Nose Job Two Years Ago...got Hit Pretty Hard Yesterday?

Hello, and sorry to hear about the issue you are experiencing. An exam would really be necessary to give you the best advice. I would recommend speaking with your surgeon right away and have them look at the area. I hope this helps, and I wish you the best of luck.

An acute injury after prior rhinoplasty must be evaluated by a doctor, and preferably by your last surgeon or a rhinoplasty specialist, as soon as possible. If there is a fracture, then a closed nasal fracture reduction is typically performed 4 to 7 days after the injury to allow for acute swelling to dissipate. Any residual deficits that may persist after fracture reduction is typically addressed six months or more later in a formal reconstructive rhinoplasty.

After a rhinoplasty the nose is considerably weakened. The healing process slowly strengths the nose until it reaches close to its original strength. It never completely achieves 100%, so it take slightly less force to create the same degree of damage. As most of the healing is essentially completed at a year after surgery, any injury beyond this time has a bout the same chance of damage as an un-operated nose. 

After two years, your nose is healed and should be able to withstand minor trauma without fracturing.  While it is possible that you broke your nose, it is unlikely to have happened from your dog's paw.  It is more likely that you have swelling related to the cut on your nose.  I would follow up with your previous surgeon who can give you better advice on your injury.  Best of luck and thank you for question.

 

 

However, if you do break your nose after a prior nosejob it may be harder to get straight, so you will need to go to your original doctor or a rhinoplasty specialist.

Noses may be swollen, even asymmetrically after nasal trauma. To determine if the nose is or was broken an X-Ray is helpful. Unfortunately if you have had a prior nosejob, the X-Ray will always show a shadow since it was likely broken as part of the surgey. So, it if's really crooked and wasn't prior to the trauma, it's broken. If it's only slightly asymmetric or just swollen, wait until the swelling goes down to tell.

    Asymmetric swelling can be a concern for possible fracture after trauma.  To give yourself peace of mind, see a plastic surgeon for an exam.  There may be nothing to do at all.  Kenneth Hughes, MD Los Angeles, CA

If your nose looks straight and feels stable when you touch it you are probably fine, you may need to ice and let the swelling resolve for a few days before you can judge deviation.  Odds are you are fine.  Good luck!  Dr K

Thanks for the question. At two years out from rhinoplasty, if you are not seeing a deviation of the nasal bones, there is probably not a clinically significant nasal fracture (broken nose). Basically, the nasal bones take around 6-8 weeks to heal after rhinoplasty, after which time, I clear my patients to return to contact sports. During this initial period, relatively minor trauma to the nose could cause the nasal bones to shift. Once this period of time has passed, the nasal bones essentially return to their initial strength and it takes a fair bit of force to fracture the nose.

Icing your nose for the first 48-72 hours and sleeping with your head elevated will help reduce the swelling after trauma to the nose. If your nose looks crooked after the swelling diminishes, it would be a good idea to get in to see your plastic surgeon within the first week or two, as the nasal bones can be straightened with what's called a closed reduction, in which the nasal bones are pushed back into place from the outside. This is possible within the first few weeks after the fracture, before the bones heal again. It can be done in the office under local anesthesia or at a surgery center with light sedation. If you wait too long, a reconstructive rhinoplasty may be necessary, to refracture the nasal bones to straighten them.

Best of luck. Hope you feel better soon!

Dr. Mehta

You should see your doctor to have them examine the cut and the inside of your nose and septum.  In order to know if there were any changes to the outside shape of your nose, you need to wait and allow the swelling to go down.  In the meantime, you can help the swelling by applying ice and keeping your head elevated on a few pillows when you sleep.  After the swelling has subsided, the shape of your nose can be better examined by your doctor.

The easiest thing to do is to see your plastic surgeon.  In all liklihood it is only swelling and nothing more.  If concerned he may order a set of x-rays and if the fracture is displaced (if there is one at all) he may set it and nothing more.  Call if only to ease your mind.