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The changes that rhinoplasty surgery does to the outside of the nose can be both significant and appearance-changing. One of the very common postoperative hurdles that patients must get over besides swelling and bruising is nasal congestion. Even when the rhinoplasty is done only to cosmetic structures of the nose, some temporary nasal congestion can occur. When both the internal and external structures of the nose (septorhinoplasty) are manipulated, that temporary congestion can really be significant.

Nasal congestion occurs as a result of several physiologic and mechanical factors. The mucosal lining inside the nose reacts to the trauma of surgery and manipulation by swelling. So even when the airway passages are made  wider or more open, the swelling of the lining will temporarily obscure any of those benefits. As the nasal lining swells the tissue reacts by producing secretions, a normal mucosal tissue response. This accounts for that postsurgical drip from the nostrils that many rhinoplasty patients experience for several weeks after surgery. Their will always be some blood clots inside the nose and they present a mechanical obstruction to breathing. Lastly, even though most plastic surgeons today don’t use nasal packing, often some form or resorbable or dissolveable packing may be used. Like blood clots, this takes time to dissolve or be blown out.

It is important to realize that significant nasal congestion is to be expected in full or more complete rhinoplasties. But more limited nose procedures, such as tip rhinoplasties, may have very little congestion if any at all. Even when the airway structures are not changed (septum, turbinates), some congestion may still occur if nasal osteotomies are done as part of the procedure.

While time will improve the nasal congestion substantially, it make take up to 10 to 14 days until it is really better for many patients. Complete resolution of the congestion and drainage will be seen by three to four weeks after surgery.

There are several things that can be done, however, to lessen the uncomfortable symptoms of postrhinoplasty congestion and help it clear sooner. The fundamental principles include humidification to loosen nasal debris and decongestant medication to help shrink the nasal lining and decrease the production of secretions.

The use of hot showers or a dehumidifier in your bedroom at night keeps down dry surrounding air. This can be supplemented by the liberal spraying of your nose with saline nasal sprays. (e.g., Ocean mist, Ayr) The use of oral and spray decongestants is also useful. Using Afrin nasal spray 3 to 4 times per day and taking Sudafed 30mg three times a day provides an immediate and significant decongestant effect. These are not usually needed beyond the first week after surgery. Also during your first postoperative visit to your plastic surgeon, those clots that are easily visible and not too painful to remove can be cleared.

Nasal congestion is usually the most uncomfortable part of the recovery after a complete septorhinoplasty. By 10 days to two weeks after surgery, this phase is significantly over. But in the interim, there are some helpful steps that can make an otherwise uncomfortable phase more tolerable.

Dr. Barry Eppley

Indianapolis, Indiana

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