Explain post open surgery pain?

Although I perform most primary rhinoplasties using the endonasal (closed) approach, the level of pain does not appear to depend much on the technique used. Rather, if a previous nasal fracture requires advanced work involving the bones of nose and septum, a dull ache may linger longer than in the "normal" rhinoplasty. 

The big driving factor that causes pain after a rhinoplasty is if the surgeon places packing inside the nose. Packing is painful and has not been used in our practice in over 20  years. Stents placed in the nose are also not required in our practice. Closed rhinoplasty is less invasive than open rhinoplasty, however the pain is probably about the same between both procedures.

Rhinoplasty surgery is usually not very painful. If bones are broken, that area can ache for a day to a few days, but usually even that pain isn't bad. Head elevation is important to minimize the risk of bleeding and swelling, which also helps minimize pain after surgery.From what my own patients say, an open rhinoplasty is no more painful than a closed one. If no bony work is done, the pain level can be very little.Most importantly, find a good board-certified plastic surgeon or facial plastic surgeon with good before-and-after photos. He/she can discuss your goals and then articulate an operative plan. I would choose the procedure that would best help you achieve your goals without worrying about the level of pain.An open rhinoplasty has the advantage that the structures can be visualized directly. In some instances a closed approach is appropriate, but there are others in which the open approach allows the surgeon to see the structures best and alter them as needed. Click on the link below to see an open rhinoplasty case. Early on the area is swollen and the scar pink, but it heals extremely well. It would be unusual to have a noticeable scar after healing. Good luck!

Postoperative pain depends on numerous issues, including the extent of surgery and the individual's tolerance to pain.  Not all rhinoplasties are the same, but I find that patients who experience the most discomfort are those who have a lot of bony work (e.g. osteotomies to narrow the upper part of the nose) along with extensive septal work.  I have not found that there is necessarily a difference between "open" (external) and "closed" (endonasal) approaches.  Most importantly, at worst, all patients get through the process just fine.  Best of luck with your surgery.

In my experience the pain after surgery is not necessarily related to the technique.  The skin comes back easily and is not on tension.  Damage to the skin is rare and more common in a severely traumatized nose.  The bones have very few nerve endings so osteotomies to move the bones is not a major factor in post op pain. Many patients are uncomfortable for 2-3 days after surgery.  Patients who are anxious about the surgery have more pain. Routine pain medications like oxycodone are generally sufficient.  You should go over all these questions with your chosen surgeon.