Rhinoplasty in Seattle, WA: Nose Reshaping and Facial Balance
Rhinoplasty changes the shape and proportions of the nose and, when appropriate, can be combined with surgery to improve nasal breathing. Facial plastic surgeons, Dr. William A. Portuese, Dr. Joseph Shvidler and Dr. Zachary Farhood evaluate your appearance, nasal structure and goals to help you understand your surgical options.
Whether you are concerned about a bridge hump, a wide tip, an uneven profile or changes after a previous operation, your consultation starts with a specific question: what can be improved while preserving the features that make your face your own?
What Can Nose Reshaping Surgery Improve?
A surgical plan considers the nose from the front, side and underneath, along with its relationship to the chin, lips and forehead. Changes may involve the nasal bones, cartilage or both. Common concerns include:
- A hump on the bridge: reducing a prominent profile while planning for the shape and support of the remaining bridge.
- A wide, rounded or bulbous tip: improving definition within the limits of your cartilage and skin thickness.
- A drooping or overly projected tip: adjusting tip position and its relationship to the upper lip.
- A crooked or asymmetric nose: addressing structural differences caused by development, injury or previous surgery.
- A broad bridge or nostril base: evaluating which structures contribute to width and what changes are appropriate.
- Concerns after an earlier nose job: assessing persistent contour problems, reduced support or breathing difficulties.
The goal is a proportionate result that suits your preferences and anatomy. Skin thickness, existing asymmetry and the strength of the nasal framework influence how much refinement is possible. Perfect symmetry and a specific result cannot be guaranteed.
Meet the Facial Plastic Surgeons
Choosing a surgeon involves understanding their training, reviewing their own surgical results and discussing how they would approach your particular nose. Our team includes three double board-certified facial plastic surgeons:
- Dr. William A. Portuese: his practice includes primary and revision nasal surgery, with an emphasis on the closed approach.
- Dr. Joseph Shvidler: completed facial plastic and reconstructive surgery fellowship training at the University of Washington and previously led facial plastic and reconstructive surgery at Madigan Army Medical Center.
- Dr. Zachary Farhood: completed a residency in otolaryngology–head and neck surgery followed by a facial plastic and reconstructive surgery fellowship at the University of Toronto.
Ask which surgeon will perform your procedure, how their experience relates to your concerns and which before-and-after cases best illustrate their approach.
Closed Rhinoplasty: Incisions Inside the Nose
Closed rhinoplasty, also called endonasal rhinoplasty, uses incisions inside the nostrils to access and reshape the nasal framework. It avoids the incision across the columella, the strip of skin between the nostrils, used in an open approach. The original incision placement is therefore hidden inside the nose.
Our practice emphasizes closed nasal surgery. During your consultation, your surgeon will explain whether this approach can accomplish the changes you want, including any work needed on the bridge, tip or structural support.
Both open and closed approaches can produce successful outcomes. Recovery depends on the extent of surgery, grafting, skin characteristics and individual healing. An incision choice alone does not guarantee faster recovery or a better result. Procedures that separately reduce the nostril base may require additional incisions.
Primary and Revision Rhinoplasty
Primary Nose Surgery
Primary rhinoplasty is the first operation to reshape the nose. Planning includes your cosmetic priorities, breathing symptoms, injury history and facial proportions. Your surgeon explains which changes are realistic and how the proposed work may affect both appearance and support.
Revision Nose Surgery
Revision rhinoplasty addresses concerns after an earlier operation. Scar tissue, changes to cartilage and reduced structural support can make treatment more complex. Some patients need cartilage grafts to restore support or improve contour.
Bring previous operative records and photographs if available. Your surgeon will assess whether additional healing time is needed before considering another operation and discuss the limits of revision treatment.
Cosmetic Changes and Nasal Breathing
Cosmetic rhinoplasty reshapes the outside of the nose. Septoplasty treats a deviated septum, the internal wall separating the nasal passages. Other functional procedures may address nasal valve narrowing or enlarged turbinates when those structures contribute to obstruction.
These procedures serve different purposes and may sometimes be performed together. If you have difficulty breathing, your surgeon will examine the cause rather than assume that changing the outside of the nose will resolve it. Allergies and sinus disease may require separate evaluation or treatment.
Am I a Candidate for Rhinoplasty?
You may be a candidate if you have a specific concern about your nose, are in suitable health for surgery and understand the likely benefits and limitations. Your surgeon will review:
- Whether nasal and facial growth are sufficiently complete.
- Your medical history, medications, supplements and nicotine use.
- Skin thickness, cartilage strength and nasal airway function.
- Any previous nasal injuries, surgery or filler treatments.
- Your expectations and ability to follow recovery instructions.
