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THE SEATTLE FACIAL PLASTIC SURGERY CENTER
WILLIAM PORTUESE, M.D. | 1101 MADISON ST #1280 SEATTLE, WASHINGTON 98104 | (206) 624-6200
THE SEATTLE FACIAL PLASTIC SURGERY CENTER
Surgical Staff
Dr William Portuese - board certified facial plastic surgeon
Dr. William Portuese is one of the top-rated facial plastic surgeons in America
Surgical Facility
Our state-of-the-art facility will make your experience comfortable and safe.

Rhinoplasty (Nose Surgery) FAQ
Facial Plastic Surgeon in Seattle Dr. Portuese

#1 How much does a rhinoplasty cost?
The cost of a rhinoplasty is driven by 3 fees, which include time under anesthesia, time in the operating room, and the surgeon’s fee for performing the procedure. It is also important to factor in costs of a touchup, if needed at one year after the procedure. The cost to perform the procedure at the Seattle Rhinoplasty Surgery Center is much less expensive than performing it in a hospital setting. The price list for a rhinoplasty by Dr Portuese can be found on our website.

#2 What is the Recovery time and down time after a rhinoplasty procedure?
The rhinoplasty procedure is performed under general anesthesia as an outpatient surgical procedure. Patients experience some degree of a hangover the first day of the procedure. A cast is applied across the bridge of the nose and is left in place for 6 days. Visible bruising and swelling in our practice lasts approximately 10-14 days. The amount of swelling and bruising patient’s experience is quite variable. Patients are able to return to work or social activities and exercise at 14 days after the surgery.

#3 What is the long term recovery time after a rhinoplasty procedure?
The recovery after a rhinoplasty procedure involves the immediate term which is 2 weeks of visible bruising and swelling after the surgical procedure. Depending upon the skin type and techniques performed, it may take several months to start to see what new nose may look like. The tip of the nose stays swollen for the longest period of time after the surgery. Approximately 60-70% of the swelling in the nose is dissipated at one month and approximately 80% dissipated at 3 months. The remaining 20% of swelling tends to stay in the tip of the nose and can take a full year for full healing to take effect.

#4 Trauma to the nose and a broken nose possible?
Trauma to the nose can cause a displaced fracture of the nasal bones which will need to be reset. A displaced nasal fracture is treated with osteotomies placed in the nasal bones during a formal surgical re-setting of the nasal fracture. A cast will be placed across the nose to hold the nasal bones into their new straight position. Trauma to the nose can also cause a non—displaced fracture which is left alone and not treated, since it is not crooked. Trauma to the nose can also cause a fracture of the upper lateral cartilages off of the nasal bones and is usually treated with a spreader graft placed underneath the concave upper lateral cartilage to make sure it is in alignment with the nasal bones.

#5 Postoperative swelling in the nose after a rhinoplasty?
It is normal to have some degree of swelling in the nose within the first few months after a rhinoplasty procedure. That swelling and edema tends to be more prevalent in patients who have thick,oily, and pigmented skin. Some patients require cortisone shots in the supratip portion of the nose in the postoperative period to help dissipate the swelling and edema.

#6 How to find the best rhinoplasty surgeon in Seattle?
While there is no formal review system to help patient’s find ” the best rhinoplasty surgeon”, there are many factors that can be looked into to judge your surgeon. Look for a surgeon who is board certified in Facial Plastic and Reconstructive surgery ,and in Ear Nose and Throat, Head and Neck Surgery, has an excellent portfolio of before and after rhinoplasty patients to demonstrate his or her work, has good ratings, reviews, and testimonials. Also look for a surgeon who has dedicated a significant component of their surgical practice to the discipline of rhinoplasty. Rhinoplasty is the hardest operation to perform it in the entire field of cosmetic surgery, so experience really does matter .

#7 Tip rhinoplasty versus full rhinoplasty?
A tip rhinoplasty involves reducing the bulbous tip only and not performing any other component of a rhinoplasty procedure. Very few patients are able to undergo a tip rhinoplasty only. If there is a hump present or a wide bridge present, then a full rhinoplasty is required. A tip rhinoplasty usually involves reduction of the bulbous tip with suture techniques applied to the lower lateral cartilages, or a conservative cartilage removal. A hanging columella can also be addressed at the same time as well as releasing the depressor septi ligament, if present. The far majority of patients tend to undergo a full rhinoplasty, not a tip rhinoplasty to make sure all of the components of the nose balance with themselves, and the entire nose balances with the patient’s facial features.

