Why So Much Fluctuation in Swelling After Rhinoplasty?

I had a revision rhino approx. 1 mon. ago. When the cast came off from the revision, my nose looked amazing, very happy with the results. My nose now fluctuates in swelling it seems like by the hour! Sometimes it looks wonderful (especially after I tape) and then other times, large and bulbous. I know that swelling can persist for a year or more, but why so much fluctuation? Should I expect the final result to be the bulbous shape I see some hours or the small defined shape I see other times?

Doctor Answers 8

Why So Much Fluctuation in Swelling After Rhinoplasty?

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Revision rhinoplasty tend to have a little more swelling post-operatively. This can go on for up to a year. The tip of the nose is a very confined space, so fluid and blood is not resorbed as quickly as we would like to see.


New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

1 month post revision rhinoplasty

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Thank you for your question!

It is understandable that you are concerned especially with the quick fluctuations after "taping". Changes after rhinoplasties vary with every patient and what you are experiencing is normal especially that swelling takes time to subside as it masks the results of your surgery.

It is important to keep in mind that it is early to pass a judgment. Usually, a year is required before formulating how your nose will be. Even then, your nose will keep shaping itself and to complement your face for better results in the years to come.

My best recommendations at the moment is to be patient, allow nature to take its course and edema subsides for better results. There is no doubt that once the swelling resolves, more definition and shape will be achieved and you should be happier with the results.

Also, it is important that you keep communicating with your surgeon and work as a team together to achieve the best results possible.

Congratulations on your surgery and please remain positive!

Ali Sajjadian, MD FACS

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Swelling fluctuations are normal after rhinoplasty

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At 1 month following rhinoplasty, you are still very early in your recovery. Recovery after rhinoplasty will vary based on the person, characteristics of the nasal tissues and what was done during surgery. Around the 4-6 week mark, most patients are able to appreciate most of the changes from surgery as a significant amount of swelling has resolved. However, it can take somewhere in and around 12-18 months to see the final results. This can take even longer after revision rhinoplasty. The areas with thicker skin in the nose such as the tip, alar rims and radix will require longer to settle.

Also there appears to be a linear decrease in swelling for the first several months followed by a period where the swelling fluctuates (sometimes little or no swelling and other times more swelling) before the nose settles. These fluctuations can be related to heat and perspiration, high salt intake and alcohol consumption as all of these cause changes in the degree your body is hydrated. Taping helps by adding pressure to the nasal skin to drive out the fluid from the tissues.

Again, after 4-6 weeks, although you will continue to notice changes in your nose, they are subtle and imperceptible to most other people. It's hard but important to stay patient during your recovery and to be diligent attending your follow-up appointments with your surgeon.

Swelling Fluctuations Post Revision Rhinoplasty

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Your nose looked good when the cast was removed because the tape and cast did restrict the swelling. After removal of the nasal dressing the swelling frequently gets worse but the frequency and severity will decrease as healing progresses. Temperature, diet, and activities will influence the amount of swelling.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Fluctuations in swelling after rhinoplasty

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As noted by the other responding physicians it is not uncommon for there to be ups and downs with nasal swelling after surgery.  For up to a year after surgery there are lots of inflammatory cells in the wound bed that make the nasal tissues a little unstable from a swelling perspective.  Over time the swelling oscillations will gradually diminish.  Keep your head elevated when you sleep to minimize morning swelling.

Swelling after a rhinoplasty versus a revision rhinoplasty...

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A revision rhinoplasty often has less swelling then a first time rhinoplasty. However, times of the day, the amount of activity and the position of your head relative to the rest of your body can all affect the amount of swelling you have at any given time. One month is still early in the healing stage, most of the swelling typically resolves in 2 to 3 months, depending on the patient.


Fluctuation in swelling

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Fluctuations in swelling of the nose is extremely common in the first few months can be caused by a number of factors

  • Salt intake in diet
  • Temperature (the hotter, the more swelling)
  • Activity (exercise increases swelling)
  • Fluid retention (i.e. menstrual)

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Swelling fluctaution after surgery

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There's not one specific reason why swelling fluctuates after surgery. After secondary surgery it takes a bit longer for the lymphatic system to reconnect because of all the previous scar tissue. Also salt/fluid balance can makes big changes. Finally, head position can affect the swelling. Keep following your surgeon's instructions.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.