I had rhinoplasty done 6 months ago & I'm concerned about the swelling & my nose tip, that area is really swollen also. On the side view you can also see that the tip is somewhat swollen and I was wondering if this is permanent? There's also just one other concern, from the front view you can see that on the left side my nose bridge is wider than my right side and it doesn't meet up correctly with the middle of my nose. This makes my nose look strange in photos. Can you please advise?
Uneven and Swollen Nose After Rhinoplasty - What Can I Do?
Doctor Answers (14)
Swelling after Rhinoplasty (Nose Job): Wait one year
Swelling after rhinoplasty is normal and expected. It can last for well over 6 months and beyond one year depending on what was done and what type of skin you have. If you had an open rhinoplasty with a lot of internal cartilage grafting and/or if your skin thick, your swelling may be persistent. This may be reduced by taping at night or a series of dilute steroid injections, however a tincture of time may be all it takes for things to get better. I would return to your rhinoplasty surgeon to discuss any additional post-operative treatments they would recommend.
I hope this helps.
Poor Rhinoplasty Results
One of the questions that patients often have is what is swelling that will go away and what is permanent. At 6 months for a first surgery, what you see is primarily what you have permanently.
There are a number of issues with the aesthetics of your nose. Some of these problems are easy to fix and some are not. The appearance of the tip is the result of two things: an inadequate removal of septal cartilage and an over-resection of tip cartilage. Ideally, in the aesthetics of the profile view on a woman, there is a slight difference in contour between the tip cartilage and the septal cartilage. This is known as the supra-tip break. On your profile, there is none. This is easy to fix. The other problem is an over-resection of the lower lateral cartilage leading to the nostrils elevating too much. It is easiest to appreciate this on the side view. We are seeing too much of the center part of your nose. This is hard to fix. As for your other concern, the appearance of the nasal sidewalls may be the result of your upper lateral cartilage position but I doubt it. I think what happened is that when your surgeon repositioned the nasal bones, the break was incomplete and the bony part of the nose is still crooked. This is generally fairly easy to fix.
What are your options now? This is where getting to a good revision rhinoplasty surgeon will make a great deal of difference. There are essentially three options: do nothing, fix the problems or camouflage the problems. Make sure you take some time to think about what is best for you before proceeding.
Swelling in the tip following rhinoplasty
It can take up to a year or longer for the last bit of swelling to resolve in the nose following open or endonasal (closed) rhinoplasty. This is not to say that the nose looks unattractive during this period but rather that there is a gradual and subtle refinement of the nose, particularly the tip and the area just above the tip. I would not worry at the 6 month point as you still have some months to go in the process.
The issue you are describing along the bridge of your nose has to do with the position of the upper lateral cartilage on this left side and its relationship to your septum and left nasal bone. It appears from your photo that this left upper lateral cartilage is slightly medialized, meaning it is closer to your septum than the right upper lateral cartilage. This issue can affect your ability to breathe as well. If this problem persists as your nose continues to heal, this can be addressed in revision surgery by placing a small piece of cartilage (a spreader graft) to push this cartilage back out to its original position. Ideally there should be an uninterrupted, smooth line from the head of your eyebrow, along the side of the bridge, and down to each side of the nasal tip.
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Assymetry after Rhinoplasty
In general, most rhinoplasty results are "there" after six months. However, I have some patients which require additional 6 months of waiting, before the final result is evident. Only your surgeon can determine this.
It is also very common for patients to look at themselves a lot more after cosmetic surgery. Looking at your photos, I do not see any major asymmetry which is distracting. You should look at your before photos and you will see your nose was not perfectly symmetrical before surgery as well.
Nasal irregularities and asymmetry s/p rhinoplasty
At six months most of the swelling is gone, but it can take as long as 2-3 years for all of the swelling to resolve. You should bring this to the attention of your rhinoplasty surgeon so this can be monitored. Sometimes if you tape the nose (with paper tape) overnight, the edema may be squeezed out and in the morning you may have a better idea of what the nose will look like.
Swelling following Rhinoplasty is Normal
I advise my rhinoplasty patients that after surgery they will most likely experience some noticeable swelling that will subside within two to six weeks. Patients should know some minor swelling can remain for as long as a year, and their nasal contour may continue to change. Final results may not be seen until that year mark. Many of the asymmetries that patients notice during the healing process prove to be a result of this residual swelling.
At 6 months you often start seeing the final form of the nose, but it stillmay take a while for this all to resolve. I would give it another 6 months.
by 6 months post op, your swelling at this point is basically resolved. If you are not satisfied with your result, I would bring this to the attention of your surgeon as this most likely would require a revision to address your concerns.
Swelling after rhinoplasty
It is understandable that you are concerned. Changes after rhinoplasties vary with every patient and what you are experiencing is normal especially that swelling takes time to subside as it masks the results of your surgery.
Unfortunately, with the pictures posted, the lack of surgical details and the inability to perform a physical exam it is not possible to provide you with a definitive answer that could be medically sound.
It is important to keep in mind that it is early to pass a judgement. Usually, a year is required before formulating how your nose will be. Even then, your nose will keep shaping itself and to complement your face for better results in the years to come.
My best recommendations at the moment is to be patient, allow nature to take its course and edema subsides for better results. There is no doubt that once the swelling subsides, more definition and shape will be achieved and you should be happier with the results.
Also, it is important that you keep communicating with your surgeon and work as a team together to achieve the best results possible.
Congratulations on your surgery and please remain positive!
Ali Sajjadian, MD FACS
Partial V deformity
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.