10 Things Patients Need to Know Before Rhinoplasty
Article by Rod J. Rohrich, MD
Dallas Plastic Surgeon
1. Plan to take enough time off.
I tell my patients they need to take off at least 7-10 days, because bruising and swelling is variable and everybody deals with it differently. You can minimize the amount of bruising and swelling if you stop aspirin and all non-steroid anti-inflammatories, as well as fish oil, at least 10-14 days pre-operatively. I usually take the splint off between 6-7 days, however it is more comfortable to wait about 10 days to return to work.
2. Plan for some bruising and swelling.
Bruising and swelling is variable. The key is to keep your head elevated and minimize your activity. Don’t get your heart rate above 100 for the first 10 days. Apply cold compresses or ice gel to your eyes. Most bruising and swelling occurs in the first 3-5 days and should be resolved by 7-10 days. Often we recommend homeopathic remedies such as Arnica, Montana, and Bromelain as well as other vitamins that will actually speed your recovery. It is important to keep your head elevated after rhinoplasty to avoid putting pressure on your nose. Don’t wear glasses for the first 3-4 weeks; contacts are fine after 2-3 days.
3. Plan for the final result in 12- 15 months.
Most of the significant swelling resolves in the first 10-14 days. Most of the residual swelling will go away in 4-6 weeks, however it may take 12-15 months to see the residual swelling dissipate, especially in the tip and the nose. This is very difficult for most patients to understand, but is something that must be reiterated at each visit - the results may often appear asymmetric due to the slow resolution of the swelling. That is all NORMAL. The key is that one must be confident that intraoperatively the surgeon did not leave the operating room until it “looked as good as it could” before completing the operation!
4. Don’t begin exercising for 3-4 weeks.
It is very important to not begin exercising for at least 3-4 weeks, especially if you have had nasal or septal surgery. An increased heart rate above 100 may cause increased swelling and even bruising and bleeding, especially if it is a secondary rhinoplasty or septal surgery for a nasal airway obstruction.
5. What will I look like after surgery?
You will not have a significant amount of pain. You will have some discomfort and bruising and a stuffiness feeling for the first few days. You will have a splint on. You may have some swelling in your eyes. You may or may not have internal nasal splints. I prefer not to use packing, as this is very uncomfortable, but this may cause some nasal stuffiness or inability to breathe through your nose. This is normal. The key is to keep the nasal airway clean with regular tap water cleansing of the nostrils to keep the airways open during the post-op recovery.
6. What is normal after a rhinoplasty?
It is normal to feel congested and have swelling around the face and eyes, as well as some slight bleeding from your nostrils for the first several days and you may feel tired. All this is normal.
7. What to expect at the first post-op visit.
At the first visit (7 days post-op), most of the time you will have your external and internal splits removed. The external nasal splint is not of significant discomfort. The internal splints may have some discomfort. Therefore, I recommend taking your pain medication or a valium before you come to your visit. Do not drive – have someone bring you to you first post-op visit.
After the removal of your internal splints you will be able to breathe significantly better for the first several hours and then it may swell again post-operatively, especially if you had septal surgery. I always tell my patients they must use a significant amount of salt water solution (i.e. Ocean spray) irrigation 3-4 times a day to keep the swelling down and to rehydrate the inside of the nose to enhance wound healing. You need to continue this for at least 2-3 weeks.
8. How long will it take for my nose to look normal?
It will look much better right after the splint is removed, but it may take up to a year for your nose to have the final result. You may have some significant swelling, which will go down over the first several weeks and then a lot of the rest of the swelling will go down over the next 4-6 weeks; the rest may take up to 12 months for a primary rhinoplasty or 15 months if it is a secondary rhinoplasty, a male, if you have thick skin, or are an ethnic nose.
The tip of your nose will be swollen longer than the top of the nose and will also be numb for the first 6 months. That is all entirely normal. What is not normal is when you have any redness, fever, chills or pus coming out of the nose – this would require urgent attention and you need to call your surgeon immediately, however this is very uncommon.
9. Choosing the right surgeon for you.
Choosing the right surgeon for your rhinoplasty is most important because rhinoplasty is the most difficult operation we do in plastic surgery, as it is a surgery of millimeters and requires significant experience and expertise. You must also be very comfortable with your surgeon and he/she will get to know you well as you will have several post-operative visits. You should also find someone who would be open to pre- and post-operative questions. I prefer to give my patients my cell phone, as well as my email and texting, so they may contact me anyway they want. In my opinion, there is no such thing as a stupid or silly question. I would rather see the patient or have the patient email me than to find out something at a post-op visit when they should have called me long before that visit.
10. What if I need a revision surgery?
In my experience, a revision surgery is usually determined for the following reasons: if there is a residual dorsal hump, the tip is still bulbous, or there is still a nasal airway obstruction. For all of these things you usually have to wait 12-15 months. If there is a significant residual hump, I sometimes consider rasping this in the office under a local anesthetic at 3-6 months. But, for a tip or functional problem the patient should wait a year, because many of these will resolve.
So much of how you heal in a rhinoplasty depends on your genetic makeup (up to 90%) and the rest is determined by your surgeon’s finesse, skill and expertise.