Beverly Hills Rhinoplasty Surgery Blog

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.

Like any surgery, Rhinoplasty is a little bit different for everybody. That’s why it is useful, and we encourage you, to talk to others who’ve had the procedure to get a sense of their experience. There are some common themes though, as far as recovery goes.

Whatever technique is used (see our Blog on Open vs. Closed Rhinoplasty), you can expect to have some dull aching and headache afterwards for a short time. In the absence of an infection or other problem, severe pain is very uncommon. Most of our patients may take some pain medication for the first day or two after surgery and then are usually feeling well enough to switch to Tylenol or other non-narcotic pain medication.

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