Rhinoplasty Recovery Time and Downtime?

SWELLING

The nose undergoes significant changes in the first 2 to 12 weeks following rhinoplasty. The swelling gradually dissipates over the first several months and thus the appearance of the nose changes gradually.


When the cast is removed after one week, the nose will look swollen.



Usually by the end of the second week, the swelling and bruising have subsided enough that the casual observer will not readily notice that the nose has been operated on.



To the patient, the nose will look swollen or "puffy" for several months.

By about 3-4 months, the majority of the swelling will be gone but will look larger in photographs.



It can take as long as a year for the final shape to become apparent.



You should give yourself several months if if there are any work or social engagements that would cause concern.


Swelling can persist during this time, particularly in the tip and over the area where a boney hump was removed. Following a hump removal during a rhinoplasty, it is very common for there to be excessive swelling over the central portion of the nasal bridge overlying the area where the boney hump was removed. This area often appears more swollen that the rest of the bridge and can remain swollen for several months. As a result, patients frequently worry that the bump will be permanent.

Taping the bridge of the nose and the supratip area (area above the tip) can significantly reduce postoperative edema (swelling). Gentle pressure from the tape does two things. First, it can help 'press' out some of the swelling that results from trapped fluid in the tissues. Secondly, and perhaps more importantly, pressure on the tissues causes the collagen fibers in scar tissue to become more organized, which reduces the volume of the swollen area.The most effective for taping is in the first six months after surgery. You should still get a benefit even if you havent started taping until 2 months after surgery.

It is very common for rhinoplasty patients to report (in the first several weeks after surgery) that their upper lip feels stiff and that it is difficult for them to smile. Fortunately, this resolves by itself in the first several weeks after surgery as the swelling subsides. Be patient, your smile should return to normal.

BRUISING

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.



Sun exposure in the first several months following rhinoplasty can cause the skin of the nose to become red or "splotchy". It can also predispose you to getting sunburned more easily. For the first several months after rhinoplasty, patients should wear sunscreen and/or a hat to prevent the above mentioned problems.


CAST / SPLINT / PACKING

Surgeons frequently place an external splint on the exterior of the nose after surgery. The casta can help preserve the operative result and also can aid in reducing swelling. Most surgeons leave the cast in place for one week.

Thank you for your question. An entire book can
be written about recovery from rhinoplasty. In summary, each person's
rhinoplasty recovery is a little different, and is influenced by exactly what
is done during your nasal surgery. Nasal swelling following rhinoplasty is
normal and should be anticipated. In most cases, the majority of the nasal swelling
is improved by the end of the first week. However, some degree of swelling
persists for about 12-24 months. The nasal dressing (taping and/or splint) are
usually removed after 1 week. Nasal congestion is the most reported complaint
during the first week. Most people use pain medications for a few days to help
minimize their discomfort. Rhinoplasty patients typically resume public
appearances and return to work after about one week and are generally pleased
with their nasal appearance by about 2-3 weeks.

For the most part, all sutures and splints will be removed one week after your rhinoplasty. You can expect swelling to subside in the following pattern:

1) Upper third of your nose: by about 3 months

2) Middle third of your nose: by about 6 months

3) Lower third of your nose: between 9 and 12 months.

Average rhinoplasty recovery time as follows:

My casts come off between the third and seventh day.
Patients may fly on the eighth day if they are returning to a home destination.
Patients may resume all normal activity by the one month.

Naturally, there are deviations from this but after 26 years of experience that is the usual recovery time.

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery in Frisco, TX:
Great question — understanding the recovery process helps set realistic expectations and ensures a smoother experience.
 

Hello and thank you for your question. The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting. Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months after surgery and continue as needed. Most patients are able to return to work and resume exercise one week after surgery. I recommend that you maintain close follow up with your surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

I would say the average recovery time, in terms of going out in public, is about 2 weeks, though it should be noted that each patient is unique and may heal at a different rate. Also of importance, the nose will continue to change over the following 12-18 months (depending on primary vs revision) as swelling resolves slowly over time so there is a great deal of patience required before you reach the "final product". Bandages typically come off at the first week after surgery (including any non-absorbable sutures).

After rhinoplasty you will have a bandage on your nose. I leave it on for one week. Most patients can be seen at this time but may need some coverup makeup for the bruising.

I perform rhinoplasty as a day case and there is no nasty packing to be removed. One week post op the splint and sutures are removed. If no nasal bone fractures were needed than you're already looking good! With fractures there is usually some bruising but once the splint is off makeup can be worn. Mostly people can head out in public a week to 10 days post-op. Of course there is still plenty of swelling at this stage.

Great question! The splint usually comes off at one week after surgery (both external and internal splits if both were placed). You should be able to go out in public after a week, accepting that there may still be some swelling and bruising around the eyes. At one week, bruising can be covered with concealer. If the bones are broken during your rhinoplasty, there may be more bruising.

Hello,
Thank you for your question. Although everyone has slightly different recoveries, I usually tell most my patients that they can expect to be back at work after the cast and stitches are removed on day 7 after surgery. Some people will still have bruising at that time, which can be concealed with cover up. Most of the significant bruising and swelling subsides by weeks 2-3. For appropriate patients, I can often perform a "rapid recovery rhinoplasty" in which I avoid breaking the nasal bones. This can lead to a shortened recovery time. In patients where that's not possible, I often incorporate medications and supplements that assist in reducing recovery times. After 3 weeks, there will still be some changes to the nose that occurs over the next year, but those are small changes that most people will not notice.
I hope this helps!
Dr. G
Dominick J Gadaleta, MDDG Facial Plastic SurgeryPalo Alto, CA