13 months post-op - Is this swelling and will it ever go down? (photo)

Question

I am 13 months post op from my septorhinoplasty. This was my first procedure and it was an open rhino. When I got the cast off I was in love with how it looked and that feeling continued for about 4 months, however, after that point up until now, my nose just continues to get larger and larger every month. I was on the table for 12 hours since my doctor changed pretty much everything about my nose. I had a really difficult deviated septum, a large dorsal hump, some crookedness, a high radix, and a droopy/bulbous tip. As of right now, I am still taping which seems to help a little. My nose does appear puffier in the mornings. I massage my nose which makes it super skinny for some time before it “reinflates” again. And overall my entire nose feels like there is a layer of squishy skin on it. I can feel the hard structure underneath when I pressed hard enough. I just really want to know if my nose is still swollen and needs time to shrink down, or if this is it and it’s gonna look like this forever. Because I really want my 4 month post op nose back.

Steven M. Denenberg, MD · Answer

From the photos, it seems that elements of your nose are wider in a way that might be correctable in a revision. Particularly the tip. Three-quarter views could help determine that, because the 3/4 view is often the one that shows tip width best. Someone needs to feel your nose and determine where the cartilages and bones sit, and whether they are the culprits, or whether continued swelling is the culprit.

It's rather unusual to have a lot of swelling at this time, but not impossible. But if it doesn't seem to be getting better month to month, then that's an indication that you're pretty much done with swelling reduction.

My two cents: I'd stop taping it, as I don't think tape does anything good for the nose. And I'd certainly stop massaging it. The digital manipulation could be generating swelling. Leave your nose alone for a month and see whether anything good happens.

I'm sooo curious about your surgery, too! Twelve hours for a primary rhinoplasty?! I personally am very slow, but I've never heard of that!

Guray Yesiladali, MD, FEBOPRAS · Answer

Your question reflects an important awareness of the healing process, and I appreciate the opportunity to offer some guidance. 
Healing can take up to 1.5 years, depending on how the surgery was performed, your skin characteristics, and your genetic healing tendenciesWaiting for the swelling to fully subside is essential before considering any new interventions.
There are ways to help reduce swelling during this period: staying well-hydrated, limiting salt intake, eating potassium-rich foods, walking regularly, drinking green tea, and avoiding alcohol can all make a positive impact. Magnesium supplementation and elevating your legs while resting can also promote better circulation. Bromelain supplements may offer additional help in managing lingering swelling.When you reach the 1.5-year mark, an in-person evaluation by your surgeon will give the clearest insight into your tissue healing and the best next steps, if needed.
Healing unfolds in layers, and final results often reward those who allow the process to complete naturally. A thorough in-person evaluation at the appropriate time will ensure the best path forward for you.
Wishing you a healthy recovery and the very best outcome ahead.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photos Depending on the skin structure, it may take 1 to 1.5 years for the nose to take its full shape. If you can send us your photos in the right light from the side profile, we can make a more accurate evaluation.
It would be better face to face consultation.
Best Regards!

Andrew Miller, MD · Answer

Your surgeon should be able to feel the tip of the nose to see what the wideness is from. If it's simply from skin, there's not much to do, although your earlier photo doesn't look like it's primarily a skin issue. If the cartilage is still wide, then a revision may be necessary. It may be useful to get a couple other opinions on the matter as well.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting. Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months after surgery and continue as needed. With that being said, the final outcome will really depend on the surgical techniques that your surgeon used during your surgery. I recommend that you maintain close follow up with your surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Eric M. Joseph, MD · Answer

We always tell our patients, when your 10:00 pm nose becomes your 10:00 am nose, that is when you know that all of your swelling has dissipated. Since your surgery was an extraordinary amount of time, and since you are noticing fluctuations, in all likelihood, this is still swelling. You should certainly discuss these concerns with your surgeon, or it may be helpful to get a second opinion from another reputable rhinoplasty specialist. Thank you for this question. Sincerely, Dr Joseph

Mats Hagstrom, MD (license on probation) · Answer

At 13 months, it’s unlikely you still have swelling and inflammation.
All tissues have interstitial fluid that can be squeezed out, compressing the tissues.
This is true for all tissue.
To make a quality assessment if we need quality information.
This is best conveyed by having proper before, and after pictures at different time intervals.
Ask your provider to forward a complete set of before and after pictures for each of your postop visits.
Your providers also the correct person to follow up with regarding your outcome.
My best guess is that it’s unlikely your results are going to change by waiting a further.
If you want any further changes to your nose, you’ll most likely need a revision procedure.
Without seeing you before and after we can’t really make a good assessment.
Best,
Mats Hagstrom MD

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