Recovery and Return to Social Life After Rhinoplasty
3 December 2019 onur
You want to have rhinoplasty. You can barely spare time from work or school. You have a social life to maintain. You want to see the facial aesthetic result you long for as soon as possible. So, how long will it take for you to recover after rhinoplasty? When will you resume social life? When will you see that beautiful nose on your face?
Here’s how the process unfolds.
Rhinoplasty (Nose Job) surgery is performed under general anesthesia. The operation lasts between 2-6 hours depending on the level of difficulty of the case. We keep you under observation in the recovery unit inside the operating room for about an hour after the operation. You are then transferred to your room in the ward. Here you will gradually recover in 2-3 hours, eat something, visit the restroom, and pace the corridor a couple of times. There will be a plastic protector (splint) on your nose as well as 2 tampons and 1 drain inside and a dressing to absorb blood at the tip.
What I call a drain is a 4mm-wide piece of soft plastic. It aims to convey the blood outside the nose, to the cloth dressing at the tip of the nose. This prevents blood from accumulating in tissues and evolving into a bruise. Particularly if we are performing “primary ultrasonic rhinoplasty” in patients who have not had surgery before, patients come out of the operating room with almost no bruises and swelling on their faces. When you come to your bedside, it often looks like you haven’t had surgery at all and just have a dressing attached to your nose. The pain level is around 2 or 3 out of 10, and this pain is felt in the form of a feeling of heaviness and fullness in the nose. Due to the drain, some bloody liquid may leak from the edge of the dressing, and you may need to wipe it with a tissue paper as it comes out. In a nutshell, you’ll feel better. We will let you go home after 4-5 hours of follow-up on the day of your surgery. Before setting off for home, we’ll prescribe you a painkiller as well as an antibiotic.
You will elevate your head before sleeping at home. Bed rest is not a must. You can get up and walk around, but you should avoid strenuous physical activity. You can eat and drink anything you want, but you should consume food in small pieces, not in large bites. You can wash your hair in the hairdresser’s way, i.e. by leaning your head backwards into the sink and not wetting the dressing in the nose. You can also wash the lower half of your body in the shower. You are free to brush your teeth and use toothwash. Make sure you are not alone in the bathroom and the door is not locked. Your blood pressure may rise and fall within the first 48 hours after surgery. If you feel dizzy at any time, this means your blood pressure is decreasing. Wherever you are, lie flat on the ground and hold your position for 2 minutes. Don’t keep walking or you’ll fall. It’s important that you don’t take any medication after surgery other than what I recommend to you. Again, it is advisable to consume nutrients such as linden, cherries and garlic in a limited fashion since they thin blood.
You’re going to spend the night at home, and the next morning you’re going to come visit me at my clinic for a check-up examination. During that examination, we will change the dressing at your nose tip and have some chat, and then I will send you back home.
There are some exceptions to this routine flow. If the operation took longer than 4 hours, if you feel nauseated after the operation, if you have a disease or risk of complications that we need to observe during postoperative follow-up, if your home is too far away or if you want to spend the night in the hospital because you will feel more comfortable, you can spend the night in the hospital. In that case, I will see you in your room in the morning and discharge you in the afternoon.
In some surgeries, there may be some bruising because we perform a much more extensive surgery on the bony roof or because the person has a hereditary tendency for bleeding. On average, in 3 to 4 patients out of 100, postoperative pain may increase up to 5 or 6 out of 10. There are some individual differences in the healing process, and the process does not unfold in the same way in every patient.
In any case, we meet on the morning of the post-operative day 1 and send you home. Your face will swell maximally within 48-72 hours after the surgery. No exceptions. That swelling was not there when you got out of the operation but appears later. It may spread to the eyelids, lips and even the jaw line during this period. From the morning of the third day, this swelling will gradually decrease. I do not recommend the use of ice in this process. It is not only cumbersome but also offers no benefits according to the literature.
I will see you once again on the third or fourth day. During that follow-up examination, I’ll completely remove the dressing at the nose tip, and you’ll start breathing through your nose. From this point on, you will feel much more comfortable. There will still be silicone tampons in the nose. We keep these tampons in place for a long time so that the nose does not get completely clogged due to edema and there are no adhesions in the nose. The tampon is not a nuisance but makes you feel comfortable. There’s an air duct in the silicone tampon which allows you to breathe albeit a little, but this duct is clogged with nasal secretion and blood clots. Therefore, you will need to wash the inside of your nose with sea water sprays 4-6 times a day when you are at home. And before you go to bed in the evening, you are going to use another spray that I will prescribe to keep your nose moist inside.
On post-op day 7 or 8, I will remove the stitches at nose tip (it will not hurt), remove the silicone tampon inside the nose (you will not feel any pain but only some slight feeling of discomfort) and also remove the protective plastic splint on the nose. At this point, the nose will be completely open.
You’ll look in the mirror. You’ll see a swollen, upturned nose. Then we’ll tape your nose. These tapes will stay for 5-10 days, and then you will remove them yourself. After the tapes come out, you can take a normal bath. You can return to work life and social life within 10-14 days after surgery. The swelling and upturned appearance will decrease to a reasonable level in the following 3 weeks, and 80% of the swelling will heal around the third month, when your nose will almost assume its final appearance. The remaining 20% of the swelling completely disappears in 24 months.
Avoid any impact on your nose for the first 3 months. Do not do sports that are likely to cause blows to the nose.
During the follow-up on post-op month 3, we will take the first before / after photo to see the progress we have made. Then we have follow-up examinations on months 6, 12 and 18. I don’t charge you for follow-ups. All I ask is that you regularly turn up for follow-ups. During these follow-ups, I will look inside the nose to see if the turbinates are hypertrophic postoperatively, if irregularities have occurred in the back of the nose as edema decreases, and if there is an asymmetry that needs to be retouched between the wings. If necessary, we will refine the result with small retouches (fat injection, cartilage grafts).
Your nose will continue to change for 24 months after the surgery. This change is positive in open structural rhinoplasty. The swelling of the nose tip gradually decreases, and the cartilage edges and angulations start to become visible. The nose tip gets defined better. The edema at the junction of the nose and the face decreases, and the nose looks thinner when viewed from the opposite.
Rarely do we have problems that we need to correct surgically after rhinoplasty. We call them revisions. My revision rate is around 3-4%. Depending on the nature of the problem, I perform revision operations between month 3 and 12 during the follow-up process.
Although there are individual differences in the healing process, this is how the process generally works.
Take good care…
… of yourself and your beauty.