes augmenting the chin forward which will help facial balance and proportions, especially from the side profile with respect to the nose. Both procedures are complementary to each other. Both procedures can be performed separately or together depending upon your desires. Digital computer imaging would be helpful to understand what one or both procedures can accomplish on your facial features.

Question: Would you consider me a candidate/be able to give me the changes I want? 
Answer: There is always a risk versus reward ratio has to be contemplated before undergoing elective cosmetic surgery. The amount of changes that your seeking are rather minimal, so is very important to have realistic expectations. A closed rhinoplasty approach can accomplish narrowing the bridge line, decreasing the overall projection couple millimeters, slightly reducing the bulbous nasal tip with all incisions placed on the inside of the nose. The nostrils can be narrowed within alar-plasty. You also appear to have thick skin in the tip of the nose which takes a longer period of time to heal. Frequent postoperative follow-ups are going to be very important for placement of steroid shots in the tip of the nose to manage the soft-tissue envelope over the cartilaginous framework of the nose.

Question: What would be the right option when it comes to fixing a upright nose? 
Answer: When there’s a short upturned nose present such as in the photographs, is very important to have realistic expectations about what can and cannot be accomplished with a rhinoplasty procedure. In our practice, the improvements would be rather minimal, but it would be possible to de-project and de-rotate the nose a few millimeters along with removing some of the nasal spine and lower part of the columella.

Question: Do you think I should get a revision as my nose is uneven and it’s hard to breathe? 
Answer: Much more information is needed such as a full set of facial photographs from all angles, a copy of the operative report and an in-person examination to make a determination about what is causing the breathing issues on the inside of the nose. Functional nasal surgery such as a septoplasty for A deviated septum or turbinate reduction can accomplish permanent improvement of breathing out of the nose. This must be documented for medical necessity at the time of the examination.

Question: How can I achieve a better nose after first rhinoplasty end result? 
Answer: When there is thick skin in the nasal tip, this is going to prevent refinement in that area, so it is very important to have realistic expectations. An alar-plasty can certainly narrow your wide nostrils. The tip can be lifted slightly as well.

Question: I would like to refine the tip of my nose, any suggestions on how I can achieve a more rounded nose? 
Answer: The photographs demonstrate a bulbous nasal tip and a hanging columella.  A closed rhinoplasty approach can accomplish refinement/narrowing of your nasal tip cartilages and reduction of the hanging columella with all the incisions placed on the inside of the nose. No external incisions are required. An alar-plasty is performed to narrow wide nostrils if needed. 

Question: What would you recommend for my nose? 
Answer: A closed rhinoplasty approach can accomplish a conservative hump removal, refinement of the nasal tip, narrowing the bridge line and releasing the depressor septi ligament which dynamically pulls your tip downwind smiling. All incisions are placed on the inside of the nose. No external incisions are required, and there’s no painful packing placed on the inside either. Digital computer imaging of your nose upon your facial features would also be helpful.

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