Rhinoplasty 101 Part Three: Healing after your Rhinoplasty!
around lunchtime of June 29th, 2006Rhinoplasty 101 part three: Rhinoplasty healing times for a nose job or Rhinoplasty Surgery ( http://drfpalmer.com/Rhinoplasty.html ). Well after Rhinoplasty 101 part 1 and 2, you should have some idea of what a Rhinoplasty Procedure is and what it can accomplish. Now, for part three let’s talk about the healing time after a Rhinoplasty and what you can realistically expect after a Rhinoplasty Procedure.
Rhinoplasty healing should be considered in two separate categories, immediate surgical healing and the long term healing or how long until you see the final result from the Rhinoplasty Surgery. First, the immediate surgical healing after a Rhinoplasty. Typically, a Rhinoplasty will take about 1 hour for a Closed Rhinoplasty and about 1 1/2 to 2 hours for an Open Rhinoplasty…that’s my operating time which does not include the time to put you to sleep or to wake you up.
Having said that, there are obvious differences in the order of how things are done and performed within the Rhinoplasty Surgery between PLastic and Cosmetic Surgeons. NEWS FLASH…not all Plastic and Cosmetic Surgeons are the same. Plastic and Cosmetic Surgeons will vary in ability, aesthetic judgement, technical skill and experience. Read my article on “How to choose your Plastic Surgeon” ( http://www.drfpalmer.com/choose.html ) to learn more. Having said that, it will not come as such a suprise when I tell you that some Plastic and Cosmetic Surgeons are more effecient and more gentle, than other Plastic and Cosmetic Surgeons, when they perform Rhinoplasty Procedures. Both time and the amount of surgical trauma play a major factor in the amount of post Rhinoplasty bruising and swelling. The amount of bruising and swelling that does occur, after the Rhinoplasty, obviously directly effects the amount of time that is required to heal from the Rhinoplasty Surgery.
In most instances, our patients, have some minimal swelling and brusing that has gone or is a slight yellow tinge at 1 week following the Rhinoplasty. Things that may increase the amount of bruising and swelling, after your Rhinoplasty, are things that thin the blood. Thin blood will create more bleeding during the Rhinoplasty (and all surgery) which is a bruise. Remember, that a bruise is just blood that is outside of the vessels and percolates through the surrounding tissues. Vit C, vit E, Aspirin, Ibuprofens, many homeopathic medications and herbs can thin the blood and increase your bruising and swelling. Therefore, I typically recommend that youi avoid these things for 3-4 weeks before your Rhinoplasty and for 3 weeks following your surgery.
Despite a quick, effecient Rhinoplasty and avoiding all the things that thin the blood, Rhinoplasty Surgery…like all Plastic and Cosmetic Surgery does cause some trauma to the tissues. Ice therapy following the Rhinoplasty and limited physical activity for the first several days will help decrease the healing time. But, you can count on about 1 week. This will also coincide with the amount of time that you’ll have the plastic cast on your nose.
When the nasal bones are manipulated by rasping and/or reduction and in-fracture with a surgical chisel, a wafered plastic cast is applied to the nasal bones in order to offer temporary support. This cast is removed at 1 week. For an additional 3 weeks, the nasal bones are vulnerable as they are not completely healed and set. Therefore, contact with the nose: bumping, twisting etc must be avoided or the nasal bones may shift position.
Beofre we leave the issue of surgical healing following Rhinoplasty, I just want to add a note about Revision Rhinoplasty. The nose, unlike other tissues that undergo Plastic and Cosmetic Surgery has a tendency to become much more difficult to elevate, manipulate and operate with each subsequent Revision Rhinoplasty. And yes, the amount of swelling typically increases with each additional Rhinoplasty that is performed. So if you’re having a Revision Rhinoplasty, plan on additional swelling during that 1 week and maybe a day or so longer.
OK. Let’s talk long term results. You can expect your nose to continue to change and improve for about 6 months. This is for a first time Closed Rhinoplasty. Since an Open Rhinoplasty has additional tissue elevation, over the nasal tip, the final result may take up to 9 or 12 months. I have Rhinoplasty patients manipulate their nose according to very specific instructions that I give them at their 1 month post Rhinoplasty visit. I have found these maneuvers helpful in eliminating post Rhinoplasty swelling and as a way to maximize the final aesthetic result.
Once again, Revision Rhinoplasty may take longer to see the final result. I tell Revision Rhinoplasty patients that they should expect final results no sooner than 1 year after their Revision Rhinoplasty and in some specific Revision Rhinoplasty cases ( excess scaring, multiple previous Rhinoplasties, mutiple cartilage grafts used) it may take 2 years.
Tomorrow: Rhinoplasty 101..Realsitic Expectations and what you need to know during your Rhinoplasty Consultation!
Dr. Francis R Palmer, III
Hi I read your article on nose surgery post operative recommendatios/expectations which was insightful. I have recently had some revision to my tip about 2 months ago and prior to this closed rhino r/t a fx’d tip cartliage 4 years ago. I still fill like my tip is very bobuluos but it is also very firm so I think alot of it is edema my Dr has me massinging the tip a couple of times a day, but do you have any recomendations to speed this process ie Anarca or any thing in your years of exp. that speeds this process of recovery
amy :: 1 week, 4 days after
Hi,
It’s not unusual to have residual swelling and edema of the nasaal tip after Open and Closed Rhinoplasty. With an Open Rhinoplasty or an Open Revision Rhinoplasty the swelling can last even longer. Arnica is typically used for the first 2 weeks to decrease bruising. I would consult your surgeon before massaging, manipulating or taking any hemeopathic medications to reduce swelling as he/she may want to advise you directly.
Dr. Palmer
drfpalmer :: 1 week, 5 days after
Hi, I had an open rhinoplasty with the correction of a deviated septum 1 month ago. Do you recommend any manipulations of my nose that I should do to imprive the4 final result and aid with decrease of swelling? My dr gave me some instructions but he has since left the country, I would like to know what you recommend too.
thank you!
Lolo :: 2 weeks, 5 days after
Hi,
Yes, I recommend daily manipulations to help ensure the proper aesthetic result. I suggest that you contact the office and ask them when you can be seen to discuss this with your surgeon. Not all Plastic and Cosmetic Rhinoplasty Surgeons have their patients use these manipulations and you should follow the directions of your particular surgeon.
Thanks,
Dr. Palmer
drfpalmer :: 3 weeks after
I had rhinoplasty surgery 6 weeks ago. My nosed was reshaped slightly smaller bringing the bridge down and thinned slightly to give it a more feminine look. My doctor is one of the best in the area. I want to trust him, but I thought by this point in my recovery, I’d start to be happy with what I’m seeing. Instead, my nose does not appear symmetrical from the front. The two side look different. The left side is swollen and a little bulbous looking at the tip with a slight indentation where the bridge and tip meet on the side. While the right side does not appear very swollen and there is no indentation, flows beautifully from tip to bridge. I’ve looked at dozens of pictures and even my doctor’s portfolio of 1 month post rhinoplastys. They appear swollen yes, but symmetrical, unlike mine. I’m so disappointed after 15 years of wanting this, the pain, and now I’m embarrassed. I’m even a little depressed. My doctor says that it’s just swelling. That my surgery went perfectly and that it will heal well in the next few months. I don’t understand how an indentation will suddenly fill itself in. How will it ever look all the same as he’s saying it will? Help?
Sherry :: 1 month, 1 week after
Hey Sherry,
It’s not uncommon for post Rhinoplasty patients to have anxiety about their nose at 6 weeks post-op. My best advice is to trust the surgeon. There is nothing that can or should be done to your nose at this point. If you’re still unhappy after 6 months or so, then you might get another opinion…but not until at least that much time has elapsed. Remember, that according to my Palmer Beauty Principles, you do not need a perfect nose, just one that’s sleek and unobserved.
Hope this helps.
drfpalmer :: 1 month, 1 week after
Hi, I had rhinoplasty about 3 weeks ago. I just wanted to ask if its common to still feel as if I have a stuffy nose at this point. Its driving me crazy!!!
Myrna :: 2 months after
Hey Myrna,
Obsolutely. You had incisions on the inside of your nose that are still swollen from surgery and are healing. Check with your Rhinoplasty Surgeon for specific do’s and don’t during this initial Rhinoplasty healing stage because we all have our own little tricks but being stuffy right now is completely normal.
Thanks,
Dr. Francis Palmer
drfpalmer :: 2 months after
Hi, i just got an open rhinoplasty about two weeks ago, and i had reduction to the witdth of the nose in the bridge, the bump straitend out from a profile shot and the tip lifted and defined, although most of it looks like its going smothly i feel like the width in the bridge is stil very thick and the left side is alot more swollen and hard with bumps it almost looks crooked, im quite worried and i was wondering if this was normal or if i should be worried?
paige :: 3 months, 4 weeks after
Hi,
Not sure. It’s not unusual to have swelling at 2 weeks post Rhinoplasty however, you should mention your concerns to your Rhinoplasty Surgeon. Only he/she knows what was done during your Rhinoplasty and should take this time to explain how this relates to what you are seeing. Best of Luck.
Dr. Francis R Palmer, III
drfpalmer :: 4 months after
I had osteotomy done almost 3 weeks ago. I had to wear glasses 2 weeks after the procedure for about 2 hours. Im nervous now that this caused the bones to fracture inwards more. Is this a likely possibility? and if so, is there something i can do to help the bones stay put?
Faith :: 4 months, 2 weeks after
Hi,
I had a rhinoplasty about an week ago, and yesterday i accidently hit myself in nose, very gently, cause it didn’t hurt but i just felt it a little bit… and i still have a metal overlay… is there a chance to have some consequences?? thanks a lot…
Doris :: 4 months, 2 weeks after
Hello, I had a closed rhinoplasty done about 7 months ago. I feel like there is still signficant swelling, and there is still tenderness around the bridge between my bridge and my eyes (painful to touch on both sides) and I still have “nose days”, some days swollen, other days better. In addition when i squint for example, i still feel pressure under my eyes and at tip of nose. My nose still seems like it is changing. I had a very englarged bridge and it was drastically reduced, so I assume this might be why. Generally, is there anything I can do to help myself with more consistent/faster healing? In addition, the left side of my nose seems to be more swollen still, and in certain lighting is significantly more puffy at the tip. Any tips doc?
Alex Balia :: 4 months, 2 weeks after
Not sure. It is true that the nasal bones can move for about 4 weeks after they are fractured during a Rhinoplasty. I suggest that you see the Rhinoplasty surgeon that performed your Rhinoplasty and ask that very question.
Dr. Francis R Palmer, III
drfpalmer :: 4 months, 2 weeks after
Yes, there may be cause for concern. If it hurt when you hit your nose, you may have caused the bones to shift and/or some rupture of the nasal tissues. I’d see your Rhinoplasty surgeon ASAP for advice.
Dr. Francis R Palmer, III
drfpalmer :: 4 months, 2 weeks after
Yes, your nose may still be healing after your Rhinoplasty 7 months ago. I have my Rhinoplasty patients manipulate their nose once a day starting at 1 mionth after the Rhinoplasty. You should see your Rhinoplasty surgeon and discuss your post op course and any action to take.
Dr. Francis R Palmer, IIII
drfpalmer :: 4 months, 2 weeks after
Hi,
I would like to know what “manipulations” are and how to do them post op. I had a septo-rhinoplasty 3 weeks ago and have been looking online for post op instructions. Should I be squeezing the bones together? Should I be close-pin squeezing the cartiledge? Please help!!
Johannas :: 4 months, 2 weeks after
hello, my friend had rhinoplasty 5 months ago. she keeps telling me that there’s a problem with it and she wants it to be revised. i told her to be patient and wait atleast a year to make a revision because that’s what most doctors advise. Her rhinoplasy consisted of a silicone implant that was placed on the bridge of her nose to add some height and definition at the tip and there was no reshaping done to her nasal bones. but the problem is, the tip of the silicone implant between her eyes does NOT seem to be firmly attached to her nose causing a slightly obvious bump. She said she can slightly “wiggle” that end of the implant and she feels a small space underneath the implant at that tip. She knows this beacuse when she presses on that tip, the bump goes away. I told her that i think it was the ice pack she put after surgery that caused the implant to not firmly attach itself during post surgery on the bridge of the nose. She put ice over and between her eyes (this is where the unatached tip is) to minimize swelling. Please help, if you have any comments on this matter. Thanks.
Vivi L. :: 4 months, 3 weeks after
Hi,
I am afraid that you must see your Rhinoplasty Surgeon for his/her post-operative instructions. It is not ethical for me to advise you at this stage of your post-op course. I instruct my post-rhinoplasty patients on the manipulations during their post-op Rhinoplasty visits in my office. I’m not sure this is something that can be learned online. You should not manipulate your nose without the consent of your Rhinoplasty surgeon.
Dr. Francis R Palmer
drfpalmer :: 4 months, 3 weeks after
Hi Vivi,
I feel that your friend should see the Rhinoplasty surgeon who performed the Rhinoplasty to discuss this issue. If this is not possible, then she should see a competent revision Rhinoplasty Surgeon for evaluation. Some silicone implants can work their way through the skin creating a problem…so she should be seen sooner rather then later to rule this out.
Dr. Francis R Palmer
drfpalmer :: 4 months, 3 weeks after
Hello Doctor,
I had a closed rhinoplasty approximately 7.5 months ago. I still sense a great deal of swelling and have pain between my eyes and my bridge (which was removed), as well as tenderness inside and on the nose. The nose also looks flat and swollen at times, whereas before it was long and pointy. Is this type of swelling still normal? They say swelling may last over a year, but does the nose really continue to change over a years time at the same rate?
Alex Balia :: 5 months after
Dr.
I have had 2 previous rhinoplasy and greatly dissatisfied with the work….During my healing time i had IPL done on my face could this have affected my nose results. Can you recommened a revision doctor in or near Toronto Ontario
Thankyou so much nicole
nicole :: 5 months after
Hi.. I had a rhinoplasty 7 months ago. I’m concerned because from a profile view the nose is curved downward; this is even more pronounced when I smile. I’m really holding out hope that this is just swelling. In addition, my surgeon informed me that when the tip cartilage heals, the tip will eventually heal to have that nice ‘attractive upward turn’ which I’m just not seeing yet. I’ve looked at lots of healing photos online, and I’m not seeing anything that looks quite like my healing progress… I’m really worried that I have a “dropped tip” and will need a revision.. should I be concerned, or is this the normal healing progress?
I do have to say that I see a slight improvement over the last month or so. I hope it continues.
Thanks
Nancy M :: 5 months after
Hello.
I just recently had closed rhinoplasty (1 week today). I am healing fine and feeling well. Neverthless, my main concern is that one nostril is slighlty bigger then the other nostril. I know that swelling plays a major part in the recovery months but could this be a symmetrical problem? Any advise is helpful! This website is great.
Thanks
Patricia :: 5 months after
Hey Nicole,
Not unless the IPL was done on the nose. Even then, the IPL’s effects are limited to the upper dermis and unlikely to be the reason you’re not happy post Rhinoplasty. After several Rhinoplasties, the nasal tissue can take up to 12 months, or longer, to heal. Have you seen the Plastic and Cosmetic Surgeon who performed the Rhinoplasty for his/her advice? I don’t know any Rhinoplasty surgeons in Canada.
Dr. Francis R Palmer, III
drfpalmer :: 5 months, 1 week after
Hey Nancy,
I’d have you see the Plastic and Cosmetic Surgeon that performed your Rhinoplasty. There are many reasons that your nasal tip may be down-turned. It could be extra tissue in the sup[ratip area. It could be continued swelling. You might benefit from a kenalog injection to the area. You must ahve a close relationship with your Rhinoplasty surgeon during the first year after your Rhinoplasty so that he/she can handle these issues. have you seen him/her lately?
Dr. Francis R Palmer, III
drfpalmer :: 5 months, 1 week after
Hi Patricia,
One week postop Rhinoplasty you still have acute swelling from the Rhinoplasty. Just bring up your concerns with your Rhinoplasty surgeon. However, this allows me to make a very important point…actually several points:
#1: You don’t need a perfect nose with perfect nostrils…just one that appears natural and refined.
#2: Not all types of Rhinoplasties or Rhinoplasty techniques will effect the shape of the nostrils. There are several types of tip procedures that can change, slim down the nasal tip etc. without changing the shape of the nostrils…so you must ask your Rhinoplasty Surgeon before your Rhinoplasty if the procedure that you are having will make the nostrils more even (not perfect..but more even) or will it leave them unchanged.
So Patricia….ask your surgeon if the nostrils will be effected by your Rhinoplasty or is this just post-op swelling.
Dr. Francis R Palmer, IIII
drfpalmer :: 5 months, 1 week after
Hi,
I had closed rhinoplasty surgery 1 week and two days ago. I got the splint and the packing removed two days ago and my doctor basically said it was okay for me to exercise, blow my nose… just about all normal activity. He did not tell me that I had stitches inside my nose, so I was pulling out what I thought were fibers left over from my packing, which I realized were probably stitches. My nose is bleeding now and it seems to be wider than it was when the cast first came off. I’m afraid that I ruined everything. What do you think? Could I have messed up the tissue? Is there anything I can do to decrease swelling?
Thank you!
cara :: 5 months, 1 week after
Hey Cara,
I think you should call your Rhinoplasty surgeon ASAP.
Thanks,
Dr. Francis R Palmer, III
drfpalmer :: 5 months, 1 week after
Hi i had rhinoplasty 6 1/2 years ago. It was an open rhinoplasty. My friends son hit me on the bridge of nose 6 months ago. I have a red mark on my bridge still. Will this go away, or should i be concerned about this?
denise sanders :: 5 months, 2 weeks after
Hey Denise,
After 6 months, you might consdie a consultation with an experienced revision Rhinoplasty Surgeon for soem advice.
Dr. Francis R Palmer, III
drfpalmer :: 5 months, 2 weeks after
Hi.
I had rhinoplasty about 6 weeks ago.Im devistated with the results as ive ended up with a “ski slope” nose.Its very turned up and has a bulbous tip.I went to see my surgeon about this and he said he wasnt happy with it either and it wasnt the nose he intended on giving me a not what i asked for.I understand that its still swollen but is it possible for a surgeon to make such a big mistake and is it common?
Could you also advise me how long im going to have to wait for a rivision?I cant bare to stay looking like this for another minute!
Thank you
Elizabeth :: 5 months, 2 weeks after
Hi Elizabth,
I’m afraid that no matter how much you hate your nose…you’ll have to wait a minimum of 6 months before you can have a revision Rhinoplasty. As I Have said over and over on this blog….Rhinoplasty and especially Revision Rhinoplasty is very technically difficult. I see your in the UK. You may consider coming to the states for your revision. More on Rhinoplasty here: http://www.drfpalmer.com
Best,
Dr. Francis R Palmer, III
drfpalmer :: 5 months, 2 weeks after
Dear Elizabeth,
I wanted to let you know that I recently had a rhinoplasty and am very uncomfortable with it. It takes a lot of patience to get through such a tough time.
Just wanted you to know you are not alone.
Frankie
Frankie :: 5 months, 3 weeks after
Rhinoplasty 101 Part Three: Healing after your Rhinoplasty!…
Well after Rhinoplasty 101 part 1 and 2, you should have some idea of what a Rhinoplasty Procedure is and what it can accomplish. Now, for part three let’s talk about the healing time after a Rhinoplasty and what you can realistically expect after a…
To Lift Or Not To Lift :: 5 months, 3 weeks after
Hello dr palmer,
I’ve had a septo-rhinoplasty two months ago and the last 15 days i’ve noticed a supra-tip deformity, just like as described in bibliography as a parrot’s beak deformity. i’m concerned about this fact a lot lately so i’m wondering if, in fact is a complication of the surgical procedure or it’s just supratip swelling of concentration of soft scar tissue and if this tissue is prone to augmentation or will it subside by the time (and for how many months should i wait till the final result?) is there a hope that my nose tip finally will be elevated? thanks a lot..
with respects, anthony g.
anthony :: 5 months, 3 weeks after
Anthony, That’s the rub. There’s no way to know what is swelling and what is thickening scar tissue in the supratip area without seeing and examining the nasal tissue. see your Rhinoplasty surgeon and seek advice on this subject.
Dr. Francis R Palmer, III
Frankie,
Thanks for the support for Elizabeth. Post-op healing after a rhinoplasty can try one’s patience…but patience you must have as severe problems can arise if a revision Rhinoplasty is performed before a minimum of 6-12 months after the initial surgery.
Dr. Francis R Palmer, III
drfpalmer :: 6 months after
I had the surgery about a month ago. after the 1st week and the cast came off the docotor advised me to “mold” the nose. I had a broken nose from boxing and my nose was crooked to the side. dr advised me to take my fingers and press the sides in 2-3 times a day ( and the more i do it, sure the better he said). I didnt really do it at all until i met him the 2nd week and advised me to do it again, then i was crazy about it. one side of my nose seems very fine and the other rigid. in the mirror it looks ‘ok’, and straight, but in pics i take at home it doesnt look symetrical on both sides of my face. as if my cheek bones on my right side go right down into my face and the left seem raised. right side seems to have too much of a reduction. im worried my “molding” and pressure i put on my nose ruined it.
jay :: 6 months after
Jay,
The best thing for you to do is to follow the advice of your Rhinoplasty surgeon. Only he, or she knows what you had done during the Rhinoplasty. Healing takes 6-12 months.
