Questions to Ask a Rhinoplasty Surgeon

How long will it take for bruising to go away after a rhinoplasty?

This is one of the most common questions we are asked after surgery. The first thing to note, is that not all patients will bruise. Often times, bruising occurs when we have to cut or move the bones of the upper part of your nose. In patients who don’t have a cut in the bone, bruising is less likely—but still possible—so it is always best to plan, just in case.

If you do have bruising, it usually lasts about 7-10 days, but everyone is different. It depends on how thick and dark your skin is, as well as your body’s ability to remove the old blood under the skin from the surgery, which causes the bruising. It is very rare for people to have bruising after 14 days, but as mentioned, most will see their bruising clear up between 7-10 days. If you have light bruising, you may be able to use make up to subtlety cover it up.

People have tried many things to reduce bruising. This includes taking steroids during surgery and using Arnica. At this point in time, there is no research suggesting that these treatments work and therefore, treatments, like steroids, are not recommended. It is unlikely that Arnica causes damage or harm to the nose, so if patients are interested, this is something they can try.Return to the top

How long does the cast stay on after a rhinoplasty?

A cast is used after a rhinoplasty (or nose job) for a few reasons. Most importantly, it helps you remember to keep your fingers and hands away from you nose! It also helps keep the nose in a straight position, but unlike casts on other parts of the body, it can move because it does not completely protect the nose. However, not all patients need a cast on their nose after a rhinoplasty. If you have the bone cut or you have a bump on your nose removed, you will likely have a cast after surgery. For other types of rhinoplasties, it is unlikely you will have a full cast.

A cast stays on the nose between 5-10 days, but we try to remove it a week after your surgery. If it falls off prior to that, it is usually not an issue, but we always tell patients to never remove the cast on their own or try to move the cast; this can result in your bones moving and making your nose a bit crooked.

The majority of patients do not find removing the cast painful. It is like removing a bandage; it’s a little uncomfortable for a minute, but it is rare that patients require pain medication during the removal.Return to the top

After a rhinoplasty, my nose looks crooked with the cast on, what should I do about this?

This is also a very common question. People often ask me why their cast looks off-centre, twisted, or a bit crooked. A cast for the nose is made out of a material that softens when warmed. At the end of the surgery, we place this piece of hard material in warm water to soften it. Then, we put it over your nose and hold it in place. It’s almost impossible to make it “perfectly” straight as the cast tends to warp as it hardens. What’s important is that the tissue under the cast is not warped, which is an uncommon occurrence. The look of the cast in almost all situations has no relationship to how the tissue looks under the cast. It is important to remember that you do not want to try to change or move the cast, as this can alter the shape of the tissue under your nose. In some cases, there is a reason why we make the cast a certain shape, so it is best to leave it and try your best not to worry about the shape.Return to the top

My nose really hurts with the cast on after a rhinoplasty. What should I do about this?

It is not common to have a lot of pain after a rhinoplasty. Many people have mild to moderate pain, but taking your pain medication will help significantly. If you find that your pain is worsening or your pain medication is not working, it is very important to call your surgeon or Dr. Bonaparte as soon as possible. If you cannot get in touch with your surgeon and the pain is getting worse, some patients need to go to an emergency department or walk-in clinic. However, this is only in very rare situations.Return to the top

After I took the cast off, my nose looks big. Why does it look so big?

Before I answer, let’s do a little review of anatomy and physiology. When we do a rhinoplasty –nose job—we have to cut the skin, as well as “lift” the skin of the deeper tissues of the nose. Normally, blood and fluid flow all around your skin and tissue, and there are microscopic channels that the flow. Surgery disrupts this normal flow and there is no way to avoid this. Any time you cut the skin, you disrupt the flow of blood and fluid. Additionally, your body wants to heal after surgery, so it secretes hormones and other chemicals to trigger the healing response. Healing results in more swelling. So, the combination of healing and a disrupted flow causes the swelling to increase and your nose to look big.

But remember: this is the early phase of healing. Swelling usually peaks at about two weeks after surgery and then, it slowly goes away over time as your body starts to make new channels to drain all the fluid. This can take up to a year or more in some people.

