No packing = nothing at all?

Most surgeons will not "pack" the nose after surgery, as it is decidedly uncomfortable and not needed. "Splints" are commonly used when there have been incisions placed internally that could undesirably heal together and cause webbing or scarring.In my practice, I commonly use soft internal splints when I perform septoplasty as part of a rhinoplasty surgery as it helps keep the septum moist to optimize the early healing period. These splints do not block the nose the way that nasal packing does, and are removed with the external splint within the first week after surgery.Hope this helps,Nick Slenkovich, MD FACS

It is relatively rare for plastic surgeons to "pack" a nose with gauze or other materials, as this tended to cause rare infectious complications.  Now, soft silastic splints are placed that tend to be much more comfortable than packing.  This is usually performed when septal work has been completed and can stabilize the nose into a preferred position. 

Both of your suspicions are correct. In most cases, I put NOTHING in the nose other than sutures. In some cases where the nasal septum is very deviated or a septoplasty is performed with osteotomies of the nasal bones, I will place a thin flexible wafer type splint in the nose to keep the septum from re-deviating and prevent scar tissue formation from the nasal sidewall to the septum. Your surgeon can tell you what they anticipate needing to do for you.

In over 20 years of practice following my fellowship I have not routinely placed nasal packing or splints. I have noted no problems related to this. I feel my patients have a more comfortable post-op experience with out them. There are many different practices however, discuss this with your surgeon at the time of consultation. Good luck.

Dear Yael1Rhinoplasty is a broad term applying to a wide range of procedures. Different parts of the nose are addressed to different degrees. Generally the degree of support/packing used will match the need for stability and support for certain aspects of what was done. In a simple rhinoplasty with dorsal reduction, osteotomies and tip work, not using packing might be ok (I use packing in all my cases). In a complex nose with septal reconstruction and extracorporeal septoplasty, splints and packing are used by most surgeons. In my experience packing serves an important purpose. It stop bleeding into the back of the patients throat in the first 24hrs. Less bleeding seen = less anxietyLess coughing from blood in throat = more stable and safer resultsLess blood in stomach = less nausea, better tolerance of po, hydration and pain management...I, similar to most rhinoplasty surgeons, remove packing on first post-operative day. This gives me the chance to make sure everything is in place, I answer all my patients new questions and the patients packing is removed as soon as its benefits are done (bleeding usually stops within 24hrs of surgery.)

When I perform rhinoplasty surgery, I place internal splints that have a flat surface facing your septum (separation between two nostrils) and a straw-like tube so you can still breathe through your nostrils. This is more comfortable than packing. I remove it after one week.

Some surgeons use some form of packing, some do not.  It probably depends on how much the internal lining (mucosa) is dissected of the underlying structures.  When I do pack, I do so in a limited fashion and remove the packing after 2-3 days.All the Best,Dr. Brian Reagan

"Packing" most likely means the traditional technique of stuffing both sides of the nose using a long role of thin gauze folded onto itself until the nasal space was completely full. I haven't used this approach for many years. If I use anything I either place half a cotton ball covered in petroleum jelly in each nostil to cover the nasal incisions overnight or if the septum needs support, I place a thin silicone rubber splint on each side of the septum for a few days. Neither gives the blocked head pressure feeling go the old packing

Hello Yael1,True packing involved the placement of essentially yards of a threadlike material to keep everything in place and prevent the collection of blood in the middle part of the nose.  This has largely been replaced by carefully placed stitches.  I cannot comment on your doctor but I never place packing and rarely use splints (unless a lot of septal work was required).  If the surgery is predominately for cosmetic rhinoplasty and techniques aren't required to straighten a septum then I don't place the splints either.  If splints are placed surgeons leave them in for different periods of time.  You should clarify what your surgeon has planned although things can change depending on what is seen in the operating room.  I hope this helps and good luck.  

Thank you for your question and in my practice I only use packing to control bleeding if it occurs. In most of my noses there are controlling sutures or flat internal splints - No packing!Dr Corbin