Uneven and Swollen Nose After Rhinoplasty - What Can I Do?

Question

I had rhinoplasty done 6 months ago & I'm concerned about the swelling & my nose tip, that area is really swollen also. On the side view you can also see that the tip is somewhat swollen and I was wondering if this is permanent? There's also just one other concern, from the front view you can see that on the left side my nose bridge is wider than my right side and it doesn't meet up correctly with the middle of my nose. This makes my nose look strange in photos. Can you please advise?

Andrew P. Trussler, MD · Answer

Swelling after rhinoplasty is normal and expected. It can last for well over 6 months and beyond one year depending on what was done and what type of skin you have. If you had an open rhinoplasty with a lot of internal cartilage grafting and/or if your skin thick, your swelling may be persistent. This may be reduced by taping at night or a series of dilute steroid injections, however a tincture of time may be all it takes for things to get better. I would return to your rhinoplasty surgeon to discuss any additional post-operative treatments they would recommend.

	I hope this helps.

Ali Sajjadian, MD, FACS · Answer

Thank you for your question!It is understandable that you are concerned. Changes after rhinoplasties vary with every patient and what you are experiencing is normal especially that swelling takes time to subside as it masks the results of your surgery.Unfortunately, with the pictures posted, the lack of surgical details and the inability to perform a physical exam it is not possible to provide you with a definitive answer that could be medically sound.It is important to keep in mind that it is early to pass a judgement. Usually, a year is required before formulating how your nose will be. Even then, your nose will keep shaping itself and to complement your face for better results in the years to come.My best recommendations at the moment is to be patient, allow nature to take its course and edema subsides for better results. There is no doubt that once the swelling subsides, more definition and shape will be achieved and you should be happier with the results.Also, it is important that you keep communicating with your surgeon and work as a team together to achieve the best results possible.Congratulations on your surgery and please remain positive!Ali Sajjadian, MD FACS

Jamil Ahmad, MD · Answer

Recovery after rhinoplasty will vary based on the person, characteristics of the nasal tissues and what was done during surgery. Immediately after the splint or cast is removed, it is common for the nose to look more defined. After the compression has been removed, the skin and soft tissues can swell and this can take weeks to months to significantly improve. After rhinoplasty, tip shape is typically the last thing to settle before seeing the final result; this can take 12 months or longer in patients with thick, oily skin. My experience has been that edema may take 18 months or longer to resolve. During this time you will notice that the size of your tip decreases as swelling resolves and subtle details and tip definition appear. Additionally, the tip may descend causing the tip to rotate downwards (depending on what was done during surgery). Around the 4-6 week mark, most patients are able to appreciate most of the changes from surgery as a significant amount of swelling has resolved. However, it can take somewhere in and around 12-18 months to see the final results. The areas with thicker skin in the nose such as the tip, alar rims and radix will require longer to settle. In some cases, swelling can occur asymmetrically where one are is more swollen and takes longer to settle than other areas. It's hard but important to stay patient during your recovery and to be diligent attending your follow-up appointments with your surgeon.

Jerome Edelstein, MD · Answer

In general, swelling after rhinoplasty takes months and months to fully resolve, and the tip generally takes the longest.  You should wait at least a year before considering revision rhinoplasty.

John Michael Thomassen, MD · Answer

I see your concern and it appears the upper lateral cartilage on the right may have separated at the keystone region from the nasal bone.  this can lead to the deformity your notice.  Placing a cartilage spreader graft can help this.  Can you discuss this with your surgeon?  Best wishes.

Ross A. Clevens, MD, FACS · Answer

I advise my rhinoplasty patients that after surgery they will most likely experience some noticeable swelling that will subside within two to six weeks. Patients should know some minor swelling can remain for as long as a year, and their nasal contour may continue to change. Final results may not be seen until that year mark. Many of the asymmetries that patients notice during the healing process prove to be a result of this residual swelling.

Umang Mehta, MD · Answer

It can take up to a year or longer for the last bit of swelling to resolve in the nose following open or endonasal (closed) rhinoplasty. This is not to say that the nose looks unattractive during this period but rather that there is a gradual and subtle refinement of the nose, particularly the tip and the area just above the tip. I would not worry at the 6 month point as you still have some months to go in the process.

	The issue you are describing along the bridge of your nose has to do with the position of the upper lateral cartilage on this left side and its relationship to your septum and left nasal bone. It appears from your photo that this left upper lateral cartilage is slightly medialized, meaning it is closer to your septum than the right upper lateral cartilage. This issue can affect your ability to breathe as well. If this problem persists as your nose continues to heal, this can be addressed in revision surgery by placing a small piece of cartilage (a spreader graft) to push this cartilage back out to its original position. Ideally there should be an uninterrupted, smooth line from the head of your eyebrow, along the side of the bridge, and down to each side of the nasal tip. 

	Best wishes,

	Dr. Mehta

Michael A. Jazayeri, MD · Answer

In general, most rhinoplasty results are "there" after six months.  However, I have some patients which require additional 6 months of waiting, before the final result is evident.  Only your surgeon can determine this.

	It is also very common for patients to look at themselves a lot more after cosmetic surgery.  Looking at your photos, I do not see any major asymmetry which is distracting. You should look at your before photos and you will see your nose was not  perfectly symmetrical before surgery as well.

Steven Wallach, MD · Answer

At 6 months you often start seeing the final form of the nose, but it stillmay take a while for this all to resolve. I would give it another 6 months.

Jack Peterson, MD · Answer

by 6 months post op, your swelling at this point is basically resolved. If you are not satisfied with your result, I would bring this to the attention of your surgeon as this most likely would require a revision to address your concerns.

Uneven and Swollen Nose After Rhinoplasty - What Can I Do?

Answers (16)

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