A Patient’s Guide to Rhinoplasty with The Portland Center For Facial Plastic Surgery

Rhinoplasty sits at an unusual intersection of art and problem-solving. A nose must look natural from every angle, but it also needs to function smoothly when you run, sleep, or catch a cold. Patients typically arrive with a mix of motivations: a hump they have disliked since high school, difficulty breathing through one side, a crooked bridge after an old soccer injury, or a desire to refine a tip that feels too wide for the rest of the face. The right strategy balances structure, function, and aesthetic proportion, and that balance looks different for every person.

At The Portland Center for Facial Plastic Surgery in Northwest Portland, rhinoplasty is a focused part of the practice, not an occasional add-on. That matters because repetition refines judgment. The surgeons, Dr. William Portuese and Dr. Joseph Shvidler, are board certified and concentrate on facial surgery, which shapes how they analyze a face, communicate options, and anticipate trade-offs. What follows is a practical guide based on how experienced facial plastic surgeons evaluate, plan, and execute rhinoplasty, along with what you can expect before and after surgery.

A successful rhinoplasty does three things at once: it harmonizes the nose with the rest of the face, preserves or improves airflow, and holds up over time. Those goals sometimes push in different directions. A tip that looks sharp and sculpted on day 7 may collapse by month 12 if the underlying support was over-reduced. Likewise, aggressive hump removal without attention to internal valves can yield a cute profile that whistles when you breathe.

Most patients fall into a few broad categories. There are structural concerns like dorsal humps or a drooping tip, deviations from trauma, congenital asymmetries, and internal obstruction from a deviated septum or weak nasal valves. Ethnic rhinoplasty adds another layer, where the aim is refinement without erasing heritage or creating a generic “done” look. A surgeon who spends much of their week on facial anatomy tends to approach these changes with restraint, relying on cartilage grafts and precise suture techniques to mold rather than overcut.

When function is an issue, breathing improvement is more than a bonus. If the septum crowds one side, or the lateral walls collapse when you inhale, combining septoplasty and valve support with external reshaping often makes the result both prettier and easier to live with. Many patients describe the difference the first week a cold hits after surgery, when the improved airway still feels open enough to sleep.

You should expect the first visit to run somewhere between 45 and 90 minutes, long enough to cover history, goals, photography, and an exam. The best use of this time is specificity. Vague requests, like “make it smaller,” are hard to translate. Clear preferences, like “I want to keep a slight slope in the profile but narrow the upper third and soften the tip,” give the surgeon a map to follow.

An exam typically includes best plastic surgeon external assessment from multiple angles and internal evaluation with a headlight and small speculum. The surgeon will look at septal position, turbinate size, valve integrity, skin thickness, and the strength of the alar cartilages. These details determine how much can be refined and how. Thick skin, for instance, softens definition and may limit how sharp a tip can appear, whereas thin skin shows every contour and requires extra care to avoid edges or shadows from grafts.

Photography serves as both documentation and a planning tool. Many practices use imaging software to illustrate potential changes. These are not promises, and they shouldn’t be treated as such, but they help align expectations. The Portland Center team uses this exercise to discuss proportion: how a 2 millimeter change at the bridge can make the chin appear stronger, or how tip rotation subtly influences upper lip length and smile.

Fees are usually discussed once a plan is clear. A full rhinoplasty that includes internal functional work, operating room time, anesthesia, and follow-ups will sit in a range that reflects the complexity and the surgeon’s experience. Most comprehensive cases land in the mid-to-high four figures locally, sometimes crossing into five figures if extensive grafting or revision complexity is involved. It is reasonable to ask for a written breakdown and to learn what happens if a minor touch-up becomes necessary.

Patients often ask about open versus closed rhinoplasty as if one is inherently superior. In experienced hands, both techniques can produce excellent outcomes. Open rhinoplasty uses a small incision across the columella and allows the skin to be lifted like a visor for direct visualization. This helps with complex tip work, major asymmetries, revisions, and cases requiring multiple grafts. Closed rhinoplasty keeps incisions inside the nostrils and is well suited to plastic surgeon certain dorsal hump reductions, subtle tip shaping, and situations where the anatomy is relatively favorable.

