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

Facial Plastic Surgery Blog | Facial Rejuvenation Procedures

A rhinoplasty, and more specifically a columellar-plasty can be performed when patients have a hanging columella. The hanging columella is usually composed of both bone and cartilage. The cartilage component is the most inferior caudal extension of this nasal septum. A small amount of the caudal septum is composed of the bony nasal spine. Cartilage, bone and skin all need to be adressed to reduce the hanging columella. The columella angle with relationship to the upper lip can also be adjusted upwards or downwards depending upon the angulation of the cartilage removed. To lift the tip, more cartilage and skin is removed from the most superior portion of the columella. To bring the tip downwards requires more cartilage and bone along the nasal spine brought in to cantilever the tip back downwards. Skin is also removed from both sides of the columella as well to tuck the entire septum upwards and inwards. It is also important to release the depressor septi ligament if present, which prevents the tip from drooping when patients smile or talk.
Dr. William Portuese performs closed rhinoplasty when patients have a dorsal hump that needs to be removed. Removal of the dorsal hump is the most common reason patients seek out a rhinoplasty procedure. The dorsal hump is composed of 3 structures, which include the cartilaginous upper lateral cartilages, the cartilagenous dorsal portion of the nasal septum, and the nasal bones. These 3 items come together in the nose called the rhinion, which is a growth center for both cartilage and bone. A dorsal hump needs to be shaved down in to be able to remove it successfully. To remove cartilage, this must be cut with a knife or scissors. The bone can be cut with an osteotome, or filed down with a rasp, but it really depends on how large the bony dorsal hump is. Dorsal hump removal with closed rhinoplasty Removing the dorsal hump creates a flat-top, open roof nasal deformity. Once the dorsal hump has been removed, both medial and lateral osteotomies of the nasal bones are performed with an osteotome to narrow
Board Certified Facial Plastic Surgery in Seattle with Dr. William Portuese Facial plastic surgery is a rapidly growing field, and the demand for experienced and skilled facial plastic surgeons is at an all-time high. Seattle is home to some of the best facial plastic surgeons in the country, and one of the most highly regarded and well-known is Dr. William Portuese. Dr. William Portuese’s Expertise and Qualifications Dr. William Portuese is a board-certified facial plastic surgeon who is known for his exceptional skills and expertise in the field. He is certified by both the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology Head and Neck Surgery. In addition to his training and expertise, Dr. Portuese is dedicated to providing high-quality, personalized care to each of his patients. This means that he takes the time to listen to each patient’s unique needs and concerns, and develops a customized treatment plan to meet their individual goals. Rhinoplasty Expert in Seattle One of the areas of expertise that Dr. William Portuese is
A significant facial feature is the nose. Its irregular shape can give the face an off-balance appearance. Rhinoplasty can change the contour of the nose, balancing the face and increasing attractiveness as a whole. To correct a crooked nose, patients frequently get rhinoplasty done. It can be difficult to straighten a crooked nose, so a skilled cosmetic surgeon like Dr. William Portuese, a rhinoplasty expert, is needed. We encourage you to book a consultation with Dr. Portuese  if you live in or around Seattle, WA and are thinking about getting a rhinoplasty for a crooked nose. The Difficulties in Straightening a Slanted Nose One of the trickier goals of rhinoplasty is typically thought to be straightening a crooked nose. It might be challenging to straighten a crooked nose for a few reasons. One of them is that the bone and cartilage that make up the nose might progressively revert to their pre-surgery positions. The second explanation is that the anatomy of the face may contribute to a crooked nose. In other words, the nose is
The bulbous tip is created from wide and divergent lower lateral cartilages that compose the nasal tip anatomy. The bulbous tip is usually not created from the width of the actual cartilages themselves, but the angulation at which they’re oriented in the nasal soft tissue envelope over the nose. To narrow a bulbous tip, this can be accomplished with either a closed rhinoplasty, or an open rhinoplasty depending upon the surgeon’s preference. Reduction of the bulbous tip Dr. Portuese prefers to perform this procedure with a closed rhinoplasty approach, whereby all of the incisions are placed completely on the inside of the nose. To narrow the cartilages requires a combination of inter-domal and intra-domal sutures, which narrow them individually, and then narrow them together as a unit. Once the cartilages had been narrowed, some patients also require a conservative cartilage removal as well on the sides of the nasal tip. Removing the cartilage also helps narrow and refine the nasal tip. This is considered a cephalic trim removal of the lower lateral cartilages of the
