Want to know the most significant complaint we hear about after Rhinoplasty surgery?

It’s not pain, pressure, headache, or even discomfort. In fact, rhinoplasty is rarely very painful.

The symptom we hear about most is nasal congestion.

The picture above shows one technique that some surgeons still use to pack the nose. Most surgeons still use some form of packing or splint, which can either be merocel, gauze, xeroform or a variety of other forms. The end result unfortunately is more discomfort for the patient.

While not being able to breathe through your nose is not earth-shattering, it is extremely annoying. Think of it like a bad head cold that lasts. So, anything we can do to prevent this symptom is meaningful to you, and therefore important to us. And the biggest thing we can do to help, is to avoid nasal packing.

Packing is routinely used by some to help prevent excessive bleeding or dripping. We find we almost never need it. By handling tissues exceedingly carefully and gently, we find that we can generally keep bleeding, bruising, and swelling to an absolute minimum…and the benefit to you is an earlier return to breathing through your nose, less blockage from the beginning, and no painful removal of crusted packing.

We really have a passion for rhinoplasty, and we do all we can to help make your experience with us the best it can be… so we encourage you to come in and experience the difference.

Your concerns are valid and it is important to discuss your history of poor scarring whenever you undergo any type of surgery. You should note however that different parts of the body will heal differently. The simple answer is that keloids rarely develop in the central face and we here at Profiles have never seen a keloid develop after we have done rhinoplasty.

A more in depth explanation begins with an explanation of scarring. First, we need to help you in understanding the difference between a hypertrophic scar and a keloid. Clinically, hypertrophic scars are enlarged scars that stabilize or shrink with time. Keloids, however, initially develop as hypertrophic scars but later extend beyond the original injury area. They rarely regress on their own and have a propensity for recurrence after excision.

Keloids may affect virtually any surface on the body with the central chest, deltoid/shoulder region, and back having the highest frequency. And this has led some doctors to speculate that motion and tension play a large role in causing keloids to develop. While this may be true to some extent, the earlobes, which are one of the most frequent sites affected, are obviously subject to minimal motion or tension forces.

This African American patient demonstrates a typical example of a large keloid scar of the earlobe that was removed in one session with flap reconstruction of the back of the ear. The After photo to the right shows her postoperative result over 6 months after the procedure.

All this being said, while you should explore this issue with your doctor before surgery, you should feel some comfort in knowing that the nose is rarely a site for keloid development after rhinoplasty or nasal surgery. In fact, we did a literature review to check on your answer and were unable to find any papers which could point to a case of a keloid after rhinoplasty.

First and foremost, do not panic.

Early changes after Rhinoplasty are influenced by swelling and do not necessarily reflect the end result nor what was done during your operation. Trust your instincts and talk to your doctor about your concerns. There may be a perfectly good explanation for what you’re seeing. Sometimes, reassurance is all that is needed.

Once the cast comes off your nose, the natural tendency is to stare in the mirror for far too long- looking for the smallest of changes. This is precisely the most harmful thing to do because it will not change your healing and will only make you more nervous.

You will find that you are more swollen in the morning, when you are more active, or after lying down for long periods of time. This is because blood and fluid pools in the area of your nose and cheeks. Aside from that, healing happens in drips and drabs. You may not notice any changes for a few days, and then suddenly see a big reduction in swelling. There is a range of ‘normal’ healing. Don’t be alarmed if you are on the edge of that range. Your surgeon should let you know if anything unexpected is happening. If you are still unhappy at six months or a year, it may be time to talk about your options for improvement.

Your original surgeon is still the best place to start with this conversation, if he or she still has your trust. If not, consult a surgeon who has an experienced practice in Revision Rhinoplasty to see if this is a good option for you.

If you have any questions, please feel free to give us a call or send an email.

Skin quality and thickness is one of the most important factors in determining your final Rhinoplasty result. And it can also be one of the hardest to predict. When we perform Rhinoplasty, most of what we do involves altering the cartilage and bone that makes up the nasal skeleton. We shape the cartilage and bone in many ways to take on the new desired contour. During the healing period for many months after surgery, the skin and soft tissue that lays over this skeleton must contract inwards and ’shrink wrap’ onto this altered framework for the desired changes to become noticeable. That’s why you don’t see real definition for weeks to months after surgery while the skin and soft tissue is swollen.

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We find that the decision to tell friends and family is a very personal one that largely depends on you and your relationships. For most of our patients we find the question of telling friends and family is very simple and they find that the added support helps in making the entire process easier.

Occasionally, however we have some patients who feel that they have family or friends who simply will not accept their decision to proceed with surgery. Occasionally, these patients want to remove some family defining characteristic such as a nasal hump that they feel their family would want them to keep. For other patients, especially those who are still in school, we will wait to have surgery over the winter or summer break so that changes are not quite so obvious to classmates. Overall, however we have found that the social stigma that used to be associated with plastic surgery is no longer really an issue and in general when our patients discuss their reasons for wanting to pursue surgery, their families and friends are generally much more supportive throughout the process than you may otherwise expect.

