i had a first closed rhinoplasty 6 weeks ago to remove a small hump on bridge of my nose, and also narrowing of nasal bones and had work done to change shape of tip.When my cast was removed my nose was wider than before surgery i emailed my surgeon who says it is swelling but im not so sure its been six weeks since surgery and this swelling as not reduced at all,do you think this is swelling or the way my bones have set? I had surgery abroad so not seen surgeon since surgery.
Is This Swelling or Have my Bones Set Like This?
Doctor Answers 9
Bones wide or swelling after Rhinoplasty
From your photo, there's appears to be a significant degree of swelling adjacent to the nasal bones. This could be from Breaking the bones, rasping the bones or swelling within the thicker nasal tissues above the bone that must be dissected off of the nasal bones before the bones are manipulated during the Rhinoplasty. At 6 weeks after the Rhinoplasty these nasal bones should be set and you can perform a simple maneuver to tell, whether the bones are wide or what you see is swelling. However, because you are not my patient, I must advise you to get your surgeons permisiion before trying this maneuver.
Once approved by your Rhinoplasty surgeon, take your index finger tip and apply gentle but sustained pressure to one side of your nose in the middle of the swollen area pushing inwards while counting slowly to 100. In the beginning, the tissue will feel very firm but continue the pressure. At some point during the 100 count, your finger will slowly start to remove swelling, creating a localized indentation as it does so. This continues until your finger contacts the true surface of the nasal bone...that could be 4-7 mm's or more inwards from the swollen skin surface. It's important not to push to hard or to fast but rather use gentle suatained pressure.
This will tell you whether the bone is wide (finger creates a very small or no indentation) or what you see is swelling (very deep indentation is created). If it's bone, a revision Rhinoplasty with bone osteotomies will be required at 6 months (earliest) from the last Rhinoplasty to narrow the bones and move them closer together.
If it's swelling, you still should IMHO do something about it to prevent excess scar tissue formation caused by prolonged swelling within the tissues. Nasal massage performed daily, not exercises, is a form of lymphatic drainage that directs nasal tissue swelling onto the large lymphatic vessels, of the face, for removal. I have all of my Rhinoplasty patients begin this at 1 month post Rhinoplasty and continue for 6 - 12 months depending on the thichkness of their skin and whether it was a primary or revsion Rhinoplasty. You will need to see a Rhinoplasty surgeon in person for these massage instructions. In addition due to the excess amount of swelling over tha nasal bone area, IMHO a kenalog 10 injection should be considered.
IMHO, once again, this has nothing to do with where you had your Rhinoplasty but rather seems more an indication of lack of communication, post op instructions and follow up planning. My pratice is in Beverly Hills but I have a very large international clientelle that travel here for their Rhinoplasty, Face Lifts, Breast Implants etc. and do just fine upon returniing to Europe, Asia, the Middle East and elsewhere because the surgery was performed properly, they were properly instructed on post op care and the lines of communication are always open.
Is This Swelling or Have my Bones Set Like This?
This may be swelling or hematoma or incomplete osteotomy. If it is hematoma, it will be evacuated. You have to see a surgeon ASAP.
Swelling is normal after rhinoplasties
It is understandable that you are concerned. Changes after rhinoplasties vary with every patient and what you are experiencing is normal especially that swelling takes time to subside as it masks the results of your surgery.
It is important to keep in mind that it is early to pass a judgment. Usually, a year is required before formulating how your nose will be, but longer with a thick skin. Even then, your nose will keep shaping itself to complement your face for better results in the years to come.
My best recommendation at the moment is to be patient, allow nature to take its course and edema subsides for better results. There is no doubt that once the swelling resolves, more definition and shape will be achieved and you should be happier with the results.
Also, it is important that you keep communicating with your surgeon and work as a team together to achieve the best results possible.
Congratulations on your surgery and remain positive!
Ali Sajjadian, MD FACS
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A wider nose can be bones or low bridge height
Your nose is quite wide--this is not only swelling.
If massive swelling occurred after your surgery, your bones may have drifted outward. These bones can be easily repositioned at this point.
However, I can also see from the appearance of the middle third (notice the shadow that looks like an upside down letter "V") that your bridge was reduced several millimeters during the operation. You may thus need other corrections, so you may wish to wait a while and then see an experienced surgeon. For example, raising the bridge can narrow your bridge quit dramatically (just like lowering the bridge widens the nose).
You do not want to have your secondary corrections one at a time.
At six weeks this could still be swelling. Occasionally, a small injection of cortisone could help reduce this. However, at three months post-op, if the swelling still exists, it may require repeat ostiotomies in order to narrow the bones.
Swelling on the bridge of the nose often lasts for many months
Is your nose swollen vs. overly wide after hump reduction?
- You will have to wait at least 3 months to answer this question.
- I do not believe nasal exercises are necessary to bring down swelling or narrow your nose.
- Consult with a local plastic surgeon in about 6 weeks, the 3 month mark.
Cause of Swollen Appearance after Rhinoplasty
Your swelling is not normal 6 weeks after surgery. Even though your surgeon is not available, see a physician for evaluation and treatment. This is one of the problems with having surgery abroad.
Nasal Bone Shape After Cosmetic Rhinoplasty
Swelling vs bone healing
Without a physical exam it is hard to say but it appears that you have a collection of either serious fluid or blood. Either way It is imperative that you see a plastic surgeon as soon as possible to determine which therapy is recommended for you. The healing process post rhinoplasty is very important and any deviation from the norm can alter the final appearance of the surgery. So treatment for the area that is "swollen" is imperative.