Is it too soon after surgery to be worried about uneven nostrils?

Question

I recently had open rhinoplasty and am now one week post-op. I realize that the end result is forever away, however, I am a little concerned about the convex shape of my right nostril. I want to know: (1) if this is normal, (2) will this fall away or fade, (3) are there possibly stitches there that are making it keep this shape or something else that could be causing that? I am hesitant to ask my doctor simply because it's his "art" and I can't help but think that his answer would be slightly biased (therefore not succeed at putting me at ease) :) Thank you all so much in advance for volunteering your time to do this -- it means a lot!!

John M. Hilinski, MD · Answer

Kacee, I would encourage you to discuss your concerns with your surgeon - the current one and any future ones that might arise. The surgeon who performed the rhinoplasty knows precisely what was done and could easily explain to you what is going on with your right nostril rim. In some cases it could be elevated more on the one side due to unwanted scabbing around internal sutures.

	If this were the case, the nostril rim should settle down with better wound care and simply time. There are other possible explanations but, again, your surgeon is the best resource at this time. The bottom line is that it is very premature to judge your results at one week out following rhinoplasty. Happy healing.

Richard J. Bruneteau, MD · Answer

It’s not unusual for rhinoplasty patients to have asymmetry
in the immediate post-operative period. In the vast majority of patients, this asymmetry resolves with the
passage of time.Rarely,
structural phenomena may contribute to nasal asymmetry.Possible causes include slipped cartilage
grafts, distortion from internal and external splints, and sutures that have
caused distortion or have separated prematurely.Your
pictures suggest nostril asymmetry secondary to elevation of the right alar
rim.Without performing a physical
examination it’s impossible to determine the specific cause of this particular
problem.For this reason it’s important
to consult your plastic surgeon.Your surgeon
understands exactly what was done at the time of your procedure and can tell if
this is an expected or unexpected finding.Whether it requires intervention or should be left alone.Hopefully this consultation will address your
concerns and alleviate your anxiety.

Jerome Edelstein, MD · Answer

In general, swelling after rhinoplasty takes months and months to fully resolve. You'll notice your nose is swollen at the moment and its shape will gradually improve as you progress in your recovery.

Rod J. Rohrich, MD · Answer

It is normal to have some asymmetry of the nasal tip and nostrils after rhinoplasty. Some may experience unevenness and asymmetric swelling from the procedure itself. The patient needs to know this pre-operatively. This is especially true in secondary rhinoplasty. This may take up to 12-15 months to correct itself. The key element is that it must be symmetrical intra operatively which only your surgeon can tell the patient as this is very reassuring.

Daniel Reichner, MD, FACS · Answer

Kacee
One week after open rhinoplasty is too early to judge your results.  There is still significant swelling, scar tissue is forming, mucosal sutures can pull one alar rim higher than the other and the splints and taping can alter the shape.   After 6 to 8 weeks you will have a better idea of any asymmetry and you should discuss that with your surgeon at that time.

Sergio Pasquale Maggi, MD, FACS · Answer

Dear Kacee,
I tell all my rhinoplasty patients many times before the surgery that this particular procedure requires allot of patience on the part of the patient.  In my experience this is particularly evident in an 'open" rhinoplasty.  I feel that most of this is because  rhinoplasty is a "surgery of millimeters".  And until the majority of the swelling of the various tissues (skin, cartilage, bone, etc) many of early concerns are dynamic and will change as the healing process takes place,  In terms of my practice, and I feel is similar for most other physicians, having my patients ask me questions, or voice any concerns, is seen by me and my staff as a fundamental part of the healing/post-operative process, and thus encouraged.  I hope you still trust your surgeon, as I am sure you do since you chose him to perform the procedure, and you should be confident that you will get an honest answer to this question.   As far as answering your specific question about the contour of your right alar rim/nostril you would be best served to ask your surgeon, since it may require inspecting inside your nose to properly evaluate the area in question.
Best wishes,
S.P. Maggi, M.D.

David Mattos, MD · Answer

Good question. I see why you're concerned. There is definitely a difference between the two sides. I know most of the time we say swelling could be the cause, and it certainly may be contributing this early on, but the nose should not look the way it does immediately after surgery, and it's rare for it to look the way it does in the photo. It could very well be that more was done on that side that is causing the early retraction, and it could get better or worse. If it is a stitch or something that is too tight I would look under the nose to see if anything obvious is causing it that can be addressed early on. Unfortunately it's rare that something addressable early on will be found. Hopefully it gets better!
-Dr. David Mattos, New York Plastic Surgical Group

Jon Kurkjian, MD · Answer

Thank you for your question. 
With any nasal surgery, the name of the game is patience. At one week, we would expect you to have quite a bit of swelling and bruising still noticeable and may have trouble breathing out of one or both nostrils. By the end of two weeks, typically, you will still be swollen but look more like you have a bad cold, rather than post surgical. Swelling can take up to a year to be completely gone, however, by 9 weeks you will look very good and should see big difference from your pre-op pics. I encourage you to stay patient.

Wayne Foster, MD, FACS · Answer

Your question is a reasonable and common question at this point after your surgery. Certainly, almost all asymmetries at one week  post op will smoothen and disappear over the ensuing weeks and months. The best approach for you is to maintain contact and communication with your surgeon who is most competent and capable. The surgeon has a clear understanding of the problems you had before the procedure and reasonable expectations for improvement and correction of assymetries. Be sure to ask those questions that you find difficult to ask.

Kris M. Reddy, MD, FACS · Answer

While it is fine to question the surgeon, you also have to remain patient for the healing to complete. It will take at least three weeks to have an idea of the result with a clearer concept after 6 to 8 weeks. If you approach a surgeon in a positive manner, they will provide you an honest evaluation of the work and what steps that can be taken to maximize the result.

Is it too soon after surgery to be worried about uneven nostrils?

Answers (12)