Facial Plastic Surgery Questions and Answers: Part 04

Question: Is my goal of a smaller nose achievable with an African American Rhinoplasty?
Answer: The Model nose photographs presented are not achievable and are unrealistic. Since the side profile looks very good, the only changes that would be made would be from the frontal view. It is possible to narrow the bridge line, refine the nasal tip, and narrow the nostrils with an alar-plasty.

Question: There does seem to be loose skin so I was considering a neck lift or other procedures?
Answer: Much more information is needed such as your age, and status of the skin tone in your neck. In our practice, a neck lift procedure involves liposuction with fat removal above the platysma muscle and surgical extraction of the fat deposits below the platysma muscle in addition to a platysma plasty. If you are less than 50 years of age, no skin is usually removed. Over 5o years of age, or patients who have very inelastic skin will require a lower face and neck lift.

Question: Why does the nose look nice right after surgery but different when the cast is removed?
Answer: Swelling after rhinoplasty takes many months to subside, and full healing takes 1 year. The amount of swelling is dependent upon thickness of the skin, and the techniques used to accomplish the changes in the nose.

Question: Deviated septum. Will insurance pay for it?
Answer: Documentation from your surgeon must be performed in the chart for medical necessity, and then a letter of preauthorization is usually sent to the patient’s medical insurance for coverage. Expect to pay for co-pays and deductibles associated with any medical insurance. All cosmetic surgery must be paid for by the patient. Both functional and cosmetic nasal surgery can be performed together under one anesthesia with one recovery.

Question: Least invasive options for jaw definition?
Answer: Your side profile photographs demonstrate a recessesive mandible bone, and significant fat deposits located both above and below the platysma muscle in your neck. Noninvasive treatments will be waste of money and time. Consider placement of a chin implant to augment your chin forward for better facial balance and proportions. This will also give better structural support for the soft tissues in your neck. If you’re trying to clean up your jawline, liposuction alone will only remove that compartment of fat above the muscle. Most of your fat in the neck is below the platysma muscle which is going to require a necklift to remove the fat compartment below the muscle itself. A platysma-plasty is then performed which significantly improves your jawline. No skin removal is required. All this can be performed through a 1 inch incision underneath your chin.

Question: Jaw, definition, add possible neck lift 
Answer: It’s very important to understand that there are two compartment of fat in the neck located both above and below the platysma muscle. Liposuction can only accomplish removal of the fat deposits above the muscle. A surgical neck lift is required to remove the fat deposits below the muscle which also includes a platysma plasty to significantly improve the jawline. In our practice, we do not use compression garments, we use surgical drains left in place for two days which removes blood out from underneath the skin.

Question: Is this level of advancement realistic with sliding genioplasty?
Answer: A sliding genioplasty is performed by an oral surgeon Under general anesthesia in a hospital setting with an overnight stay, and is much more invasive. It’s usually done when the teeth are significantly out of alignment. If you’re looking for purely cosmetic improvement, then consider placement of a medium sized chin implant, which can be performed under local anesthesia which takes about 30 minutes.

Question: How to improve side profile? Genetically saggy cheeks
Answer: The profile photograph demonstrate early jowls, fat deposits above and below the platysma muscle in the neck, and a recessive Chin. Consider a neck lift procedure in combination with a chin implant. The neck lift involves removal of fat above the model with liposuction, and surgical extraction of the fat below the muscle which also includes a platysma-plasty to significantly improve the jawline. No skin removal is necessary. Placement of a chin implant can augment your chin forward which also offers additional structural support for the soft tissues in the neck, and gives you better facial balance and proportions. Before undergoing the necklift, you should be your ideal body weight for best results.

Question: Would a rhinoplasty that narrowed my bridge make my eyes look too wide set?
Answer: Your eyes are beautiful, and your inter-canthal distance cannot be changed. If the width of your nose bothers you enough, then do a rhinoplasty. It’s not going make your eyes look even wider. Digital computer imaging by a rhinoplasty specialist would be helpful to understand what can be accomplished with the procedure upon your facial features Rhinoplasty is a very difficult endeavor, so choose your surgeon wisely based on extensive experience.

Question: Can I get a rhinoplasty to improve the hump on my nose and my airflow? 
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump to give you a nice cosmetic improvement. All the incisions are placed on the inside of the nose. Functional nasal surgery such as a septoplasty or turbinate surgery may be required to improve air flow dynamics, and is usually billed to patients medical insurance. If you’re having headaches behind your nose, a CAT scan of your sinuses maybe necessary. Look for a double board-certified ENT/ facial plastic surgeon who can accomplish both functional and cosmetic nasal surgery under one anesthesia with one recovery.


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