1101 MADISON ST #1280 SEATTLE, WASHINGTON 98104 | (206) 624-6200
The Seattle Facial Plastic Surgery Center
Dr William Portuese - Board Certified Facial Plastic Surgeon in Seattle WA

Facial Plastic Surgery Blog | Facial Rejuvenation Procedures

Lower Eyelid Surgery – Remove Baggy Eyelids

Posted by admin on  January 23, 2019

Lower eyelid surgery, performed by Dr. Portuese, is a popular procedure because it can rejuvenate eyes of any age. Whether a patient has genetic bags or they have acquired them with age, Dr. Portuese’s approach removes the cause of the bags under the eyes. No stitches are used in this surgery which makes for a simple recovery.

– Hi, I’m Dr. Portuese from Seattle, Washington. Today we’re gonna talk about upper eyelid surgery. The primary goal for upper eyelid surgery is to remove excess skin that’s usually touching the eyelashes or creating the hooded or tired look. The incision’s located right in the upper eyelid crease. We’re also removing a small amount of fat from the inner corner of the eyelid here that rejuvenates the upper lids and makes patients look more refreshed or well rested. The sutures that we use are dissolvable. They fall out in about a week, but you can anticipate about two weeks of visible bruising and swelling after the procedure.

Rhinoplasty Cast Removal – One Week Post Op

Posted by admin on  January 23, 2019

There are numerous varieties of rhinoplasty.
While certain nasal operations are closed, others are open.
Some operations change the nose’s bones, while others only affect the nostrils or tip.
The kind of rhinoplasty treatment you receive and ultimately how quickly you recover afterward are determined by your particular nose needs.
When recovering after rhinoplasty surgery with a cast, it’s important to understand what to anticipate, how the cast is removed, and what you can do to recover as quickly as possible.

When Following a Rhinoplasty Would I Need a Nose Cast?

Following a rhinoplasty, many plastic surgeons tape the nose to help reduce nasal edema.
Typically, tape is used for compression during procedures that include the nostrils or the tip of the nose.
The surgeon will place an outer nose cast consisting of metal, plaster, plastic, etc. when bones are purposefully shattered during the rhinoplasty operation (also known as osteotomies).

While the nose swells during the healing process, the nasal cast will retain the bones in the proper position.
In order to ensure that the nasal structure is adequately maintained and that the patient’s nose will recover properly in its new shape, rhinoplasty casts are used.

This external cast is crucial for protecting your surgery results; one week in a cast is nothing compared to the delight your new nose shape will offer for the rest of your life.
Inadequate aftercare during the healing period is the cause of many unsuccessful nose jobs.
Working closely with your surgeon is essential prior to, during, and following the rhinoplasty process because the management of casts differs from case to patient.
If the cast from your rhinoplasty fell off or became wet, they can assist you.

How and when is a nose cast taken off?

Casts are often taken off six to seven days following surgery since it takes time for the nasal bones to mend after a rhinoplasty.
The surgical outcome may be impacted by premature cast removal.
When your cast to be taken off will be determined by your surgeon.

Ask the facial plastic surgeon to remove the cast if at all possible.
If this is not possible, you could try doing it yourself.
Make sure your surgeon is on board before removing the cast.
In this procedure, it’s critical to exercise gentleness.
To progressively loosen the nasal cast, start at the edge and slowly work your way around it.
Wait a day and try again if it is hard to remove.

The cast from a rhinoplasty rarely comes off on its own.
To keep the nose cast in place, the surgeon will use an adhesive.
The likelihood of the rhinoplasty cast coming off increases if you get it wet.
Make an effort not to play or interfere with the cast.
It should remain on if you are careful.
Do not become alarmed if your rhinoplasty cast comes off naturally or becomes wet.
Make an appointment with your doctor, and they’ll put everything back where it belongs!

What to Expect Following Removal of Your Rhinoplasty Cast

Make no snap decisions regarding your nose’s final shape after the cast is taken off; edema from rhinoplasty is frequent after cast removal.
Be patient because post-operative edema can vary from day to day.
For the tissue to settle and the bones to fully mend, it often takes a few months, and it typically takes a full year before you see your ultimate results.
Once more, being patient is essential throughout the recovery period following removal of the rhinoplasty cast.
Call your surgeon if you have any concerns.

