Reduce Bruising and Swelling After Rhinoplasty or Septoplasty

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How to Reduce Bruising and Swelling After Rhinoplasty or Septoplasty – Top Recovery Tips After Nose Surgery

There are many reasons to have a nose job.  No matter the reason, before you reach your final decision, you should be aware that it can take time to fully heal and see your final result. Below are some tips to help reduce swelling and bruising after nose surgery.

Nose Surgery is one of the most popular and complex plastic surgeries, it can help:

    • Straighten a crooked nose
    • Smooth a bump on the nasal bridge
    • Refine the shape of the nasal tip
  • Reduce nose size
  • Restore symmetry after a nose injury

What is Rhinoplasty?

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Rhinoplasty, more commonly known as a “nose job”, is a surgery performed to alter the nose’s external appearance by reshaping the nasal structures. This includes; your nasal bones, nose cartilage (the soft part that provides your nose support), and overlying skin.

Septoplasty is another form of nose surgery that involves altering your septum – the flexible internal structure that separates your two nostrils. This procedure can significantly improve your breathing if you suffer breathing difficulties. A Rhinoplasty is often done in conjunction with a septoplasty. When performed together they provide both aesthetic and functional improvement.

A nose job is tailored to each individual’s nose anatomy and the changes they desire. As a result, the exact technique your plastic surgeon uses will vary depending on the patient. However, there are three main procedural approaches when it comes to rhinoplasty: Open & Closed Rhinoplasty and Tip Rhinoplasty.

 

  • Open Rhinoplasty: This is usually reserved for noses that require extensive reshaping. To increase access to your nasal structures, a small incision will be made under your nasal tip – between your nostrils. Any resulting scars are unnoticeable and are hidden in the natural contours of your nose.
  • Closed Rhinoplasty: As the name suggests, the incision is made inside the nostril, while the outer skin is left intact. This approach is suitable when only minor adjustments to the nose need to be made.
  • Tip plasty: Lastly, the tip plasty technique can involve either an open or closed approach. It refers to the area of reshaping, the nasal tip only, rather than the type of incision used.

Bruising and Swelling After Rhinoplasty – Why does it happen?

Many people contemplating rhinoplasty are excited about the surgery but worried about the recovery process. Pictures of swollen faces and the infamous raccoon black eyes immediately come to mind when mentioning a nose job. However, this is not always the case.

You’d be surprised to know that bruising after a nose job, though common, does not always occur. Severe bruising after rhinoplasty depends on several factors like;

  • The extent and technique of the procedure
  • Your age (older people tend to bruise more easily due to fragile blood vessels)
  • The presence of a bleeding disorder
  • Or, the usage of blood thinners.

Bruising is due to the disruption of blood capillaries during rhinoplasty, allowing blood to leak and collect underneath the skin. This results in the classic black eyes look. Under-eye bruising is most common after a nose job, however, you can also see bruises on the eyelids and/or cheeks.

Swelling, also known as edema, is a natural part of recovery after any surgery and nose jobs are no exception. The body’s response to injury caused by incisions or other forms of manipulation to the nasal architecture is inflammation. Inflammation permits body fluid to collect in the tissue to promote healing, this, in turn, causes swelling. Swelling of the nose reaches its peak by day 3 after rhinoplasty, and it starts to decrease after.

Bruising and Swelling After Rhinoplasty – How long does it last?

The road to full recovery after rhinoplasty is notoriously long and depends on not only the individual but the procedure as well. Not to be able to see immediate results can be frustrating, especially since bruising and swelling are at their peak in the first 1 to 2 weeks.

Under-eye bruising typically disappears in the first 7 days, as the tissues reabsorb the collected blood. But, swelling can take longer to get rid of. The soft tissue of the nose tends to retain swelling longer than other body parts. However, don’t be discouraged. Most of the swelling will decrease within the first month following your nose job. While, about 90% of all swellings will subside in the first 3 months, to the point where you can confidently take unfiltered close-up selfies of your face to show off your new nose.

