Apr 28

Swelling after Rhinoplasty

You often hear that it can take a year or longer after a nose job before you’ll see the final result. Many of you may be skeptical and a small number of you probably roll your eyes when you hear a statement like this. Does it really take that long to see results or are surgeons just telling you that so they can buy time in case you’re not seeing what you want to see after surgery?

The answer is that surgeons aren’t just feeding you a line. It really does take time for the skin to shrink down and wrap onto the new structure underneath. That’s not to say that you’ll be miserable for months. Our patients generally bound into the office for their 3 month visit ecstatic about their noses. Still, when we take photos, we can see that there is still some swelling that needs to settle so that more definition can show through. The photos below are a perfect example of just how much your nose changes over the first year after rhinoplasty. In cases of revision rhinoplasty, thick skin, or when the nose has been deprojected or brought in significantly, this process happens even more gradually.

Looking at these photos, you can understand why we tell our patients that it matters far more to us how their noses look at 1, 2, or 10 years after surgery than it does at 2 weeks after surgery. At 2 weeks, your nose will look good but puffy. If a surgeon is showing you photos that look absolutely perfect 2 weeks after surgery, be very wary. You can bet that those same perfectly cute noses at 2 weeks will probably look scooped and overdone at 2 years once the skin contracts. It’s important to make sure your prospective surgeon is showing you long-term results.

The young woman below underwent primary open septorhinoplasty with us at Profiles Surgery Center. Photos below (from left) show her pre-op, at 3 months, and 1 year after her surgery. Note how her 3-month photos still show some fullness and rounding while at 1 year we see a lot more definition.

Rhinoplasty chronology front

Rhinoplasty chronology oblique

Rhinoplasty chronology profile

Share and Enjoy:
  • Digg
  • Sphinn
  • del.icio.us
  • Facebook
  • Mixx
  • Google Bookmarks
  • MySpace
  • Twitter
30 comments

30 Comments so far

  1. Michael C. Pickart, M.D., F.A.C.S. May 28th, 2010 2:27 pm

    Terrific result.

    Just wanted to let you guys know that this photo set is very helpful to show your own post-op patients. I have been trying to gather photos like these myself.

    I just showed your photo set to a post-op patient (and gave you the credit). She didn’t believe that her nose was ever going to shrink. Now she believes me. She realizes that the edema will resolve in a few months. The photos speak much louder than my words.

  2. Aaquil August 11th, 2010 10:09 am

    Hi

    Had a septorhinoplasty here in the UK. The nose had a prominent bump and is quite large and wide. I did request the surgeon to remove the bump and reduce the size. The splint was removed a few days ago and although the nose is straighter it is exactly the same size if not bigger. I am probably the ‘thick skinned’ type (Pakistani Asian). So I have a few questions:

    (1) Can I expect a reduction in size?
    (2) What are nose exercises? I have not been told about these at all.
    (3) I was advised to use Arnica cream on the puffy swollen tissues around the eye. Should I apply the cream to my nose or leave well alone?
    (4) I have a review in 6 weeks time. When will I know if I need any revisions made to my nose as I presume 6 weeks would be far too early?

    Thank you for your time and assistance.

  3. admin August 11th, 2010 5:12 pm

    Hi Aaquil,

    Yes, you can expect a reduction in size! Some patients experience more swelling than others and, depending on the amount of reduction needed, you may not yet be noticing big changes from the before photos. If the bump was reduced 3mm in height but there is 1 to 2mm of swelling circumferentially, you will not perceive much of a difference yet. Moreover, since the skin was lifted, you will not yet see the level of definition that you might have experienced previously.

    All of that will come in time. We do not find Arnica cream to be of particular use although it certainly will not hurt. Nasal exercises refer to placing slight even pressure with your fingers along the sides of bridge for about a minute several times a day after rhinoplasty. Some surgeons advocate this to help push out swelling from the tissues early after rhinoplasty. It may also help to maintain narrowing of the nasal bones if that was a goal of surgery, although it will certainly not compensate for improperly performed osteotomies.

    If you are thick-skinned, it will likely take several months before some of the cosmetic changes become substantially evident. Still, you should be starting to see real improvements before then. Have a frank discussion with your surgeon about what can be done to speed healing.

