Asymmetrical Swelling or Bad Rhinoplasty?

Question

I just had a rhinoplasty with septoplasty and turbinate reduction on June 21st. Now, it is 3 weeks later, and my nose looks REALLY crooked. The tip was definitely a looked crooked before surgery, but now it looks more so! And my tip is still rock hard and swollen. The doctor doesn’t seem worried, but I am. He gave my an injection in the tip at my 2-week check-up 5 days ago. I don’t notice any change yet.I am so sick about this. Professional opinions please?

Anil R. Shah, MD · Answer

Hello,Asymmetric nostrils can be a result of several issues including: 
Deviated septum- a deviated central portion can contribute
Asymmetric facial structure- Almost every person’s face is asymmetric and imbalance can lead to difference in nostril appearance
Asymmetric nasal cartilage structure- Natural noses as well as those operated on can have asymmetry resulting in nostril asymmetry
Facial muscle imbalance- Some patients will have a dominant side that they smile or express on leading to imbalance.  Dynamic change (change which happens while expressing) is often a result of muscular imbalance.
Rhinoplasty can be used to make nostrils appear more symmetrical but it is almost impossible to make nostrils exactly the same.  Improvement and not perfection should be the goal.
Best, 
Dr. Anil Shah

Jeff Angobaldo, MD · Answer

Thank

you for submitting your question. Your very early in your recovery from
 a rhinoplasty. Swelling after a rhinoplasty, with 
tip and septal work will last for a year. Swelling can cause temporary asymmetry. Discuss your 
concerns
 with your surgeon and follow his/her advise. Best wishes

Jerome Edelstein, MD · Answer

In general, swelling after rhinoplasty takes months and months to fully resolve. You'll notice your nose is swollen at the moment. The initial swelling may disappear after 2 weeks, but that doesn't mean you still don't have any swelling right now. You should wait at least a year before considering revision rhinoplasty.

Sam Naficy, MD, FACS · Answer

Three weeks post surgery is still very early for you to judge the results of your surgery - be patient and follow up with your surgeon

Toby Mayer, MD · Answer

Having said that wait about 6 months and if the deviation and hump are still there return to your surgeon and if you are not satisfied seek a second opinion from an experienced revision rhinoplasty surgeon.

Raghu Athre, MD · Answer

I agree with Dr.'s Eppley and Bentkover.3 weeks after surgery is too early to tell.  I am not going to call this old-fashioned.  It is just the way the nose is.  Only the surgeon know what grafts were placed, how much inter operative bleeding existed, what the nose looked like on the table, etc.  Relax…  I would reassess at 6 weeks post operative and again at 3 mos after surgery.

Peter E. Johnson, MD · Answer

At two weeks, it can be hard to tell how things will sort out and steroid injections at two weeks seems meddlesome if a sound surgical plan was followed. It can be reassuring if you used computer imaging to help plan nasal changes as you and your surgeon will have a clear idea as to how things are to be. Wait six months, and if your nose is not what you hope for seek a second opinion.
	Best of luck,
	peterejohnsonmd

Barry L. Eppley, MD, DMD · Answer

During the recovery phase from a rhinoplasty, the hardest thing to have is patience. While three weeks to you is understandably an eternity, when it comes to getting the final result from a rhinoplasty you are just getting started. If you read the forums here on Real Self on Rhinoplasty, you will see that the most consistent question or concern after surgery is swelling and/or asymmetry. Whatever your result may be, it is impossible to predict now and the only thing you know for sure is that it will change...in most cases for the better. Even though it is not the answer a patient wants to hear, six months after rhinoplasty is the time to critically assess where you are. And revisional surgery, if needed, will not be performed by most plastic surgeons until one year after the original procedure.

Michael L. Schwartz, MD · Answer

You are very swollen and too early in the process to be seeking other opinions. Trust your doctor as he/she is the only one who knows what was done at this time. You have at least 3-6 months of healing ahead where you are going to see changes.

Michel Siegel, MD · Answer

It appears that you have some collapse of the lateral walls on your tip, causing the asymmetry. This may be from the position of the cartilage, or if too much cartilage was removed. Steroid injections will not solve this issue.

	As far as the bridge it is hard to tell since you are only 3 wks from surgery. It is common to see asymmetries after surgery. If the asymmetry is related to swelling time will solve this.  Swelling is part of the surgical post op course, and steroid injections may work for specific areas, but not for the entire area involved. There are potential side effects to them as well so judicious use should be kept in mind.

	Your best option is too allow the swelling to decrease, and monitor the progress. No treatment at this time.

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