Facial Plastic Surgery Blog | Facial Rejuvenation Procedures
Video Transcript: Hi, I’m Dr. Portuese from Seattle. Today we’re going to talk about revision rhinoplasty. A revision rhinoplasty involves another procedure performed on the nose, for patients who’ve had a previous rhinoplasty in the past. They’re much more difficult and much more complicated because of the fact that there’s been previous changes to the normal anatomy, and scar tissue formation in the nose from the previous procedure.
A good candidate for a revision rhinoplasty is someone who has realistic expectations about what we can accomplish. There are things we can accomplish, there are things we cannot accomplish. For example, if there’s a small indentation in the upper lateral cartilages, and there’s plenty of cartilage left on the inside of the nose, we can harvest a small piece of cartilage and put a little spreader graft in that area to build that little dent or that depression up.
Another good example would be somebody who maybe has a residual bump on the bridge of their nose, and we can file that down, or somebody who has, their nose is too scooped out, too much cartilage has been taken away, we can come back in and add an additional cartilage graft in that area, usually taken from the inside of the nose. But if there’s been a cartilage-depleted nose from prior surgery, then we may have to use a piece of ear cartilage to reconstruct the nose.
I would not recommend revision rhinoplasty in someone who has unrealistic expectations. There is no perfect nose. If you want a perfect nose, there’s no reason to undergo this type of procedure. There’s improvements, but nope, there is not a perfect nose.
Video Transcript: Hi, I’m Dr. Portuese From Seattle, Washington, and today we’re talking about placement of cheek implants. Cheek implants offer a permanent augmentation to the cheeks versus fillers that offer temporary augmentation. Cheek implants are manufactured in a large array of sizes, thicknesses and shapes. Today we’re gonna look at three different shapes of these implants. These are all size small. And the first one is what’s called a ubmalar Implant. These are sizers. These aren’t the actual implants. The actual implants are clear but this is a submalar implant. And this implant is used for patients who have a flat … the mid face is flat in the lower area down in here where they have buccal fat pad atrophy in this area.
But these implants go in this location and are performed to augment the lower mid face. The next one is a malar implant and that goes in the … that augments the entire mid face like this in a equal fashion. This is for patients who have more of a broader range of a flat cheek. This is a combined malar and submalar implant that is performed for patients who have an overall flat cheek and are really flat in the lower portion of their mid face. And this implant goes like this.
These implants are placed through an intra-oral approach above the teeth through the mouth usually under a brief general anesthesia as an outpatient surgical procedure. They can be removed at any time or they can be replaced with a larger or a smaller cheek implant. If you’re interested in a consultation?
Lip Augmentation in Seattle WA
Lip enhancement surgery is a group of procedures that can involve a variety of substances to increase the volume of the lips or surgery to reshape the lips. Lip enhancement surgery can be divided into procedures which increase the volume of the lips by adding material or procedures which reshape the lips utilizing various incisions. Occasionally, lip augmentation procedures are performed in conjunction with lip reshaping procedures. Most lip augmentation or lip reshaping procedures can be performed under local anesthesia.
Lip augmentation surgery can be performed by a variety of methods and there is no one method which is best for all patients. It is common in most practices that the patient makes various decisions regarding their lip augmentation surgery. Like everything in life, there are advantages and disadvantages for each option and every patient has different opinions and desires so you are encouraged to discuss the various options with your plastic surgeon at length to find out which option is best for you. Your Seattle WA plastic surgeon will review a few common options and some of the advantages and disadvantages of each option.
There are several incisions used for lip reshaping procedures. For a lip lift procedure, the incisions are placed beneath the nostril sills and base of the columella of the nose. For a corner of the mouth lift procedure, the scars are placed at the junction of the pink portion of the lip and flesh-colored skin in the upper lip just above the corners of the mouth. The corner of the mouth lift scars are probably the most noticeable or visible of all the scars discussed so far. The most common incision used for lip augmentation is 2 small incisions near the corners of the mouth and is made outside the crease or fold of the corner of the mouth. The scars are almost inconspicuous and by avoiding the precise corner of the mouth, the risk of narrowing of the mouth is minimized.
Lip augmentation surgery can be of performed utilizing a variety of materials. A key distinguishing feature between materials is whether to use your own tissues to augment the lips or artificial tissues. Artificial tissues can include things such as Gore-tex and various types of plastic particles mixed with collagen or hyaluronic acid. In general, lip augmentation looks most natural when performed utilizing your own tissues. Several types of donor tissues can be used for lip augmentation and fascia (muscle lining), fat, tendon and dermis (the deeper layer of skin) have very successfully been used over the past 20 years with very good results. Sometimes, the donor material/site is determined by an associated procedure being performed at the same surgical setting such as a facelift or tummy tuck. You can discuss this with your surgeon during your consultation. Other materials such as Alloderm can also be effective and will become incorporated into your own tissue over time. Artificial materials such as Gore-tex or plastics do not incorporate into your own tissues and have a higher propensity to cause deformities with animation such as speech, eating or kissing.