    Good luck!

  4. Aaquil August 13th, 2010 5:02 am

    Thank you for taking the time to answer my questions. I greatly appreciate it!

    Regards

    Aaquil

  5. sali April 24th, 2011 9:47 pm

    hi can I have oestomy twice witout damaging my nasal bone
    Thanks

    sali

  6. admin April 25th, 2011 9:43 am

    Hi Sali,

    Yes, you can have osteotomies more than once. Osteotomies are one the hardest aspects of the rhinoplasty procedure to control fully. The final position of the bones depends on where and how the osteotomy is placed. An experienced revision surgeon should be able to address your bony issues without much cause for concern. Good luck.

  7. Maylene June 2nd, 2011 1:31 am

    Great Blog!!

    I had rhinoplasty performed 8 days ago and am very happy with the results. My tip is more rounded than I would like and is still swollen and numb. These pictures are very helpful because even if the tip only went down a tad bit more I would be ecstatic.

    Only question is on one side of my nose the flap/nostril is slightly more pinched in than the other, not noticeable to the standard eye, but I am obsessing over my nose at this point and was wondering will this even out since I just got the splint taken out yesterday?

    Thanks,

    Maylene

  8. admin June 2nd, 2011 9:36 am

    Hi Maylene,

    Good to hear that you are happy with your result so far! It’s not unusual for there to be some uneven swelling in the first weeks after surgery, especially when you’ve had the splint compressing the skin over the last week. Our best advice is not to obsess about details at this point- it is far too early for that. Talk to your surgeon about what you can expect with healing. All the best,

  9. Nara June 28th, 2011 8:34 am

    Hi there! I had rhinoplasty 3 months ago and I’m not liking my nose tip, it looks big, rounded and a bit droopy .. I’m very worried. I want my tip elevated, but it looks like it won’t elevate anymore. Will it elevate, or will it just stay the same?

  10. admin June 30th, 2011 7:13 am

    Hi Nara,

    Your whole tip likely still has some swelling and should continue to improve over time. Whether your tip will elevate depends on what your surgeon did to allow for elevation. Some surgeons prefer to cut back cartilage behind the tip to allow it to elevate as the skin contracts. This can sometimes be unpredictable in terms of how this affects the tip. We prefer to set the tip back with suture and anchor it there so we know exactly where it is going to end up. Talk to your surgeon to find out what you can expect.

  11. Amanda July 17th, 2011 7:52 pm

    Hi,

    I’ve had my nose done a year ago but the tip is still swollen. I feel like going to get the tip refined. I love the rest of it but the tip drives me crazy and when I roll my finger over it, I feel the swelling. Any suggestions on what I can do about this?

  12. admin July 25th, 2011 1:57 pm

    Hi Amanda,

    Talk to your surgeon about this. Sometimes, a steroid injection may help even after a year. Sometimes, it is an issue of the skin not being able to contract enough in order to show more definition. If your surgeon is not able to help or you’d like another opinion, feel free to send photos via the Contact Us page on our main site. All the best,

  13. Kattie August 30th, 2011 7:53 pm

    Hi, thank you for these pictures. They are hard to find on the internet and you can definitely see a difference in all stages. These photos and your above explanations for swelling gave me comfort about my nose. It has only been 11 days since surgery, but I was concerned about my nose looking big.

    I can tell you guys know the many worries patients go through and I just wanted to say thank you for caring.

    By the way, the blond above is a beautiful woman and you made her nose look great!

  14. admin August 31st, 2011 8:43 am

    Hi Kattie,

    We’re happy you found the photos comforting. We wish you the best in your recovery and a beautiful result.

  15. Lisa September 2nd, 2011 6:59 pm

    I found your website as I am looking for an explanation why I still have the bump on the bridge of my nose. I am 2 weeks post open reduction nasal septul fracture.

    From your description above, am I understanding… that since I had the bump under my skin for so many years, the bump is still there out of ‘habit?’ Eventually, it will settle down to the new shape of the bone underneath?

    I’m almost 47; much older than the woman in your photos. Will my skin still be resilient enough to redesign itself, and release the habit of the bump that was once there?