In those cases, when our patients are from out of town or when they do not have support, at PROFILES we have developed a comprehensive team and program to help take care of all your postoperative needs and to make you feel comfortable every step of the way.

We recently received a question from a patient who had underwent rhinoplasty elsewhere and noted that a few days later her nose was very itchy. Upon removal of the cast she had red, swollen skin with multiple tiny pustules. She wrote to us in a panic wondering what had happened.

Of course without an evaluation, we told her that we would only be speculating. But we did note that on rare occasions, there are people who have allergic reactions to the adhesive on the tape that is used on the bridge of the nose after surgery. The tape and splint are intended to help keep pressure on the skin in order to help reduce swelling and to prevent the nasal bones from moving after surgery.

When an allergic reaction occurs, most patients generally report in hindsight that they noted some itchiness starting as soon as the day after surgery but that it only became intolerable after a few days. Of course once the tape is removed the allergen- the thing that is causing the allergic reaction- is gone but it generally takes days for the swollen, red, itchy skin to return to normal. The long term consequences of this are generally negligible outside of the transient initial itchiness and discomfort, but it does occasionally mean that it will take a while longer for you to see the final results of your surgery.

Depending on the severity of the reaction, some surgeons will provide anything from a topical to an oral steroid to help in treating your itchiness as well as in helping to reduce the swelling and inflammation. Hope this helps.

Yes, this can be normal for you. Swelling after any surgery resolves in stages and this is also true of Rhinoplasty. The worst “I can’t leave my house” swelling is gone within 1, or sometimes, 2 weeks. After this, you will be presentable and your nose will look ‘normal’ to others. But, intermediate swelling or puffiness can and will last for weeks beyond that. By 6 weeks, your nose will begin to look ‘normal’ to you and you will start to really see the early results of your surgery.

Your nasal breathing will also be returning to normal at this point. Changes beyond this point are more subtle. But, as every surgeon will tell you, you won’t see the ‘final result’ until 6 months…a year…or even 2 or 3 years after surgery, especially if this is not your first nasal operation.The rate of improvement in swelling is different for each individual, and depends on your genetics, your health and nutritional status, your skin type and thickness, your activity level, the extent of your procedure, and other factors. Try not to compare yourself too much to others. If you are uncomfortable with your progress, ask your surgeon for advice.

At Profiles, we discuss your postoperative care and routine in great depth prior to your surgery in order to address all your concerns. A couple of relevant points for you are that postoperatively you will find that for a dew days your nose is swollen and congested. After that initial period, we try to minimize the possibility of trauma to your newly operated nose or bleeding from your nose.

As such, we tell our patients to avoid sniffing after surgery and to avoid blowing your nose if possible. This generally will not relieve the sensation of blockage - it will only aggravate it because the suction created on the inside will cause more swelling. Not only will this aggravate the swelling, but also it may cause infection, bleeding, or the accumulation of scar tissue inside the nose.

We obviously wouldn’t want you to have a nose bleed while you’re in the water. Can you imagine the sharks?

If a turbinate resection is part of your nasal procedure, bleeding can occur from this area for up to six weeks after your surgery. Therefore, your exercise regimen needs to be curtailed at least to some extent for the first few weeks following surgery. Upper body exercise is especially prohibited, as it is more likely to cause turbinate bleeding. No strenuous athletic activity for one month, including swimming, jogging, aerobics, etc. And as for your specific concern, we recommend no diving to our patients for two months.

It is hard to answer that question without examining you. But, there is usually no cause for serious concern.

If your nose was crooked before, it may remain slightly crooked after. Making a crooked nose completely straight is one of the hardest things to do in Rhinoplasty. So, while our goal is perfection, we sometimes have to be satisfied with ‘just almost’. In most cases, the appearance is due to asymmetric swelling more on one side than the other. This will subside and improve with time, but only time will tell the degree of improvement.

Our best advice is to ask your surgeon because he or she is most familiar with your case and can explain what was done during your surgery and what you can expect in the future. Sometimes, further interventions will be recommended such as massage, steroid injection, or minor revisions down the road that can lead to further improvements.

Nasal Allergies, whether seasonal or year-round, generally are not a factor in rhinoplasty. If you experience nasal allergy symptoms, you should be thoroughly evaluated to see if there are any other factors that may exacerbate your breathing problems- such as a deviated septum or enlarged turbinates. If these problems are also present they should be addressed during your rhinoplasty.

Otherwise we find that in general patients have a period of reprieve from their allergy symptoms following surgery. We do counsel our patients not to blow their nose for about 2 weeks after surgery and also to keep your mouth open if you have to sneeze. Overall, there should be no reason why your allergies should affect your surgery with us.