RHINOPLASTY GUIDE©copywrited William Portuese MD, 2007/8

Rhinoplasty surgery (nose-job, cosmetic nose-surgery) is the most frequently performed and sought after procedure at the Seattle Rhinoplasty Center. Most patients elect to have rhinoplasty surgery because they feel their nose is out of balance in relation to their other facial features. Specific reasons as to why patients desire rhinoplasty surgery include presence of a dorsal hump, wide nose, droopy nasal tip, and boxy or bulbous tip. Other common reasons for rhinoplasty are to correct a nasal fracture (broken nose) or to revise a previous rhinoplasty. Patients who have suffered a nasal fracture (broken nose) have weakened cartilage and bones, which cause the nose to be crooked and naturally these individuals would like this corrected to their pre-injury state. Additionally, some patients have a deviated nasal septum from the nasal fracture.

Rhinoplasty can create a drastic change to ones appearance such as in the case of a patient with a broken nose or a congenital malformation. Conversely, cosmetic nose surgery can also create overall balance to a person’s face in a subtle manner.

Many patients seek rhinoplasty at the Seattle Rhinoplasty Center due to the experience of Dr. Portuese and his staff. For over 18 years Dr. Portuese has been performing rhinoplasty and medically necessary nasal surgery in Seattle.


imaging room

Patients begin by meeting Dr. Portuese at a consultation appointment to establish and communicate their concerns and wishes. This provides an opportunity for Dr. Portuese to conduct a physical exam of the inside and outside of the nose and discuss specific options a patient may have. This consult lasts approximately one hour. There is a consultation fee of $75, which includes photo imaging with our patient care coordinator.

Photo imaging is a tool for Dr. Portuese to communicate the potential outcome in a visual fashion. It is a means for Dr. Portuese and the patient to understand the goal of nose surgery, however it does not guarantee outcome.

Once photo imaging is complete, patients have the opportunity to inquire about the financial aspect of having surgery, scheduling, possible surgery dates, and any additional questions. We encourage patients to educate themselves on rhinoplasty surgery and are happy to provide additional resources. It is important for the patient to be comfortable with the information when securing a surgery date.


Once a surgery date has been determined, a pre-operative evaluation is conducted. The purpose of this appointment is to establish the physical health of the patient and whether he/she is a candidate for elective cosmetic surgery. It is the policy of our Anesthesia Provider that all men who are 45 years in age and older undergo an EKG evaluation prior to surgery. This policy applies to women who are 55 and older. Our patients are then given instructions to discontinue all aspirin products (ibuprofen, naproxene, etc), vitamin E and herbal supplements two weeks prior to their surgery date. Patients who smoke should refrain from smoking as it delays the healing process.

At this time, patients are educated on the role their caregiver will assume so they may select the best individual to fill this position. This person can be a family member or a professional caregiver.


At the Seattle Rhinoplasty Center, Dr. Portuese performs closed technique rhinoplasty, whereby all incisions are made within the nose. An open rhinoplasty requires an incision across the columella, while a closed rhinoplasty does not. The closed rhinoplasty method permits Dr. Portuese’s patients to recover without any packing in their nose, less swelling and edema with an overall shorter recovery time. Specific surgical techniques performed will depend upon each patients concern. Dorsal humps, a wide nose or nasal tip will require cartilage removal. If a nose is crooked, fractured or broken, the nasal bones will need to be reset. Individuals who wish to heighten their nasal bridge and profile may require a cartilage graft or Silastic implant. For patients who feel their nose is too large and projecting, a reduction in the projection will be done and in some cases a chin implant is placed for a retrusive chin. Often times a chin implant de-emphasizes an over projected nose by creating balance with the patients other facial features.

Patients who have had a rhinoplasty done elsewhere and come to Dr. Portuese for a revision should be aware that revision surgery is more complicated than the initial surgery due to presence of previous scar tissue and altered healing process. The healing process becomes less predictable when an area is operated on more than once.


Once the surgery is complete, a splint is placed on the patients nose. They then spend approximately 60 minutes in recovery where they come out of anesthesia under the care and supervision of our registered nurses. A simple dressing (drip pad) is placed under the nose and remains there until the next day. After the patient is stable and ready, they are then discharged to their caregiver. Prescription pain medications are given to patients so they may better manage post-operative pain. Most individuals discontinue these medications after a few days and begin using Extra Strength Tylenol. Aspirin and related products such as Advil and Aleve should be avoided for two weeks after surgery. Patients return to the Seattle Rhinoplasty Center one week after surgery to have their splint removed and to be evaluated by Dr. Portuese. At this time, there is a significant amount of swelling in the nose, much of which is in the nasal tip. When 10 – 14 days time has passed since surgery, patients are free to resume their regular routine of physical exercise and social activities. A series of post-operative appointments with Dr. Portuese are made to monitor the patients healing and progress. After the first month, 80% of the swelling will resolve and patients can see what their final nose will look like.

At the Seattle Rhinoplasty Center our services have been fine tuned by many years of experience with rhinoplasty and nasal surgeries. Dr. Portuese has been in private practice for over 18 years and has performed thousands of rhinoplasty, deviated septum, and broken nose surgeries. He and his staff take pleasure in assisting patients fulfill their vision of a new nose and are happy to serve as a resource of information and support during this process.

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