When Should Cast Be Removed After Rhinoplasty?

Question

Also my cast would be removed 5 days after rhinoplasty surgery. I thought it was a minimum of 7 days after. Was also told I can fly 5-6 days after my surgery. Am I getting positive information?

David C. Pearson, MD · Answer

I tend to leave the cast in place for 6 or 7 days post-op.
As for flying, remember that the cabin is a very dry place, so I recommend the frequent use of a saline (salt water) nasal spray throughout the flight (most bottles are way less than the 3 oz. limit imposed by the TSA). If the flight's longer than about two hours, I also recommend getting up and walking the aisle a few times to minimize the risk of deep vein thrombosis (clots in the deep veins of the legs). But flying after a week should be fine.
All the best,
--DCP

Richard J. Bruneteau, MD · Answer

It’s not unusual for surgeons to use nasal splints following rhinoplasty surgery. These are used to hold the nasal bones in proper position. Nasal splints are typically left in place for about a week following this type of procedure. The majority of patients tolerate splint removal without difficulty
                Travel of any type following rhinoplasty can potentially complicate the post-operative course. In most cases, patients have recovered sufficiently to travel in about seven to ten days following surgery.
  
                Air travel often involves prolonged periods of immobilization and because of this, patients may be at risk for the development of blood clots in their extremities. These blood clots, known as DVT’s can potentially represent life threatening phenomenon when they occur.
  
                In addition, nasal congestion can be extremely uncomfortable when patients fly. For this reason, it’s appropriate to use nasal Afrin before taking off and landing. This maneuver will hopefully minimize nasal edema and relieve nasal congestion.
  
                To avoid complications, it’s important that these issues be discussed with your plastic surgeon. This will dramatically decrease the potential for complications.

Oakley Smith, MD, FRCSC · Answer

But yes, its there for the first week. Why? The usual answers are to protect your new nose and to reduce the post operative swelling. However if you look with a critical eye, a nasal cast doesn't really do either of these functions very well. Its too small to really protect and post operative swelling is more effectively treated by the taping beneath the cast. So the third reason is probably the best; its traditional. Surgeons are by and large conservatives. Surgeons do what they were trained to do, so if your surgeon's teather/mentor used a cast, then your surgeon will too. There's essentially no down-side, unless its a denver metalic cast and then because of its inflexability there's a fractional risk of ischemia and tissue loss. So lie back and relax. There more important issues to focus on.

Paul S. Nassif, MD · Answer

Hello,
With my patients, I have a cast on the nose for the first week, then the nose will have tape on it for the second week. I prefer my patients avoid flying for a minimum of two weeks. Hope this helps answer your question. Thank you and best of luck.
Dr. Nassif

J. Smythe Rich, MD · Answer

Most surgeons use tape and or firm splint or cast for 5 to 7 days. I have patients mold the nose with their fingers (in a mirror) for weeks after. This offers more control of the final shape of the nose, especially asymetry.

Toby Mayer, MD · Answer

Most surgeons leave the cast on for 5-7 days. It is only the preference of each surgeon.
It keeps swelling down and protects against trauma.

Stephen Prendiville, MD · Answer

Most surgeons would agree that casting the nose after Rhinoplasty (especially if osteotomies are performed) is a good idea to protect the nose and serve as a reminder of the procedure. However, the length of time a cast should remain on is more a product of surgeon preference than real science. I typically leave the cast (fiberglass) on for 7 days, after which I tape the nose (brown paper tape) for another week. The nasal bones take a full 6 weeks to heal after osteotomies, so care should be taken during this period postoperatively. I like my patients to remain in town until after the cast is removed, so 1 week of flying restriction is typical.

Scott Trimas, MD · Answer

The cast in rhinoplasty in my opinion serves two main purposes. The first is to keep the swelling down so that it does not shift the bones or grafts for the first five to seven days. The second is to serve as a reminder not to bump your nose. The timing of removal may be more dependent upon the extent of rhinoplasty you are having and if it is smooth and uncomplicated those two days should not make a difference.
The only reason not to fly sooner is because of the risk of bleeding. If you are young and otherwise healthy there probably will not be any issues. However, I will say if you have work done on the inside or there is significant swelling, the flight could be quite miserable before two weeks due to pressure changes and the inability to clear your ears. I hope this information helps.

Michael A. Persky, MD · Answer

Hi Heather,
I remove nasal splints or casts from my rhinoplasty patients at 5 days after surgery (i.e. surgery on Friday, cast off on the following Weds).  It does no harm to leave it on for 7 days. 
I have had patients fly after they had their cast removed, 5 to 7 days after their surgery.
Good luck and be well.
Dr. P

Dean Fardo, MD · Answer

The answer as to when to remove the splint (or cast) should be left up to your doctor. They know what was done and how long it needs to stay on. Sometimes after an infracture (braking) of the nose, the bones are so stable that the cast is only used to help decrease swelling. I would say 5 days is average for many surgeons.

When Should Cast Be Removed After Rhinoplasty?

Answers (19)

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