How do you tell if shifted nose grafts, caused damage? Conflicting advice?

Why is it that I hear one doctor say to limit facial movement including laughing, excessive chewing, grimacing etc. because it can move around grafts and sutures?? but my surgeon said chewing, laughing etc. wont affect my results in the long-term... I'm confused... I laughed a lot after I got my rhinoplasty while my splints were still in-did I do damage or not? and how can I tell??

Doctor Answers 6

Shifted Nose Grafts

Dear Vanetzviaan in Orange County, California:      Generally, facial movements will not affect the position of grafted cartilage.  Cartilage tends to stay quite well put, even if it is not sutured into place.  The splint down the nose protects the relocated cartilage during the first 5 critical days.  By that point nature has somewhat started to weld tissues together to hold everything into place.  Do not worry about disturbing the cartilage after surgery because you laugh.  You did not harm yourself.  If the result is imperfect, it may just be due to the technique and the effect of nature upon healing.       I would recommend that you do some consultations and get the situation checked out with highly specialized, long-experienced surgeons whose practice is nearly exclusively rhinoplasty, both primary and secondary.  Be sure the check out the possibility of having nonsurgical revision rhinoplasty, either temporary or permanent. You want to do your homework before consultation.  Prepare well for your consultation.  When you search, look for rhinoplasty super-specialists.  These are surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and related procedures.  This would include both primary and revision rhinoplasty surgery.  Why not have the most specialized talent in your service?  Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the education continues. Part of your preparation for consultation should be preparing a list of questions beforehand.  Bring a notepad or ipad or laptop with you and take notes as the surgeon answers the question you are asking.  You should spend more time with the surgeon than with the office administrative staff, because you need to get a sense of whether you are comfortable with the doctor.  You should not feel rushed that you are on a consultation conveyer belt.  If the presentation by the office staff seems a bit to “salesie” that is a bit of a yellow or red light.  Take a friend or relative along since two heads are better than one in gaining information and understanding.  In the end, the purpose of the consultation is for you to be educated and be comfortable, not to be “ sold”.  Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my life and my face into this particular surgeon’s hands? Can I trust him/her?” There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have.  When you visit doctor’s websites, the most important feature on the site is the before and after gallery.  If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries.  There need to be dozens and dozens of examples.  The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours.  Look closely at the photos for natural results.  That is what you want.  Nobody wants to carry a sign saying “I have had a rhinoplasty.”      Reviews on review sites, particularly RealSelf are very important and should be carefully digested. The larger the number of reviews the most accurate the picture of the practice and particularly the doctor. A consensus is generally correct.      A consultation without computer imaging is, in my opinion, of much less value.  Why shouldn’t you see the predicted result of the procedure the doctor is proposing?  At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on the nasal surgeons input.  Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, in the doctor’s opinion, achievable.  After all, cosmetic surgery is 100% visual.  It is about appearance, so without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied.  Talking about it is worthless.  To anticipate a successful outcome, there must be a meeting of the minds between surgeon and patient.  Best wishes,
Robert Kotler, MD, FACS Over 4,500 nasal procedures performed

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 86 reviews

Shifting grafts

normal facial movements should not cause the grafts to shift.  I recommend following your surgeon's recommendations.  I doubt you have done any damage simply by laughing.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Limiting Facial Movement after Rhinoplasty

My best advice is to follow the recommendations of the surgeon you trusted to operate on your face. Post operative activities should not be influenced by the advice of surgeons who have never seen you.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Recovering from rhinoplasty: smiling and restrictions

Recovering from rhinoplasty is a healing process. Your surgeon wants you to have both an excellent surgery and recovery period. Many of the restrictions after rhinoplasty may seem like too much. These guidelines are trying to cover all patients. A few patients may chew, laugh, or make facial expressions in an exaggerated fashion that may potentially put stress on the healing nose. You can't keep your face completely, as you need to breath, eat, and talk.  
The point is do your best. If you have questions or concerns, bring them up with your surgeon so they can answer or address them as early as possible for a safe and happy outcome. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Shifting of cartilaginous graft in the nose after a rhinoplasty

Laughing and smiling will not affect the shape of the nose or cause cartilage grafts to shift, move, or migrate. Cartilage grafts are typically placed in a precise pocket and sewn in place. Its always  best to check with your operative surgeon

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews


it is very doubtful that the normal activities of life short of unexpected trauma would affect the results of your surgery but a quick exam by your surgeon should relieve your anxieties
Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 61 reviews

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.