Can I Touch My Nose Now That the Cast is Off?

After the cast is removed, you can touch your nose, but do so sparingly.
Ask your surgeon for advice on how to thoroughly clean the skin and massage the nose.
While essential massage and cleaning won’t interfere with your rhinoplasty, excessive contact could slow down the healing process.

Depending on the individual, recovery after rhinoplasty will vary.
Give your nose some time to heal and voice your concerns to your doctor.
You shouldn’t worry about your nose’s swelling or look when the rhinoplasty cast is taken off.
You will get closer and closer to the intended outcome as time goes on.
As you go through the rhinoplasty cast process, give your nose some time to heal and heed your surgeon’s instructions.


Pacific Northwest

Teenagers underwent five times as many plastic surgery procedures in 2012 than they did in 1997, according to the American Society of Plastic Surgeons.
The most popular plastic surgery on teenagers among these operations is rhinoplasty. Teenage years can be opportune for rhinoplasty because procedures can be done over the summer and winter breaks and the nose has typically finished maturing. Teenage rhinoplasties can produce effects that last a lifetime and leave almost imperceptible scars from the treatment. But the age at which a rhinoplasty is not appropriate still remains a mystery.

After the Nose Stops Growing

The Nose Stops Growing Around the Age of 14 for girls and 15 for boys, the nose typically stops growing and abnormalities start to show up. This is when rhinoplasty surgery is performed. Only after the growth of the nose has stopped should rhinoplasties be done. A skilled surgeon will be able to determine when a nose has reached its full size.
The growth center of the nose will be stopped if rhinoplasty is done before it stops growing, which may result in an unnatural or asymmetrical appearance that may require a revision rhinoplasty in the future.

Outpatient Surgery

Teenagers can choose rhinoplasty, an outpatient procedure, once the growing of their noses has finished. By this time, the potential patient will be aware of any internal nose problems, such as a deviated septum that can lead to snoring, breathing problems, or nasal congestion. By the middle of adolescence, physical deformities will also be evident.
A bulge on the bridge, an unproportionately large nose or nostrils, crookedness, or a lowering nasal tip are examples of these outward deformities.

Preparing for Facial Surgery

A rhinoplasty should only be done if the patient has the emotional maturity to tolerate facial surgery, even though a teenager’s nose may have stopped developing.
If the youngster has only lately expressed a desire for a nose job, it is likely that this desire has not been carefully considered. The desire for a nose job may also be the result of peer pressure if the teenager has recently started attending a new school or has a new group of friends. The rhinoplasty in these cases is probably impulsive, and your surgeon shouldn’t approve the treatment.

Rhinoplasty Recovery

Teenagers need to be aware of the potential 6–8 week absence from contact sports required for recuperation following surgery, as well as possible bruising, swelling, and discomfort. The patient must also have reasonable expectations for their rhinoplasty because it won’t make all of their teenage problems go away. The patient can better grasp how his or her appearance will change through pre-surgery computer face modeling. There is no danger in waiting for the patient to emotionally grow because rhinoplasties are permanent.

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Should I Get a Revision Rhinoplasty?

Posted by admin on  October 12, 2018

Revision Rhinoplasty Video

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.

How Do Cheek Implants Work?

Posted by admin on  October 12, 2018

Cheek Implant Video

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 Surgery in Seattle Washington

Posted by admin on  September 19, 2018

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 board certified facial plastic surgeon will review a few common options and some of the advantages and disadvantages of each option.

Lip Enhancement

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.

For more information about lip augmentation in Seattle Washington contact board certified facial plastic surgeon Dr William Portuese at The Seattle Facial Plastic Surgery Center.

Best Washington State Facial Plastic Surgeon

Posted by admin on  September 10, 2018

Otolaryngology is the primary discipline in the multidisciplinary field of facial plastic surgery, which also encompasses oral and maxillofacial surgery, dermatology, ophthalmology, and plastic surgery. Both reconstructive and cosmetic elements are included.

