Information about rhinoplasty and maybe a brow/cheek lift

25 January 2015

Dear Dr. Pataki,

I am interested to know about the conditions for having a rhinoplasty and may be a endoscopic cheek lift (incision around temple inside the hair line) for improvement of lateral brow, minor sagging of cheek area and nasolabial fold.

I am 49 years old male, This would be my first rhinoplasty, non-smoker, never been in a hospital, no mental disorder, not on medication, occasionally a beer or two, not allergic to certain substances and don't drink herbal tea.

I used Photoshop and have modified my images to visually express what my wishes are. Pictures are attached. The image marked "1" is my current nose; the image marked "2" is the one I would like to have; and the image marked "3" is both before and after in one so you could see how much change is applied. Or maybe you have a better suggestion.

So, as you can see, my main objectives regarding the nose are as follows:

1. Correction of retracted alar, do you use cartilage graft for this? From my ear?
2. Removed hump, this is routine I guess?
3. Lowered radix (nasoforntal), is it possible to lower the Radix?
4. Deprojection
5. Finer tip contour (sharper tip, smaller radius) and more triangle and not so much boxy.

Other general questions:
- Is it possible for you to send me a two before and after picture from cases similar to mine especially with retracted ala?
- What is your error figure and how it is handled if the result didn't go according to the plan?
- Do you use graphic like Photoshop or Vectra to discuss and agree detail? Or what method do you use to visualize the plan and agreement?
- How many days before the surgery do you need me to be there?
- What is the name of the hospital where the surgery will take place?
- Could you please help me to find a good and affordable hotel close to your practice?
- Do I need to fill any form or something? Or in general, what is the procedure and what steps I shall go through?

Thanks in advance.
Best regards,
Arthur C. H.


PMA

Dear Arthur,

Thank you for your email and the answers of the presurgery consultation forms. Dr. Pataki has investigated your pictures and read your questions.
We will try to help you. According to your questions and the fotos you have sent, we kindly let you know:
surgery (also rhinoplasty) and would healing are beyond absolute precision and control, therefor it is not possible to answer your questions accurately.

Would you have any more questions, please contact us through email or phone.

We will supply you with the necessary information to your questions, please see below.
“Dear Dr. Pataki,
Thank you for your answer. I here are the pictures and some questions I still would like to know the answer.”
So, as you can see, my main objectives regarding the nose are as follows:

1. Correction of retracted alar, do you use cartilage grafting for this? Do you take cartilage from my ear or Septum?

Yes. We would take it from the septum if it exists. If not we have to take your ear cartillage.

2. Removed hump, this is routine I guess? Yes it is.

3. Lowered radix (nasoforntal), is it possible to lower the Radix? It is possible, but minimally.

4. Philtrum is backed a little bit. Yes, but not as much it is represented on the drawing.

5. Deprojection some 3-4mm. Probably yes, but in the drawing it is much more !

6. Finer tip contour (sharper tip, smaller radius) and more triangle and not so much boxy. Yes, it is a standard.

7. How long (years) will the improvement of the lateral brow lift last? Depends on the person and the technique usually 5-7 years.

For the face:

1. I always had my lateral brow “bend” and I would like to have my brows to be straight. Is there any surgical procedure than can achieve that? I have heard about endoscopic (minimal incision) lateral brow lift; can that be used for me? An if yes, how long is the longevity?

As written above.

2. Or temporal lift (minimal incision inside the hair line) to achieve that

Hardly predictable, but usually 5-7 years.

3. Or any method you could recommend?

Volume filling with microstructural fat grafting to the brow area and forehead.

4. My face look like that I have hamster cheeks and I would like to improve that and to have a more slimmer cheek area. Does Dr Pataki perform Bucall/Bichat fat removal as well (with incision inside the mouth)?

Yes we do, but we do not see an indication for this in your case. Although this might change at a personal examination.

Other general questions:

Q1- Do you also use graphic like Photoshop or Vectra to discuss and agree detail? Or what method do you use to visualize the detailed plan and agreement?

We have our own developed imaging and visualization software, similar to the above.

Q2- Is it possible for you to send me (or refer to) two before and after pictures from cases similar to mine especially with retracted alar? Of course if confidentiality is an issue, the pictures can be modified to show only the nose area and the rest of the face is blurred or covered so the identity of the patient cannot be determined.

As member of the German Plastic Surgery Society dr. Pataki is not entitled to send you pictures of patients through the internet, nor to place them publicly. At the consultation you can see preop-postop pictures.

Q3- How the complications will be handled if the result didn’t go according to the plan?

Early complications are covered by us. Late complications should be covered by the patient.

Q4- How many days before the surgery do you need me to be there?

48 hours.

Q5- don’t you have discount for combined procedures? In this case what is the total price for the surgery (nose + lateral brow lift)?

We do recommend to fill out the questionnary form attached to receive a quote. As we write autologous fat grafting would maybe be a solution for your problem instead of a brow lift, but this could be decided upon a personal consultation.

Yours Sincerely,

Edit

Assistant to Dr. Greg Pataki

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