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Will I Look Like I Was in a Bar Fight After a Nose Job?

...and I lost! I mean, black eyes and bruises that last for weeks. I really need to fix my crooked nose (broken a few times--not in fights!). thanks Doctors!

Doctor Answers (21)

If the surgeon is experienced and the case is straightforward, you should not look that bad.

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I am reposting this answer to a related question:

Unless we are talking about a very difficult and extensive revision procedure, the majority of the recovery period depends on your surgeon's experience and technique.  I truly believe the single biggest thing that can lead to either a massive recovery or a small one is what instrument the surgeon uses to perform the osteotomies (bone breaking in common parlance) and of course what his skills are.  If the surgeon is unskilled he typically uses much larger instruments with support guides.  These instruments cause significant tissue trauma, bruising, and swelling.  I rarely if ever see bruising or significant swelling.  If I do get bruising it is typically in less than 10% of cases and it is only very mild with a couple small streaks on the mid cheek that I can actually use my laser and eliminate at a week in less than 24 hours.  Swelling is directly related to the instruments mentioned above and also how long the surgeon takes to perform the procedure.  I typically on take between 1 to 2 hours to perform a primary rhinoplasty.  Because of that my recovery time is short.  Because you have to wear a bandage and splint on your nose for one week, that time is the time that the most glaring evidence of your surgery is and I counsel patients that recovery is about a week to 10 days. The splint is kept on for 7 days.


Dallas Facial Plastic Surgeon
4.5 out of 5 stars 38 reviews

Black eyes

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All patients are different as are all rhinoplasties, however certain techniques can be used  thatt will lessen post operative swelling. Most important is to hold pressure on the osteotomy sites for 5 minutes after they are done, this lessens bleeding into the tissues and subsequent black and blue. Next go to a surgeon with lots of experience because you want someone that can complete even a " tough" complicted rhinoplasty in less than 2 hours. After 2 hours in operating time the level of post op black and blue starts to go up dramatically

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Bruising and swelling after Rhinoplasty

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Patients may have bruising and obvious swelling for 1-3 weeks. After this, although swelling exists, it usually subsides enough so that the nose does not look as though it has been injured. Residual swelling may take as long as 6 months to totally subside. However, this is relatively subtle and ususally of no great aesthetic concern. Bruising is more likely when the bones of the nose are repositioned to narrow its width.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 8 reviews

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Bruising and swelling after rhinoplasty surgery

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yes, and no.

Your immediate appearance after rhinoplasty largely depends on the exact rhinoplasty procedure, and your bodies natural healing ability. For patients with deviated or twisted noses, and history of broken noses, then one should expect some black and blue eyes right after surgery. Most bruising and swelling after rhinoplasty surgery is usually not as severe as seen in traumatic injuries.

Bruising and swelling with nasal surgery occurs both on the outside and inside of the nose. For elective nasal surgery, most patients are generally "restaurant ready" and socially acceptable within 2 weeks. Most nasal swelling with rhinoplasty resolves within a month. The final swelling takes a much longer time to resolve, up to a year or longer after surgery. Fortunately, this final swelling is usually only evident to the surgeon and patient.

The more extensive the surgery, the more you will swell and the longer the swelling will last. The tip of the nose holds onto swelling longer than the other parts of the nose. Patients with thicker skin will also have more swelling for a longer period of time.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

Bruising after a rhinoplasty will last approximately seven days.

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Bruising after a rhinoplasty will last approximately seven days. On occasion, it may last upwards of 10 to 14 days. The swelling can last a little bit longer. The majority of patients are able to get back into their normal social activities at two weeks after surgery.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Rhinoplasty bruising and swelling depend on both you and your surgeon

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Patients can help reduce swelling and bruising by following instructions, particularly those which advise patients to refrain from strenous activities the first several days after surgery. Walking is great, but don't run back to the gym just because you feel OK. You see, the more active you are the higher your blood pressure runs and the higher the pressure the more leakage of blood being forced out of the blood vessels into the tissues.

What you see as bruising is blood that has leaked from these vessels and spread out in the tissues under the skin.

The surgeon is certainly a factor. The more efficient the surgeon, meaning the faster he can do the operation, the less swelling and bruising. Efficiency means getting the job done without wasting time; not speed for speed's sake. Also, the doctor can prescribe medications to reduce swelling and bruising.

Getting back to you, and your own influence on your operation, remember, no aspirin and be sure to tell your doctor all medications -- prescription and non- prescription -- that you are taking. This includes homeopathic meds. Your doctor will suggest you go off all meds 10 days prior to surgery. If you need certain medications for specific medical reasons, the doctor will make sure that the medication will not interfere with blood clotting or will substitute a more appropriate one.

Finally, if you have had surgery before with increased bleeding, be sure to tell your doctor so he can order extra tests to check blood clotting. Of course, you will want to have the usual and proper tests as part of your pre-op exam just to make sure you are not low on blood to begin with. Family history of poor clotting with lots of bruising? Don't forget to mention that too,

Remember, good care is the product of the union between a helpful patient and a thorough doctor.

