How do I minimize bruising from a rhinoplasty?

If you are an easy bruiser you will probably bruise after a rhinoplasty.  There are a few guidelines:

• To minimize bruising, you should avoid any/all medications and supplements on this list http://www.seattlerhinoplasty.com/html/pdfs/pre-op_instructions/Meds_to_avoid.pdf
• Avoid bending or straining after surgery
• Avoid nose blowing
• Treat nause so you don't end up vomiting
• Keep your head elevated
• Use cold compresses

The best way to minimize bruising is to take preventative measures.   Patients must refrain from any aspirin, aspirin-containing compounds, ibuprofen, Vitamin E, blood thinning medications or herbal supplements two weeks prior to the surgery.    The bruising is caused from blood that extravasates out into the skin.   Bruising will dissipate in approximately ten days after the surgery. 

Bruising is staining of the undersurface of the skin with blood that has leaked from the vessels. Unfortunately eyelid skin is the thinnest skin on the human body and can really show the staining underneath very easily (like a window). In rhinoplasty, the blood that leaks from the break or cut in the nasal bones or from dissection during nasal shaping in the upper third of the nose, will likely show itself on eyelid skin.

Now that we have an understanding of the cause(s), here is what may help minimize bruising.

• If your surgeon does not cut or manipulate the bones (osteotomy), then bruising may not even occur at all! However, more often than not, this is needed to balance the gentle shape and contours of the nose. If this is not done, the nose may be too wide and look disproportionate.

• Avoid products that can thin your blood and make your vessels more leaky or fragile. There is a long list and many natural herbs can do the same thing. These should be stopped between 1-2 weeks before your surgery date. Here is a very abbreviated list of what to avoid: Aspirin, Ibuprofen, Motrin, Aleve, Naprosen (any NSAIDs) , garlic, vitamin E, and many other herbs.

• Quit smoking!!! Not only does this improve healing and swelling but your vessels will become stronger, and cells that fight infection and help break down and dissolve the bleeding or bruising will become stronger.

• Some ethnicities that already have dark pigment under their eyes can bruise more heavily and for longer. This can last up to several months. Many believe that the natural pigment itself is a result of weak blood vessels.

• Also, ice packs or eye masks and gels can help, along with resting with your head elevated above the level of your heart rather than flat.

• The last thing to mention is that when your surgeon handles the tissues (skin, ligaments, cartilage, bone) of your nose gently and with care, bruising can be minimized.

Some vitamins or oral medications that can help healing and bruising, to take before and after your rhinoplasty, are:

• Bromelain (pineapple extract), Arnica Montana, B-Complex, and short course of steroids (Medrol Dose Pack).

To minimise the appearance of bruises, I advise the following:

• Avoid blood-thinning tablets (e.g. Aspirin, neurofen, ibuprofen etc.) 2 - 3 weeks pre-op

• Take arnica tablets 4 days pre-op only

• Sleep with head up (i.e. 2-3 pillows) for 1 week after operation

Although bruising and swelling is almost inevitable after rhinoplasty, there are measures one can take to minimize the amount of bruising and swelling.

I really think that sleeping at 45 degrees for the first week in addition to using a Medrol dose pack and Arnica cream 3 times a day helps minimize bruising and swelling after a rhinoplasty.