Does everyone need nasal packing after a rhinoplasty? It sounds really uncomfortable.
After Rhinoplasty Surgery Will I Need Nasal Packing?
Doctor Answers 14
Want to know the most significant complaint we hear...
Want to know the most significant complaint we hear about after Rhinoplasty surgery? It’s not pain, pressure, headache, or even discomfort. In fact, rhinoplasty is rarely very painful. The symptom we hear about most is nasal congestion.
Most surgeons still use some form of packing or splint in the nose after surgery to reduce bleeding. These can either be merocel, ribbon gauze, xeroform or a variety of other forms of packing. The end result unfortunately is more discomfort for the patient.
While not being able to breathe through your nose is not earth-shattering, it is extremely annoying. Think of it like a bad head cold that lasts. So, anything we can do to prevent this symptom is meaningful to you, and therefore important to us. And the biggest thing we can do to help, is to avoid nasal packing altogether.
Packing is routinely used by some to help prevent excessive bleeding or dripping. We find we almost never need it. By handling tissues exceedingly carefully and gently, we find that we can generally keep bleeding, bruising, and swelling to an absolute minimum…and the benefit to you is an earlier return to breathing through your nose, less blockage from the beginning, and no painful removal of crusted packing.
Nasal packing is only required when the surgery includes work on the nasal septum
The answer to this question is simple. If your nose requires a correction of a deviated septum or your surgeon requires the use of septal cartilage for cosmetic purposes, then your nose may be packed. The septum is the internal cartilaginous structure that devides the nose into the right and left nasal passages. If this structure is bent due to injury or just developed that way, then it could block one or both of your nasal passages. This would lead to difficutly breathing and could be corrected during your cosmetic rhinoplasty. Or your surgeon may just need to harvest the septal cartilage for a graft used as part of the cosmetic changes he is planning for your nose.
Packing is placed whenver septal work is performed to apply pressure and reduce the post-op risk of hemorrhage. If your Rhinoplasty does not have a concurrent septoplasty then packing is not necessary.
Nasal packing after Rhinoplasty
Typically, we don't use nasal packing unless there's an absolute need. It all depends on the amount of work your septum is getting and that is determined at teh time of surgery. Every rhinoplasty is different so you never really know what you're going to end up with when you're talking about details like this one.
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Packing is rarely needed with rhinoplasty
Routine packing of the nose is not required with modern rhinoplasty techniques. Any surgeon who performs rhinoplasty on a regular basis should be able to place dissolving sutures inside the nose (called quilting sutures) that make packing unnecessary.
Over the past 1,000 rhinoplasty procedures that I have performed there was only one patient who required overnight nasal packing due to persistent oozing.
Packing is very uncomfortable when it is inside the nose, and even more uncomfortable when it is being pulled out with you awake! There are other major risks with nasal packing, such as toxic shock syndrome and obstructive sleep apnea.
After rhinoplasty surgery will I need nasal packing?
Nasal Packing After Rhinoplasty
In almost all cases of rhinoplasty you can avoid packing the nose, which translates into a much more comfortable recovery for the patient. I have not 'packed' the nose in over 7 years now. In the past, this was done commonly to help minimize chances of bleeding the early recovery phase and to help encourage the internal lining of the nose to heal quicker. In most cases of septoplasty and rhinoplasty, an absorbable suture can be used inside of the nose to accomplish the same goal - obviating the need for packing.
As with any rule though, there are those exceptions. If the surgeon encounters bleeding unresponsive to normal techniques, it needs to be controlled with placement of packing. Fortunately, this is quite rare.
Placing packing in the nose depends on the surgeon's preference. While the term "packing" often reminds patients of a long string placed in the nose after surgery as done in the "old days" and often told stories of removing large amounts of gauze.
However, surgeons sometimes place small pieces of cotton in the nostrils that are not uncomfortable and barely felt. Removal is often easy and painless. The purpose of the small cotton ball is to prevent any drainage during the first night. This is usually worthwhile for the patient.
Nasal packing not required - depends on surgeon preference
The decision to pack your nose after Rhinoplasty will depend on the surgeon's preference. In my opinion nasal packing is very uncomfortable for patients and not necessary. For this reason I NEVER pack my noses after rhinoplasty whether it be a comsetic rhinoplasty, functional nose surgery, or a combination. Instead I use dissolvable sutures on the septum that you will never notice.
Nasal packing after rhinoplasty surgery
I amost never use nasal packing because it is indeed uncomfortable and in my extensive experience, it is unnecessary in most cases. In the rare instance that a patient has a severe nosebleed one week postoperatively, nasal packing would then be indicated.
Nasal packing is a thing of the past for rhinoplasty
I think most surgeons, including myself, don't ever use nasal packing at the time of rhinoplasty and or septoplasty. The only rare exception would be someone abnormally bleeding at the end of the procedure. This has happened to only 1 of my patients out of thousands over the last 13 years.
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.