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Recovery after Rhinoplasty

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Hi Will, Here's what you can expect after your rhinoplasty: You will have a splint on your nose for a week or two. You can expect bruising between your eyes and nose, usually up to 2 weeks. The bruising does tend to be worse in men, and also with your history of previously broken noses. Swelling will be present for a year, but half gone at about 3 months. It's important to avoid contact sports and not reinjure your nose, particularly in the first 6 weeks after surgery.

I'm a board certified Otolaryngologist that focuses on rhinoplasty. so I encourage you to choose a surgeon who is well trained and experienced in straightening your nose and making it look the way you want. However, you may have other functional problems breathing through your nose; deviated septum is common with nasal fracture and often needs to be corrected at the same time-this may all or partially covered by health insurance.

Good luck!

Edmund Fisher, MD
Bakersfield Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Black Eyes after a Nosejob

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No, it should not look like that. Some bruising is expected. You can minimize your chances of bruising by taking Arnica pills (a homeopathic remedy) before and after your surgery. Do not take any Aspirin, Motrin, Excedrin, Aleve or similar products for 2 weeks before surgery. Do not take any supplements like fish oil, omega 3 etc for 2 weeks. No Alcohol for a few days (3-5days) before surgery. If you have blood pressure make sure it is well controlled by your internist before surgery.

Then choose a surgeon who does delicate rhinoplasty. Another key is to use Sharp Osteotomes (chisels) for the surgery. Mention it to your surgeon.

After surgery, spend the first day just lying in a bed with at least 2 pillows or better yet a recliner. Don't walk or do anything other than going to bathroom. Ice like crazy. Do not bend over.

I am attaching my personalized instructions that I use for my own patients. Read these and goodluck.

Regards

2345 Lamington Rd, Ste 108 Bedminster, NJ 07921
Tel: (908) 470-2600 Fax: (908) 470-1660
www.janjuafacialsurgery.com

INSTRUCTIONS FOR PATIENTS UNDERGOING SEPTOPLASTY/RHINOPLASTY

BEFORE SURGERY

• PLEASE CAREFULLY READ THE GENERAL SURGICAL INSTRUCTION SHEET GIVEN TO YOU AND FOLLOW THE INSTRUCTIONS.
• These are the supplies you will need to buy ahead of time; Rubbing Alcohol, Hydrogen Peroxide, Ziplock bags, Frozen peas, Q-tips, Saline Nasal Spray, Ayr Gel (A saline gel)
• Remember, our goal in a good rhinoplasty is to achieve a better looking nose, not a perfect nose.

AFTER SURGERY
• After surgery apply cold compresses to the forehead and eyes for the first two days. Use the frozen peas in a ziplock bag or rubbing alcohol mixed with water in a ziplock bag which becomes soft like jelly on freezing. It will help with the swelling which usually gets worst the day after surgery.
• Apply the antibiotic ointment you get from the hospital in your nostrils three to four times a day with a Q-tip for one week.
• Do not blow your nose for 7 to 10 days. Wipe or dab nose gently with a tissue, if necessary.
• Do not chew gum for one week.
• Do not eat anything that requires excessive chewing, is hard to chew or needs a big bite like an apple or a burger for one week.
• Change the dressing under your nose (if present) until drainage stops. The drainage usually is mucus if mixed with some blood. You will experience frequent drainage requiring dressing changes.
• Spray your nose with saline spray four to five times a day for the first month.
• Apply Ayr Gel in each nostril before going to sleep for one month.
• Sleep with two pillows.
• If there is any packing inside your nose, you will have to breathe through your mouth. That can make your mouth and throat dry and at times, sore. Carry a water bottle with you and sip on it frequently. At night, use a cool mist humidifier in your bedroom. If any packing comes out of your nose, give us a call.
• Watering of eyes and sinus type headaches are common with nasal packing. If headaches are severe, notify the office.
• The nasal splint will remain in place until removed in the office between 3 to 7 days after surgery. Do not disturb it and keep it dry. After the splint comes off, your nose will be tender, oily and itchy.
• Occasionally there will be stitches under the tip of the nose. These will be removed at the same time as the nasal splint. Some absorbable stitches are placed inside the nasal cavities. If you find a stitch hanging out of the nose, do not pull on it but you can trim it with small scissors.
• Avoid physical activity. Do not bend down as it increases blood flow to your face increasing the chances of bleeding.
• You may wash your face carefully around the dressing. Take tub baths until the nasal splint is removed.
• Wear clothing that fastens in front or back for 1 week. Avoid slipover sweaters, T-shirts and turtlenecks.
• Don't swim for 1 month, since injuries are common during swimming.
• Don't be concerned if, following removal of dressing, the nose, eyes and upper lip show some swelling and discoloration. This usually clears in 2-3 weeks. In certain patients, it may require 6 months for all swelling to completely subside.
• Do not wear regular glasses or sunglasses which rest on the bridge of the nose for at least 4 weeks. You can get cheek supports placed on your glasses by an optician or tape the center bridge to the forehead.
• We will instruct you in the method of taping the glasses to your forehead to avoid pressure on the nose.
• Contact lenses may be worn within 2-3 days after surgery.
• After the nasal splint is removed, the skin over the nose may be cleansed gently with a mild soap or Vaseline Intensive Care Lotion. BE GENTLE. Makeup may be used as soon as the bandages are removed. To cover discoloration, you may use "ERASE" by Max Factor, "COVER AWAY" by Adrien Arpel, "ON YOUR MARK" by Kenneth or "DERMABLEND" by Corrective Cosmetics.
• When we remove your splint, your nose will be swollen and will remain so for several weeks. In fact, it takes at least 1 year for all swelling to subside.
• Return to work or school a week after surgery, if you feel well. Work involving physical exertion should be resumed in two weeks after surgery.
• A low fever, i.e., 99? is common the night of surgery, but any higher fever or pain not relieved by medication must be reported to the doctor.
• The nasal skin can be excessively oily after rhinoplasty. Clean it with a cleanser or hydrogen peroxide.
• The tip of your nose will be numb for as long as three months. Make sure to protect it against excessive cold or heat.
• It is normal to feel irregularities along the nasal bones or skin after surgery. The purpose of the surgery is to have a better looking nose and not a better feeling nose with no irregularities. It is just not possible to achieve that.
• Lastly, if in doubt about anything at any time, please call my office. (908) 470-2600 / 2636