    Thanks for all this information!

  16. admin September 7th, 2011 8:27 am

    Hi Lisa,

    Yes, the skin will slowly contract over time and the impression of a residual bump should resolve itself. Your age should not be a factor in this healing. All the best.

  17. Mila October 29th, 2011 7:07 am

    Hi there,

    I had a closed rhino 11 months ago, with hump removal, and basically resizing all parts of my nose. After I removed my cast, I was stunned by the look of my nose, and I absolutely loved it. But of course, once the the swelling kicked in, my nose never looked the way it had looked immediately after the removal of my cast. I still can feel that my nose is very, very, swollen, and very stiff right in the middle part of it. There are some bumps I can feel right where my hump was removed, and the tip is still not fully symetrical from both sides and looks quite bulbous. Actually, the profile view of my nose is stunning and beautiful, but the front view shows a swollen nose and lack of definition. On the other hand, I have two friends who recently underwent rhinos with a different surgeon, and their noses looked so good and slim a month after the surgery. I really wonder how is this possible? I would greatly appreciate your opinion.

  18. admin October 31st, 2011 9:22 am

    Hi Mila,

    Everyone heals differently so, while it is frustrating, it’s best not to compare your healing to anyone else’s. We would suggest talking to your surgeon at this point. If you are feeling swelling and firmness over an old hump, it may be that you are forming some callus (new bone thickening) that can potentially be addressed in the office. Your surgeon can best evaluate what is happening at this stage. If you continue to be unsatisfied, feel free to contact us via our main site http://www.beverlyhillsprofiles.com to discuss options further.
    Regards,

  19. Mia November 10th, 2011 3:40 am

    Hi
    I had my rhinoplasty over a year ago. I am not satisified with the result. My nose still looks wide around the bridge and the tip is lacking in definition. I went to see my surgeon and he insisted that he had removed all the cartilage he could and that my nose has thick skin which will never achieve the look which I desire. Is that true?

    Thanks

  20. admin November 10th, 2011 10:11 am

    Hi Mia,

    Sorry to hear that you are unsatisfied with your result. Removing a lot of cartilage in patients with thicker skin does not always achieve better tip definition. In fact, in a good number of people, it can do the opposite because the thick skin has less structure to drape over. The key to creating definition in thick skin is to create a strong, structured tip that has the desired shape without removing a lot of cartilage. It may sound strange but sometimes it is necessary to add cartilage to achieve this goal. You can check out our blog topics on rhinoplasty in thick skin for more information. Feel free to send us some photos and we can comment further.

    All the best,

  21. J P December 10th, 2011 1:49 am

    Hi there,
    I had surgery by a reputable revision surgeon in November 2010. So it has been one year. I still think my nose is too wide and undefined. I have thick, oily Asian skin. I had an open rhinoplasty.

    My primary was in October 2008. I was born with a wide, Asian nose that does not fit my face at all. The goal was to augment the dorsum to narrow out the wideness. An L-shaped silicone implant was used (that was it, nothing else was done). The implant shifted to the right and my tip felt very stiff. It was crooked too, so I decided on a revision. The only thing I liked about my primary was the height and definition it gave to my bridge.

    My revision last year consisted of removal of the silicone implant. It was replaced with my own ear cartilage. It is still crooked to one side. It seems to follow the pattern of the removed silicone implant. However, I have lost the definition the silicone implant gave me. Ear cartilage really has no definition as it is too soft. I had an alar base reduction which really did nothing to narrow my nose. Now my tip is round, wide, and bulbous. I feel like I’m back to square 1, but poorer and now my bridge is crooked too.

    My question is, will my nose continue to improve even though it has been 1 year? I’ve heard of these oddities which people describe how their nose changed in 2-3 years. Is my case likely? Could my nose be droopy because of the loss in height since my L-shaped implant was taller/bigger than my ear cartilage graft (so it needs time to “re-drape”?

    Thank you, please reply.