#8 Nonsurgical nose job versus surgical nose job?
In our practice, we do not recommend a non-surgical nose job. Injecting temporary fillers into the nose is not FDA approved. There have been multiple complications of skin necrosis by placing injections in the skin for a temporary augmentation of the nose. Placing fillers in the nose only makes the nose bigger, wider, and taller, not smaller which is what most patient’s desire. A surgical rhinoplasty changes the nose for a permanent shape such as removing a dorsal hump.

#9 How to minimize swelling and bruising after a rhinoplasty?
An experienced rhinoplasty surgeon can help minimize the amount of bruising after a Rhinoplasty procedure by placing careful cuts in the bones of the nose with osteotomies in a minimally traumatic fashion. Most patients get some degree of visible bruising and swelling after the nasal procedure for at least 10 days to 14 days afterwards. Steroid pills can also help with the swelling but are not given on a routine basis. Steroid shots are given to the tip of the nose starting at one month after the procedure when there is edema located in the supratip area of the nose.

#10 When is it acceptable to fly an airplane exercise after a rhinoplasty?
In our practice, we allow patients to fly in an airplane or exercise 2 weeks after the procedure. Even at 2 weeks after the procedure, there still swelling present which can be exacerbated by exercise or flying in an airplane, but will not hurt the end result of the nose surgery.

#11 Uneven swelling after the rhinoplasty procedure?
The swelling and bruising that occurs after the rhinoplasty procedure is never symmetrical. One side of the nose always gets more bruising than the other side does. When patients sleep on their left side at night, typically they get more swelling in their nose in the morning when because they slept on that side. Time will dissipate the swelling.

#12 Open rhinoplasty versus closed rhinoplasty?
Open rhinoplasty involves making incisions on the outside columella of the nose and on the inside as well. Closed rhinoplasty involves making the incisions only on the inside of the nose. Dr. Portuese performs closed rhinoplasty and is able to prevent the scarring that occurs across the columella of the nose with open rhinoplasty. The closed versus open rhinoplasty debate is only about the incisional approach, and does not have anything to do with the actual procedures/techniques performed on the inside of the nose. All of the techniques such as narrowing the bulbous tip with suture techniques, cartilage removal, advanced cartilage grafting techniques, osteotomies and hump reduction can all be performed with closed rhinoplasty approach

#13 Can I have my nasal hump removed without breaking the nose bones?
The dorsal hump is composed of both bone and cartilage and must be surgically shaved down in order to remove it. Osteotomies of the nasal bones are then required to close the open roof deformity created from the hump removal. When the hump is removed, a flat top open roof deformity is created which is cosmetically unacceptable, therefore breaking the nasal bones is necessary to bring the nasal bones into alignment with the remainder of the nose.

#14 Bulbous tip repair, how is it done?
A bulbous tip can be caused from thick skin in the nasal tip or wide lower lateral cartilages of the nasal tip. Thick skin will be an impediment to seeing a very refined result in the tip of the nose. When the bulbous tip is created from wide and divergent cartilages, suture techniques are applied to narrow the lower lateral cartilages of the nasal tip. Sometimes a conservative cartilage removal is also performed simultaneously. Nothing can be done about thick skin.

#15 Can a Septoplasty and a rhinoplasty be performed together?
A septoplasty is considered a functional nasal surgery and is performed when there is a deviated septum present that is blocking air flow. A septoplasty is performed for medical necessity which must be documented in the office at the time of examination and consultation. A septoplasty is typically billed to the patient’s medical insurance. A septoplasty will not change the shape of the nose, only improve air flow functionality. A rhinoplasty is performed for cosmetic purposes to shave down a dorsal hump, narrow the tip and narrow the bridge. Patients must pay for the cosmetic portion of their nasal surgery themselves. Both procedures can be performed under the same anesthetic with the same recovery period.

#16 How painful is it after a rhinoplasty?
Dr Portuese Does not place any packing or stents inside the nose, so there is only minimal discomfort after the surgical procedure. Most patients experience some degree of congestion, mild headache and a burning sensation in the nose for the first few days after the procedure. Most patients take a few pain pills such as Vicodin or Percocet in the first few days after the surgical procedure.

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