Will Removing Nose Splint Early Affect Rhinoplasty Results?

Unfortunately, I can state honestly that in the 23 years (as of 2010) I have done rhinoplasty surgery, I have had early splint removal by patients ruin the results--requiring reoperation--in 3 of the 4 patients who admitted they did this. I also believe that I may have caused less-than-perfect results by my own removal of nasal splints earlier than would have otherwise been better. I now leave nasal splints on for ten days in most cases.

Splints are used to hold the nasal skin in place over the surgically-altered support structures--the bones and cartilages--that have been carved, rasped, broken, and repositioned. In one week the tissues have just begun to stick together and heal, and if the splint is taped and/or glued in place to keep it secure, damage may be done even with "careful" removal. Patients who remove their own splint invariably do it incorrectly--they pull the splint away from the skin, which often pulls the skin away from the underlying bones and cartilages. A small amount of bleeding occurs, stops as the blood clots (like a cut or other minor injury), but in the nose this can turn into scar tissue that can leave an unsightly appearance or require re-operation!

If you can't see a difference in your post-operative appearance, then you could have caused loss of support for the new bony position, allowing them to "spring" back out to the old unwanted appearance. Or, you could have removed your swelling-reduction splint, causing swelling, bleeding, or scar tissue to obscure your improvements.

This is not a good thing, and if I were your surgeon I would be very unhappy that you did this to yourself, particularly if you were to later blame a poor result on your surgeon! How much "irritation" do you think you will experience if you need re-operation because of this! Best wishes! Dr. Tholen

Increased nasal bridge width is a frequently seen component
of nasal deformities. Correction of this
problem requires an infracture of the nasal bones.This procedure involves cutting the nasal
bones at their base and moving them in an inward direction. Once this has been accomplished the bones are
held in place with a nasal splint.The
management of nasal splints varies from patient to patient and depends upon the
patient’s specific anatomic deformity. In some cases, nasal splints may not be necessary. In other cases where the nasal bridge is
narrowed, nasal splints may be an absolute necessity. Under these circumstances, premature removal
of the splint may result in spread of the nasal bones. This can adversely impact the surgical
result.It
takes time for nasal bones to heal following an infracture. For this reason, nasal splints are usually
left in place for at least one week following rhinoplasty surgery. This allows time for resolution of swelling
and bone healing. Removal of splints
three days after surgery can result in spread of the nasal bones and a poor
surgical result.For
this reason, it’s important that you contact your surgeon immediately. Your surgeon should be able to determine
whether or not your splint should be replaced. It’s important to realize that post-operative instructions are made for
specific reasons and are rarely optional.

The effect of removing your spint will depend on the techniques that your surgeon used for your nasal surgery. You should schedule and appointment with your surgeon so that he or she can assess your nose and make sure that no negative consequences will arise from removing your splint early.
The external splint is a very important part of preserving your surgical result. Most surgeons place surgical tape/steri-strips on the exterior of the nose. This helps do two very important things: (1) protect the skin from the splint, and (2) most importantly, decrease the amount of swelling. The tape puts mild pressure on the skin envelope and can help prevent a blood pocket (hematoma) from forming between the skin and the nasal framework. When a hematoma develops, the blood is eventually replaced by fibrous tissue (scar tissue) and can distort the nose or add volume to the tip.
On top of the surgical tape, surgeons will put an external splint made of aluminum, plaster, plastic, etc. The purpose of this splint is to protect the nose and hold the nasal bones in position if they were broken.
Internally, most surgeons place some sort of internal splints. The internal splints do several things: (1) put mild pressure on the septum to prevent a septal hematoma, (2) help hold the inside straight during the early healing process, and (3) prevent scar bands from forming from the lateral side of the nasal passage to the septum. These can be soft plastic, silicone, telfa pads. They are left in place for one day to one week depending on the surgeon's preference.

I hate to say it, but taking off the cast early--especially if their are splints or packing in the nose or significant swelling in the nose--may well have permanently affected the final result. Most of the time, the cast and taping are actually critical parts of the final stabilization of the nose. If it were me, I would contact my surgeon immediately about this.

Good question. To be honest I would be disappointed if one of my patients took off the splint too early unless there was an emergency reason for doing it, and that's never happened to me before. You're undergoing an elective operation and the splint helps keep things straight, help with early swelling, and gives some time for the bones to start healing before removal. That being said, it will likely still be ok. I would NOT recommend trying to put on the splint again yourself. You are more likely to do harm and very unlikely to positively influence the outcome. At this point you should just give it time to heal and see how it does. It will most likely be ok assuming you were careful when you removed the splint.
-Dr. David Mattos, New York Plastic Surgical Group