William A. Portuese - Rhinoplasty Expert

Rhinoplasty Seattle Washington

Board Certified Facial Plastic Surgeon
William A. Portuese, M.D.

If you are considering rhinoplasty Seattle Washington contact board certified facial plastic surgeon William A. Portuese. Dr William Portuese is double board certified in facial, plastic and reconstructive surgery and in ear nose and throat surgery. Because of the double board certification he can extend the level of expertise, mastery and professionalism to his patients for the three operations he does the most in his surgery center. The top procedures performed at the Seattle Rhinoplasty Center are facelift surgery, eyelid surgery and rhinoplasty.

Dr William Portuese, a Seattle facial plastic surgeon, is also a Clinical Instructor in the Dept. of Otolaryngology, Head & Neck Surgery at the University of Washington, and the author of numerous publications in his field. He regularly gives presentations about facial plastic surgery on local, national and international levels.

Primary and Revision Rhinoplasty Specialist

There are four reasons why nose surgery is done today. They are cosmetic in nature, broken nose, breathing problem or sinus problem. Typically when you break your nose or have a breathing or sinus related problem, those are usually covered under the patients medical insurance plan. The cosmetic surgery portion is not – that is where the shape of the nose is changed so that it looks better for cosmetic purposes.

There are different techniques on how to perform a rhinoplasty. There is the open approach – where an incision is made across the columella ( the area outside the nose between the nostrils) and the external portion of the skin is peeled up and the tip is resculpted. The Seattle Rhinoplasty Center doesn’t offer the open technique. They place all of the incisions inside the nose ( closed technique ) which allows for no visible scarring. The closed technique tends to heal faster and better than the open technique.

Learn more about Rhinoplasty

How long does nasal surgery take to perform?

There are many variables when performing a rhinoplasty procedure that can either take longer or shorter than anticipated. Revision rhinoplasty always takes longer because it is more complicated. Open rhinoplasty is also going to take longer because of the external incision required. Some rhinoplasty procedures require additional cartilage grafting techniques to add support to the nasal tip cartilages or the upper lateral cartilages in the midportion of the nose. A crooked nose also takes extra time to straighten crooked nasal bones. As a general rule, a cosmetic rhinoplasty procedure takes from 1-3 hours, and is performed under general anesthesia as an outpatient procedure.

Is a nose job permanent?

Yes, a surgical rhinoplasty is a permanent change made to the nose. It is very important to get it done right the first time, so experience really does matter. Non-surgical nose jobs are only temporary, must be repeated, will only make the nose bigger, and can have significant complications such as skin necrosis.

What should I expect for rhinoplasty recovery?

All nose surgery is performed under general anesthesia and usually takes about an hour to an hour and 1/2 to recover and wake up from the anesthesia itself after the procedure. A thermoplastic cast is applied across the bridge of the nose and stays in place for 6 days. There will be some degree of visible bruising and swelling for 2 weeks present in the cheeks which are a direct result of the osteotomies placed in the nasal bones. Depending upon many factors, approximately 60% of the swelling will subside after a nasal surgery at 1 month, approximately 80% swelling will subside at 3 months, and full healing takes a year.

Why does experience matter in rhinoplasty surgery?

Everyone’s nose is unique, and it takes an individualized surgical plan of action to accomplish your anesthetic goals during a rhinoplasty procedure. The nose also heals 3 dimensionally, and must look good in all 3 dimensions. Thick skin in the tip of the nose prevents refinement in that area, however very thin skin tends to show loss of nuances. Both of these issues can create the need for a touchup and revision. Rhinoplasty is the most difficult operation to perform correctly in the entire field of cosmetic surgery because the results are measured in millimeters.

What are my options for anesthesia?

At our Seattle rhinoplasty medical center under the direction of our facial plastic surgeon, we perform all nasal surgery under general anesthesia by a Board Certified physician anesthesiologist for patient comfort and safety. This provides a protected airway while the facial surgeon performs the rhinoplasty Seattle procedure. Other offices may offer Intravenous Sedation, however patients will have conscious awareness/ recollection of the plastic surgery being performed. It’s not advisable to undergo a nose procedure under local anesthesia since there are lots of nerve endings in the nose and it will be very painful.

What can I expect immediately after a rhinoplasty surgery?

