Dr William Portuese

Dr William Portuese

Need Cosmetic Surgery? Check Out This Helpful Information First!

With a growing list of possible cosmetic surgeries available these days, more and more people are turning to it for many reasons. It could be to repair damage done from injuries, birth defects or to improve their appearance. No matter, the reasoning behind the decision, there are many considerations to be made prior to undergoing.

Cosmetic surgery can be used for a variety of reasons, so it is important to understand what type of surgery you are undergoing. The difference between general plastic surgery and reconstructive surgery is vast and there are different procedures regarding each of these two different types. Make sure to get the correct information.

Cosmetic surgery should always undergone with a sound mind. This means you need to check out as much, as you can about the surgeon beforehand. Don't worry about being offensive when you ask him personal questions about his qualifications. Include the school, and extra courses that he has studied. This helps give you peace of mind.

Make sure that the results you want to achieve from a cosmetic procedure are realistic, and not based in achieving Hollywood, red carpet perfection. There aren't always guarantees with plastic surgery. Even with the best doctor and care, you may not get the exact result you had hoped for.

Researching the hospital where your surgery will be performed is an excellent step in your decision-making process. This is a real surgical procedure, and you shouldn't take your decisions about where it will be performed lightly. Treat it as seriously as you would any other medical procedure and become educated about the facility. You should find out how successful the facility has been with plastic surgery cases, as well as any problems they have had.

Now that you are more educated about the process of cosmetic surgery, you are better equipped to handle the big decision you are facing. Use the tips you have found here to converse with your surgeon about the procedure you are considering. Get all available information prior to your surgery.

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200

A Closed rhinoplasty procedure can accomplish building up the nasal bridge. In many cases patients are born with a low bridge profile and would simply like to build up the height of the bridge for better facial aesthetics and balance. Other patients, have had an over-resection of the dorsal hump, and are left with a residual ski-slope deformity. In addition, some patients have received a traumatic injury to the nose and are left with a saddle nose deformity. When performing a revision rhinoplasty, it’s important to know how much cartilage as left on the inside of the nose for potential grafting purposes. A cartilage graft is the preferential way to build up patients own bridge line with their own natural tissues. If there is a cartilage-depleted nose, ear cartilage can be considered. In rare cases, rib cartilage may be needed. Once the nasal cartilage or ear cartilages have been harvested for potential grafting, they are then fashioned in the proper shape and inserted through a small incision along the bridge line of the nose. Most of the time the grafts are placed in a precise pocket, but they also can be sewn in place if needed. Alternatively, some patients require a significant amount of augmentation and they have no cartilage left on the inside of the nose and do not wish to have a rib cartilage taken out. For these patients, a Flowers Silastic nasal dorsal implant is used. These are also inserted in a small anatomical pocket along the bridge line. These implants are composed of Silastic, and can be custom carved when necessary. These implants are not the typical L- strut used in Asia. The L- strut implants can cause a lot of problems and many times have to be removed. In addition to building up the bridge of the nose, many patients require osteotomies placed in the nasal bones to narrow a pre-existing wide bridge line in addition to adding height to the bridge. This also helps to give added height to the bridge as well. Both medial and lateral osteotomies of the nasal bones are required to narrow them. It is also important to evaluate the status of the nasal tip to make sure it is in balance with the new and higher bridge line. Some patients require a reduction in the size of the tip with a conservative cartilage removal, while other patients require augmentation of the tip to of balance with the bridge. Tip cartilage grafting techniques are sometimes required to make sure the tip balances with the entire new bridge line. Dr. Portuese performs nasal surgery at The Seattle Facial Plastic Surgery Center, a state-of-the-art licensed and certified outpatient surgery center in Seattle Washington.

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200

Closed Rhinoplasty to widen a narrow nose

Some patients are born with an unnaturally narrow nose and would like to have it cosmetically widened. Other patients are born with an “hourglass deformity” which means they have pinched or very narrowed upper lateral cartilages in the mid-portion of the nose. Typically these patients have wide nasal bones, a dorsal hump, and a wide tip. The inverted upper lateral cartilages appear concave and relatively speaking, can make the tip look more bulbous and the bridge look wider. To widen a narrow nose requires osteotomies placed in the nasal bones, which include both medial and lateral osteotomies. The medial osteotomies are placed at the junction between the upper lateral cartilage and the lower portion of the nasal bones. Instead of narrowing the nasal bones, they’re actually cantilevered out more widely, also known as reverse osteotomies. Cartilaginous spreader grafts are then inserted in the space where the medial osteotomies were placed to hold the nasal bones open in their new wider position. The cartilaginous spreader grafts can be harvested from the dorsal hump that’s been removed or from inside the nose from nasal septal cartilage. The spreader grafts are also placed in a sub-perichondrial and sub- periosteal pocket. It’s also important to make sure the tip of the nose balances with the new bridge line. In some patients the tip may need to be narrowed, and other patients, the tip needs to be widened. A conservative cartilage removal is required to narrow the tip, while cartilage-grafting techniques are required to widen it. Rhinoplasty is a very difficult endeavor, so is very important to choose a rhinoplasty specialist based on extensive experience performing osteotomies, spreader grafts, and advanced bone and cartilage work to create a natural appearance. Dr. Portuese performs all of his nasal surgery procedures at the Seattle Rhinoplasty Center, which is a state-of-the-art Medicare certified outpatient surgery center located in Seattle Washington