Dr. Francis R Palmer, III
drfpalmer :: 6 months, 1 week after
i had my nose done nearly 3 weeks ago, and im really worried. the last week i have noticed that one side of the bridge of my nose looks flat, like its dinted. Ive spoken to the company that did it, and they said dont worry, and just booked my apointment for the end of this month. but i feel really emmbarased. does this sound like normal healing proces??
Sian :: 6 months, 1 week after
Hi Sian,
Well I’m not sure, from what you described, whether this is normal or typical post Rhinoplasty healing. Only your Rhinoplasty Surgeon knows what was done to your nose during the Rhinoplasty. Wait until you can have this discussion with him/her.
Dr. Francis R Palmer, IIII
drfpalmer :: 6 months, 1 week after
I had open rhinoplasty 1 week ago. The doctor tried to make my nostrils the same size, so there are stiches in between my nostrils. I can’t smile/grin/eat easily with them. How long until these scars heal? A few more days, weeks or months? This was my first rhinoplasty and I am 22 years old. The scars have shown minimal progress since the surgery and are very visible. Thank you.
Janis :: 6 months, 1 week after
Hey Janis,
At 1 week after your Rhinoplasty…the sutures are most likely still in from the surgery. The scar should fade over the next weeks and months….consult with your Rhinoplasty surgeon for his/her post-op instructions.
Dr. Francis R Palmer, III
drfpalmer :: 6 months, 1 week after
another quick question….i box and go mixed martial arts, reason i broke my nose in the first place and had the surgery. well its been 6 weeks, my nose looks better…my question is how long do u recommend until i can start wrestling again and boxing, without worrying about damaging my nose? thanks
jay :: 6 months, 2 weeks after
Hi there, I just had open rhinoplasty done less than 2 weeks ago. My cast and stitches have been taken out and my PS put tape on my nose and told me I could take them off in 5 days. It has only been 3 days, and the tape has peeled off…is this something I should be concerned about?
michelle :: 6 months, 2 weeks after
Best thing to do, is call your Rhinoplasty Surgeon….but shouldn’t be a problem.
Dr. Francis R Palmer, III
drfpalmer :: 6 months, 2 weeks after
Hi, I had an open rhinoplasty 7 weeks ago. My nose has a bump in the bridge. My doctor says that it will go away after a month more or so. My question is: Is it possible for the bone to be still swollen after 7 weeks. And if so will the bump in the bridge go down? Thamk you.
Aries dumont :: 6 months, 4 weeks after
Hi Dr. Palmer,
Is it possible for each nostril to heal in a different time frame after rhinoplasty? I mean, can one nostril look normal while the other is more swollen after 3 week? Why would the same nose act differently on each side? shouldn’t the swelling go down on the nostril at the same time?
Soni :: 6 months, 4 weeks after
All bets are off when it comes to post-op swelling. Different section, of your Rhinoplasty can swell and heal at different rates..especially at 3 weeks. If you are concerned, see your Rhinoplasty Surgeon to dicuss.
Dr. Francis R Palmer, III
drfpalmer :: 6 months, 4 weeks after
If you have a bump that bothers you…the only person who can answer your question, at this point, is your Rhinoplasty Surgeon. have that discussion with him/her.
Dr. Francis R Palmer, III
drfpalmer :: 6 months, 4 weeks after
I can tell everyone this…….I’m on my second rhinoplasty..And healing can take along time………My first one took almost 2 years to heal…Right now I’m in my third month on my second one.And it still taking it’s sweet old time……I just pray and hope for the best!
Joe :: 7 months after
Hi Dr. Palmer,
I had gore tex put into through my right nostril to elevate my bridge about a month ago. For the past few days my right nostril has been stuffed with mucus and constantly running. There is sometimes very little dark colored blood mixed in with the mucus. I’ve had no other problems up until this point. Would this be considered normal?
eugene :: 7 months after
Hi Eugene,
I wouldn’t think so and you should see the Rhinoplasty surgeon to have things checked if you are concerned.
Dr. Francis Palmer
drfpalmer :: 7 months after
Hey Joe,
True words indeed…that’s why Rhinoplasty is the most difficult plastic and cosmetic surgery procedure. Many times in Rhinoplasty and almost always in Revision Rhinoplasty the more experienced Rhinoplasty surgeons know that less is more.
Dr. Francis R Palmer
drfpalmer :: 7 months after
Dr. Palmer,
Thank you for providing insightful information on your web site. If you would be so kind to offer me your expertise I would sincerely appreciate it.
I had my first-ever rhinoplasty done exactly one year ago. I eliminated a hump, a hook on the tip, as well as (supposedly) trimming down excess cartilage on both sides of the tip of the nose. The hump is gone, as well as the hook, however, the nose around the tip and tip, look the same, and still appears puffy and big–not sleep. One side of the nose is puffier than the other. In close pictures with flash, you can easily see the oddly shape front a front shot. One of the cuts of the nostrils, is actually more high-cut than the other, where there is also a scar visible from just looking from the outside. I have been so patient and non-obsessive at all, because I understand rhinoplasties take a long time to heal. My physicial told me the right said was still swollen (because it is evident that it is bigger);however, it has been an entire year.
Is it possible for this area (the cartilage around the tip of the nose, and the round tip bc my nose has no point now) take this long to heal? Should I expect that this really is the final result of my surgery and perhaps my surgeon is not being realistic with me leaving me with the idea that it will still get smaller? Or is possible that it take longer than a year to settle?
How soon is it recommended to get a revision rhinoplasty after the first one?
Thank you so much for your help. I really appreciate it.
v :: 7 months, 1 week after
Hey V,
Most likely, a full year after your primary (first) Rhinoplasty….your nose is fully healed. Sounds like you may require a Revision Open Tip-plasty. You may consider sending me photos of your nose for further evaluation and I do recommend an in person consultation. You can undergo a Revision Rhinoplasty..Tip-plasty any time after 6-12 months from the previous Rhinoplasty.
You can e-mail my staff regarding photos and booking a consultation at drfpalmer1@aol.com or call 310-652-9583.
Dr. Francis R. Palmer
drfpalmer :: 7 months, 1 week after
Hi There
I am currently 2 years post primary rhinoplasty. I will be having a closed revision rhinoplasty to remove excess scar-tissue in the supratip area.
I have been told that as the procedure is closed, the swelling this time around will not be as bad as my primary, which was open. Is this usually the case?
In addition, the surgeon says he will use Cortizone injections to prevent a re-occurence of scar-tissue buildup. I know some surgeons are against the use of such injections – why so?
Thanks for your time.
Mark :: 7 months, 2 weeks after
Dear Dr. Palmer,
I had closed rhinoplasty 9 weeks ago and I still have dark circles under my eyes. While most of the bruising has faded, what remains is not fading and is noticeable. Is this permanant or common?
Thank you,
S
S :: 7 months, 2 weeks after
Hello Dr.Palmer,
I am 4 weeks post op and was wondering if there is anything that can be done for the tip to keep it up instead of coming down? why do surgeons in the first week leave that little tape that holds the tip up and then remove it? if putting the same kind of tape to hold it up after 2 weeks will that make the tip less likely to descend? what exactly is done in the nose for the tip to stay elevated and after the surgery if I held the tip up with hand for a period of 30min will that cause a bad result? Thank you
lisa :: 7 months, 2 weeks after
Lisa,
The tip, if operated on properly during Rhinoplasty should not drop and it generally is not a good idea to manipulate the tip without the express advice of your surgeon as you could cause damage to your nose. The tape is used to decrease the swelling immediately after the surgery for a period of only 1 week. You probably don’t want to do anything unless instructed by your Rhinoplasty surgeon.
Dr. Francis R Palmer, III
drfpalmer :: 7 months, 2 weeks after
Hey S,
Yes, the rest of the dark should fade…but in rare instances it can remain for years. It’s the hemosiderin pigment in red cells that’s creating the dark circles…..as your Rhinoplasty surgeon if he/she has some suggestions for you. You could also consider checking with your homeopathic pharmacy.
Dr. Francis Palmer, III
drfpalmer :: 7 months, 2 weeks after
Hey Mark, I think I need to clear a few things up for you.
1. Revision Rhinoplasty is ALWAYS more difficult than a primary Rhinoplasty. There is more scarring, the tissues is tough to dissect and things have been mucked with during the previous Rhinoplasty. There is more swelling not less and the recovery can be much longer.
2. Supratip scarring that causes thickening once cleaned out using another Rhinoplasty has the same if not higher likelihood of coming back again. There are things that can be used as an attempt…not a promise of sucess but an attempt to minimize this. These include, in my opinion, manipulation daily by the patient using very specific nasal massage techniques and injections of kenalog (cortisone) into the supratip area.
3. The only bad thing that can be said about kenalog injections to decrease the supratip thickening is that they may cause depressions….they are to effective. This can be minimized by using kenalog 10 and not 40 (4 times stronger) and by using it only when needed. I see patients like you every month and decide at that time if kenalog is needed.
Dr. Francis R Palmer, III
drfpalmer :: 7 months, 2 weeks after
Hello Dr.Palmer
Thanks very much for taking the time out to get back to me and thank you for highlighting these issues.
If the swelling is likely to be worse, I’m not sure I will want to go through that again – it has taken 2 years for the swelling to dissipate and I really wouldn’t want to have to deal with it to that extent, or even worse, once more.
Just a couple of questions on scar-tissue: naturally scar-tissue shrinks as it matures. Can I expect it to shrink any further over the next few years? In addition, would the use of kenalog at this stage be inadvisable?
Thanks again for the information. It has made me think long and hard about this revision and I’ll certainly have more questions to ask my surgeon when I see him next – unfortunately I had been led to believe that a revision would be plain sailing when clearly this is not the case.
Kind Regards
Mark :: 7 months, 2 weeks after
Thank you for taking time to explain my long-term bruising. This is the only place I have been able to get an accurate diagnosis. I am very appreciative.
Stevie :: 7 months, 3 weeks after
Hey Stevie,
You’re welcome…glad the info helped.
Dr. Francis R Palmer, III
drfpalmer :: 7 months, 3 weeks after
Hello Doc,
It has been almost 2 weeks since my rhinoplasty procedure and I had just taken off the bandage that was on my nose and now my nose looks like as if theres a strange plastic blanket covering it, i just wanted to know if it is normal for it to look like this. It almost looks as if it’s all melted. =/ Please let me know what a nose is supposed to look like 2-3 weeks after the surgery
Thanks =]
Tina :: 8 months after
Hey Tina,
I’m not getting a clear picture of what your nose exactly looks like but the mere fact that you are concerned tells me that you should be seen ASAP by the surgeon that performed your Rhinoplasty. Typically 2-3 weeks post Rhinoplasty, the nose appears a bit larger due to the swelling but otherwise should appear normal, including the skin.
Dr. Francis R Palmer, III
drfpalmer :: 8 months after
Dear Dr. Palmer,
I just underwent an open rhinoplasty from a well known San Francisco plastic surgeon, so I feel like I should be in good hands. However, my first glance at my new nose was a bit disturbing. I understand that swelling is always an issue, but my concern involves the columella. I had an open rhinoplasty involving a slight revision of a drooping tip, and in my case the columella now actually appears higher than the bottom outside edge of my nostrils. When I look at a “normal” nose, if there is such a thing, from a side view the columella is lower than the lower edge of the nostrils. When my stiches are removed, can I expect the columella to descend somewhat? Needless to say, I am a bit apprehensive at this point. I feel like the orientation of my tip is backwards, giving it a piggy appearance…
Any insight you can give would be appreciated.
Sincerely yours,
Debbie
Debbie :: 8 months, 2 weeks after
Hey Debbie,
What you are describing is called a hanging columella and can be a result from over rotation of the nasal tip. Obviously, I haven’t seen your nose, so I have no idea if this is what is happening in your particular case. I suggest you see your Rhinoplasty Surgeon for a follow up and express your concerns.
For Debbie and others reading this blog. Hanging columella can be cortrected using 2 methods (in my opinion) these include the following:
1. I frequently use the ear cartilage from an incision placed behind the ear. The appearance of the ear is unchanged by taking this cartilage which is used to lengthen and rotate the nasal tip back down to a more aesthetic position making it look less like a pigggy upturned nose. The ear cartilage is fashioned into a perfectly shaped nasal tip and is secured using tissue glue. I do not like gortex, septal or rib cartilage as these materials are too stiff for the nasal tip and will eventually cause the tip to become hard and may even erode through the skin at a later date.
2. If you are lucky…the bottom of the anterior nasal septal cartilage can be trimmed and the bottom of the columella is tucked inward. This gives the illusion that the nasal tip has been rotated downward and restores a more normal appearance to the columella.
Hope this helps.
Dr. Francis R Palmer, III
drfpalmer :: 8 months, 2 weeks after
Hi Doctor Palmer,
I am a 33 year old female who has had several rhinoplasties over the last 14 years to try to correct problems (e.g., sleep apnea, severe sinus problems) resulting from an accident that seriously damaged my nose when I was a child. The second rhinoplasty had to be done to correct problems from the first rhinoplasty (cleaning out a lot of scar tissue and moving the septum back into place. It has slid over to the right and was blocking my right nostril). However, after the second rhinoplasty, I had to wear tape for a month because the septum was trying to lean back over to the right. We were able to get it straightened with the tape, but a third rhinoplasty had to be done last month (seven months after the original procedure) because the doctor had not put any cartilage on the top of my nose, which resulted in a major saddle deformity and caused me to start having some minor breathing problems again, as my airways were a little constricted. This time, the doctor put cartilage grafts on top of my nose. However, when we took the splint off, the graft had slid over to the right side of the nose and seemed to have “bunched up” toward the top of the nose. We are using tape again to try to correct it, but my doctor is already talking about having to operate again.
I have several questions resulting from this rather traumatic experience. The first is – what is causing my septum and its cartilage to do this? Is it something the doctor is not doing right, or is there something structurally wrong with my nose? The second is – how long should I wait to get this fixed? Should the doctor go back in ASAP, or should I wait for a year or so before we work on this again?
Thanks for any help you can provide!
Leigh Steele.
Leigh :: 8 months, 3 weeks after
Hi Dr. Palmer,
I forgot to mention in my previous, lenghthy post, that the cartilage used was ear cartilage. Sorry!!
Thanks,
Leigh Steele
Leigh Steele :: 8 months, 3 weeks after
Hi Leigh,
Ok let me take this step by step. Remember that I have not seen your nose, so I have to go by your history and of course, this is my opinion.
1. You have had 3 prior Rhinoplasties.
2. Cartilage typically will not respond to external taping measures.
3. I don’t like ear cartilage along the nasal bridge as it has a tendency to erode in an irregular pattern and can be difficult to secure (prevent it from slipping off to one side).
4. If you need a 4th Rhinoplasty, you might want to wait a minimum of 6 months from the previous Rhinoplasty….you didn’t mention if any of the Prior Rhinoplasties were open…if they were, you need to be sure that the blood supply to the nasal tip skin is adequate.
5. From all of the above, you may want to consider a silicone dorsal implant to build up the nasal bridge during the next Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 8 months, 3 weeks after
Thanks for replying so quickly, and thank you for the good advice. My first two rhinoplasties were open, actually, but this latest one was closed. I have decided to wait 6 – 12 months before I try to do this again, and I will mention your suggestion about using something sturdier on my bridge like a silicone dorsal implant.
Thanks again,
Leigh
Leigh Steele :: 8 months, 3 weeks after
Anonymous :: 9 months after
Hi, Dr. Palmer, I’m concerned about the healing pocesss of the bolbus. I’m 2 weeks in from from my rhinoplasty, and the bolbus appeares to be enlarged. I know it’s swollen and takes time to heal, however what should I expect within the year as far as healing on the bolbus of the nose.
Thanyou, Mike Jacobe
Milke Jacobe :: 9 months after
Hey
Your tip should be close to healing 6 months after your Rhinoplasty. Since I don’t know if it was an Open or Closed Rhinoplasty or what type of tip work eas during your Rhinoplasty Procedure…this should be discussed with your Rhinoplasty surgeon.
I personally use Kenalog 10 because the 40 can cause permanent indentations. Typically this is done before 6 months post-op.
Dr. Francis R Palmer, III
drfpalmer :: 9 months after
Hey Mike,
If you’re 2 weeks post Rhinoplasty and your nose is getting larger you should see the Rhinoplasty surgeon who did the surgery and be sure all is well.
Dr. Francis R Palmer, III
drfpalmer :: 9 months after
It’s been 10 months since my surgery. It was closed, my doctor took a hump off and slimmed the bulb of my nose. Everything looked great until 6 months now where my hump was is an indentation and at the middle of my nose is a bump. Should I wait a few more months? I would love my nose if it weren’t for the new bump in the middle of my nose. It still feels fuzzy to the touch. My doc said since I have allergies it may take longer for the swelling to go down is this true? I’m getting worried the closer I get to a year and the bump still has not gone down. Thank you.
Andee :: 9 months, 1 week after
Hey Andee,
10 months, most likely your nose is what it’s going to be but only the Plastic and Cosmetic Surgeon who did your Closed Rhinoplasty Procedure knows for sure. You may want to pay for a consultation with another Plastic and Cosmetic Surgeon.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
Dr. Palmer,
It has been 4 weeks since my open nose surgery. On the 7th day I began to bleed a lot from my right nostril. I believe it was due to me bending over to put my son in a car seat.
In my 4th week of recovery, I noticed that the bony part of my bridge (close to under my right eye)is still very swollen. It feels very hard to the touch, like it is bone. I am scared that the bones are healing incorrectly and wanted to know if it is possible for the bone to be swollen? As I mentioned it does not feel like tissue.
Adrienne
Adrienne :: 9 months, 2 weeks after
Adrienne,
The covering of the bone may be swollen…but unlikely it’s the bone itself. This covering can feel very hard like bone after a Rhinoplasty and I have my patients manipulate the tissues a certain way (I instructed them) beginning 1 month after the Rhinoplasty. You may wish to discuss this with your Rhinoplasty surgeon.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
Hi Dr Palmer,
I had an Open Rhinoplasty about 3 months ago but there is still a whole lot of swelling which makes my nose look big still. Is there anything I can do to help reduce the swelling under the eyes as well as the tip of the nose. My wedding’s in a month and Im really concerned, I was expecting the swelling to be minimal by then but it still a lot. Kindly suggest something..Thank you.
Bee :: 9 months, 2 weeks after
Dear Dr. Palmer,
I have consulted a plastic surgeon in London who did a simulation of what I could expect from a rhinoplasty. I was very excited. However, afterwards I felt strangely seduced, simply because it looked to perfect to be true (having seen several imperfect results from rhinoplasty).
So my question is the odd one: To what extend does a program like that actually mirror the result that you can realistically expect – if you indeed presuppose that you are in the hands of a surgeon who places himself among the top 5 percent in your infamous bell-curve of statistical fact?
Thanks in advance,
Joseph
Joseph Walsh :: 9 months, 2 weeks after
Dear Bee,
You can still have swelling at 3 months. I can’t recommend my post-op Rhinoplasty manipulations because you are not my patient and that’s unethical. I do suggest that you see the plastic and cosmetic surgeon that performed your Rhinoplasty and have that discussion with him/her. Good luck and congratulations on your upcoming wedding.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
Hey Joseph,
It would appear that you are a wise man. I have written many times that the computer simulations have ZERO relevance to what your nose will look like after your Rhinoplasty. It’s far better to see actual before and after photos…only then will you get a true sense of the Plastic and Cosmetic Surgeon’s level of expertise and experience. I do not use computer imaging for Rhinoplasty or any form of Plastic and Cosmetic Surgery during consultations….I do not believe it gives accurate results.
Since you brought it up, I will also tell you that there are a mere handful of highly skilled Plastic and Cosmetic Surgeons with vast experience in Rhinoplasty (in the world)…as this experience takes (in my opinion) a minimum of 15 years to accumulate. I had a practice in London for about 6 years…my advice to you…see someone here in the states for your Rhinoplasty…it will be worth the journey.
Lasty, a word of caution. Never, use price as your deciding factor in selecting Rhinoplasty or any Plastic and Cosmetic Surgery Procedure. That is a slippery slope.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
hi Dr. Palmer
I have read your “beuaty principles” on you website and was surpriced to learn that the cheekbones play such an important role in defining the beauty of the rest of face. Also I wouldve have contributed the nose a more significant part in this matter.
now, my question concerns a different issue: You write that gravity “pulls the tissues of the face similarly for all individuals”. Now, I wonder if sleeping with your face in the pillow also does this to your face: that is, does it make any sense (as the saying goes) to sleep on your back to avoid pulling your facial tissues while sleeping?
Cheers,
Marc
marc :: 9 months, 2 weeks after
Hello Mr. Palmer,
I think my other comment was not saved, so Ill try again:
I underwent cosmetic nasal surgery in Sweden 3 days ago. I am, of course, very bruised and feel significant pain at this stage.
I have noticed that one side of my face is more swollen than the other, and especially the one eye, which is completely closed and very red and swollen. Although I feel certain that is perfectly normal, I wonder why this is so: Why does one side of the face, especially around the eyes, get more traumatized from rhinoplasty than the other?
Anna
anna :: 9 months, 2 weeks after
Hi Anna,
This is a reasonable question to ask. I have explained this to many of my patients over the years. There is no reason to expect that the two sides of the face or body should swell, bruise or react the same….and they don’t. One side can have more or less swelling, bruising or discomfort just because. If this continues however, you should contact the Plastic and Cosmetic Surgeon that performed your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
Hey Marc,
Yes indeed, if you could sleep on your back…the tissues of the face would not be stretched as much. This isn’t so much because of gravity but the sheer act of the pillow pushing on the face tissues.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
To the patient in India regarding Cheek Augmentation. Somehow your post was deleted. You can e-mail us jpeg pictures of your face for further review and comment.
drfpalmer1@aol.com
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
Hi again,
thanks for answering my question just above regarding swelling. I was thinking that maybe the difference in swelling from right to left could be caused my the way the surgery is performed. But I understand this is not the case then. Thanks again,
Best,
Anna
anna :: 9 months, 2 weeks after
Thanks for your reply.
