Rhinoplasty can be performed through either an open or closed rhinoplasty. During rhinoplasty surgery a hump can be removed, the sidewalls narrowed, and tip adjusted through either open or closed technique.  All grafting in the nose addressing the tip, alar rim grafts, and spreader grafts can also be preformed either through open or closed technique.

The decision whether to perform an open or closed rhinoplasty depends on the surgeon’s preference. Dr. Portuese prefers the closed technique.

Open Rhinoplasty:

• Incisions are located on the outside of the columella in addition to some incisions inside of the nose.
• The open technique takes longer to perform.
•  Longer healing time. There is more residual swelling in the tip that takes longer to subside.
• Patients may experience healing and scarring issues across the columella and scarring from the outside incision may be noticeable, even after it is fully healed.

Closed Rhinoplasty:

• Incisions are located completely inside of the nose.
• There is no visible scarring.
• The nose tends to heal much faster after surgery.
• The healing is more predictable.
• A closed rhinoplasty doesn’t take as long to perform.

Dr. Portuese has performed thousands of rhinoplasty surgeries. In his experience, the patient prefers rhinoplasty using the closed technique.

To enhance your consultation and understanding of your surgical treatment plan, Seattle Facial Plastic Surgery Center (the “Center” ) has chosen AlterImage® by Seattle Software Design to allow your immediate viewing and comparison of pre- and post-operative computer images.

In addition, AlterImage® allows digital manipulation of pre-operative images to demonstrate potential surgical changes. For facial cosmetic surgery in particular, the projected changes are demonstrated on your face, allowing clear understanding of recommended refinements. Of course, the Center cannot provide a guarantee of a specific surgical result.

Computer images from AlterImage® represent potential results of surgical intervention only. The Center makes no express or implied warranties of any kind with respect to surgical result. Computer images serve merely to indicate a potential result that could be obtained as a result of a particular surgical procedure. The computer images create no warranty that the surgical result shall conform to the images.  Nor is a recommendation for a specific surgical procedure made in this computer imaging.

You will receive a copy of your Before and After Computer Imaging photos at the time of your consultation. Another copy is filed in your chart.

Computer Imaging is used mainly for patients interested in Rhinoplasty and Chin Implants surgery, and is best used when viewing the face from the profile view.

After facelift surgery, some surgeons bandage the surgical area with compression wraps, sending patients on their way looking like mummies. Dr. Portuese uses drains for all facelift patients.

The drains are two long, thin, perforated tubes, which Dr. Portuese places under the skin during surgery. The tubes are connected to a compressed bulb, which provides continuous gentle suction. Fluid collects in the bulb and is then emptied on a regular basis until drainage subsides. The purpose of these drains is to reduce your healing time and drain blood  from the surgical site, so your body does not have to absorb it.  They also minimize bruising and swelling more effectively than traditional gauze wraps used by some surgeons.

It is important for your caregiver to know that you will require hands on care through the evening of surgery. Your caregiver will be responsible for stripping your drains every thirty minutes and emptying the bulb, until you go to bed that evening.

Some patients are able to manage their own drains the day following surgery, but never the day of surgery.

While you are in recovery, our nurses will instruct your caregiver on drain care and give them all the necessary supplies and written instructions for your post-operative home care.

The favorite appointment for facelift patients is the day the drains are removed. The drains are removed 48 hours after surgery during your first post-operative appointment. Although you may experience momentary discomfort, the procedure is very quick and over before you know it.

You can now kiss those drains goodbye and focus on the next phase of healing after your facelift surgery!

After Rhinoplasty surgery, patients wake up in recovery sporting a new accessory.  Not the lovely paper bracelet with name and date of birth, but a hard plastic bandage called a splint, across the bridge of the nose.

Dr. Portuese places Aquaplastic splint across the bridge of the nose after he has performed Rhinoplasty surgery. The splint is used to stabilize the reshaped nasal bones and tissues, compress the area and reduce swelling during the healing process.

It is important to keep the splint dry when showing or washing your face. Use a washcloth to gently clean your face, avoiding your nose. In the shower, keep your face out of the stream of water.

For some patients the swelling goes down quite rapidly the first week after surgery. You may wake up in the morning to find the splint on your pillow, having popped off on it’s own. Don’t panic, this will not affect your end result. Simply call the office for answers to any of your questions.

One week after Rhinoplasty surgery you will come in for your first follow-up appointment with Dr. Portuese. During this appointment, the splint will be removed by one of our nurses and the doctor will check your progress.

Removing the splint is not painful.  The nurses may use some water to wet and soften the splint before gently removing it.

