Rhinoplasty is a common but complex procedure that heals in stages, within a generally predictable timeline. In our plastic surgery practice serving Beverly Hills and Sacramento, we have done thousands of rhinoplasties. Our decades of experience in this procedure has given us a wealth of knowledge in terms of advising patients about what to expect during the healing process, and the do’s and don’ts of aftercare in order to achieve the best results in the shortest amount of time.
What is rhinoplasty?
Colloquially called a “nose job,” a rhinoplasty is a cosmetic surgery which restructures and reshapes the nose to bring it into more attractive alignment and proportion with the rest of the face. Rhinoplasty is one of the most popular and sought-after procedures in plastic surgery, and for good reason. As the central feature of the face, an ill-shaped or oversized nose can steal focus from other beautiful features. Modifying the nose to bring it into greater harmony with the rest of the face can have an incredible impact on a person’s appearance and general confidence level.
Rhinoplasty is a term used to describe altering the outer appearance of the nose. This can have both cosmetic and functional consequences. If the outer structure of the nose is stronger, the patient often looks better and breathes better. The nasal septum, which is the central pillar of the nose, can be deviated from trauma or congenital deformity. Simultaneous repair of the nasal septum (nasal septoplasty) is usually performed with cosmetic rhinoplasty. If properly performed, septorhinoplasty can have significant functional and cosmetic benefits.
How much swelling is normal after rhinoplasty?
The amount of swelling you will experience after a rhinoplasty will depend on the extent of the work done to reshape and resize the nose. But in any case, especially in the first couple of weeks following surgery, you should expect a moderate amount of swelling. Keep in mind that the swelling will obscure the new shape of the nose until it goes down, so if at first, your nose appears to look too “fat” or the tip appears to look too lifted, don’t worry — everything will settle into proportion as your nose continues to heal. However, if at any point, you’re concerned that your swelling is excessive, don’t hesitate to call your surgeon’s office just to check. Do keep in mind, though, that swelling may take several days after surgery to reach its maximum, so there is usually no cause for alarm if you are more swollen on day three than you were on day one.
How long does swelling last after rhinoplasty?
While every patient and every procedure is different, most of the swelling will go down within the first month following surgery, and about 90% of all swelling should subside within the first three months. However, the full result is in the last 10% — where the tip and bridge definition is maximized. This may take 12 to 18 months.
Although I discuss this healing timeline with all my patients (and this information is readily available on the internet), the most commonly asked question to me, two or three weeks after a rhinoplasty is, “Am I still swollen?” or “Will my nose continue to get smaller?” The reason for this is human nature. People can intellectualize that their nose should be a little swollen, but they still want the final outcome as soon as possible. This makes them often forget the previous conversations of the healing and swelling timeline.
At the three-to-four month mark, most patients feel their results are complete enough that they feel comfortable and happy posing for things like wedding pictures and senior portraits. It can, however, take up to a year or longer for your nose to settle completely into its new shape and position. Especially around the tip of the nose, more delicate refinements may take longer to appear as swelling goes down and cartilage heals and reforms. And if you are having a revision rhinoplasty, healing may take a bit longer than your initial surgery. Still, most clients are already thrilled with their results at their 4-week follow-up appointment.
Is nose tip swelling normal?
Yes, nose tip swelling is completely normal after rhinoplasty. The reason for this is purely anatomical. The skin and soft tissue of the tip of the nose is thick and subateous, and it is also densely adherent to the underlying cartilaginous infrastructure. This makes the skin on the lower half of the nose take longer to reach its final outcome, post-rhinoplasty, than does the skin on the upper half of the nose. Many patients notice that the swelling around the bridge of the nose improves more quickly than swelling around the nose’s tip, as the tip is often the last part to heal completely. While the vast majority of all swelling should go down after a few weeks, subtle definition at the tip of the nose may take a few more months to fully develop.
Is face swelling normal after rhinoplasty?
Yes. While the nose is obviously the site of the surgery, residual swelling is to be expected in the surrounding areas of the face. You may have bruising and puffiness around your eyes, cheeks, and upper lip in the first couple of weeks after surgery, but most patients find that this resolves fairly quickly, within about the first week, and that they can use cosmetics like concealer to hide any remaining facial bruising if they need to go out in public. About half of patients have no facial bruising at all at 7 days post-op; about 40% have only minimal bruising; and about 10% have moderate bruising. The amount of facial swelling and bruising depends on the complexity of the procedure as well as the individual person — some people simply tend to swell and bruise more easily than others. Regardless, almost all patients can expect any visible signs of facial trauma to have resolved within a few weeks after surgery.
What are the stages of swelling post rhinoplasty?
While most swelling from rhinoplasty goes down within a few weeks, swelling may initially get worse before it gets better, so don’t be alarmed if it is worse on day three or four than it was immediately following surgery. Every patient is different, so recovery times vary, but generally speaking, most patients can expect to look “normal” after about three to four weeks, with a small amount of residual swelling and tenderness lasting about three months — though it is usually only noticeable to the patient themselves.
The thicker the skin is, the longer it takes for the final outcome to be achieved. For this reason, patients who have thick skin preoperatively, that their outcome may take closer to 18 months, rather than 9 to 12 months. Additionally, if a patient is undergoing a revision rhinoplasty procedure, the final results are more likely to take a greater amount of time, versus a primary rhinoplasty. This occurs because the skin soft-tissue envelope is thicker and less compliant in revision rhinoplasty patients.
Swelling of the tip of the nose may last a bit longer for some people, and those who have a more complex procedure involving both internal and external reshaping may experience more swelling for a bit longer. Patients should expect it to take about a year for their nose to settle into its final position, but by the one-month mark, most people are very happy with the initial result, and show no signs that the procedure was ever done. Generally speaking, rhinoplasty is a remarkably well-tolerated surgery that produces dramatic results with relatively little downtime.