If sleeping with my head against the pillow will accelerate an aging face, as opposed to sleeping on my back, then I guess I will have to kiss my once belowed beauty-sleep byebye.
Regarding your beauty-principels: I’m not sure I have fully understod your view that surgery should aim at creating a nose that is ‘neutral’ rather than a nose that is beautiful in itself. Could you perhaps clarify this?
I guess that you believe that other facial features play a more prominent role in defining the overal facial beauty than the nose? I find it rather impossible to define what kind of nose is neutral, beautiful or even strong or cute regardles of the rest of the face.
In my eyes, Angelina Jolie has a beautiful (or cute) nose, but it would fit would not look so cute on brad pitts handsome face. Would it perhaps be meaningful (though it’s not a very new principle) to say that a nose “should be in harmony with the rest of the face”, since the relation to the rest of the face is what defines the perception (and conception) of the nose – and vice versa?
Cheers,
Marc
marc :: 9 months, 2 weeks after
Dear Dr Palmer,
I had a septo-rhinoplasty done 14 days ago. My surgeon said i had a saddle nose so he used a bone graft and it was a closed procedure. However, my nose is achy and my left nostril looks alot bigger than my right nostril. I am still swollen 14 days on. Will my nostril reduce in size in the forthcoming weeks? Also, the staff nurses havent educated me much on what i should do following the removal of my cast, when is it fine to sleep flat and touch my nose? Thankyou so much for your time.
Sara_uk :: 9 months, 2 weeks after
Hi Sarah,
You’ll need to get the specific post-op instructions from the Plastic and Cosmetic surgeon who performed your Rhinoplasty. It’s actually considered unethical for me to give advice to fresh post surgical patients.
I can say a few things in general. In my Beverly Hills Practice:
1. I take the cast off after 7 days.
2. I ask patients to sleep on their back for 4 weeks after the Rhinoplasty.
Swelling is highly variable and unless something was done to the nsotril…it should appear the same as it did before the Rhinoplasty…unless the cartilage of the nasal tip is modified during the Rhinoplasty which could chance the nostril hape. I don’t use rib, irradiated cartilage, bone or ear cartilage to build up the nasal bridge as these all have a tendency to dissolve unevenly with time. I prefer a silastic graft along the bridge only…no component extending to the tip.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 2 weeks after
Dear Dr. Palmer,
I underwent an open rhinoplasty two years ago come this August (The surgery was done in August of 2005). I had previously had a very small nose with almost no bridge, and the surgery basically built a bridge (with silicone) and elongated my nose. The doctor used ear cartilage for the tip.
I did this surgery in Seoul, South Korea with a very well reputable doctor.
The nose is fine and looks natural– no uneven spots or any droops or bumps. The tip, however, is unnaturally hard. I’m not sure if it should be this unyielding after so long. I heard that rib cartilage would have been better (making the tip softer), but the healing process would have been too long. Was doing the tip with ear cartilage a bad idea? Is that hardness still understandable after two years? Will it ever be softer? Is there a way to make it feel more natural to the touch?
Any insight you can give would be greatly appreciated.
Sincerely,
Elizabeth
Elizabeth :: 9 months, 2 weeks after
Hello Dr. F. Palmer,
My sister had a rhinoplasty 3 weeks ago. She is very, very unhappy with it since it looks ‘turned-up’, and I agree. Sadly enough, she explicitly told the doctor that she wanted to avoid a turned-up nose. The doctor has said that the nose needs time to settle and that the tip will also come down a bit. Can this be true? One thing is the swelling, for weeks and months, but does it make sense that the tip may move downward as it heals?
/Sean
Sean :: 9 months, 2 weeks after
Hello Dr.,
I was wondering why you contribute less importance to the nose, when analyzing facial beauty, than to the cheeks and the eyebrows.
As a cartoonist at WB I can certainly verify that the nose is a type-changing feature. And more so than the eyebrows and the cheeks.
So perhaps, rather than dissecting beauty into percentages related to different parts of the face, it should be kept in mind that visual perception is a ‘gestalt’; a whole.
Seen as such, the nose contributes 100% to the beauty of a face, and so does the cheeks and the eyebrows.
Best Regards,
Kevin
Kevin Slattery :: 9 months, 2 weeks after
Hey Kevin,
These percentages and their relative beauty importance were obtained over many years and from the analysis of thousands of patients. In cartoons, the nose may be a large contributor but in human faces it only causes distraction…never does a perfect nose make someone beautiful. The Cheeks however can do just that. How do I know? Because I’ve done it on faces thousands and thousands of times.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Hey Sean,
Not sure but the tip may drop a little with time. Without knowing what type of Rhinoplasty and tip modification technique was done…this is impossible to know for sure. Why haven’t you and your sister had this conversation with the Plastic and Cosmetic Surgeon who performed the Rhinoplasty? Try that. If you’re still not convinced…you might want to spend the money for a second opinion. There are things that can be done, if needed.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Hey Elizabeth,
You’re correct. The tip of the nose should be soft at 2 years after your Rhinoplasty. Ear cartilage makes the softest and in my opinion most reliable graft for the nasal tip. However, are you sure that the silicone graft that was used to build up your nasal bridge did not include the small vertical section that goes through the nasal tip area? Commonly done in the some countries, this vertical segment is way too hard for the nasal tip skin and 100% will erode through the skin within 15 years from the time of the Rhinoplasty. Rib cartilage is way too hard for the nasal tip and has a tendency is absorb unevenly withing 5-10 years and I never use it for that reason anywhere in the nose.
May I suggest that you call the Plastic and Cosmetic Surgeon’s office that performed the Rhinoplasty and ask for the catalogue number for the dorsal silicone implant and the manufacturer name. A quick look at the implant website will reveal the shape. If it is indeed an L-shaped implant, I suggest that it be trimmed which should make the tip much softer. You may need some repair of the nasal tip cartilages and or additional placement of ear cartilage. I have done this procedure often and it will not change the size or shape of your nasal bridge. The rest of the implant is undisturbed.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Hi Dr. FRANCIS PAMLER
I had revised nose surgery as well as had my upper lip shortened. there is an incision along the top of my lip (base of nose) that after 4 wks of surgery feels like cement. it is difficult to even smile. is this normal?
thanks
shauna
shauna :: 9 months, 3 weeks after
Dear Dr. Francis Palmer
Reading your answer above to Kevin, I must admit that I tend to agree with him. A nose does make a difference. I do I know? I’ve seen thousands of them!
If pretty simple: If a nose can be defined as ugly on a certain, then it can be pretty too.
Another expert
John :: 9 months, 3 weeks after
Dear Dr. Palmer,
I just had rhinoplasty here in LA, and Im really unhappy with it! I did my research and found a qualified plastic surgeon. He said he’s done more than a thousand noses, but when I had my cast removed today, it’s not straigt any longer! Also its way bigger than we agreed, but I know I have to patient – I just can’t imagine that it will shrink 20%. Im really just so unhappy, I look like an Alien with a potato. At least before my nose was huge in an ethnic way, had charisma
I called my doctor (he didnt even remove it himself, is that not a bad service?), but he said that the nose may well straighten up by itself, especially because I had an infection in my left eye for which he precribed Ciprofloaxacin Hexal, 500mg twice daily.
I don’t know why am writing you, you can’t really help. Ive been reading your tips and advices, so I knew about the site. I guess I just dont have confidence in my own doctor, he doesnt seem to care too much. I have an appointment with him in 6 months. I just hope that my nose will change 75% the weeks to follow, refinement is not what Im looking for here.
Please tell me something comforting,
Truly,
Melissa
Melissa J. Kelly :: 9 months, 3 weeks after
Melissa,
Take heart and remember that no matter what you need to wait the post op healing phase. If after 6 months you hate the way your nose looks…see another Plastic and Cosmetic Surgeon to see if Revision Rhinoplasty would be an option. That’s worse case scenario. Best case..the nose looks great when the swelling goes down. Either way you’ll ultimately be fine.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Hey John,
That’s what makes the world go round. Differences of opinion. We’ll have to agree to disagree. But that’s cool.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Hey Shauna,
The upper lip lift that’s peformed below the nose can change the way that you smile…think about it this way. Your mouth is wider than your nose (not just yours but everyones) and the lip lift, shortening procedure only effects the center area of the mouth or upper lip.
The dissection could be causing the stiffness but the actual procedure could alter the shape of your upper lip and the way you smile. I’m not a fan of these types of lifts for that very reason. As always, it’s best to take up these issues with the Plastic and Cosmetic Surgeon that performed your Rhinoplasty and lip lift.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Dear Dr. Palmer: I had revision rhinoplasty 3 months ago with Dr. Gunter in Dallas Texas. I flew 5,000 miles, because I was told he was one of the best in the world – and the “father” of the rib-grafting procedure. I paid nearly $25,000. I was very specific with what I asked for – when I came out of the surgery he said “it may be a little wider than we discussed” – He is a “perfectionist” and his bedside manner isn’t the greatest… (he definitely makes you feel like he has the last word on what is best for you) and I feel intimidated to tell him that this is not what I wanted. Any suggestions on how to approach that when I see him for my first post-op visit next month?
nadia :: 9 months, 3 weeks after
Hey Nadia,
Best way is with honesty. It’s your face, nose and money. Worst case scenario…you both don’t see eye to eye. Rhinoplasty is the most difficult Plastic and Cosmetic Surgery procedure for many reasons…not the least of which is accurate communication between patients and the Plastic Surgeon. Let me know what happens.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Dear Dr. Palmer, I had a revision rhinoplasty done 12 weeks ago. The left side of my nose had collapsed from a botched nose job 12 years earlier) and I couldn’t breath, the doctor used a ribgraft on my left nostril to open up my nose. I love the way it looks – much more even and he refined the tip as well…the “only” issue I have is that you can actually see and feel the hump/bump on the left. Others point it out. If that wasn’t there.. it would be perfect. It makes the bridge look unnatural and much wider and uneven. When I called he said that was because that was where they inserted the graft. My question is.. Will that go away? Can it? Does that “go down” along with the rest of the “swelling” you talk about? what are your thoughts? I’m a little vervous about it and trying to be patient…
natalie :: 9 months, 3 weeks after
Hey hey,
I love the beauty theme
…” differences of opinion”. Well, I’ve been searching for a rhino-specialist for about 3 years now, and I still haven’t found one. Why? Because when I look at before/after photos, at least 2-3 photos out of a bunch make me think “what Godly principle of beauty what that surgeon thinking of?!”. So I have arrived at the obvious conclusion, namely that the fault is mine – or rather: Beauty is in the eyes of the beholder
My own principle is that beauty is ‘broken’. I may envy a very big nose, I may love a very small nose (but probably not a neutral one). As far as I know, most principles of beauty change with time, Barbie’s nose is not even the ideal any longer. Besides, how should you define a ‘neutral nose’ in the first place? What does it look like? What seems neutral in once face may appear vulgar in another. In the end, you will definitely want to go for a ‘beautiful’ nose, or at least one that fits your face beautifully. The question that remains is how to define this, how to communicate it and how choose a surgeon who shares your opinion!
Best wishes for all rhinos,
Mat
Matthew :: 9 months, 3 weeks after
Dear Dr. Palmer,
Thank you for your words. I wrote my surgeon again and he asked me to come to his clinic. He requested that I do not eat for 12 hours before arrival, in case he needs to sedate me and straighten up the nose. ? I have no idea what he has in mind, is it possible that he may try to straighten it with his bare hands? Should I refuse this if this is his plan?
Truly,
Melissa
Melissa Kelly :: 9 months, 3 weeks after
Hey hey,
I love the beauty theme
…” differences of opinion”. I’ve been searching for a rhino-specialist for about 3 years now, and I still haven’t found one, bcause when I look at before/after photos, at least 2-3 photos out of a bunch make me think “what Godly principle of beauty what that surgeon thinking of?”. So I have arrived at the obvious conclusion, that the fault is mine – or rather: Beauty is in the eyes of the beholder
My own principle may be that beauty is ‘broken’. Im into big noses, small noses, but probably not a neutral ones. As far as I know, most principles of beauty change with the course of time, Barbie’s nose is not quite the ideal any longer. Besides, how should you define a ‘neutral nose’ in the first place? What does it look like? What seems neutral in once face may appear vulgar in another. In the end, you will definitely want to go for a ‘beautiful’ nose, or at least one that fits your face beautifully. The question that remains is how to define this, how to communicate it and how to choose a surgeon who shares your opinion!
Maybe you can clarify your principle or maybe we actually agree?
Best wishes for all rhinos,
Mat
Melissa J. Kelly :: 9 months, 3 weeks after
ps, thanks for comforting my girlfriend, I share her frustration, and Im afraid is has made my own fear of surgery even greater :/
Mat
Melissa J. Kelly :: 9 months, 3 weeks after
Hey Natalie,
Rib gratfs are made up of bone and cartilage and while they can dissolve unevely over the years when used in large pieces over the nasal bridge, smaller areas of fullness are likely to remain. This may be the way it’s going to look. As always, it’s best to ask this question to the Plastic and Cosmetic Surgeon that performed your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Mellissa,
In almost 20 years as a Beverly Hills Plastic and Cosmetic Surgeon I have come to the conclusion that patients need not fear plastic surgery but rather the lack of aesthetic judgment of the Plastic and Cosmetic Surgeon.
Aesthetic Judgment is the knowledge of what makes a face, cheek, nose, lips, chin etc. attractive. Simple concept yet something that’s not taught to plastic and cosmetic surgeons and rarely discussed. Yet it’s crutial if you want to be more attractive and isn’t that the purpose of doing the plastic surgery in the first place?
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Hey Mat,
Keep looking until you’re staisfied…but realize that you may never connect on all data points. Plastic surgery is like life in general. There are good parts and bad parts…pros and cons for every procedure. The skilled plastic and cosmetic surgeon makes sure that the pros far outweight the cons for any given procedure and patient. That’s the best that we can do.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Gosh Mellissa,
I don’t have any idea what he has planned. If you’re worried, you should talk this out with the surgeon. You should be comfortable with any treatment or procedure. Best of luck to you.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Thank you for your response Dr. Palmer… One last Quick question… is that something that can be “shaved down” after the “year of waiting”?? It would look strange (and I think you would agree if you saw it) if it were to “remain” like this?
natalie :: 9 months, 3 weeks after
Dear Dr. Palmer
I went to to see my doctor and he confirmed that I had a severe infection in my left eye which may have been causing my nose to turn a bit to the right in the healing proces. He removed as much of the bacteria as he could and said that the the remaing bump on the top of my nose were actually an infection and not a ‘left over’ from my original hump. I am to continue antibiotics and see him again in two weeks, then he may have to straighten out my nose with a small surgery. He said that would only take 10 minutes. I hope I wont have to wear a cast again.
Is this something you ever experience in your own practice?
Truly,
M
Melissa Kelly :: 9 months, 3 weeks after
Dear Dr. Palmer,
Thank you for offering this service. Your comments are very much appreciated.
I had an open rhinoplasty 3 1/2 weeks ago. When the cast came off, the bridge of my nose much wider than my original nose. My doctor had to break my nose to removal a dorsal hump. My first question is, will the wide bridge become more slender and could this be due to swelling?
Additionally, my nose was straight as a board when the cast came off, over the past 3 weeks the hump came back and there is a lump on each side of the ridge of my nose as well. I’ve been instructed to put pressure on the lumps and firmly massage them, which temporarily helps, but does not competely eliminate the humps. This leads me to my second questions, if my nose was straight when the cast came off, will it return to the straight position with constant massaging? The bridge of my nose is so swollen, wide and has distinctive bumps in the middle and on both sides of the bridge, where he had to cut the bone. I also have a long bridge and thin skin, so this is a hard thing to live with for the time being. I look like I was on the loosing end of a fist fight. Any comments and words of wisdom will very much be appreciated.
Thank you,
Michelle
Michelle :: 9 months, 3 weeks after
Hey Michelle,
These are difficult questions to answer since I don’t know what was done and how they were done during your Rhinoplasty. In theory all can be improved but I can’t say for sure. I suggest that you follow your Plastic and Cosmetic Surgeons advice as he/she is the person who performed the Rhinoplasty. Good luck and have faith.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 3 weeks after
Dear Dr. Palmer – Thank you for creating a website such as this.. I think we are all in the same boat and just need some reasurrance.. this service that you provide is more helpful than you will ever know. If/when I need to have my “third” revision.. I am coming to you for sure!!
Although I live in the land of plastic surgery/surgeons – I went to the “best of the best” out of state 3 and a half months ago. I was very comfortable with my original surgeon.. but went for a “second opinion” just in case – he was very straight forward and told me that “If I was his wife” he would make me cancel my surgery with the original surgeon as he was not qualified to do the in-depth surgery needed for my particular case.. I took heed – and went to where I was advised. Clearly my surgeon is one of the best in the world.. no doubt.. And I can now breathe much better..(although I went in for purely cosmetic reasons) All I wanted was for it to be “straighter” at the end (which it now is).. but it is also MUCH wider.. and not as feminine.. I am desperately trying not to look at it every 5 minutes and be reasonable.. but I was attractive before.. and feel very unnattractive now and unhappy… I have my first visit with him in a month.. If he agrees that it’s not looking so great.. (although I am sure he will tell me I have to wait a year to see the “end result”)should I trust him to do it yet a third time? From your website alone I feel like you are more qualified and compassionate…I know you are professional and would never deter someone from another physician.. but don’t I need to trust the hands I’m in? Is it even realistic or possible that the nose will slim down that much in the next few months??? I have a friend who is a surgeon and he said you can go back and operate now if you want to – it’s more ifficult but “possible.” What are your thoughts? Would you ever consider doing that prior to the suggested “One year waiting period?”
Suzanne :: 9 months, 4 weeks after
Dear Dr. palmer Do you agree with the following? Isn’t it true that you can in fact re-operate 6 months after if it really isn’t the shape you wanted?
It’s important to wait one entire year after a
> rhinoplasty before making another attempt.
>
>
> The scar tissue that forms underneath the skin of
> the nose after a primary (first-time) rhinoplasty is
> hard at first, as is any scar. If you have a scar
> from an operation, such as an appendectomy, the scar
> starts out being quite firm; it feels like a cord
> underneath the skin. With time, the scar softens,
> so that eventually you can’t find your appendectomy
> scar by feeling for it — you have to look for the
> scar, because it feels just like the surrounding
> skin.
>
>
> The scar tissue in the nose starts out hard, and
> after a few months it starts to soften. You can’t
> feel much of the firmness, except perhaps at the tip
> of the nose, which might feel more solid than
> natural, but the firm scar tissue is there,
> underneath all of the nasal skin, until the scar has
> had time to soften. It takes about a year for the
> scar tissue to soften completely.
>
>
> If a surgeon attempts a revision rhinoplasty before
> that scar tissue has had a chance to soften
> completely, he is operating with one hand tied
> behind his back, because he is guaranteeing himself
> a difficult time trying to fight through the firm
> scar. Even after it has softened, the scar tissue
> makes a revision operation difficult, but before it
> has softened, it’s just impossible.
>
>
> Also, as the swelling in the nose decreases after a
> primary operation, the nose gradually looks
> different, hopefully better, and it’s important to
> wait until the swelling has resolved and the nose
> stops changing in appearance before attempting a
> revision operation. Scar tissue under the skin of
> the nose can also shrink as it softens, further
> helping with the appearance of the nose. If you
> operate too early, the surgeon may be operating to
> correct problems that would at least partially
> correct themselves as the rest of the swelling
> resolves. He doesn’t really know how much to do if
> he operates too early.
>
>
> Re-operating on a nose too early can be likened to
> building a house on a soil foundation that is still
> settling: you want everything to stop moving before
> you decide exactly what changes to make and attempt
> those changes.
>
>
> Finally, we have said that a revision rhinoplasty is
> much more difficult than a primary rhinoplasty. A
> third-time operation is even harder yet. You want
> to give yourself every possible advantage before
> having a secondary operation, to absolutely minimize
> the chances that you’ll need or want a third
> operation.
Leslie :: 9 months, 4 weeks after
Hey Suzanne,
First thank you for the kind words about my blog and website on plastic and cosmetic surgery. After almost 2 decades as a Beverly Hills plastic and Cosmetic Surgeon with a practice in London for 6 years as well, it’s been my experience that patients are more confused about these plastic surgery procedures than ever. They (patients and people not my patients) just need a source of good information from someone that has the necessary experience.
OK..now on to you. I have several comments.
1. I don’t like to hear that any surgeon bad mouths another surgeon because it’s just too easy to do and it’s not professional or ethical.
2. With your revision Rhinoplasty, your tip may be accummulating scar tissue and making the tip appear wide…although without knowing what was done during your Revision Rhinoplasty it’s impossible for me to know.
3. Because of #2 above, I instruct all of my Rhinoplasty patients in manipulation of their nose, beginning at 1 month, to soften and eliminate the soft tissue swelling before it becomes scar tissue….Leslie this part is for benefit also. Sometimes placement of kenalog in the supratip subcutaneous tissue may also help soften and shrink the nasal tip but this typically becomes ineffective at about 6 months from the time the Rhinoplasty was performed. You may want to dicuss all of this with your surgeon.