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Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
Seattle has so much to offer its visitors. It is surrounded by evergreen forests and snowy mountains. Seattle is also leading the way in technology. It is home to the largest tech companies in the United States. Seattle has something for everyone. If you are looking for the latest club or get reconnected to nature, there is a place to visit in the Emerald City.
Every visitor to the city has to check out its famous landmark. The Space Needle was built in 1962 to celebrate the World’s Fair. It has become an iconic symbol of the city. The Space Needle has an observation deck where visitors can get incredible views of Seattle. For those wanting to dine with a view, the SkyCity restaurant is a good place to have a meal.
Pike Place Market
Pike Place Market is known for fish getting hurled through the air. This historic market opened in 1907. It is the oldest public farmers’ market in the United States. The market is where many of Seattle’s merchants, craftspeople, and farmers sell their goods in the city. For musical entertainment, you can often catch a street show by one of the local performers. The market can get a little crowded. Pike Place welcomes over 10 million visitors per year. For a unique experience, the Market Theater Gum Wall is nearby. This attraction is outside the main entrance of Pike Place Market. The wall is completely covered with chewing gum. The tradition started in 1993 when the patrons of the Theater stuck their used gum to the wall.
Seattle is surrounded by the beauty of nature. Discovery Park has over 534 acres of natural space for visitors to explore. The park is located on the shores of Puget Sound in the Magnolia neighborhood. Discovery Park is the largest public park in the city. It has 11.8 miles of walking trails. The park is also famous for the West Point Lighthouse. This spot offers great views of the city.
Museum of Modern Culture
The Museum of Modern Culture, or MoPOP, is dedicated to celebrating the best of contemporary culture. It was founded in 2009 by Microsoft co-founder, Paul Allen. The museum was originally known as the Experience Music Project but changed its name in 2011. The museum has many exhibits including props from the Marvel films to the early concert posters of Nirvana. MoPOP is home to the Seattle International Film Festival in the winter.
The Hiram M. Chittenden Locks are located on the west end of Salmon Bay. This lock system carries more boat traffic than any other lock in the United States. The site welcomes over 1 million visitors per year. They do not come just to watch boat traffic. The Carl S. English, Jr. Botanical Garden is located near the Locks. It has over 7 acres of flowers and trees. The Ballard Locks fish ladder is another spot to visit. Visitors can watch salmon pass through the fish ladder during the summer months.
Seattle is home to many exciting places to visit. Whether you want to see nature in action or take in a little history, Seattle has it all. It is the hidden gem of the Pacific Northwest. Learn more about what you can do in Seattle WA
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RealSelf Names Seattle/Portland Plastic Surgeons Among Leading Doctors of Cosmetic and Aesthetic Medicine
Seattle – May 9, 2018 – William Portuese, MD and Austin Hayes, MD have been named as two of 100 board-certified doctors worldwide to receive the RealSelf 100 honor. This esteemed accolade recognizes the highest-rated and most active doctors on RealSelf, the world’s largest online aesthetics community to learn about cosmetic treatments and connect with doctors and other clinicians.
Portuese and Hayes received this honor thanks to robust patient-provided information on RealSelf, such as the quality and quantity of patient reviews, combined with the doctors’ commitment to engaging with the RealSelf community via questions and answers, sharing videos and of before and after treatment photos.
“Empowering patients has always been a passion for me. Posting answers, sharing videos, and before and after photos within the community allow me to empower patients with possibilities and expectations. I am grateful to be part of RealSelf and the RealSelf 100 for eight years in a row,” said Dr. Portuese. “It’s a privilege to be able to help people improve their confidence. I think that one of the best parts of my practice is that I have a lot of time to learn about my patients and connect with them on a deeper level.” – Dr. Hayes
Every month, 10 million consumers visit RealSelf to connect with aesthetic providers and research cosmetic treatments ranging from surgical procedures like rhinoplasty and mommy makeovers to non-surgical options like facial lasers, Botox, and Invisalign.
“The RealSelf 100 recognizes committed medical professionals who are leading the way to help educate and empower consumers to make smarter decisions about aesthetic treatments,” said RealSelf CEO Tom Seery. “RealSelf 100 honorees are among the most engaged doctors on RealSelf — they represent less than one percent of the 20,000 medical professionals in our community yet collectively contributed 100,000 answers to consumer questions last year.”
For more information on Dr. Portuese and Dr. Hayes,, please visit
To be eligible for the RealSelf 100, doctors must meet the requirements of the RealSelf Professional Policies. In addition, doctors must have joined the RealSelf Doctor Community prior to July 1, 2017, meet minimum criteria for participation, and be in good standing.
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Dr. William A. Portuese is board certified by the American Board of Facial Plastic and Reconstructive Surgery and by the American Board of Otolaryngology, Head & Neck Surgery. He is a Clinical Instructor in the Department of Otolaryngology, Head and Neck Surgery at the University of Washington and the author of numerous publications in his field. He is also the current president of the Washington State Chapter of Facial Plastic Surgeons. He has been in private practice in Seattle for over 20 years. Dr. Portuese specializes in all aspects of Facial Plastic Surgery which includes Facelifts, Blepharoplasty (eyelids), Rhinoplasty (nose), Coronal Forehead (brow lifts), Facial Implants, Neck Lift / Liposuction, Otoplasty (ears), and Dermabrasion.
