Solutions for Long-term Swelling After Rhinoplasty?

Tara
Thank you for your question. I would like to know exactly where on your nose you have the swelling - I am assuming that most of the swelling is around the tip and top of the nose. Soft tissue swelling of the nose 20 years after a rhinoplasty is most likely due to vascular congestion. I see many noses with numerous large blood vessels in the soft tissue over the tip and dorsum. These vessels can become congested and cause the soft tissue to swell. It is also possible that after a reduction rhinoplasty excess soft tissue and sub-dermal fat was never properly addressed during the first rhinoplasty - creating a persistent supra-tip fullness or deformity. The third possibility is that you have rhinophyma - an inflammatory condition of the soft tissue and skin of the nose and face caused by rosacea. This condition may be totally unrelated to your first rhinoplasty.
The good news is that many of these conditions can be treated successfully. If you can provide high resolution photographs of your nose, this can help make the diagnosis.

The swelling in and around the nose and the visual changes on a day-to-day basis, have to do with fluid retention in the nasal tip. Surgery will not correct this and will only make it worse. Make sure that you are on a low salt diet and that allergies are under control. You do not need a revision rhinoplasty.

It would be very unusual for you to have swelling 20 years after surgery. It is not uncommon to have some persistent mild swelling for one to two years folllowing rhinoplasty. It is more likely that there is an anatomical issue that still bothers you.
You should seek a consultation with a rhinoplasty specialist to further evaluate your nose and give you some advice.