Rhinoplasty surgery is certainly a complex and complicated procedure to perform. Small maneuvers can result in big changes and unintended consequences. It certainly helps to have a surgeon working on you that knows what they are doing. Unlike most plastic surgery procedures, nose reshaping takes longer to heal and deliver a final result. Of all the procedures I perform, rhinoplasty easily requires the closest patient management to get the best results.
Because healing from nose surgery can take up to a year, it is best for patients to exercise a bit of patience to avoid going crazy over those 12 months. Aside from asymmetry, one thing that most patients fret over is swelling in the nose after surgery. Having answered 100’s of questions on RealSelf.com, one theme that pops up a bunch has to do with prolonged swelling after rhinoplasty. In general, it doesn’t seem like nose surgeons are doing a great job in preparing their patients for recovery after surgery. Many prefer to take the auto-pilot approach and let time determine the final outcome.
In my opinion, that’s nonsense! An exceptional rhinoplasty surgeon will take the time necessary to educate their patient before and after surgery to make sure that there is a healthy partnership that ensures optimal results. I am great proponent of a hands-on approach to after surgery management of nasal healing and make sure that my patients are taught all they can do to get the best results. To manage swelling after surgery, here are a few things to consider.
CARE TAKEN BEFORE SURGERY
Being nutritionally sound prior to surgery will definitely help reduce recovery times after surgery. I am a big proponent of a high protein diet and use of certain supplements for several days before and after surgery. My favorite supplements are Arnica Montana, Bromelain, and Vitamin C. Each supplement has an important roll in healing after surgery.
CARE TAKEN DURING SURGERY
One of the biggest causes of post-surgical swelling after surgery is inadequate control of bleeding while the patient is on the operative table. Time spent on controlling bleeding in the O.R. will benefit the patient after.
PATIENT ISSUES AFTER SURGERY
After surgery, the race is on. Patients are so busy trying to get back to their regular lives that they don’t realize they have a big part to play in reducing swelling. I require icing and head of bed elevation to control the major swelling that occurs during the first five days after surgery. In addition, a nasal splint is applied for both protection of the nose and to reduce swelling, pain, and bruising. While patients hate packing in the nose, it is a great way to tamponade bleeding and cut down on bruising and swelling.
Patients groan when they learn of the many things that can increase swelling after surgery. When I remove the splint at one week after surgery, patients are so excited by the results. However, soon that excitement turns to caution as they watch their now uncontained nose swell. This is where patient behavior and compliance with teaching become critical. At the day of splint removal, I teach patients how to tape their noses at night and how to gently mold the nose using pressure several times a day. This helps guide nasal shaping in my opinion.
Patients often remark on how every day they have a new nose because of the ebb and flow of swelling they see. Over time this stops and the nose shapes up quite nicely. Patients in Denver love to be active but this can make recovery slow after nose surgery. Anything that increases your heart rate or blood pressure will increase the swelling in your nose. Extra icing after workouts can help in this situation.
Excess salt or alcohol in the diet can cause swelling. Low protein intake can cause swelling. Excess heat exposure can cause swelling. Sunburn that injures the delicate nasal skin after surgery can cause swelling. Re-traumatizing too early after surgery can increase scar and worsen swelling. So many things can cause swelling. Often the difference between a successful rhinoplasty and a mediocre one is how well the patient managed swelling after surgery.
If swelling doesn’t seem to be resolving despite the patient being compliant with aftercare, the problem may be scar in the nasal skin. This scar can block lymphatic drainage causing a backup of soft-tissue fluid under the skin. A go-to for me in this situation is the use of low dose steroid injections. Steroids shut down inflammation, thereby reducing fluid accumulation.
A final trick that works well is to make sure that the pores of the nose are clean and dry. Anything that plugs the pores will make the skin boggy. Patients with aggressive T-zones have more swollen nasal skin after rhinoplasty than those whose T-zones are small. Pore strips or charcoal waxes that pull out blackheads are very helpful. Nightly hydrogen peroxide cleansing of the nasal tip skin also helps by killing the bacteria in the pores that make the blackheads. Reduced blackhead formation leads to cleaner, less porous skin.
