How Do I Minimize Bruising from a Rhinoplasty?

I am considering a nose job but worried about buising after wards. Tips for reducing bruises are really helpful

Doctor Answers 119

Bruising largely depends on how your surgeon does surgery

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Perhaps one of the most frequent fear patients have regarding rhinoplasty is that they will bruise severely and that the bruising will result in them needing extended time off from work and away from friends.

 In our experience, here at Profiles we tell our patients that the vast majority of our patients experience minimal bruising and even those who do experience any bruising are can expect to return to work 6 days after surgery when the nasal cast is removed.

We believe that the most important factor in minimizing our patiens' bruising is your surgeon. After all, bruising in rhinoplasty generally occurs when your surgeon has to make cuts in your nasal bones to narrow the bridge width. Bruising can result from these cuts in the bpne because when making the cuts in your nasal bones your surgeon very often ends up cutting and shredding through the periosteum which covers the upper and lower surfaces of your nasal bones.

 In other words, if your surgeon cuts through the periosteum, which is the major blood supply to your nasal bone, it will bleed into the skin underlying your eyes and cheek and result in extra bruising and swelling . By always taking the extra time to elevate the periosteum when it is necessary to cut the nasal bones, we are able to minimize the trauma to your periosteum and thereby reduce your bruising.

 So the most important factor in how much you bruise is ultimately the care your surgeon takes in doing surgery.

There are also a number of patient factors that can lead to bruising:

 1. Age- older patients tend to have more fragile blood vessels and therefore can bruise slightly more

 2. Bleeding tendencies/disorders- if you, or any family members have any history of excessive bruising or bleeding after procedures or in general, it is important that you discuss this with your surgeon so proper testing can be done

 3. Medications- if you take medications that thin the blood it is important for you todiscuss this with your surgeon who can then make proper arrangements with your primary care doctor

 Finally, there are a number of tips that physicians will recommend in order to limit the extent of bruising and swelling:

 1. Avoid any non essential medications that thin the blood for a minimum of 2 weeks before surgery and do not resume them until your physician directs you to. These medications include (but are not limited to): aspirin, ibuprofen, and many other over the counter anti-inflammatories.

 2. Avoid high dosing any multivitamins/herbal remedies/teas etc that contain high levels of Vitamin E, Ginseng, Ginko and fish oils

 3. Ice packs, or even better, frozen peas, applied to the cheeks for the first 2 days after surgery

 4. Keeping your head elevated will, at least can help reduce swelling and may also decrease bruising

 5. Herbal supplements such as bromelin, papaya extract, vitamin K “oxide” and arnica may be of marginal benefit, but to date there are no well designed studies that show markedly less bruising in those patients who take these or other supplements.

 We hope this helps answer all your questions.

Warm Regards,

Peyman Solieman, MD

Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Rhinoplasty Recovery: Tips for Minimizing Bruising and Swelling

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Bruising and swelling are a normal part of rhinoplasty recovery. They are dependent on several factors related to both the surgical technique and the patient. Techniques that increase bruising and swelling include whether or not the nasal bones were broken (osteotomies), the extent of soft tissue dissection/elevation from the bony-cartilaginous framework, and whether the surgery was performed open or closed. Patient factors include age, skin thickness, nutrition, bleeding tendencies/disorders, and medications that thin the blood.

Obviously, not many of these variables are within the control of the patient; however the extent of the bruising and the severity of swelling can be minimized by following these tips:

  • Avoid any medications that thin the blood for a minimum of 2 weeks before surgery and do not resume them until your physician directs you to. These medications include (but are not limited to): aspirin, ibuprofen, anti-inflammatories, heparin, lovenox, coumadin, plavix.
  • Avoid multivitamins/herbal remedies/teas etc that contain high levels of Vitamin E, Ginseng, Ginko -- these can cause you to bleed more freely.
  • If you have a tendency to bleed or bruise easily, have a history of a bleeding disorder, or have a family member with a bleeding disorder, you should discuss this with your physician before surgery.
  • Ice packs to applied to the cheeks for the first 48 hours
  • Keep you head elevated higher than your heart. This will help minimize the amount of edema (swelling).
  • Avoid smoking
  • Herbal supplements such as bromelin, papaya extract, and arnica may be of benefit, but few studies have proven their effectiveness.

Most of all, be patient. Most of the bruising and swelling will gradually subside over the first one to two weeks after surgery.

Minimizing Bruising After Rhinoplasty

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For two weeks prior to your rhinoplasty surgery, it is important to avoid certain medications and supplements which can increase your risk of bleeding and bruising. In my practice, we give each patient a list of these products at the preoperative visit, which we schedule 2-3 weeks prior to the surgical date. After surgery, we advise you to place crushed ice in a glove and apply this (20 minutes every hour for 48-72 hrs) to the eyes and forehead, where bruising and swelling may occur. Other measures, such as taking arnica montana and bromelain supplements and elevating the head while sleeping, are also highly recommended. 

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Tips you can do to minimize bruising

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1.  Do not take aspirin, wine, alcohol, or multivitamins for 7 days before and after surgery.

2.  After surgery try and sleep with your head elevated for 2-3 days (2 pillows)

3.  Use ice for 30 mins on and 30 mins off after surgery.  There is another product called an Aqua-Cool that really works very well!