In the United States, rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma repair, and the correction of facial deformities following skin cancer removal may all fall under the purview of facial plastic surgeons. Injectable fillers, neural modulators (such BOTOX Cosmetic, made by Allergan Pharmaceuticals in Westport, Ireland), lasers, and other skin-rejuvenating tools are also used in facial plastic surgery.

The subject of facial plastic surgery is constantly developing thanks to new innovations in surgical methods and aesthetic adjuvant technologies. In addition to highlighting recent developments and trends in procedures and surgical techniques, this article seeks to provide an overview of the numerous procedures that make up the field of facial plastic surgery.

Modern facial plastic surgery was first performed more than a century ago.

Facial plastic surgery was first developed as a specialization of otolaryngology by otolaryngologists who believed in addressing physical flaws that caused patients psychological distress, social disadvantages, and/or economic difficulties. Aesthetic surgery was initially considered to be outside the scope of traditional medicine, but Jacques Joseph was the first to champion the advantages of cosmetic surgery as a distinct specialty.

The pioneer of many of the initial surgical aesthetic methods that were later adopted and refined by other surgeons, Jacques Joseph is regarded as the father of contemporary facial plastic surgery.

In his 1920 book Plastic Surgery of the Face, Sir Harold Gillies, a New Zealander by training and an otolaryngologist, standardized rhinoplasty, skin grafts, and facial reconstruction.

He is frequently referred to as the inventor of plastic surgery.

Modern facial plastic surgery began as a specialization of otolaryngology with the establishment of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) in 1964.

Since that time, the international network of facial plastic surgery societies has grown to include organizations like the International Federation of Facial Plastic Societies and the European Academy of Facial Plastic Surgery.

Although many surgeons have large practices involving both, facial plastic surgery is often split into cosmetic and reconstructive operations.
The majority of facial plastic surgeons in the United States specialize on aesthetic surgeries (such as rhinoplasty, browlifts, blepharoplasty, and facelifts) and the rebuilding of facial deformities following skin cancer removal. The majority of facial plastic surgeons also employ lasers, neural modulators, injectable fillers, and other skin-rejuvenation tools. Focusing on skull base, craniomaxillofacial trauma, or microvascular restoration, facial plastic surgeons typically work in tertiary settings like university hospitals.

The AAFPRS recognizes facial plastic surgeons as diplomats in the field of otolaryngology head and neck surgery. Otolaryngology residency program that is certified by the American Board of Medical Specialties is followed by a 1- to 2-year facial plastic surgery fellowship by facial plastic surgeons. Facial plastic surgeons concentrate on procedures and operations affecting anatomy starting at the neck, in contrast to generic plastic surgeons. Actually, there is a lot of crossover and overlap between this field of medicine and general plastic surgery, oral and maxillofacial surgery, ophthalmology, and dermatology.

The broad field of otolaryngology surgery known as facial plastic surgery includes reconstructive and cosmetic procedures as well as the use of biomaterials, lasers, and other adjunct materials to enhance results. Although by no means exhaustive, this article provides an overview of the major facial plastic surgery techniques, emphasizes recent developments and interventional trends, and attempts to predict the direction of emerging technology and cosmetic products.

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Washington State Facial Plastic Surgeons

Surrounding Areas in Seattle WA

Posted by admin on  September 6, 2018

There are lots of great areas to visit in Washington, but here are 5 cheap places to see in Seattle.

Things to do in Seattle WA and the 98104

Posted by admin on  August 14, 2018

Driving Directions


Top Rated Medical Clinic in Seattle, WA

Posted by admin on  August 10, 2018

The goal of face cosmetic surgery is to enhance the patient’s facial look.
Rhinoplasty, blepharoplasty (eyelid surgery), rhytidectomy (facelift), browlift, genioplasty (chin augmentation), otoplasty (ear relocation), liposuction, and fat transfer are examples of common surgical treatments. The effects of aging, including as loose skin, diminished tissue volume around the face and neck, crow’s feet at the corners of the eyes, fine lines on the forehead, loss of jawline contour, drooping jowls, and double chin, are often treated surgically.