How to Help Swelling After Rhinoplasty
Swelling after rhinoplasty can be reduced by keeping the head elevated, which includes while sleeping. Ice packs may also be used to reduce puffiness and discomfort, especially in the first 48 hours after surgery, but should not be used for more than 10 to 15 minutes at a time, and should be wrapped in a clean towel rather than applied directly to skin. While using ice packs, be careful to avoid any sutures and be sure not to move any splints or tapings out of alignment. Swelling can also be reduced by drinking plenty of water and avoiding especially strenuous sports or activities for the first few weeks after surgery. It is okay to be up and active as you feel ready, but take care not to overexert yourself initially. Also, be sure to eat a nutrient-rich diet as you heal. Foods rich in an enzyme called papain, like fresh pineapple or papaya, can help the body eliminate bruises more quickly. Try to avoid salty foods, as they can increase swelling.
Your surgeon may also employ different techniques during and after surgery to help reduce swelling and speed up the healing process, such as the use of platelet rich plasma and steroid injections. You may also be prescribed antibiotic and vitamin-infused topical ointments, or sterile saltwater sprays to keep the nose hydrated.
What are the healing stages of rhinoplasty?
The initial healing stage is about ten days. This is the period when you will need to be most vigilant about aftercare instructions, and plan to take a break from your normal activities to allow everything to heal. After ten days, much of the bruising and swelling will have dissipated, and any lingering effects can be concealed with makeup. After about three weeks, you’ll likely have no readily apparent signs that you ever had surgery, and can resume non-weight-bearing exercise. At three months, almost all swelling has gone down permanently, and the nose looks basically like the final result. It will take a year or two for the nose to totally settle into its new structure, but at three months, the vast majority of rhinoplasty recovery is complete.
What is the healing timeline after rhinoplasty?
Day of Surgery: You will be under general anesthesia while the surgery is performed, and go home the same day, after your care team has cleared you for discharge. You will want to use ice packs to bring down swelling as much as possible, and your surgeon will advise you about where and how to apply them. If you need to apply any topical ointments, your doctor will give you instructions as to how to do that, as well. You may also need to change your nasal drip pad and any packing material inside the nose at intervals prescribed by your doctor, if applicable. The night after surgery, and for as long as swelling persists, it is a good idea to try and sleep upright in a chair to ensure that your head stays elevated.
1 Week After Rhinoplasty: If you have any staples or non-dissolvable sutures, these will be removed, as will any splints or protective coverings. At this point, you may still experience some swelling, but any difficulty breathing through the nose will have subsided, and you will be able to see a very visible change in your nose’s shape. Any bruising around the nose and eyes will have started to fade to green or yellow, making it easier to conceal with cosmetics. Though parts of your nose and face may remain very tender to the touch, your resting pain level should be pretty minimal if not nonexistent, and easily controllable with over-the-counter pain medications.
2 Weeks After Rhinoplasty: At this point, you will probably experience a dramatic reduction in post-op swelling, and any bruising will likely have disappeared. As swelling recedes, the new shape of the nose becomes more apparent and distinguishable. Any fine-tuning of the nose’s shape may be done with special taping, injectable treatments, or massage techniques — though this is usually not needed. After two weeks, you generally will not need much in-office follow-up, and will probably be back to your regular activities.
3-4 Weeks After Rhinoplasty: Almost all the visible signs that you ever had the surgery will be gone, and it is safe to return to cardio workouts. Your nose’s shape will be more well-defined with the continued reduction of swelling. At three weeks post-op, the patient can really begin to see what the final result of the surgery is going to look like. At one month to six weeks, you will likely have another follow-up appointment with your surgeon, just to check on things.
6 Weeks After Rhinoplasty: Since the bone structure has now set and stabilized, you can resume weight-bearing exercises, wear glasses if you want, and blow your nose if necessary.
3-6 Months After Rhinoplasty: If you were experiencing any issues with sensation inside your nose or on the skin of your nose, they will start to resolve at this point.
1 Year After Rhinoplasty: The healing process is complete. Any repositioned cartilage has fully conformed to the new nasal shape; all swelling has gone down entirely; and the tip of the nose is more refined and nuanced.
Will I need a rhinoplasty revision surgery?
The national average for revision rhinoplasty — meaning a rhinoplasty that has to be redone due to poor aesthetic or functional results — is about 15%. Many of our patients come to us after a previous procedure, and ask us to perform revision rhinoplasties. We cannot stress enough the importance of finding the most skilled surgeon for your procedure the first time. Finding an expert plastic surgeon, like those on our staff, can save you the time and expense of a repeat procedure.
Do I need a rhinoplasty plastic surgeon near me?
To ensure the best quality of care and technique, patients seeking a rhinoplasty often travel for the procedure in order to access the best experts in the industry. Because there are only a handful of expert rhinoplasty plastic surgeons in the country, patients should expect to travel to a location like Beverly Hills for their procedure.
Email Dr. Sykes at [email protected]
About Dr. Jonathan Sykes
Dr. Jonathan Sykes is a world-famous expert plastic surgeon who performs all cosmetic and functional plastic surgery procedures on the face and neck. He is a past president of The American Academy of Facial Plastic and Reconstructive Surgery, and served on their Board of Directors for over 10 years. He is also a Professor Emeritus in Facial Plastic Surgery from UC Davis Medical Center, and the former Director of Facial Plastic Surgery at that institution. He is known as the expert’s expert, and is often called to consult and advise other plastic surgeons in both Northern California and Beverly Hills. He has a special interest in eyelid and browlift surgery, facial rejuvenation surgery, including facelifts and rhinoplasty.