Bad Smell from Left over Suture in Nose, When Will This Go Away?

I read that some patients get "bad smells" coming from their nostrils when not all the sutures in the nose is removed/dissolved even years after their rhinoplasty. After some time when they finally remove/"blow" the suture out, the smell disappears. Is that true?

Doctor Answers 1

Bad smell after rhinoplasty (usually NOT due to suture).

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Dissolving sutures used in rhinoplasty are all dissolved and "gone" within weeks after surgery in most all cases; even "long-lasting" dissolving sutures are gone in a few months. Only permanent sutures remain in place "years after rhinoplasty." While bacteria-contaminated permanent sutures can indeed cause nasal odor, a much more common cause of this is exposed bone edges (mucosa not covering the bone) that have become bacterial growth areas that inhibit healing and self-perpetuate because of this.

Sinusitis or sinus infections can also cause nasal odor; this is seen after some rhinoplasty operations since swelling can block the openings that drain the sinuses. Antibiotics can be the appropriate treatment for this.

But long-term chronic nasal odor without the other symptoms of sinusitis is often the result of surgically-caused exposed bone edges that become contaminated/low level infected by bacteria, which cause the odor. Eventually the dead bone rots away (sorry for the graphic terminology), the mucosa heals over, and the odor finally goes away.

Or, your surgeon can locate the area of incomplete healing (often from a partial turbinectomy or turbinoplasty, or from a septal bone edge--vomer or ethmoid--that occured during septoplasty) and remove the contaminated dead bone that will allow the mucosa to finally heal over this area. If the septum is the culprit, however, septal perforation can occur, so this is not a "slam dunk" procedure.

Thus, the smell is usually from bacteria-contaminated bone, not sutures, and the "cure" is either time, or removal of the offending area. BTW, antibiotics won't work since dead bone edges have no blood flow and no way for the antibiotics to get to the area of concern.

If you have nasal odor after rhinoplasty, antibiotics are not unreasonable, as there can also be sinusitis or frank sinus infection eminently treatable with antibiotics. But your description sounds more like the bone edge problem discussed above. Ask your surgeon! Best wishes! Dr. Tholen


Minneapolis Plastic Surgeon
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