Rhinoplasty is arguably the most popular and challenging facial plastic surgery.
It is done to fix internal and external nasal pathology, improve unattractive aesthetics, lessen airway obstruction (caused by septal deviation, inferior turbinate hypertrophy, deviated/fractured nasal bones, and limited internal nasal valve area), and fix congenital nasal anomalies.

The cartilaginous and skeletal framework, mucous membrane lining, subcutaneous soft tissue, and nasal skin are all altered during a rhinoplasty.

The columella, the fleshy tip of the nose that divides the nares, is where the incision is done during an open rhinoplasty as opposed to an endonasal rhinoplasty.

The osseocartilaginous nasal framework is separated from the nasal skin and soft tissues in a rhinoplasty procedure so that the framework can be modified to create the ideal nasal outlines. Complication rates for the technically difficult technique of rhinoplasty range from 4.8% to 18.8%.

Revision surgery may be necessary due to patient dissatisfaction, postoperative edema and scarring, or both (secondary rhinoplasty).

In the last ten years, structural procedures that use cartilage tissue to enlarge the airway, reconstruct form, and create the proper aesthetic contour have become more popular in rhinoplasty surgery.

The use of cartilage for structural grafting has advanced in this field.
The usage of rib cartilage in rhinoplasty has increased at least tenfold recently as rib graft use became more common in even primary aesthetic rhinoplasty. Traditionally, rib cartilage was exclusively utilized for large reconstructive nose procedures.

Polydioxanone foils to stabilize structural planes, ultrasonic instruments to execute precise osteotomies, and the use of traditional high-speed powered instruments intranasally are just a few of the new technological innovations that have emerged in recent years.

Digital imaging has advanced to become a crucial part of the preoperative consultation and has become an increasingly significant component of rhinoplasty planning.
Most surgeons today frequently use three-dimensional (3-D) imaging devices and 3-D image morphing technologies, albeit there is no commonly used software platform.


Another frequent surgery carried out by facial plastic surgeons is the facelift.
Over a century ago, the early proponents of facelifts recommended performing the surgery by making several incisions and tightening the skin on the face.
The old incision used to be made behind the ear, up into the hairline, curling around the base of the lobule, and then in front of the ear.

Sutures are used to separate the deeper tissues from the skin before they are further tightened. The superfluous skin is cut off and the skin is redraped in the last stage.

The expectations and preferences of patients have played a significant role in the advancement of facelift operations. Modern patients choose minimally invasive procedures that require little to no recovery time. The advent of so-called lunchtime facelift-type procedures has had a significant impact on the treatment of the aging face.

Due to significant soft tissue dissections and exposure of the facial nerve branches in the middle of the 1990s, facelifts and other procedures for skin rejuvenation were becoming more technically challenging and dangerous.

In the hands of a skilled surgeon, these challenging surgeries produced excellent results; however, patients treated by less skilled surgeons frequently suffered from protracted postoperative edema, sensory or motor nerve injury, and facial asymmetry.

Deep plane facelifts, composite facelifts (which require moving and fixing the orbicularis oculi muscle), midfacelifts, minifacelifts, thread lifts, periosteal facelifts, skin-only facelifts, and minimal access cranial suspension lifts are only a few of the facelift techniques used today.

Both are capable of producing excellent results, but they mostly depend on the surgeon’s expertise and the anatomical differences between patients.
Less invasive operations that could be carried out under local anesthetic with oral benzodiazepines or with moderate sedation increased in popularity in the 2000s.

Because of the marketing of numerous nationally recognized facelift and rejuvenation companies, the overall number of facelifts grew.
The American Society for Aesthetic Surgery estimates that there were 27.7% more facelifts performed in 2014 than there were in 1997.

Combining facelift procedures with autologous fat transfer has become a popular approach in recent years since it also addresses the volume loss that comes with age.

Check out directions to Dr William Portuese.

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