The Most Common Post-Rhinoplasty Side Effects

What you’ll learn

Listen to the audio version below.

Audio Transcript:

Dr. Undavia:

Hey guys, it’s me, Dr. Undavia from NJENT in facial plastic surgery. And I wanted to talk to you about a hot topic that patients who come in for consultations for primary rhinoplasty asked about. And it essentially is, what do we deal with post -op rhinoplasty that we need to do something about? They are asking differently. They’re saying, what is your revision rate?

Well, my revision rate is very low, but that doesn’t mean that we’re not dealing with little issues post -op. So I wanted to talk to you about the most common issues that we deal with post -op. So first, when we talk about post -op visits, we generally see patients at one week. We take off their cast, take out sutures, vacuum out their nose so they can breathe better again. And then depending on where patients live and how stuffy they are, we sometimes see them at two or three weeks, or we just see them at the eight week mark. I see everybody at the eight week mark, and the reason for that is that I’m really beginning to take a look at the outside of the nose. So from the front of the nose for the first eight weeks, patients are extremely, extremely swollen. And they’re swollen mainly for the first two to three weeks, and it comes down pretty quickly. Over eight weeks, about 50 % of the swelling comes down.

From the side, patients look fantastic immediately after taking off the cast, but it’s from the front that they look a little bit swollen. And so at eight weeks, about 50 % of the swelling has come down and you could really take a look at the nose and it doesn’t always come down very smoothly. Sometimes it comes down a little on the left, a little on the right. So we just, we know that this is a part of the process and by eight weeks it’s evened out. But by eight weeks, if something hasn’t evened out, so if it comes down and the left side is a little bit, higher than the right, we want to address those things so that they don’t persist for long. And so that is by far the most common thing we deal with. It’s swelling that’s in a particular location. The most common site for swelling is an area called the supra tip, right above the tip. And it’s usually where the hump used to be. And then it’s just pooling up swelling right there. And most of the times we do we inject a small steroid called Kenalog into that area. Patients tell me different things of how fast it works. Sometimes patients tell me it works within a week. Sometimes it takes a month. So what we usually do is we inject the steroid in at eight weeks if we need to, and then we see them back at least six weeks afterwards. Sometimes patients are traveling from far, so they want to come back at three months instead.

So that’s one thing. Some patients don’t wanna have the injection and I think that is completely fine. They just wanna let nature take its course and they want to tape their nose. And I love that actually. Taping your nose at night helps keep the skin down or if you can tape during the day, if you have the option to do that, it’ll be very helpful. And it just helps keep the skin down as long as the tape is on. So we deal with that. Sometimes there’s swelling that happens along the sides, but by far the main area is this supra tip right here. The other thing that we deal with a lot with rhinoplasty is something called a bony callus. And I’ve had patients come in from other surgeons and they say, I still have a bump there. So they had the rhinoplasty, everything was good. And then all of a sudden they develop a little bump right here. And in truth, that’s not that the hump is coming back.

What that is, is that there is, when you do something called an osteotomy, which is you have to narrow the bones. When you take down the hump, you have to narrow the bones back. And when you do that, as the bone is trying to fuse to its new site, it can overgrow a little bit and you get a little bony callus. It’s like a little knot that’s there. And for, I would say 99 % of these patients, we do not need to do anything again. We do not need to go to the operating room for that. We can take care of that in the office and it even happens to our patients too. It’s a very normal part of the healing process. I used to wait nine to 12 months because for the most part, they go away on their own, but I’ve become a little bit more, I haven’t waited as long lately. And typically what we do is we, if we notice it around three or four months, I might wait a month or two, but then what we do is we just take care of it in the office. I use a small, small needle to numb up that area and then we just use another needle to shave it down. There’s no incisions, there’s no cuts. It does bruise for two to three days and then there’s swelling for a few weeks, but not like before where there’s the big swelling. This is very localized and very small. Those are the most common things we deal with. I’ve had a few patients come and tell me that after the septal plastic part of the rhinoplasty, they’re getting a little bit more allergy symptoms like runny nose or sneezing.

That’s because more of the pollen or whatever allergen there is, is getting into their nose. Now that they do have a straight septum, you can use nasal sprays to control that pretty well or just plain old sinus rinses. Those are the main things that we deal with and that’s why I see patients either on telemed or in person up to a year. Typically, after a year, you’ve got about 90 -95 percent of your swelling gone.

There are some journals that have said that it technically takes three or four years for 100 % of the swelling to be gone. There are some rhinoplasty surgeons that say you never really get to 100%, you get to 99%. I’m of the camp where in about two to three years, your result is a final result. But by one year, you’re looking fantastic. I actually would say that by one to two months, you’re looking great. It’s just a swollen version of your nose.

Yeah, those are the main things that we deal with post -op rhinoplasty and that in my practice we’re actively treating post -rhinoplasty. If you guys have any other questions, just email us at info at ent .com. Take care.