THe Portland Rhinoplasty CEnter

Rhinoplasty – Nose Surgery FAQs

Q: How much does Rhinoplasty cost?
A:
The cost of the Rhinoplasty is directly related to the amount of time it takes to perform the procedure in a formal operating room, time monitored under general anesthesia by a physician anesthesiologist, and Dr.Portuese’s professional fees for performing the procedure along with the postoperative follow-ups for one year. Our current price list is located on the pricing tab on this website

Q: Can a functional Septoplasty be performed at the same time as a cosmetic Rhinoplasty?
A:
Yes, a functional Septoplasty and a cosmetic Rhinoplasty can be performed under one anesthesia with one recovery period. To perform a Septoplasty, a thorough examination of the inside of the nose is required to determine medical necessity, and then preauthorization with your medical insurance will be required. Anticipate Co-pays and deductibles associated with your medical insurance. The cosmetic component of the nasal surgery is not billed to insurance, and must be paid by the patient. Anticipate visible bruising and swelling for two weeks after the surgery. No painful packing is placed on inside the nose. Both procedures are performed with a closed technique with all of the incisions placed on the inside of the nose.

Q: Once you shave the dorsal hump down, will you break my nose?
A:
Yes, the nasal bones must undergo osteotomies to move them to a narrower position, which allows closure of the open roof deformity created from the simple hump removal. This will allow narrowing of the bridge line and the nasal bones. This is a mandatory step after the hump has been removed. This is the reason the cast is applied across the bridge line of the nose to hold the nasal bones in their new and narrower position

Q: How do you accomplish reduction of the bulbous nasal tip?
A:
When patients present with a mild bulbous nasal tip, a simple conservative cartilage removal can be applied to the lower lateral cartilages that compose the nasal tip. When patients have a square boxy and significant bulbous nasal tip, suture techniques are required to narrow these cartilages. In many instances, a conservative cartilage removal is also performed as well. Reduction of the bulbous nasal tip can be accomplished with closed Rhinoplasty techniques, which allows changing the shape of the nose to f the patient’s facial features. Involves making all of the incisions placed on the inside of the nose. For diagrams of how this can be accomplished, please see the bulbous tip reduction diagram on this website.

Q: How do you address my bottom heavy nose, also known as a hanging Columella?
A:
The hanging Columella can be congenital, but more frequently it is related to previous Rhinoplasty. The hanging Columella represents excess skin and cartilage on area between the nostrils. A closed Rhinoplasty approach can accomplish trimming back excess skin and cartilage from both sides of the nostrils in this area to reduce the hanging Columella. This can be performed as a standalone procedure, or as part of a full Rhinoplasty.

Q: Who is performing the anesthesia for me, and what type of anesthesia is being used?
A:
In our practice, we use board-certified physician anesthesiologists from Providence/Swedish Hospital to administer a general anesthesia for patient safety and comfort. We do not perform conscious awareness/twilight surgery.

Q: Where is the surgery being performed?
A:
In our practice, we have an outpatient surgery center is fully accredited by Medicare, and licensed by the Washington State Department of Health. This surgery center meets strict criteria to be able to obtain that level of certification/licensure. The surgery center is located on First Hill adjacent to Providence/Swedish Hospital in downtown Seattle

Q: How much pain will I have after my Rhinoplasty?
A:
In our practice, we do not place any painful packing on the inside of the nose, therefore there is very little pain associated with the procedure. Patients do experience a mild burning sensation, mild headaches and moderate congestion. The worst part for patients tends to be the nasal obstruction for the first week and inability to breathe out of their nose.

Q: How long does the cast stay on the bridge of my nose?
A:
The cast stays on the bridge of the nose for 5 to 7 days and is there to hold the nasal bones in their new position. Anticipate 10 to 14 days of visible bruising and swelling.

Q: What type of suture is used for my nasal surgery?
A:
In our practice we used dissolvable sutures placed on the inside of the nose that fall out approximately 7 to 10 days after the surgery

Q: Do you perform Open versus Closed Rhinoplasty?
A:
In our practice, we perform closed rhinoplasty, which involves making all of the incisions on the inside of the nose. There are no external incisions. Advanced cartilage grafting techniques, dorsal hump removal, osteotomies, and reduction of the bulbous nasal tip with suture techniques can all be performed through a Closed Rhinoplasty approach. This avoids the visible external incision.

Q: How long will I have to take off from work?
A:
In our practice, most patients take approximately 10 days off from their work environment to allow the visible bruising and swelling to subside before returning to work.

Q: What kind of activities can I do after nasal surgery?
A:
In our practice, we ask patients not to perform any strenuous activities for the first two weeks after the nasal surgery, in order to prevent a nosebleed situation. It’s important not to raise your heart rate and blood pressure for the first two weeks after Rhinoplasty.