4. No, I do not believe it prudent to re-operate on the nose any sooner than 6 month intervals and even this is not written in stone. The plastic surgeon must be able to look at the skin, of the nose, and determine if it’s soft and healed enough to have another operation (again Leslie this part applies to you also). Most of the time, it is but I have turned consults away and told them to return at 1 year so I could see if the skin was soft enough for me to perform my revision rhinoplasty. Medicine is an art not cook book and all surgeons will practice this art at some varying level of competency.
5. You are correct, I will not tell you or any other person to go or not go to a specific plastic and cosmetic surgeon. You may however want another opinion about your nose at 6 months before you let anyone do anything…I think that would be prudent.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 4 weeks after
Leslie,
Read my note to Suzanne it has some info that applies to your question as well.
OK…what’s the big mystery about the 6 month or 1 year rule for re-operating on noses? Let me try and explain.
1. Rhinoplasty is performed by lifting the skin off from the nasal skeleton. The act of doing this causes trauma to that skin. It distrupts the blood supply, blood and lymphatic drainage….which causes the swelling that all of you ask me about.
2. The Lymphatic vessels that were disrupted during the Rhinoplasty typically are hooked up again at 6 months….
3. Rhinoplasty swelling typically (again typically, not always) is mostly resolved by 6 months….
Do you start to see a pattern in this 6 month logic?
Because these things typically happen by 6 months, most experienced Rhinoplasty surgeons feel that this is the shortest interval that Revision Rhinoplasty can be performed without causing injury to the nasal skin. The injury can cause the skin, of the nose, to appear like a cobblestone street and the change is often permanent….not a good look or an acceptable risk in my opinion.
So, that’s the reason behind the 6 month rule. Is it violated? Sure. Should it be violated? In my opinion…NO! Having said that as an experienced Rhinoplasty Surgeon, I absolutely reserve the right to exam the nose and skin of a prospective patient before making the determination if they are ready for a revision Rhinoplasty be they 6, 7, 8, or 12 months post op from their previous Rhinoplasty. That’s why I charge for my advice and time during consultations.
Over and over again, in this blog I am asked about post op Rhinoplasty yet I almost never hear anything about post-op manipulation maneuvers that surgeons are telling their Rhinoplasty patiuents to perform. I have found this to be the single most important factor in the post-op healing and obtained results following a Rhinoplasty and certainly a Revision Rhinoplasty. Sadly, I can not instruct another plastic surgeon’s post-op Rhinoplasty patient in how to perform these manipulations as that is unethical…it is considered interference in the post-op healing process and that’s why you don’t see me giving these types of instructions. I do when patients see me in consultation but even that is tricky and I prefer that they deal with their current plastic surgeon until such time that they want to sever that relationship.
Dr Francis R Palmer, III
Leslie, I think you may want another opinion as well before having your Revision Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 4 weeks after
Dr. Palmer… if I am 4 months post -op of a revision rhinoplasty and have not been doing “manipulations” is it prudent or even worth it to start doing them now? Should I ask my surgeon about this?
nancy :: 9 months, 4 weeks after
Dear Dr. Palmer… How many “revisions” can one person have before the nose actually collapses? I heard that Micheal Jackson had 7 or eight… is it safe to have 3?
shelah :: 9 months, 4 weeks after
Dr. Palmer, I e-mailed my surgeon (also considered one of the BEST in the world…) re: the benefits of post manipulations on revision rhinoplasty.. and this was what was written in response.. ” I think he Dr. XXX is afraid that patients will get too overzealous and do more
damage than good. He has new grafts in place and manipulating your nose may dislodge or break them. Believe me, if he felt like you would benefit from doing it he would recommend it.
lisaf :: 9 months, 4 weeks after
Hey Nancy,
Yes, in my opinion it is the single most effective method of controlling the post Rhinoplasty swelling and accumulation of excess scar tissue in the supratip area. Can’t hurt to ask your Plastic and Cosmetic Surgeon to see what he/she says. I use it for all of my Rhinoplasty and revision Rhinoplasty patients.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 4 weeks after
Dear Shelah,
There are no set answers when it comes to Revision Rhinoplasty and the correct answer is as many as the nasal skin can safely withstand. That’s why Revision Rhinoplasty should be spaced at minimal intervals of 6-12 months depending on how quickly and well the nose is healing.
It’s also true that the more Revsion Rhinoplasties a person has, the more difficult each subsequent Rhinoplasty is to perform, the more difficult it is to get a good result and the more risk there is of excess scar tissue formation that will make the nose appear thick and not attractive.
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 4 weeks after
Hey Lisaf,
There will always be a difference of opinion between Plastic and Cosmetic Surgeons about all plastic surgery procedures that they perform including Rhinoplasty. Medicine and plastic surgery is an art, not cook book which means that plastic surgeons will do things, procedures and evaluations differently. This should not be a surprise but expected by patients.
Having said that, you can find plastic surgeons who don’t have their patients do post-Rhinoplasty manipulations. I can’t comment on why they feel that way…you’d have to ask them. I can only tell you that I have all of my Rhinoplasty and revision Rhinoplasty patients do them because I believe it to be of great value in the final cosmetic result.
It is also true that if these manipulations are done at the wrong time or in the wrong manner, it can damage the nose…that’s why Rhinoplasty patients need to be instructed in person on exactly how to perform these manipulations. Infact, I see many of my Rhinoplasty patients at monthly intervals after they have been instructed on how to perform these manipulations so that I can be sure they are performing them properly. I believe that the manipulations make the nose look better faster with a higher degree of predictability for the final result. They’re not difficult to perform or teach to my patients, so I sure don’t see any reason not to share the knowledge with them. After all, whatever it takes to get a great cosmetic result….that’s the goal!
Dr. Francis R Palmer, III
drfpalmer :: 9 months, 4 weeks after
Dr Palmer, can you please tell me if septal cartilage on the dorsal area always dissolves, or loses its shape? and if so, how long after the surgery is this likely to happen?
Nicole :: 10 months after
Dr Palmer, i had septorhinoplasty just over four weeks ago, my nose still aches, im alittle concerned about how much activity i can do. I am still sleeping vertically amongst over things like not looking down. My plastic Surgeon has been vague regarding this. Could you please tell me how long it takes for the bones to set and can they still move out of place after 4 weeks. Thankyou.
lacy :: 10 months after
Hey Lacy,
I tell my Rhinoplasty and Revision Rhinoplasty Patients that they should avoid strenuous activity and direct contact to the nose for 1 month. after which, I believe the nasal bones are set.
Dr. Francis R Palmer, III
drfpalmer :: 10 months after
Hello I have just had a rhino/septoplasty conducted 10days ago. I had my previously broken nose rebroken and a bony bridge smoothed over. Is it normal for my bridge to look broader and boxier than prior to surgery?? (as previously I had quite a narrow bridge and I am hoping this will go back to a similar size). Should I expect this to take a month or 2 to be apparent? Also you seem quite adament that post operative manipulation is important for aesthetic results. My Dr hasn’t given me any as yet. When do you normally advise they are started?? And are these mainly for tip manipulations or bridges as well?
Thankyou for your time, I have found reading your blog very informative and comforting in this horrible stage where I am quite impatient and concerned…… Even all the way from Australia!!
Tonia :: 10 months, 1 week after
Tonia,
Thanks for the kind words about my blog. It is a true labor of love.
First realize that it’s quite common to be anxious at this stage after a Rhinoplasty. Typically, the nasal bridge will be swollen for 1-2 months after a Rhinoplasty. If at that tiem the bridge is still wide or you can feel a flat separated section along the top of the nose…this may be an indication of an open roof deforminty. At this point, follow the post op instructions of your Rhinoplasty surgeon and express to him/her any of your concerns. Your Rhinoplasty surgeon is the only one who knows what was done during your Rhinoplasty and as such can give you the type of comfort that you are seeking.
Yes, I have every one of my Rhinoplasty or Revision Rhinoplasty patients manipulate their noses after surgery beginning at 1 month. Both the supratip (above the tip) and nasal bridge areas. The tip itself should not be touched as this could disrupt the delicate tip cartilage wok performed during the Rhinoplasty.
You should have this discussion with the Palstic and Cosmetic Surgeon who performed your Rhinoplasty. As I have mentioned previously, mediacl ethics preclude me from administering specific post- op advice to any patient….this must come from the plastic and cosmetic surgeon who performed the Rhinoplasty or other plastic surgery procedure.
I should mention that no one should attempt to manipulate their noses after a Rhinoplasty without the specific instruction of a qualified plastic and cosmetic surgeon who ’s care the patient is curretly under.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 1 week after
Thankyou Dr Palmer for your quick response, it has certainly eased my mind and given me renewed patience during this ‘recovery period’.
My surgeon has not requested to see me for 3mths but I think given some of your advice I will book in for a 1mth post-op follow-up to discuss ‘post-op manipulation’ with him.
As the results of my rhinoplasty are only going to be very subtle I want to ensure maximum aesthetic result, but I don’t want to disrespect my surgeons professional expertise, as I do believe he is an experienced plastic surgeon…
But, if he does not suggest anything would it be suitable to refer him to what you have said on your site and possibly have him contact you? Or me contact you?
Thanking you
Tonia :: 10 months, 1 week after
Dear Dr Palmer,
I had a closed rhino 17 days ago. This was done to reduce the overall size and make my nose a little slimmer. I am pretty happy with the overall result and my PS, but have quite a bit of swelling on the bridge of my nose between my eyes. It doesn’t dip but almost feels straight even a little raised. The sides of my bride closest to my eyes feel lumpy (tiny lumps) what is this? Even my forehead hurts when I’m rummbing in my moisturiser. Will this settle and come down, how long before it does? Thank you for answering. Would have asked my PS but he is off on a skiing holdiay for two weeks!
Lucie :: 10 months, 1 week after
Hey Lucie,
Most likey swelling still. Yes, you may feel small lumps along the bridge and sides of your nose after a Rhinoplasty, these have a tendency to become less noticed with time. See your Plastic Surgeon who did your Rhinoplasty when he/she’s back in town to go over your concerns.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 1 week after
Hi Lucie,
Have been keeping an eye on the blog after my rhinoplasty surgery also 17days ago today!! Just to provide some ‘me too’ empathy, I have also noticed some little lumps in the same areas and tenderness when I’m applying moisturiser etc, sounds like a fairly normal process…. so we’ll both have to continue the mantra “be patient, the swelling will take time!!!” Good luck
Tonia :: 10 months, 1 week after
Dear Dr. Palmer – it has been exactly 4 onths since my revision rhinoplasty (with reib graft) I feel like the swelling seems to go up and down (one day less- one day more) is this normal at this stage?
Also – you can still visible see the graft – which was inserted to open up my breathing (which is fabulous now..) but I want to ask is that will also “disappear” while the swelling goes down? I know that i was told it could take a year to see the results (I am trying to be a patient patient) and I’m told the “waiting game” is the hardest part.. Would you please anser my two queries?
Thank you
lande r :: 10 months, 1 week after
Hey Lande,
Rib grafts can take up to a full year for the swelling to go down and see the final result. Rib grafts may also slowly dissolve over the next 10 years or so. You have nothing to loose by being patient, so wait and see. Yes, the most difficult thing to do…is to wait. You may want to have this discussion with the Plastic and Cosmetic Surgeon that did your Rhinoplasty and ask if there is anything that you can or should do to speed the healing along. Doesn’t hurt to ask.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 1 week after
Dear Dr Palmer,
I had a closed rhinoplasty in Delhi, India four weeks ago. The surgeon was competent but as I am far away from him I am suffering from anxiety in regards to tip swelling which is rather large and the upturned tip.
I live in the UK and just feel anxious about the healing process. Any comments would really be appreciated. Many thanks.
priya :: 10 months, 2 weeks after
Hello again Dr Palmer,
My post op journey continues… a) I am finding that the appearance of my nose can change slightly each day, especially in the morning when it seems to have ’swelled up’ again. Is this normal for the swelling to go a bit ‘up and down’? Or should it be a progressive move forward? b) Also it is 3weeks after my op and I was advised I can fly for work trips, should I expect a little swelling after a short air flight? And c) The area above the tip of my nose, I think you refer to as the supratip, is not showing any real signs of reduced size since my op? Is this area paerticularly stubborn, or should I be concerned thatit hasnt really gone down? Thanks again for your advice.
Tonia :: 10 months, 2 weeks after
Hi Priya,
Yes, this is a difficult period after Rhinoplasty…the first month. I typically see all of my Rhinoplasty patients at this time to comfort them and instruct them in the post Rhinoplasty manipulations that I ask them to do to their nose.
Yoy may be far from India and your Plastic and Cosmetic Surgeon but you can call and e-mail the Plastic and Cosmetic Surgeon a picture of your nose and express your concerns. You’ll feel better. promise.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 2 weeks after
Hi Dr. Palmer,
I just had a rhinoplasty done 5 days ago in Seoul, Korea from a very reputable PS. I did my research (and liked his aesthetic judgement) but I am getting very concerned.
I have almost no brusing or swelling but my nose looks very, very unnatural. I know that he put in a silicone implant and lessened the width of my nose using stiches (invisible…) but I cannot move my nose at all and cannot make any expressions with it, making it look extremely awkward.
Also, the nostrils are not “round” as it should be –it simply doesn’t look right. I am Asian and my nose looks too small to be proportional. I know as the “swelling” comes down that the size of the nose gets smaller…This would not be ideal because my nose is smaller than it should be.
I have no idea what to do–Any words of advice would be appreciated….. (esp. the manipulation techniques–I am having language problems here because I am not 100% fluent in Korean. They simply told me to hold my nose together when I sneeze or yawn so the nostrils would be the same size….)
Thank you so much–hope to hear from you soon
Jen :: 10 months, 2 weeks after
Hey Jen,
Wow 5 days ago is really, really soon after your Rhinoplasty to worry about the appearance. I say let the nose heal for the next 3 weeks and then during your post Rhinoplasty visit with the Plastic Surgeon who doid the Rhinoplasty have this discussion. That’s also the time toi ask your Plastic Surgeon if he recommends any manipulation of the nose after your Rhinoplasty. Do not do anything until you get his approval as your nose is quite vulnerable at this early stage after the Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 2 weeks after
Hello Dr. Palmer,
Thank you so much for your assurances and posting a reply so quickly. This comment does not need to be posted up on this website, but I do have a question.
I am departing Korea on Monday to head back to Atlanta and today will be the last time I will go to the PS Clinic. I am getting extremely anxious because I will be 8000 miles away if there is a problem or if my nose does not improve.
I am becoming mostly extremely anxious at the thought of going back to school next Tuesday because the transformation on my face is too dramatic….
Is it possible to send over a picture to you for a very quick assessment of whether something went wrong with my surgery? The clinic is not offering any help and I have no idea whether I look like this because something went wrong or whether this is expected.
How much is the nose expected to change in the course of the healing process? The width of my nose is very small and therefore unproportional to my face….I would be so incredibly grateful for your help–
Sincerely,
Jen
Jen :: 10 months, 3 weeks after
Hello Dr. Palmer!
I had my nose done a little over a week ago and am very happy with the outcome. Its still swollen but I think I am going to be very happy with it. My question though is that my nose and upper lip still feel numb. I know this is normal but its affecting my smile. so much that my smile is completely different. My upper lip doesnt even lift above my upper teeth like it used to. Is this normal? Once the numbness goes away will this go back to normal? I love my new nose but I hate my new smile!! Help!
Thanks!
Stella :: 10 months, 3 weeks after
Hi Dr Palmer,
I tried to post my question but do not see it so here I go again, I wrote before regarding the swollen right side of my nose under my eye it is a pretty big bump. After my surgery on the 7th day I started to bleed a lot from the right nostril and felt a lot of pressure in the area that is still swollen. My Dr. had already said that all is well and that I just need to give it time, but it really is worrying me. Could the bleeding have caused my nose to heal abnormally, it has been 2months since surgery, and the rest on my nose (except that side) looks fine..
Adrienne :: 10 months, 3 weeks after
Hi,
I’m post rhinoplasty 5 weeks ago to correct a broken nose which was had a very slight deviation and slight hump due to the broken nose. Although I have fine features, I had what was considered a large nose for my frame and naturally had an upturned boxy tip.
The surgeon has done a fantastic job in my request to shorten my nose, eleviate the bump, and keep my box like upturn tip but make everything pretty much smaller, and overall, I have had a pretty good effect which has kept an upturned tip and drawn more towards my eyes than my nose. My main concern is that over the past week, (I’m now in the 5 week phase) my nose seems to have settled a bit more and given it the effect that it seems longer from the side and profile and not as cute in an upturned way which is starting to concern me as i feel my old nose is started to grow back!
I notice you mention manipulation, I have been taping my nose nightly and from the front it looks perfectly straight, is there anything I can do to manipulate my nose to keep my tip upturned? Please advise your suggestion?
Many thanks Nicky
Nicky :: 10 months, 3 weeks after
Hey Nicky,
No, I’m afraid that you can do manipulations to lower and thin the nose but not to elevate (rotate the tip). That has to be surgical. My advice is to speak with the Plastic and Cosmetic Surgeon that did your Rhinoplasty and see what the Plastic Surgeon says you can do.
Worst case scenario…and this is worst case so don’t worry about it now….in several more months if you indeed need the tip rotate up, there is a permanent suture method that can easilly do just that without any other manipulations to the nose. yes, it does require an incision and a surgical modification to your Rhinoplasty but it’s no big deal.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 3 weeks after
ahoy there! Doc,
I got open Rhinoplasty with a dorsal cartilage graft (human rib allograft) a month ago.
After the third week all the swelling was gone and I began to notice my nose was a ski slope before and unfortunately still looks that way.
Looking at it now, I like the top half but not the bottom half. Only 2 weeks back when it was taped it was flat and straight like I wanted!
The only difference is now instead of the ’ski slope’ being caused by a depressed upper half it is being cause by a bulbous bottom half. I WANT THE TIP FLATTER!
I consulted my surgeon about it this morning again (who is btw a world renowned member of the AAFPRS) and he continues to say that I must wait a year!
Is there anything I can do about it right now ?
Jared :: 10 months, 4 weeks after
Hey Jared,
Yes, there is. You can ask your plastic surgeon if he can recommend specific manipulations that you can do to ensure less swelling and tissue accumulation along the “Supratip” region. This is the area that you’re calling bulbous.
Most Rhinoplasty results happen within 6 months after the Rhinoplasty. However, if this is a revision Rhinoplasty or in cases where rib grafts are used, the result may take up to a year to finalize. Is there any rib cartilage in the tip? If not, the tip result may occur before a year.
I personally don’t like rib cartilage whether it’s the patients own or alloplastic (donated cartilage from a tissue bank) because these have a tendency to absorb unevenly over the years. For that reason, I prefer a silastic dorsal implant. But hey that’s what makes medicine and plastic surgery an art and not cookbook. Different plastic surgeons perform Rhinoplasty differently and like to use different materials.
Dr. Francis R Palmer, III
drfpalmer :: 11 months after
hi dr,
6 yrs after my first rhino, i had formed so much scar tissue. So i went to a different dr and had a revisional rhino to remove it. He then gave me a series of kenalog 10 injections to help prevent the scarring again. I’m now 4 yrs post op from this second rhino and still get occasional kenalog 10 injections (about every 6 mos). I feel at about the 6 mos mark there is a little scar tissue that seems to get remedied by the injection STILL. Have you ever heard of this? I was hoping the scarring would have stopped by now. Will I have to get these injections for ever?? Will they continue to be effective??
ks :: 11 months after
Hi Nicky here again,
Thanks for your advice regarding the surture option later on to keep my tip upturned. I’ll definitely have a chat to my surgeon regarding this if it turns out how I don’t anticipate.
I’ve got another question in relation to taping as I am still taping my nose on a nightly basis coming up to 6 weeks after surgery. I tend to tape 4 strips along the top but now taping underneath to hopefully position the tip higher (you’re probably laughing your head off now!) ;ODD.
But seriously, what are your thoughts on (a) the actual benefits of taping the nose after surgery and (b) the length of time people should do this.. (c) does it make any difference as to where you should tape?… cheers Nicky
Nicky :: 11 months after
Hey Nicky,
In my experience there is little to no value in patients taping their noses after Rhinoplasty. Why? Because patients are unlikely to apply the proper amount of pressure to the correct area(s) of the nose. It’s painful and the patient will not do this on a consistent basis.
This is why I have them (patients) do manipulation of their noses after Rhinoplasty. There is nothing special that the tape offers. Having said that, you do need to follow the advice of the plastic and cosmetic surgeon who performed your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 11 months after
Hey KS,
Good question. Most plastic and cosmetic surgeons performing Rhinoplasty or Revision Rhinoplasty believe that the benefits of kenalog injections dimish after 6 months and certainly by 12 months. I guess the real question is…do you feel that you are receiving any benefit from the injections at 4 years after your Revision Rhinoplasty? The scar should be well healed at this time but your plastic and cosmetic surgeon may think the injections are still helping. Sounds like you’ll have to make the call.
Dr. Francis R Palmer, III
drfpalmer :: 11 months after
Dear Dr Palmer
Thankyou for your wonderful website, since my Nose Job 3 weeks ago, I cannot eat or sleep, because I am devastated by the outcome. I came to my PS stating that I would like a more defined tip and a slight narrowing of the nostrils. My nose to start off with is not huge but just lacks definition, and my base was wider than my eyes which was why I wanted the narrowing. The day of surgery my PS tells me he would widen my bridge and elevate it by 2mm because that was the only way to get a tip because he said my bridge was not high enough (which it is because I have never had an issue with my bridge especially since I know I am very self critical of my features and I would be the first one to find fault) at which point I told him I wanted only what we had dicussed. He told me I would look great and not to worry.