However, it should be noted that it can take up to 12-18 months for the remaining 10% of swelling (usually at the tip) to disappear and your nose to settle into its new form. Corrective revisional rhinoplasty may take an even longer time to heal. Time of recovery should never be a deterrent from undergoing a nose job – the vast majority of our patients report being thrilled with their results in their 4-week follow-up appointment.

What are the Stages of Healing after Rhinoplasty?

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A full recovery from a nose job can and will take some time. To make this more manageable and to track your progress more easily, we’ve broken down the healing process into a timeline:

Day of surgery

  • A rhinoplasty is usually done under general anaesthesia, with a one-night stay in the hospital. Occasionally you may be able to go home the day of your surgery after you’ve been cleared by your care team.
  • Your surgeon will provide you with a list of tips and tricks to follow and may prescribe you medication to manage pain and prevent infection.
  • Dr Stephen Kleid almost never uses nasal packing nor intranasal spints. This is much safer and more comfortable for the patient. Dissolving septal sutures hold the septum in place for several weeks, which creates a more stable and predictable result. The nasal cartilages are sutured in place with long-acting dissolvable sutures (6 months). Occasionally very fine permanent nylon sutures may be used.

Nose care following your surgery

  • You should wash-out your nose with a saline rinse, (which we will give you to take home) three times a day.
  • Then you should use Chlorsig eye ointment in each nostril and across incisions. This helps keep sutures and scabs soft.
  • Contrary to popular advice, it is safe to blow your nose. In fact – it is advisable to blow your nose after the washouts, and any other time it is necessary.
  • At the one-week postoperative visit, the cast is removed by the surgeon, and your nose is “vacuumed out”.
  • At this point, the worst of your bruising and swelling should have subsided.
  • Your black eyes and any other bruising should also start to fade.
  • Swelling after a nose job can make your face appear asymmetrical and your nose may seem too fat in the beginning. The upper lip can also feel a bit swollen which can distort your smile, and it can often push the nasal tip up. This will all settle overtime.
  • You will have noticeable changes in your nose shape and any breathing difficulties associated with swelling should be significantly reduced.
  • You may still feel some tenderness at the nose job site and face, but nothing that cannot be managed with over-the-counter medications.

First few weeks of Recovery 

  • By now you’ll notice a major reduction in your nose swelling.
  • Your under-eye bruising should have almost disappeared and your eyes should no longer look “sunken”.
  • The new shape of your nose will be remarkably more distinguishable.
  • Dr Kleid does not retape the nose after the first week.
  • After 2 weeks you will be able to go back to the gym, running, yoga etc.
  • However, you should avoid contact sports for at least 6 weeks. You don’t want to get hit on your new nose!
  • You shouldn’t wear spectacles for 6 weeks. This is because they can leave “foot-prints” on your nose.
  • 3-4 Weeks: Though far from full recovery, you’ll start to notice how great your new nose looks. Almost all visible signs of rhinoplasty will be gone.
  • 6 Weeks: At this point, your nasal bone structure has stabilized. You can return to wearing eyewear and playing contact sports (preferably not kick-boxing!).
  • Any lingering swelling, especially at the nose tip will continue to improve.

Recovery during the first 12 months

  • 3-6 Months: Your nose tip will appear more refined as the minimal remaining swelling continues to decrease.
  • Sometimes the skin may still be a bit swollen. You might require one or two steroids (Kenacort) injections into your nose to enhance recovery.
  • If you had any problems with sensation inside your nose or its skin, they should resolve by this time.
  • 1 Year +: You’ve made it! The healing process is complete (although revision rhinoplasty operations can take even longer!). Your altered nasal architecture has fully conformed into its new modified shape; with all the edema well and truly gone.

