Post-operative swelling from Rhinoplasty - does it get worse before it gets better? (photos)

Question

I've seen so many versions of my nose is the last 9 weeks, but I liked it best wk 4, does it get worse before it gets better? I'd like to understand a few things: 1. What criteria do surgeons assess if swelling is still present? 2. What is occurring within and beneath the skin that causes the nose to shapeshift during the first 3-4 months? 3. Is it common to see the shape of the "old nose," sometimes bigger, in situations of large reduction to tip as the skin settles over the new structure? Why?

Edwin F. Williams, III, MD · Answer

Thank you for your question. It is very common to have postoperative swelling after rhinoplasty, especially an open rhinoplasty (which it looks like you had). At some points in the healing process, especially early on in the first couple of months, it is normal to have times when it appears more swollen or less swollen. We can tell whether a nose is swollen by the appearance and feeling the tissue. Your body heals by making different types of tissue like collagen that remodels with time. It is not uncommon, especially with thicker skin or bigger operative changes, to continue to see changes and refinements for up to (and sometimes even past) a full year. Best of luck!

Jonathan Kulbersh, MD · Answer

I appreciate your concern, but I assure you that your nose is likely to undergo many changes during the first few months after rhinoplasty. Swelling can persist for up to one full year, so you won't see your final outcome until that time. I encourage you to remain patient, although I know it can be a difficult wait. See how your nose looks at the one-year mark - my guess is you will be much happier with your results at this time.

Kian Karimi, MD, FACS · Answer

Healing and swelling from a rhinoplasty will fluctuate day by day which is why I prepare my patients with the information that it will take a full year to see the final results of your nose. That doesn't mean it will take that long for you to enjoy your nose as you have began to enjoy it already, but you will have what I call good nose days and bad nose days. You can determine if swelling is present due to the softness during palpation. Swelling can occur for many reasons such as too much salt, working out and drawing inflammation to the area, and simply just because your body is still recovering from a surgery. It is completely normal for the nose to appear even bigger after surgery, especially with thick skin, due to swelling. You have more tissue that is inflamed which can cause the nose to look bigger when healing. Once all of the swelling has subsided you should be able to enjoy the nose you and your surgeon agreed on.

Best of luck,
Kian Karimi MD, FACS

Best of luck, 
Kian Karimi MD, FACS

Ricky Sayal, DO · Answer

Hi, 
Your nose will undergo many changes after rhinoplasty. Sometimes, the swelling will be asymmetric depending on your skin thickness etc. The final result should be present around 1 year after the surgery. It is best to consult with your rhinoplasty surgeon as they can best assess your nose , as they have seen it pre-operatively. 
Thank you!

Robert Ciardullo, MD · Answer

Postoperative swelling after rhinoplasty.. Swelling after rhinoplasty is the cause of a great deal of anxiety in many patients following rhinoplasty. Swelling during surgery is also the Factor that makes rhinoplasty so difficult since what the surgeon is seeing on the table is not necessarily what the final product is going to be. The term swelling is used to refer actually to more than one process early in the postoperative. There are really three factors involved. One is actual swelling of the soft tissues. This results from the surgical trauma much as you would get swollen if you were punched in the eye. Swelling is fluid accumulating in the tissue much as water accumulates in a sponge. It makes the tissue expand and look larger. The swelling after surgery is maximal at 48 hours postop. If that gradually goes down and is mostly gone in about 8 weeks .However as the swelling goes down the second factor which we refer to as “swelling“ increases . This factor is scar tissue. The surgery is performed underneath the skin between the skin and the cartilage and bone as the skin then read here’s to the cartilage, and bone and has the bone and Cartlidge heal scar tissue is formed .this develops over the period of 3 to 8 weeks and is maximum at 6 to 8 weeks. The scar tissue that forms in the area above the tip often can change the appearance of the nose and give it a slight convex shape in profile even though the original profile was either straight or slightly concave. The third factor is the original skin of the nose. The skin is not cut during surgery it Has to shrink. thin skin shrinks easily and quickly. Thick skin particularly in the area of the tip and just above the tip called the supratip can take a year or more to shrink , and in people with very thick skin ,three or even up to five years to shrink as much as it is going to. So there are three elements changing the appearance of the nose in the post operative period .Swelling, scar issue, and the skin which is still the skin of the old nose. All these interact in a complicated way which can make the nose at times look a little bit like a cross between the new nose and the old nose. Sometimes an injection of Cortizone is given in the area of the supratip to reduce swelling, dissolve scar tissue, and it can’t even atrophy or shrink normal tissue. Because of all these factors it is usually said that you do not see your final nose till at least one year after surgery particularly the lower halfAnd longer if you have thick skin.

Post-operative swelling from Rhinoplasty - does it get worse before it gets better? (photos)

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