Needless to say I was horrifed after. Through closed rhino, he used a gortex implant to build a bridge that I was happy with beforehand and define my tip, which only made my tip look more bolbous and look bigger. My profile is so unnatural, with it starting from as high as between my eyes,it just juts out and there is no sloping, it just goes straight down.
When I went in for my post op, I was told that RASPING could be done to file dowm my bridge and refine the tip. I am aware that RASPING is done to humps but can it be done when it is as high as where my eyebrows begin??? That how far up my implant goes. Is rasping effective for the tip also? Also because the implant is placed so high it has pulled my skin higher , making my eyes appear smaller, will rasping help this? Thankyou for taking the time to read this……I wish I lived in your city….or that you would move to Toronto…
Much Love and Respect Annisa
Annisa :: 11 months after
Hi Annisa,
First. Let’s both take a deep breath and realize that this is a situation that has a remedy. OK, now that you have hope let me present some information.
1. I advise all of my readers to go back to your PS and have a frank discussion about your feelings. If you’d like the gortex graft out…then ask him to remove the Gortex dorsal graft that you never wanted in the first place. The sooner this is removed, the better as Gortex can allow tissue ingrowth making removal more difficult.
2. Do some research and get a second opinion in your area with a plastic surgeon who does tons of Rhinoplasty surgery and see what he/she has to say.
3. I’m not a fan of Gortex anywhere in the nose and you may want to remove it from the nasal tip if it’s there as well. Some plastic surgeons do use gortex all over the nose however and this is what makes plastic and cosmetic surgery an art….we all do things slightly differently.
No, rasping is not done to the nasal tip and would not reduce the gortex graft which is soft and pliable and therefore not able to be rasped.
Timing, in this case is a tough call. Typically revision Rhinoplasty is done at no sooner than 6 months from the initial Rhinoplasty however, if it’s just to remove the gortex graft from the nasal bridge you may find a plastic surgeon who is willing to make a small incision inside just large enough to get out the graft without lifting all the skin off the nasal skeleton.
Sorry. I know this is much to digest. See your plastic surgeon and have a frank discussion with him/her and try to work this out. You always have the option of a second opinion to sort out your options. Please do not take any of my comments as criticism of your surgery or plastic surgeon in any way. I present this information for educational purposes only and encourage all of my readers to see well trained plastic surgeons for a full evaluation and treatment.
Dr. Francis R Palmer, III
drfpalmer :: 11 months after
Dear Dr. Palmer,
I had nose surgery performed two weeks ago for the removal of a dorsal hump that developed as the result of a break years ago.
Unfortunately, there’s still an albeit smaller hump on my nose. My Dr. explained this away as “tenting” but it seems to be more than just skin. Is this a common occurance, and do you think it will reduce in size with time?
Thanks!
-C
Cary :: 11 months after
Hey Cary,
Very common at this stage in the post Rhinoplasty healing and nasal hump removal to still see some fullness in the nose. Give it time and follow up with the plastic surgeon who did the Rhinoplasty. Another reason, I strongly believe in post Rhinoplasty manipulations performed daily by my Rhinoplasty patients beginning at 1 month after their Rhinoplasty. However, don’t do anything to your nose without the knowledge and consent of the plastic surgeon who did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 11 months after
Dear Dr Palmer,
Thank you for your kind words of hope and speedy reply to my dilemma. I am grateful that I stumbled across this website because after reading everyone’s questions and your answers, I find you to be truely knowledgable and quite caring to take the time out to do this especially since you are such a high profile plastic surgeon in the cosmetic surgery world. I will go to my PS. and ask for the removal of the gortex, but will there be any detrimental effects, would I look exactly the same as before?
And what do you suggest I can do if I did look the same? Can I still have the narrowing of the nostrils and defintion of the tip that I was trying to achieve?
Would I be able to do this at the the same time as the removal? After 10 years of waiting (now 29) I feel kinda cheated that this is happening….
With continuing admiration,
Sincerely, Annisa
Annisa :: 11 months, 1 week after
Hi Dr. Palmer, I had a rhinoplasty done about 5 months ago to reduce the size of the nose. The shape of the nose looks good but i still have a lot of swelling. Is there anything I can do to reduce it, Im getting married next month and I don’t want to have a swallon nose in my wedding pictures =( please suggest something, I have been sleeping with my head elevated but that didn’t help much, still a lot of swelling around the nose right under the eyes and some at the tip of the nose. Please suggest something, Thank you!
Bee :: 11 months, 1 week after
My surgeon hasn’t really suggested anything, and he just expects me to wait. Im devastated, i don’t want to be a bride with a swallon nose =( is there anything i can do at home, any kind of treatment, therapy nething, that would help a bit. Kindly help, it means a lot.
Bee :: 11 months, 1 week after
Hi,
I had open Rhinoplasty done a week and a half ago. I did not have my nose broken just the tip worked on. I had a bullish tip and it faced down. Last night in my sleep I hit my nose. It did throb a little but only lasted a short time. Should I be worried? I didn’t have any bleeding and from day one I had no brusing only swelling. (which I still have) I keep hearing nothing can be done for one year anyway so do you think I need to contact my doctor?
Thank you,
Susan
susan :: 11 months, 1 week after
Dear Dr, I have until june 24th..do u think putting icy packs or ice would help reduce the swelling? I got my surgery done beginning of Febuary, it has been about 5 months now. Kindly suggest the name of some treatment or therapy that I could ask my surgeon about. May be if I show some awareness, He’ll consider helping out. Thank you once again.
Bee :: 11 months, 1 week after
Hi Annisa,
Have a frank discussion with your plastic surgeon about your Rhinoplasty. He may not suggest removal of the gortex graft but if you don’t want the bridge that high you should discuss that as well. I have no way of knowing what was done during your Rhinoplasty so I don’t know if it will look the same after the gortex graft is removed. Ask your plastic surgeon because he performed your Rhinoplasty and knows what was doen to your nose.
The tip may narrow with time and again your plastic surgeon can answer this question. I’m sure that your plastic surgeon wants you to be happy so go back and talk things out.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 1 week after
Hey Bee,
5 months after your Rhinoplasty ice therapy may have little effect on swelling. It doesn’t hurt however and may improve the look. Ask your Plastic and Cosmetic Surgeon about nasal manipulatioons or kenalog injections and see if he/she thinks this may help.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 1 week after
Hi Susan,
You should call and speak with the Plastic Surgeon that did your Rhinoplasty. He/she will decide if you could have caused some type of injury because they know what was done during your Rhinoplasty. Try to be careful as it’s never a good idea to bump the nose after a Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 1 week after
Thank you for taking the time to respond. I did call today and he said it should be fine.
Take care and thanks again,
Susan
susan :: 11 months, 1 week after
Hi,
I had rhinoplasty surgery (narrowing of tip/nostrils and bridge), and a correction of a deviated septum, one week ago. I just got the cast taken off today, and was told to firmly pinch the bridge of the nose daily, so that the bone falls into place. I was told to do this once a day, for a few weeks..is this okay? And are there other things I should do to make sure my nasal bone takes shape correctly? Thanks!
Roya :: 11 months, 1 week after
Hello Dr Palmer,
My closed rhinoplasty was 7weeks ago. Most of the swelling around my bridge seems to have gone but there is still quite alot of swelling along the rest of the nose. At times it feels like my nose is throbbing (not intense, just a nagging feeling of pressure) and it is very stiff towards the bottom of my nose. If this is normal, how often should these feelings last and is it part of healing process?
Rebecca :: 11 months, 1 week after
hi, i had rhinoplasty a little over 2 months ago and it went great. It healed quickly and my surgeon said it’s one of the best he’s seen. But, I wanted to know, can blowing or picking at the inside of the nose gently after about a month still have an impact? Recently, I’ve noticed a very slight bump on the bridge of my nose, where the septum is. I used to have a bump there before the surgery, and it was smooth up until now. Is this just temporary swelling or is it something to be worried about? I am seeing my doctor in about a week, but I just wanted to know if there is any information you could give me until then.
Emily :: 11 months, 2 weeks after
Dear Dr, I have made an appointment with my Dr. and will be seeing him today. Hopefully the suggested treatments will help. Thank you sooo much again =)
Bee :: 11 months, 2 weeks after
Hi,
Yes, even at 2 months after your Rhinoplasty you could cause injury blowing your nose, manipulating the inside of your nose or wearing glasses on the nose. Not sure if you caused any issues since I’m not sure what was done during your Rhinoplasty. If you’re concerned, contact the plastic and cosmetic surgeon that performed the Rhinoplasty and ask…better yet, go in for a post-Rhinoplasty visit and show him/her the area of concern.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Hey Rebecca,
You sure that you’re not too active at this point? Throbbing is a sign of increased swelling, so you may want to take it a bit easier. You might want to see and or ask the plastic and cosmetic surgeon who did your Rhinoplasty and see what he/she has to say.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Hey Roya,
Yikes. At a week after your Rhinoplasty…be sure to follow whatever your plastic and cosmetic surgeon tells you to do. If you’re unsure of what he/she said or meant, don’t be afraid to call and ask for clarification of your post Rhinoplasty instructions.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Hello Doctor, I’m thinking of undergoing rhinoplasty surgery (narrowing of tip/nostrils & bridge) and a correction of a deviated septum…do you think it’s a good idea to do BOTH of them at the same time?
Samrat Das :: 11 months, 2 weeks after
Hi Samrat,
Sure. The septum is done if you have breathing problems. I rarely fix it otherwise and it is a simple operation taking about 15 minutes in my hands. I do septoplasty during Rhinoplasty often. Septoplasty will have no effect on the appearance of the nose…do keep that in mind. In my opinion it’s just to help breathing problems. The Rhinoplasty is what improves the shape and appearance of the nose. FYI…this is the only time that I use packing in the nose after a Rhinoplasty. When doing a Septoplasty, I place two small pieces of Telfa in the nose over night. Hope this helps.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Hi doctor,
I was wondering when it is ok to start running after rhinoplasty. It has been almost 4 weeks since my open Rhinoplasty and I have been doing light squats for about a week now. I was very active before my surgery and I am very excited to start working out again. I’ve looked on many websites and some say 3 weeks others say 6. It seems that there are alot of different opinions out there. What do you recommend. I didn’t have any bones broken only the tip worked on. I am going crazy not being able to do my normal workouts.
Thanks again,
Susan
susan :: 11 months, 3 weeks after
Hi doc,
Susan again. I had one more question…..I was going to do a blue peel next week and I was wondering if that was ok. By then it will have been 4 weeks since my Rhinoplasty.
Thank you,
Susan
susan :: 11 months, 3 weeks after
Thanks Dr. Palmer, I have already spoken with my plastic surgeon, and so far things are going well… I just have to squeeze the nasal bone once a day to make sure that it’s in place. He had narrowed it down quite a bit.
I also had a septoplasty done, but feel that my nose feels stuffy off and on.. how long after surgery will I be able to breathe completely normally? Thanks!
-Roya
Roya :: 11 months, 3 weeks after
Hello Doctor, I recently had rhinoplasty done to fix a deviated septum, it has been 2 weeks after my surgery so far and and still i am unable to squint my eyes and smile properly. The top row of my teeth are now covered and I have a horrible fake smile. I was wondering will I ever get my old smile back, if not is there anything I can do to get it back.
joy :: 11 months, 3 weeks after
Hey Joy,
2 weeks after your Rhinoplasty, Septoplasty it’s not uncommon to have some numbness and or lack of movement of the upper lip. There is a nerve just inside the tissues of the mid upper lip where it meets the nose. Swelling from the Rhinoplasty or septoplasty can cause some numbness just as swelling can cause some weakness of the upper lip. This should be temporary but if you’re concerned you should speak with the Plastic Surgeon who performed the Rhinoplasty for confirmation.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 3 weeks after
Dr. Palmar, I have had quite an ordeal stemming from a sports injury I suffered about 19 years ago. This sports injury created a bad saddle nose deformity that had to be fixed with nasal grafts. My story is complex as I have had 3 grafts to date. The first graft was cranial bone (very good graft) and it lasted for 15 years before it reabsorbed significantly and broke. The last two grafts were rib grafts. The first rib graft warped & absorbed and my surgeon tried unsuccessfully to fix it. So, I sought help from a revision specialist in rib grafts. The specialist recommended replacing the rib graft and did a successful, second rib graft surgery. Unfortunately, I caught a staph infection during the 2nd rib graft surgery and the entire graft had to be removed. Needless to say, I was devastated. Now, I am hesitant about doing any future surgeries but I still have to correct the saddle nose.
Rather than opting for another rib graft surgery, because of all that I have been through, I am hoping to find something else that I can use besides rib. I was reading information on your site regarding silicone for dorsal grafts but I have been told in the past that due to my nasal perforation that I should not pick any man made materials; as infection rates are higher in people with nasal perforations.
Is there a type of dorsal graft that you would recommend, besides rib, for patients with nasal perforations? Or would silicone and/or gore-tex still be viable options? Thanks a lot for your help.
Kevin
Kevin :: 12 months after
Hey Kevin,
Sounds like you have just a couple of options. In my opinion rib and bone grafts dissolve and that’s their disadvantage. I have found Gortex has a problem of getting infected some years later for no apparent reason and as such I have discontinued it’s use. Medpore is another possibilty but is quite stiff and your skin may not do well with that material. That leaves silicone for a permanent correctiona and Radiesse Injections as a temporary solution (might last 18) months. Continuous nasal rinsing with saline might help control the bacterial count in your nose but infection is always a possibilty with a man made nasal implant.
Dr. Francis R Palmer, III
drfpalmer :: 12 months after
Hi Dr Palmer,
I have undergone three rhinoplasties at an interval of 6 months each and I had my last rhinoplasty some three years back. My last rhinoplasty involved a cartilage graft at tip of my nose(graft taken from ear). Since then I have been experiencing that my nose gets stiff when exposed to pressure (e.g. exposure to heat, exertion, lack of sleep, eating something hot or spicy). I feel the nerves around my nose get compressed during this stiffening phase. Finally the nose swells and returns back to normal state. I have consulted many skin specialists, ENT and plastic surgeons, each offfering different explainations, however the most appealing explaination I could get was that excessive scarring stimulates my nerves causing the nose to stiffen.
I want to ask, have you ever experienced similar problem with somebody who has undergone multiple rhinoplasties. Could the above explaination be valid enough. If so can I do something to soften the scarry tissue.
Thanks
shreya :: 1 year after
Hi Shreya,
What you are describing is the lack of lymphatic drainage from the tissues of your nose after something….exercise, spicy food etc. causes an influx of blood into your face, including your nose. Things like sun exposure, heat, bending over and many other things will cause blood to flow to your face. Since each Rhinoplasty adds more scar tissue and distrupts the lymphatic drainage a little bit more, you experience these symptoms. The lymphatic vessels typically remove blood and swelling from tissue and the ones inside your nasal tissue don’t work as well as they did before your Rhinoplasties. You can try massage, ice therapy and kenalog injections under the guidance of an experienced Rhinoplasty Plastic and Cosmetic Surgeon…but there’s no guarantee any of this will help.
As the tissue swells, the nerves are pulled and that most likely is the other sensation you describe. You may also try to visit a homeopathic pharnacist and see if there are any recommendations to match this scenario.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Thanks Dr Palmer for diagnosing it so beautifully. I think now that I’m clear about the cause, my progress towards managing it would be more focussed.
shreya :: 1 year after
Dr Palmer after reading your reassuring words to your other bloggers, I was hoping you could provide me with a response to my concerns about excessive post-op anxiety.
I have found the slow recovery process of my rhinoplasty 2 and a half months ago quite distressing, as it has also coincided with some significant tragedy in my family and my anxiety and grief has been high.
I have been feeling many of the sensations described by Shreya above – in the same conditions – but also after I have been very tense and stressed. Thus my swelling seems to be going up and down – sometimes seeming to regress quite significantly. I have also had alot of the pulling feeling around my bridge – most days.
My questions are: Will significant tension in the body & crying etc affect the long-term outcome of my nose??
I am concerned I am doing something to prevent the swelling from draining and thus leading to scar tissue development
Or will the lymphatic drainage system you describe above eventuall sort this out naturally, as it is my 1st rhinoplasty?
I am trying not to worry too much, but my surgeon is away at the moment and your honest & constructive response would really help at this point, as it will help set my expectations.
Kind regards,
Elisa
Elisa :: 1 year after
Dr. Palmer
My main objective was to get a smaller,more delicate less bulky tip and still avoid the “pinched nose” look. My first rhinoplasty was a year ago and although the tip was my #1 concern my doctor suggested to also make the bones in the upper part more narrow. A few months after the surgery my nose didn’t look straight, a slight indentation could be seen right in the middle.According to my doctor those bones ended up “shifting” in the wrong direction during the healing process,also the tip looked pretty much the same as before so a revision rhinoplasty was needed. I had the second one 3 months ago and although this time the bones look nice and smooth I still don’t see significant difference in the tip area. More cartilage was taken out of the tip but the doctor said my “thick” skin wasn’t helping much to see the new adjustments. Although It still feels firm and sometimes, while massaging my nose i feel like a needle pinch on both sides of the tip my doctor says the swelling is almost gone. How can this be possible??
At the exact moment all bandages,tapes were removed(two weeks after the surgery) my nose looked slimmer than the folling days or even now. I really don’t understand this healing process.
Jenny :: 1 year after
Dear Dr Palmer,
I had a closed rhinoplast procedure 11 days ago, to remove the hump and reduce a bulbous tip. I had the cast off 4 days ago but I am feeling very self conscious. The nose is now straight but I still feel like the tip is still large and feels quite firm and the more I worry about it the more I cant face leaving the house. Is there still swelling and is it likely to reduce more. My plastic surgeon says he is very pleased and I have another appointment in 6 weeks.
Amy :: 1 year after
i don’t see my original message. does it take a few days to be posted?
jenny :: 1 year after
ok now i see it, thanks
jenny :: 1 year after
Amy,
I’m sure there’s lots of swelling 11 days after your Rhinoplasty. Why don’t you call the plastic surgeon’s office and ask the nurse for their advice to rediuce the swelling…and keep your chin up. It’s normal to be swollen and self concious after plastic surgery but this is just a healing phase….not the premanent result.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
hey Jenny,
Yes, this is possible. The Rhinoplasty shapes the tip cartilages making them smaller and more symmetric but the thicker the skin the likely additional scar tissue can form between the cartilages and the skin surface….this makes the cartilage less visible and the tip appear larger and more bulbous. As scarring can continue for months (up to 12) after the Rhinoplasty, the tip may actually wind up larger than it was when the cast was first removed 1 week after the Rhinoplasty. There are things that can be done during the healing phase of a Rhinoplasty including daily nasal manipulations and kenalog injections. Ask your plastic surgeon for specific recommendations. You may also want to read my Post Rhinoplasty Healing listed here in my blog.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Hi Elisa,
OK…let’s both take a deep breath and try to relax. First, after a Rhinoplasty it’s completely normal for the swelling to go up and down. This occurs as whatever you’re doing from nothing to crying or exercising places varying amounts of blood flow to the face and nose. For 6 months after a Rhinoplasty the lymphatic vessels that normally remove blood from the nose are not yet fully re-attached and the drainage is seen as swelling. The blood to the face/nose…the more the swelling.
Crying will definetly cause your nose to swell more than it would if you were not crying…but you have to deal with the emotional loss that you went through in order to heal emotionally. You can call the plastic surgeon that did your Rhinoplasty and ask for specific instructions on how to ice your nose in order to reduce the swelling during this emotional time. You may also ask about daily nasal manipulations to reduce the swelling before it causes permanent scar tissue formation.
You have at least 6 months to get rid of the swelling, so crying now most likely would not have permanent effects….you should avoid physically touching, blowing or twisting the nose as this may cause permanent changes to your nose…I can’t say for certain because I wasn’t there during your Rhinoplasty. Your plastic surgeon was, so if you’re concerned call and ask questions. I hope this helps.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Dr. Palmer is the scar tissue you are talking about permanent? would i get the same results in the long way if i get kenalog injections or if i just wait to heal naturally? What about cortisone creams? are they also an option to reduce swelling? I would like to know anything possible to try help the swelling subside and also would like to know why if my PS says the swelling is almost gone my nose is still sore and firm. Thank you for the advice.
(i had the open technique for the original surgery a year ago, and a close technique for the revision three months ago).
Jenny :: 1 year after
Hi
I had a primary op first time around in London and the surgeon took way too much off my nose leaving it flattened, scooped out and turned up. My original nose was actually already quite straight but I wanted two bumps on either side of the bridge refined as they made the nose look crooked. The doctor knew what I wanted was a subtle change but when the cast came off I was devasted that it was so much shorter. He broke the bones and repositioned them lower on my cheeks in order to reduce the height of the bridge (we did not agree this but he said he thought it would make it look more refined). Since then I have had a tip revision which has brought the tip down but the whole nose still looks weird as the bridge is much lower than it should be. Most surgeons that I’ve spoken to don’t want to seem to re-break the bones and reposition them as they were (though they are quite long nasal bones already – about one third of the entire length of the nose). Before I get a further revision done I would like to ask if you think it is possible to rebreak and rest the bones to give more height and projection? I don’t really want an implant as the bones look strange on the cheeks as they are.
