Rhinoplasty like all facial reshaping surgeries undergo an evolution during the healing process. There is the immediate appearance of the various aspects of the nose as they appear to the surgeon during surgery. And then there is the much longer healing process, up to one year after surgery, in which the nose continues to change shape over its constituent parts as the swelling subsides and the shrink wrap effect takes place.
Both the intraoperative appearance and the eventual nasal shape outcome involve a similar process but it affects their appearance differently. Every patient is very aware of the effects of swelling. This plays some role during the actual surgery but it has a more major influence during the early and intermediate recovery process where the entire nose becomes distorted and is not close to what it will eventually become.
Conversely the relative unknown tissue shrink wrap effect is a major player both in surgery and in the long term outcome. It is important to note that the appearance of the nose is a reflection of the bone and cartilage framework with the TIGHTLY attached soft tissues adhering to it. During surgery it is necessary to separate the soft tissue attachments to access and change the hard tissue framework. This makes the overly soft tissues free floating. This why during a rhinoplasty the surgeon is constantly modeling the soft tissue over the reshaped framework to get an idea as to how the nose shape is changing. But no matter how much squeezing of the skin is done onto the framework it is never a 100% representation of what the actual long-term result will be.
During the recovery process the swelling of the soft tissues largely subsides by eight to twelve tweeks after surgery. But the tight readherence of the soft tissues (shrink wrap effect) takes much longer. (months to a year) This is why how the nose appears early on can change significantly later. Small details in its shape, both favorably and unfavorably, appear many months later that were not present initially.
This is why revisional rhinoplasty rarely should be performed early. The changing of the nasal shape through resolution of swelling and the shrink wrap effect creates a moving target until the process is complete.
Dr. Barry Eppley