4.  Vitamins that help to minimize bruising.  Vitamin K, Vitamin C, Folic acid, Bromelain, Arnica Montana.  Start vitamins 5 days before surgery and take vitamins twice daily for 10 days total.  Vitamins are available at the Vitamin Shoppe

How to minimize bruising after rhinoplasty

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Bruising is staining of the undersurface of the skin with blood that has leaked from the vessels. Unfortunately eyelid skin is the thinnest skin on the human body and can really show the staining underneath very easily (like a window).

In rhinoplasty, the blood that leaks from the break or cut in the nasal bones or from dissection during nasal shaping in the upper third of the nose, will likely show itself on eyelid skin.

Now that we have an understanding of the cause(s), here is what may help minimize bruising.

If your surgeon does not cut or manipulate the bones (osteotomy), then bruising may not even occur at all! However, more often than not, this is needed to balance the gentle shape and contours of the nose. If this is not done, the nose may be too wide and look disproportionate.

Avoid products that can thin your blood and make your vessels more leaky or fragile. There is a long list and many natural herbs can do the same thing. These should be stopped between 1-2 weeks before your surgery date. Here is a very abbreviated list of what to avoid: Aspirin, Ibuprofen, Motrin, Aleve, Naprosen (any NSAIDs) , garlic, vitamin E, and many other herbs.

Quit smoking!!! Not only does this improve healing and swelling but your vessels will become stronger, and cells that fight infection and help break down and dissolve the bleeding or bruising will become stronger.

Some ethnicities that already have dark pigment under their eyes can bruise more heavily and for longer. This can last up to several months. Many believe that the natural pigment itself is a result of weak blood vessels.

Also, ice packs or eye masks and gels can help, along with resting with your head elevated above the level of your heart rather than flat.

The last thing to mention is that when your surgeon handles the tissues (skin, ligaments, cartilage, bone) of your nose gently and with care, bruising can be minimized.

Some vitamins or oral medications that can help healing and bruising, to take before and after your rhinoplasty, are:

Bromelain (pineapple extract), Arnica Montana, B-Complex, and short course of steroids (Medrol Dose Pack).

Bruising after rhinoplasty?

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I find that significant bruising after rhinoplasty is the exception not the rule.  When it does occur it usually lasts for about 1 week and is much improved by the time the splint comes off.  Good luck!

Minimizing Bruising After Rhinoplasty

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As others have discussed. Stay away from medications and herbal/natural supplements that increase your bleeding and bruising risk. Your surgeon should be able to provide you with a list (which is pretty large). Some of my patients also believe in the use of a supplement called Arnica Montana. I'm not sure if it's held up to scientific scrutiny but there are plenty of believers out there and the supplement is relatively inexpensive.

After surgery you should also adhere to icing instructions and your head of bed should be elevated so the swelling dissipates away from the nose. Your bruising will also largely depend on the technique used and your own anatomy. Noses that require precise bony repositioning (osteotomies) will bruise more than those that do not.

Michael Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Follow these tips to reduce bruising after rhinoplasty

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You should stop using anything that can increase the risk of excessive bleeding during and after surgery 1 to 2 weeks before surgery. This includes:

1. Most herbal supplements
2. Fish oil
3. Non steroidal anti inflammatory medications such as aspirin, ibuprofen (Advil Motrin).
4. Vitamin E
5. Foods: Alcohol, garlic

What you can take to reduce bruising and bleeding before, 2 to 7 days before and after:
1. Arnica oral
2. Yunnan (Chinese herb)
3. Bromalin
4. Vitamin K

Ran Y. Rubinstein, MD
200 Stony Brook Court, Newburgh, New York

Board Certified Facial Plastic Surgeon (ABFPRS)
Fellow American Society forLaser Medicine & Surgery (ASLMS)
Clinical Professor New York Presbyterian Hospital
National Education Faculty (physician trainer) for:
Allergan (Botox, Juvederm, Voluma), Galderma (Scultpra, Restylane, Silk),
Cynosure (Cellulaze, Precision Laser Lift)& Solta (Fraxel, Thermage)
Zeltiq( CoolSculpting)

Ran Y. Rubinstein, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 156 reviews

Minimizing Bruising After Rhinoplasty

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The best way to minimize bruising is to discontinue the use of NSAID’s (Advil, Motrin), aspirin, fish oil, vitamin E and any other type of blood thinner seven to ten days prior to surgery. Be sure to make your surgeon aware of all medications you are taking in advance so he can advise you appropriately. Ice-packs can also be utilized on the sides of the nose and cheek area post surgery to reduce bruising and swelling.

How Do I Minimize Bruising from a Rhinoplasty?

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Although swelling is a normal part of healing after rhinoplasty, bruising is less common and more dependent on surgical technique. With surgical technique steps can be taken to reduce the risk of bruising, this includes the methods used to bring the bones inwards (osteotomies), as well as the extent of soft tissue trauma along the nasal bridge and base
In addition there are patient factors that influence bruising including increasing age, ethnicity, relative skin thickness, bleeding disorders, and medications and herbal products that thin the blood.
There are steps that I recommend taking to reduce the chance of bruising occurring with rhinoplasty surgery:
  • Avoid medications that thin the blood for a minimum of 2 weeks before surgery and after the surgery, I give all my patients a comprehensive list of medications to avoid.
  • Avoid herbal remedies that thin the blood for a minimum of 2 weeks before surgery and after the surgery
  • Use of ice packs or cold compresses to the bridge of the nose for 3-days after surgery.

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.