Any advice very gratefully received – this whole thing has been such a terrible nightmare – thanks
Amy :: 1 year after
Hi
I had a primary op first time around in London and the surgeon took way too much off my nose leaving it flattened, scooped out and turned up. My original nose was actually already quite straight but I wanted two bumps on either side of the bridge refined as they made the nose look crooked. The doctor knew what I wanted was a subtle change but when the cast came off I was devasted that it was so much shorter. He broke the bones and repositioned them lower on my cheeks in order to reduce the height of the bridge (we did not agree this but he said he thought it would make it look more refined). Since then I have had a tip revision which has brought the tip down but the whole nose still looks weird as the bridge is much lower than it should be. Most surgeons that I’ve spoken to don’t want to seem to re-break the bones and reposition them as they were (though they are quite long nasal bones already – about one third of the entire length of the nose). Before I get a further revision done I would like to ask if you think it is possible to rebreak and reset the bones to give more height and projection? I don’t really want an implant as the bones look strange on the cheeks as they are.
Any advice very gratefully received – this whole thing has been such a terrible nightmare – thanks
Amy :: 1 year after
Hi Amy,
It sounds like you need to be seen in consultation or have your photos evaluated for further comments. Without seeing you or photos, I couldn’t make further comments. You can e-mail these photos to drfpalmer1@aol.com. You may be able to rebreak the nasal bones but if they are too short, an implant or radiesse injections may be your only option. Either way, I nee to see what your nose looks like now.
If you wish to see me in consultation, call the office at 310-652-9583.
drfpalmer :: 1 year after
Hello,
I had an open rhinoplasty w/ tip work (among other things) 2 and a half weeks ago. The recovery had been great until two days ago. My niece accidentally headbutted me with a moderate amount of force. The strike was toward my face and upward, hitting the tip and pushing it toward me, from right to left, and slightly up. No bleeding, but there was some pain, and my nose swelled slightly. Now it looks like the middle/lower thirds of my nose is drooping compared to where it was before the impact. I am wondering if the only risk relating to post-surgery trauma is bone shifting/fracture, or are there any support grafts, etc, that may have been broken or dislodged with the strike? If so, is it necessary to wait for the typical 6 months to attempt to repair them? Sorry for the long post, I have searched for hours upon hours for any info on post surgery trauma, but the only things I have found are journals to which I cannot get access. Thanks
Josh :: 1 year after
Josh,
I’m away on vacation but felt it important enough to answer your post. You need to call and see your Plastic surgeon asap and tell him/her what happened. The nose is vulnerable during the early post-Rhinoplasty periosd and you may have caused trauma to your nose. Avoid further contact to your nose and make the call now.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
This is for the lady from TX asking about extreme makeover. The shows are all re-runs at this point and there are no new shows…no new candidates. You may consider sending photos and your story to Oprah, Dr. Phil. You never know. They may be able to help you. Good luck and God Bless you and provide what you need.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
I just did my rhinoplasty two weeks ago…now i feel my nose very sensitive and skin ard my nose very itchy…any comments pls email to me angeline_ooi@hotmail.com
angeline :: 1 year after
I just want to say a HUGE Thankyou to Dr Palmer. What a generous person to continue to provide reassurance and advice on his holidays.
I have been reading this blog since my surgery in April and have found it has provided so much sound and rational explanation and facts, but also kind words of support and reassurance which is as vital after surgery to your face!!!
Thanks Dr Palmer. Enjoy the rest of your well deserved holiday
Tonia :: 1 year after
Thankyou for your response Dr Palmer.
In the last few weeks following the deaths, my stress levels which were already higher after my surgery have increased significantly and I feel I am now suffering from anxiety – as I think I’ve got myself into a negative process of ‘worrying that my worrying’ is affected my nose.
As a result I have had a few incidence where I have been having heart palpitations; flushing to my face and feeling significant pressure around my nose as a result. I am working to get this under control and am aware all those hormones and blood pressure are not likely to help my healing, but if I get control of it, can I prevent any long term damage? Do you think any would have occurred?
Sorry, to keep coming to you, but my surgeon is also on leave and I have an appointment with him next week.
Thankyou so much…..
Elisa :: 1 year after
Dear Dr Palmer,
I am now 16 days post op, and i seem to have contracted a really bad cold. I am constantly sneezing, blowing my nose and sniffing. Can this cause damage to my nose as im a bit worried as my nose seems to feel slighty burning and stinging sensation. This has to be the worst time to catch a cold, but thats what you get for living in England where the weather is rubbish. Also i still feel like my nose is still extremely huge and bulbous, can having a cold affect the swelling.
Thank you.
Amy :: 1 year after
Angeline,
call your plastic surgeon’s office…and discuss the symptoms with them…you may be allergic to the tape, or some of the medications.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Amy,
Blowing your nose and sneezing is definetly not good in the immediate post Rhinoplasty healing phase…call your Plastic Surgeon’s office for advice.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Tonia,
Thanks for the kind words. It’s a labor of love and yes, I’m having a great vacation.
Dr. Palmer
drfpalmer :: 1 year after
Elisa,
Just be aware that the swelling may take longer to go away.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Someone asked me to delete their last name. I’m happy to do so but ask that you include the subject and the number of the comment…otherwise I can’t locate the comment message stream.
Dr. Francis Palmer
drfpalmer :: 1 year after
Hello Dr. Palmer …is the scar tissue you are talking about permanent? would i get the same results in the long way if i get kenalog injections or if i just wait to heal naturally? What about cortisone creams? are they also an option to reduce swelling? I would like to know anything possible to try help the swelling subside and also would like to know why if my PS says the swelling is almost gone my nose is still sore and firm. Thank you for the advice.
(i had the open technique for the original surgery a year ago, and a close technique for the revision three months ago).
Jenny :: 1 year after
I had a revision rhinoplasty 1 week ago. Though I realize it takes at least 6 months to see significant results, and in my case potentially longer, I am concerned about the bridge of my nose. During my first rhinoplasty the area near my eyes was filed down – and results were immediately achieved. However during my second one, my surgeon used a rasp to shave down the bone around the midway point of the nose, and I still have a hump in that area. It feels extremely firm, and I am worried that this is still the bone and not just swelling. Did he not file it down enough or is this just swelling? When I apply pressure to the area it appears to go down and my profile appears to improve for a moment.
Billy :: 1 year after
Hi Dr. Palmer,
What a great service you are offering.
I just had a rhinoplasty about a month ago to reduce the size of the tip and width. I still have some swelling, with one side more than the other. My problem is though when I smile I don’t smile like I did. My upper lips curl under instead of curling up/out–I don’t show any teeth. Is this normal? Will it go away? It feels as if my skin is really tight (is that the swelling). I really feel the pressure on my nostrils when I try, so now I don’t smile very ofter. But, outside of the functionality of the nose in coordination with the rest of my movements in smiling, I do like my new nose. He did do well, if I could just smile to show it…
Lastly, wearing this splint for a week really reeked havoc on my skin–I need a deep cleaning. It is safe a month post-surgery to get a facial.
Thanks, jamie
Jamie :: 1 year after
Hey Jamie,
Thanks for the comments. Yes, it sounds like typical swelling. No, it’s not recommended to have the skin of your nose manipulated with a facial at 1 month post Rhinoplasty. Call your plastic surgeon for more specific instructions on when he’s ok with you having a facial.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Billy,
That’s the million dollar question. At this point in your post Rhinoplasty healling, I’m afraid there’s no way to know. Since you are concerned, ask your plastic surgeon at your next post-op Rhinoplasty visit. be patient and allow the healing to take place….
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Dear Dr Palmer,
i am now nearly for weeks post-op after a closed rhinoplasty. I had a hump in the bridge removed and a bulbous tip reduced. I have now noticed that the nose seems to dip underneath just below where the hump was removed. I cant tell if its a dent or if it looks like this because the bulbous still looks extrememly huge. But from a side profile my nose is no longer straight like after my surgery but dips below the bridge and and is then raised to an even bigger bulbous tip than before. Is this normal?
Amy :: 1 year after
I had my nose done both side fractured and the bridge filed down. I had it done almost 5 weeks ago and the bridge still looks as if there is a bump and one side there is a bump and the other side it is PERFECT! How long should I wait before calling my doctor who did it and getting it redone?
Thanks!
Layla :: 1 year, 1 month after
Dear Dr. Palmer:
I too am 4 weeks post-op and I too had a bump removed and a bulbous tip reduced. My nose also looked straight until this stage, where the tip seems quite large and bulbous. It no longer looks straight, but rather scooped. I realize that the reduction in swelling takes time; however, I am also worried that what I am seeing is a swollen version of the final shape. How much more will the tip reduce after 4 weeks?
Thanks for this site. Reading it has helped me immensely.
Stacey
Stacey :: 1 year, 1 month after
hai Dr Palmer i would like to know something..
i just had my implant in the begining of january..then after 6 month i notice my tip is not very sharp and it does not look like i did the implant..so last month i just did my rhinoplasty..the doctor just took the cartilage at the side of the nose…but the doctor told me that he cant trim the silicon which was put in my nose because it might cause complicating…
but then after few weeks the rhinoplasty..i still notice there is still bulbous n big hump at the tip of my nose..i feel uneasy with that..but the doctor told me to picnh my tip of nose for few min so that it will get higher but i notice it never works anything…
im planing to do the again the surgery…so could u pls tell me wat surgery suits fo me so that the tip will look very sharp,straight n small…i dont want the bump that look like the clown nose at the tip…please help me???
is there any side affects if i do ot again??when can i do again the surgery…coz the last rhinoplasty i did is 2 weeks ago…
i hope u will answer all my question…thank you..
lia :: 1 year, 1 month after
Lia,
Yes, the silicone nasal implant can be trimmed in theory but because I wasn’t the Plastic and Cosmetic Surgeon that did the Rhinoplasty, I have no idea od how large or long the nasal implant is. You should have this discussion with the plastic surgeon that did your Rhinoplasty. Some of these implants can erode through the nasal skin so you may want to see the plastic surgeon sooner than later.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Dr. Palmer
As i said before I had my second rhinoplasty 4 1/2 months ago and still don’t see a significant change in the tip area which was my #1 concern. My doctor says the swelling is almost gone but to me the tip looks more or less the same as before and is still firm. How much swelling can i loose in the following months? Is my nose definitely going to change more or will it look pretty much the same as now?
Is there anything i can do to help the remaining swelling subside?
Jenny :: 1 year, 1 month after
Hey Jenny,
That’s hard for me to say since I don’t have any idea what was done to your nasal tip during your Rhinoplasty. It’s not impossible for some swelling to still be there at this time…sometimes it takes 6 months or more for the swelling to dissipate. Yes, I advise my Rhinoplasty patients to do daily nasal massage but this must be done under your plastic surgeon’s orders…he/she may not want you to touch your nose. You may want to ask him/her that question.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
hi Dr. Palmer .. i just had a close rhinoplasty 8 days ago .. it doesnt hurt much now but the bridge on my nose between my nose has like a gap on it has created a bump and when i push it down it becomes normal but when i let go the bump shows again. my surgeon said that i should push it down at least once a day so it will flatten out and she said it might be also that its still swelling the reason why it has that bump. is this true? will it flatten out after several days or months or will this be permanent?
aya :: 1 year, 1 month after
Hi Aya,
I’m afraid that I don’t know for certain since I’m not sure what your Plastic Surgeon did during your Rhinoplasty…she does and you’ll have to listen to her instructions and do what your plastic surgeon instructs during this crutial post Rhinoplasty phase. You’ll know for certain in several months.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
hi dr. palmer thank you for the fast response. what was done to my nose was a nose lift im a japanese so i got a noselift to make my nose look defined and to have a slightly higher bridge. the incision was made inside on the right side of my nostrils. its been 10 days now when i got this nose job. everything looks nice however , the bridge in between my eyes the top part, is not firmly attached. it pops up. so its gives a very obvious bump and it looks like it has a triangular shape poping out in the bridge between my eyes. if only that part was firmly attached, my nose would look perfect and not have that obvious bump which disturbs me.
my ps said i should push it down at times but im just concerned what if the bump just stays up and never go down? will this be permanent or will it still change??
aya :: 1 year, 1 month after
Aya,
You, of course, should follow the advice of the plastic surgeon that did your Rhinoplasty. If the problem still exists in several months however, you may want a second opinion on the issue. The dorsal (bridge graft) is typically placed below the nasal bone covering which holds it inplace and prevents if from moving in the area you describe.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Hi Dr Palmer,
I had an open rhinoplasty procedure 3 weeks ago to “make my nose smaller”. The surgeon lifted the droopy tip, removed the hump on the dorsum, and performed an osteotomy to reduce the width of the dorsum.
Now, 3 weeks later and there is a marked discoloration on the area where the hump was removed. It doesn’t look like bruising, just some discoloration. I had bruising elsewhere around the eyes, etc. and that was gone after about 10 days. Also, one side of the nose appears thicker and the hump is not completely gone.
Should the nose start to resemble its final contour at this poit (ie hump gone) and what is this discoloration business. I should mention that I am of mexican descent and have thicker darker skin.
THanks
Frank :: 1 year, 1 month after
Hey Frank,
The discoloration is most likely from a bruise with the red blood cell pigment staining the skin. darker pigmented skin can has this to a greater extent. It can takes months to go away completely…and in some cases it never goes away. As far as the rest of the questions, you should ask the plastic surgeon that performed your rhinoplasty….he/she knows how much bone was removed from the hump and therefore how long the area should remain swollen.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Hello Dr Palmer,
What treatment do you recommend to remedy dilated/broken blood vessels that have formed around my nose/cheeks following my rhinoplasty?
I was aware this may occur with my skin type, but would like your expert recommendation about the safest/most successful option for this condition.
Thanking you,
Tonia
Tonia :: 1 year, 1 month after
I had a rhinoplasty 2 yrs ago to fix a bulbous tip that was the result of a hemangioma I had as a baby. I was very happy after the surgery as the tip was small and no longer stuck out. As time went on the nose began to get bigger and the dr said it was swelling. I did not return to him till recently and he said it is scar tissue that is making the nose appear this way. He then gave me some cortisone shots and said to come back in 2 months. Do you think these shots will be effective or that ultimetly another surgery will need to be done to have the nose look as it did after surgery and remove the scar tissue? Thanks so much!
Ana :: 1 year, 1 month after
Hey Ana,
Not sure, but it doesn’t hurt to see if the Kenalog shots will help. Give them a try for awhile and see what happens.
Dr. Francis R. Palmer, III
drfpalmer :: 1 year, 1 month after
hello again dr. palmer, thank you for the fast response you gave me here and i wish you will continue answering questions here cuz it helps us a lot.
ive went to my ps a few days ago and i talked to her about the rhino and why was the top is not firmly attached to the bridge. it turned out before i got the rhino, she examined my nose and she told me the tip of the bridge of my nose is a bit bent to the left side is not straight. that was the reason why it pops up.
so i had my 2nd rhino done by her and she said shes going to use like a wider implant. i will see the result after a week. i hope it will go well this time.
aya :: 1 year, 1 month after
hello again dr. palmer, thank you for the fast response you gave me here and i wish you will continue answering questions here cuz it helps us a lot.
ive went to my ps a few days ago and i talked to her about the rhino and why was the top is not firmly attached to the bridge. it turned out before i got the rhino, she examined my nose and she told me the tip of the bridge of my nose is a bit bent to the left side is not straight. that was the reason why it pops up.
so i had my 2nd rhino done by her with no extra cost and she said shes going to use like a wider implant. i will see the result after a week. i hope it will go well this time.
aya :: 1 year, 1 month after
I am 17 years old. I had surgery on my nose about a week ago to fix my breathing, get rid of the bump and slightly fix the bottom.
I don’t know what to do because the doctor says my nose looks find but I think it looks horrible!
There was another post which is similar to what I have..
“I had rhinoplasty surgery 6 weeks ago. My nosed was reshaped slightly smaller bringing the bridge down and thinned slightly to give it a more feminine look. My doctor is one of the best in the area. I want to trust him, but I thought by this point in my recovery, I’d start to be happy with what I’m seeing. Instead, my nose does not appear symmetrical from the front. The two side look different. The left side is swollen and a little bulbous looking at the tip with a slight indentation where the bridge and tip meet on the side. While the right side does not appear very swollen and there is no indentation, flows beautifully from tip to bridge. I’ve looked at dozens of pictures and even my doctor’s portfolio of 1 month post rhinoplastys. They appear swollen yes, but symmetrical, unlike mine. I’m so disappointed after 15 years of wanting this, the pain, and now I’m embarrassed. I’m even a little depressed. My doctor says that it’s just swelling. That my surgery went perfectly and that it will heal well in the next few months. I don’t understand how an indentation will suddenly fill itself in. How will it ever look all the same as he’s saying it will? Help?”
My nose looks smushed because one nostril is lower and more closed than the other. This makes me very nervous. Could I have caused damage? It might be because I kept trying to remove the blood…
Can you please tell me what you think?
upset :: 1 year, 1 month after
now I think my nose looks too large and pig-like for my gentle face..
confused :: 1 year, 1 month after
hi, I had a rhinosplasty about 5 weeks ago, i’m happy with the results of the bone but i dont like tip I think it looks big, i’m hoping is swelling, and my docotr said to wait, but how long would it take for me to see the result of the tip. is there anything I can do to make sure my tip ends up thin.
monika :: 1 year, 1 month after
Hi Dr Palmer,
I went to see my surgeon a couple of days ago and he told me he used the Goldman’s technique during my closed rhinoplasty. Could you tell me a little more about what this technique is? Also what is the average healing time when this procedure is used.
Many thanks,
Amy :: 1 year, 1 month after
Dear Upset and Confused,
I’m sorry that you are either of these after your Rhinoplasty but waiting is just part of the post Rhinoplasty healing phase. I’m afraid that only time will tell the final result and this can take at least several months. Till then, follow your plastic surgeon’s advice and feel free to ask him/her questions about your nose and the final result.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Hey Monika,
Depends on what Rhinoplasty technique was used…open versus closed and what technique the plastic surgeon used to thin your nasal tip. Some of the techniques I use have virtually no swelling while others require as long as 9 months to see the final result. That’s a question for the plastic surgeon that did your Rhinoplasty. At 5 weeks….it could easilly still be swelling however…so try and be patient.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Hey Amy,
Yes, the Goldman tip is a type of tip thinning technique that was popular some time ago. It may require some months for the swelling to go away….ask your plastic surgeon to show you with diagrams how your nasal tip was thinned. This will help you understand the Rhinoplasty surgery and the following post Rhinoplasty healing process.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Hi doctor
Its been three months since my nose surgery. i had a bump on my bridge removed. the trouble is there is a flat appeance across my nose now. the doctor said he did not break my nasal bones as he didn’t think he had to. will this flat appearance go away with the healing process? i do kknow it takes up to a year for the nose to heal fully.
sinead :: 1 year, 2 months after
Hi Sinead,
What you’re describing could be an “Open Roof Deformity” where the nasal bones are resected along the top and not broken at the base resulting in a separation between the top of the nasal bones that’s seen as a flattened area across the top of the nose.
I have no way of knowing if that’s what’s happened in your case since I didn’t perform your Rhinoplasty. You may want to see another plastic and cosmetic surgeon for a second opinion. If an open roof deformity exists, you’ll still need to wait for a minimum of 6 months after your previous Rhinoplasty to have a Revision Rhinoplasty and the nasal bones broken across the base to close the open roof. Hope this helps.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Dear Dr Palmer,
I had septo-rhinoplasty with a bone graft for a saddle nose approximatly 5 months ago (it was closed). It took three months for the bruising to heal, i got a major infection afterwards and one of my eyes is slightly squinted than before (is this squint a side effect of septorhinoplasty?).
Also, i am writing to you, as my nose has been knocked quite a fe times since my operation but today it was knocked quite hard. I am worried about the healing of my nose, will this affect its final outcome. Since the knock, it hasnt stopped being runny and my top lip feels numb. Can you please tell me any advice especially how long the nose will heal (is 5 months an adequate time). Thanks alot Dr Palmer,
Sincerly , mel
mel :: 1 year, 2 months after
Hey Mel,
No the squinting is most likely temporary and unrelated other than some swelling issues. Can’t keep banging your nose or something really bad might happen…like bleeding and infection. Contact the plastic surgeon who did your Rhinoplasty and have him/her take a look at your nose. With a bone graft, I’d expect healing to be at least 1 year.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
HI DOC,
I am 2.5 weeks post rhinoplasty. I had my cast removed after one week. But my doctor still wants me to wear the cast at night for an additional month. Is this common practice? and lastly when are the bones generally fully healed, without the possibility of shifting?
Thanks for your help doc!
jeff :: 1 year, 2 months after
Hello Dr Palmer, I am hoping you all can help me. I had an open rhino (tip rhino actually, no bone work was needed) 2 1/2 weeks ago for a large, bulbous tip that was rotated up ALOT and had the line down the middle (“bi” something, forget the name). Anyhow, the swelling of my tip looks good, seems to get better every day, but the incision line looks NASTY. It’s not so much directly on the front of my columella that looks bad, but the side, where it wraps around and heads into my nostrils, it’s all bumpy and uneven looking, “notched” is the word I think I would use to describe it, quite noticeable in my opinion (even with makeup, the horror!). It seems to be healing ok, by that I mean not open or oozing or anything (though it is still red in color), so I am wondering if this is just the result of swelling in that area yet??? Or did my dr do a poor job of stitching the area up?? I have read over and over and over again how great the incision line of an open rhino heals…..yet mine looks icky. Am I expecting too much at two and a half weeks? Also, the columella is still stiff and hard and quite protruding, is this normal in an open rhino at this stage? I’m just so worried that I”m not healing well or that he did a bad job and it’s so hard to be patient and let things settle down before judging the final product. Thanks much, I’m quite depressed over here thinking I may have made a big mistake in getting my nose done
LB
Laurie :: 1 year, 2 months after
Hey Jeff,
The nasal bones are set at 1 month following the Rhinoplasty..that’s the rule I have used with my patients for over 20 years doing Rhinoplasty. The bones are set and I lift all physical restrictions at that time.