Q: How do you straighten my crooked nose?
A:
The nose can be straitened by a variety of techniques. To straighten crooked nasal bones requires medial and lateral osteotomies placed in them. To straighten the mid-portion of the nose requires a spreader graft placed underneath the concave upper lateral cartilage in the mid-portion of the nose. This cartilage is harvested from inside the patient’s nasal septum. To straighten the crooked nasal tip cartilages requires asymmetrical cartilage removal and cartilage grafting techniques along with suture techniques on occasion. To straighten crooked nostrils requires a Columella-plasty to make sure the Columella is straight, and then a differential amount of excess skin removed during the alar-plasty to enable the nostrils to become more symmetrical. There is no perfect nose, just improvement.

Q: What is your touchup rate regarding a primary Rhinoplasty?
A:
In our practice, approximately 10% of our patients must undergo a touchup procedure a year after the initial nasal surgery has been performed. These are usually very limited in scope, and involve rasping down a small bump that is regrown after the primary Rhinoplasty. These procedures are performed under brief general anesthesia usually lasting no more than 30 minutes.

Q: What is a Septoplasty?
A:
A Septoplasty is a functional procedure performed for medical necessity in the back of the nose to improve airflow dynamics. A Septoplasty will not change the shape of the nose, and will only improve breathing. A Septoplasty is sometimes performed in addition to the submucous resection of the turbinates when both issues are creating nasal obstruction.

Q: What is a rhinoplasty?
A:
A rhinoplasty procedure involves reshaping the entire nose to fit with the patient’s facial features. It is very important that all the components of the nose including the nasal bones and four cartilages are all balanced with themselves and harmonious. Many times this involves shaving down dorsal hump, adding some cartilage grafts for support, and narrowing the bridge line and refining the bulbous nasal tip.

Q: How hard is a Rhinoplasty procedure to perform?
A:
Rhinoplasty is one of the most difficult operations to perform correctly in the entire field of cosmetic surgery, so it’s imperative to find a surgeon who is well versed in all the hundreds of techniques available in order to give a consistent and natural result. Rhinoplasty is both an art and a science, and it takes many years of experience to master this discipline.

Q: I have a shallow nasal bridge, is it possible to build it up?
A:
Yes, it is possible to build up the nasal bridge. This is usually performed with the patient’s own cartilage harvested from inside the nose and grafted along the top of the bridge line.

Q: Can you lift my droopy tip? It tends to droop every time I smile.
A:
A Rhinoplasty procedure can accomplish lifting the tip so that it shortens the nose on more permanent basis when needed. This is performed when the nose points downward and it’s very long. When patients have an active depressor septi ligament, it pulls the tip down even further with smiling. It’s important to release the depressor septi ligament to prevent the tip of the nose from drooping when smiling. Dr. Portuese releases this ligament when necessary during the closed Rhinoplasty approach.

Q: Do you have a lot of experience with Rhinoplasty in your practice?
A:
Dr. Portuese has been performing Rhinoplasty for over 26 years in private practice, and performs them quite often on a daily/weekly basis. Dr. Portuese is a clinical instructor in the department of Plastic Surgery and the Department of Otolaryngology, Head and Neck surgery at the University Washington, located in Seattle. The senior plastic surgery residents visit frequently to observe his techniques. Please feel free to review our before-and-after rhinoplasty photo gallery on this website which is extensive.

Q: Do you have any photographs of noses similar to my own that you performed surgery upon?
A:
Our Rhinoplasty photo gallery located on this website is extensive and reflective of the experience Dr.Portuese has performing for over 26 years. There are most likely a few patients that have noses similar to your own.

Q: What can I do about my broken nose?
A:
Trauma to the nose can cause a displaced nasal fracture, a non-displaced nasal fracture, a dislocation of the upper lateral cartilages off the nasal bones, a deviated septum, and a twisted nose. A Rhinoplasty procedure can accomplish straightening the nasal bones with osteotomies, and a spreader graft can be placed underneath the concave/dislocated upper lateral cartilage. No surgery is required for a non-displaced nasal fracture, since it’s not crooked. A Septoplasty is performed when there’s fracture of the nasal septum causing nasal obstruction.

Q: Do you perform computer imaging for Rhinoplasty?
A:
Yes, we do perform digital computer imaging, which is helpful in the communication process between Dr. Portuese and patient to understand what can and what cannot be accomplished with the Rhinoplasty procedure. Digital computer imaging is an integral component of the consultation process. It is important to understand there are limitations, and that there is no perfect nose. In our practice, we strive to come very close surgically to what the digitally altered images portray

Q: How long does the consultation last with Dr. Portuese?
A:
Appointments involve spending 30 minutes with the doctor, and an additional 30 minutes with the patient care coordinator going over costs, scheduling, and computer imaging. When patients schedule surgery, another 30 minute appointment with one of our registered nurses is required to go over the preoperative and postoperative care regimen. This educates patients about the entire process when undergoing nasal surgery

Q: Can I take aspirin or ibuprofen prior to nasal surgery?
A:
It’s best not to take any blood thinners prior to nasal surgery to prevent a nosebleed. In our practice, we ask patients to take only the medications are given to them for the first 10 days after the procedure.

Q: Do you perform non-surgical Rhinoplasty?
A:
In our practice, we do not perform non-surgical Rhinoplasty. This procedure involves placement of fillers in the nose and is only temporary, is not FDA approved for that application, and can have significant complications. We perform surgical closed Rhinoplasty

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