Recovery After a Nose Job That Requires Breaking the Bone

Question

What is recovery like when you have a nose job where the bone is broken in order to reshape the nose?

Umang Mehta, MD · Answer

I get this question all the time from patients. "Doc, do you really have to break my nose?!?"

	First off, a little background... Breaking the nose in rhinoplasty refers to the making of osteotomies, which are thin, controlled, and curved fractures in the nasal bones. These may be done to narrow the nasal bones, straighten them, or to bring them together after a hump is removed.

	There are three types, medial, lateral, and intermediate. Medial osteotomies are made from the center of the bridge of the nose, where the nasal bones end, towards the corner of the eyes. Lateral osteotomies are made along the sides of the nose, where the nasal bones meet the cheeks. And internediate osteotomies are also made along the sides of the nose, closer to the bridge than the lateral osteotomies. Lateral osteotomies are the most common. In all cases the fractures are made very delicately, with a small chisel, from the inside of the nose.  

	As recovery goes, I have found that there is somewhat increased bruising and swelling around the eyes in patients who have osteotomies. This seems to be present for 3 to 4 days following the rhinoplasty, though the swelling and bruising largely subside by day 6 or 7, when the splint is removed. Of course every patient is different but the vast majority look quite presentable between day 8 and 12 following rhinoplasty, whether osteotomies are done or not. Pain is usually mild, regardless of osteotomies, and most patients require pain medication for the first 3-4 days. Icing around the nose, keeping the head elevated, and taking supplements such as arnica montana and bromelain all seem to help minimize bruising. 

	The bottom line is that osteotomies sound scary but are really quite routine and shouldn't deter patients from undergoing a rhinoplasty. Your recovery after nasal surgery is really not bad regardless of whether they are done or not. 

	Best,

	Dr. Mehta

Jacob Sedgh, MD · Answer

In most cases of rhinoplasty there will be some breaking of the bone involved either in the form of the nasal sidewalls or nasal septum. Whether such manipulations of the bone is done or not there will be 1 to 2 weeks of swelling following a nose job, the degree of which can depend on many factors. However, if the bone is broken and reshaped during a rhinoplasty, it usually takes 3 to 6 months for sensitivity and tenderness of that area to resolve.

Burke Robinson, MD, FACS · Answer

Recovery from Rhinoplasty is fairly predictable.  What I tell my patients is there is essentially three phases of recovery.

The first phase is the first week in which they will typically have a bandage on their nose made up of some light brown (flesh colored) tape covered by a firm splint.  The nose is not packed unless there was an issue with bleeding during or at the end of the procedure.  (Packing is extremely rare, given the more contemporary Rhinoplasty techniques now employed as well as the medications utilized in the OR that minimize bleeding.)  Because the nose is not typically packed, the postop pain is minimal, and feels more like congestion from a head cold.  Even if you have zero bruising and swelling, the bandage is a dead giveaway, so most patients lay low socially the first 7 seven days.

At one week, the dressing is delicately removed in the office and the nostrils and skin cleaned.  At this point there is obviously some swelling, and I tell my patients in advance that between the first and sixth week I wouldn't have any keepsake photos taken, but will be fine for their normal day to day activities except for any contact sports.  I advise them not to bump the nose or wear glasses for the first six weeks as the bones heal into their new position.  During that second week they may require some makeup depending on if they bruised, and if so to what degree.  Our Esthetician routinely sees every Rhinoplasty patient at their one week postop appointment, and if some camouflaging is indicated, helps the patient with that.

The last phase is between 6 weeks and one year.  At six weeks, there is typically still a small amount of swelling noted, and is typically in the tip of the nose.  This is swelling that usually only I and the patient are aware of, but not anyone else.  Over the remainder of that year this small amount of swelling waxes and wanes and eventually is permanently gone.  There are no restrictions from glasses or activities after six weeks

Hope you found this answer helpful.  All the best!

Paul S. Nassif, MD · Answer

Following a rhinoplasty where osteotomies are performed, the initial recovery will be around 2 weeks. You will have a hard cast on your nose the first week, and brown paper tape the second week. For the first week, you will be taking it easy. Sleeping with your head elevated and resting throughout the day is important. You will gradually increase activity the second week. When osteotomies are performed, bruising around the eyes will be present for around two weeks. The bruising may last longer depending on the patient. You will want to avoid any strenuous activity for 4-5 weeks. Not sticking to these guidelines will increase swelling and delay your healing time. Thank you and I hope this helps.

Adam Bryce Weinfeld, MD · Answer

Recovery is a patient specific thing

	but in general a rhinoplasty with breaking the bone will take a little while longer to heal than one without.  This is due to a little more bruising and swellling.  But when done well the recovery does not need to be that bad

	This is a generally opinion: one should not avoid Osteotomies just because the recovery might be longer.  If they are needed they are needed and they have a powerful affect on the upper 1/3 of the nose.  You only have one opportunity to do it right the first time - obvious but true.

	 

	Recovery

	one week with splint

	5-10 days of bruising if any is present ( not all rhinoplasty patients have brushing under the eyes)

Thomas A. Lamperti, MD · Answer

The recovery isn't normally very different if you do or don't have controlled bone fractures (osteotomies) done during surgery. You'll have a higher chance of having bruising afterward, but the pain is usually about the same.

Steven Wallach, MD · Answer

Most rhinoplasty requires some controlled fraturing of the nasal bones.  Usualy the recovery is the same. The splint comes off in a week and most bruising goes away in 10-14 days( realistically)

Scott Chapin, MD, FACS · Answer

Sometimes the nasal bones need to be moved or narrowed slightly when performing rhinoplasty. This is rarely perceived by the patient and is not as bad or painful as it sounds. I find that the swelling is socially acceptable within 5 to 7 days following the surgery. About 1 in 5 people will have a small bruise as a result of this.

William B. Rosenblatt, MD · Answer

Recovery is quick with a rhinoplasty weather or not you break the bones. The swelling is the worst at day 3 - it gets progressively better after that. The same for black and blue. Most people are out of work for no more than 5 - 7 days ==. Breaking the bones is very common and does not add to swelling in my patients.

Stephen Weber MD, FACS · Answer

It is difficult to answer your question accurately without knowing exactly what procedure will be performed. If the nasal bones and cut and respositioned to straighten the nose then recovery is fairly straightforward. You require tape and a plastic nasal splint for about one week. You can have swelling and bruising for 2-3 weeks. If a more involved rhinoplasty is performed where a bump is taken off the bridge or the nasal tip is modified then you can experience more prolonged swelling of the nose. In most cases, the majority of swelling has resolved by three months but small amounts of swelling can persist for up to 12 months.
	Thank you for your question.Stephen Weber MD, FACS

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