YOUR QUESTIONS AND NOTES:
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Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

You won't be missing any teeth,, but you may have "raccoon eyes"

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If you are having an extensive rhinoplasty with both inside work and outside work, you will have bruising, especially if the nasal bones have to be fractured and repositioned. For work on the tip or internal work only on the septum, you shouldn't have significant bruising . The bruising itself lasts anywhere from 5-10 days. Of course you could always tell people that you were in a bar fight if you did not want them to think you had a nose job.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.0 out of 5 stars 10 reviews

Rhinoplasty Recovery

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Recovery from a rhinoplasty follows a normal progression over the first several weeks and months after surgery. The two biggest questions that patients frequently have about rhinoplasty recovery concern the degree of swelling and the amount of bruising.

SWELLING

The nose undergoes significant changes in the first 2 to 12 weeks following rhinoplasty. The swelling gradually dissipates over the first several months and thus the appearance of the nose changes gradually.

  • When the cast is removed after one week, the nose will look swollen.
  • Usually by the end of the second week, the swelling and bruising have subsided enough that the casual observer will not readily notice that the nose has been operated on.
  • To the patient, the nose will look swollen or "puffy" for several months.
  • By about 3-4 months, the majority of the swelling will be gone but will look larger in photographs.
  • It can take as long as a year for the final shape to become apparent.

BRUISING

Bruising and swelling are a normal part of rhinoplasty recovery. They are dependent on several factors related to both the surgical technique and the patient. Techniques that increase bruising and swelling include whether or not the nasal bones were broken (osteotomies), the extent of soft tissue dissection/elevation from the bony-cartilaginous framework, and whether the surgery was performed open or closed. Patient factors include age, skin thickness, nutrition, bleeding tendencies/disorders, and medications that thin the blood.

Obviously, not many of these variables are within the control of the patient; however the extent of the bruising and the severity of swelling can be minimized by following these tips:

  • Avoid any medications that thin the blood for a minimum of 2 weeks before surgery and do not resume them until your physician directs you to. These medications include (but are not limited to): aspirin, ibuprofen, anti-inflammatories, heparin, lovenox, coumadin, plavix.
  • Avoid multivitamins/herbal remedies/teas etc that contain high levels of Vitamin E, Ginseng, Ginko -- these can cause you to bleed more freely.
  • If you have a tendency to bleed or bruise easily, have a history of a bleeding disorder, or have a family member with a bleeding disorder, you should discuss this with your physician before surgery.
  • Ice packs to applied to the cheeks for the first 48 hours
  • Keep you head elevated higher than your heart. This will help minimize the amount of edema (swelling).
  • Avoid smoking
  • Herbal supplements such as bromelin, papaya extract, and arnica may be of benefit, but few studies have proven their effectiveness.
  • Sun exposure in the first several months following rhinoplasty can cause the skin of the nose to become red or "splotchy". It can also predispose you to getting sunburned more easily. For the first several months after rhinoplasty, patients should wear sunscreen and/or a hat to prevent the above mentioned problems.

CAST / SPLINT / PACKING

Surgeons frequently place an external splint on the exterior of the nose after surgery. The cast can help preserve the operative result and also can aid in reducing swelling. Most surgeons leave the cast in place for one week.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 91 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.