Crooked Nose or Uneven Swelling After Rhinoplasty?

One of the hardest things to do in plastic surgery is correct a deviated or crooked nose. The problem, in many cases, is complex in nature and involves asymmetry of multiple cartilages, asymmetry of the underlying facial skeleton, and deviation of the nasal septum. While correcting all elements in a single surgery is not always possible, significant improvement can be achieved in the vast majority of cases.
Because correcting the deviated nose is, by definition, a more elaborate and aggressive type of operation, there is usually more pronounced swelling afterward than with standard rhinoplasty. This is especially true if the bones required straightening as well. When I perform foundation rhinoplasty, several grafts are used to compensate for these underlying asymmetries. Each graft produces a variable degree of swelling where it was placed.
Although you should be able to see some improvement early on, it is certainly possible that swelling is making your nose appear more crooked than it actually is. At this point, try to be patient and see where things settle. It is likely that you will see an improvement, provided that your chose a surgeon with experience in deviated nasal repair.
For more information about deviated nasal repair, check out the link below.

Hello and thank you for your question. Since you just had your splint removed, you are very swollen and it is difficult to evaluate the results at such an early stage. The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting. Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months after surgery and continue as needed. Most patients are able to return to work and resume exercise one week after surgery. I recommend that you maintain close follow up with your qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for your question and I appreciate your concern. Unfortunately, it is difficult to see what the nose is going to look like for many months after this surgery. It is possible the crookedness you see now is due to swelling as there can be significant swelling for many weeks and even months afterward. I assume you are going in for follow-ups with your surgeon, so I encourage you to bring up your concerns at your next appointment. However, understand that you will not see your complete result for up to 12 months or even a bit longer. At that time, if you are unhappy with your result, you could consider a revision procedure.

Your question is formulated very well since it can be either. Even if there is a genuine underlying problem, swelling can make it appear much worse. Because the support of the nose is elastic in the lower two thirds, swelling creates tensions that can end up distorting the shape. The cartilage of the nose is able to revert some of these temporary asymmetries as the swelling decreases and the soft tissue tensions come down. It usually takes 6-12 weeks for the tensions to decrease but sometimes spontaneous improvement is seen even later.

I would not be alarmed. The cast is usually removed one week after rhinoplasty. Most patients willl experience bruising and swelling that is noticeable to others for 1-2 weeks post-operatively, and it is not uncommon for the bruising or swelling to be uneven. The swelling will gradually subside over the following weeks, though you may notice that your own nose is swollen for another 2-3 months. It often takes one year for healing to be totally complete. 

Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

It is not unusual to have some asymmetry when the cast is removed 1 week after rhinoplasty.  There is usually a lot of swelling and asymmetric swelling is quite common and can be the cause of what you are noticing.  I recommend regular follow up with your surgeon.  The final result from your rhinoplasty won't be visible until 6-12 months after surgery.  If there is still unsatisfactory asymmetry at that point, you should speak with your surgeon about a possible revision.  

Generally speaking, the nose should be straight when the cast is removed. Swelling can give the appearance of crookedness though and it’s very hard to diagnose without an in person examination. Express your concerns to your surgeon.Best

Since you have taken your splint off recently and the nose is still very swollen from the surgery, it is still too early to make any realistic assessments of your post-op situation, let alone think about ulterior corrections.

At this point, you will have to be patient and wait for at least two months to pass, for the primary swelling to go away. After those two months I advise you talk to your surgeon and discuss the results of the surgery – at this point you will have a more realistic idea of what your nose will look like, but keep in mind that the nose shape changes for at least six months and up to a year after the procedure. This period is also the advised period to wait for the revision surgery.

I wish you all the luck with your recovery! 

The nose will never look totally crooked after surgery and be corrected in time! However this is when there is real distortion of the underlying bony-cartilaginous framework, either due to improper surgery or deformation after the surgery. This however is not the main reason for minor asymmetries after the cast is removed. Asymmetrical swelling is usually the reason one may find his/her nose not straight immediately after the cast has come off. Proper management of the edema usually results in resolving of the asymmetry and straightening of the nose.
Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

Dear Tigerfan, It is too soon after your rhinoplasty to assess the final result. Your nose is very swollen the first few months after surgery and can take a full year for all the swelling to resolve. However, it is always best to communicate your concerns with your surgeon. 

Swelling after a rhinoplasty can mask your  final results, especially in the first few months.  Try to be patient and allow some more time for the swelling to resolve.  If you still have concerns, you should discuss these with your surgeon.