What is the typical rhinoplasty recovery like? What can I expect? How long after a nose job does it take to heal and how long before you can go back to work, the swelling goes down, etc?
Doctor Answers 202
Recovering from rhinoplasty is not as bad as you may think!
Like any surgery, Rhinoplasty is a little bit different for everybody. That’s why it is useful, and we encourage you, to talk to others who’ve had the procedure to get a sense of their experience. There are some common themes though, as far as recovery goes.
Whatever technique is used, you can expect to have some dull aching and headache afterwards for a short time. In the absence of an infection or other problem, severe pain is very uncommon. Most of our patients may take some pain medication for the first day or two after surgery and then are usually feeling well enough to switch to Tylenol or other non-narcotic pain medication.
The most obvious and slightly annoying symptom after rhinoplasty is congestion. Because there is internal swelling in your nose, you will experience some congestion in the first few weeks afterward, until the swelling slowly subsides. This is usually at its worst in the first few days after surgery and then starts to get better.
Some patients who had major breathing problems before surgery will notice an improvement immediately after surgery, even with all the swelling. Others may take some more time to start noticing the positive changes. Those of you who did not have breathing problems to begin with will probably notice this congestion more.
It can sometimes interfere with sleep in the first few nights after surgery and so, a light sleep aid is often provided. It is helpful in the first weeks after rhinoplasty to avoid dry environments and nasal irritants, and to use a saline (salt water) spray and some ointment in your nose several times a day as necessary to help with dryness and crusting. But, you should avoid blowing your nose until your doctor says it’s OK to do so.
Swelling and bruising on the outside of your nose and cheeks is seen after surgery as well. This can sometimes be moderate and sometimes almost non-existent, but usually falls somewhere in the middle of those extremes. The extent of bruising and swelling depends on your body, on what was done, and on how carefully your tissues were handled. If it was necessary to fracture your nasal bones to move them inwards, your chances for bruising are a little higher. Even in the worst cases, bruising is usually mostly gone by 7 days or so after surgery. Your doctor may advise some remedies or herbal medication to help with bruising, but don’t take anything without first consulting him or her.
Most patients plan to take about a week from work and other major activities. You will usually have a cast on your nose and you may have some stitches that need to be removed. This is all usually done about 5 to 7 days after surgery. While you’re probably going to feel well enough to work after a few days, you may not want to be seen with the cast on. Some patients work from home and other brave souls throw caution to the wind and just go in to work with the cast and all. Once the cast is removed, you will look presentable within 1 to 2 weeks after surgery, although it may be on the longer side of that for a revision procedure. You wouldn’t want to have your wedding the next week, but your friends and colleagues shouldn’t be aware of anything. You can wash your face gently and put on a little cover-up makeup or foundation after one week.
By 2 to 3 weeks after surgery, about 70% of the swelling is gone, so you’ll be starting to appreciate some changes. You won’t really see more of the details, though, until about 6 weeks after surgery when about 80 to 85% of the swelling has gone down. While you’ll be looking pretty good at 2 weeks, you might still feel a little self-conscious. That’s because your nose (especially your tip) will feel a little (or sometimes a lot) numb after surgery, no matter what technique was used. It can take anywhere from several weeks to 6 or more months for the feeling to return completely. For the first 6 weeks or so, your nose just won’t feel like your own. Things like smiling and animated talking will feel strange. You’ll feel the odd strange pulling or twinge of pain if you make a wrong move like rubbing, bumping your nose gently, or rolling over onto your nose. These are unfriendly reminders that you’ve had surgery, but they are all normal and expected parts of the recovery.
