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What is the recovery after rhinoplasty? The truth revealed…

On this page Dr. Julian De Silva talks candidly about a common question that many patients ask.

On average after nose re-shaping 90% of my patients back to normal in one week. The truth is that recovery after rhinoplasty does differ on you as an individual, no two patients have an identical experience. The truth is that recovery after rhinoplasty does depend on several factors.

1) What do we mean by recovery? Different aspects of the nose heal at different times.

2) What are the individual factors that influence recovery?

3) What can you do to speed up your recovery?

1) What can I expect 1-week after rhinoplasty surgery, what do we mean by recovery?

  • Swelling. 1-week after rhinoplasty 80% of the swelling will have resolved. When the cast over the bridge of your nose is removed after one week, although you will see a change in the shape of your nose it will look swollen. Although the swelling will resolve in most of the nose the fine detail of the nose will not be seen as swelling particularly at the tip and over the bridge of the nose, can persist for some weeks. It is common for the to be swelling over the central part of the nasal bridge where a boney hump was reduced, this may look like a residual bump to the patient soon after the surgery it does however resolve. To the patient, the nose will look swollen or “puffy” for several months and by about 4-months, the majority of the swelling will be gone but will look larger in photographs. The swelling gradually dissipates over the first several months and thus the appearance of the nose changes gradually and it can take as long as a year for the final shape to become apparent.
  • Bruising. Most patients have minimal bruising that resolves over 1-2 weeks. Occasionally, less than 20% of the time, there can be a marked bruise immediately below the eyes where the skin is very thin, this bruising can take 6-weeks to go, though it can be covered with make up after 1-week.
  • Congestion. Immediately after rhinoplasty your nose feels blocked and breathing through your nose is difficult. This is a result of swelling of the inner lining of the nose, this will improve at the end of the first week. In addition swelling can alter your sense of smell and this returns over the first 4-6 weeks.
  • Sensory Change. There is often numbness at the tip of the nose, so your nose will not feel like your own, occasional pulling or discomfort when moving or rubbing the nose, this usually improves over the first 6 weeks although occasionally it can take longer. It is common for rhinoplasty patients to report that their upper lip feels stiff and that it is difficult for them to smile. Fortunately, this resolves by itself in the weeks after surgery as the swelling subsides.
  • Pain. In terms of pain, there is surprisingly little, and usually for less than 48 hours. Oral analgesia is adequate for a couple of days after surgery, and many of my patients never take any analgesia.
  • Dryness. Some patients are sensitive to dryness after rhinoplasty, and in addition to avoiding dry environments after surgery, using a saline spray (salt water) and ointment into your nose several times a day will help with symptoms of dryness.
  • Scars. What about the incisions with open rhinoplasty, well the position and shape of the scar is hidden under the nose, they reach their final endpoint 6-12 months later. Often they are discrete and difficult to see after a few weeks, there are steps that can be taken to speed up their recovery and soften their appearance. One week after surgery they can be covered with cosmetics/ makeup so they cannot be seen.
  • Social activities. Most can be restarted after 1-week, there will be some residual bruising and swelling, generally this can be covered up with makeup. On average, at 2-weeks after surgery, 80-90% of the appearance of the nose will have resolved. An important event such as your own wedding, you should allow 6-months as a minimum to allow the great majority of the swelling to have resolved.
  • Exercise. As a general rule 3-4 weeks. However if you play contact sports or racket sports these should be avoided for at least 8-weeks to allow the nasal bones to heal. Often the tip of the nose can temporarily swell during exercise for several months after rhinoplasty.
  • Activities. Reading, computer work, these kind of low level activities can be started after the surgery and will not affect healing. They are not the same as lifting or strenuous activities that increase blood pressure which have the potential to increase swelling and increase the risk of nose bleeds. Many patients are concerned that they will do something to harm their result. It is true that a major bump on the nose can cause unwanted healing problems and damage the healing nose, otherwise there aren’t many things you can do to really harm the result.

2) What are the individual factors that influence recovery?

  • You. If you have any medical conditions like diabetes or high blood pressure, these should be well controlled before rhinoplasty as they effect healing. Environmental factors such as smoking delays healing, Dr. De Silva insists all patients stop smoking before surgery to improve healing and reduced risks of surgery. Your constitution is an additional factor that influences healing, two people having identical surgery will not heal in the same time, we all heal differently. Mental attitude, cosmetic surgery can be an emotional experience, and having a positive mental attitude goes a long way towards faster recovery.
  • Your Surgery. What surgery did you have as not all rhinoplasty is the same, whether the surgery is principally on the tip, the bridge of the nose or revision surgery. Whether you have additional procedures such as narrowing of the nostrils or a chin implant at the same time will affect the recovery. Depending on how much surgery was required influences the amount of bleeding and bruising during the surgery.
  • Your Surgeon. Different surgical techniques influence the length of recovery, the level of bruising and swelling. Dr. De Silva performs conservative surgery that limits trauma to the nasal cartilages and soft tissues of the nose, and where appropriate innovative techniques such as 3D telescopes and micro-burrs to speed up the recovery process. Other innovations that can be used to reduce bleeding, such as the use of tissue glue in a patient with known bleeding issues.

3) What are things you can do to speed up recovery?

  • Before surgery. Dr De Silva provides all patients detailed instructions on medications and other treatments that can influence bleeding and should be avoided before surgery. In addition there are herbal medications that should be taken to reduce bleeding, Arnica.
  • After surgery. Icing the bridge of your for the first three days, in the form of ice in a zip lock bag, frozen peas or gel mask all have a beneficial effect on reducing swelling when applied to the nose for ten minutes every hour during waking hours. There are other factors such as resting and taking things easy during the daytime that will maintain a relatively low and stable blood pressure.
  • Taping. Taping the bridge of the nose and the supratip area (area above the tip) can significantly reduce postoperative edema (swelling). The taping reduces the amount of swelling through a pressure affect is thought to cause the collagen fibers in scar tissue to become more organized, which reduces the amount of swelling. The most effective for taping is in the first six months after surgery.
  • Nose blowing. It is important not to blow your nose for three weeks after surgery, this is to avoid further bleeding from the nose or an infection.
  • Head Elevation. Sleeping with you head elevated reduces the effect of gravity on the face and reduces swelling of the nose after rhinoplasty.
  • Sun exposure. In the first several months following rhinoplasty can cause the skin of the nose to become red. You should avoid sun exposure, wear hats and high sun protection factor sunscreen for a minimum of 6-months after rhinoplasty.
  • Surgeon’s advice. It is important to follow your surgeons’ pre and post-operative instructions in order to heal properly and minimize prolonged recovery.
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