William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 04

Question: Where should I start, I want to make myself look more attractive? 
Answer: Regarding your eyelids, we do not recommend placement of filler around the eyes, especially at such a young age. If you’re trying to narrow and refine your nose, a surgical rhinoplasty is going to be required. Fillers placed in the nose will only make the nose bigger, not smaller. A closed rhinoplasty approach can accomplish narrowing the bridge line and refining the nasal tip, with all incisions placed on the inside of the nose. An alar-plasty can accomplish narrowing wide nostrils.

Question: Mini facelift? Under eyes? Eyebrow lift? What do I actually need? With so many options it’s impossible to tell. 
Answer: Your eyebrow position is totally acceptable, and a brow lift is unnecessary. There’s extra skin on your upper eyelids and an upper blepharoplasty procedure can accomplish improvement, as long as there’s not ptosis present. You do not need a mini facelift at age 30.

Question: How can I improve the appearance of my droopy eyes? Could 10 years of using Latisse be making my eye area look worse? 
Answer: The Photographs demonstrate excess skin on the upper eyelid creating the hooded look. An upper blepharoplasty procedure can accomplish improvement to rejuvenate the eyelids. An upper blepharoplasty procedure can be performed under local or general anesthesia depending upon the patient’s desires.

Question: Are my eyes really at different heights, and if so, is there anything I can do? 
Answer: The amount of asymmetry in your eyelids is within normal limits, and eyelid surgery is not required. It is important understand that there are 2 halves of the face, and there never exactly symmetrical. The Nose can be straightened with a closed rhinoplasty approach which involves osteotomies placed in the nasal bones and a spreader graft placed underneath the concave upper lateral cartilage on your left side.

Question: I have sagging jowls, turkey neck, hooded eyes. What all do I need done?  
Answer: An upper blepharoplasty procedure can accomplish removal of excess skin creating the hooded look on your upper eyelids. The incision is located directly in the upper eyelid crease. A lower face and neck lift can accomplish lifting the jowls, tightening loose facial and neck skin, tightening loose facial and neck muscles, and removing the fat deposits in the turkey neck in addition to a platysma-plasty. Anticipate two weeks of visible bruising and swelling after both procedures. Study your prospective surgeon’s before and after photo gallery to make sure the results look very natural.

Question: Best treatment to tighten this loose facial skin round eyes? 
Answer: When performing lower eyelid surgery, the amount of skin removal in the lower lid is determined at rest, not when smiling.  A small pinch technique of extra skin is removed when necessary.  In our practice, we close this incision with tissue glue.  The crows feet are best treated with Botox.

Question: Fat repositioning under the eyes? 
Answer: A full set of facial photographs looking straight into the camera are going to be required to make a determination about how best to proceed. Looking upwards accentuates the fat bags more than when looking straight ahead. In our practice, we perform a conservative fat removal through a trans-conjunctival approach on the inside of the lower lids. If you have allergies, make sure they are under control before undergoing surgery.

Question: What is standard for first night home care after deep plane face lift?
Answer: In our practice, the patient’s family member is usually the caregiver and RN is not required. We prefer the family member to be with the patients for the first 48 hours after the surgery to make sure the patients are doing quite well after a facelift procedure and the drains have been removed.

Question: Upper blepharoplasty or skin resurfacing for hooded eyes? 
Answer: The photographs demonstrate excess skin and fatty deposits in the upper lids creating the hooded look for which an upper blepharoplasty procedure can accomplish improvement.  The procedure can be performed under local or general anesthesia.

Question: Is Ativan alone enough for an upper blepharoplasty?
Answer: An upper blepharoplasty procedure can certainly be performed under local anesthesia with or without oral sedation. Some patients also elect to have the procedure performed under general anesthesia. In our practice, we use a scalpel, and never use the laser around the eyes.


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