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The Seattle Facial Plastic Surgery Center
Dr William Portuese - Board Certified Facial Plastic Surgeon in Seattle WA

Facial Plastic Surgery Blog | Facial Rejuvenation Procedures

Facial Plastic Surgery Procedures

Posted by admin on  August 10, 2018


Eyelid surgery, often known as blepharoplasty, is another common facial operation.
In order to cure dermatochalasis (aging-related alterations in the periorbital tissues) and blepharochalasis, excessive eyelid skin and/or orbital fat are removed during blepharoplasty (excessive papery thin skin).

Visually unappealing alterations known as “droopy eyelids,” “tired eyes,” or “bags under the eyes” may result from the influence of gravity on periorbital structures, diminished strength in periorbital muscles, UV damage, and changes in skin composition.
Lower blepharoplasty is traditionally performed with a subciliary incision with a raised skin and muscle flap, herniated medial, middle, and lateral fat detection, and repair.

The simplest blepharoplasty is the skin pinch procedure.
This method avoids a bulky skin-muscle flap that could lead to unsettling vertical traction and swelling in the periorbital tissues by just excising extra skin through a subciliary approach.

In order to prevent nerve damage and lessen scarring, the pinch blepharoplasty of the lower lid also avoids piercing the orbicularis muscle and the orbital septum.

More thin, wrinkled skin can be safely removed using this method while yet maintaining a pleasing position for the eyelids.
Upper and lower lid blepharoplasties are frequently carried out while the patient is under moderate sedation or local anesthesia.
Notably, blepharoplasty is also used to treat the condition known as lid ptosis, which has a variety of origins.

Attenuation of the levator palpebrae superioris is the most typical cause.

Browlifts and Forehead Lifts

A significant portion of a facial cosmetic surgery practice also involves forehead lifts or browlifts.
In terms of the traditional method, which involves removing extra skin and repositioning the forehead skin upward, this treatment is rather simple.

If the frontal hairline is low, the incisions are made along a coronal line within the hair-bearing scalp.
For individuals with a high hairline, a trichial or trichophytic incision is used.

The majority of women who adopt these two strategies are female.
A third option for males is a midbrowlift, which involves making an incision in a deep brow furrow and removing a fusiform ellipse of skin.

Rarely is a direct browlift performed, where the incision is placed at the upper edge of the brows.
If a patient has considerable brow ptosis that is causing a mechanical visual field defect, functional brow surgery is more frequently performed using mid- or direct browlifts, both of which may leave a noticeable scar.
The most recent method is endoscopic surgery, in which a number of tiny incisions are made behind the hairline and an endoscope is used to view the procedure as the forehead skin is elevated.
The surgeon can redrape and fix the skin more cephalad by releasing soft tissue from the arcus marginalis and temporal line of fusion with the endoscope inserted beneath the forehead flap.

The outcomes are less striking, but it is a superb strategy for the younger patient who wants less pronounced and more natural alterations.

Using procedures like chemical peels, lasers, and various injectable chemicals to generate improved facial aesthetics is a significant aspect of facial plastic surgery that is always improving. These office-based operations have a significantly shorter recovery time than the majority of cosmetic surgery procedures.

Cosmetic Peels

Glycolic acid, trichloroacetic acid, and phenol are a few examples of chemical peeling agents (listed from mildest to strongest). When doing a chemical peel, the substance passes through the epidermis and into the top dermal layer. There are four histologic grades for different agents, each of which has a variable depth of penetration. The chemical substance damages the skin at different depths and activates poorly understood skin regenerating pathways in the dermis.


Another method for removing deeper scars and wrinkles is dermabrasion. Under the guidance of a local anesthetic and/or a freezing substance, this method is carried out.
To remove the epidermis, a high-speed rotating brush, sandpaper, or some equivalent abrasive tool is employed. You can use this method on a single blemish or a big portion of your face.


Scarring, photodamaged skin, facial rhytides, and other aging symptoms can all be treated using laser technology. Little to no bleeding and minimum skin harm are brought on by laser treatments. The method enables exact control over the depth of ablation. Ablative and nonablative laser therapy are both available.

