Patients like to know the details of an entire recovery process. What does rhinoplasty look and feel like post op after a few days, a few weeks, months, and even years? With over 40 years experience on the job as a rhinoplasty surgeon I can expand on all facets of the recovery process so that you can feel comfortable and know exactly what to expect through each phase of the recovery timeline.
Patients can go home right after rhinoplasty to begin their recovery. The bruising will diminish every day. The swelling will continue to abate. Remember, the swelling at the bridge and the upper parts of the nose will go down quicker because the skin is thinner. The nasal tip swelling will take a little longer because as the swelling moves from the bridge down to the tip, it then has to dissipate from there, but it always goes away. There are other factors, including the thickness of the skin and how much work had to be done to narrow the tip of the nose.
Rhinoplasty swelling is common and its resolution is a function of complexity. If people have had many broken noses and had a deviated septum and the whole nose has to be basically disassembled and rebuilt, of course, there is going to be a little more swelling and bruising. But, again, it goes away. It does not take 3 or 4 weeks. It is always a matter of 7 to 10 days typically. Every day you look better. In my own rhinoplasty experience, within 9 to 10 days after surgery the appearance of my nose was very improved but not as good as it was a week or 10 days later. The swelling continues to go down.
The basic healing process of rhinoplasty is just like any other operation of the body. It is really a matter of 3 months, 100 days, but it is not that you do not look good at 3 weeks or 4 weeks. You look excellent, but the nose keeps getting better and better, meaning more refinement, more finesse, and more in accord with the predicted results. Remember that nature does best when there is no manipulation, when there is no massaging, and when there is no putting various tapes and things on the nose. Nature likes to be left at rest to encourage the best healing.
Rhinoplasty bruising is usually very short. For someone having just the rhinoplasty surgery, there can be very little. There could be more if the operation was a correction of a broken nose including the cosmetic changes. Generally, five, six, or seven days is the limit and it continues to go down and fade away very quickly. There are variables for everybody. No two people have the same issues. Some people just have a tendency to bruise more and others do not. The one constant that nature provides is that the bruising will always go away.
From the get-go, immediately after your rhinoplasty, in the recovery room, ice application is of great help in preventing or at least reducing swelling and bruising. We recommend as much icing as possible in the first 48 hours. The early-on care of your nose after rhinoplasty is the key to a faster rhinoplasty recovery time.
The first night, sleeping slightly upright, two to three pillows, helps drain any blood in from the nose. This promotes less swelling and bruising.
After surgery, the top Rhinoplasty surgeons provide recovery tips to ease recovery and accelerate healing.
The outside plastic protector is in place for anywhere from 4 to 6 days. Once that comes off, one can already see the changes that have been made. If you had a bump, it’s gone. The profile already is a big improvement. The tip is more refined and so you have a very good idea of the outcome. Each day the swelling recedes and if bruising present, it lightens in color and evolves from purple to green to yellow. This is good news, because both green and yellow are easier to conceal cosmetically.
At 3 months, 85% to 90% of the refinement has taken place. Remember that in rhinoplasty, it involves changing the shape of the nose by altering the bony and cartilaginous structure, so it is required that the skin that has been raised continue to shrink down to the new dimensions. Typically results at 3 months are considered very close to the end result, although at 6 months it will look even better and even more at a year.
We like to see our patients at the 6-month mark and at the 1-year mark and we will compare their appearance with the preoperative photographs which is always of great interest to the patient, particularly because by that 6-month mark they often forgot exactly what their nose looked like before.
While by 3-6 months the rhinoplasty “healing” is considered complete, there is even further maturation and improvement up to the one-year mark. Typically the tip of the nose becomes even more refined until 12 months after surgery. Likewise, the width further narrows as the very last vestiges of swelling under the skin recedes. Just like fine wine, time makes the nose even better.
At the one-year mark and milestones after, visits are offered at these stages on an as-needed basis, and most patients find them unnecessary. Over this time, final results become apparent, and you will be able to truly enjoy your rhinoplasty – by forgetting you ever had it. Your nose will seem like it has always been a part of your face, and looking back on your old nose in photos will seem foreign.