Even though it can take up to a year, your nose will still look good during this time. Patients should expect their nose to be swollen for the first month after surgery. After about two months, your nose will look great, but not perfect. The tip is often still round, shiny, and very firm. This is all due to swelling. After about six months, the swelling will improve. The tip will soften a bit and will be less full, but you will still find it a bit swollen. By a year, the tip should be soft and look great. However, some patients require even longer for all the swelling to go away.Return to the top

How long does the swelling last after a rhinoplasty?

This is a complicated question and one of the most common questions we get asked after a rhinoplasty. There are two possibilities:

• If you have a closed rhinoplasty, the swelling of the skin usually resolves around the first month. However, the bone can change during the first year.
• If you have an open rhinoplasty, the swelling often takes longer. The problem is that swelling can last up to a year and sometimes longer, but that doesn’t mean your nose doesn’t look good during the year after surgery. It will look good, but not “perfect”. Your nose will be very swollen and puffy for the first two weeks after surgery. But after a month, you nose will look natural, but the tip will be swollen and firm. By the sixth month, the swelling will improve; the tip will soften a bit and will be less full, but you will still find it a bit swollen. In a year’s time, the tip should be soft and look great. However, some patients require even longer for all the swelling to go away.

Why does the tip of my nose look so big after a rhinoplasty?

Similar to Question 5 above, we have to cut the skin, as well as “lift” the skin of the deeper tissues of the nose, which disrupts the normal flow of blood and fluid around your skin and tissue. There are microscopic channels that also continue to flow. There is no way to overcome this disruption. After surgery, your body wants to heal so it secretes hormones and other chemicals to trigger the healing response. Healing results in more swelling. As a result, the combination of healing and disrupting causes the swelling to increase and your nose to look big.

It’s been a few months after my rhinoplasty and the tip of my nose still looks big. How long does it take to go away?

The tip of the nose is often the last part of the rhinoplasty to heal. If you look at some of the other questions about swelling, you will see that the tip can take up to a year to heal. However, the tip will look great, but not “perfect” after one month.Return to the top

It’s been a few months after my rhinoplasty and I can still feel a bump on my nose. Does this mean it is going to come back?

The short answer is no. In rare situations, the bump will still be present after surgery, but this is the exception. After you cut the bone of the nose—or remove the bump on the nose—the bone has to heal. It forms what is called a “callous” that is kind of like a scab on the skin. This allows the bone to heal underneath it. You can, sometimes, see this bone healing and it looks like a small bump. Over time, the body will absorb this and the swelling will go away.

In rare situations, your body may scar or form a thick bone. In this situation, it is possible to see the bone or a small bump. If this was to happen, you should talk to your surgeon to see what can be done to fix it. In nearly all cases, this can be easily fixed with a minor surgery.Return to the top

It’s been a month after my rhinoplasty and the scar under my nose looks uneven. How can I improve this and why did it happen?

This question is related to other questions regarding swelling of the nose.

Similar to questions five and seven, a rhinoplasty (nose job) requires the cutting of the skin, as well as the “lifting” of the nose’s deeper tissues. Microscopic channels allow blood and fluid to freely flow all around your skin and tissue. Surgery disrupts this normal process and there is no way to overcome this apart from your body forming new channels within the skin. Anytime you cut the skin, you disrupt the flow of blood and fluid.

The scar on your nose is called the columellar scar and acts like a water dam. It disrupts the flow of fluid and the fluid tends to build up above the scar. This gives the impression that your scar is not perfectly lined up as the skin above the scar is swollen and the skin below is not. All patients who have an open rhinoplasty have this for 6-12 months while the swelling goes down. It is usually not a concern, but some patients are worried the scar will not heal perfectly. This scar usually looks fantastic once the swelling is gone.Return to the top

How long do I have to wait to get the final result of my rhinoplasty?

If you scour the internet, you will find the same answer: 12 months. This is a bit arbitrary and it’s different for all patients. I usually tell patients that by the second month, your nose will look great and by the sixth month, it will look fantastic. However, it can take one to two years for it to be fully healed. Most people are not bothered by the small amount of swelling that resolves over time, but it’s important to remember that it can take time for all the swelling to go away.Return to the top

When can I start blowing my nose after a rhinoplasty?

