Dr William Portuese

Anticipate drains in place for 1 to 2 days after the procedure, and two weeks of visible bruising and swelling after a facelift or neck lift. The incisions are located in front of the ears, behind the ears and under the chin are going to stay dark pink for a few weeks, and light pink 3 to 4 months. The after photos are not taken until 4 to 6 months after the procedure. Makeup can be applied as soon as the sutures have been removed in one week.

Yes, one of the main goals of a facelift is to lift the jowls back up into the cheeks, which involves re-suspending them and lifting them with the high-SMAS facelift technique. In addition to improving the jowls, a facelift accomplishes tightening loose neck skin, tightening loose facial skin, removing fat deposits in the neck, and tightening loose facial and neck muscles

A hematoma can occur when there's a pooling of blood underneath the skin. If this is a small one, it usually resolves with a little local pressure. It's a large hematoma, the incision will have to be opened up and the active bleeder cauterized. Most patients also have some temporary numbness around the ears in the neck, which usually resolves on its own. To prevent infection, we place patients on antibiotics. Permanent facial nerve paralysis is extremely rare.

Some facelift and neck lift procedures can be performed under local anesthesia, but when performing a comprehensive facelift, it's recommended the patient undergo general anesthesia, since the procedure can take upwards of three hours. Most patients are not able to lie still under local anesthesia for that period of time. In our practice, we use board-certified physician anesthesiologists exclusively for patient safety and comfort. The procedure is performed in our Medicare certified, Washington State licensed ambulatory surgery center.

A mini lift tends to give mini results and we rarely perform them. Basically, a mini lift involves a very minimal tightening of facial skin and a small amount of tightening of the fascia layers in the face. A full facelift involves tightening loose facial skin, tightening loose neck skin, tightening loose neck muscles including a platysma-plasty. It also involves lifting the jowls with the high-SMAS procedure, which accomplishes tightening the fascia layers in the face underneath the skin. The fat deposits in the neck are removed with liposuction above the platysma muscle and surgical removal is required of the fat deposits below the muscle in the neck.

The primary goal for lower blepharoplasty is to remove the fatty deposits in the lower lids, which are also called eye bags. These eye bags are created by herniated fat in the lower lids creating the puffy look. A trans-conjunctival approach lower blepharoplasty can accomplish removal of this eye bag fat through an incision located on the inside of the lower eyelids. If there is extra skin at rest, (not when smiling) then a small pinch of extra skin can be performed just below the lash line directly below the eyelashes. In our practice we close this incision with tissue glue. There are no sutures. All lower eyelid surgery is performed under general anesthesia by a board-certified physician anesthesiologist for patient safety and comfort.

The primary goal of upper eyelid surgery is to remove the excess skin creating the hooded look. This is known as an upper blepharoplasty procedure. The incision is located directly in the upper eyelid crease, and in some cases extends laterally if there's an extra pleat of skin the outer corner of the eye, or a downturn upper lid. The Upper blepharoplasty procedure can be performed under local general anesthesia or general anesthesia. In our practice, we close the upper eyelid incision with dissolvable sutures.

The dorsal hump itself is composed mostly of cartilage, and a small amount of bone. The dorsal hump is shaved down with knife and scissors and then the bone is filed down with a rasp. Shaving down a large dorsal hump creates a flat top, open roof nasal deformity, therefore osteotomies placed in the nasal bones are then going to be required to close the open roof created from the hump removal. It is also important to adjust the nasal tip cartilages to balance with the new bridge line. A cast is then placed across the bridge of the nose for one week.

The cost of a cosmetic Closed Rhinoplasty/nose job is directly related to three fees, which include costs for the operating room, costs of the anesthesia provider, and cost of the surgeon’s fees for performing the procedure, in addition to all the postoperative follow-up appointments.

Painful packing in the nose is not required after Rhinoplasty, Septoplasty, broken nose repair or sinus surgery. Patients experience some congestion after the surgery, but no painful packing is required. Stents placed on the inside of the nose are also unnecessary.

In our practice, we perform general anesthesia for all cosmetic rhinoplasty procedures, deviated septum repair procedures also known as a septoplasty, straightening the nose from a nasal fracture and broken nose, and functional endoscopic sinus surgery for chronic sinusitis. Board-certified physician anesthesiologists perform the anesthesia in our Medicare certified outpatient surgery center.