Ablative lasers heat the dermis and encourage fibroblasts to produce new collagen, which causes the dermis to vaporize, removing the top layers of skin. Two laser wavelengths used most frequently by ablative lasers are pulsed carbon dioxide (CO 2) and erbium:yttrium-aluminum-garnet (Er:YAG). With each pass, CO 2 systems typically vaporize 20 to 60 m of tissue, with subsequent passes causing residual thermal damage to reach a depth of 20 to 100 m.

The 20–50 mm zone of residual thermal damage is left behind by the Er:YAG pulse laser systems after vaporizing 2–5 mm of tissue per pass. Erbium laser systems are advantageous for precision, carefully regulated, light to medium ablations because they can be tuned more precisely than CO 2 systems. Deep ablations benefit more from CO 2 systems.

Novel systems are now being developed to deliver simultaneous irradiation from dual ablation/coagulation Er:YAG laser, variable-pulse Er:YAG, and combination Er:YAG laser and CO 2 laser. With fewer skin wounds to induce granulation tissue and fibroplasia, but with tiny zones of thermal injury, these novel techniques seek to accomplish a significant degree of therapeutic improvement. Pain, edema, prolonged erythema, infections, postinflammatory hyperpigmentation, and hypopigmentation are some of the side effects of ablative lasers.

View Dr William Portuese on Google Maps.

Facial Plastic Surgery

Posted by admin on  August 10, 2018

Fat Grafting

As years of evidence—largely the result of the efforts of numerous surgeons and dermatologists—demonstrated the effectiveness of manual fat liposuction and the careful injection of small aliquots of this tissue into the areas surrounding the midface, orbit, temporal fossa, neck, and other areas, complementary fat grafting gained widespread acceptance across the specialty. There is a great deal of discussion and disagreement about whether mesenchymal stem cells are transferred in this technique as well because fat grafting is now a crucial part of many people’s facelifts.

Local anesthesia or mild sedation can be used to accomplish fat grafting. The variety of graft survival (10–80%) is a problem with autologous fat grafting, however research is ongoing to increase fat transplant survival.

To increase the longevity of lipografts, several methods include pharmacologic modification of grafts with insulin-like growth factor, basic fibroblast growth factor, selective -1 blocker, and platelet-rich fibrin matrix.

The regulatory landscape surrounding these alterations is rather complicated.

Dermal fillers

One crucial method for healing scars and rhytides as well as recontouring the aging face involves replacing missing or misplaced fat pads using dermal fillers.
Temporary fillers that have received FDA approval include collagen, hyaluronic acid, calcium hydroxylapatite (CaHA), and poly-L-lactic acid (PLLA). For treating nasolabial folds, polymethyl methacrylate is the only permanent filler that has received FDA approval. PLLA and CaHA are artificial fillers that were created in a lab and are unrelated to the components of natural skin.


Human connective tissues like skin, cartilage, the vasculature, and bone are largely made of collagen. Collagen that is refined for injectable forms can come from either bovine or human origins. These items are rarely used and were voluntarily removed from the American market in 2010. Hyaluronic acids have since taken their place.

Hyaluronic Acid

Hyaluronic acids are currently the most popular face filler ingredient. Additionally, a key component of connective tissues, particularly in the human dermis, is hyaluronic acid. Hyaluronic acid moisturizes, lubricates, and stabilizes connective tissues; nevertheless, as skin ages, less of it is present in tissues. Preinjection skin testing is not necessary with hyaluronic acid because it does not contain any items of an animal origin.

The concentrations, cross-linkages, and viscosities of the hyaluronic acid compounds that are readily available vary.
Recent studies have concentrated on how to create hyaluronic acid in more stable forms with longer in vivo retention durations.

Pain, discomfort, and swelling following a procedure are the top patient worries about dermal filler injections.
Injection procedures including microcannulas and the addition of lidocaine solution to fillers are becoming more popular.

Facial Plastic Surgery Trends and MOre

Posted by admin on  August 10, 2018

The beauty industry is changing as a result of how individuals view themselves in the digital age. The desire to enhance one’s appearance and spend money on med spa and plastic surgery procedures persists despite the rational understanding of the differences between photo filters and what you see in real life.

The development of surgical technology has made it simpler than ever to perform seemingly small aesthetic procedures that have a dramatic impact. Plastic surgery is a fantastic alternative, so it doesn’t matter if you want to eliminate fat from a few trouble spots or improve the texture of your skin.