  22. admin December 12th, 2011 9:46 am

    Hi JP,

    It certainly doesn’t hurt to wait longer. If you have thick skin, you may very well see some more redrapage and improved definition as time goes by, especially only one year after a revision. That being said, while ear cartilage is a wonderful material, it does not provide a lot of strength to achieve significant definition in the tip. So, if your goal was to achieve a very defined tip, you may want to speak to your surgeon or seek another opinion in-person about whether you are likely to achieve that goal without further surgery. We would be happy to speak with you in more detail if you would like to send photos to our main website http://www.bhprofiles.com. Photos can be uploaded from the Contact Us page.
    All the best,

  23. Setare January 9th, 2012 1:19 am

    Hello!I have some questions and hope you answer me:).When i studied at school i had injury with ball and i had crook on the nose.Then i decide did operation and i did rhinoplasty,but 1 time was not so lucky,then i did 2 time.And after 2 time i still have something like a callus on my nose and not good looking :(,my doctor told me ‘no problem,i can do 3 operation’,but i dont believe him and i am afraid:(….How you think why i had callus after 2 operation and can i do 3 operation ?And result can be good? Hope hear you soon

  24. admin January 9th, 2012 10:57 am

    Hi Setare,

    Sorry to hear you are having problems with callus formation after surgery. In our experience, there is a small percentage of patients who tend to form bony callus a little more aggressively. Sometimes, steroid injection into the callus can help it to flatten and avoid another operation. Otherwise, a third operation will be necessary and should be able to take care of it. A frank and detailed talk with your surgeon will be of benefit. Best,

  25. Lacey March 29th, 2012 2:49 pm

    I found this website and was hoping you could help answer a concern I have. I had rinoplasty five weeks ago and even though I still have some swelling I love the results. My problem is the surgery caused a septal perforation. My surgen said it was mild to moderate and if I wasn’t having any problems he wouldn’t do any further surgery to repair it. I haven’t had any problems with it thus far. I didn’t even know I had it until he pointed it out. I this a common thing to have happen? I had broke my nose at least twice and had a lot of scar tissue and bone cartledge but I’m not sure that caused this to happen. I was wondering if the hole could get smaller own it’s own over time since it’s still earlier in my recover. I’ve also read that if I don’t have it fixed it could cause the nose structure to collapse. Is this something I should be concerned with having fixed or is it something people can live with?

  26. admin April 18th, 2012 1:02 pm

    Hi Lacey,

    Sorry for the delayed reply. The question of whether a septal perforation needs to be repaired really depends on the size and location of the hole, and whether it is causing significant symptoms. The perforation is unlikely to get smaller over time on its own, but it doesn’t always continue to enlarge either. A perforation that is on the larger side, especially one that is located closer to the front or top of your septum, has a higher chance of causing some loss of cartilage support over time, producing both breathing and aesthetic concerns. An honest discussion with your surgeon is helpful. You may also want to seek a second opinion from a qualified revision rhinoplasty specialist to get another viewpoint.

  27. Barbara September 27th, 2012 2:59 pm

    Hello,

    My daughter 13 was born with a wide unilateral cleft lip and palate. She had a complete rhinoplasty about 9 months ago. When the bandage first came off in the Dr. office she was thrilled because her nose was slimmer and symmetrical. Soon after that her nose started swelling and has become as wide as it was before. The symmetry is much better but the sides of ther nose and the tip are still hard to the touch. Is this normal? Any advice?

  28. admin October 29th, 2012 10:58 am

    Hi Barbara,

    I’m happy to hear that your daughter was initially happy with the narrowing and symmetry achieved with her surgery. After 9 months, there may still be a fair bit of swelling responsible for the sense of width she has, something that is supported by the fact that her tip is still very hard to touch. In general, cleft lip rhinoplasty is quite involved as it is necessary to re-support the entire tip and nostril areas, and can take quite a while to settle. It would be best to first talk to your daughter’s operating surgeon to see if that is the case and what can be done to improve it.

    All the best,

  29. Gosia August 15th, 2013 12:48 pm

    How much of the swelling You can exspect to go down in first year ? 20% ? More ?

  30. developer September 16th, 2013 9:37 am

    Hi Gosia,

    In most cases, we expect about 90 to 95% resolution of ‘swelling’ or skin contraction to have happened by one year after surgery. In some patients, especially those with thick skin or where the nose was made a lot smaller, it can take longer for the skin to contract fully.

Leave a comment