I had open revision rhinoplasty 11 weeks ago and the sides of my nose are still swollen as well as my nostrils are uneven. Also, when I smile my face looks swollen still and the left side of my nose goes up more than the right. Will this get better over time? I am getting very frustrated.
Answer: Open Rhinoplasty results in prolonged swelling adn should be generally avoided Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons. In secondary cases such as yours it is even more crucial that sound grafting techniques are used. It sounds like you will need bilateral spreader grafts and a columellar strut but a complete L-strut should be considered and harvesting a small bit of rib cartilage may be necessary depending on your findings. Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. Because you have had two open rhinoplasties I would wait one year MINIMUM to see where the result is heading. I hope this helps!All the best,Rian A. Maercks M.D.
Helpful 6 people found this helpful
Answer: Open Rhinoplasty results in prolonged swelling adn should be generally avoided Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons. In secondary cases such as yours it is even more crucial that sound grafting techniques are used. It sounds like you will need bilateral spreader grafts and a columellar strut but a complete L-strut should be considered and harvesting a small bit of rib cartilage may be necessary depending on your findings. Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. Because you have had two open rhinoplasties I would wait one year MINIMUM to see where the result is heading. I hope this helps!All the best,Rian A. Maercks M.D.
Helpful 6 people found this helpful
Answer: Swelling after revision Hello and thank you for your question. At 11 weeks it is still very expected to be very swollen. 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. 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
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Answer: Swelling after revision Hello and thank you for your question. At 11 weeks it is still very expected to be very swollen. 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. 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
Helpful
October 4, 2021
Answer: Swelling after a revision rhinoplasty You are correct in thinking that there is still swelling in the nose, especially after a revision rhinoplasty that often requires more advanced approaches, and therefore it might take longer to heal. As a specialist in rhinoplasty and revision rhinoplasty surgery, I advise my patients to openly communicate with me and my team in terms of their healing experience. Sometimes, hand-holding is needed to help patients through the swelling period. I recommend you continue to follow up with your revision rhinoplasty surgeon and to discuss your concerns, I am sure your surgeon will agree that it needs more time to resolve. Be patient with your healing -- and if your result does not please you after the swelling has dissipated, you might consider consulting with another board certified plastic surgeon with experience in revision rhinoplasty to discuss your concerns and options.
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October 4, 2021
Answer: Swelling after a revision rhinoplasty You are correct in thinking that there is still swelling in the nose, especially after a revision rhinoplasty that often requires more advanced approaches, and therefore it might take longer to heal. As a specialist in rhinoplasty and revision rhinoplasty surgery, I advise my patients to openly communicate with me and my team in terms of their healing experience. Sometimes, hand-holding is needed to help patients through the swelling period. I recommend you continue to follow up with your revision rhinoplasty surgeon and to discuss your concerns, I am sure your surgeon will agree that it needs more time to resolve. Be patient with your healing -- and if your result does not please you after the swelling has dissipated, you might consider consulting with another board certified plastic surgeon with experience in revision rhinoplasty to discuss your concerns and options.
Helpful
January 13, 2019
Answer: Revision rhinoplasty swelling gets better over time Be patient because it's normal to be still swollen after 11 weeks. Usually the swelling tends to be symmetrical so if one nostril looks a little different than the other it may not correct itself when the swelling finally goes away. When you smile it may be your smile muscles that is pulling one nostril higher than the other. People don't always have symmetrical smiles. Try to stay positive and don't get frustrated. The swelling will eventually disappear in 6-12 months and if there are any persistent deformities they can be corrected.
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January 13, 2019
Answer: Revision rhinoplasty swelling gets better over time Be patient because it's normal to be still swollen after 11 weeks. Usually the swelling tends to be symmetrical so if one nostril looks a little different than the other it may not correct itself when the swelling finally goes away. When you smile it may be your smile muscles that is pulling one nostril higher than the other. People don't always have symmetrical smiles. Try to stay positive and don't get frustrated. The swelling will eventually disappear in 6-12 months and if there are any persistent deformities they can be corrected.
Helpful 2 people found this helpful
August 23, 2017
Answer: Uneven Swelling After Revision Rhinoplasty Swelling after revision rhinoplasty generally takes longer to resolve than after the initial or primary rhinoplasty, especially if a significant amount of work is necessary. Often swelling may be more on one side than the other. Uneven swelling from side to side can occur because more work is necessary on one side compared to the other. Sleeping position may also influence swelling from side to side. It is important to communicate any concerns you may have with your surgeon. Best of luck, Dr. Kaniff
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August 23, 2017
Answer: Uneven Swelling After Revision Rhinoplasty Swelling after revision rhinoplasty generally takes longer to resolve than after the initial or primary rhinoplasty, especially if a significant amount of work is necessary. Often swelling may be more on one side than the other. Uneven swelling from side to side can occur because more work is necessary on one side compared to the other. Sleeping position may also influence swelling from side to side. It is important to communicate any concerns you may have with your surgeon. Best of luck, Dr. Kaniff
Helpful
April 21, 2016
Answer: Swelling after revision rhinoplasty Swelling after any rhinoplasty can be very frustrating but especially after a revision rhinoplasty as there is now increased scar tissue and the scar tissue from the previous surgery slows down the drainage of fluid. Believe it or not, 11 weeks is still early, especially if you have thicker skin or if you have pigmented skin (tan easily). It's not unusual to have to wait 6-9 months to begin to see the shape you are wanting.
Helpful 2 people found this helpful
April 21, 2016
Answer: Swelling after revision rhinoplasty Swelling after any rhinoplasty can be very frustrating but especially after a revision rhinoplasty as there is now increased scar tissue and the scar tissue from the previous surgery slows down the drainage of fluid. Believe it or not, 11 weeks is still early, especially if you have thicker skin or if you have pigmented skin (tan easily). It's not unusual to have to wait 6-9 months to begin to see the shape you are wanting.
Helpful 2 people found this helpful