Acceptance of Plastic Surgery in Culture

There used to be stigma associated with plastic surgery. People who made the decision to spend money on these operations kept it a secret since they didn’t want to face criticism from their friends, family, and neighbors.

Now that the mentality has changed, it is a more accepted aspect of life.
For instance, friends schedule Botox parties or schedule surgery together so they may recover together.

This cultural change has not only made cosmetic procedures more affordable for people of all ages, but it has also given rise to a forum for open discussion about self-care.
The most efficient strategy to increase general self-esteem is to address some of the most prevalent cosmetic issues. These self-improvement techniques boost each person’s social confidence, which has a ripple impact on all facets of their lives, including their work, friendships, romantic connections, family dynamics, and more.

Plastic surgery performed locally versus abroad?

Many people choose to stay close to home when they are prepared for plastic surgery and other cosmetic procedures as these beliefs continue to change.
There was a time when people coupled vacation time with plastic surgery, spending a few weeks in a tropical setting as they recovered.

But because to the subpar outcomes that patients are receiving, medical tourism is developing a poor name. This inexpensive solution comes with a cost: possibly harmful outcomes that don’t provide patients what they wanted. Too frequently, problems arise or someone returns home in need of a thorough revision. In addition to the higher overall expense, the anguish and suffering caused by a failed surgery are indescribable.

It’s understandable why most people want to stay close to home rather than taking a chance with their health and appearance at a medical facility abroad.
You may take advantage of the advantages without having to travel too far thanks to technology, which makes cosmetic procedures more accessible to everyone.
You get what you pay for if the price appears too good to be true, therefore proceed with caution.

Seattle, Washington, is famous for what?  Seattle is well-known for its coffee culture, the Seattle Seahawks, the Space Needle, Pike Place Market, the headquarters of several tech companies (including both Amazon and Microsoft), as well as for its grunge music scene, hiking, kayaking, and general outdoor lifestyle (think REI).


For what is Seattle well-known?

There is a LOT more to Seattle than rainy days and the best lattes in the world, which will excite you if you’re trying to decide if this is the city for you.

Pike Place Market

Pike Place Market, one of the oldest farmer’s markets in the US, is the place to be on a weekday morning.You may interact with Seattle’s culture at Pike Place Market with food, drink, and, of course, the world-famous fish toss.Hot tip from a local: make sure you take a close-up look at the monkfish in the Fish Market.

TV programs and films

Seattle is well-known for having served as the backdrop for a number of successful TV episodes and films over the past few decades, including Grey’s Anatomy, Fraiser, Sleepless in Seattle, and others. Wherever you go on vacation, the first comment you’ll get is about Grey’s Anatomy or another well-known Seattle show or movie as soon as you mention being from Seattle or having visited Seattle.

Seattle Beaches & Parks

Seattle’s fantastic parks and beaches are a frequently disregarded beauty of the Emerald City, and you better believe Seattleites take advantage of them throughout the summer.

Enjoy some volleyball and a campfire on Alki Beach, paddle a kayak or paddle board from Gas Works Park to Lake Union Park, or visit the conservatory at Volunteer Park.
Explore more lovely parks outside of the nearby area by going for a stroll around Green Lake, through Woodland Park Zoo, or to the lighthouse in Discovery Park.


Of course, Nirvana must be included in this list in some capacity.Nirvana, a 1980s rock band that is one of the main things Seattle is renowned for, influenced Seattle towards grunge music and started the thriving music scene that has remained in Seattle to this day.

Seattle Gum Wall

The Gum Wall, an iconic work of art from Seattle, has been a city landmark since that year.According to legend, customers of Seattle Theatresport, operated by Unexpected Productions, originated the custom that year.Two times, Theater staff members wiped the wall clean, but they eventually gave up because locals and visitors alike were committed to continuing the tradition.One of the numerous things for which Seattle is well-known is the Gum Wall, which has been classified as a tourist site since 1999.

Coffee Culture

Few other cities can rival Seattle’s coffee culture.Even today, visitors may get a taste of Seattle’s storied coffee culture by visiting the original Starbucks, which is situated immediately across from Pike Place Market.Seattle is highly recognized for its coffee culture and a large population of coffee snobs in addition to its fame for rain, mountains, and beards.

Space Needle

The Space Needle must be included on any list of Seattle’s well-known landmarks.The Space Needle, which was constructed in 1961 for the 1962 World Fair, is a Seattle landmark and one of the city’s most popular tourist attractions.