When patients have boxy and wide nasal tip cartilages, suture techniques and conservative cartilage removal are applied to those nasal tip cartilages to refine and narrow them. Thick skin in the tip of the nose prevents refinement in that area, so it is very important to have realistic expectations with nasal surgery, especially in the nasal tip. Some patients also require steroid shots to be placed in the supra tip area of the nose to reduce swelling in that area after these specific techniques. These steroid shots are usually applied for the first several months after the procedure.

A Rhinoplasty can accomplish refining the tip, narrowing the bridge line and narrowing the nostrils all for cosmetic purposes. Patients must pay for this procedure itself, because it is altering the shape of the nose. This is elective surgery. A Septoplasty is performed in the back of the nose to improve airflow through it when there's a deviated septum present. This is functional medically related surgery. A Septoplasty will not change the shape of the nose. In order to qualify for Septoplasty, there must be a significant deviated septum present, which demonstrates medical necessity. A Septoplasty is performed for functional purposes, and a cosmetic Rhinoplasty is performed to change the shape of the nose. Both can be performed together under one anesthesia with one recovery period.

The crooked nose is straightened with osteotomies placed in the nasal bones to straighten them, a spreader graft placed underneath the concave upper lateral cartilage in the midportion of the nose, and a tip-plasty to straighten the crooked nasal tip cartilages. The tip-plasty nose job accomplishes conservative cartilage removal or grafting techniques depending upon the asymmetric issues in the tip itself. In many cases, a Septoplasty is required to straighten a fractured nasal septum. This is also known as a deviated septum. A Septoplasty improves airflow in the back of the nose if the septum itself is crooked and blocking airflow. Anticipate a cast on across the bridge of the nose to hold the nasal bones in their new and more straitened position, with visible bruising and swelling after the procedure lasting approximately two weeks.

An Open Rhinoplasty involves making incisions on the outside of the nose across the columella in addition to internal incisions to gain access to the nose. A closed Rhinoplasty involves making incisions only on the inside of the nose to make whatever changes to the nose are required. The open versus closed Rhinoplasty debate is only about the access to get into the structures of the nose, not what is performed internally. A Closed Rhinoplasty approach nose job can accomplish osteotomies placed in the nasal bones to narrow them, shaving down the dorsal hump, placement of advanced cartilage grafting techniques, spreader grafts, reducing the hanging columella, and performing suture techniques and conservative cartilage removal to reduce the bulbous nasal tip. No external incisions are required with the closed approach. No painful stents or packing is placed on the inside of the nose.

It is a very good idea to have a pregnancy test done within a few days prior to any surgery including rhinoplasty surgery. The anesthesiologists who perform anesthesia in our surgery center do not wish to have women who are pregnant put to sleep under anesthesia for cosmetic nasal surgery.

Most patients take approximately one week off from their work environment. The cast will usually stay on the nose for approximately one week after the surgery and bruising and swelling lasts upwards of two weeks. Patients who are able to work from home can certainly do computer, phone work and book work but may not feel comfortable venturing out of the house until the cast is removed from the nose.

Our caring staff of three registered nurses, patient coordinator, and ancillary staff are able to answer questions. If they are unable to answer the questions, I will personally answer all questions necessary to make sure that patients feel comfortable with their new face or nose.

All incisions are placed inside the nose. I do not perform the open rhinoplasty

Typically, the cast will remain on the outside portion of the nose for five to seven days. The cast is removed usually at your first postoperative appointment.

At least one week after nose surgery to take the cast off and check healing progress. In an ideal situation, like to see patients back approximately one month after the surgery to see how the final result is coming along and again three months, six months, and one year postoperatively.

All surgery is performed in our on-site Medicare Certified outpatient surgery center

Board certified physician anesthesiologists from Swedish Medical Center in Seattle perform the anesthesia in our Medicare-certified ambulatory surgery center.

Secondary and revision rhinoplasties are always much more difficult than a first time primary rhinoplasty. There is more unpredictability of healing with prior scar formation from previous surgery.

No. There is mild-to-moderate discomfort after a rhinoplasty and/or nasal surgery. Since there is no packing placed on the inside of the nose, this is typically not a painful operation. Patients usually take mild pain medication for the first day or two after the surgery and then switch to Tylenol for minor discomfort after the first few days.

Our office policy is to avoid aspirin, ibuprofen, vitamin E, and all herbal products for two weeks prior to the surgery. This is to prevent any nose bleeds from occurring in the postoperative healing phase. Women of childbearing age need to make sure they are not pregnant before undergoing elective cosmetic surgery.

Dr William Portuese is a board certified facial plastic surgeon.

Please call the office on Monday morning