At The Portland Center, the approach is chosen to match the anatomy and goals rather than ideology. If you need significant tip support and rotation control, the open route provides precision and predictability. If you need modest dorsal refinement and preservation of strong native tip support, a closed approach can speed recovery with minimal external swelling. The scar from an open incision, when handled delicately, typically fades into a thin line that is hard to find at conversational distance.

Revision surgery demands respect. Tissue planes are less forgiving, cartilage may be scarce or weakened, and scarring alters how the nose behaves. The mindset is different too. You are no longer starting with natural anatomy, but with a past surgeon’s choices and your body’s healing response to them.

Experienced revision surgeons often harvest cartilage from the septum if any remains, or from the ear or rib if needed. Ear cartilage is curved and soft, useful for valve batten grafts or subtle tip contouring. Rib cartilage is strong and straight, excellent for major support or dorsal augmentation, though it requires careful carving to avoid warping. Patients should plan for a slightly longer recovery and temper expectations with the reality that perfect symmetry is rare when the Portland Plastic Surgeon baseline is already altered.

If you struggle to breathe through one or both sides, functional work can be life changing. A deviated septum bends like a sail inside the nose, forcing air through smaller channels and creating turbulence. Enlarged turbinates, which are normal structures that warm and humidify air, can hypertrophy from allergies or chronic irritation. Valve collapse, either static or dynamic, may narrow the entryway when you inhale.

Functional rhinoplasty combines septoplasty, turbinate reduction when indicated, and structural grafts that buttress the sidewalls. Spreader grafts open the internal valve angle, usually between 10 and 15 degrees for comfortable flow. Alar batten or lateral crural strut grafts support the nostril rims to prevent collapse. Patients often measure success in quiet nights: fewer mouth-breathing awakenings, reduced snoring, and less dryness in the throat.

Portland’s sensibility leans toward subtlety. Patients often want to look like themselves, just more balanced. That translates to small dorsal refinements, conservative tip shaping, and preservation of character. A mild convexity might be retained rather than erased if it suits the face. Strong bridge lines, common in certain ethnic backgrounds, can be softened without eliminating identity.

The surgeons at The Portland Center discuss proportion across the entire face. Sometimes the best nose is the one that allows the eyes to command attention. If the chin is recessed and the nose projects strongly, a conversation about chin augmentation may arise, not as an upsell but as a way to align facial thirds and profile balance. Not every patient wants or needs two procedures. Still, understanding how facial elements interact prevents chasing perfection in the nose when the real issue is harmony.

The weeks before surgery matter more than most people realize. Optimized skin and healthy tissue bleed less and heal better. Avoid nicotine for at least four weeks before and after surgery, ideally longer, because nicotine constricts the small vessels that nourish the skin envelope and cartilage. If you take blood thinners, aspirin, or certain supplements like high-dose fish oil, ginkgo, or vitamin E, your surgeon will guide you on when to pause them safely in coordination with your prescribing doctor. Stable body weight, controlled blood pressure, and good sleep are unglamorous but powerful.

Plan your recovery space. Elevate the head of your bed or use two pillows for the first week. Prepare soft, low-sodium foods, chilled compresses, and saline spray. Arrange rides and childcare for the first few days. If you wear glasses and anticipate a bridge splint, plan for a short period of taping the frames to the forehead or using lightweight alternatives to avoid denting the healing bridge once the splint is off.

Most rhinoplasties are outpatient procedures under general anesthesia. At The Portland Center, a typical case ranges from 2 to 4 hours depending on complexity. Time is not a direct measure of quality. Some noses require meticulous tip and valve grafting that simply takes longer. The priority is sound structure and precise closure.

At the end of surgery, thin internal splints or soft packing may be placed to stabilize the septum, and an external thermoplastic or aluminum splint is molded over the bridge. Bruising around the eyes happens in a meaningful minority of patients, more often when bones are gently narrowed to refine the upper third. The bruising usually appears on days two to four and then fades over a week.

