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
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.
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.
Swelling after revision rhinoplasty
Swelling after a revision nose surgery can take up to two years to resolve.
Having said that, most of the swelling comes down in the first six months.
Sometimes swelling can occur more on one side than another and cause asymmetries.
Though it is difficult, be patient for now.
Discuss your concerns with your surgeon.
Revision Rhinoplasty Long Term Results
One of the most important thing is being patient if you had a Revision Rhinoplasty. Healing takes longer time than Rhinoplasty. In order to see the final results you need to wait at least 1 year.
What to Expect After a Revision Rhinoplasty
Swelling after a revision rhinoplasty procedure is normal and takes time to resolve. Fortunately, since you are only 11 weeks post-op the swelling that you are describing sounds completely normal. Many patients notice an asymmetry after surgery because your body doesn't heal in an organized and symmetric way. These differences will even out as you complete the healing process. My patients notice significant changes in their swelling over the first few months after surgery, and even when the swelling seems to be gone, there is internal healing that takes place throughout the first year. I know it can be frustrating, but try not to let it be your sole focus. It's easy to drive yourself crazy analyzing it in the mirror every day, but remember that healing takes time. It's also important to keep in mind that a certain amount of asymmetry is normal and that no patient prior to, or after a rhinoplasty has a perfectly even nose. If you feel that something is abnormal, you can always contact your surgeon and have it checked out.
Swelling after rhinoplasty
One of the downsides of the open approach to rhinoplasty is the duration of post-op swelling. I counsel my patients that undergo open rhinoplasty to expect nasal swelling to hang around for 6-9 months. Of course, that swelling decreases at time goes along; but some edema should still be present 9 months post-op.
All of your complaints should resolve with time as the surgical edema resolves.
Hope this helps.
revision rhinoplasty swelling
The swelling that occurs from your revision rhinoplasty is greater then the primary rhinoplasty because of the previous interruption of cartilage and bone, altered lymphatics and scar tissue. Be very patient, and followup with your surgeon. It is best to wait at least a year before making any decisions about revision rhinoplasty or touch up procedure.
Revision Rhinoplasty Swelling
Even primary rhinoplasty takes many months for swelling to resolve. In your case, a revision rhinoplasty takes longer. 11 weeks is far too early to tell and the answer to your question is the swelling will decrease over time.
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It will get better
Your concerns are common. During this time your patience can be one of the most difficult parts of your recovery. The nasal tip is the most cosmetically sensitive region of the nose also it is the most gravity dependent. Revision rhinoplasty patients can expect longer healing times because of altered anatomy and scar tissue. It is important that you communicate your concerns with your surgeon.
Swelling persists longer than first time rhinoplasties
Rule of Thumb for most swelling to go down
primary rhinoplasty 3-6 months
revision rhinoplasty 4-8 months
Meanwhile, warm soaks, gentle massage.
I hope this information has been useful to you.
Jon I Sattler, MD, Board Certified Plastic Surgeon, Glendora, California