Crooked Nose Four Months After Rhinoplasty?

You will still be swollen 4 months after your rhinoplasty, and it is not abnormal to have some irregularities. The final result may not be evident for 18-24 months after surgery. 70% of the swelling is resolved after the first 3 months, and the remainder goes down over time. While you are healing, I would recommend communicating any concerns with your surgeon. He/she knows the extent of your procedure and exactly what was performed. Every patient heals differently, and after you have healed your surgeon will be able to provide you with advice regarding whether or not you are a candidate for a touch up. I hope this helps, and I wish you the best of luck with your recovery. 

At this point it is a bit early to draw conclusions about the final appearance and contour of the nose.  If the irregularities you feel eventually do become visible once the swelling goes away, a small revision may be helpful to create better symmetry and smoothness to your nose.  Remember, the dorsum, because it is linear with distinct light/shadow border, is an "unforgiving" area.  That is, even small imperfections can be discerned because the eye is sensitive to interruptions of a straight line. Small adjustments in this area are generally readily performed in a revision, however.

Irregularities under the skin are fairly common after rhinoplasty. This usually gets better with time as things heal, but they may not go away completely.

During nasal reshaping surgery, it is never possible to create a perfectly smooth structure of bone and cartilage over the nasaL bridge, particularly when the dorsum is reduced.  In the majority of cases, however, the irregularities are minor and fortunately camouflaged by the overlying soft tissues.  During the first several months, as the soft tissue swelling subsides, these irregularities may or may not become visible.  If at 1 year postop, they are visible you can proceed with a minor revision procedure to correct them should you desire to do so.

Mario J. Imola, MD, DDS, FRCSC.

Post operative swelling and healing of the nasal bone after a rhinoplasty are normal.  Sometimes you will feel an irregularity but it does not visually appear abnormal.   In this case just give it time and it should get better.  Bring it to your plastic surgeon's attention at your next follow up visit.