This is the short, slow week. Take your prescribed pain medications as needed, though many patients step down to acetaminophen quickly. Keep the head elevated, use cold compresses on the cheeks and eyes without wetting the splint, and begin saline spray several times per day to keep internal passages moist. You will breathe mostly through the mouth if internal splints are present, which dries the throat. A cool-mist humidifier helps.

Expect a trickle of blood-tinged mucus for 24 to 48 hours, then a shift toward congestion. The splints come off around day 6 or 7. Patients commonly feel a rush of relief when they can finally rinse more thoroughly and take a proper look. The nose will look swollen, particularly at the tip and along the sides, but you will already see the new outline.

Rhinoplasty teaches patience. Most people are camera-ready by 2 to 3 weeks, meaning bruising has resolved and casual acquaintances won’t notice anything odd. Swelling, however, follows a curve. Around 60 to 70 percent resolves by six weeks, 80 to 90 percent by three to six plastic surgery recovery months, and the final 10 to 20 percent, mainly in the tip and along edges where skin meets cartilage, can take up to a year. Thick skin holds edema longer; thin skin declares every contour early.

Sensation in the tip can feel muted for a few months. Numbness gives way to tingling as nerves regenerate. The upper lip sometimes feels stiff for a few weeks because the muscles that lift it during smiling are near the base of the nose. Gentle massage may be recommended starting a few weeks after surgery to help even out swelling, but this is case dependent. Avoid salt-heavy foods in the early months if you notice swelling spikes after certain meals.

Natural results rely on structural support, conservative reduction, and respect for airflow. Surgeons who lean on cartilage grafts use them to replace what reduction takes away. A strategic columellar strut stiffens the tip without freezing the smile. Spreader grafts keep the middle vault from pinching. When you see a nose that holds its shape when laughing or exercising, you are usually seeing the fruits of this approach.

Durability also depends on how you treat the nose during recovery. Wear sunscreen, because sun exposure can darken post-surgical redness and make swelling linger. Avoid contact sports for at least six weeks, sometimes longer if bones were moved, and protect the nose from accidental bumps. If you wear heavy glasses, discuss taping strategies or light frames that rest on the cheeks initially. The nose is more forgiving than it feels, but early trauma can alter a well-made plan.

Athletes often ask when they can safely return to training. Light stationary cycling can resume within a week if balance is good and your surgeon agrees, but anything that risks jostling or contact should wait, usually three to four weeks for light jogging and six weeks or more for full contact or ball sports. Sweat itself is not the enemy, but wiping the nose reflexively can be.

Allergy sufferers benefit from a preoperative conversation about control. Using a steroid nasal spray consistently before and after surgery can keep turbinates quieter and improve long-term airflow. Environmental triggers matter too. If your dog sleeps on your pillow and you are allergic, the nose will tell you all about it in the first month.

Asymmetry is part of human faces. Even with expert technique, a nose that started with crooked bones and a twisted septum may land at “dramatically improved but not mathematically straight.” Skin drapes over bones that are not mirror images, and cartilage has memory. It helps to evaluate outcomes in motion and in varied lighting, not just with a static, harshly lit selfie that exaggerates shadows.

The national revision rate for rhinoplasty hovers in the single digits, often quoted between 5 and 15 percent depending on the surgeon’s case mix. Many revisions are small, like smoothing a mild edge along the bridge or adding a tiny graft for symmetry, and can be handled under local anesthesia once swelling fully resolves. Major revisions are less common but are best handled by surgeons who routinely deal with scarred tissue and altered anatomy.

Patience prevents unnecessary revisions. Early swelling and scar tissue can mimic irregularities that later smooth out. Surgeons typically wait at least 9 to 12 months before judging the final tip definition, especially in thick-skinned patients, unless there is a clear structural issue that warrants earlier intervention.

Rhinoplasty spans a wide cost range because no two noses require the same resources. Fees reflect surgeon expertise, operating room facilities, anesthesia, and postoperative care. Functional components like septoplasty or valve repair may be partially covered by insurance if medical necessity is documented, while aesthetic refinements are not. The Portland Center team can help separate these components and work with insurers when appropriate.

Value in rhinoplasty comes from alignment: your goals, the surgeon’s aesthetic, and a plan that respects anatomy. A lower price for an operation that does not address functional issues, or a high price for a look you do not want, are both poor value. During consultation, compare before-and-after photos of patients with noses similar to yours. You are looking for consistency and a range of outcomes, not a single spectacular case.

