Spokane Doctors

Poor Dysport Results Last Time, is it Time for Upper and Lower Eyelid Surgery Instead? (photo)

Always had great results with Botox but went with Dysport last time and results were horrible. Made my eyes smaller, brow lower and lids super puffy. It's worn off now but my lids have become so hooded that they stick together, I raise my brow to see better and I always look mad (due to being 45, not result of Dysport). Do I go with Botox/Dysport again or get upper and lower lid surgery? Or given how my lower lids look, would fillers work instead? Thanks!

Fillers are not indicated to reduce hooded puffy eyelids.  According to the pictures presented, you are an excellent candidate for an upper and lower blepharoplasty.  The goal of upper lid surgery is to primarily remove excess skin with a small amount of fat, while the reverse is true for the lowers: excess fat is removed from the lower lids to reduce the bagginess and sometimes a small amount of skin is also removed at the lash line when needed.  The blepharoplasty procedure will reduce the hooding of the upper lids and the puffiness in the lower lids.  This is typically done under general anesthesia and takes approximately 1 hour.

William Portuese, MD

Seattle Facial Plastic Surgeon

Crooked Nose - Nose Implant Possible?

Hi. I have a broken nose from a fight one and a half years ago. Luckily, the cartilage tip etc. is all intact, however the bone itself is not fitting straight and is going to one of the sides, which brings the cartlage etc. with it. It wont fit, they tried 2 times, it still goes to one of the sides. Is it possible to "cut" the bone in half, attach a implant to the top part in order to make it fit with the lower part of my "forehead" where the break is or whatever its called. Can anyone do this?

While nasal implants are possible, it is best to use the patient’s own cartilage when possible.  If the nose has been completely depleted of cartilage, ear cartilage would be the next best choice.  It is important to have full osteotomies of the nasal bones with realignment of the nasal pyramid to give symmetric dorsal aesthetic lines.  Look for a surgeon who has lots of experience and has dedicated his practice to rhinoplasty and revision rhinoplasty before embarking on this difficult endeavor.

William Portuese, MD

Seattle Facial Plastic Surgeon

Big Nose And Hollow Eyes - What Do I Do?

I have REALLY hollow eyes and a big nose (just my luck!). I was wondering if there are surgeons that would do fat transfers and a nose job all in one day. If not, what do you think would be the best thing to do. The nose job first or the eyes? I was thinking that making a drastic change with the nose may cause a lot of extra skin... effecting the eye area.

We do not recommend fat injections around the eyes due to the poor results we have seen from other practices with this procedure.  Rhinoplasty should not create any extra skin effecting the eye area. Typically, rhinoplasty is done under general anesthesia and takes approximately an hour and a half to perform.

William Portuese, MD

Seattle Facial Plastic Surgeon