Rhinoplasty Portland Oregon – Top Nose Surgery Procedures
Dr. William Portuese is a top rhinoplasty surgeon in the Pacific Northwest and has dedicated a significant portion of his practice to the discipline of closed rhinoplasty, revision rhinoplasty and functional nasal surgery. The nose is the most prominent feature of the face and rhinoplasty surgery can achieve the goal of a natural looking nose – some of the best outcomes possible.
Rhinoplasty is one of the hardest operations to perform in the entire field of cosmetic surgery and Dr. William Portuese and his plastic surgery team takes great pride in caring for patients throughout the entire process of nasal surgery.
Closed Rhinoplasty Procedure
The closed rhinoplasty procedure places all incisions on the inside of the nose. This top rhinoplasty procedure can accomplish all of the best techniques of an open rhinoplasty; shaving down a dorsal hump, which is composed of both bone and cartilage, osteotomies of the nasal bones to narrow the bridge line and cartilage grafting techniques – sometimes used to build up the upper lateral cartilages when they’re concave. The bulbous tip is reduced with suture techniques applied to the lower lateral cartilages of the nasal tip and when patients have wide nostrils, an alar-plasty is performed.
The consultation process for rhinoplasty Oregon involves a 30 minute in-person consultation with Dr. William Portuese to address concerns and techniques with the patient and another 30 minutes with the patient care coordinator for computer imaging. Fees, additional questions and scheduling are also discussed. Computer imaging for rhinoplasty allows patients to get a reasonable idea on how their new nose would look with their facial features.
Day of Surgery From Top Rhinoplasty Surgeon
On the day of the surgery, Dr. William Portuese reviews the surgical plan and computer imaging with the patient. Patient’s also meet the board certified physician anesthesiologist and are then admitted into our Medicare certified outpatient surgery center. In our practice, a rhinoplasty is always performed under general anesthesia for patient safety and comfort. Nose surgery usually takes between one to two hours under the direct supervision of the anesthesiologist. Dr. Portuese performs the entire surgery with a closed rhinoplasty approach and then applies a cast across the bridge of the nose that will stay in place for 6 days. Patients are taken to the recovery room where they will wake up from the anesthesia and then go home with their caretaker. Patients will have visible bruising and swelling for approximately 10-14 days after the procedure. The first postoperative visit is at one week when the cast is removed and patients can see their initial results. There will also be followup appointments at one month, 3 months 6 months and one year.
A revision rhinoplasty is more difficult than a primary rhinoplasty due to the fact that there have been previous alterations to the normal anatomy of the nose and scar tissue. The healing process is not as predictable with a revision rhinoplasty than for the first rhinoplasty procedure. It’s also important to have realistic expectations about what can and cannot be accomplished with a revision rhinoplasty procedure. Digital computer imaging can be performed at the time of the consultation to give the patient an idea of what may be accomplished with revisional nasal surgery.
Techniques available to the rhinoplasty surgeon include the closed rhinoplasty approach or open rhinoplasty approach, depending upon the surgeon’s desire. In addition, some revision rhinoplasty procedures will make the nose smaller, while other revision rhinoplasty procedures involve building up the bridge line, tip or sidewalls of the nose with cartilage grafting techniques.
Polly-beak deformity is treated by shaving down excess cartilage that is present in the supratip are of the nose. This is due to cartilage left behind during the primary rhinoplasty. In most instances in patients with thick skin, steroid shots will be required first few months after the procedure. Blenderm taping is also recommended for patients who have thick skin in the supra-tip portion of the nose.
A hanging columella is addressed by shaving down excess skin and cartilage that gives the illusion of a “bottom heavy” nose. The hanging columella is usually the result or rhinoplasty, but can be congenital in nature. The columella-labial angle can be adjusted upward or downward with this technique.
When patients have a dorsal convexity or a residual hump and irregularities across the bridge of the nose, this can be filed down. Patients who have an over- resected nasal dorsum will require cartilage grafting techniques to build up the bridge.
A residual bulbous nasal tip is addressed with suture techniques and conservative cartilage removal applied to the lower lateral cartilages, which comprise the nasal tip. When there is asymmetry present in the tip, asymmetrical cartilage can be removed on one side and cartilage grafting techniques can be applied to the opposite side.
When patients have a crooked nose, osteotomies will need to be placed in the nasal bones. Both medial and lateral osteotomies accomplish making small cuts in the nasal bones and manually setting them straight. A cast is then applied across the nose for one week. Anticipate 10 days of visible bruising and swelling
When patients have a concave upper lateral cartilage in the mid-portion of the nose creating crookedness in that area, a cartilaginous spreader graft is harvested from the nose and is fashioned into place underneath one or both concave upper lateral cartridges. This is known as a spreader graft, which lends structural support in the mid-portion of the nose.