What is the Protocol for Fixing Newly Broken Nose?

Can the doctor put a cast/splint of some sort to help it heal straight? If not, do I wait for it to heal and then seek plastic surgery to fix it?

Doctor Answers 16

Nasal Fracture Treatment

The approach your surgeon will take with your nose will depend upon whether the fracture has displaced your nose and if so, how severely. A non-displaced nasal fracture can be observed and it will heal to the same shape it was prior to the injury. If your nose was displaced during the trauma, you will likely have to have the fractures reduced to straighten the nose.
The reduction procedure will also depend upon the degree of displacement you sustained. Your surgeon will decide and discuss this with you. My suggestion is to fix your nose before it heals, if all you want is to have the nose you had before your injury. If you are looking for cosmetic improvements, you can either do it at the same time as the fracture repair, or you may have to delay the surgery until the nose has healed enough to perform cosmetic rhinoplasty.


Chevy Chase Facial Plastic Surgeon
4.7 out of 5 stars 27 reviews

How to treat a newly broken nose

The first thing is to be seen in the Emergency Room or by an ENT/Facial Plastic Surgeon to ensure there is no septal hematoma (i.e. blood trapped underneath the mucosa covering your septal cartilage).  If not diagnosed early, the cartilage will be without a blood supply resulting it dying/absorbing and the bridge collapsed.  This is an easy issue to address, but needs to be diagnosed early i.e. within the first 1-2 days after the injury.

Next is to be seen by an ENT/Facial Plastic Surgeon approximately one week after the trauma.  The reason is that a fractured nose is a clinical diagnosis (i.e. does it look crooked, off center, depressed, etc.) This can’t be determined for 7 days because of the swelling.  Swelling will fool the best of eyes the first week.  X-rays are of NO value in determining a fracture.  If a fracture line is seen on the X-ray, it still can’t tell the surgeon if that is a current fracture, or one from years ago.  The x-ray doesn’t tell the timing, and a CT is the same.

If it is determined that there has been a recent trauma, typically the surgeon will want to perform a closed nasal reduction within the 7-10 day period after the trauma.  During this time frame the swelling is gone, and the bones are now becoming “sticky” as they are starting to heal.  Typically, the patient is taken to the operating room for a very brief (10-15 min) anesthetic, during which time the bones are moved back into their previous anatomic state, absorb-able gauze is placed beneath the nasal bone and a metal splint is placed on the outside to help stabilize the bone to heal in the correct position.

Should the above closed nasal reduction not be successful, the patient is then taken back to the operating room at 6 weeks or any time thereafter to formally re-fracture the nose in a much more controlled manner using osteotomies (similar to delicate chisels) and then properly set with a splint.

Hope you found this answer helpful.  All the best!

Burke Robinson, MD, FACS
Atlanta Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

In many cases a newly broken nose may be repaired with local anesthetic in an office setting.

If the result of your broken nose is a crooked appearance, the nasal skeleton may be repositioned to appear straighter. The key is to be evaluated by a reputable rhinoplasty specialist within the first two weeks following the trauma before the nasal skeleton heals and becomes fixated. Some nasal fractures are severe and surgical intervention may be warranted. Post-traumatic nasal surgery may be performed after all nasal and facial swelling has dissipated.Hope this helps.Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 413 reviews

Broken Nose Treatment

The "textbook" answer is that it should be fixed within the first two weeks before the bones begin to really heal.

However, in my practice I have reduced nasal fractures at every possible time - immediately, 2 days, 2 weeks, 2 years, 20 years! The primary difference is that if the bones have healed, then the fracture lines need to be recreated by "re-breaking" the nose. I have not noticed any difference in the outcomes of these different groups, in my hands.

A surgeon who performs frequent rhinoplasty would find this to be a routine and relatively minor procedure. A general ENT doctor or plastic surgeon who does not perform frequent rhinoplasty, however, may find this to be a challenge.