closed-rhinoplasty

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200

There are many issues in the nose that can create an asymmetrical appearance to the nose. A nose job procedure, also known as a rhinoplasty can accomplish making the nose look more symmetrical. There are a variety of techniques available to accomplish making the nose look much more symmetrical than it already is. As a surgeon, it is very important to evaluate what is causing the structural asymmetries underneath the skin soft tissue envelope. A closed or open rhinoplasty procedure can address mild, moderate, or significant asymmetries. With a closed rhinoplasty approach, all incisions are placed on the inside of the nose and dissolvable sutures fall out in about a week. If the nasal bones themselves are asymmetric and crooked, medial and lateral osteotomies of them are required with an osteotome to set them straight and parallel. If the upper lateral cartilages are convex or concave, they need to be adjusted as well. A convex upper lateral cartilage can be shaved down. A concave upper lateral cartilage will make the nose looked twisted in the mid-portion of the nose, and this is corrected with a spreader graft placement. The nasal tip cartilages are often asymmetric and they need to be adjusted as well. The mild asymmetry is adjusted with shaving down a thick lower lateral cartilage of the nasal tip, while a cartilage graft is placed on the thinner nasal tip cartilage on the opposite side. When significant asymmetry exists in the nasal tip cartilages, a full delivery with suture techniques is required to make the lower lateral cartilages of the tip look symmetrical. Asymmetrical nostrils can also be adjusted with an alar-plasty, and a columellar-plasty. A deviated caudal septum can cause the columella to be twisted as well. Dr. William A. Portuese is the medical director and founder of the Seattle Rhinoplasty Center, a Medicare certified, Washington state licensed, outpatient surgery center located in Seattle Washington.

Assymmetrical Nose

 

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200

Rhinoplasty : Cutting edge Techniques and What you really need to Be aware of

Rhinoplasty is cosmetic facial surgery that’s commonly done to beautify a person’s overall look or to reconstruct their nasal area for health related purposes . A rhinoplasty technique involves modifying the cartilages and bones of the nose area , or sometimes tissue is included order to strengthen the aesthetic appeal . The procedure is also commonly performed to fix nasal fractures as well . If rhinoplasty is carried out to repair someone’s nasal fracture , the medical professional tries to recover the nose area to its pre-injury condition . A complementary surgery often known as septorhinoplasty is done on patients that additionally have a nasal obstruction . Septorhinoplasty works to strengthen the look of the nostrils , but also stabilizes the overall structure and eradicates any internal obstacles that might be blocking the patient’s nasal breathing .

Exactly what does a rhinoplasty operation involve ?

Any cosmetic worries and expectations you have needs to be completely discussed before surgery treatment . The recommendations of your cosmetic surgeon along with any special restrictions concerning the structure of your nose , skin , or face in general are crucial to have thoroughly explained you . Make-up free photographs are typically taken prior to surgical procedure to assist with both the preoperative and post surgery planning stage in order to document the results .

Make inquiries and express your concerns .

Finding an experienced , certified doctor to perform your rhinoplasty surgery should be your primary priority when taking into consideration getting any type of cosmetic procedure . ASAPS ( American Society for Aesthetic Plastic Surgery ) suggests that each patient should ideally consider the following tips for best results :

• Consult at least 3 different surgeons before choosing one

• Be sure the cosmetic surgeon you choose is board certified

• Ask where your surgeon is privileged to legally practice to ensure his credibility

• Request to see before and after photos of previous patients

• Talk in-depth about the surgery as well as the results and recovery and any potential things that may possibly go wrong or happen unexpectedly

• Ask about the surgeon’s rhinoplasty experience . How many has he done ?

• Does the surgeon have malpractice insurance ? If not , get up and leave

• Ask about the follow-up procedures

• Request to contact former patients about their own experience

• How much does the procedure cost ? What about insurance ?

The results of rhinoplasty

Rhinoplasty outcomes could be minor or major , based on the type of correction you want done , but they are however permanent . It’s very important that both you and your cosmetic surgeon are on the same page regarding the goals of your surgery . If you have realistic expectations and your plastic surgeon, the outcome will likely be very positive overall .

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200