It’s hard to say why your plastic surgeon wants you to wear your cast at night for the first month but I don’t see any harm in that added precaution. Sometimes, typically for Cheek and Chin Augmentation with implants, I’ll have patients sleep with a U-shaped pillow that avoids sleeping on the post-op area. You could do the same to avoid sleeping on your nose. You could always ask your plastic surgeon why you have to wear the cast at night.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Hey Laurie,
You’re way to hard on yourself and your plastic surgeon at 2 1/2 weeks post op from a Rhinoplasty. The scar will typically fade, from an open Rhinoplasty, for several months. If that notching is still there after 6 months, it’s a simple matter for your plastic surgeon to numb up the area and scrape the scar with a scalpel.
Relax and allow your body to heal….
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Thanks Dr…that’s all I needed to hear. You are a gem
Laurie :: 1 year, 2 months after
Dear Dr. Palmer;
This is Alice again, Sorry I forgot to ask:
If there has been damage to the nose due to the hitting, woud I be able to tell by looking at it? Imean if there has been any change to the structure can i tell or would it take sometime for it to show? Can X-Ray determine that bones have shifted???
I really need your help ASAP,
Thank you very much
Alice.
Alice :: 1 year, 2 months after
Dear Dr. palmer,
After 7 weeks of having rhinoplasty, I accidentally hit the tip of my nose hard. ( with my fist towards the tip, not the sides.) Oy hurt a lot and throbbed for about 30 minutes or more. i had this wierd sensation inside. My dr. is out of country, should i see another surgeon so that he can take X-Rays and determine if the bones have moved? Is it possible for bones to move at 7 weeks after surgery?
Thanks, Alice.
Alice :: 1 year, 2 months after
Hey Alice,
Ouch! Yes, you should call the office of the plastic surgeon that performed your Rhinoplasty and ask for a referral to the plastic surgeon covering his/her practice while your plastic surgeon’s out of the country. Let that plastic surgeon examine your nose and look at the operative report from your plastic surgeon. Let him/her then decide what steps, if any you should take for further workup. For all of my readers…it’s never a good sign when getting hit in the nose to:
1. hear a pop or a snap
2. see stars
3. have significant pain, bleeding or swelling
These mean that the nose has sustained some type of trauma…broken bones, cracked cartilage and or torn tissue within the nose itself. If this occurs, see a plastic surgeon or an ear nose and throat surgeon at the nearest ER ASAP because the ER doc may not know how to evaluate nasal trauma.
And no, you can’t tell what happened to your nose by looking at the outside…the swelling frequently masks the true issue.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Dear Dr. Palmer,
Thank you so much for your response. I was really worried. I just want to ask you if it’s posisble that I see another surgeon but without the post-operative report. I had the surgery in a different place and there is not really a way for me to get the report. Would he be able to help me without knowing what was done during the surgery???
p.S; would an X-ray show if any damage has been done??? I really appreciate it if you could help me with this.
Thank you so much,
Alice.
Alice :: 1 year, 2 months after
Dear Dr Palmer,
I had asian rhinoplasty done about 6 days ago (Silicon implant) Now i find my bridge is so high. When i feel my top bridge area-the area inbtween my eyebrow i can feel a bump that feels like the implant. When i asked my surgeon he told me it just tissue swelling and that my implant is actually lower, where my pupils are. Im just wondering if this is common? Im scared what if my implant is infact this high? Please help… Thanks
Angie :: 1 year, 2 months after
Hey Angie,
6 days is really soon to be worried about the final result of your Rhinoplasty. Give yourself and the nose at least 2-3 months for things to settle and then make your decision. I advise my Rhinoplasty patients NOT to touch or manipulate the area where a graft has been placed, so you may want to not touch the area as this may cause a shift in the nasal dorsal (bridge) implant. After a couple of months, see your plastic surgeon who did the Rhinoplasty and if you’re still concerned you can see some other plastic surgeons for a second opinion. Hope this helps.
For all my readers, I’d like to remind you that the immediate post-op period can be the most frustrating for patients who understandably (it’s just human nature)are looking for immediate results. Give yourself time for things to heal and try to remain positive as things are doing so….
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Dear Dr. Palmer,
I really need your help. I noticed that you did not get a chance to reposnd to my second post yet.But please I desperatley ask for an answer.
Can X-ray show if any damage has been done to my nose?
I want to take an X-ray and then take it to the pastic surgeon since It’s hard for me to afford two visits to the surgeon. But first I need to know If that would help me in finding out whetehr there has been a change to the sturcture or not.
Please your immediate response would mean a lot to me.
Thank you sooooo much
Best Regards,
Alice.
Alice :: 1 year, 2 months after
Dear Dr Palmer:
My name is Daniel and i’m from Argentina.
A year and half ago i had an open revision rhinoplasty with Dr Jose Juri, here in Argentina (it was my 3rd surgery).
I’m concerned because somedays my nose looks fine and i like the result, but those are just “lucky” days, most of times my nose tip is swollen and hard like a balloon. Maybe one day the nose looks really good but when i wake up the next one, it’s HUGE, and it’s frustrating because at one year and half post op it gets more swollen than in the first months.
I really don’t know if this situation is going to change someday and if the nose will ever settle in and look like it does in those lucky days when it’s
refined and nice or my nose will keep changing from swollen to unswollen forever (i think this is called persistant swelling)
Any advice u can give me will be really appreciated !
Thanks for taking the time to read my email, and excuse me if my english is not perfect.
Hugs from Argentina!!!
Kind Regards
Daniel
Daniel :: 1 year, 2 months after
Hello again Dr. Palmer how are you?? Its me again aya, im 1 month post op after I have my revision rhinoplasty I had a nose lift and had a silicon implant. Before I had my 1st nose lift, the doctor examined my nose and she said the bridge was not aligned. But she said that it will be ok to have a noselift since the implant will cover up the unaligned bridge that I have. So I had my first nose lift which looks bad since the implant looks so obvious and it pops up. It freaked me out a little bit since I cant even go out cuz it really looks weird. So I went back to my surgeon and she said shell revise it with no extra cost.
So I had my revision rhinoplasty, and the implant which is in between the eyes, still is slightly popping up. But its less obvious now and looks much better than the first one so I will not complain about that. Im actually ok with this but the thing is, it was just 2 days ago when I realize that the tip of my nose is actually pointing a bit to the right. I even took an id photo and it looks so obvious on the photo. The tip is going to the right. Im a bit upset now since I have to go to work now and I cant have another nose revision since I’ve run out of vacation leaves to use. Im thinking maybe I should just have this implant removed since my bridge is unaligned, maybe every time ill have a nose lift, the nose lfit will still be unaligned. So its like useless. So my question to you dr. Palmer is should I just remove this nose lift? Or will it still be possible for me to have an aligned nose lift even though I have an unaligned bridge? I don’t know what to do right now.
aya :: 1 year, 2 months after
Hey Aya,
It would seem that you should be able to have a bridge that matches the tip after a Rhinoplasty but snce I can’t examine your nose and I haven’t done any of your Rhinoplasty procedures, I really can’t say for certain. In any case, you won’t be able to have another Revision Rhinoplasty for a minimum of 6 months. My advice, to you, is if you hate how your nose looks after 6 months, get another opinion from another plastic surgeon.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Hey Daniel,
I bet that you’re frustrated after a year and a half. It is however, good news that at least some days your nose looks good after your fourth Rhinoplasty. That’s an indication that the days it doesn’t look good swelling in the nasal tip (I think you described)may be the problem.
It is unusual to have such dramatic swelling this late post op from even Revision Rhinoplast but it can occur. Are you manipulating your nose? Do you smoke? Can you identify and specific behavior or agents that cause your nose to swell the following day(s). I suggest keeping a daily diary to identify such patterns after your Rhinoplasty.
You can ask your plastic surgeon for advice at this point. You may also wish to consult a homeopathic specialist and ask for a hoemepathic remedy to decrease swelling and water retention in the nasal area.
These steps will at the very least help you feel like you are doing something and they may help in the end.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Alice,
An X Ray will not show cartilage which is radio-opaque and as such not visible on X Ray. If you’re really concerned, you should have your plastic surgeon examine your nose inside and out. This should identify any tears or possible breaks. Sometimes it’s necessary to wait a few weeks for all the swelling to subside before a crack in the cartilage, of the nose, can be identified by examination.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Alice,
Yes, you can e-mail us photos of your nose to look at….in many cases, it’s best to allow the swelling of the nose to subside which can take several weeks. E-mail pictures to drfpalmer1@aol.com.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Dr. Palmer, I had a revision done two weeks ago. My nose was crooked, with a pinched tip and collapsed nostril. I had cartilage harvested from my rib, ear, and fascia from my temple. I think the ear cartilage was put on the side of my nostril, and now when I look in the mirror I can see a giant chunk of graft that covers 50% of my nostril. My question is: How much can I expect this graft to shrink? How do grafts heal and what can I expect? I hope I don’t see the graft permanently. Thanks in advance for your help!
Mike :: 1 year, 2 months after
I see. When i realize that the bridge wasnt straight im starting to sleep now sideways on my left side hoping my nose will drop a bit down so ill have the bridge straightened up. Will this help or should i stop doing this?? Thank you so much for your advice.
aya :: 1 year, 2 months after
Aya,
If you are worried that you’re sleeping on part of your nose,you might want to sleep on a U-shaped pillow available at Sharper Image. This allows you to sleep on your back and will prevent you from sleeping on your nose. I’m not sure that it will help but it won’t hurt to try.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Hey Mike.
2 weeks is really early to look at the shape of your nose after a complicated nasal reconstruction and Revision Rhinoplasty. I can’t be certain how much of the graft will ultimately show since I didn’t see how large and thick the graft was at the time of your Rhinoplasty.
Ask your Plastic Surgeon to show you a drawing of what was placed in your nose. Before your Revision Rhinoplasty you should have had a detailed conversation with your Plastic Surgeon about what was going to be done, what grafts would be used, how long it would take for your nose to heal and what it might look like as it healed and once it was stable.
It is possible to make the nasal tip larger when placing cartilage grafts to reconstruct the nostrils….only your Plastic Surgeon can explain what was done during your Rhinoplasty. Go have a chat and have things explained to you in detail.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Hi Dr Palmer, thank you for the advice.
My nose get swollen specially if the weather is hot, or i’m too stressed, or very tired. And most of times that my nose is swollen it is congested too. Could it be an allergy?
When i have sex it gets really swollen too, hehe, even in that moment i’m concerned about my nose lol.
I don’t know what’s going on, but the thing i’m sure is that my nose changes from time to time, from bad to a little better, maybe bad again, then really good, then super swollen, etc, etc, I’m afraid it will never settle in.
(by the way, it’s not only the tip zone that gets swollen, the skin around the bridge too, there are days that the skin is very puffy, and some that it’s very “pasted” to the bridge and then it looks defined, not sure if you will understand this, my engilsh is not the best)
Thanks for everything,you’re great for helping people that are not even your patients, that talks really good about you.
Daniel.
Daniel :: 1 year, 2 months after
Hi Doctor
I wondered if you could enlighten me. If there is too much nostril show from the front, can the tip be rotated back downwards using some kind of external graft? How common is this, and would you recommend only going to the best rhinoplasty doctors to do this, or is it a lot more common?
Also how difficult is it “close” the nostril as such, i.e smaller?
Many thanks in advance
Pat
Pat :: 1 year, 2 months after
Dr Palmer
My 15 year old daughter broke her beautiful nose in July – it was crooked after the break so we were directed to a surgeon to correct it. While correcting the break he did some manipulating to the tip of her nose. I can’t stop looking at her nose, It appears at times as though he shaved off the tip but I can’t tell for sure – when she smiles it looks like the nose is pulling down, like it wants to “hook” – I can’t figure out if this is just part of the healing process – that her tip is okay but the nose is just pulling from the inside?? – or if there has been some damage to the tip of her nose. She is a beautiful girl and photographed beautifully before the accident and the surgery – I realize it’s only been 6 weeks or so since her surgery but her photographs look terrible to me, her nose looks very strange. When I feel her nose the tip feels very hard – she is just starting to get a little feeling back into the tip. When the nose heals more will the tip “move” more? This might be the problem – but I’m not sure. I appreciate any advice you can give – perhaps you can tell me what the manipulation exercises are that you talk about.
Sue :: 1 year, 2 months after
Daniel,
From what you describe, it seems that your nose is still swelling from your Rhinoplasty even at this late date. I suggest that you see a plastic surgeon and see if a course of Medrol reduces the swelling.
Yes, you may be allergic and this may also make your nose swell. The exertion history however is more consistent with increased blood supply to the nose and limited lymphatic drainage from the nose resulting in prolonged swelling. Try the homeopathic remedies and perhaps some manual lymphatic drainage performed by an aesthetician.
Thanks for the kind words.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Sue,
It’s upsetting when the nose doesn’t look good after a Rhinoplasty but 6 weeks is still very early post op. The nasal shape may improve. If the procedure was an open Rhinoplasty, the tip area can be without proper lymphatic drainage for around 6 months. Why don’t you speak with the plastic surgeon who performed the Rhinoplasty and express your concerns? Any revision Rhinoplasty, if needed, would need to wait 6 months anyway.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Pat,
Very good questions. Yes the tip is rotated downward using external grafts of which ear conchal cartilage is the best, in my opinion. I have done this very frequently, for over 20 years, but this is a quantum level more dificult than a garden variety Rhinoplasty.
I always advise people to seek out very weel experienced plastic and cosmetic surgeons for their Rhinoplasty as this is the most technically challenging procedure in all of aesthetic plastic surgery. There simply is no substitute for experience when it comes to Rhinoplasty.
Yes, the size of the nostril opening can be reduced and this is also fairly common. I advise using an internal versus external approach to hide the incisions.
Dr Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Hey Julie,
The 15 point improvement (and that’s a significant amount) is added to the existing points that you have in the cheek area of which 75 would be perfectly shaped cheeks like Halle Berry or Jessica Alba. So, if your cheeks were 55 points now, then add 15 more for a total of 70 points out of a possible 75 points for the cheeks…does that clarify things?
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Hi again Dr Palmer,
Many thanks for your prompt response. In addition to rotating the tip downwards using grafts, would this also “lenghten” the nose as such, or at least give an illusion of length? The reason I ask is because I feel my nose was made too short after a primary rhinoplasty. I am of Indian origin and I desire to have some of my ethnicity back, so do you think grafts can achieve this?
Thanks again for this wonderful site
Pat
Pat :: 1 year, 3 months after
Pat,
That’s exactly what the tip cartilage graft does…it lengthens the nose and rotates the tip back downward… I use these grafts frequently in Rhinoplasty and Revision Rhinoplasty to acheive a more natural looking nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dear Dr. Palmer,
I have been instructed by my plastic surgeon to tape my nose at nights for 3 months. However no one mentioned to me how I was supposed to remove the tape in the mornings. So for the past 2 months, I have wet and peeled it off in the morining. ( Which caused some pulling of the skin no matter how gentle I tried to be.) Now I’m concerned, b/c I read online that there is a solution which helps remove the adhesive tape. Can you please tell me what that solution is and how I can find it and whether it’s necessary to be used.
Thank you very much,
Michelle.
Michelle :: 1 year, 3 months after
Michelle,
I advise calling your plastic surgeon’s office and ask the nurse what solution they recommend for you. That’s the safest bet. Also, try placing your finger just behind the edge of the tape on the nasal skin as you remove the tape. This prevents the skin from lifting up off the nasal structure…which should be avoided.
Dr. Francis R Palmer, III
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dr. Palmer, How can I tell if I am swollen or have a begining of a polly beak deformity? Can I send photos?
nosey :: 1 year, 3 months after
Hey Nosey,
Possibly. Photos may not allow me to see the true amount of subcutaneous thickening and scar formation which is the cause of a “Polly Beak” deformity. You can e-mail pictures to drfpalmer1@aol.com along with some history of when your Rhinoplasty was performed and what was done during the surgery. Close up Jpegs of your nose from front and profile are the best. You may need to have an examination of your nose to determine the extent of the thickening.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Nosey,
Have you had any kenalog injections into the area or a course of oral anti-inflammatory steroids to decrease the swelling?
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dr. Palmer, I had a revision done over 3 weeks ago and my nose was rebuilt with cartilage grafts (ear, rib). I have a foul smelling odor that smells like dirty feet. I still have the big graft that is blocking half my nostril when I look into it. Do grafts typically shrink with time and feel like regular nose tissue? When does the smell go away?
Mike :: 1 year, 3 months after
Mike,
You need to run, not walk back to the plastic surgeon who performed your Rhinoplasty. A foul odor is a sign of possible infection until proven otherwise and a smoldering infection of the nose can lead to very serious medical problems. Please call your plastic surgeon’s office and go in for a check up ASAP.
Secondary issue, the graft probably will not decrease in size that much, so after the odor issue is resolved, you can bring up this point to the plastic surgeoon who did your Rhinoplasty. While it is true that rib cartilage has a tendency to dissolve over time, it takes years to occur and is typically of an uneven nature.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
(Mike here again, responding to the message above)
He said that the “dirty feet smell” is common, and that the graft should shrink by 50%. Does this sound possible to you? He’s a pretty famous surgeon also in beverly hills, initials are P.N. .. Thanks Dr. Palmer!
Mike :: 1 year, 3 months after
Mike,
You then have to decide if perhaps you want to pay and have another plastic surgeon give you a second opinion based on how severe you feel things are at this point. Obviously, I can’t judge by e-mail so you’ll have to make the call. 50% shrinkage of a cartilage graft, rib or not seems out of the ordinary. You could have the plastic surgeon who did your Rhinoplasty examine the inside of your nose just to check everything out…no harm in that and it may make you feel better.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
hello again dr palmer .. i keep on going back on your website cuz im a bit unsatisfied with my nose revision after 6 weeks now. The tip is going to the right and it looks so obvious when i take photographs of my face when im looking up the camera. its like someone hit my nose thats why it went a bit to the right. I dont want to have another revision again cuz it takes too much time for recovery and i dont want to hope again and take chances if the result will be good or not. Im unable to see my surgeon now since im working until saturdays. so i emailed her and ask if i can do any manipulations omake the tip get in place in the middle, so I send some photos of my nose and this is what she said — ” No amount of manipulations can change the position of your implant because it lies on a crooked and slightly bulging nosebridge. The slight deviation of the nasal tip to the right looks tolerable… ” Before I had the surgery she said my bridge was not straight .. I was just wondering why didnt she warned me that if ever i had the nose lift since my bridge is not straight, there might be a possibility that the implant will not be straight also since it lies directly underneath the bridge. I just wish shed tell me this before so I shouldnt have this nose lift done and have the hope for having a natural and perfect looking nose.
aya :: 1 year, 3 months after
hello again dr palmer .. i keep on going back on your website cuz im a bit unsatisfied with my nose revision after 6 weeks now. The tip is going to the right and it looks so obvious when i take photographs of my face when im looking up the camera. its like someone hit my nose thats why it went a bit to the right. I dont want to have another revision again cuz it takes too much time for recovery and i dont want to hope again and take chances if the result will be good or not. Im unable to see my surgeon now since im working until saturdays. so i emailed her and ask if i can do any manipulations omake the tip get in place in the middle, so I send some photos of my nose and this is what she said — ” No amount of manipulations can change the position of your implant because it lies on a crooked and slightly bulging nosebridge. The slight deviation of the nasal tip to the right looks tolerable… ” Before I had the surgery she said my bridge was not straight .. I was just wondering why didnt she warned me that if ever i had the nose lift since my bridge is not straight, there might be a possibility that the implant will not be straight also since it lies directly underneath the bridge. I just wish shed tell me this before so I shouldnt have this nose lift done and have the hope for having a natural and perfect looking nose. And also the time interval of my reision rhinoplasty from my 1st rhinoplasty was only two weeks she said it will be much easier to put a new implant as earlier as possible since it will be harder to remove the implant after several months since new tissues will be forming on the implant then. I also have some red little veins on my upper nos bridge which is still visible after 6 weeks of revision rhino. I would also like to ask if ever I decide to remove the implant, will I still look the same before i had the nose lift?
aya :: 1 year, 3 months after
Aya,
I’m not sure what to tell you at this point as I am not certain what was done during your Rhinoplasty. You have three options: listen to your plastic surgeon, see another plastic surgeon fo a second opinion or do nothing. If it bother you this much, take a day off from work and see your plastic surgeon.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Hey doctor,
I had open rhinoplasty about 5 months ago to minimize a bullish tip and reduce the tip in length. It is looking thinner but the tip still seems long. Could it still be swelling? How do I know if the tip is still swollen? I didn’t have any bones broken only shaved down a bit. I never had any black and blue marks only swelling.
Thank you for your time,
Susan
susan :: 1 year, 3 months after
Susan,
It could be especially if you had an open Rhinoplasty for the tip work. It could also be sub-Q tissue fullness and excess scar tissue or just cartilage that wasn’t trimmed. What does your plastic surgeon who did the Rhinoplasty say?