Clarity beats volume when it comes to preoperative questions. Focus on the experience behind your specific needs, the plan to support breathing, and how the surgeon manages the details after surgery.

Patients are often surprised that discomfort is not the main challenge; it is congestion and patience. The first two nights are the hardest because of mouth breathing. Most people describe pressure rather than sharp pain, managed with a few days of prescription medication followed by over-the-counter options. By the time the external splint comes off, the worst is behind you. The psychological arc matters too. Day seven brings relief and excitement, week three invites overanalysis, and months two through six require the most restraint as you resist making conclusions based on transient swelling.

A brief anecdote helps set expectations. A patient in her thirties with thick skin, a moderate hump, and a bulbous tip sought a refined but not tiny nose. During consultation, the surgeon explained that the profile could be smoothed predictably, but tip definition would improve gradually over months. At three weeks, she felt the tip was still too round. At three months, family noticed the change and called it natural. At nine months, the tip looked distinctly smaller and more defined without sharp edges. The key was the plan for strong tip support that allowed the skin to redrape in its own time.

Noses age and move with the face. Support structures loosen, skin thins or thickens depending on genetics and sun exposure, and habits like smiling or sleeping on one side influence contours. Surgeons who focus on facial work learn how these variables play out over years. They also recognize patterns: which cartilage sutures hold best in thick skin, how to avoid long-term valve compromise after dorsal reduction, and when to leave well enough alone.

At The Portland Center for Facial Plastic Surgery, the focus on facial procedures fosters a rhythm throughout the process. The consult explores goals without rush. The plan prioritizes support. The operating room staff knows the choreography of rhinoplasty cases. Follow-ups are systematic, and the door remains open for small refinements when time proves them necessary. Patients notice this in the calm of the process as much as in the mirror.

Surgery timing should respect life rhythms. Schedule rhinoplasty when you can take at least a week away from in-person work or school, more if your job involves heavy physical exertion or public-facing roles where bruising is undesirable. Consider seasonality if you have severe allergies; many patients prefer winter when pollen is low. If you are planning a major life event, build in a cushion. For photos, three months yields a strong result, six months is better, and a year is safest if fine tip definition matters in close shots.

Filler rhinoplasty, sometimes called a liquid nose job, can camouflage a small hump or lift a drooping tip by adding volume. It cannot shrink a large nose, fix a deviated septum, or improve airflow. It also carries unique risks near the nose, where blood supply is intricate. When used judiciously by experts, it can test a new profile or bridge line temporarily. For patients on the fence, a careful filler trial can clarify whether definitive surgical change is worth pursuing. For most structural or functional concerns, rhinoplasty remains the right tool.

The best rhinoplasty draws attention away from itself. Friends might comment that you look rested or ask if you changed your hair. Selfies stop centering on the one angle you used to avoid. Running feels easier. Your smile reads as you, nothing more or less. The story of a nose done well fades into the larger story of your face.

If you are considering rhinoplasty in Portland, schedule a consultation with surgeons who listen closely and operate deliberately. Bring photos of noses you like for specific reasons, not as a template but as a way to point out curves, slopes, and tip styles that speak to you. Ask about breathing. Ask how the plan fits your skin and cartilage. A thoughtful process tends to yield a satisfying result.

Healthy healing is a partnership. Your surgeon designs the structure. Your daily choices in the early weeks shape how that structure settles. Give the process time, and let small gains accumulate. Rhinoplasty is a measured craft, and when done with care, it quietly improves both form and function for years.

The Portland Center for Facial Plastic Surgery

Top Rhinoplasty Surgeons in Portland

The Portland Center for Facial Plastic Surgery is owned and operated by board-certified plastic surgeons Dr William Portuese and Dr Joseph Shvidler. The practice focuses on facial plastic surgery procedures like rhinoplasty, facelift surgery, eyelid surgery, necklifts and other facial rejuvenation services. Best Plastic Surgery Clinic in Portland

Call The Portland Center for Facial Plastic Surgery today at 503-899-0006