We understand that if you are considering a procedure you will surely have questions.
Below are some of the most frequently asked questions we hear.
This is probably the most common question encountered in my practice both private and academic. Unfortunately, it is also one of the most difficult to answer. There are multiple factors that are involved in determining how long the nose remains swollen.
For simple procedures with minimal dissection (trimming out a piece of cartilage, placing a small graft in a precise pocket, performing closed osteotomies of the nasal bones) the swelling is greatest at 1-2 weeks and then slowly improves over the next month or two. In those cases where the nose is opened and a wide dissection is performed of the skin envelope, the swelling can persist for months and longer. Part of it is the bodies natural response to injury. The cascade of inflammation to proliferation of healing tissue to scar tissue formation can take up a year to occur. The nose tends to hold onto water and build up scar tissue after surgery. The maturation of scars has been well studied and is known to occur throughout the first year of healing as the tissues remodel and scars contract. This is most readily observed with anyone who has had a scar on their knee. The heaped up red scar slowly over the course of several months flattens and loses its vascularity as the blood supply that helped the initial healing tissue is no longer required and the muscle like cells of the scar contract making it smaller. Sometimes it takes 2 months for the scar to fade but more often it persists for up to a year. Disrupting the skin/soft tissue envelope in open rhinoplasty tends to exacerbate this swelling by interfering with the drainage of the excess fluid that leak out between the cells. Every injury causes some amount of swelling, and the body naturally helps drains this extra fluid through the lymphatics. The lymphatics run through the body like blood vessels but do not regrow as rapidly as blood vessels. When they are disrupted, the fluid is trapped in the nose and the swelling persists for a longer time.
Mature scar tissue has fewer blood vessels and lymphatics for drainage than normal unoperated tissue. Those people who have had 2 or more previous surgeries can look forward to a longer recovery for each surgery, again depending on the amount of dissection performed. In these cases it is not unheard of for people to say that one and a half years after their surgery the swelling finally came down and they were happy with the results.
Any infection causes swelling and will prolong the duration that the nose is swollen. In a surgically traumatized nose, the normal system of capillaries and blood vessels that help bring white blood cells to the area is disrupted and makes fighting off infections harder. This is why we give perioperative antibiotics at the time of surgery and if you have a foreign material placed- are given postoperative antibiotics. Those patients who have suppressed immune systems for whatever reason, should be especially observant for signs of infection in the healing phase such as redness, warmth, tenderness, swelling and purulent discharge.
Many foreign materials used in surgery are non-reactive. Rarely, can a person have an allergy to material or more often an infection of the material leading to prolonged swelling. If the swelling does not respond to antibiotics then typically the only option is to remove the offending material. Unfortunately, most of these foreign bodies are susceptible to infection months to years after surgery. At this time, we can’t predict who will have a late infection of a graft requiring removal which is why I tend to use the patient’s own tissues in reconstructing their nose.
Smoking. This is a bad one. The nicotine and other chemicals from smoking lead to small vessel injury and decreased tissue perfusion. In other words, your smallest capillaries that bring food, your immune cells, and oxygen are depleted and damaged. This increases the risk of infection and poor wound healing. If you are considering surgery and smoke, stop. The longer you can stop for, the safer your surgery will be.
Beverly Hills plastic surgeons like us understand that there are a host of other less common factors that can affect wound healing. Chances are if you have one of these conditions, you already know that you are at risk for bad outcomes. This is why every doctor takes a medical history to see if you are at risk and to minimize those risks. Speak freely and often with whoever is taking care of you as the most important goal is to have a safe and successful outcome to surgery.
So getting back to answering the question. I can’t say for certain. Most likely with a first-time surgery there will be 6 months to 1 year of swelling. For revisions it goes from 6 months to 1.5 years, although these are ranges. There of course will be some who have less and some who have more.
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