The Portland Rhinoplasty Center is a boutique medical and surgical practice devoted to the art and science of nasal surgery, specifically Rhinoplasty. There are many reasons people undergo a Rhinoplasty procedure, which include a broken and twisted nose, removal of a dorsal hump, reducing the bulbous nasal tip, or their nose is simply out of balance with the remainder of their facial features. The nose is the most prominent feature on the patient’s face, and it is a very defining characteristic of the face. When the size and the shape of the nose is out of balance with the remainder of the patient’s facial features, a Rhinoplasty procedure can accomplish making patients feel more self-confident about themselves. Dr.Portuese is the founder and medical director of The Portland Rhinoplasty Center. Dr.William Portuese prefers the Closed Rhinoplasty approach, which accomplishes making all the incisions on the inside of the nose in order to reshape it. When patients have been feeling uncomfortable for a long period of time about the shape of their nose, consider a nasal reshaping procedure, also known as a nose job. Rhinoplasty is the fourth most common cosmetic surgical procedure performed in the United States today. Rhinoplasty is one of the most difficult operations to perform correctly in the entire field of aesthetic/cosmetic surgery, so it is imperative to choose your surgeon based on extensive experience producing natural results. The nose is a three-dimensional structure that must look good in all three dimensions, and Rhinoplasty is performed in a three-dimensional fashion. The healing process also occurs in a three-dimensional fashion, so it’s important to choose a surgeon who can anticipate the surgical results. Dr.Portuese is a Rhinoplasty specialist who has dedicated a significant component of his practice to the discipline of cosmetic nasal surgery.
Candidate for Rhinoplasty
A candidate for a Rhinoplasty must be in excellent physical health to undergo elective cosmetic surgery. The procedure itself is performed under general anesthesia as an outpatient surgical procedure. The Closed Rhinoplasty approach accomplishes making all the required changes to the nose by placement of all the incisions on the inside of the nose. No visible external incisions are required. No painful packing is necessary.
The consultation with the physician usually lasts at least 30 minutes, and an additional 30 minutes spent with the patient care coordinator discussing scheduling, costs, and digital computer imaging. It is very important that patients get all their questions answered, and they understand the process of how to accomplish their goals of obtaining a new nose. It’s also imperative that patients understand what can and cannot be accomplished with the rhinoplasty procedure. Patients are not going to get a celebrity nose. It’s also very important patients present to the consultation with specific goals in mind on exactly what they are trying to accomplish, such as shaving down dorsal hump, narrowing the bridgeline, refining the nasal tip, etc. It is best to talk very specifically about what the goals are so that there’s no miscommunication between the surgeon and patient.
A thorough internal and external examination of the nose is performed at The Portland Rhinoplasty Center. It’s important to rule out any issues with breathing difficulties such as a deviated nasal septum on the inside of the nose, valve collapse, turbinate hypertrophy or broken nose. Examination of the external portion the nose is also performed to develop a customized surgical plan in order to accomplish refinement of the nose.
Digital computer imaging
Digital computer imaging is performed in our practice after they normal five photos are taken from all angles with a high-resolution camera. This includes the frontal, three-quarter view, and site profile with excellent lighting and in a chin neutral position. Digital imaging is then performed upon these images to show patients approximately what their prospective new nose would look like upon their facial features. This is not a guarantee results, and is only a guideline as to the potential outcome. It’s also very important communication tool to understand what both the surgeon and the patient are trying to accomplish together.
It’s important that patients do not take any blood thinners, aspirin and ibuprofen and vitamin E supplements to prevent a nosebleed for the upcoming cosmetic nasal surgery. We ask that patients refrain from taking all these type of products for two weeks before and two weeks after the surgery. At The Portland Rhinoplasty Center, we have a list of preoperative instructions for the patients, so that there are no surprises and patients understand what’s going to happen during the surgical process
Surgical and Anesthesia considerations
Nasal surgery in our practice is performed under general anesthesia in our outpatient surgery center. The reason for this is for patient safety and comfort. We do not perform conscious awareness or twilight surgery for Rhinoplasty. The surgery center is a state-of-the-art Medicare certified outpatient surgery center. It is also licensed by the Washington State Department of Health. The surgery center meets strict criteria to be able to be licensed and certified by these entities. The surgery center is located in downtown Seattle, Washington adjacent to Providence/Swedish Hospital. The anesthesiologists are all board-certified physician anesthesiologists who perform general anesthesia in our surgery center, and have many years of experience. The anesthesiologists also come to our surgery center from Providence Hospital as well. The surgery will last anywhere from 1 to 2 hours.
At the conclusion of the surgery, a cast is applied across the bridge of the nose and this is left in place for one week. Anticipate visible bruising and swelling for approximately 10 to 14 days. We ask patients to refrain from any physical exercise or vigorous activity to prevent a nosebleed situation. Most patients return to work at approximately 10 days.
The follow-up appointments are just as important as the actual surgery itself, so it’s imperative that patients follow up for the first several months after the surgical procedure to address swelling in the tip of the nose. Steroid shots, Blenderm tape and a low salt diet are all helpful in managing the soft-tissue envelope over the new cartilaginous and bony framework of the nose. The typical postoperative follow-up regimen would be once the first week to remove the cast, another appointment at the first month to start to see how the nose is taking shape, then again at three months, six months, and a year. Postoperative pictures are also taken at six months to a year. Full healing takes a year after Rhinoplasty, especially in patients when there is thick skin and extensive tip surgery performed.
Undergoing a Rhinoplasty procedure is a lifelong dream for many patients who are self-conscious about their nose. Many patients have significant increased self-confidence and feel better about themselves. Helping patients accomplish their goals gives great pride to our entire team of professionals.