Facial Cosmetic Surgery

Posted by admin on  August 10, 2018

One of the first regions to exhibit aging symptoms is the neck region.
Extreme weight loss can also leave the neck area excessively slack and uncharacteristic of the newly obtained overall look. Some Seattle, Washington neck lift patients may undergo a number of procedures to address their sagging neck skin, underlying fatty tissue, muscular structures, and jawline.

What choices do you have for neck treatment?

Which of the following—fat, sagging skin, or muscle—is the source of your aesthetic worries?
How to Prepare

Usually local anesthesia with IV sedation

Surgery lasted for around three hours.

In / Outpatient – Typically out-patient in a hospital setting or in our on-site, accredited surgery center.

Return to work after recovery: 10 to 14 days.
3 to 4 weeks of intense activities.
Inflammation: 2 to 3 weeks.
For several months, sun exposure must be restricted.

Results last for a while; you’ll appear to be a few years younger.
various outcomes
You will notice changes in your neck lift as you continue to age.

The Technique:

The majority of operations used to improve the neck are carried out through an incision made behind the ears or beneath the chin.
A combination of treatments is required to assist tighten and straighten the muscle tissue (platysmaplasty), as well as remove extra skin and fatty tissue, in order to get the desired result and improve the neck and jawline (submental lipectomy).
When muscle tightening is not required and there is simply localized fat under the chin in younger individuals, liposuction may be utilized.
The skin normally shrinks to the altered contour of the neck once the fat is suctioned out.
When there is too much extra skin that cannot be removed through the incisions under the chin or behind the ear, a cervicoplasty is performed.
This treatment necessitates extra neck incisions and is often exclusively done on men.

What Dangers Exist?

Even elective surgical procedures like neck lift surgery have some level of risk.
Our surgeons will go over the hazards during your appointment so you can make an informed choice.

Dr William Portuese of The Seattle Facial Plastic Surgery Center is a revision rhinoplasty expert with thousands of secondary nose operations under his belt. Dr. Portuese  is one of the best doctors for rhinoplasty revision because he is a nose specialist, and when other less skilled surgeons have failed to produce the natural outcome their patients were hoping for, they turn to him.

Any prospective patient can examine our unrivaled collection of revision rhinoplasty before and after photos from our pleased patients who have suffered a rhinoplasty gone wrong, much like you may have before meeting Dr.Portuese, due to the practice’s major focus on fine-tuning the nose.

Dr. Portuese had the honor of training under one of the most well-known nasal surgeons in the world after receiving his board certification and fellowship training.
Dr. Portuese has been doing revision rhinoplasty procedures for many years, including permanent non-surgical revision nose jobs and revision rhinoplasty for ethnic groups.
Patients may rest easy knowing Dr. Portuese is the right choice for anyone seeking their secondary rhinoplasty and the revision nose surgeon with the most experience.

Due to his extensive training and specialty, Dr. Portuese has developed a unique understanding of the common issues that may arise during and after rhinoplasty. Dr. Portuese is pleased to have treated thousands of patients with this extremely difficult operation. Dr. Portuese, a rhinoplasty surgeon, can help you get the results you want, whether your initial rhinoplasty left you with cosmetic flaws or you are just dissatisfied with the outcome.

The majority of patients undergoing revision rhinoplasty are particularly concerned about how their procedure will turn out, but at our office, you won’t have to worry because there won’t be any surprises. With the aid of computer imaging technology, our surgeon can show you the final result of your secondary nose operation before the treatment is carried out.

How long do patients need to wait before having a secondary rhinoplasty?

The outcomes of cosmetic nose surgery are sometimes obscured by swelling and other postoperative side effects.It may be time to think about having a revision rhinoplasty if, six months after your initial surgery, you are still not happy with the results.After surgery, it is customary to wait for about a year to allow the nose to recover completely.

Why Get Rhinoplasty Revision?

Broken Bridge

The nose’s support and shape are greatly influenced by cartilage.During rhinoplasty, specific areas of the nose may eventually collapse if too much cartilage is removed.Usually, this happens over a period of years.Patients might observe the bridge’s dorsum developing a depression before it eventually falls apart.The collapse may clog the interior of the nose and impair breathing depending on how severe it is.Bridge collapse can also happen after a dorsal hump has been removed, particularly if the procedure includes removing dorsum cartilage.