The video below shows my technique taught to patients for managing the swelling that occurs the first 2 months after surgery:
About the author Manish H. Shah, MD, FACS
I am a board-certified plastic surgeon practicing in Denver, Colorado. I specialize in cosmetic surgery of the face and body. Rhinoplasty, Revision Rhinoplasty, and Ethnic Rhinoplasty are my favorite procedures.
What is Preservation Rhinoplasty?
Using Nanofat to Improve the Results of Revision Rhinoplasty
Check out Dr. Shah on Daily Blast Live!
My doctor seriously didn’t tell me any of these things today after removing all the crap from my nostrils. This is so helpful and seriously gives me hope in shaping my cartoon swollen lump of clay looking nose!!
I do hope that your nose healed up to your liking?
My nose is exceptionally swollen post revision rhinoplasy at 13 months. I have oily, thick nasal tip skin. I respond very well to steroid injections, but only for a month. If I have scar tissue blocking lymphatic drainage, will the swelling ever stop or will I have to have cortisone injection for ever?! 🙁
If you have thick oily nasal tip skin, I recommend seeing a dermatologist to ask about low dose Accutane. It has been the most effective treatment for your type of skin. It takes 2 years to heal from revision rhinoplasty. Instead of steroid injections, consider oral steroids in the form of a Medrol Dose pack prescribed by your surgeon.
Hi Sir, I had my first rhinoplasty 3,5 years ago. The results were ok but my right nostril was higher than the left nostril, and my columella was hanging a little bit.
6 days ago I had my revision rhinoplasty, to lower the right nostril with a septum graft and to fix the hanging columella conservatively.
Right after the operation, my nose looked okay (I only had a tape cast so I could see it). But then, after each day, the right nostril which was lowered, was going up again ( I think because of swelling?). Today my cast was removed (1 week after operation), and my right nostril was a bit higher than my left, and my columella was still hanging a bit, but less than before. This all made me very sad. But now, 9 hours after removal the asymmetry is getting worse. The right side of my nose is much more swollen than my left (because the surgeon did more work on the right nostril, to lower it, left wasn’t touched). Is this the reason?
Also, is my columella hanging because of how swollen everything is? and will that go up a little bit in weeks?
The surgeon told me that on the operation table both nostrils were on the same level, will this return? How big is that chance?
I know it is very soon to judge the results, but I am asking for your experience and how it resolves in most cases.. I definitely don’t want to have a 3th operation, as each revision brings more risks.
I hope that your response will give me some relief…
Thanks in advance,
4th year med student from Europe 🙂
It is probably cyclic swelling from revision surgery. It will get better with time.
Yes hi it’s been 11 months since my rhinoplasty still gets swollen like it could look amazing one day then fat the next is this normal?
It can be normal. Modulate your salt intake and try some taping to see if things improve.
I wish you were the one who did my rhinoplasty. Would have turned out a whole lot better.
Hello! It’s been more than 7 months since my rhinoplasty and the tip is still super swollen. My doctor has used steroid injections twice already. Is it safe to do more?
Yes it is safe to do more.
Hey I got a nose job in December 2018. I have an ethnic nose, and my doctor says I still have edema and scar tissue on my tip, and we tried steroid injections. Will oral pills help too?
Probably not this far out from surgery. You may need a scar removal surgery to help out or injections of PRP/nanofat.
Also, is it ok to do the injections and pills together?
That could be a bit too much steroid exposure. I wouldn’t recommend it.
Yes it is.
Thank you so very much for this video! Very helpful!!!
You are welcome!
[…] Manish H. Shah (9-12-2019), “Managing Swelling in the Nose After Rhinoplasty”، http://www.allaboutrhinoplasty.org, Retrieved 9-12-2019. […]
[…] Source: 🔗 […]
Hi Dr. Shah,
I had a simple fascia graft to the nose tip nearly 4 years ago in January 2019.
I have experienced intermittent swelling of the nose tip ever since. It is triggered by sleeping, air travel, exercise, warm weather, sun exposure, sinus colds, alcohol… or for no reason at all. It often swells up and down several times throughout the day.
At this point, what actions can be taken?
Hi. Steroid injections are a good start to try to reduce any subcutaneous scar that can trap fluid in the nasal tip.