click-to-call
206-624-6200
THE SEATTLE FACIAL PLASTIC SURGERY CENTER
DR WILLIAM PORTUESE | 1101 MADISON ST #1280 SEATTLE, WASHINGTON 98104 | (206) 624-6200
The Seattle Facial Plastic Surgery Center - Dr William Portuese
Dr William Portuese - Board Certified Facial Plastic Surgeon in Seattle WA

Rhinoplasty in Seattle WA – Nose Job Bellevue

A Rhinoplasty, or ‘nose job,’ is a facial plastic surgery procedure to alter and change the shape of the nose and enhance facial features. It is the most common procedure performed in our medical practice. The goal by our board certified facial plastic surgeon is to give a very natural appearance with all of the components of the face balanced with each other, and the entire new nose balanced with the facial features. Most surgeons would agree there are many undesirable features that can be changed. If its too wide, it can be narrowed, a dorsal hump ( bump ) can be removed, a wide and boxy nasal tip can be refined, and if its crooked – which may have been broken – can be narrowed. If there are functional breathing problems, it can also be addressed at the same time with cosmetic surgery.

Before and After Photos

Straightening Noses

There are many issues contributing to a crooked nostril; a deviated nasal septum, fractured and displaced nasal bones and a deviation of the septum creating a crooked nostril in addition to a fracture of the septum off the maxillary crest and vomer. When an upper lateral cartilage has been fractured and dislocated off of the nasal bone itself, it can create a concave midportion. Treatment for this is usually includes osteotomies in the nasal bones to correct them back to their pre-injury state. A cartilaginous spreader graft, harvested from inside, can accomplish correcting the midportion and building out the concave upper lateral cartilage. A tip-plasty is required on the cartilages when they are asymmetrical and cartilage grafting or cartilage removal may be required. A Septoplasty is required for a fracture and deviated septal cartilage itself. Any of these components can be accomplished using the closed rhinoplasty method as an outpatient.

crooked nose

Reduction of the Bulbous Tip

The bulbous nose is created from a combination of wide, divergent and thick cartilages, known as the lower lateral cartilages of the nose. Sutures called inter-domal and intra-domal stitches are used to narrow the existing wide and boxy cartilages. In addition to these techniques to narrow the nasal tip cartilages, a conservative amount of cartilage is also removed to improve the contour and maintain a natural outcome. These maneuvers are associated with a closed approach where all incisions are inside.

bulbous tip

Narrowing a Wide Nose

A wide nose is usually present due to the congenital development of nasal bones. Wide and splayed nasal bones can also be present due to trauma and a nasal fracture. Narrowing the nasal bones requires medial and lateral osteotomies in the nasal bones themselves. This accomplishes the narrowing of the upper two thirds – the nasal bones and the corresponding upper lateral cartilages. A cast or splint is over the bridge to hold the nasal bones in their narrower position.

narrowing a wide nose

Lifting a Droopy Nose

A droopy nose is usually the result of downwardly pointing cartilages. These cartilages can be lifted with a closed procedure. The drooping tip can also be caused from a downward deviation of the caudal as well. When the tip droops when smiling, “releasing” the depressor septi ligament is required. This prevents the tip from drooping dynamically when smiling. It is very important to lift the tip for both static and dynamic results.

Lifting a Droopy Nasal Tip

Shaving Down the Dorsal Hump

To remove the dorsal hump is a very common reason to choose a surgical nasal procedure. Most dorsal humps are composed of about two thirds cartilage and one third bone, but it can quite a variable based on individual anatomy. The hump must be shaved down in order to remove it. Once the hump has been removed, osteotomies placed in the nasal bones are required to close the open roof ( flat-top) nasal deformity that is created from the hump removal. The dorsal hump is the most common reason to have nasal contouring.

dorsal hump removal

Breathing Difficulties Out of the Nose (Nasal Obstruction)

There are many issues that can cause these difficulties; Allergies – treated with nasal sprays, antihistamines and decongestants and turbinate hypertrophy – treated medically as well. When a medical therapy has failed, consideration for turbinate procedure may be made. Valve collapse and vestibular stenosis on the inside can be static or dynamic with inspiration, and are treated with spreader graft placement (from cartilage harvested) to bolster the nasal valve and upper lateral cartilage from falling inwards when. This is treated with a surgical septoplasty. Chronic sinusitis is caused from chronic sinus polyps located inside the sinuses and is treated with functional endoscopic sinus surgery.

Breathing Difficulties

Widening a Narrow Nose

Many people are born with a very narrow and inverted upper lateral cartilages creating an hourglass appearance along with thin nasal bones. Reverse osteotomies and spreader graft placement are used to hold the nasal bones in the new open and wider place. These maneuvers are part of a closed method and used to widen a narrow nasal vault and narrow nose. A cast is applied for one week.

widening a narrow nose

Rhinoplasty Surgery with a Chin Augmentation using an Implant

A chin implant is performed when an overly projecting nose in combination with an under projecting chin is present. The under-projection of the chin makes the nose look more prominent than it really is and placement of a chin implant can augment the chin further to give better facial balance and proportion, realized mostly from the side profile. Chin implants are manufactured in a large array of sizes, thickness and shape and the appropriate size is best determined at the time of the consultation and examination. Digital computer imaging is also helpful to understand what can be accomplished with both procedures to give better facial harmony and balance or a more appealing nose.

