Is the Swelling Expected to Fluctuate After Nose Surgery?

I broke my nose and had the septum re-aligned and the bone "popped" back into place. I went back for my checkup 10 days after and the doctor seemed surprised at the amount of swelling. The swelling went down a little each day for 4-5 days after that visit but when I wokeup this morning it seemed as swollen as ever. Are these fluctuations in swelling normal?

Doctor Answers 12

Yes, fluctuations and swelling after nasal reconstruction are expected

The nose is extremely prone to edema (soft tissue swelling) after nasal surgery. Many reasons for this tendency exist. The most common reason for swelling in the morning after facial surgery is due to changing from an upright position during the day to a horizontal position during sleep.

This causes significant congestion of fluid, which is worst in areas that have been recently injured or operated upon. Simply sleeping with the head, neck and shoulders elevated above the heart can greatly reduce this morning swelling. Additionally, avoiding turning on one's side helps further.

Naples Facial Plastic Surgeon

Swelling in the nose after rhinoplasty can fluctuate.

After rhinoplasty, the vast majority of the swelling, perhaps 70-80% resolves over the first 7-10 days. At this point, the nose is usually quite passable and patients can return to work or social situations. The remainder of the swelling gradually dissipates over the course of 12-18 months, as the nose becomes increasingly refined. 

You may have days, in particular in the morning, during which your nose appears slightly more swollen. I have found that a number of factors can contribute to this daily fluctuation, a phenomenon which can last for up to a year. These include: excessive sodium intake, alcohol, hot environments (saunas etc.), and flying (due to changes in cabin pressure). I usually advise my patients to avoid sodium-rich meals and alcohol for 1-2 days prior to a big event, such as a wedding or class reunion, if you want your nose to look as good as possible. On the night of the event you can eat and drink to your heart's content, as the swelling usually doesn't occur until the next morning!

Best wishes,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Swelling after Rhinoplasty

Swelling and fluctuations in that swelling are common 2 weeks after surgery. This can be influenced by activity and position. Avoid strenuous activity for another couple weeks. Use 2 pillows under you head when sleeping; drainage of fluid causing that swelling will be more efficient.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Swelling Fluctuations After Nasal Surgery

It is normal to see fluctuations in swelling for weeks to months after nasal surgery.  There are many factors that play a role: activity, temperature, humidity, allergens, pollutants, position, other metabolic parameters, and many we never identify.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 41 reviews

Swelling can cycle after rhinoplasty surgery

Swelling can get better and worse after rhinoplasty surgery.  i do not know what kind of dressings, etc you had after surgery.  I place a nasal dressing, and splint on all nasal surgery patients.  I fimnd that patients look pretty good on post-op day 1 and hit their max swelling on post-op day 2.  After that their swelling seems to slowly subside.  However, I take the splint off on Post-op day 5.  When the splint comes off, I frequently notice that patients get a second round of swelling that lasts for 1-2 additional days.  After this point, patients look pretty normal, but there is still swelling that prevents visualization of all of the detail in the tip, etc.  This type of swelling takes months to go away completely.

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 90 reviews

Postoperative Swelling After A Rhinoplasty

Swelling is common after a rhinoplasty and can fluctuate.  Their are several ways to minimize fluctuations and improve swelling faster.  Some of these are as follows:

  • Avoid salty food
  • Taping nose at night- Nose tends to swell at night and taping at night can help decrease morning swelling
  • Avoiding the sun

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 166 reviews

Post-operative swelling fluctuation normal

Although most patients will find that their postoperative swelling gradual improves after surgery it is not uncommon to experience some fluctuation. 

In my experience some things that can lead to an increase in swelling during the recovery phase are:

  • sleeping in a non-elevated position or with the nose in a dependent position (i.e., aimed down)
  • an increase in general activity or exercising (anything leading to an increase in blood pressure will cause the nose to swell more)
  • increased sodium intake

The later point about sodium intake isn't commonly discussed but I recommend to all my patients that they follow a low sodium diet (1000 mg a day) temporarily after surgery. It's one of the few things that you can do to help they swelling and It really helps to improve the postoperative edema.

Importantly, if you are also experiencing a dramatic increase in pain or a fever you should be examined to make sure an infection isn't starting.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Swelling after nose surgeryif

  The swelling you describe is normal, but it would worry me that you may have an infection with the sudden swelling after 4 days. I would have your physician look up your nose to make sure that all is well. Fluctuations in swelling are common but one should not assume that its all OK unless you are examined.

Good Luck 

Carlos Wolf, MD
Miami Facial Plastic Surgeon
4.9 out of 5 stars 66 reviews

Swelling Expected to Fluctuate After Nose Surgery

Yes, fluctuations in swelling are expected after nasal surgery. There could be a number of factors (such as activity, temperature, humidity, allergens, pollutants or position) that could affect swelling. Review postoperative care and direction with your surgeon to ensure that you are following correctly. Your surgeon will be checking you repeatedly after surgery to monitor that you are progressing appropriately.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 42 reviews

Rhinoplasty and swelling fluctuations

It is common to have swelling fluctuations in the post operative rhinoplasty phase especially during the first few weeks. I would suggest keeping a low sodium diet, sleep with your head elevated with a few pillows behind your back, avoid smoking, alcohol and excessive heat when possible. This should help with the edema (soft tissue swelling) and as the recovery process moves forward you should start seeing less fluctuations in the swelling. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 210 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.