Swelling 4 Years After Rhinoplasty - How Can I Determine What's Causing It?

Question

Hi,
I have undergone four consecutibve rhinoplasties, first 2  at a gap of 6 months, and last at a gap of 4 years. The second last rhinoplasty involved cartilage graft and lot of other changes, like filing of bone of nose. After that rhinoplasty, I have always felt my nose to swell as soon as I experience exposure to heat, even minor exertion, eat spicy or hot food. This also causes a condition like chording where the skin inside my nose feels pulled.
Finally sleeping, fresh air gets back my skin to normal. Moisturizing the skin also helps a bit.
I contacted a lot of doctors, including my PS and all they could diagnose is that due to subsequent rhinoplasties, there is excessive scar tissues in my nose, which causes disruption of lymph flow.
I came across this question on RealSelf about rhinoplasty swelling and I'm wondering if the cartilage graft is the real problem? I never had a infection, but the rhinoplasty swelling is recurrent even after 5 years of my second last surgery.
Can somebody please clarify, if there are some tests to identify the real cause behind the swelling?

Toby Mayer, MD · Answer

What you describe sounds like you "feel" it is swollen. That's different than it is swollen and changes shape. Sometimes patients have strange feelings from there nose after surgery. These paresthesias usually last only a few months but may last longer. There is no treatment for this.
If there is actually swelling that recurs you should see a surgeon to make sure you don't have an infection or a cyst. We see patients routinely who have had 4 or more rhinoplasties who actually have thin noses and no swelling and no lymph blockage.

Sam Rizk, MD · Answer

Swelling, though a main component of a nose job, should generally 
completely subside within the first year or two of a rhinoplasty 
procedure. Swelling that persists 4 years later is relatively rare and 
is an indication that you should get a medical professional to examine 
your condition. The cause of your swelling can be a multitude of 
reasons, ranging from possible impact from your particular lifestyle, 
complications of surgery, or a persistent infection. My best advice 
would be to either contact the original surgeon who conducted the 
surgery, or to seek the expertise of a new surgeon altogether.

Rod J. Rohrich, MD · Answer

Swelling is normal after rhinoplasty. In a primary rhinoplasty, most of the significant swelling subsides in the first 3-6 months, but can take up to one year or longer if the patient is a male or has thick skin. For secondary rhinoplasty, it take 1 ½ - 2 years and can be compounded if they’ve had other procedures as well especially if they’ve had grafts done along with the procedure. If abnormal swelling occurs several years after rhinoplasty, it can be due to an infection. However, this is very uncommon.

Michael A. Persky, MD · Answer

Hi itzz,
There is no test to determine the "real" cause of your nasal swelling.  It seems that your swelling fluctuates and is worsened when there is increased blood flow to your nose (exercising, etc.).  The doctors that advised you are likely correct in explaining that what you are experiencing is due to scar tissue and lymphatic and blood flow.  Hopefully your symptoms will resolve with more time.  Be well.
Dr. P

Steven Wallach, MD · Answer

Swelling at this late stage can possibly be due to poor lymphatic drainage after several previous procedures. 
If it is only related to activity, then this is the likley diagnosis. If it happens at other times for no specific reason, then perhaps it could be infectious in nature. 
Is there any drainage or redness to the nose?  Althought I doubt this will give you answers, sometimes an  MRI of the nose may be helpful to check for inflammation and infection.

Swelling 4 Years After Rhinoplasty - How Can I Determine What's Causing It?

Answers (5)