I MAY have a copy of that paper in our office's digital library. DM me if you're interested :P

Heya! Ok let me go one by one

• How much of the orbital rim can be reduced in surgery? What are the limiting factors?

Depends on what the CT scan of your skull shows. It's a case-by-case scenario. Often we're able to grind down 3mm or more, but again, we HAVE to analyze it. As for limiting factors, basically, you don't want to damage the eye socket or make your eyes look too big/unnatural, or worse, make the orbital area too thin/prone to damage or fractures.

• When the nose is done how is the upper bridge connecting to the brow treated? Can it be widened/smoothed in some way?

A cephalometric analysis (Using the skull's CT scan and a series of skull x-rays, specifically lateral and dental panoramic) is made to study your facial proportions and figure out what needs to be changed to harmonize them. That includes your nasofrontal area.

When the anterior table is cut off and removed, thus exposing the frontal sinus (In the case of type 3 which is the most common), the surgeon proceeds to burr the surrounding areas to make everything smooth. That also includes the nasofrontal transition, which is either slightly burred, or fractured when performing the rhinoplasty.

• Do heavyset brows typically require a brow lift if they are already in a reasonable position before brow reduction?

Yes!

You see, think of facial skin/muscle as a blanket. When you put it over something, it grabs the shape of the thing it's over. That thing is the bone. If you look at cases from other surgeons, when they close everything back, they have to remove a stripe of skin that's leftover because when developing, the skin stretched to accommodate that protuberant forehead. So when you set back the forehead and burr the surrounding areas, there's gonna be a LOT of leftover skin.

As a result, yes, the eyebrows are gonna be elevated. How much? It depends on how much the forehead is set back.

This can be camouflaged using a coronal incision AND simultaneous hair transplants, so the eyebrows can be elevated, while still showing enough forehead that it will look natural and seamless.

• What is done in a case where a lip lift would expose some of the upper gum? Is this an acceptable result?

Would you mind elaborating a bit further, please? Do you mean showing gum when smiling or when the face is resting? The former is somewhat acceptable. The latter isn't. That's why the cephalometric analysis is crucial before going into the OR. In fact, if it's the latter, perhaps orthognathic surgery would be worth considering.

Be mindful that sometimes it's better to be conservative with the lip lifts and keep them subtle. Volume can be added later on with hyaluronic acid and get a good result.

• Does the surgeon obliterate the membrane of the sinus or attempt to preserve it in type 3?

We always preserve the membrane and in all of our cases, the frontal sinus remains functional.

• Is your surgeon (and others) aware of verteporfin and its promising effects on removing scar formation? Would you be willing to explore this in your surgery?

I haven't looked into it until now but this seems promising ! Let me forward it to the team :) Thanks for the lead!