Many patients are very afraid that they will do something to harm their result. While it’s true that a major bump in the nose can cause unwanted healing problems, there aren’t too many things you can do to really harm the result, so don’t be too gun-shy about touching your nose. There are some things you can do, however, to speed up healing and get you back into camera-ready shape more quickly. First is to listen to your doctor and follow all the instructions to the letter. They are usually there for a reason. You will probably receive a list of medications and supplements to avoid before and after surgery, and you should follow this advice to avoid unnecessary anaesthetic problems, bleeding and swelling. Keep your head up after surgery. Keep some cool compresses over your eyes and cheeks in the first 48 hours. For a few weeks, avoid bending, lifting anything over a few pounds, exercise, or anything that gets your blood pressure up. This can increase swelling and cause bleeding. Get a lot of sleep. Get outside and take some light walks. Eat well. Stay attuned to your body and alert your surgeon if your healing seems to be different than expected. In the first weeks, things will not look perfect, so try to avoid staring in the mirror or over-analyzing small changes.
Some other symptoms are common in the months after surgery. Your nose may run more easily, especially when irritated. Nasal allergies can be better or worse for a time. Your nose will tend to swell up a little when you exercise or do anything exertional. The skin over your nose can break out more easily and can be more sensitive to sunburn. While all of these things are irritating, they do get better and your nose will return to a more normal state after the inflammation settles fully. It’s important to remember that with each subsequent revision surgery, this entire process of recovery is slowed down somewhat. So, it’s not uncommon to take up to 2 years or more to see some of the changes you seek if you’ve had a revision procedure.
No one will tell you that recovery was a blast. But, most Rhinoplasty patients will tell you that it was very bearable when they knew what to expect. It is the path you have to walk to get to where you want to be. And, hopefully, your surgical team can help make it a little easier for you.
Rhinoplasty Recovery: What to Expect
The "downtime" following rhinoplasty is variable depending on what rhinoplasty techniques are used such as whether the surgery was performed open or closed, whether any tip work was performed, and whether the nasal bones were broken (osteotomies). Patients who undergo open rhinoplasty typically have more edema (swelling) that persists longer compared to patients in whom closed rhinoplasty techniques were used. If the nose was surgically broken by performing osteotomies then there is usually more swelling and bruising.
Patients are generally encouraged to take a week of from work or school. After two weeks, most patients can gradually return to strenuous activities such as exercising.
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 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.
Recovery after rhinoplasty
The recovery after rhinoplasty varies for everyone. However, these are the general guidelines I give to patients.
1. It doesn't hurt as much as you would think. Most patients tell me the rhinoplasty wasn't as painful as they expected.
2. The first day is the most uncomfortable. You might have a little nausea and some discomfort which pain pills will take care of.
3. After about 2-3 days, you will feel pretty good.
4. The tapes and the protective splint need to stay on for at least 7 days. Most people prefer not to go out in public before these come off.
5. You will pretty good after 7 days, although you will still have a little bruising and a lot of swelling.
6. You could return to work after about 7-10 days. Most of your coworkers probably won't even notice you had anything done.
7. I recommend you avoid any important social interactions (wedding, big party, etc) for at least 2-3 weeks in order to allow most of the bruising and swelling to subside.
8. You'll look very close to your final result after about one month. It takes up to 12 months for all of the swelling and minor small changes to heal.
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Rhinoplasty Recovery Takes About Two Weeks-Final Result One Year
Thank you for your question. After Rhinoplasty the external splint comes off between 10-12 days. Bruising can last two to three weeks. Most patients do not complain of pain but complain that the nose is "stopped Up."
Final results, that is the time for the very last of the swelling to resolve and show the details of the new tip, can take a year. You will however look fine and see most of your result by 6 weeks.
You look much worse than you feel during Rhinoplasty recovery
Many patients considering Nasal Cosmetic Surgery have been exposed to a relative or friend who has already completed the procedure. If they have actually seen this individual during the recovery phase of they expect the worst. The post rhinoplasty patients' face is bruised,swollen and they are sporting a characteristic nasal bandage called a splint. If you see someone in this condition naturally you would assume they would also be in lots of pain. Surprisingly, they are not. When I question my post rhinoplasty patients about their intake of pain medicine most have consumed little to none. In fact, facial cosmetic surgery in general is relatively devoid of severe pain. Rhinoplasty patients most often complain of headache type pain and discomfort from nasal congestion. Because the nasal passages become blocked by dry blood and the nasal lining swells it is difficult to initially breath through the nose itself. Patients have to employ mouth breathing in the early going until the nasal passages clear in a week or so.