Our practice provides all of the supplies and non-prescription medications that should be used to speed the recovery. This includes a 10-day supply of Arnica, which patients start taking just before surgery day. We provide antibiotic ointment for use inside the nose. Also, saltwater or saline spray mentioned above is important to use to keep the nose refreshed and speed the healing, particularly in the first several weeks, which is very refreshing and can help reverse the dryness of the nasal lining due to the procedure.
The main precaution after rhinoplasty is to avoid any injury to your nose. The second precaution, of course, is to avoid those things that would interfere with blood clotting. For example, we do not recommend going on large doses of aspirin or even non-steroidal anti-inflammatories like Advil or Motrin because they could interfere with the proper healing and kick up the possibility of some bleeding. Only in the first 10 days is one at risk for that particular situation.
Stay away from situations where your nose could be bumped. If you are going to be flying on an airplane, do not plan on lifting your luggage overhead and stay away from people who are lifting their luggage over your seat. You do not want anybody’s luggage to bump your nose.
Depending on the surgical procedure (open vs closed rhinoplasty), there might be scarring. The majority of Dr. Kotler’s procedures are performed using the closed technique. In closed rhinoplasty, the incision is internal and there is no visible scarring.
A moderate amount of alcohol meaning 1 or 2 drinks a day is certainly tolerable. Any greater volume of that runs the chance of some instability. Drunkenness is a risk because of the chance of a fall and contact damage to your nose.
Smoking is one of the biggest no-no’s because it slows healing. Dryness is the enemy of the nose and so is heat, so it is a double loss here. We do not recommend it and most people are wise enough to know that they would tamper with rapid healing by smoking. It is a good time to consider stopping smoking since for the first 10 days if you can get through that, you will be on the road to ridding yourself of an unhealthy habit.
If the nasal bones have been repositioned, as in the case of 90% of rhinoplasties, glasses should not be worn for typically 5 weeks or so. However, patients are instructed on how to suspend them with small pieces of clear transparent tape such that it would be very hard to see that the glasses are suspended just above the bridge so there is no pressure. Of course, those who wear contact lenses may put them in the day after surgery.
The nose will not grow after rhinoplasty. One might think their nose looks bigger after rhinoplasty for the first 7 to 10 days because it is a little swollen but the truth is, it does not grow. As a matter of fact, as people get older and the noses tend to droop either because of an overactive depressor muscle pulling the tip down or just due to the effect of gravity, and there is less chance of that if you have had a rhinoplasty because the internal scar tissue keeps the nose tight.
The external plastic splint or protection is typically removed anywhere from 4 to 6 days. It does not hurt to remove it. It is gently slid off the skin and, at that point, there are no external signs that you had any surgery, particularly if you had the closed rhinoplasty approach which demonstrates no external incisions.
Sometimes there is a little bit of itching. Be gentle. Use a Q-Tip. Also remember the skin can get a little oily after surgery so we recommend using witch hazel, as well as an antibacterial hand soap. There is a small chance of getting a little outbreak of acne which can occur after rhinoplasty because there can be trapping of oil on the skin due to swelling. If you follow the typical post-op instructions, that will not be a problem.
In the first 10 days, we do not recommend it because the veins will become filled with blood and are more likely to leak. Rather than bending over, just bend the knees. Be careful if you are lifting children also because remember that the young infants will tend to buck their heads back and if they do you will not be a happy parent.
One can shower even the day after, as long as the splint is protected from the direct spray of the water. We recommend taping some saran wrap to your forehead and therefore providing a nice little cover. The splints are well adhesed to the skin so there is not much chance they will separate even if a little water gets in there. Certainly, shower and shampoo and be comfortable.
If you have just had a rhinoplasty and have not had the septoplasty and turbinate resection you should be able to breathe quite well. In our practice, of course, we have the Kotler nasal airway in place, which is guaranteed to be able to breathe whether there is packing in your nose or not. Remember, today’s contemporary packing materials both dissolve and also do not stick. When the non-absorbable packing is removed, liquid anesthetic is put into the nose.
The purpose of packing is to speed healing, reduce the chance of infection, and also minimize the chance of any bleeding, so packing is very important. However, if the nose were packed without having the little plastic air tubes in place, which do not hurt and sit in an un-operated area, it would not be quite as pleasant. The combination of packing with the airway, and those can be in place for up to 4 to 5 days, gives you the best prospect for having a satisfactory postoperative experience.
