What is the average rhinoplasty recovery time? When should I expect to be able to go out in public after a nose job, and when will the bandages come off?
Rhinoplasty Recovery Time and Downtime?
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Recovery after Rhinoplasty
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.
- You should give yourself several months if if there are any work or social engagements that would cause concern.
Swelling can persist during this time, particularly in the tip and over the area where a boney hump was removed. Following a hump removal during a rhinoplasty, it is very common for there to be excessive swelling over the central portion of the nasal bridge overlying the area where the boney hump was removed. This area often appears more swollen that the rest of the bridge and can remain swollen for several months. As a result, patients frequently worry that the bump will be permanent.
Taping the bridge of the nose and the supratip area (area above the tip) can significantly reduce postoperative edema (swelling). Gentle pressure from the tape does two things. First, it can help 'press' out some of the swelling that results from trapped fluid in the tissues. Secondly, and perhaps more importantly, pressure on the tissues causes the collagen fibers in scar tissue to become more organized, which reduces the volume of the swollen area.The most effective for taping is in the first six months after surgery. You should still get a benefit even if you havent started taping until 2 months after surgery.
It is very common for rhinoplasty patients to report (in the first several weeks after surgery) that their upper lip feels stiff and that it is difficult for them to smile. Fortunately, this resolves by itself in the first several weeks after surgery as the swelling subsides. Be patient, your smile should return to normal.
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 casta can help preserve the operative result and also can aid in reducing swelling. Most surgeons leave the cast in place for one week.
Rhinoplasty recovery--a detailed timeline.
Until your external splint (plastic, metal, or plaster, usually secured with tape to your cheeks) comes off, it is evident you have had surgery. Most surgeons remove their rhinoplasty splints at 5-10 days after surgery. If your nasal bones have been reshaped (bump removed or upper nose narrowed), you will probably have some degree of periorbital bruising (black eyes) that takes a week or two to resolve. So, unless you will wear cover makeup (women) or "bronzer" (men) to cover your bruising, others can tell you have had surgery and you may want to restrict social outings or return to work for a week or two as well. But let's go back, start at the beginning, and explain all this in more detail:
First of all, make sure you have researched your surgeon carefully. Now that I have over two decades of experience with cosmetic (and reconstructive, though I no longer accept insurance) rhinoplasty, I firmly believe that this is an operation that should only be done by experienced surgeons. Unfortunately, one does not gain experience without doing lots of these procedures and learning how you could have done better. A more senior board-certified plastic surgeon or facial plastic surgeon (ENT) who does lots of cosmetic rhinoplasties is a good starting place.
Once you have your surgical plan, ask your surgeon what type of internal splints, if any, will be used and when they are removed. When septal work is done that requires internal splints, I generally leave them in for two weeks. (These cannot be seen, but they do have an effect on your breathing.) Nasal packs are removed in a day or so (if no or little septal or turbinate surgery) or in 4-5 days if turbinate surgery is done (to allow the mucous membranes to heal before removal.)
Next is the external splint and any tapes or adhesive used. Some surgeons remove the external splint in as little as 4-5 days, but most leave them on for a week. I find that leaving the splint in place for 10 days is a satisfactory compromise between patients wanting their splint off as soon as possible, and me wanting it on longer to reduce the potential for damaging the healing nasal skin. By damage, I mean traumatizing the tissues with splint removal, causing even slight bleeding under the skin, and causing scar tissue or lumps that can require multiple steroid injections over several months to reduce scar lumps and irregularities. In some cases re-operation is necessary! I know this occurs because several of my own patients have removed their own nasal splints, wrecked the nose, and required second or third surgery. I have also removed splints too early (such as for patients who want to travel), and caused less-than-perfect results that perhaps could have been avoided by more caution and patience. This is one of those experience issues that surgeons learn the hard way over many cases and many years.
I advise patients not to blow their nose for three weeks after surgery, in order to ensure that the tissues have durably healed enough to sustain the substantial forces generated by nose-blowing! This is critical to avoid forcing bacteria up into the nasal tissues and potentially causing a very serious infection with nasty bacteria.
Because the nose looks good (and bruising is minimal or gone by two weeks after surgery in most cases) to someone looking at you, but it feels firm and numb to your own touch, you have to be cautious around other people in circumstances where it will not be evident that your nose has not yet healed. This might include crowds, sporting events (spectator only for three weeks), parties, or establishments that sell liquor. Be careful! You should not engage in anything that can raise your blood pressure or cause exertion for 2-3 weeks as well. Even minor bleeding = scar tissue = irregularity or crookedness = unhappy and redo.
