Delayed swelling after alar base reduction?

Question

I had an alar base reduction done 8 days ago, and was very pleased with the initial results right after the procedure. The stitches were removed on the 5th day, and I noticed that the nose appeared wider the following day. While the nostrils are reduced in size, the alar skin now appears thicker, and the base looks wider that it did in the first few days. Is this just swelling that should subside soon? Is it common for swelling to be this delayed (starting 6 days after the alar base reduction)?

Terence Goh, MBBS, MRCS(Ed), FAMS (Plast Surg) · Answer

Dear Iwadin,Thank you for your question. This is a common question that I get asked all the time. To allay your fears and anyone else with the same concerns, the initial swelling is not predictive of the final result. 8 days after operation is still a very early phase of healing but I understand your anxiety and like I always counsel my patients - plastic surgery is a journey and part of it requires you to be patient to give the body time to heal. Usually after days 5-7, some of the swelling would have started to come down but this can of course vary from patient and also depends on what was done during the surgery.  Every surgery goes through the same stages of healing - hemostasis, followed by inflammation then proliferation and finally maturation. You are still at the very early stage of wound healing and there is a lot of inflammation which causes the swelling. So do not worry. However, there are things you can do to reduce swelling. I routinely provide this advice to my patients:
WHAT TO EXPECT AFTER YOUR RHINOPLASTY SURGERY:Swelling varies from patient-to-patient. It is usually worst in the first 3 days before it starts to settle.  I routinely review my patients on the 5th post-surgery day to remove the stitches. When the nasal splint is removed at this point, the nose may appear must more swollen and up-turned. This is to be expected. Most of the swelling should resolve over the next two weeks. At the end of the two weeks, most patients will be comfortable with returning to their work or school. The swelling will continue to improve over the next few months with the best results at 12 months. Do expect minor fluctuations in the swelling of the nose over the course of the next few months. Bruising will vary like swelling from person to person. Most bruising, if it occurs should resolve over the first 10 days. It will turn from pink/red to a purple/bluish colour before it becomes green and finally orange and then it fades away.Nasal Drip.  Some patients have allergic rhinitis or persistent nasal drip after rhinoplasty. We will prescribe a course of antihistamines to help you to reduce the nasal drip. Numbness. Your nose will be numb following surgery. This is normal and the numbness willl subside over the next few weeks to months. Occasionally you will feel pins and needles and this is a sign of the body healing. The nose will be hyper-sensitive during this time and accidental brushes against the nose may cause pain that is more severe than normal. Bleeding. Depending on the surgery performed, you may have some residual bleeding from inside the nose. This may trickle to the back of the throat or through the nose. If bleeding  occur, lie down with your head elevated. You may pinch the sides of the nose gently and swallow the blood. Cold compression over the forehead in-between the eyes will help.  Most of the bleeding should stop within 10 to 15 minutes. If bleeding continues, please contact our nurses or clinic.RHINOPLASTY POST-OPERATIVE CARE INSTRUCTIONS1. Apply cool compress across the nose for the first 48 hours after surgery. This involves multiple washcloths and a basin of ice water. These washcloths should be changed out of the basins every twenty to thirty minutes to keep them cool. The washcloths should be applied diagonally over each eye and crisscrossed over the forehead. The nurse will demonstrate how to do this before you leave recovery.2. The suture lines should be cleaned 3-4 times a day just before you apply the antibiotic cream. There will be absorbable stitches inside the nostril. You may apply antibiotic cream to the suture line inside as well. 3. Patients may shower the second day following surgery, but it is important to keep the tape and splint on your nose dry at all times. 4. You should try and avoid wearing eyeglasses for 2 weeks after your surgery. If necessary, eyeglasses may be worn with the nasal splint in place. If you are wearing glasses after the removal of splint ensure that the nose pads are not compressing the nose. They should be either suspended from the forehead or supported on the cheek for a period of six weeks or until the swelling subsides. This is extremely important as the pressure on the nose may change its final shape. 5. Avoid taking traditional medicine such as garlic, ginkgo and ginseng as these may increase the risk of bleeding. Avoid a high salt diet as this may cause increased swelling. Most other foods are fine as long as you do not have any food allergies.
I hope this answers your question. Have a great week ahead and speedy recovery!
Dr. Terence Goh
Plastic Surgeon, Singapore
MBBS (S'pore), MRCS (Edinburgh), MMed (S’pore)
Fellow, Academy of Medicine, Singapore (Plastic Surgery)
President, Singapore Association of Plastic Surgeons (SAPS)
International Member, American Society of Plastic Surgeons (ASPS)
The information provided is purely for educational purposes and does not constitute medical advice or create any physician/patient relationship. Results may vary between individuals.

Delayed swelling after alar base reduction?

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