With a specialized rhinoplasty surgeon, breathe immediately after rhinoplasty or nasal surgery. As one of the most specialized rhinoplasty surgeons in the U.S, Dr. Kotler is also an inventor. The Reltok Clear-Flo™ Nasal Airway System. was created to advance post-operative care for rhinoplasty for breathing and comfort. Speak with your surgeon about a homecare kit to learn how you can breathe clearly after nose surgery.
Most patients tell us, in our detailed surveys, that their nose pain after rhinoplasty was less than they feared. And even if there is significant pain, of all of the things that doctors do, pain control is the easiest. There are a variety of medications that can be used. Many people are happy using just extra strength Tylenol or even plain Tylenol – just no aspirin, please. However, it is wise to have something stronger on hand and our practice typically provides Tylenol with Codeine as opposed to an opioid because we think that is a better medication and you are only going to use it for a couple of days.
Patients are concerned about nose pain after rhinoplasty in the tip of the nose because it tends to be the most sensitive area. On the contrary, the tip of the nose tends to actually be a little numb and is less painful than the bridge, but it is not great pain.
I can tell you from my experience as a rhinoplasty patient, I never even took a pain pill. I was waiting for the big pain to “show up” and it never did. I got up the next day and felt fine and never took a pain pill. However, everyone is different and some people have a higher or lower tolerance to pain and that needs to be taken into account. We do not want you to suffer because the physician’s job is to prevent suffering. Equally important is that if you have pain the blood pressure goes up. If the blood pressure goes up, there is a greater chance of bleeding within that first 7 to 10 day critical postoperative period.
After rhinoplasty, not uncommonly, the usual nasal mucus glands tend to reduce their production. This results in dryness that while not a threat to the result nor likely to cause other problems, is a bit of a nuisance. Nasal surgeons anticipating this temporary condition provide moisturizing solutions to be used after surgery. There are many brands and varieties, e.g. Neil Med, Pretz. The common ingredient is salt water; the same solution used for intravenous solutions. These products, sprayed into the nasal passages will minimize dryness, soften some internal crusts and hasten healing. Since the inside of the nostrils may also be a bit dry, bland ointments are recommended.
For those patients with naturally dry skin, some minor skin care is recommended. The skin will be a bit flaky and since patients are rightly reluctant to be vigorous about cleansing the skin of the recently operated nose, there can be a build-up of the surface skin’s unremoved shed layer. The remedy is simple, gentle washing and then application of a light moisturizer. The dryness and flakiness will gradually disappear as the patient becomes more comfortable with skin washing. The moisturizer is safe, practical and is used as needed.
For patients with often oily skin, after the dressings come off a few days post rhinoplasty, skin is oilier. Why does oily skin happen post-nose surgery? Shiny nose after a rhinoplasty is common and happens as a protective response from the skin. To treat oily skin or avoid oily skin during recovery time, wash your face more often with an antibacterial hand soap for hands, face, and nose. The use of witch hazel and toner will help to remove oil off the skin so you can prevent acne outbreaks. Rest assured, shiny noses are temporary and will go away as you heal.
The patient whose skin tends to be oily will have different issues than a patient with dry skin. The oily skin combines with the skin that normally flakes off to form a film that can clog pores and even lead to a skin condition known as acneiform dermatitis. Little red bumps, a la acne develop as some bacteria invade the very surface and thrive in the oily-dead skin environment.
This is not a serious condition and does not threaten the nose. However, it should be dealt with so that the appearance is more normal for the healing stage. Further, if left untreated, the condition can advance to the more invasive acne. Removal of the oil and skin using a variety of astringents such as Witch Hazel is very helpful. Also, the use of an antibacterial soap will eradicate the bacteria and hasten the resolution.
Rhinoplasty recovery is common sense, more than anything. We will guide you. We provide all of the information, written material, and instructions, and supply all the medications, both prescription and non-prescription. This is all geared to having the most rapid and complication-free recovery. A little common sense goes a long way and most people know that the postoperative period is important so there will be no slowing of the healing, so there will be no chance of increased bruising or swelling, and therefore are motivated to do the right thing to have a successful outcome as opposed to an unpleasant experience.