Finally, since your nose will be numb for several months to as long as a year, you must avoid sunburn or frostbite, since you won't have the sensation that you need to get away from the heat or cold. You could damage your nasal skin and cause permanent problems if you aren't protective of your new nose until everything has softened and sensation has returned to normal!
Remember the initial caution: find the right surgeon! Good judgment comes from experience. Experience comes from bad judgment!
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Recovery After Rhinoplasty
- Bandage, cast and/or suture removal after 5-7 days. There will still be significant swelling and buising.
- "Restaurant Ready" in about 7-10 days. "Restaurant Ready" is a term used in the industry to mean that you can go out in public without any signs of surgery. There will still be some persisting swelling.
- 75% of your results may be apparent at 3-4 weeks. There will still be some swelling and settling, but at this point, you will have a good idea what the new shape of your nose is.
- 100% of your results should apparent at 9-12 months.
Bruising is another factor that varies from patient to patient and depends on the type of procedure used by your surgeon. You can expect more bruising if bones had to be broken, if a larger portion of cartilage was removed, or if the surgery was an open rhinoplasty.
Supplements and medicines to avoid for about 2 weeks before surgery include any blood thinning medication or aspirin, Ginkgo, ginseng, and Vitamin E. Avoiding these will lower your risk of bruising and swelling.
Keep in mind that these are general guidelines and your individual experience may vary.
I hope this is helpful.
Rhinoplasty recovery time? The truth revealed…
1) What do we mean by recovery? Different aspects of the nose heal at different times.
2) What are the individual factors that influence recovery?
3) What can you do to speed up your recovery?
1) What can I expect 1-week after rhinoplasty surgery, what do we mean by recovery?
• Swelling: 1-week after rhinoplasty 80% of the swelling will have resolved. When the cast over the bridge of your nose is removed after one week, although you will see a change in the shape of your nose it will look swollen. Although the swelling will resolve in most of the nose the fine detail of the nose will not be seen as swelling particularly at the tip and over the bridge of the nose, can persist for some weeks. It is common for the to be swelling over the central part of the nasal bridge where a boney hump was reduced, this may look like a residual bump to the patient soon after the surgery it does however resolve. To the patient, the nose will look swollen or "puffy" for several months and by about 4-months, the majority of the swelling will be gone but will look larger in photographs. The swelling gradually dissipates over the first several months and thus the appearance of the nose changes gradually and it can take as long as a year for the final shape to become apparent.
• Bruising: Most patients have minimal bruising that resolves over 1-2 weeks. Occasionally there can be a marked bruise immediately below the eyes where the skin is very thin, this bruising can take 6-weeks to go, though it can be covered with make up after 1-week.
• Social activities. Most can be restarted after 1-week, there will be some residual bruising and swelling, generally this can be covered up with makeup. An important event such as a wedding, you should allow 6-months as a minimum to allow the great majority of the swelling to have resolved.
• Exercise, as a general rule 3-4 weeks. However if you play contact sports or racket sports these should be avoided for at least 8-weeks to allow the nasal bones to heal. Often the tip of the nose can temporarily swell during exercise for several months after rhinoplasty.
• Activities. Reading, computer work, these kind of low level activities can be started after the surgery and will not affect healing. They are not the same as lifting or strenuous activities that increase blood pressure which have the potential to increase swelling and increase the risk of nose bleeds. Many patients are concerned that they will do something to harm their result. It is true that a major bump on the nose can cause unwanted healing problems and damage the healing nose, otherwise there aren’t many things you can do to really harm the result.
2) What are the individual factors that influence recovery?
• You. If you have any medical conditions like diabetes or high blood pressure, these should be well controlled before rhinoplasty as they effect healing. Environmental factors such as smoking that delay healing, I insist patients stop smoking before and after surgery to improve healing and reduced risks of surgery. Your constitution two people having identical surgery will not heal in the same time, we all heal differently. Mental attitude, cosmetic surgery can be an emotional experience, and having a positive mental attitude goes a long way.
• Surgery. What surgery did you have as not all rhinoplasty is the same, whether the surgery is principally on the tip, the bridge of the nose or revision surgery. Whether you have additional procedures such as narrowing of the nostrils or a chin implant at the same time will effect the recovery. Depending on how much surgery was required influences the amount of bleeding and bruising during the surgery.
• Surgeon. Different surgical techniques influence bruising and swelling include and there are steps in the surgical technique and innovations that can be used to reduce bleeding, such as the use of tissue glue in a patient with known bleeding issues.
3) What are things you can do to speed up recovery?
• Before surgery. I give patients detailed instructions on medications and other treatments that can influence bleeding and should be avoided before surgery. In addition there are herbal medications that should be taken to reduce bleeding, Arnica.
• After surgery. Icing the eyelid for the first three days, resting taking things easy, and head elevating will all aid in reducing bruising and swelling.