For teenagers, physical maturity, emotional readiness and parent or guardian involvement matter more than a single minimum age. Adults of different ages may be suitable candidates following an individualized assessment.
What Happens During Your Consultation?
Your consultation is an opportunity to explain what bothers you and identify the features you want to preserve. The surgeon examines your nose, discusses breathing symptoms and reviews the changes that may be achievable.
Before-and-after photographs can help you assess the surgeon’s work. Look for patients with starting features similar to yours and compare several views. Digital imaging can help communicate proposed changes, but a simulation is an educational tool rather than a prediction or guarantee.
View rhinoplasty before-and-after photographs before your appointment. Ask about the surgical approach, anesthesia, recovery, total fees and the practice’s policy if additional surgery becomes necessary.
How Much Does Rhinoplasty Cost?
Rhinoplasty – (Primary):
$11,600 (Surgeon & Operating Room)
Rhinoplasty – (Complex/Revision):
$13,800 (Surgeon & Operating Room)
Rhinoplasty – (Columella/Weirs):
$4,850 (Surgeon & Operating Room)
Rhinoplasty – (Triplasty):
$6,250 (Surgeon & Operating Room)
What to Expect on Surgery Day
Nasal surgery is generally performed as an outpatient procedure. Our practice uses general anesthesia administered by a board-certified physician anesthesiologist. The anesthesia team reviews your health and explains the plan before surgery.
Many procedures take approximately one to three hours, although complex revisions or additional grafting may require more time. After monitored recovery, you go home with an adult caregiver and written instructions. A splint may protect the nose, particularly when the nasal bones have been repositioned.
Rhinoplasty Recovery Timeline
Recovery has two stages: returning to everyday activities and allowing the final contour to develop. Your surgeon’s instructions take priority over a general timeline.
- First week: expect congestion, swelling and some discomfort. Keep your head elevated, protect the nose and attend your scheduled follow-up. The external splint is often removed around six to seven days after surgery.
- First two weeks: bruising and visible swelling usually improve. Many patients plan one to two weeks away from work or social commitments, depending on their procedure and comfort level.
- Following weeks: activity increases gradually with clearance. Ask when you can resume lifting, strenuous exercise, flying and wearing glasses on the bridge.
- Following months: swelling continues to settle, particularly at the tip. Final refinement may take a year or longer, especially with thicker skin or revision surgery.
Our usual postoperative guidance restricts exercise for the first two weeks. Your surgeon may extend restrictions for demanding activities. Do not blow your nose or put pressure on the bridge until cleared.
Preparing for Surgery
Provide a complete medication and supplement list at your preoperative appointment. Your team will give specific instructions about fasting, nicotine, medications and arranging transportation and home support.
Some medicines and supplements can affect bleeding or anesthesia. Do not stop prescribed blood thinners or other prescription medication without instructions coordinated with the prescribing clinician. Bring any questions about pain control and postoperative care to this appointment.
Risks and Realistic Expectations
Possible risks include bleeding, infection, anesthesia complications, altered sensation, scarring, persistent asymmetry, breathing difficulties and dissatisfaction with the appearance. Further surgery may sometimes be needed. Your surgeon will discuss the risks relevant to your health and planned procedure.
A surgical result is intended to last, although the nose continues to change with aging. Healing varies, and early swelling can conceal the eventual contour. Ask how the practice monitors recovery and when it evaluates concerns about the result.
Frequently Asked Questions
Will I have a visible scar?
A closed approach places the main incisions inside the nose and avoids a columellar incision. If your plan includes nostril reduction or another procedure requiring an external incision, your surgeon will explain its location and expected healing.
Will my nose need to be broken?
Some operations involve controlled repositioning of the nasal bones to straighten or narrow the bridge. Others focus on cartilage and do not require bone work. Your surgeon can explain which steps your anatomy requires.
Will I need nasal packing?
The practice does not routinely use traditional nasal packing for cosmetic nose surgery. Internal splints or other support may still be appropriate for certain procedures. Ask what your specific plan involves.
Are the stitches dissolvable?
Internal incisions commonly use dissolvable stitches. Their time to dissolve varies with the material and procedure. Follow your team’s instructions rather than trying to remove them yourself.
Can a nose job look natural?
Natural appearance is part of the planning discussion. Tell your surgeon which features you want to change and preserve. Review comparable surgical results and discuss how your skin and framework influence the outcome.
Schedule Your Consultation
Discuss your goals with a facial plastic surgeon at our Seattle office. Your visit gives you an opportunity to understand the proposed changes, review relevant results and decide whether surgery fits your priorities.
Office: 1101 Madison Street, Suite 1280, Seattle, WA 98104
Phone: (206) 624-6200