A Closed rhinoplasty procedure can accomplish building up the nasal bridge. In many cases patients are born with a low bridge profile and would simply like to build up the height of the bridge for better facial aesthetics and balance. Other patients, have had an over-resection of the dorsal hump, and are left with a residual ski-slope deformity. In addition, some patients have received a traumatic injury to the nose and are left with a saddle nose deformity. When performing a revision rhinoplasty, it’s important to know how much cartilage as left on the inside of the nose for potential grafting purposes. A cartilage graft is the preferential way to build up patients own bridge line with their own natural tissues. If there is a cartilage-depleted nose, ear cartilage can be considered. In rare cases, rib cartilage may be needed. Once the nasal cartilage or ear cartilages have been harvested for potential grafting, they are then fashioned in the proper shape and inserted through a small incision along the bridge line of the nose. Most
Some patients are born with an unnaturally narrow nose and would like to have it cosmetically widened. Other patients are born with an “hourglass deformity” which means they have pinched or very narrowed upper lateral cartilages in the mid-portion of the nose. Typically these patients have wide nasal bones, a dorsal hump, and a wide tip. The inverted upper lateral cartilages appear concave and relatively speaking, can make the tip look more bulbous and the bridge look wider. To widen a narrow nose requires osteotomies placed in the nasal bones, which include both medial and lateral osteotomies. The medial osteotomies are placed at the junction between the upper lateral cartilage and the lower portion of the nasal bones. Instead of narrowing the nasal bones, they’re actually cantilevered out more widely, also known as reverse osteotomies. Cartilaginous spreader grafts are then inserted in the space where the medial osteotomies were placed to hold the nasal bones open in their new wider position. The cartilaginous spreader grafts can be harvested from the dorsal hump that’s been removed
There are many issues in the nose that can create an asymmetrical appearance to the nose. A nose job procedure, also known as a rhinoplasty can accomplish making the nose look more symmetrical. There are a variety of techniques available to accomplish making the nose look much more symmetrical than it already is. As a surgeon, it is very important to evaluate what is causing the structural asymmetries underneath the skin soft tissue envelope. A closed or open rhinoplasty procedure can address mild, moderate, or significant asymmetries. With a closed rhinoplasty approach, all incisions are placed on the inside of the nose and dissolvable sutures fall out in about a week. If the nasal bones themselves are asymmetric and crooked, medial and lateral osteotomies of them are required with an osteotome to set them straight and parallel. If the upper lateral cartilages are convex or concave, they need to be adjusted as well. A convex upper lateral cartilage can be shaved down. A concave upper lateral cartilage will make the nose looked twisted in the
Rhinoplasty, commonly known as a nose job, is a transformative procedure that can enhance both the aesthetic appearance and functional aspects of the nose. At The Seattle Facial Plastic Surgery Center, we understand the significance of this decision and aim to provide you with a comprehensive guide to help you plan and prepare for your rhinoplasty journey. Choosing a Trusted Surgeon: Selecting a qualified and experienced surgeon is vital for a successful rhinoplasty. At The Seattle Facial Plastic Surgery Center, our team of board-certified facial plastic surgeons specializes in rhinoplasty procedures. During the initial consultation, you’ll have the opportunity to discuss your concerns, goals, and expectations. Our surgeons will evaluate your facial anatomy, assess your medical history, and provide expert recommendations tailored to your unique needs. Defining Your Goals: Before undergoing rhinoplasty, it’s essential to have a clear understanding of your desired outcomes. Communicate your aesthetic goals, whether it involves correcting a nasal hump, refining the tip, adjusting nostril size, or improving overall facial harmony. Our surgeons at The Seattle Facial Plastic Surgery Center will
Facelift surgery, also known as rhytidectomy, is a cosmetic procedure designed to reverse the signs of aging and restore a more youthful appearance to the face and neck. Over the years, advancements in surgical techniques have made facelifts more effective and safer than ever before. However, like any surgical procedure, facelifts have both pros and cons that should be carefully considered. In this in-depth article, we will explore the advantages and disadvantages of facelift surgery, providing you with the information you need to make an informed decision. Pros of Facelift Surgery: Rejuvenated Appearance: One of the main benefits of facelift surgery is the ability to achieve a more youthful and refreshed appearance. The procedure can effectively address sagging skin, deep creases, and jowls, resulting in a smoother and firmer facial contour. By tightening the underlying muscles and repositioning the skin, a facelift can take years off your appearance, boosting self-confidence and improving overall facial harmony. Long-Lasting Results: Compared to non-surgical cosmetic treatments, facelift surgery offers longer-lasting results. While the aging process will continue, a well-performed

Facial Plastic Surgery Procedures

Facelift Surgery
Browlift – Forehead Lift
Chin Augmentation
Blepharoplasty – Eyelid Surgery
Cheek Implants
Ear Surgery
Rhinoplasty – Nose Surgery
Neck Lift

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