Facial Plastic Surgery Questions and Answers: Part 10

Question: Does Kybella just not work for some people? Or do I need more treatments?
Answer: Kybella is just not very effective, and cannot get rid of fat deposits located below the platysma muscle in the neck, which many people have. Liposuction can accomplish removal of fat deposits above the muscle, while a surgical neck lift is required to remove the fat deposits underneath the platysma muscle which also includes a platysma-plasty to significantly improve the jawline. Please submit a full set of facial and neck photographs to make the right determination.

Question: What’s the issue with my asymmetrical nostrils?
Answer: You have alar or attraction on your left side of your nose. This is improved with a composite graft taken from the ear. Your nostrils will never be perfectly symmetrical. You also have a hanging columella and an overly rotated nose. Trimming back the membranous and cartilage in the columella will help with your excess columella show. Choose your second rhinoplasty surgeon wisely based on extensive experience due to the fact that this is a very difficult procedure to perform correctly.

Question: Would a forehead reduction improve my face? 
Answer: Many folks have a high forehead, and that does not distract from your facial features. In our practice, we only perform forehead reduction at the same time as lifting the eyebrows, but only when patients have low set eyebrows.

Question: Bulbous tip + uneven nostrils – what non-surgical treatment would help? 
Answer: Your nostrils are asymmetrical now, and will continue to be asymmetrical after any surgical intervention. A full and closed rhinoplasty approach can accomplish refinement of your nose by shaving down any dorsal hump, reduction of the bulbous tip, and narrowing the bridge line to ensure that all the components of the nose are balanced three-dimensionally from all angles. You’re not a candidate for just a tip-plasty. Injection of fillers in the nose would only make the nose bigger, not smaller and is not recommended.

Question: What’s the chance of having a successful revision rhinoplasty with a piece of cartilage hanging in my nostril?
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty due to the fact that there is scar tissue, and previous alterations to the normal anatomy. It’s also very important to have realistic expectations, since there is no perfect nose, just improvement. The extra piece of cartilage can be adjusted on the inside of your nostril, and the residual dorsal hump can be shaved down all the way into the glabella to give you a more feminine side profile. Osteotomy’s will also be required after the hump removal to narrow the bridge line. All this can be done with a closed rhinoplasty approach with all the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required either. Choose your revision surgeon wisely based on extensive experience.

Question: What type of brow lift is best for a large forehead?
Answer: When patients have a high hairline like you do, the incision is placed at the frontal forelock and the bald skin is removed so that hairline becomes lowered. From the photos presented, your eyebrow position is normal, and a brow lift is not necessary otherwise you’ll look too surprised.

Question: Blepharoplasty – Transcutaneous or Transconjunctival for my lower eyelids?
Answer: In our practice for over 30 years, we have only performed trans conjunctival approach for fat removal. The reason for this is that a transcutaneous approach can weaken the lower eyelid muscle and can give ectopion or scleral show.

Question: Which procedures would help me achieve more facial harmony and can they be done at the same time? 42 y/o
Answer: From the photos presented, you have significant fat deposits in the neck located both above and below the platysma muscle. A surgical neck lift would be required to remove both compartments of fat including a platysma – plasty to significantly improve the jawline. You also have a recessive and narrow chin, therefore consider placement of a chin implant at the same time. A closed rhinoplasty can accomplish shaving down the small dorsal hump on your nose along with narrowing the tip and narrowing the bridge line. All of these procedures can be performed together or separately depending upon your goals. They are all performed under general anesthesia as an outpatient surgical procedure.

Question: Can the bridge of the nose be shaved down without altering the tip? Will the tip still be susceptible to deformities?
Answer: Much more information is needed such as a frontal photograph on a three-quarter photograph to make that determination. If your tip is excessively wide, then the nasal tip cartilages need to be adjusted to the new bridge line, otherwise the tip will be out of balance.

Question: What would I need done to fix my neck and jowl line?
Answer: The limited photographs demonstrate significant fatty deposits in the neck, loose skin and jowls. A lower face and neck lift can accomplish tightening loose facial and neck skin, tightening loose facial and neck muscles, and removing the Fatty deposits located above and below the platysma muscle in addition to a platysma-plasty.


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    The Idaho Center for Facial Plastic Surgery ®

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    Ketchum, ID 83340

    (208) 481-9155

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