Long-Term Changes After Rhinoplasty
3 December 2019 onur
“It takes several years for the nose to assume its final shape after rhinoplasty.”
This is the conventional sentence uttered.
In the lead-up to rhinoplasty, your doctor will inform you that recovery is a “process”. Most doctors think that this sentence suffices to describe the post-operative process, and most patients think they understand what is being explained.
However, this is not exactly the case in real life.
Unfortunately, it takes more than a sentence to describe the long-term changes after rhinoplasty.
This is why I wrote this article.
It is not possible to choose the technique before the surgery or to enter the OR with realistic expectations before the long-term post-operative changes are fully understood.
I will list the recovery steps in the post-operative process one by one in an attempt to explain what the long-term changes are and how they will affect you.
All surgical procedures cause damage to tissues. The amount of fluid, blood supply and the number of cells in the tissue increase. This increase is externally seen and explained as swelling. In order for the swelling to disappear, the tissue must heal completely, all foreign bodies (blood, suture materials, tissue fragments, etc.) must be cleaned by the body, and the lymph and blood vessels damaged during surgery must be restructured. This process takes about 12-18 months. Edema at the tip and base of the nose, where surgical trauma is intense, is expected to last longer than that in other areas. Edema hides things, sometimes the beautiful underlying skeletal structure and sometimes the underlying skeletal defects. In any case, it is too early to make an assessment on the nose shape in the first 3 months after surgery. Unfortunately, this time period may extend up to 2-3 years in patients with thick nasal skin.
Nasal surgery often reduces the nasal skeleton but does not change the amount of skin at all. Therefore, post-operatively, the skin remains somewhat loose compared to the underlying skeleton. Fortunately, human skin has the potential to shrink to a certain extent and adapt itself to a smaller skeleton. However, this potential is limited. Think of it like pregnancy. Just as it takes 1 to 2 years for the enlarged abdominal skin to tighten after giving birth, the nasal skin, which remains relatively loose in surgeries where the nasal skeleton is reduced significantly, likewise adapts to the underlying skeleton 1 to 2 years after the operation.
Scar Tissue Remodeling:
After a nose job, a healing tissue (scar) is formed between the inner layers of the nose. This tissue is hard at first and may cause shrinkage in the tissue as well as minor asymmetries between the nose wings particularly. Scar tissue becomes very thin and soft within 9-12 months. Minor asymmetries may heal spontaneously in the process.
Dynamic Processes, Gravity and Mimics:
Life continues after rhinoplasty. Even individuals who have never had nose job will see a change in their nose during the aging process. As we age, the tip of the nose droops, cartilages weaken, nose wings are pulled up, and the nasal skin gets thinner. In some individuals, the lip muscles will pull the tip of the nose down over time. Therefore, I prefer the structural rhinoplasty philosophy in nose jobs. In other words, we construct the tip of the nose solidly and rigidly so that it can resist dynamic processes.
Surgical Scar Quality
The quality of the scars after rhinoplasty changes over time. It will take 18-24 months for the dermal scars on the tip and wing of the nose to reach the best quality.
After rhinoplasty, nasal cartilages weaken. When we open the nose in secondary nose surgeries, we always encounter the same picture. Cartilages are thinner, weakened and often bent at undesired places. Weakened cartilages cannot withstand skin pressure, dynamic processes and scar contracture. Therefore, we routinely strengthen the nasal tip cartilages in nasal surgeries by supporting them with hard cartilages harvested from the medial wall of the nose. We often connect these reinforced cartilages to the strong septal cartilage in the midline. Called structural nasal tip rhinoplasty, this approach creates resistance against weakening of the cartilage in the long run. In this approach, there may be some increased swelling due to the cartilage added in the early period, the multiplicity of the procedures performed in this area and the suture materials used, but it has a great long-term advantage.
Post-Rhinoplasty Skin Atrophy
After rhinoplasty, the blood supply of the nasal skin changes. For reasons we do not know exactly, the nasal skin may become very thin in a group of patients within 5-10 years after surgery. This thin skin may show all underlying skeletal and cartilage defects. Thus, it is very important to build the inner structure of the nose as smooth and symmetrical as possible during surgery. Everything may look fine at post-op months 1 and 3, and year 1. However, in cases with skin atrophy after rhinoplasty, this good appearance may begin to deteriorate 4-5 years later. The risk of skin atrophy is higher in repetitive surgeries, particularly in cases where cartilage grafts and foreign materials are placed under the skin. Performing the surgery without any traumas and preserving the natural anatomical details are key in terms of preventing skin atrophy.
The primary task of our nose is to smell. In order to smell, the air must be warmed, humidified and slowed down. There’s a reason we’re not breathing heavily through our noses at huge volumes. After the surgery, the internal volume of the nose increases, and patients generally say that they breathe much more easily. However, the body does not like this rapid air flow. Nasal conchae enlarge, narrowing the airway and slowing the air flow. This allows chemicals in the air to have longer contact with the odor receptors in the nose. In the years following the surgery, nasal conchae may enlarge due to nasal allergies, viral infections and climate changes. In that case, although the patients’ nasal breathing function has been good for a while after the surgery, it will decrease. Additional treatment for additional nasal problems may be required in the long run after rhinoplasty.
In summary, the nose continues to change over the years following the surgery. Long-term post-operative changes and the aging process are often intertwined. The key thing to know is that you should not rush to evaluate the outcome of the surgery. Waiting can be stressful. After all, people want to see the result right away. In order to obtain a beautiful, robust and healthy nose structure in the long run after surgery, we may sometimes have to compromise our comfort in the early period. This is one of the main arguments between closed dynamic rhinoplasty and open structural rhinoplasty. The winner in the early period is definitely closed rhinoplasty. If you evaluate the results of the surgery in 1 to 3 months, you conclude that the results of closed rhinoplasty are much better than open structural rhinoplasty. When you extend the evaluation period to 5-10 years, the picture is often reversed.
Please contact us if you want to get information about long-term changes after rhinoplasty.
Take good care…
… of yourself and your beauty.