What is the typical rhinoplasty recovery like?

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.

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.

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 qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

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

This is a great question that every patient considering a rhinoplasty wants to know. The answer varies from patient to patient based on degree of surgery, revision vs primary surgery, and patient characteristics (thick vs thin skin) but in general:
- Week 1: You'll have a nasal cast, splints in the nose, and sutures underneath the tip of the nose. At this point, most patients complain more of pressure than pain. You will likely be very congested because of the nasal splints. At this stage it is very important to keep the nose clean (q-tips with hydrogen peroxide for nasal crusts, saline sprays to keep the inside of the nose moist, antibiotic ointment to the incisions). We typically have patients take tylenol, motrin, and oxycodone (a stronger pain medication). Patients typically take the oxycodone for around 2-3 days before they feel like they can manage with tylenol and motrin alone. Elevating the head of the bed or sleeping on a few pillows can help the swelling improve and will also keep you from rolling over onto your nose. Avoid nose blowing, bending over, or heavy lifting.
- Week 2: Around 5-7 days after surgery we will remove the nasal cast, splints, and sutures. We recommend eating something the morning of this procedure as some patients can become light headed when removing splints or sutures. After these are removed, patients typically feel a significant relief of the pressure sensation and nasal congestion they had in week one. At this point we switch from the antibiotic ointment to regular vaseline as you no longer need the antibiotic portion. It should be noted that you will experience some "rebound swelling" after removing the cast and splint and it is normal to feel more swollen/congested the day after splint and cast removal, but this will return back to normal over the following few days. At this point we encourage patients to continue to avoid blowing the nose, bending over completely, or heavy lifting (typically for around 4 weeks). Based on how you are feeling, it is okay to return to work at this point with the aforementioned precautions being followed. Some patients will have bruising around the nose or under the eyes which can be treated with arnica ointment or tabs to help resolve more quickly.
Week 3-6: By now, most of the bruising should be resolved. You should continue to use saline sprays and ointment to help with healing. We will typically see you back for a second follow up anywhere from 4-6 weeks after surgery to ensure everything is healing as expected. Around week 6, we have patients switch from vaseline to a scar cream like mederma. We will also clear patients at this point for more strenuous exercise. At this point, alot of swelling will have gone down, but it should be noted that it can take anywhere from 12-18 months for all of the swelling to completely resolve, particularly in the nasal tip. That being said, the majority of the swelling is completed in the first few months, and the subsequent improvement over the follwing several months will only refine the nose further.
Hope this helps and best of luck! Kyle Kimura, MD