Don’t be alarmed when seeing your new nose for the first time after the splint removal. It is normal to see swelling especially in the tip area. Keep in mind that the splint has been compressing the bridge for one week and the swelling has nowhere to go but to the tip of the nose. This will all calm down and slowly dissipate with time.

Save your new accessory for later, add a bit of face paint and viola! you have a perfect addition to a Halloween costume!

Continuing education for the staff and credentialing of our facility is an on going priority for our practice.  The SFPSC – an ambulatory surgery center (ASC), is Medicare certified through the Washington State Department of Health.  A survey team periodically visits our facility and reviews our practices – much like an audit – to determine that we are in compliance with all aspects of patient care. We are essentially “just like the hospital” and are very proud of our Medicare Certification.

In addition, Dr. Portuese is Board Certified in Ear, Nose & Throat (sub specializing in sinus surgery) and also Board Certified in facial plastic surgery.  He is affiliated with ABO, the American Board of Otolaryngology and AAFPRS (American Academy of Facial & Reconstructive Surgery).  These certifications have stringent requirements to uphold.  Dr. Portuese, as well as our entire nursing staff, is ACLS (Advanced Cardiac Life Support) trained and credentialed as well as PACU (Post Anesthesia Care Unit) certified.

Our medical team is highly trained and credentialed.  We always have 2 or 3 of our registered nurses in recovery with our post op patient and one assisting Dr. Portuese in surgery.  All of our nurses (RN) are PACU certified (Post Anesthesia Care Unit) and ACLS certified (Advanced Cardiac Life Support).  These designations indicate that our nurses are extremely knowledgeable in pain medications and patient post operative needs for pain management.  They also have a thorough knowledge of anesthesia and it’s effects on patients. Our nurses monitor our patients until they are awake, conscious and stable from anesthesia and ready to be discharged to their caregiver for home.  A board certified anesthesiologist from Swedish Medical Center is also in our surgery center.

The care of our medical team does not stop when our patient leaves the surgery center.  We are available for any questions or concerns from patients or their caregivers by phone.  The day following surgery, our nurse will pro actively check in with our patients to assess how the post operative period is going and to answer any questions or concerns.

Dr. Portuese performs surgery two days a week on Mondays and Thursdays. We affectionately call Thursdays “Nose Day” here in the office. On average, Dr. Portuese performs five Rhinoplasty surgeries a week and nearly two hundred a year!

Some surgeries are cosmetic Rhinoplasty only and others are combined with medically necessary procedures, such as Septoplasty, and sinus surgery.

Patients are typically in surgery for one hour under general anesthesia, and in recovery afterwards for approximately one hour. When the patient is stable and awake, they are discharged and ready to go home and relax.

Dr. Portuese will see you one week after surgery for the first post-op appointment. But, the care doesn’t stop the minute the patient leaves after surgery. The following day one of our nurses will call to check in and answer any questions you may have.

No matter how prepared you think you are for surgery, there are always questions and concerns that may arise. We are here to help you through the recovery and healing process.

Some things to keep in mind after nasal surgery:

• You will feel very stuffy and unable to breathe fully out of your nose for at least two weeks after surgery
• If you had cosmetic Rhinoplasty, you will see bruising under your eyes for at least two weeks after surgery
• The tip of the nose is extremely swollen after surgery and this is not what your nose will look like after the nose heals completely
• The splint on the bridge of the nose may come off on it’s own before the one week post-op appointment
• After sinus surgery a debridement of the sinuses is done one week after surgery and a second debridement is done two weeks after surgery

I am excited to announce that we are now offering Juvederm!

Juvederm is an FDA approved injectable gel, used to fill and smooth facial wrinkles and folds.

Injecting this filler into lines around the lips, marionette lines and nasolabial folds gives a youthful appearance instantly with minimal downtime.

You can expect some redness and swelling at the injection site immediately after treatment. Tenderness and slight bruising are also common.

Unlike other fillers, Juvederm will last up to one year with one treatment! The amount of product needed varies depending on the area treated. What is best for you will be determined at the time of your consultation.

Juvederm XC contains lidocaine which improves comfort during treatment.  It’s smooth consistency is easily injected with minimal pain.

The cost for 1cc syringe of Juvederm Ultra XC is $500. Juvederm Ultra Plus XC is 20% thicker and used to address deeper lines, costs $550 per 1cc syringe.

Pam and Angela are available throughout the week by appointment. Both experienced nurses are trained in Advanced Injection Techniques with Hyaluronic Acid Dermal Fillers.

Combining Juvederm with Botox treatments will give you a smooth, natural, and rejuvenated look and make you feel that way too!