Rhinoplasty Question: How long the swelling lasts?

Dr.K.O.Paulose FRCS, DLO.Consultant ENT Surgeon.

Jubilee Hospital, Trivandrum, Kerala, South India

Post-operative Swelling & Bruising:

Post operative swelling after Rhinoplasty is normal. The reason that the nose swells after Rhinoplasty has everything to do with the surgical dissection that occurs, resulting in tissue edema. If the nasal bones need to be surgically fractured during the surgery, you may expect slightly more swelling particularly on the cheeks and around the eyes. This is normal. To help minimize post-operative swelling:

1. Thermoplastic dorsal Splint: At the conclusion of the Rhinoplasty, a surgical splint will be placed across the nasal bridge. This typically stays on for one-two weeks and will help to minimize swelling.

2. Intranasal Splints: Swelling after Rhinoplasty not only occurs under the skin, but also occurs inside the nasal airway. I use silastic Intranasal Splints into the nasal airway at the completion of Rhinoplasty. This is removed after one week when the patient comes for suture removal

3. Nasal Taping: At the conclusion of the Rhinoplasty, just prior to application of the dorsal splint, steristrips across the nasal bridge and a sling across the nasal tip. This tape will be taken off and replaced one week after your operation when your sutures are removed. After about two weeks of continuous nasal taping, you will be given instructions about how to “self-tape” and started on a regimen of nighttime taping. Taping your nose after Rhinoplasty will help reduce post-operative swelling.

4. Steroid: I give Dexamethasone 8mg IV three times a day during the day of operation

5. Enractin®: Trypsin and Bromelin is having been shown to reduce surgical swelling and should be started the day prior to surgery.

How long the swelling lasts?

A common question patient always asks.

If you have done all of these things and think that your nose is still swollen, do not worry. This is normal. As a rule of thumb, you can expect the swelling in your nose to persist for 3-6 months in the upper third of the nose, 6-9 months for the middle third of the nose, and 9-12 months for the lower third of the nose. After a Rhinoplasty, it may take as long as one full year for the swelling to do down completely at the tip. The tip will appear very hard for the first 3-6 months.

The amount of swelling after a Rhinoplasty will depend on the patient’s skin, what was changed, and what techniques were used. It is so variable it is impossible to describe this in specific millimeters. The post -operative swelling can cause the tip to look “upturned”. My only constructive advice is be patient.

Multiple factors cause tissue edema:

The amount of surgical trauma, bleeding, patients wound healing response; dietary habits etc all contribute to swelling. Most of these can be prevented or controlled by the surgeon and the patient. Minimal surgical trauma and prophylactic use of anti inflammatory corticosteroids will reduce the risk of excessive swelling. There fore detailed preoperative consultation appropriative post operative care is essential,

As after any surgery, swelling is a normal occurrence in the post-operative period after Rhinoplasty. The tip tends to swell the most and stay swollen the longest. An “open” Rhinoplasty, which creates a scar on the skin between the nostrils, usually causes more swelling than a “closed” one, where all the incisions are hidden inside the nose. There will be some descent of the tip once swelling resolves, but it depends on many factors, such as thickness of the skin and cartilage support, and is difficult to quantitative.

To those who are worried about the swelling after Rhinoplasty, my advice is be patient and don\’t have unrealistic expectations.

Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India. www.drpaulose.com   www.snorefreesleep.com

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