Nasal Swelling after Rhinoplasty

If you’ve read up on rhinoplasty or you’ve had one in the past, you are likely aware that swelling is the name of the game after surgery.  You’ve probably read that the nose is healed in 1 year after surgery.  Very few surgeries are discussed in these terms, making the rhinoplasty healing process unique.  I’d like to discuss this and offer some additional thoughts on the swelling and healing process that you may find useful in your research on rhinoplasty.

Why does the nose swell?

Swelling is natural after any surgery, as it is the body’s response to surgical “dissection”.  This refers to the process of physically separating the different layers of tissue during the procedure and then closing them back up.  When this is performed, fluid tends to fill the spaces created, and this buildup has to be reabsorbed by the body, which takes time.  Early on there is also a component of inflammation which occurs as a natural effect of performing surgery.  These factors are all normal parts of the healing process.

Other causes of swelling which should be addressed urgently after surgery include infection or hematoma, which is a large blood clot forming underneath the skin.  These are not normal aspects of surgery and require your surgeon’s immediate attention if you suspect them. 

How does swelling affect the nose?

The result of swelling is that it obscures the shape of the nose in the early postoperative period.  Typically the tip lacks the final amount of definition, and bumps can occasionally be seen on the bridge of the nose.  More rarely swelling can cause a congested feeling or some blockage of nasal breathing.  Surgeons very commonly advise patience when confronted with these issues postoperatively.  Alternatively, sometimes swelling hides bumps or other irregularities and these only become apparent with time.

Does everyone swell the same amount?

Although everyone goes through a similar process after surgery, there are natural differences between patients.  Some patients will take longer for the swelling to go down, while some noses “shrink up” very rapidly.  There are advantages and disadvantages to both, and it is not necessarily favorable for the nose to shrink rapidly.  One of the major determinants of this is the skin thickness of the nose.  Thick skinned patients will have a slower recovery than thin skinned patients, but the skin thickness hides imperfections very well.  Thin skinned patients have their final result achieved sooner, but at the risk of having more bumps and asymmetries.  Additionally, swelling can fluctuate for months or years after the surgery.  This usually does not affect the outcome, but is noticeable if you look for it, and may be relevant if you are trying to look your best for a specific event (wedding, vacation, etc).

Can anything be done to manage swelling?

Yes.  Follow up is the key to observing and managing the swelling after surgery.  Although for the most part swelling will go away with time, there are times when it may be beneficial to actively manage it.  For example, a small dose of steroids injected under the skin can have a significant effect if there is some scar tissue forming.  Massages or exercises are also effective tools if used correctly.  Your surgeon can help you determine if these measures will improve the outcome, but only if you follow up regularly.  Other factors that affect the swelling process are diet, climate, and even gravity.  Salt tends to cause the body to retain water and slow down the resolution of swelling.  Hot weather can also do the same thing.  It is best to avoid salty foods, stay inside when it’s hot out, and sleep mildly upright (two pillows do the trick) to help slowly reduce the swelling.

When is my nose healed?

The common advice is that it takes a year for the nose to heal.  A year is a useful landmark for most people in that changes are relatively small at this time point.  However, the healing process continues for many years.  Surgeons who follow their patients for 5, 10, 20 years out have noticed this.  Changes at this time point can be significant if the original rhinoplasty was performed poorly and in these cases can even result in the development of breathing problems later in life.  That is why it is so important to have the nose surgery done right the first time around.  I hope that this answers some of the questions you may have had about swelling and healing after rhinoplasty! 

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