Dr. Hayes has received the highest level of training and has been mentored by the country’s most esteemed reconstructive and aesthetic surgeons. He has Ivy League training and received his M.D. degree from Columbia University, in New York City. In medical school, Dr. Hayes spent an additional year studying microsurgery and traumatic injury to the hand. He was also inducted into the AOA Medical Honor Society, an honor that only 10% of the class receives. He completed his residency in Plastic Surgery at The University of Washington, one of the premier programs in the country for comprehensive plastic surgery training to care for adults and children. Following residency, he completed a fellowship at The Curtis National Hand Center in Baltimore which focused solely on surgical care of the hand and upper extremity. Lastly, he went on to train under several of the country’s most prominent aesthetic surgeons, including Dr. Portuese.
RealSelf is the largest online marketplace for people to learn and share experiences about elective cosmetic procedures and connect with the right providers. Offering millions of photos and medical expert answers, RealSelf attracts 10 million people each month to find out which treatments and providers live up to their promise of being “Worth It.” From simple skincare to highly considered cosmetic surgery, RealSelf makes it easy to discover what’s possible and find the right provider.
Brow Ptosis & Brow Lift in Seattle WA
A forehead lift, or brow lift, is a surgical procedure to improve the appearance of aging associated with the forehead and eyebrows. As we age, our skin looses elasticity and tone which can lead to brow ptosis. Brow ptosis is a low position of the eyebrows that can create a tired or sad appearance. In addition to low brow position, other signs of aging include deep transverse forehead wrinkles and frown lines between the eyebrows.
There are many variations to the brow lift procedure which include the traditional open approach, limited incision or temporal approach, and the endoscopic brow lift. The traditional open or coronal forehead lift involves an incision from ear to ear that is hidden 2-3 inches behind the hairline. For those with receding hairlines or long foreheads, the incision can also be placed at the hairline; this is termed a pretrichial incision. A limited incision or temporal brow lift utilizes shorter incisions that are hidden within the hair, usually slightly above and behind the temple area. An endoscopic brow lift utilizes a lighted camera that can be placed through 3-5 small incisions hidden within the hair. The goal of all of these techniques is to elevate the brow to a more youthful position that will create a more rested or refreshed appearance. In addition to elevating the brow, the upper eyelid area is opened up. This can help improve mild to moderate upper eyelid skin excess, and in severe cases a brow lift can be combined with an upper eyelid tuck (blepharoplasty) if additional skin removal is needed. Frown lines between the eyebrows can also be treated at the time of a forehead lift by removing the muscles responsible for these lines.
Brow lift procedures can be performed in conjunction with other procedures such as upper and lower eyelid tucks to rejuvenate aging eyes and facelifts to rejuvenate the aging face.
After your consultation you should have a clear understanding of the different treatment options for improving the appearance of your forehead and brow. These options may include a traditional open forehead lift, a limited incision or temporal forehead lift, or an endoscopic forehead lift. The procedure may also include treatment of frown lines and/or treatment of excess skin of the upper eyelids. The selection of a specific procedure will be determined by your physical examination and expectations.
During the examination, specific measurements and observations will be made by your plastic surgeon. Brow position in relation to the bony orbit will be evaluated. The effects of your forehead muscle on brow position will also be addressed. Excess skin of the upper eyelids and the position of the upper eyelids in relation to the eye will be measured as well. These measurements and observations along with patient expectations will help determine the appropriate procedure.
Some of the potential risks associated with forehead lifts are areas of permanent numbness of the forehead and scalp, hair loss around the incisions, and asymmetry of the brows.
Following your surgery, bandages and a light wrap will be applied to your forehead. Small drains may be placed temporarily to drain any excess fluid or blood that may collect. You will be given specific instructions on how to care of your incisions and drains, including any medications that you may need to take. The immediate recovery will depend upon what type of anesthesia that your plastic surgeon will employ for the surgery. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. Most surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in 3-4 hours and most patients will experience mild to moderate discomfort at this stage that is well controlled with pain medication prescribed by your doctor. Patients should avoid strenuous exercise for 3 weeks following surgery. Patients may shower the following day; but no Jacuzzi, swimming or soaking in the tub for a week. Most surgeons want to see their patients back in the office 5-7 days after their surgery to remove the drains which may have been placed at the time of surgery as well as to remove any sutures that do not dissolve on their own. Healing time is highly variable; but most patients experience moderate swelling and some bruising that can persist up to 2 weeks. One of the potential risks of surgery is infection and this usually manifests itself around 5-7 days after surgery and is usually effectively treated with oral antibiotics. Numbness around the incisions is normal after surgery and can persist up to several months.
The actual “full” recovery period from plastic surgery is up to a year and this involves a gradual softening and settling of the scars and tissues. A significant amount of the recovery occurs within 2-3 months, but it will take the external scars a year to soften and mature.