Why Do Some Doctors Use Packing of the Nose and Others Don't?

Not all Rhinoplasty surgeons pack the noses. Some patients required packing some do not .For example, if I performed a Rhinoplasty with septum grafts. I often  do not pack the nose on  these patients . Instead ,I use a nasal sepal splint to immobilized the septum but not nasal packing.

Sometimes in medicine we do things because "that is the way I learned it and it has worked for a long time."  With nasal packing, this is unfortunately the case.  Thankfully, most are going away from it.  Anyone who has had nasal packing realizes that it is torture to have it in place for any period of time and worse when removing it.  The only historical benefit is that the bleeding is worse without the packing.  After surgery my patients have a drip pad placed to catch the oozing that is normal after surgery.  They are instructed to change the dressing as it gets dirty and fills up with the oozing.  It is common to need to change the dressing as much as every 15 minutes on the first night after surgery.  My most common phone call that first night is asking about the oozing.  Most prefer changing a drip pad to having their nose packed.   

There is certainly nothing wrong with placing packing in the nose if it is deemed necessary; in fact there are times when it is to the patient's benefit.  The concept behind packing is to minimize bleeding or prevent a severe nose bleed. If major septal work is performed, I will use some form of packing. However, what causes discomfort is the type and quantity of packing.  The variety I use most commonly is a folded non-stick gauze (Telfa) which slides out easily the next morning.

In cases where no septal work is required, I rarely use packing.  However, since there is no such thing as zero-downtime Rhinoplasty, understand that (usually) your Surgeon wants to do what is in your best interest.  If packing is necessary, consider it a part of that downtime.

Nasal surgeons have used packing of the nose after rhinoplasty and septoplasty procedures for years...the thought being that the compression applied by the packing gauze prevented the dreaded complication of bleeding.

I have not used nasal packing for all of my routine primary rhino/septoplasties for years and occasionally place a septal splint (plastic with holes to breathe thru) with major septal reconstructions. Literature and my personal experience shows that patients who are not packed after surgery are much more comfortable and have less infectious complications that those patients who are packed.

Hope this helps!

Dr. C

During my ENT residency, nearly all patients that underwent nasal surgery were given packing for 1-3 days. During my fellowship in facial plastic surgery (1998), my mentor convinced me it was not necessary. If septal work is performed, a septal quilting stitch is placed: this reduces or eliminates the possibility of a septal hematoma.

Nasal packing breeds infection, causes patient discomfort, and is largely unnecessary for the vast majority of my patients. I don't use it routinely on anyone.

Occasionally (<1%) there is excessive post-surgical nasal bleeding that might necessitate packing.

Good luck with your revision rhinoplasty.

All the best.

This depends on the doctor. We use a strip of paper like product and others use packing. It is for oozing after surgery.

That being said, I still usually use a very light packing over night for most rhinoplasties. This is not absolutely necessary and can be avoided if the patient really does't want packing. The reason I use packing is to absorb the oozing (aka light bleeding) that may last for a few hours after surgery. Another reason is ta ht I use cartilage grafts in the vast majority of rhinoplasties for long lasting support. These grafts are often taken from the septum. A light packing against the septum over night also reduces deeper scabs.
My analogy is that when you have a cut on your finger and you don't use a band-aid there is usually a large scab over the area by the next day. If you use a band-aid, then by the next day all you usually see is a fine dark line where the cut was. The packing acts in a similar manner.

So you trade one night of stuffiness to have less crusting for the next week or two.

When the lining of the septum is elevated and the cartllage is removed, a space that has the potential to collect blood can occur. Packing decreases the tendency by pushing together the seperated linings allowing them to stick together and obliterate the space. If no cartilage is harvested, then the lining will not be separated and no packing is required. Alternatively, the two separate linings can be sewn together like the layers of a quilt blanket and this will eliminate the potential fo blood collecting.

Packing of the nose is an antiquated way of performing a rhinoplasty that was discarded over 20 years ago. Packing in the nose creates lots of pain and pressure because the nasal tissues swell against it. Extensive pain medication will be needed if packing is placed. Many inexperienced rhinoplasty surgeons continue to pack noses. In our 20 years of private practice we have not used packing after nasal surgeries.  

There are different approaches to ensuring a smooth post-operative course after rhinoplasty, and packing the nose may be indicated in certain cases but not others. Sometimes after septoplasty sutures are placed inside the nose to obviate the need for packing.