After a rhinoplasty, there are a few parts of the nose that could potentially move if you blow your nose:

• The bone
• The stiches
• The septum

If you had the bone of your nose cut, there are some pieces that can move if pressure is applied to them. If you blow your nose, there is a chance that they could move. It is also possible that a stitch will pop out because of this. When we do a rhinoplasty, its common that have a septoplasty at the same time. This allows us to harvest some material to help build and shape your nose. If you blow too hard, you can potentially damage this.

I tell my patients that they cannot blow their nose for the first week. After a week, if you spray some saline water in your nose you can do a very gentle blow to help remove some mucus. After three weeks, you can start to blow a bit harder while applying the saline spray before doing so to loosen up the material. After a month, you can get back to normal.Return to the top

When can I go back to the gym and start exercising after a rhinoplasty?

After a rhinoplasty, there is the potential for bleeding in your nose. This can be severe in rare cases and if it happens, it can affect the result of your surgery. This is why we are very cautious about anything that may increase the risk of bleeding. Exercise can increase your heart rate and blood pressure and that can increase the risk of bleeding. I recommend people wait at least three weeks before they start exercising; it is uncommon to have a nose bleed after three weeks. However, exercise can also increase the swelling in your nose. Some people find their nose swells a little more after they exercise in the first month or two.Return to the top

Why are there red pimples on my nose after my cast was removed?

When we do a rhinoplasty, we use special glue and tape on your nose. This helps keep the swelling down, as well as allow all of the tissue and skin to stay in the right place. In some people, the tape can block your pores and cause a breakout similar to acne. If you are prone to acne, we can help limit this by starting a special skin treatment prior to surgery. Ask us about this and we can help. In almost all cases, the breakout will go away once the tape is removed and the skin is cleaned, but we are here to help if there are any issues.Return to the top

Some of the stitches fell out after my rhinoplasty/nose surgery. Is this a problem?

When we do a rhinoplasty surgery, we use different stitches for different purposes. Some of these stitches are dissolvable and fall out on their own; some are designed to be removed by our professionals. However, the tissue in the nose tends to heal quickly and once this happens, the stitches fall out. In some situations, the stitches can fall out in a few days while others can last a few weeks if they are not removed. In almost all cases, a stitch that falls out early is likely to not impact the results of your surgery. If you are concerned, we always recommend following up with Dr. Bonaparte to take a look and see if anything needs to be done. But rest assured, most times one or two stitches falling out early is not a problem.Return to the top

Why is it so difficult to breath after my nose surgery/rhinoplasty?

One of the most important things that patients need to consider when they plan for a rhinoplasty or any type of nose surgery, is the risk to their breathing after surgery. Although we do our best to limit any effect the surgery has on breathing, there is always a risk that people temporarily or permanently have reduced breathing through their nose. After surgery, almost all patients have trouble breathing through their nose. This is due to some swelling in the nose, as well as the stiches.

Additionally, the mucus doesn’t move around the way it should after surgery and this can also affect your breathing. Between the second and fourth week after surgery, this will usually return to normal.

Understandably, patients are concerned about permanent breathing problems. Any time you make the nose smaller, you risk affecting breathing through the nose. This is a part of cosmetic surgery, although we do everything we can to prevent this. If you do have breathing problems after surgery, it is important to talk to your rhinoplasty surgeon. In many cases, this can be improved and/or fixed.Return to the top

My nose feels numb after a rhinoplasty. How long does it take to go away?

After you have an open rhinoplasty, it is not uncommon to have some numbness at the tip and under the nose. This is due to cutting some small nerves in this area and happens whenever you cut through the skin. In almost all cases, this will resolve itself between six to eight months after your rhinoplasty, but it can take up to a year in some cases.Return to the top

I had a revision (second) rhinoplasty. What should I expect after the surgery?

A revision rhinoplasty is significantly more complicated than a primary rhinoplasty. This is mainly due to scaring from the previous surgery. The most important thing to remember is that healing can take longer. The swelling often lasts longer than a primary rhinoplasty.

If you are thinking of having a rhinoplasty or any type of nose surgery, contact our team of experts for help with planning this procedure.