Within a few days after rhinoplasty most patients would feel well enough to return to a sedentary occupation if they were willing to explain the source of their bruising and nasal splint. But most prefer to hibernate until the telltale signs of the surgery disappear. The splint can be removed by the 5th to 6th day post-op. Bruising is mostly confined to beneath the eyes whereas the nose itself is rarely if ever bruised. This bruising begins to fade from purple to green towards the end of the first week. It is possible to cover the green phase with makeup and get out in public. Naturally there is some variation in the rate at which the bruising recedes depending on the extent of the surgery. Rare cases take two weeks for this to occur.
When you first see your new nose out of the splint you are not looking at a finished product because of tissue swelling that normally accompanies any surgery. The swelling most dramatically affects the width of the nose from bridge to tip. It takes approximately three month to see the final shape minus the swelling.
After one week most patients can return to their daily routines minus athletic endeavors. Exercise routines can commence at two weeks but one should avoid contact sports for six weeks.
Pain requiring narcotic pain medications is usually only significant for a few days after rhinoplasty. Most patients complain of a dull, aching sensation that is present for 2-3 weeks after surgery.
The amount of swelling you will experience depends on whether you have an open versus closed rhinoplasty. In an open procedure, you will have a small incision made across the base of your nose, between the nostrils. This allows your surgeon to elevate the nasal skin from the underlying support structures; because of this, there tends to be more swelling. In a closed rhinoplasty, the incision is not made between the nostrils, thereby allowing swelling to improve much more quickly.
I generally tell patients that they will look "socially unacceptable" for 2-3 weeks after surgery. After two weeks, particularly with an open rhinoplasty, there will still be a significant amount of swelling, but they will have an acceptable appearance for the public. After about 6 weeks, the vast majority of swelling will be gone, but the patient and surgeon will still be able to appreciate some. After 6-12 months, the final result will be apparent.
Hope this helps - best of luck
Immediately after surgery, we typically place...
Immediately after surgery, we typically place steri-strip (tape) followed by a thermoplastic (custom contoured) splint or shell over the nose. Stitches may or may not be present on the columella (the bridge of tissue between the nostrils). I avoid packing the nose, and patients find this much more comfortable.
After about 7 days, all of these are removed.
My general guidelines are (and they may vary by individual):
•No blood thinning medicines for 2 weeks prior and 2 weeks after rhinoplasty (aspirin, ibuprofen, naproxen)
•Week 1: Walking is ok, no bending over or lifting over 8 lbs; return to work OK
•Week 2: Light aerobic exercise is OK (light jogging) but no weight lifting
•Week 4: (ie, after 21 days) No restrictions, excepting contact sports
•Week 7: Contact sports OK
Rhinoplasty Recovery and What to Expect and How to Optimize Yours
Basic tips for planning and preparing for your rhinoplasty and optimizing your recovery:
- Good lifestyle -- a healthy balanced diet with adequate protein and a multivitamin setup your body for healing after surgery.
- Be realistic -- understand that there is no such thing as a perfect result, and that there is always a some possibility that you will have unfavorable results or need some sort of revision
- Time off -- allow adequate time off for your initial recovery (typically 5-15 days for non-strenuous work environments, depending on your level of tollerance for looking like you had an operation)
- Swelling -- I typically remove internal and external splints at 6 days and follow this with 1-2 weeks of self-taping of the nose at night to help reduce swelling
Length of time for Swelling
- 2 weeks -- 80% of swelling is gone
- 6 weeks -- 90% of swelling is gone, but tip swelling is typically still present
- The last 10% takes up to 12 months to go away fully
- Massage -- we have incorporated lymphatic massage into the first visit at 6 days to help reduce swellings
- Moisturization -- this is your homework assignment: do not let the nose dry out and have crusts form. We give out a nasal rinse kit to help you keep the nose clean and moist on the inside
Other things to consider:
- Bruising and "black eyes" are possible, and if you experience this, it may take two weeks or more to fully go away
- Pain is usually not severe
- As with nearly any surgery, you are expected to walk several times each day after surgery
- Return to more vigouros physical activity is generally started around week three
Hope this helps
Nick Slenkovich MD, FACS
After rhinoplasty, a tape dressing and a protective...