BEST Tips to reduce your bruises and swelling after rhinoplasty

Although Dr Kleid takes special care during the operation to reduce it, bruising and swelling are unavoidable after any surgery, including Rhinoplasty. It makes no difference to the final result but does make you look and feel uncomfortable. Many patients wonder if there are any ways to reduce the swelling and bruising, or sped up its resolution after rhinoplasty. There are actually quite a few home remedies that we can suggest. If you’re preparing for or have undergone rhinoplasty, here are some tips to follow:

Listen To Instructions from your Surgeon and Support team

Perhaps one of the most important and obvious tips to reduce swelling and bruising after nose surgery is to follow your surgeon’s instructions. A plastic or ENT surgeon will go over what to expect in the upcoming recovery process. They will also;

  • Provide you with information regarding what medication needs to be taken and when
  • Show you how to change your nasal drip pads and packing material
  • Tell you how and where to apply the cold compresses and special nasal tape
  • And, when you’ll need to come back for a follow-up appointment.

Keep Your Head Elevated for 1- 2 days.

After your discharge, and for as long as the edema persists, you will be advised to keep your head elevated during the night. If you can sleep this way for a few nights, that’s even better. Sleeping on your side will be not only uncomfortable but can also prolong your recovery time and displace your nose. To prevent this from happening, some rhinoplasty patients opt for sleeping in a recliner for the first weeks. If this is too uncomfortable for you, another trick is to prop your head up on two or three pillows during the night, perhaps aided by a travel “collar”.

Use Cold Compresses

The nurses in the Recovery room will have put ice compresses on your nose for the first few hours after surgery. Doing that for longer is probably unnecessary.

Sleep It Off

Sleep is one of the most underestimated methods when it comes to the recovery process post-surgery. Though it might be difficult to sleep for the first few days due to pain and nose congestion keeping you up, a solid 7-8 hour sleep each night gives energy to the body, allowing it to heal itself.

Stay Hydrated

One of the best ways to deal with swelling, and this may be surprising, is staying hydrated. The more you drink water, the lesser the chance of water retention. Hydration also promotes better blood circulation, which plays a role in faster healing.

Take A Break

It is strongly advised to take 1-2 weeks off after a nose job. This will allow you enough time to rest and have the worse signs of nose surgery (sunken eyes, under-eye bruising, nose swelling) fade. This does not mean you can resume a normal lifestyle right after. It takes about 6 weeks for your nasal bones to set after rhinoplasty.

Creams to help bruises resolve

Once the cast is removed at the one-week visit, you can wash your nose gently (it will still be a bit tender).

Arnica, Lasonil or Hirudoid cream rubbed 3 times a day onto the skin over the bruises, can also help resolve them.

Avoid Eyewear

No one wants revisional rhinoplasty if it can be helped. Eyewear after a nose job and anything else that puts pressure on your healing nose can cause indentations. In more severe cases it can even displace your nasal bones and cartilage. Glasses can further exacerbate your bruising and edema after rhinoplasty. One method to avoid this from happening is to start wearing contact lenses. Another method is to use the faceguard or splint likely given to you after rhinoplasty to wear beneath your eyeglasses, only if necessary.

Don’t Smoke

If you’re a smoker, any day is a good day to stop smoking. Smoking has many known side effects on health. Quitting smoking 2 weeks before and after your nose job is vital. Nicotine in tobacco damages your blood capillaries and limits blood and nutrients from reaching your injury site. This will interfere with the recovery process after rhinoplasty, prolonging the duration of your swelling and bruising.

Listen To Your Body

Despite your plastic or ENT surgeon’s experience, they will only be able to see how your rhinoplasty recovery is going from the outside. Only you can tell how well it’s going from the inside, by listening to your body’s cues. If you end up feeling that something isn’t right after your rhinoplasty, never wait until your next scheduled appointment, contact your doctor right away.

Be Patient

Rhinoplasty, like many other cosmetic surgeries, has things become worse before they get better. Your black eyes will disappear, your swelling will fade -it just takes some time. These home remedies won’t reduce the healing process into a week, but they will significantly help speed recovery and make your nose job experience better.

