William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 05

Question: Can anything be done surgically if the nose appears slightly pinched between the eyes?
Answer: A full set of facial photographs from all angles are going to required to make a determination about how best to proceed, since the nose is a 3-dimensional structure, and rhinoplasty is performed in all 3 dimensions.

Question: Will blepharoplasty take away my naturally hooded eyes that I love? 
Answer: A very conservative skin only upper blepharoplasty can accomplish improvement in that area. It’s important not to remove any fat or muscle if you’re trying to keep the hooded look. This procedure can be performed under local anesthesia as an outpatient procedure.

Question: Brow lift or blepharoplasty for uneven eyes?
Answer: From 1 limited photograph, the brow position is normal, therefore a brow lift is not necessary. Your eyelids appear normal other than some ptosis on the right side.  Seek out consultation by plastic surgeon for improvement.

Question: What are my best options to fix my eyes? I have droopy eyelids and love thick eyeliner looks. 
Answer: The photographs are rather limited, however a very conservative skin only upper blepharoplasty can accomplish raising your upper eyelid crease  if that is what you are trying to accomplish.  This procedure can be performed under local or general anesthesia as an outpatient procedure. 

Question: What surgical procedure(s) do you suggest for a refreshed look to my eyes/face/neck?
Answer: In our practice, we perform a high-SMAS lower face and neck left.  The goal of a lower face and neck lift is to tighten loose facial and neck skin,  tighten loose  facial and neck muscles, lift the jowls, and remove any fatty deposits in the neck which also includes a platysma-plasty.    The hooded and extra skin on the upper lids can be addressed with an upper blepharoplasty, while the puffiness can be removed from the lower lids with lower lid blepharoplasty procedure. Eyelid surgery and a facelift can be performed together under one anesthetic which allows one recovery period.  

Question: What surgeries would you suggest for uneven eyes and eyebrows, and a bulbous nose tip and bridge bump? 
Answer: Botox can be used to help with asymmetrical eyebrows, however eyebrow lift would not be necessary. A closed rhinoplasty approach can accomplish shaving down the dorsal hump, narrowing the bridge line and refining the bulbous nasal tip with all the incisions placed on the inside of the nose.

Question: Am I a candidate for otoplasty? 
Answer: From the one limited photograph, it does appears that and otoplasty may be of some benefit, especially if the prominence of your ears are bothering you.  The Otoplasty procedure involves re-creating the anti-helical fold  and pinning the cartilages back with permanent sutures behind the ears. the procedure itself can be performed under local anesthesia as an outpatient procedure usually takes approximately one hour.

Question: I had rhinoplasty 11 years ago, and have noticed some changes in the shape of my nose, the tip, nostriles, and bridge. Advice?
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty, therefore a full set of pictures from all angles are going to be required to make a determination about how best to proceed. From the two limited photographs, it appears that there’s thick-skin in tip of the nose and an inverted V deformity. The inverted V deformity as a result of inwardly collapsed upper- lateral cartilages in combination with  wide nasal bones. The revision rhinoplasty procedure can accomplish placement of spreader grafts to hold open the collapsed Upper lateral cartilages, and osteotomies placed in the nasal bones to narrow them.

Question: Will upper and lower blepharoplasty help with wrinkles under the eyes and crows feet? Would I need a brow lift as well? 
Answer: The primary goal for upper eyelid surgery is to remove excess skin that is creating the hooded look, and the primary goal for lower lid surgery is to remove the fat bags creating the puffy look. The incision on the upper lids is located directly in the upper eyelid crease, and the lower lid incision fat removal is performed through trans-conjunctival approach on the inside of the lower lids. If there’s lower lid wrinkles  at rest, then a pinch technique of excess skin can be performed. In our practice, this is close with tissue glue. The eyebrow position is normal, and eyebrow lift is not necessary. Crows feet are best treated with Botox.

Question: What are my treatment options for puffiness/fat bags/circles under eyes from thyroid eye disease? 
Answer: As long as your  Thyroid eye disease is stable, a trans-conjunctival lower blepharoplasty  can accomplish removal of the fatty bags  from the inside of the lower lids.  All the incisions are placed on the inside of the lower lids, there is no external incisions.

    Contact Dr. William Portuese