After rhinoplasty, a tape dressing and a protective shell will cover the bridge of the nose for 5 to7 days. This nose dressing is kept dry for a week, and Vaseline ointment is placed inside the nostril a few times a day.
No packing is used inside the nose, which means you can breathe through it, but you should still avoid blowing your nose for 2 weeks after surgery.
One week is usually enough time for returning to work and social activities, but some people may need up to 2 weeks. Avoiding strenuous exercise and medications that promote bleeding, such as aspirin and ibuprofen can minimize bruising and swelling.
Most go back to work within a few days of Rhinoplasty
A small splint will be placed on your nose. This splint's purpose is to protect your nose and to keep it stable for at least five to eight days. Some surgeons may use nasal packing to help reduce swelling and bleeding. This packing is placed inside your nose during surgery and removed the morning afterward.
As far as going back to work goes, I have had patients that go back to work the next day and others that take a week off or schedule their surgery during a holiday period so they can be free to recover without work obligations. Many of my patients coordinate their surgeries late in the week and arrange to work from home a day or two and are ready to go back to the office within 3-5 days, granted they are comfortable going to work with their splint on their nose. It seems like more patients are concerned about going back to work with a splint/bruising than actually being uncomfortable after the initial 48 hours, so some prefer to stay home until their splint comes off, but that is a personal choice.
However, come mild to moderate discomfort after your nose reshaping surgery is common. This is usually controlled with your prescribed pain killers. Most people are able to stop taking pain medication within 48 hours of their rhinoplasty. Nausea is also common following surgery, especially if it was done under general anesthesia. Your surgeon can prescribe medication to alleviate your symptoms.
You may also feel extremely stuffed-up after nose surgery. The challenge here is that you should not blow your nose for at least one week. Decongestants may help relieve your stuffiness. Try to avoid decongestants that also contain other active ingredients, as some combination products may contain aspirin or other non-steroidal anti-inflammatory drugs that increase bleeding risk. Ask your surgeon for guidance before taking any medication.
There will be some bruising and swelling in the days and weeks after your nose surgery. You may even develop two black eyes. Try applying cold compresses on the sore areas. Bags of frozen peas or frozen raspberries may also do the trick. Ask your surgeon what else you can do to help minimize swelling and bruising. Some surgeons may recommend homeopathic remedies such as Arnica Montana or bromelain.
Your surgeon will give you specific instruction on how long you need to keep your head elevated after rhinoplasty. You must sleep on your back for a few weeks following surgery to avoid placing any pressure on your nose.
Be careful to avoid any trauma to your nose after your rhinoplasty. This means no contact sports, and you should be careful around small children or pets that may move suddenly when in close proximity. If you are not sure if an activity is permitted, ask your surgeon for guidance.
If you wear glasses, do not wear them for the first three weeks after your cast has been removed. Ask you surgeon for specific instructions about how and when to wear your glasses after your nose surgery. Contact lenses are OK immediately after nose surgery. The opposite is true with eyelid surgery.
Be careful washing your face and make sure to apply sunblock to your nose once your surgeon says it's OK. Your nose will be very sensitive for a while after your rhinoplasty.
Most of the swelling resolves within two weeks, and the rest tends to go away within a month, but it can take up to one year for all the residual swelling to abate. Be patient. You should wait at least one year before considering revision rhinoplasty.
Certain red flags may indicate that your rhinoplasty recovery is not going smoothly. For example, a fever is a sign of infection. It is important to monitor your temperature regularly, and to take your antibiotics as prescribed.
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.