Peter Lee, MD, FACS

In answer to your question, yes, it is possible to improve your breathing through your nose and to “deliver a natural straight nose that fits my face”. To achieve this we would perform an open septorhinoplasty. Because of the size of the dorsal hump, we might need to perform lateral osteotomies, after taking down the dorsal hump, in order to achieve the nasal shape you seek.

A profile view is usually more helpful to assess the neck. To address the signs of periorbital aging, you would benefit most from an endoscopic browlift paired with upper and lower blepharoplasty. While a minifacelift, which we call a wavelift, and perform with an endoscope to minimize the length of our incisions, would rejuvenate your midface, and cause some improvement along your jawline, you do not have much jowling, so it might be the case that performing liposuction of the neck would satisfy you for the time being, allowing you to postpone a facelift until later in life. We would need to see you in person to allow you to better choose among these different options.

Thank you for your question. Judging from the photographs you shared, you would benefit the most from an endoscopic browlift, upper and lower blepharoplasty, face and neck lifts. We would probably use a a combination of excised SMAS tissue and fat to further soften your nasolabial folds, tear trough and temporal regions at the end of the procedure.

Ideally, after a rejuvenative facial procedure, the upper, middle and lower thirds of the face should be harmoniously balanced, which requires that the appropriate procedure be performed in each region of the face and neck. In your particular case, based on the photographs you shared, we would perform and endoscopic browlift, upper and lower blepharoplasty, facelift, and necklift.

While it is possible to rasp a dorsal hump such as yours via access through an internal nostril incision, we have found, over time, that this approach results in a high frequency of secondary revisions. Most commonly, the dorsal hump is composed of both cartilage and bone, each of which is optimally addressed with different instruments and techniques. The precision of such a treatment is optimized by direct visualization. Accordingly, we therefore prefer to take down a dorsal hump, such as the one seen in your photographs, by an open approach, rather than by simply rasping it in a closed fashion.

Thank you for your photos, We are not sure what a “snatched jawline” is, but question whether that is something that you would really like to suffer. Actually, your jawline looks pretty good in profile. However, the profile view does reveal that your cervicomental angle has become less acute. Your overall skin quality also looks pretty good as well. While a limited necklift is always an option, before your take this step, you might first consider a skin tightening procedure such as Ultherapy, Necktite or Morpheus.

Men tend to have thicker skin than women, and, for that reason, Ulthera tends to deliver less satisfactory results for men. Juvederm might make your nasolabial fold less deep, but, overall, it will add more volume to your face, without lifting the soft tissues, which is what you really want to achieve. Unfortunately, a facelift can not be performed without making incisions, which become scars. However, you might be a candidate for a short scar facelift, which we perform in our practice with an endoscope, allowing us to hide part of the scar inside the ear, and to end the length of the scar at the earlobe. This might be a preferred option for you in light of your short hair.

You did not specify what surgery was recommended to you, so I cannot answer your questions in that regard. However, looking at the photos you shared, I can tell you what procedures we would recommend: An endoscopic browlift to address your brow ptosis Bilateral upper blepharoplasty with ptosis repair to remove excess eyelid skin and raise the lash line so you do not look quite so sleepy Bilateral lower blepharoplasty with lateral canthopexy and fat transfer to the tear trough to remove excess skin from the lower eyelid, improve eyelid support, and address the hollowing at the lid-cheek junction Facelift to elevate the soft tissues of the midface, soften the nasolabial crease, treat the signs of early jowling, and deliver a sharper jawline Necklift to address the platysmal bands and tighten the redundant skin of the neck Rhinoplasty to correct your drooping columella and bulbous nasal tip All of these procedures could be performed concomitantly if you wished. Surgical time would be about six hours. Or you could have them done in stages, if you preferred. You would be out of bed and walking around in about a day or two after the surgery. You would be ready to appear in public about two weeks after the surgery. You would be ready to gradually resume exercise about six weeks after the surgery.

The short answer to your question is yes. You are also correct that the basis of the asymmetry you see is the facial skeleton, and definitive treatment would involve a fronto-orbital advancement. This is a rather big surgery, and your hesitancy in regard to it is understandable. A less aggressive approach to correct this asymmetry would be an endoscopic browlift to differentially lift the eyebrows and create greater symmetry in their position. This procedure takes about 60 to 90 minutes to perform, and can be done under local anesthesia with intravenous sedation. Additionally, you also have some moderate eyelid ptosis, which could be corrected at the same time with a ptosis repair of the upper eyelids. This would open up your eyes and make you look less “sleepy”.

Your photo reveals that your orbits, the bony sockets in which the eyeball resides, are asymmetric, the right being larger than the left. You also demonstrate bilateral ptosis of the upper eyelids, greater on the left than the right. Additionally, as you point out, your left brow sits lower than the right brow. I suspect that a CT scan would reveal that some of the soft tissue asymmetry we are seeing is due underlying asymmetry of the facial skeleton, so the achievement of ideal symmetry will not be possible without craniofacial procedures to address the bone. However, short of this, there are some soft tissue procedures that could address the issues we have identified. First, bilateral ptosis correction of the upper eyelids, could open up your eyes, and make you look a bit less “sleepy”. The asymmetry of your brows could be addressed with an endoscopic browlift. If a preoperative visual field test indicated that your eyelid ptosis has limited your peripheral vision, it may be theoretically possible for your health insurance policy to pay for some of the cost of these procedures.