Why is Nose Tip Hard After Rhinoplasty?

Question

I had Rhinoplasty only 2 months ago, i had it done because my nose had been smashed not broken for about 8 years, the doctors said i had to wait til i was a certain age for my nose to stop growing. I was wondering why the tip of my nose is a little hard? and will i ever be able to move it again?

Oakley Smith, MD, FRCSC · Answer

There can be many reasons why the tip of a nose feels hard after surgery. As everyone knows surgery causes swelling. In the case of a nose, this creates firmness. Of course this resolves with time. Secondary most times the delicate nasal cartilage is strengthened with surgery. This is due to adding cartilage as a graft. Cartilage usually from deep within your nose is transplanted along the columella, the fleshy strip between the nostrils to better support the tip. Other times the cartilage is placed over the tip itself to alter its shape. And finally the tip skin is numb from the surgery for several months and this can alter the sensation of hardness itself.

Richard J. Bruneteau, MD · Answer

It’s not unusual for patients undergoing rhinoplasty to have prolonged swelling.  Several factors including the use of open rhinoplasty, fracture of the nasal bones, thickness of the nasal skin and a previous rhinoplasty have been associated with prolonged swelling.
            When nasal swelling is present the nose often feels hard and stiff.  Most patients note significant swelling for about two to three weeks following surgery.  After two weeks, most patients are comfortable resuming their normal lives and going out in public.
  
            Swelling will persist in most patients for at least one year following surgery, with the nasal tip being the last sit to experience resolution.  In the immediate post-operative period, nasal splints, elevation of the head and ice can be utilized to minimize swelling.  At this point in time, it’s important to be patient, this problem will gradually resolve with the passage of time.

Jerome Edelstein, MD · Answer

It can take several weeks for the initial swelling to occur, then months for it to subside. Swelling in the tip generally takes the longest to subside, and it's generally this that is causing the hardness you're feeling. Please wait a few months before evaluating your results. Best of luck!

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Nasal tip "hardness", swelling can be very normal after rhinoplasty.  This "hardness" represents swelling and internal healing.  This will improve "soften" as time passing and the healing is complete.  Your tip will become more flexible.

	Dr. ES

Houtan Chaboki, MD · Answer

The nose will always feel at least a little stiffer immediately after rhinoplasty surgery due to swelling of the tissues. Over time the stiffness should settle down. Scar tissue, cartilage grafts, sutures or stitches to reshape cartilage, or rib cartilage will also contribute to a rigid feeling nose. Rhinoplasty is not one operation, but rather many potential operations. Depending on the specific operation, the nasal stiffness that ones feels gradually improves over time.

Michael A. Persky, MD · Answer

Hi,

	It often takes months for the tip of your nose to get back to feeling normal.  The "hardness" can be related to swelling and scar tissue that will resolve.  If grafting material was used in your nasal tip, it too contributes to hardness and stiffness.  You should be able to move the tip of your nose within a few months.

	Enjoy your new nose and be well.

	Dr. P

Edward J. Gross, MD · Answer

The swelling that occurrs in the nasal tip after Rhinoplasty is called induration.  This is normal and will soften in 3-4 months.  Not to worry.

	Dr. G.

Kevin M. Robertson, MD, FACS · Answer

The answer is the tip is firm from swelling and increased support that are expected during early healing.  And two months post op is still considered early.

	The swelling of the skin/soft tissue envelope will feel rigid for a few months, so that might be settling soon.  But a bigger consideration is the structure that your surgeon rightfully restored.  If your nose was indeed smashed, that would have been a focal point of reconstruction.  That's because over time, with or without surgery, the tip tends to lose support.  To anticipate this dynamic, your surgeons neeeded to ensure that the reconstruction would hold up to normal healing patterns.  Thus as strong, structural tip.  It will continue to soften throughout your year of healing.   Most patients return to normal recoil eventually.

Richard W. Westreich, MD · Answer

Depending on the type of work that was done, tip stiffness can last a few weeks to a few months. If suture modification of your tip was performed, then it is reasonable to expect tip stiffness for at least 3 months. This should slowly soften over time.

	Don't worry, your nose should move again with a little time.

	Best of luck.

David Mattos, MD · Answer

In the first year after rhinoplasty, the tip of the nose is the slowest to heal and the part with the most swelling. It usually feels hard and swollen for some time and gradually dissipates. If the swelling and hardness are much more than expected, I sometimes will inject Kenalog, a type of steroid, into the nasal tip. This helps reduce the swelling a bit faster in these cases. 2 months is very early on and far from your final outcome. you will likely be able to move your nose again but it still may be months before that is the case. 
-Dr. David Mattos, New York Plastic Surgical Group