Facial Plastic Surgery Questions and Answers: Part 04

Question: What is the appropriate procedure to address my issues with my nose?
Answer: A septoplasty is performed on the inside of the nose to improve air flow dynamics when you have a deviated septum. That procedure is usually billed to the patient’s medical insurance, once medical necessity and preauthorization has Occurred with your medical insurance. A cosmetic closed rhinoplasty can accomplish straightening the external portion of your nose. All the incisions are placed on the inside of the nose. No external incisions are required, and no painful packing is required either. This procedure can accomplish straightening the nose, shaving down the dorsal hump, and placement of the spreader graft underneath the concave upper lateral cartilage on your left side which may be compounding your breathing issues as well making the nose look crooked. Rhinoplasty the most difficult procedure to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty specialist very wisely based on extensive experience producing natural results.

Question: I know I have a low radix nose. How can I fill the space?
Answer: From the one limited photograph, you do have slightly low radix, but you also have a dorsal hump which is composed of both bone and cartilage. A closed rhinoplasty approach can accomplish not only shaving down the dorsal hump, but permanently augmenting that area with a small cartilage graft. All of the incisions are placed on the inside of the nose. We do not recommend filler placed in the area due to vascular occlusion and skin necrosis. Digital computer imaging of your nose would also be helpful to understand what Can and cannot be accomplished with a closed rhinoplasty.

Question: Crooked nose in certain lighting after rhinoplasty (6 years post OP). Can it be fixed with fillers or only revision?
Answer: A side profile photograph would also be helpful to make a determination about how best to proceed, however from the limited photographs, it appears that on your left side the upper lateral cartilage has collapsed inward and your septum may have collapsed as well. It’s very important to know how much cartilage is left over on the inside of the nose for grafting purposes, since you will probably need a couple of cartilage grafts to restore symmetry to your nose. A copy of the operative report would also be helpful to find out what was accomplished in the first procedure. Revision rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty specialist very wisely based on extensive experience.

Question: Would I be a good candidate for a rhinoplasty?
Answer: Based on the one limited photograph, a rhinoplasty can accomplish narrowing and straightening the bridge line, and reducing the size of your nostrils with an alar-plasty. A full set of photographs from all angles would be required to make a better determination. You have thick skin in the nasal tip area, so it’s also important to have realistic expectations.

Question: Can a rhinoplasty be combined with functionality to fix narrow airways?
Answer: Yes indeed, a cosmetic rhinoplasty and functional nasal airway improvement such as a septoplasty can’t be performed together under one anesthesia with one recovery period. The functional surgery is billed to the patient’s medical insurance, while a cosmetic component is billed to the patient. Anticipate co-pays and deductibles associated with any medical insurance. Cosmetic rhinoplasty it’s much more complicated than functional nasal surgery, so choose your rhinoplasty specialist very wisely based on extensive experience producing natural results.

Question: Is there any other less invasive procedure that could benefit the removal of the droop permanently?
Answer: A less invasive closed rhinoplasty approach can accomplish shaving down the hump, and refinement of your nasal tip cartilages and lifting the tip of your nose statically. Releasing the depressor septi ligament will prevent the tip of the nose from drooping dynamically. Choose your rhinoplasty specialist wisely, since this procedure is the hardest operation to perform correctly in the entire field of cosmetic surgery.

Question: Help! Dislike my side profile, what procedures could be done to better my appearance?
Answer: The side profile photographs demonstrate a recessive Chin profile, therefore consider placement of a small chin implant to augment your chin forward for better facial balance and proportions. In our practice, we place chin implants through a small supplemental incision under local anesthesia as an outpatient procedure which usually takes about 30 minutes.

Question: What can be done to my nose without it resulting in a Michael Jackson after surgery nose?
Answer: The side profile photograph demonstrates an overly projecting nose with a dorsal hump, and a significant recessive chin profile. The recessive chin profile makes your nose look bigger than it really is. A closed rhinoplasty can accomplish shaving down the dorsal hump, decreasing the projection of it, refining the nasal tip and narrowing the bridge line with all of the incisions placed on the inside of the nose. Consider placement of a small chin implant to augment your chin forward for better facial balance and proportions from the side profile. Professionally done digital imaging would also be helpful to understand what one or both procedures can accomplish upon your facial features.

Question: What has happened to my nose? I’m considering revision rhinoplasty
Answer: When patients have thick skin and undergoing a rhinoplasty procedure, steroid shots are going be required to reduce the swelling in the nasal tip for the first several months after the procedure. In addition, there’s a hanging columella present along with alar retraction. The alar retraction will need to be addressed with a composite skin/cartilage graft harvested from the ear.

Question: My cheeks are sagging. What treatment or surgery can you suggest?
Answer: At age 27, your cheeks are not sagging. If you having fat pads in the lower lids, a trans conjunctival lower blepharoplasty with a conservative fat removal can accomplish improvement in that area. The side profile photograph demonstrates a recessive chin profile for which a chin implant can improve.


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