Changing the appearance and improving the function of the nose through rhinoplasty surgery is sought by many patients. Having the opportunity to get rid of that hump, narrow and lift the tip, straighten the nose and overall make the nose more proportionate can improve the look of one’s entire face. Coupled with improving the breathing through one’s nose, should that also be a problem, provides a functional benefit as well.
While the outcome of a rhinoplasty can be very exciting, it is surgery and with that comes a recovery period. While often stated as being two or three weeks for a rhinoplasty recovery period, what happens in an actual patient is quite different than what is written in a brochure or on a website. Because it is a surgery that affects the most prominent part of one’s face, the recovery period after nasal surgery will always be much longer than most patients anticipate. Recovery from rhinoplasty must be thought of as having both a cosmetic and functional component that occurs in four stages.
The first stage of rhinoplasty recovery is up to a week after surgery and is largely a functionally restrictive period. It is during this period that splints and tapes will be on the nose and it is obvious one has had surgery. This is the ‘social reclusion’ stage for most patients. Few patients want to go in public or go to work with this external marker present. Whatever pain one will have is during this phase although rhinoplasty is not commonly very painful. It is uncomfortable with the splint in place for sure and, when combined with congestion and nasal stuffiness (if septal and turbinate work has been done), is a week one wants to get over quickly. If nasal osteotomies (breaking the bones) are done, bruising may appear under the eyes but often will not appear for several days. The nose does not get swollen (because of the splint) but the surrounding face might in the cheeks and down to the jowls.
The second stage of rhinoplasty recovery is between one and three weeks after surgery. After one week, the nasal splint and tapes are removed as well as any internal splints. The nose is also cleaned of any clots if possible. That is a breath of fresh air for every patient, no pun intended. If bruising has occurred it will still be present and will take up to the end of stage two to go away completely for most patients. This is not the end of the functional recovery as further improvements in breathing will occur but it is the beginning of the cosmetic recovery. Removing the splint is not a ‘TV moment’, meaning the final result is not going to appear. The nose will be swollen and distorted and often will look worse than before surgery. This is normal. The thicker one’s skin is and the more work that has been done leads to a lot of swelling. This swelling will not go away in the next two weeks. It will improve but even at three weeks after surgery less than 50% of the swelling will be gone. Most patients understand this but it is still hard when it is one’s own nose.
The third stage of rhinoplasty recovery is between three weeks and three months. It is a completely cosmetic recovery at this point as the swelling gradually goes down. While many patients want to look critically and note many ‘flaws’ in the result, what is seen now is still not the final result. While the biggest parts of swelling have subsided in the first couple months after surgery, many finer nasal issues such as the size of the tip or shape of the nostrils still needs more time. But during this phase the general change in nose shape should be apparent even if it needs more time for further refinement. This is the hardest phase as one’s patience is growing thin but just remember how far you have come sicne stage two. But no matter how it looks, even if it is not what one anticipated, the thought of revisional rhinoplasty will never be entertained at this time. All plastic surgeons will advise patience.
The fourth and final stage of rhinoplasty recovery is between three months and one year after surgery. Subtle changes continue to take place. Something that looked not quite at three months may have completely gone away by six or nine months after the surgery. Conversely, an asymmetry or bump may appear at six months after surgery that was not apparent at three or four months after surgery. Revisional surgery, if needed, may be entertained at the end of this stage.
In conclusion, recovery from rhinoplasty surgery is a long process and the final result may take up to a year to fully appreciate.
Dr. Barry Eppley
Indianapolis, Indiana