Expect some disorientation with arousal from the general anesthesia. When the patient is awakened, there will be a cast placed across the bridge of the nose, and usually a drip pad across the nostrils to prevent bleeding. Post-operative instructions are given to the caretaker and the patient goes home, since this is outpatient plastic surgery. Patients return to the Seattle clinic to have the cast removed in 6 days. In our surgical practice, there is no painful packing placed on the inside of the nose. Patients will feel some mild headache and congestion for the first week, usually relieved by mild pain medication

How should I prepare for my rhinoplasty consultation?

Since a nose job is the most difficult operation to perform correctly in the entire field of cosmetic surgery, it is important to do some homework on the procedure itself, since it is very complicated. Before your consultation, it is imperative to study your prospective facial surgeon’s before and after nasal contouring photo gallery to make sure that it is extensive with results that you like. Also look at ratings, reviews and testimonials from each individual surgeon. Have your nose surgery surgeon perform digital computer imaging as an education tool to understand what your proposed results might look like.

How do I prepare for my rhinoplasty surgery day?

In our medical office in Seattle WA, patients undergo a pre-operative consultation with one of our Registered Nurses several weeks prior to a nose job surgery to get all expectations understood prior to the upcoming plastic surgery day itself. Is important not to take any blood thinners such as aspirin, ibuprofen, vitamin E, and stop all herbal supplements 2 weeks before and 2 weeks after the nose job surgery. Leave all jewelry at home, and dress in comfortable clothes

What should I do immediately after my rhinoplasty surgery?

Immediately after the surgical procedure, it’s important to keep your head elevated above your heart and sleep propped up on a few pillows. A low-salt diet will also help with swelling. Important to avoid blowing your nose for the first week, and avoid exercise for 2 weeks.

What are the risks of a rhinoplasty procedure?

The risk of a nosebleed occurring after a nose procedure is approximately 1 in 1000 patients that require emergency packing placed in the nose for hemorrhaging. This packing must be left in place for 2 days. This is why it is important not to take any aspirin or blood thinner products and make sure blood pressure is under good control. General anesthesia is very safe, and is exceedingly rare to have any anesthetic complications when there is a board certified physician anesthesiologist administering the anesthesia. There is always a 10% to 15% touchup rate associated with the procedure so it is important to be prepared for that as well

What is the recovery for time for rhinoplasty?

The recovery time after a nose job procedure is quite variable and depends upon the individual healing process and what surgical techniques were performed to obtain the new changes to the nose. Thick skin in the tip of the nose delays the healing process. A cast is applied across the bridge of the nose and remains intact for 1 week after the procedure. Anticipate approximately 14 days of swelling and bruising after the facial plastic surgery procedure, but some residual bruising and remaining even upwards of 3 weeks. Anticipate 1 week of decreased breathing and congestion out of the nose.

What is the minimum age to have a rhinoplasty surgery performed?

Age 15-1/2 for young women and age 17 for men seems to be the minimum age where the growth plates on the nose have quit growing and the nose is mature and can undergo a cosmetic rhinoplasty operation.

How long must I refrain from exercise after my rhinoplasty surgery and/or nasal surgery?

For any type of nasal surgery including a rhinoplasty, septoplasty, or sinus-related surgery, it is important to not exercise for two weeks following the surgery Dr. William Portuese from The Seattle Facial Plastic Surgery Center and The Portland Center for Facial Plastic Surgery wants patients to keep activities to a minimum to prevent a nose bleed. Patients should refrain from flying in an airplane for two weeks after nasal and/or rhinoplasty surgery.

How long will the swelling last after my rhinoplasty surgery?

Typically, the majority of the swelling subsides in the first two to three weeks after the surgery. Bruising tends to last approximately ten days. 70-80% of the swelling is gone from the nose within the first month; however the residual 20-30% swelling in the tip of the nose can take upwards of a year to go away.

What types of stitches are placed inside the nose for my rhinoplasty surgery?

All stitches on the inside of the nose are dissolvable. There are no permanent sutures on the inside of the nose and they dissolve within the one week postoperative period.

Do I get a cast on my nose after my rhinoplasty?

In most rhinoplasty surgeries a cast is placed on the nose when the nasal bones are reset. On a few occasions, a cast does not have to be used if the patient is only having a tip plasty surgery.

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    The Seattle Rhinoplasty Center

    William A. Portuese, M.D.
    Rhinoplasty Expert®

    Seattle, Washington 98104

    (206) 624-6200

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