Why does my nose keep changing in size? I had a primary rhinoplasty. My nose looks much bigger. Will I need a revision? (Photo)

Question

When I got my cast removed, 1 week after surgery, my nose looked completely different and was much smaller in projection. It has been almost 2 months and it feels as if it keeps getting bigger and the skin in the supratip and tip feels REALLY thick (I had thick skin to begin with, but now it's much thicker). Will I need a revision? The projection right now is huge and looks almost the same as before surgery. I'm worried. (Pictures are before and after cast in 1st pic and right now in 2nd pic)

Jamil Asaria, MD · Answer

It is always difficult to wait for a rhinoplasty to heal after surgery as the final result really does take a significant amount of time. If the nose looked so good when the cast was taken off, it is my guess that as the swelling settles over the next six to twelve months, you are going to see a lot more refinement of the tip. At your stage (two months) steroid injections can help to reduce the swelling. Consult your surgeon to see if that may be appropriate for you.Best wishes,-Dr. Asaria

Philip Solomon, MD, FRCS · Answer

Your nose will shrink over many months.   Rest assured this is not your final result.  Steroid injections are useful to manage nasal tip swelling.  There are limitations to your final result based on your thick skin.

Steven Wallach, MD · Answer

At two months after rhinoplasty, you will likely have a lot of swelling. This will take a year and sometimes longer to completely resolve.  Good luck.

Andrew Kornstein, MD, FACS · Answer

There are a number of things that MAY be going on.The picture you included as "right now" is not a good lateral(side view) so I cannot make any observations.Remember your skin was never taken away/removed, it must slowly shrink after reductive rhinoplasty.Are you over exerting yourself(increasing your blood pressure) creating more swelling?Does your nasal swelling go "up and down" or does it simply stay "swollen?"On the other hand, as the swelling reduces, you may notice a lack of tip support that is common with your particular pre-operative nasal issue. I can manifest in the apparent return of the bridge hump.Hope this helps

R. Stephen Mulholland, MD (retired) · Answer

Dear r091989,

Thank you for your clinical post and photographs.  Nasal reduction surgery is always full of concerns,
angst and anxiety with patients.  When
the cast first came off there was symmetrical swelling and diffuse swelling
along your bridge and tip.  The more
elevated bridge would affect the optical illusion of the amount of tip
projection.  In addition, your nose
bridge bump was reduced and there were fractures along the nasal sidewall,
which result in swelling of your cheeks. 
The swelling of the cheeks would have given the illusion that the nasal
tip was less projected than it is now. 
Over the ensuing 2 months the swelling of your cheeks have come down
which again gives the illusion of the nasal tip being projected and the nose
still somewhat long.  It appears to be an
excellent bridge reduction and if there’s some swelling in your super tip area
this can be amenable to a very dilute Kenalog or steroid injections.

The nose changes tremendously over the course of 2-12 months
especially in the nasal tip area.  I
would continue seeing your operative rhinoplasty surgeon who can inject some
Kenalog if warranted and show nasal tip massages and taping that can help
reduce any edema and swelling.  Your
final nasal tip result will be evident by 12 months and you can decide if there
needs to be any enhancement surgery at that time.  From your photos I think you’re going to end
up with an excellent result and will be overall quite pleased with the nasal
tip projection and nasal length.  Any
reductive surgery should be carefully weighed against the risk and recovery and
only decided after one year.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

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