Variable Nostrils

Patients who have rhinoplasty occasionally get asymmetrical nostrils.
Special care must be used while making changes to the delicate structures of the nose to prevent overcorrection or excessive bone and cartilage removal.
From the frontal view, nostril asymmetry is caused by weak spots in the nose that may collapse in and protrude to the opposite side.
While some asymmetry is common, it can be upsetting to have your nose look even more crooked following rhinoplasty.

By repositioning the projecting cartilage and strengthening the nose’s supporting structure, Dr. Portuese tackles nostril asymmetry.This also assists in halting the emergence of new flaws.

An Upturned or Drooping Nose

Overcorrection is commonly to blame for drooping or tilted noses, as it is for many post-rhinoplasty flaws. The nasal tip rotates excessively and collapses backward when the nose is not properly supported. On the other hand, if there is insufficient support, the nasal tip may become under-rotated and droop forward. As a result, the appearance is overturned. Scar tissue that has contracted can also result in an inverted nasal tip by effectively pulling the tip backward. By repairing the supporting structure of the nose and releasing scar tissue as necessary, Dr. Portuese can correct this cosmetic flaw.

Unacceptable Results

Overcorrection is commonly to blame for drooping or tilted noses, as it is for many post-rhinoplasty flaws.The nasal tip rotates excessively and collapses backward when the nose is not properly supported.On the other hand, if there is insufficient support, the nasal tip may become under-rotatedand droop forward.As a result, the appearance is overturned.
Scar tissue that has contracted can also result in an inverted nasal tip by effectively pullingthe tip backward.By repairing the supporting structure of the nose and releasing scar tissue as necessary,

What operations or treatments should you spend money on to improve your appearance?
The fact is that there isn’t a one-size-fits-all answer for everyone.
It is preferable to arrange a meeting with a skilled plastic surgeon so that you can talk about your issues and create a treatment plan together.

The extensive number of plastic surgery procedures accessible will surprise you.
Some of these cosmetic procedures use minimally invasive techniques and deliver outstanding results.
Other treatments require surgical procedures, which after recuperation produce startling effects.

The following are some trends we have noticed in the plastic surgery sector this year:

More people are using injectables

Botox and fillers are injectables that belong in the “med spa” area rather than the field of plastic surgery, but they are nevertheless important to talk about.
Many people choose to begin with minimally invasive procedures in order to postpone the need for extensive plastic surgery procedures.
Easily customizable, injectables provide quick effects.

These injections increase volume and plumpness while also diminishing the appearance of fine lines and wrinkles.

Several factors explain why Botox and fillers are frequently used as the first step in aesthetic improvement:

Affordable: Compared to complete surgery, the cost of injectables is far lower.
If money is tight, Botox or fillers can be an excellent method to enhance your confidence while you put money up for future, more intensive treatments you’d like.

Fast: Since the procedure only takes a little over an hour, you may easily book a Botox appointment for during your lunch break.
When you can fit a short injectable therapy into your hectic schedule, there’s no need to take time from work.

Minimal downtime is experienced following Botox and fillers.
You could experience some discomfort and swelling.
However, these symptoms won’t interfere with your normal everyday activities.

Introduction: Compared to immediately undergoing cosmetic surgery, many people believe utilizing injections has a lower barrier to entry.

Minimally Invasive: Speak to our cosmetic specialists about injections and other minimally invasive procedures if you don’t like the idea of having surgery.

The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) reports that plastic surgeons who specialize in face enhancements do up to 4 out of 5 non-surgical procedures (like fillers and Botox)

Learn more about a nose job at the plastic surgery offices of Dr William Portuese.


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Chin Implant Video

Posted by admin on  July 10, 2018

Learn more about chin augmentation.


Dr. William Portuese Recognized Among Top 100 Doctors Worldwide in RealSelf 100

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, and Botox

“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.”

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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William Portuese MD offers the following Facial Plastic Surgery services: Facelift Surgery, Blepharoplasty (eyelid surgery – upper and lower), Rhinoplasty (nose), Coronal Forehead (brow lifts), necklift surgery, and more.

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.

About RealSelf
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.

Washington Ambulatory Surgery Center Association Washington State Medical Association American Academy of Facial Plastic and Reconstructive Surgery Real Self