4 Months Post-op Rhinoplasty Nose Tip Still Bulbous, Could it Still be Swollen?

I hear and read this question alot.  There is a difference between swelling and "shrink wrapping"  The swelling goes a way after 3 months or so.  But, the skin takes a much longer time, a year or two, before it contracts around the underlying cartilages.  That is what takes a very long time.  You may hear and read that the "swelling" can go on for a year, and in some cases, where the nose appears bigger in the am than the pm that is the case, the vast majority of the time it is simply that the nasal skin has yet to maximally contract.  I hope this helps you.  Best, 

Dr. Miller

Swelling after any rhinoplasty persists for one year or more. Especially after revision rhinoplasty, swelling may take longer. There are other factors that affect swelling such as thickness of skin, use of cartilage grafting, the condition of the nose at the beginning of the procedure, patient propensity for scarring, number of revisions, length of surgery, among other factors. However, if you see significant deformity in the nose, then it's time for a consultation with a facial plastic surgeon.

The recovery time for rhinoplasty surgery varies from person to person and is also related to many different conditions. I am going to explain this in a systematical approach:
First of all, a nose job shows its final result in 1 year. It sometimes even takes up to 2 years for some patients for their nose to have its final shape post surgery. Typically, you get operated, have your cast removed in 5-7 days and will have your nose swelling start to decline with time. I generally tell my patients that 70% of  swelling will be gone in 1 month, 90% in 3-6 months, 99% in 1 year and 100% in 2 years. However there are some factors contributing to this recovery:
1. Surgery: The technique used and the delicacy the surgeon utilized has a great role in how minimal your swelling will be and how quick your recovery shall be.
2. Skin thickness: The thicker your nasal skin, the longer your swelling takes to go away and hence the longer your recovery period. The thinner your skin is, the shorter this period will be and the quicker you will see your final results.
3. Bleeding: If you have bleeding disorders and/or are operated close to or throughout your menstrual period, you are more prone to swelling and therefore a longer recovery period.
In summary, you will be required to rest for 3-5 days, although you can go out for a coffee to meet friends, have your cast removed in a week after which you can return to your own country (get in a flight) with no trouble. You can start to work immediately after this period in case your job does not imply a risk of trauma to your face.
Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

Hello, It usually takes 1-3 years for the swelling to fully go down after a rhinoplasty. The tip takes the longest time to heal and mold to the new framework because it is the thickest skin of the nose. The skin over the profile is thinner than the skin over the tip. Patience is required during this healing phase. Some alternatives can help with swelling like a steroid shot and anti-inflammatory medicine. Consult with your board certified facial plastic surgeon to see if this an option.All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

I suspect that there is still some swelling present, especially if it changes throughout the day, as you describe. A steroid injection might help regardless. Check with your surgeon.

The fact that your tip is larger in the morning proves that it is still swollen.   The tip of your nose is likely to shrink dramatically during the next several months as swelling further subsides.  My recommendation is against massaging and/or steroid injections at this time, but a double dose of patience will likely help.

Good question. It is early enough after your rhinoplasty that this could all still be due to swelling. Try to be patient. It usually takes at least a year before everything normalizes and you reach your final rhinoplasty result. Steroids can sometimes be helpful in the first six months if the nose is very swollen and hard. This is decided by the surgeon on a case by case basis.
-Dr. David Mattos, New York Plastic Surgical Group

Each
rhinoplasty procedure can lead to the buildup of more scar tissue inside the
nose. The final results form a rhinoplasty can be related to the surgeons
experience and the technique used to perform the rhinoplasty.

The tip is no longer swollen, though there is scar tissue as the tip fully heals and the skin conforms and it really can take up to a year. As long as there is stiffness in the tip, the scar is not mature, and as it does the tip will continue to improve and shrink in over time.
Best of luck, peterejohnsonmd.com

Thank you for your question.

The tissues of the nasal tip hold fluid for a very long time after surgery. Also, the skin of the tip of the nose must gradually shrink after surgery to refine a bulbous tip.

It is very true that most experienced Rhinoplasty surgeons recommend waiting a year to see the final tip result. If you wait you may be pleasantly surprised.

The fact that you are more swollen in the morning suggests that fluid build up is a problem.

Ask your surgeon about massage and taping to improve the process.