Daniel Gerry, MD

Although most swelling should be resolved after 8 months, in truth the soft tissues of the nose can remain mildly swollen for as much as 12 months following a rhinoplasty.  I would agree that tip refinement might benefit your appearance if this is something you desire.  However, rhinoplasty is a very personal decision and each patient will have unique goals for the appearance of his or her nose, so it can be difficult to make blanket recommendations about what type of rhinoplasty procedure you need.  I will say that your columellar show does not seem excessive, although I don't have the benefit of making direct measurements.  Typically, 2-4 mm of show is considered aesthetically ideal, with anything significantly greater than this being considered a "hanging columella".  Just be sure you have a very clear idea of what you want to accomplish, and speak with a surgeon who will be honest with you about what is needed to achieve your specific goals. Thanks for your question!

There are many factors that play into maximum safe anesthesia time, including age, cardiac health, vascular disease, or the presence of chronic lung conditions.  For most patients who are generally healthy, 5-6 hours of general anesthesia is typically quite safe, as many procedures extend well beyond this timeframe, even in excess of 12 hours, without any significant long-term impact.  Without knowing more about your overall health, it is hard to say what is safe for you.  Be sure to speak to the anesthesiologist prior to surgery to get more information about the type of anesthesia and airway management being used, as these can have almost as much impact of safety as the duration of the anesthesia.  Thanks for your question and best of luck!

Hello and thank you for your question.  From the photos you only appear to have very early jowl formation, and a slim neck and well-defined jawline.  While it is true that your jowls would be most effectively treated with a lower face/neck lift, your results may not be dramatic.  However, fillers like sculptra and restylane lift are not a great remedy for jowls.  Although they can smooth the pre-jowl sulcus (that small depression just in front of the jowls), they do nothing to actually eliminate the jowl and can actually give the jawline an oddly swollen appearance if not used sparingly.  Better to treat the underlying problem with the correct procedure and have modest results that last for years than to spend money on a temporary solution that doesn't truly solve the problem at all!  That being said, surgery is a big decision and only you will know when the time is right.  Best of luck, and thanks again!