Reduction of the Hanging Columella

The hanging columella can be the result of a previous procedure, although many people are born with excess cartilage in that location. When there is excess skin and cartilage creating a “bottom heavy” look, a columella-plasty can be performed. This involves surgical removal of cartilage on the inside of the nostrils. This procedure, in addition to just simply tucking the columella inward can also help raise or lower the tip when necessary . Columella-plasty is usually an integral part of a closed procedure.

reduction of the hanging columella

Revision rhinoplasty

Revision Rhinoplasty is more difficult than a primary rhinoplasty due to the fact that there is scar tissue present and previous alterations to the normal anatomy. There are many reasons; a residual dorsal hump, polybeak deformity, a hanging columella, twisted and asymmetric nasal bones or concavities somewhere which requires a cartilage graft. Learn more about revision rhinoplasty and asian \ ethnic rhinoplasty.

revision rhinoplasty

Sports Related Injuries

Basketball, football and soccer tend to be the most common sports-related injuries. Males typically desire a stronger profile which keeps the nose masculine, yet refined while females may desire a subtle feminization.

sports related nasal injuries

Closed Rhinoplasty versus Open Rhinoplasty

In a Closed Rhinoplasty all of the incisions are inside of the nose, with no visible external incisions. An Open Rhinoplasty means there is an incision across the columella to access the tip and the bridge and it is done by lifting the entire surface up off of the cartilages. Our board certified doctor with years of experience, Dr. William Portuese uses the closed technique to obtain natural and balanced results without the need for an external incision on noses. View some of our before and after photo gallery. Learn more about scars, discomfort, structure, symmetry, reshaping, the consultation, concerns, medication and more.

Anesthesia in Washington State

Dr. William Portuese performs all surgeries under general anesthesia by a board certified physician anesthesiologist. The procedure is available in our Medicare certified outpatient surgical center / clinic / office adjacent to Swedish Medical Center in Seattle, Washington.

Postop Rhinoplasty Recovery

A cast is placed across the bridge which will stay on for one week. There is no painful packing placed on the inside of the nose, and all the incisions are internal with dissolvable stitches. It is important to understand that there will be 2 weeks of visible bruising and swelling and patients must refrain from any physical exercise during that time. Desired visible end results show around 3 months post op and a full year of healing and rhinoplasty recovery is to be expected.

How much does it actually cost?

Rhinoplasty (Regular) Price:
$8,350 (Surgeon & Operating Room) + $729 (Anesthesia)

Rhinoplasty (Complex/Revision) Price:
$10,000 (Surgeon & Operating Room) + $891 (Anesthesia)

Is Nose Surgery Worth It?

Fortunately, most of these issues can be addressed by an experienced and trained doctor for the proper client. It can improve a person’s self-esteem, beauty, balance, harmony and confidence, allowing them to live a happier life.

What is the Best Age For Rhinoplasty?

The Best Ages to Have Rhinoplasty. While there is no set age for treatment, it is often believed to be between the ages of 18 and 40. You’ve matured physically and emotionally to the point where you’re an excellent candidate.

Does Insurance Cover Rhinoplasty?

Cosmetic operations are often considered elective and are not covered by insurance. If there is a functional, structure or medical component to the operation, such as a breathing problem or another reason, that element of the reconstructive surgery procedure may be covered by an individual’s insurance plan.

Facts and Statistics

  • In 2018, there were approximately 2,000 rhinoplasty procedures performed in Seattle.
  • The majority of rhinoplasty patients in Seattle are female.
  • The average age of a rhinoplasty patient in Seattle is 35.
  • The average length of time required for recovery from a rhinoplasty in Seattle is two weeks.
  • The majority of rhinoplasty patients in Seattle are satisfied with the results of their surgery.
  • Rhinoplasty is considered to be a safe and effective procedure with a low risk of complications.
  • The most common complication following a rhinoplasty is a small amount of bleeding.
  • Most patients who undergo a rhinoplasty in Seattle report a significant improvement in their quality of life following surgery.

If you are looking for a Rhinoplasty procedure in Seattle or other service or treatment by our rhinoplasty surgeon to enhance facial features in Washington State for improvement or augmentation schedule a nurse consultation or a Doctor’s visit / appointment with Dr. William Portuese at 206-624-6200 We are located in downtown Seattle a city on Puget Sound in the Pacific Northwest. Our doctors see people from Bellevue WA, Kirkland WA, Redmond WA, Lynnwood WA, Renton WA, Kent WA, Federal Way WA, and surrounding areas. Dr William Portuese does not offer non surgical rhinoplasty.

Useful Links
Frequently Asked Questions
Nasal Issue Information and Diagrams
Sinus Brochure
Complete Health Guide
Revision Rejuvenation Treatment

Upload Your OWN Photo - See What You Would Look Like With A New Nose

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