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Facial Plastic Surgery Questions and Answers: Part 6

Question: How Can I get the right side of my nose to more like my left?
Answer: Much more information is needed, such as a full set of facial photographs thaare in focus including the entire nose and face. It is important understand there will be asymmetries because there is a left half of the nose and the right half of the nose and they come together in the embryo phase during facial development. There is no perfect nose, just improvements with rhinoplasty.

Question: Is this a fractured nasal bone and will insurance cover the cost to straighten it out? 
Answer: Based off of the photographs, you have crooked nasal bones and a concave upper lateral cartilage along with a dorsal hump. A cosmetic rhinoplasty can accomplish shaving down the hump and straightening the nose with osteotomies and placement of a spreader graft in the midportion of the nose. Expect to pay for this component yourself. Medical insurance can be billed for functional problems such as breathing in the back of the nose. Both cosmetic and functional breathing surgery can be performed together under one anesthesia with one recovery period. Medical necessity must be documented at the time of the examination along with preauthorization with your medical insurance. Anticipate co-pays and deductibles associated with your medical insurance,which can be expensive.

Question: Is it possible for revision rhinoplasty to make my nose look like my altered-photo? 
Answer: Revision rhinoplasty is much more difficult than a primary rhinoplasty due to the fact there is scar tissue present and previous alterations to the normal anatomy. A full set of unadulterated facial photos from all angles will be required to make a determination about how best to proceed. Also important to know how much cartilage is left over the inside of the nose for potential grafting purposes. Best to obtain the operative reports for next plastic surgeon to have a understanding of what was accomplished in the primary rhinoplasty procedure.You will need an in-person exam.

Question: How can I improve my appearance by approaching surgical enhancement holistically to balance my features and face shape? 
Answer: A full set of facial photographs looking straight ahead in chin neutral position is going be required to make a determination about how best to proceed. A closed rhinoplasty approach can accomplishing shaving down the dorsal hump and refining the nose, including the tip. The eyebrow position is normal, therefore a brow lift is unnecessary. We do not perform buccal fat pad removal in our practice.

Question: I am interested in rhinoplasty to address my long nasal tip. Would it be possible to achieve a balanced look? 
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty, so it’s important to have realistic expectations because there’s been previous alterations to the normal anatomy and scar tissue present. In addition, it’s also important to know how much cartilage is left over on the inside of the nose for potential grafting purposes, if needed. A revision rhinoplasty can accomplish lifting the nasal tip statically, and reducing the hanging columella. If the nasal tip droops more when smiling, then it is important to release the depressor septi ligament. Nostril asymmetry is very difficult problem that must be addressed at the time of the consultation and examination.

Question: Can I get a non-surgical nose job for my droopy tip when I smile?
Answer: The reason that your tip droops when you smile is because you have an active depressor septi ligament which must be released surgically. This is usually performed as a component of closed rhinoplasty procedure.

Question: Will my “smiling face” shape and appearance change after a mid and lower face/neck lift?
Answer: Much more information is needed, such as your age, and a full set of facial and neck photographs from all angles to make a determination about how best to proceed. In our practice, the goals of a lower face and neck lift are to tighten loose facial and neck skin, tighten loose facial and neck muscles, remove fat deposits in the neck located above and below the platysma muscle along with a platysma-plasty, and lift the jowls.

Question: My tip/profile points down when I smile 10 months after septo/rhinoplasty. What can be done to fix my tip? 
Answer: From the photographs presented, it appears that you have a residual hanging columella. If your tip groups down dynamically when smiling, consider releasing the depressor septi ligament at the base of the columella itself.

Question: What are the medical terms to describe my ethnic nose? What procedures/methods would work best on me? 
Answer: A closed rhinoplasty approach can accomplish shaving down the Dorsal hump which is composed of both bone and cartilage. You also have a hanging columella which is excess skin and cartilage between the nostrils which must be tucked inwards. If the tip of your nose droops dynamically when smiling, then it’s important to release the depressor septi ligament. Osteotomies placed in the nasal bones are performed to narrow the bridge line. An alar plasty is performed to narrow wide nostrils.

Question: Ready to enhance my features (nose, eyelids, upper lip), can you help? 
Answer: The side profile photographs demonstrate an overly projected nose and an under projecting Chin. The under projection of your chin makes your nose look bigger than it really is. Consider placement of a chin implant to augment your chin forward for better facial balance and proportions, especially from the side profile. A closed rhinoplasty procedure can accomplish reduction the dorsal hump, reducing the projection of the nose, refinement of the nasal tip, and preventing the tip of the nose from drooping down dynamically when smiling. All the incisions are placed on the inside of the nose. Both procedures can be performed simultaneously on one anesthesia with one recovery period.

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