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.