Is Packing the Nose Needed After Rhinoplasty and Septoplasty?

Why do some pack the nose afterwards and some don't? My daughter is considering a Rhinoplasty and Septoplasty and we're swondering what the pros and cons of packing the nose are and whether or not it is necessary and beneficial.

Doctor Answers 6

Nasal packing may not be necessary after septoplasty and rhinoplasty surgery.

We do not routinely use nasal packing after rhinoplasty and septoplasty surgery. Nasal packing may breed infection, and having nasal packing is uncomfortable, and may lead to excessive bruising postoperative. Hope this helps you. Dr Joseph

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 reviews

Rhinoplasty Recovery: Splints, Casts, & Packing

Internal Splints:

Inside the nose, most surgeons place some sort of internal splints after rhinoplasty. 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.

Many patient's have heard horror stories of surgeons "packing" the nose after nasal surgery -- 1 to 3 feet of gauze packed into each side of the nose. As you can imagine, this would cause complete nasal obstruction and pressure and pain. Fortunately, this practice has largely been replaced by the above mentioned splints that are much more comfortable and do allow some degree of air to pass around them.

External Splints

The external splint is an 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
  2. 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.

Discuss your concerns with any prospective surgeon. Ask lots of questions -- not only about the surgery -- but also what you can expect during the recovery period.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 147 reviews

Packing is not needed.

Packing of the nose has been out of vogue for over 20 years. The only reason to pack the nose is for a sudden nosebleed that will not stop with other methods. Packing the nose is painful, and stronger narcotics will then be required if packing is in place. Antibiotics will also have to be taken if packing is placed to prevent toxic shock syndrome. There is no reason to pack a nose after a septoplasty or a rhinoplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

There is packing.....and then there is packing.

Packing should be kept to a small piece to help control bleeding, not to do the surgery. This requires only a small piece of Telfa, not the old method of long strips of gauze! 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

It depends on what is seen during nasal surgery

No one likes packing the nose. Not the patient or the surgeon. It makes breathing more difficult and is uncomfortable for the patient. In general, most surgeons will avoid using it if they don't need it.

However, sometimes when we are fixing the septum, we realize that the septum is much more deviated than we thought. Or, sometimes, we have to do extra things in order to make it more straight. In these cases, we may need to pack the one or both nostrils to support the delicate septum during the healing process.

In other words, packing the nose is not something we like to do, but we do it if we think it will benefit the patient.

I usually tell my patients that I rarely pack the nose, unless I see something during the surgery that makes me believe it is necessary. It is done only because I want to take good care of my patient and make sure everything heals correctly.

So, the decision is up to your surgeon and whether or not he/ she thinks it will be beneficial to your daughter. If he/she does use it, understand it was for your daughter's good.

John Diaz, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Why surgeons pack the nose or use quitling sutures after rhinoplasty (nose job) & septoplasty

This varies among surgeons.

To simplify the explanation I will use an analogy: Think of the septum as a sandwich of two layers of mucoperichondrium (bread) and the cartilage between them (meat).

A septoplasty involves lifting the mucopericondrium from the cartilage (lifting the bread off of the meat and sometimes removing it). This leaves an empty space between the two layers (bread) that can fill with blood under pressure (septal hematoma). This can cause the layers to erode and open the wound.

Applying pressure to both sides may prevent collection of the blood. This is accomplished with packing.

Alternatively, placing a quilting stitch back and forth between the two layers is also used to close down the empty space and prevent a collection.

Surgeons vary in their preferences due to personal experience. Discuss this with your surgeon to discover the technique they will utilize.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.