• Head Elevation: Sleeping with you head elevated reduces the effect of gravity on the face and reduces swelling of the nose after rhinoplasty
• Sun exposure in the first several months following rhinoplasty can cause the skin of the nose to become red. You should avoid sun exposure, wear hats and high sun protection factor sunscreen for a minimum of 6-months after rhinoplasty.
• Surgeon’s advice. It is important to follow your surgeons’ pre and post-operative instructions in order to heal properly and minimize prolonged recovery.
Most patients need to account for approximately one week to recover from a rhinoplasty. Although not particularly painful the most common complaint it that it’s just hard to breathe though the nose as you recover. While I don't place any packing inside the nose during or after surgery, there is usually scabbing, crusting and swelling of the tissues that blocks one’s airway. Bruising around the eyes is common especially when any bony work has been done and the bones were fractured. The bruising has generally started to fade during the first week, but can take two or more weeks to completely resolve.
At the time of surgery, paper-thin splints are placed inside the nose along the septum and tape and a cast is placed on the outside. The stitches on the inside are all dissolvable. The patient is asked to return at one week and everything is removed. At the one week visit, the nose will still usually appear swollen and bigger than what the patient wants, but will not look strange or obviously bizarre. However, the final cosmetic result may take many weeks or even months to achieve as the swelling resolves and the healing process completes. Once the splints are removed and the cast is taken off, the breathing improves but the person may continue to feel stuffy for several weeks
Every individual is different and the actual rhinoplasty operations differ, so recovery ends up being on a spectrum. The greatest factor for being presentable in public is whether or not you develop "black eyes" after rhinoplasty. This is a bit random, but is more likely to occur if osteotomies are performed and is dependent on your immediate post operative activity levels. (Take it easy for the first 3 days and use cool compresses as directed.) The final result of the rhinoplasty takes around a year to achieve, but you will look quite good well before that:
- First 5-7 days after surgery - Visible splint and tape will be worn on the nose
- Black eyes:
- If present, they will last 2 to 3 weeks, but can usually be effectively covered with makeup 2 weeks after surgery
- If not present, you will be street presentable 10 days after surgery. (New acquaintances will generally not know you had surgery, but people who know you will notice the swelling.)
- By a month, most people who know you will not recognize you had an operation (unless the anatomy change was drastic enough to be noticeable on its own)
- To evaluate the final result, a year needs to pass for the majority of scar maturation to occur and edema to resolve
Things to Do to Reduce Rhinoplasty Recovery Time
This is a great question. The splint will typically comes off in 5-6 days. You will notice an immediate, noticeable improvement in the shape and appearance of the nose. However it will take few months for majority of the swelling to resolve.
Even though, an average patient may have some bruising early on, it typically resolves within a few days. Some specific things that you can do that will help with quicker recovery include 1. taking Arnica tablets, 2. taking pineapple extracts and vitamin C supplements, 4. sleeping with the head of bed elevated, and 5. applying cold compresses for the first few days after the surgery.
Most people are able to do light activity, drive, go to public, and do "office-type work' within a few days.
Full-contact sports should be avoided for 6 months and you can resume light exertion exercises after a few weeks. Following your surgeon's recommendations can greatly enhance your recovery time.
When to Go to a Wedding or Party after your Rhinoplasty
That is a great and very common question. The sutures (if not absorbable), splint (internal and external) are removed around 6 to 7 days. Occasionally I will remove nostril sutures even earlier to improve scarring.
Bruising and the initial major swelling should be gone by 10 to 14 days. Average bruising under the eyes is improved enough to be covered by makeup at 7 days.
Then comes the actual recovery for how the nose starts to achieve its final "look". Initially, most patients can attend a wedding or major social event by 4 to 6 weeks. I have had models and actresses be able to take their new headshot photos as early as 6 weeks! Everyone heals differently. There are taping, molding, and steroid injection protocols I follow in my office that also help speed up the final shaping.
Then the major milestones in healing are at 3 months, 6 months, 9 months and finally one year.
You can expect a lot of changes the first few weeks after Rhinoplasty
The cast usually comes off after a week. At that time in the healing process, there will still be bruising, usually under the eyes. This lasts 2 weeks, regardless of the amount. And this varies from none to some, depending on whether the bones needed to be broken. The nose and surrounding chheks, upper lip and eyes will be swollen too. However the swelling will last much longer than the bruising. Not all the swelling will be gone for up to 6 months. That's a long time! However a good half will have resolved in 2 months or so. And at that time you can seen the underlying structure appearing and should be able to recognize the improvements. Even after all the swelling is gone, the nose can shift and settle a small degree for up to another year. However these changes are subtle and likely no one but you and your surgeon would be able to recognize this.