Dr Stephen Kleid melbourne

Dr Stephen Kleid’s BEST TEN TIPS for Rapid and Comfortable Recovery after Nose Surgery

1. Use Lip Balm

Chances are you are going to have some dry lips. Keep vaseline, lip-balm or chapsticks on hand to keep your lips well moisturised and prevent cracking.

2. Buy a U shaped travel neck pillow

Surgeons have different opinions on how long you need to sleep upright for – 1 -2 nights is probably enough. A nice comfy U shaped neck travel-pillow should make sleeping upright a little easier.

3. Consider Prunes, laxatives or stool softeners

Operations cause constipation – It is better to prevent constipation, than have to treat severe problems.

4. Get Ready with Movies, series streaming, or a good book.

Netflix, Stan, AppleTV – whatever. Have some entertainment planned for your recovery.

5. Use Straws and a water bottle – stay well hydrated, especially as you’ll be mouth-breathing a lot.

Pretty self-explanatory really.  Drinking out of a straw is much easier during the immediate post-op recovery phase and you are going to want to keep those fluids up, so have plenty of water on hand.

6. Use a Saline irrigation bottle

You will be sent home with a Saline irrigation bottle to wash out crusts and scabs, a spray and ointment.

  • Use the saline irrigation 3 times a day, 5 minutes after using the Decongestant nasal spray
  • It is OK to blow your nose.
  • If the cast gets a bit wet it is OK. However,  if it gets soaked it might fall off too early.
  • Chlorsig eye ointment INTO your nose, to soften the crusts

7. Use your Pain medication wisely

You will be given;

  • Celebrex: This is to be taken morning and night. It is an NSAID, a long-acting pain-killer. (like Nurofen and Naprogesic, but does not cause bleeding)
  • Panadol: Take 2 tablets regularly
  • And, Endone: very strong, only take if needed.
  • Snoring surgery and tonsillectomy patients will also have a Norspan patch, and a spare to change on day 6.

8. Organise Pre-prepared meals

  • Organise a week’s worth of food before your surgery. Pick foods that are soft and easy to eat.
  • Fast snacks are great to keep on hand so you don’t have to take your medication on an empty stomach.
  • Better still –  stay with your mum/friend/significant other. Flatmates aren’t much help.

9 Have Moisturising face wipes handy

The post-Rhinoplasty splint and even post-op dressings are going to make washing your face difficult. Moisturising cleansing wipes will have to be the next best thing for cleaning your face.  The “bolster” under your nose is only needed for the first few days.

10. Aids to reduce Facial bruising after Rhinoplasty

Lasonil, Hirudoid or Arnica cream – help speed up the resolution of post-operative bruising.

Other FAQs – Frequently Asked Questions about bruising and swelling post rhinoplasty

When should you get a bruise checked after rhinoplasty?

  • Bruising, can be normal and usually lasts up to a week.
  • If your bruising lasts more than that or gets worse, consult your surgeon immediately.

Why does it take so long for swelling to reduce after rhinoplasty?

  • Swelling (edema) is part of your body’s healing and repair process.
  • The nose’s ability to retain fluid, gravity, and the extent of surgery, all play a role in the lengthy recovery process.

Can you ruin your rhinoplasty?

  • Yes. Any damage to your nose, be it from trauma or not following postop instructions, can increase the need for revisional rhinoplasty.

Can rhinoplasty take 2 years to heal?

  • Swelling 2 years after rhinoplasty is possible.
  • 5 to 10% of swelling can remain especially at the tip.
  • It may take up to a couple of years for the swelling to fully disperse.

When can I sleep flat after rhinoplasty?

  • You should sleep with your head elevated for at least 2 days.
  • However, if you can tolerate it, sleep elevated for a week or two post-surgery.

 

Further Reading – Medical Sources:

 

Last updated: 09/03/2021
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Dr Stephen Kleid
Dr Stephen Kleid is an experienced Ear, Nose and Throat ENT Surgeon (Otolaryngologist) based in Melbourne with a passion for aesthetic nose surgery. rhinoplasty and a strong interest in Rhinoplasty Revision.