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Why Do Some Doctors Use Packing of the Nose and Others Don't?

I've had surgery on my nose and had packing. I am needing a revision rhinoplasty and this doctor is stating he does not need to pack my nose. That this does not need to be done anymore. Is this true? Why do some doctors pack and others don't?

Doctor Answers 17

Packing after nose surgery not necessary

Packing of the nose is an antiquated way of performing a rhinoplasty that was discarded over 20 years ago. Packing in the nose creates lots of pain and pressure because the nasal tissues swell against it. Extensive pain medication will be needed if packing is placed. Many inexperienced rhinoplasty surgeons continue to pack noses. In our 20 years of private practice we have not used packing after nasal surgeries.  

Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

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Why Do Some Doctors Use Packing of the Nose and Others Don't?

Not all Rhinoplasty surgeons pack the noses. Some patients required packing some do not .For example, if I performed a Rhinoplasty with septum grafts. I often  do not pack the nose on  these patients . Instead ,I use a nasal sepal splint to immobilized the septum but not nasal packing.

Jaime Perez, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 37 reviews

Packing the Nose: Sometimes Necessary, Sometimes Not

There is certainly nothing wrong with placing packing in the nose if it is deemed necessary; in fact there are times when it is to the patient's benefit.  The concept behind packing is to minimize bleeding or prevent a severe nose bleed. If major septal work is performed, I will use some form of packing. However, what causes discomfort is the type and quantity of packing.  The variety I use most commonly is a folded non-stick gauze (Telfa) which slides out easily the next morning.

In cases where no septal work is required, I rarely use packing.  However, since there is no such thing as zero-downtime Rhinoplasty, understand that (usually) your Surgeon wants to do what is in your best interest.  If packing is necessary, consider it a part of that downtime.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 45 reviews

Nasal Packing after Rhinoplasty

Although there is nothing wrong with packing after rhinoplasty, I think it is fair to say few surgeons do this any more. Although this was the standard of care many years ago, normally it is not necessary. I use a single piece of telfa overnight to keep the nasal lining in proper position.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Nasal packing after rhinoplasty

There are different approaches to ensuring a smooth post-operative course after rhinoplasty, and packing the nose may be indicated in certain cases but not others. Sometimes after septoplasty sutures are placed inside the nose to obviate the need for packing.

Olivia Hutchinson, MD
New York Plastic Surgeon
5.0 out of 5 stars 6 reviews

No Packing Necessary

Sometimes in medicine we do things because "that is the way I learned it and it has worked for a long time."  With nasal packing, this is unfortunately the case.  Thankfully, most are going away from it.  Anyone who has had nasal packing realizes that it is torture to have it in place for any period of time and worse when removing it.  The only historical benefit is that the bleeding is worse without the packing.  After surgery my patients have a drip pad placed to catch the oozing that is normal after surgery.  They are instructed to change the dressing as it gets dirty and fills up with the oozing.  It is common to need to change the dressing as much as every 15 minutes on the first night after surgery.  My most common phone call that first night is asking about the oozing.  Most prefer changing a drip pad to having their nose packed.   

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 44 reviews

Nose packing after surgery

Nasal surgeons have used packing of the nose after rhinoplasty and septoplasty procedures for years...the thought being that the compression applied by the packing gauze prevented the dreaded complication of bleeding.

I have not used nasal packing for all of my routine primary rhino/septoplasties for years and occasionally place a septal splint (plastic with holes to breathe thru) with major septal reconstructions. Literature and my personal experience shows that patients who are not packed after surgery are much more comfortable and have less infectious complications that those patients who are packed.

Hope this helps!

Dr. C

John Philip Connors III, MD, FACS
Atlanta Plastic Surgeon
5.0 out of 5 stars 21 reviews

Nasal packing is not routinely used after Rhinoplasty Surgery any more.

During my ENT residency, nearly all patients that underwent nasal surgery were given packing for 1-3 days. During my fellowship in facial plastic surgery (1998), my mentor convinced me it was not necessary. If septal work is performed, a septal quilting stitch is placed: this reduces or eliminates the possibility of a septal hematoma.

Nasal packing breeds infection, causes patient discomfort, and is largely unnecessary for the vast majority of my patients. I don't use it routinely on anyone.

Occasionally (<1%) there is excessive post-surgical nasal bleeding that might necessitate packing.

Good luck with your revision rhinoplasty.

All the best.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 302 reviews

Nasal packing

I occasionally use packing in side the nose. This may because I am concerned about bleeding or I want the packing to bolster some of the internal work I have done.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Nasal packing with Rhinoplasty

Packing is not usually necessary if the surgeon uses certain techniques to re-approximate the internal tissues. However, occasionally it is needed for a short time depending on the specific problem and particular nose. Frequently a surgeon will learn one way and never consider another.

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.