I always prefer to see a patient with a nasal fracture as soon as possible. That keeps all the options open for them and gives the best chance for the best result.

Daniel G. Becker, MD
Voorhees Facial Plastic Surgeon
4.1 out of 5 stars 22 reviews

Seek attention sooner rather than later!

Nasal fractures occur frequently following facial trauma.When patients have obvious or displaced nasal fractures, they will usually require corrective surgery.Not all nasal fractures require treatment.In some cases, the bones and cartilage aren’t displaced and because of this, surgery isn’t indicated.
When corrective surgery is performed within three weeks of the fracture, closed nasal reduction is performed.This is a relatively simple procedure that re-positions and stabilizes the nasal bones.If repair isn’t done within three weeks of injury, corrections need to be delayed for one year and then a formal rhinoplasty performed.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 193 reviews

Nasal Fracture

The nose should be evaluated as soon as possible after the trauma to rule out a septal hematoma (a blood clot within the septum) which could cause permanent damage to the nasal structure. If present the hematoma should be evacuated immediately. If not, wait about 10 days to determine if there has been a change in nasal appearance or breathing obstruction. If neither has occured, treatment of the fracture is not necessary. With deviation of the nasal bones, they can be manually repositioned without making incisions within the nose. If it is determined there is more severe injury with breathing obstruction or displacement of the cartilagenous structures I would do a comlete rhinoplasty to reduce the fractures. Timing depends on the severity of the injury.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 37 reviews

Nasal bone fracture

A splint will not help it heal straight. If the nose is crooked it must first be reset to straighten it. If the nose is not reset with in the first 10 days, as the nasal bones can be shifted during this time, then usually it is best to wait 3 months.

Sharon Theresa McLaughlin MD
Long Island City Plastic Surgeon

Timing of nasal fracture repair.

There are 3 basic time points in which a nasal fracture can be repaired.

1) Within a few hours after the injury. This is due to the fact that the nose will start to swell, thus making it difficult to assess and modify the nasal contours and position.
2) After several hours and before 2 weeks. During this window, we wait until the swelling has come down and then re-set the bones into their appropriate position.
3) After 8 weeks. If the nose is not repaired within 2 weeks, it is required to wait until the nose has essentially healed prior to re-fracturing and re-setting it.
Keep in mind that it is possible a rhinoplasty will still need to be done as there are a percentage of the patients that will not get a "perfect" result and require a formal procedure.

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.6 out of 5 stars 114 reviews

Fix broken nose within ten days or wait eight weeks

The nose must be evaluated on two fronts: breathing and external appearance.

Assuming there is not major blockage preventing breathing, which is the only bonafide broken nose emergency, either the correction of breathing/appearance is done within the ten days after injury or one waits to operateuntil the bones have welded together, which is usually by eight weeks later.

The cosmetic nasal surgery specialist must perform a complete evaluation at the time of consultation after the accident. Must evaluate the degree of injury to the internal and external support structures. Must also evaluate the swelling since you cannot do the best work until the swelling goes down; typically that is within one week.

After ten days, that first window of repair opportunity is lost because the bones start to heal in whatever position they are in. So, the surgeon waits until the next appropriate time which is at the eight week mark by which time the bones are solid enough to be re-positioned.

You must understand that often, despite the best talent, there is a need for a touch-up after the original procedure, whether within that first window or later. This is because Nature can be unpredictable and set down some extra bone which might present as a little bump that was not present prior to the injury.

Finally, it is helpful to the surgeon if you bring photos of your appearance prior to accident. The doctor needs to know what your nose was like orignally.

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 85 reviews

3 times for correction

I fix broken noses at three different time - 1 at the time of injury if there is little swelling - if swolen, I wait 7 to 14 days and do a closed reduction. If you have waited longer than 2 to 3 weeks before seeing a doctor, I wait until it heals and then fix it with and open reduction at 3 months.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

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.