Many patients ask us what their recovery from rhinoplasty will be like.  Recovery has two components by our definition.  Social recovery defines when a person will be able to be seen on public without drawing attention to themselves.  Complete recovery defines when the surgical swelling and other immediate surgical side-effects will resolve.  With surgery such as a facelift or fat transfer, the surgically induced changes usally are completely resolved in a matter of weeks to a few short months.  This is not the case with rhinoplasty.

The social recovery time from rhinoplasty has more to do with the wearing of a nasal splint than bruising around the eyes or swelling.  While the nose will certainly not look its best when the splint comes off, at one week, in many instances it looks better than before surgery.  There are limitations regarding activities for a few more weeks, but the overall  appearance is usually better very rapidly.  Rhinoplasty differs significantly from other facial surgery in the ongoing changes that occur after the first few weeks and months.  The total recovery time for a rhinoplasty can be a year or longer.  The longer usually applies to rhinoplasty that has not been performed with the best of skill.  I’ll talk more about this later.

Usually the nose looks quite good by about 6 weeks.  Factors such as thick skin can influence this time however and thick skin requires longer for the swelling to resolve.  As the nose continues to heal however, more and more of the highlights of the underlying bony and cartilagenous changes occur.  As you follow the patient the nose should look better and better with each visit out to 6-12 months at which time the nose will stabilize if the the balance between the surgery and the contractile forces of the skin is balanced.  If the balance is violated then an unfavorable result may occur years in the future.  This is why the proper surgery and technique is extremely important and revision rhinoplasty is a common procedure.

Rhinoplasty in 2010 is a balance between reducing certain components of the nose and augmenting or supporting other components.  Overresecting the nose may lead to a good result at one year and a poor result at 5 years.  In this case the balance between the skin and the underlying support has been broken and the skin continues to contract leading to an undesirable result.  There are two classic examples of this.  The first is over-reduction of the nasal hump or dorsum without replacing the width of of the middle vault or upper lateral cartilages.  This can also be compounded by not performing adequate osteotomies.  This combination results in an inverted “V” deformity of the nose at the inferior border of the nasal bones.  The appearance is that of a skeleton showing through a thinned skin covering.  We have examples of this deformity on this website.  This situation can be corrected by performing an revision rhinoplasty consisting of placing speader grafts of cartilage and performing adequate osteotomies if needed.   The other classic example of a surgery which deteriates over time is that of over-resection of the nasal tip cartilages.  When this over-resction occurs it causes the margin of the nostrils to pull up and the sidewalls of the nostrils to collapse in causing an unsightly shadow and perhaps nasal airway obstruction.  Again there are examples of this on our website.  This is corrected by revision surgery to replace the lost cartilage.  Often in the original surgery, the lower cartilages are naturally placed in a positon too high in the nose.  When the upper margin of the cartilage is excised in this case it does not leave enough cartilage low in the nostril to support the skin margin and alar retraction and collapse occurs.  When replacing the cartilage a graft is placed under the mucosa of the existing lower cartilage in a location inferior to the cartilage extending the lower margin to support the nostril and decrease the unsightly shadowing.

In summary, most rhinoplasties look quite good as soon as a couple of weeks after surgery with continued improvement out to a year.  In cases where over-resection has occured however, unfavorable changes may present many years after surgery.  It is very important to replace cartilage or augment areas of the nose in combination with selective reduction to achieve long-standing excellent results.

Edward D. Buckingham, M.D.

Question:
My 15 year-old-daughter has been asking for a nose job. I, however do not feel that it is appropriate for someone her age to have such a serious cosmetic procedure. What are the risks of a teen having this kind of surgery?

Answer:
15 is an appropriate age for a female to have a rhinoplasty from a purely growth related perspective.  That does not include maturity level however.  The risks of the surgery are low and are not different for a teenager verses an adult.  Having said that, as a parent you must feel comfortable with your daughter undergoing a major surgical procedure and your daughter must be mature enough to undergo the procedure and the recovery.  While many parents may not have difficulty with the procedure, if you are uncomfortable then wait until a later time or perhaps never.

Posted by Dr. Buckingham

Question:
I’ve always wanted to get a nose job because I hate my “hook” nose. How would surgery fix this?

Answer:
The usual appearance of a nose that a patient would describe as a “hook” would be one that has a dorsal hump and usually an underprojected/underrotated tip.  Rhinoplasty surgery would be targeted at correcting these abnormalities.  Usually and open rhinoplasty approach would be utilized.  The hump is usually addressed first by shaving the cartilage and bone down.  Once this is done the top of the nasal bones are separated and need to be narrowed.  Medial and lateral cuts are then made in the bone to accomplish this.  Sometimes when a hump has been removed, the middle cartilagenous part of the nose becomes too narrow.  If this is the case then small strips of cartilage called spreader grafts are placed.  Once the upper 2/3 of the nose have been addressed the tip is rotated and projected by placing a cartilage strut on the end of the septum and then placing the tip in the appropriate position and securing it there with sutures.  The operation usually takes 3 hours to accomplish and the social recovery is usually 7 days.  Return to full activity is 3 weeks with an additional 3 weeks before any activity that might contact the nose can be introduced.

Posted by Dr. Buckingham

Question:
My nose job was about five or six weeks ago. My swelling seems extreme in the morning but then it sort of fades by evening. I know swelling is normal, but is it normal for it to come and go like this? Someone told me this morning swelling can be permanent, is this true?

Answer:
It is normal for your swelling after rhinoplasty to come and go at 6 weeks and even longer.  As you lay flat in the evenings the venous pressure builds up in your facial area causing fluid to come out of the vascular space and into the tissues.  This is the same reason that your eyes are more puffy in the morning.  As you keep your head above your heart during the day this process reverses and the fluid returns to the vascular space.  This is a normal daily cycle.  Because you had your nose operated on recently there is still some inflammation in the tissues that increases the leakiness of the vessels.  As your surgery becomes more remote this process will abate.  The swelling in your nose will continue to decrease until it is finally resolved.  The reason that some people will say that swelling can be permanent is that in some cases the nose will continue to change for years after rhinoplasty.  This is not really swelling, but is the skin contracting over the cartilage.  If the surgery was performed well this will not be an issue.  In some cases however, this can lead to changes that will be unfavorable.

Posted by Dr. Buckingham

Question:
I’d like to get a nose job but I’d rather not tell people that I’ve had anything done.  Even if I don’t tell people, won’t it be obvious? Do you have suggestions for dealing with this?

Answer:
The ala of the nose are the sides lateral to the tip. They are the fleshy areas that flare when you smile or breathe in. An alarplasty reduces these areas of the nose. It is commonly done in conjunction with a rhinoplasty, but not always. When analyzing the ala you need to think of the nostril opening as one curvilinear line and the outer skin as another. The surgeon then assesses whether the ala needs to be reduced from the inside only, outside only or both. The incision is then planned accordingly to achieve the desired result.

Posted by Dr. Buckingham