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
hi again dr Palmer. What was done to my nose was a nose lift im from a Japanese descent so i had a nose lift to have a defined and higher nose bridge. So a silicon implant was used and the incision was made inside my right nostril. I had a revision rhinoplasty made by the same doctor 2 weeks after my 1st nose job since the 1st one the top of the nose bridge was popping through the skin. The revision rhinoplasty looks more tolerable than the first one, however, since i have a crooked nose bridge which my surgeon told me before my 1st nose job, the tip of my nose is pointing to the right side. And it looks very obvious on photographs. I just want to know if i decide to have another revision rhinoplasty after 6 mos., if i wanted the implant to be removed, will i still have the look of my nose before i had the nose lift? I am a bit regretting having his nose lift, it just looks so fake. I would like to know what you think since I dont trust my surgeon anymore and I dont have plans of seeing her anymore. Its a bit dissapointing.
aya :: 1 year, 3 months after
Hi Dr Palmer
You kindly looked at my pictures and responded, thanks for that. Could you possibly comment on the following?
My surgeon I believe has done “half a nose joB”,in that I don’t think he’s botched it, but he just chiselled off the hump, but didn’t position the bones together, so my breathing is very bad now. Is it true that what he actually was supposed to do was position the bones together? If this is the case, can this still be achieved in the revision, i.e could a good surgeon just “finish off what was started”, or will scar tissue prevent that after a year?
Also, I have a lot of excess skin around my face: on my forhead, my cheeks and my chin. Is this when a nose has been overshortened and the skin doesn’t shrink well? It is really upsetting me, as not only is my nose unsuitable for my face, I also look like I need a facelift, and i’m only 23. My skin was so taut before
Regards
Pat :: 1 year, 3 months after
Aya,
I believe so from what you have described. The silicone dorsal implant posses a risk of coming through the skin if it extends into the nasal tip area. If that is the case, it (the silicone graft) most likely has been placed either through the nasal tip cartilages or above them. In either case, I frequently have to repair the tip cartilages using ear conchal cartilage tip gratfs. Hope this helps.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Hey Pat,
If the nasal bones were resected across the top, a second cut is made along the base of the bones and they are broken so that the tops of the bones once again tough along the bridge of the nose. If the bones do not meet, this is called an “Open Roof Deformity” and yes, re-breaking the bones is possible to make them come together unless the bones are now too short for them to touch…in that case a dorsal graft is required across the top of the nasal bones.
No, the excess skin of the face is in no way a result of your Rhinoplasty. Making the nose smaller will not cause cause excess skin on the face.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Hi Dr Palmer,
One year ago, I had Rhinoplasty, and now I have a very scooped bridge, pinched tip and retracted nostrils, that I want to have returned to my oringal nose shape. The revison Doctor I talked to said he can do this for me, and that I would have to choose between having the bridge built up with septal cartilage, or with an implant. (and I would rather not have an implant done by him, because i am not sure about the materials he uses). So I am thinking of using septal cartilage, I think I read on your website that septal cartilage used to build up the bridge can change shape over time. Could you please tell me, does septal cartilage on the bridge ALWAYS change shape over time? and if so, how long after surgery is this likely to happen? My surgeon said that a lot of the bridge of my nose is removed, and septal cartilage may not be the right choice.
thankyou
Nicole :: 1 year, 3 months after
Nicole,
Septal cartilage used to build up the bridge is stable over time, it’s ear cartilage that tends to dissolve in that area of the nose. Septal cartilage however rarely if ever is long enough to built up the entire nasal bridge and that’s why there are alloplastic (man made) implants for such things. I prefer silastic straight (no L-shaped)implants for this purpose that I have used on many occasions with great results. Hope this helps.
FYI…it’s unlikely that you’ll ever be able to regain your original nose. Having said that, your goal and the goal of your Revision Rhinoplasty should be, in my opinion of doing Rhinoplasty and Revision Rhinoplasty for over 20 years, is to make your nose look more natural, less operated and more attractive. It sounds like that will require a silastic dorsal implant, a conchal cartilage ear graft to restore a more natural looking nasal tip followed by composite grafts to the nostril rims to repair the alar notching. I do not like Gortex, Medpore (porex) or other porous man-made dorsal implants that encourage tissue ingrowth as these can prove problematic to remove should that be required in the future.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dear dr palmer,
Its now been more than a month after my asian rhinoplasty and i feel like my nose hasnt improved much. I got Silicon I implant and ear cartilage for tip. My bridge is so high and thick. My doctor told me the size is: thickness 0.35cm width 1.1 cm, length 4.4 cm. Is this considered a large size? Because i really think i need it removed. Also my tip is still very round and hard… ive been trying to press it down and it just gets worse. Also the shape is very downturned. Can i send my pictures to you for a second opinion? Im feeling so depressed and i dont know what i should do. Thankyou.
Angie :: 1 year, 3 months after
Dear Dr. Palmer,
I had my rhinoplasty about 3 weeks ago. I got the L shaped silicone implanted on my nose. My nose is still sore and swollen. Also since the surgery 3 weeks ago, my eyes are burning when I wake up in the morning especially after sleeping for a long period of time. Will this eventually go away? Thanks.
Jen :: 1 year, 3 months after
Hey Angie,
Chin up. One month is very soon after that type of Rhinoplasty. The nasal implant is most likely a medium size with a small at .15 cm and a large at .45 cm in thickness. You may require a small instead of the medium. Yes, you can e-mail me photos of your nose before your Rhinoplasty and now at drfpalmer1@aol.com (front and profile).
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Jen,
Not sure about the burning around your eyes…sounds like still post Rhinoplasty swelling. I’m afraid that there are other issues….more importantly the L-shaped dorsal implant that has a nasty habit of causing erosion through the skin over years. Let me know if you want me to explain more about this issues.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Hi Dr. Palmer,
Thanks for the quick reply. Yes please if you would, explain more about these other issues. Will these issues greatly affect me eventually and should I be concerned now? Do you have any suggestions? I have mixed feelings about the surgery and sometimes wonder if I made the right decision to have it done. Hope things get better.
Jen :: 1 year, 3 months after
Hello- I had the cast removed post an “open” rhinoplasty. I has asked my surgeon to correct a “divit” in my cartilage and make is look less round. Also i had a small dorsal hump.
It is now 4 days after the cast has come off and i hardly see any change EXCEPT that my nose is SWOLLEN. All my friends who see me and don’t know i’ve had it done just tell me my nose looks swollen. i’m so upset, its looks rounder then ever. infact it has less definition then it ever did. it looks like a potato.
am i panicking to early? but i come from a family of nurses and physicians and I just don’t see how all of a sudden it will become less round? i’m so worried…
what are you thoughts?
Alexis :: 1 year, 3 months after
Dear Dr. Palmer,
I had rhinoplasty about 10 weeks ago and Is till have uneven Nostrils. One of my nostrils is bigger and higher up. ( vertical shape.) while the other one is smaller and not high up. ( Horizontal shape.) I keep praying that they would become more even but I haven’t noticed any change in weeks. Do I have ANY hope at all for them to become more even or is this the final result at this time?
Thank you Very much for any help,
Michelle.
Michelle :: 1 year, 3 months after
Hello Dr. Palmer,
I notice that sometimes there are some white stuff(Skin Peelings?) on my nose and I get it off with a toner. I was wondering If this is considered to normal healing process after 3 months of rhinoplasty.
Thanks,
Monica
Michelle :: 1 year, 3 months after
Dear Dr. Palmer,
I had rhinoplasty about 10 weeks ago and I still have uneven nostrils. One of my nostrils is bigger and higher up ( Vertical Shape.) while the other one is smaller and not as high up. (Horizontal shape.) I keep praying that they would become more even as time passes but unfortunatley I haven’t noticed any change in weeks. Do I still have ANY hope for them to become more even or am i seeing the final result in regards to the nostril size at this time?
Thank you For any help,
Michelle.
Michelle :: 1 year, 3 months after
Dear Dr. Palmer,
When I got pictures of my nose for rhinopolasty, I noticed that one nostril was a bit bigger than the other one. but none of the surgeons I saw discussed that with me.( they said they were going to remove the bump, but never mentioned making the nostrils even.) One of them said that he would ecide at the end of the surgery, if there is a need to make my nostrils smaller or not. Anyways, Now after 2 months, I have uneven nostrils. There are no scars around my nostrils, so i’m assuming the surgeon hasn’t changed anything there. I was wondering If the surgery itself could have casued this and If it would become more even as time passes.
Thanks!
Mina
Mina :: 1 year, 3 months after
Hello Dr. Palmer,
I notice that sometimes there are some white stuff(Skin Peelings?) on my nose and I get it off with a toner. I was wondering If this is considered to normal healing process after 3 months of rhinoplasty.
Thanks,
Monica
Monica :: 1 year, 3 months after
Dear Dr. Palmer,
I had rhinoplasty about 10 weeks ago and I still have uneven nostrils. One of them is bigger and higher up( Vertical shape.) WHile the other one is smller and not as high up.(Horizontal shape.) I keep praying that they would become more even as time passes, but unfortunatley I haven’t noticed any change in weeks.
Do you think at this time, I still have ANY hope for them to become more even or am i seeing the final results in regards to the nostrils size at this stage?
Thanks for any help,
Michelle
P.S; ( There are no scars around my nostrils, and the Dr. didn’t dicuss whether he was going to chnage anything about them or not, so I’m assuming he didn’t.)I just don’t see how they could be so uneven If he has not changed them.
Monica :: 1 year, 3 months after
Hello Dr. Palmer.
This is Michelle again. I was wondering if it’s normal to have white skin peelings on nose after 3 months of rhinoplasty. I usually get it off with a toner in the mornings, but even after taking a shower, there are some white stuff on my nose. Should I be worried or not?
Thanks,
Michelle.
Michelle :: 1 year, 3 months after
Dear Dr. Palmer,
I just wanted to know what’s your opinion to nasal taping after a rhinoplasty. My Dr. advised me to tape my nose day and night for 1 month and at nights for 3 months. I taped it for about 2 months and a half, but had to stop becasue of the time and the trouble it took to peel it off and I was wondering If it would really affect the shape of my nose. I know you would recommend that i follow my surgeons advice, but I’d like to know your personal opinion on the’ effcteiveness of taping. Is it really bad that I stopped a few weeks earlier?
Thanks,
Lora
Lora :: 1 year, 3 months after
Dear Dr.Palmer,
After 10 weeks of having rhinoplasty, I still have uneven nostrils. One of my nostrils is way up and vertical and larger than the other one. The other nostril is smaller and more horizontal. I was wondering if I still have a chance that they would become more even as time passes. Am i seeing the final results at this stage?
P.S; I have no scars around the nostrils, so i’m assuming the Dr. didn’t change the shape. So i still don’t understand how they could be so uneven.
Thanks,.
Lora.
Lora :: 1 year, 3 months after
Hello Dr. Palmer.
Sorry It’s lora again. I was wondering if it’s normal to have white peelings on the nose after about 3 months? I usually clean it with a toner, but I don’t know if this is normal healing process.
Thank you,
Lora.
Lora :: 1 year, 3 months after
I had rhinoplasty 10 days ago. The bridge and tip were refined as well as nostrils. I had very little bruising and swelling. When the splint was removed on Day 7 there was some swelling but the tip looked beautiful. Now on Day 10, the tip appears more bulbous and not tilted up as much. My question is this: can the tip vacillate from day to day, one day swollen, the next day not, or does the tip continue to get more and more refined, and should I be worried? Thank you
Karen :: 1 year, 3 months after
Dear Dr Palmer,
I have sent my pictures to your email, please take a look when you have time. One thing i forgot to ask in the email is if ear cartilage absorbs alot over time? Because my doc used ear and septal cartilage to extend my tip, but now with a high bridge my nose looks way too long. Will it get shorter over time? Also my mid-nose area slants slightly towards the left, so my tip curves slightly to one side when i smile. Is this due to swelling, or misplaced cartilage?
Thankyou!
Angie :: 1 year, 3 months after
Dear Dr. Palmer,
I had rhinoplasty a few months ago and I feel like My nose is leaning more towards one side especially when I smile. It seems like the bone on the bridge is more towards one side and it shifts to the opposite side as it approaches the top of the nose. ( I’m not sure if I can clearly explain this). The bone is perfectly strauight but it just seems to be placed with the tip leaning more towards one side. Could this be part of the healing process or is it permanant?
Unfortunatley, after surgery my Dr. Did not provide me with a list of post-operative instructions expcept the medication So I assumed it was ok to sleep on my side. Now I can’t stop blaming myself for ruining my nose. I took naps on my side the 2nd day after the surgery and the first week after. ( not on my nose, just on my side.)When I asked my Dr., he told me that as long as I don’t sleep on my nose, it’s fine and I shouldn’t be worried.
PLease tell me that I did not ruin my nose by doing this.I keep thinking if it was important, He would have written it in the post-operative instructions and so I don;t understand why this would happen.
I really need your help. I’m really obsessing over this.
Thank You
Mia
Mia :: 1 year, 3 months after
Hello- i had one other question. I am 2 weeks post rhinoplasty and i still feel like my bridge and tip looks very wide. If i think i might benefit from kenalog but my ps hasnt suggested this, what is a good way to ask about that? Would kenalog help the fleshy skin around my nose thin out? Can a dermatologist perform this or should it be performed by ps?
thanks.
Alexis :: 1 year, 3 months after
Dear Dr. Palmer,
I had rhinoplasty about 10 weeks ago and I still have ueneven nostrils. One of my nostruls is bigger and higher up and vertically shaped. While the other one is smaller, less high up and horizontally shaped. I keep hoping that they would become more even as time passes but I haven;t noticed a change in weeks. Do you think that I have any chance for them to look more even If I just give it some more time or am i seeing the final results in regards to this at this stage?
P.S: There are no scars around my nostrils, So I’m assuming that the Dr. did not change their size,( He said he was going to remove the bump and take the tip up by a few millimiters and that;s all he discussed with me.) However, I don’t understand why nostrils would be so uneven.Could the surgery have caused this?
Thanks for your help,I really appreciate it.
Mia.
Mia :: 1 year, 3 months after
Dear Dr. Palmer,
This is Mia again. I was wondering if it’s normal to have white peelings on the nose after rhinoplasty? There are some white stuff on my nose and I usually get it off with a toner, but I have become concerned that there might be something wrong with the healing process. Should I be worried?
Thank YOU!
Mia :: 1 year, 3 months after
Hi Dr Palmer
Is it possible to restore balance and harmony to a face that a primary op has taken away?
You will have seen my photos (Pat), and the reason I am most upset I think is how weird it is making my facial expressions look. Before, with my hump and long nose, everything was in balance or so it seemed, I didn’t look weird. But now after having a shortened nose with an apparent open-roof deformity and lack of tip, my nose is making my face look animal-like and this is what is upsetting me. Can a revision help restore a natural balance to my face, is that a good goal, or is the goal purely to create a natural looking nose regardless of how it fits into the face? I know its impossible to get an old nose back, but can my face still retrieve that “look” it once had?
Also, before my primary, I had a “ball-like ” tip. Is it possible to get a substantial built-up tip back using grafts, or is it limited?
Many thanks in advance, your advice is much appreciated
Pat :: 1 year, 3 months after
Hi Dr. Palmer,
I got an L silicone implant about 6 months ago. I really don’t have any complaints about it.
But, it does concern me that many doctors warn of extrusion. How high is this risk?
I have also heard from a number of doctors that the L implant gives a sharper tip to Asians. Is this true also?
Leslie :: 1 year, 3 months after
Ok Jen,
Here goes. The reality with using an L-shaped silicone dorsal implant is that 100% will cause erosion through the skin within 15 years. This has been well documented in numerous plastic surgery medical journals over the years. Some make the skin, over the nasal tip area, red in as little as 1 year while others take a bit longer.
This happens because the L-shaped implant has a section that is too hard for the skin just above the nasal tip. It becomes hard and eventually the skin’s so thin that it opens. These implants, in my opinion, should be removed as soon as possible, the nasal tip cartilages repaired (as the vertical L portion is placed through the tip cartilages making the tip wider) and an ear cartilage tip graft placed.
I have done this many times when removing the L-portion of the implant. If you like the appearance of the bridge, the rest of the implant can remain once the vertical segement has been trimmed and removed.
I am sorry to be the bearer of bad news but you need to know what may be in the future so that you can make informed decisions before the skin is permanently damaged over the nasal tip.
You can e-mail pics to drfpalmer1@aol.com or call 310-652-9583 to schedule a consult for nasal evaluation.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Angie,
Ear cartilage in the tip area does not absorb and the length will remain.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Angie,
After 6 months swelling should be gone and curve may be due to shift in catrilage graft.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Pat,
Yes, it should be possible to re-establish facial balance. The nose should fit the face and will do so if it (the nose) has a natural look. Revision Rhinoplasty should be able to build up your nasal bridge, close the open roof deformity and lengthen the nose by placing ear cartilage graft to the nasal tip. I didn’t see any pics.
drfpalmer1@aol.com
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Angie,
Staff didn’t get your pics by e-mail either. Be sure to send them to drfpalmer1@aol.com Include a brief note.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Michelle,
The nostrils are as they will most likely be at this point. You could consider bringing in one or both nostrils with internal weir incisions. I don’t know if the Rhinoplasty made your nostrils more uneven…take a look at your before and after pics…they should answer that question.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Hey Alexis,
Yes, you’re panicking way too early. Give yourself 3-6 months to heal and for the swelling to resolve.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Monica,
Your skin may be going through a phase after the Rhinoplasty. Give it some time (3-4 months) and treat it gently.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Lora,
The nostrils are most likey where they will be at this point. The peeling skin shouldn’t be a problem and is most likely temporary.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Lora,
I always recommend that you listen to the advice of your plastic surgeon….he or she’s the one that did the Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Mia,
I agree with your plastic surgeon. Unless you slept on your nose…and that would hurt enough to wake you up…you were not the cause of this issue. It could still be swelling for 6-9 months..so hang in there. Have you mentioned this to the plastic surgeon? For all my blog readers…buy a U-shaped pillow and sleep on this for 1 month after Rhinoplasty, Cheek Implants or Chin Implant surgery…just to be sure.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Karen,
At 10 days…the swelling can make any part of your nose look off. Depending on what was done to the tip during your Rhinoplasty, it could swell for 6-9 months. Ask your plastic surgeon for a reasonable timeframe till you see the final result.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Leslie,
The L-shaped implant should be trimmed as soon as possible in my opinion to avoid extrusion through the skin. The tip cartilages will most likely need to be repaired and an ear cartilage grfat placed to the nasal tip. You can leave the horizontal portion of the implant along the nasal bridge if you like how that looks.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Readers. Please follow the advice of your plastic surgeon until you decide that you do not want to be a patient of that plastic surgeon any longer. You can always get a second opinion from another plastic surgeon but avoid having 2 different doctors treating you at the same time…. like having a dermatologist inject your nose after a Rhinoplasty. Not generally a good idea..in my opinion.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dear Dr Palmer,
My doctor told me to push my tip up after a month, as this will encourage cartilage absorption. Im really feel my tip is now too long and its being pulled downwards when i smile. Does a nose tip lift after a certain time? Also does ,35 mm usually add alot of height to a bridge? My old nose was pretty flat, and now its so thick and high. A few people ive talked to said their bridge stayed the same after 2-3 weeks. Its been more than a month for me.
Angie :: 1 year, 3 months after
Dr Palmer,
Sorry its Angie again… i just took some pictures smiling and my nose tip is so beak like! When i touch my tip in between my nostrils its bing pulled down by something hard inside, i really think i need it removed. Unfortunately i did my surgery in Taipei, and am now back in Canada. Would getting tip shortened be a easy procedure to do?
Angie :: 1 year, 3 months after
I tried posting this a few minutes ago but it didn’t seem to work so I’m trying again:
Dear Dr. Palmer,
Thank you so much for replying to my (previous) post so quickly (swollen tip at 10 days). I think it’s absolutely great that you’re helping all these people with their questions and concerns! Can I ask just one more question: can the “bump” at the top of the bridge swell also? mine seems a little bigger then it did a few days ago, but it feels like it’s just bone there. Can bone swell? btw, I love my new nose
Thanks again!
Karen
Karen :: 1 year, 3 months after
Dr Palmer,
Does ear cartilage dissolve as much as rib cartilage? I have an ear graft that is holding open my collapsed nostril, and I have rib grafts all around other areas of my nose. Thanks.
Mike :: 1 year, 3 months after
Dear dr. Palmer,
Thank you so much for your reponse. Your advice means so much to all of the people in post-operative period! I just have one more question. you mentioned that I could consider bringing in my uneven nostrils with a weir incision? I’m not really clear on what that exactly is. Are you refering to a procedure in a revision rhinoplasty?
Also after my surgery, the left side of my face. ( The one with the larger and vertically shaped nostril) was more swollen for weeks, So i;m just wondering if that could cause the unevenness. ( However, from a profile view, the tip of bigger side looks more defined.)
Could the unevenness be because I had more work done on my left side.( I’m just assuming that because of the swelling.).
I read online that somepeople started to have more even nostrils after 4 months. So do you think I still could have anyhope that the swelling would go down?
Thank you somuch
Looking forward to hearing from you
Michelle
Mia :: 1 year, 3 months after
Mike,
Ear cartilage to the nasal tip seems to be very stable over many years and is my choice for the tip area. Ear cartilage, rib cartilage, irradiated cartilage and bone all have a nasty habit of dissolving irregularly when used over the nasal bridge which is why I use a silastic implant in this area during Rhinoplasty. Hope this helps.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Angie,
The nasal bridge can have irregular swelling after a Rhinoplasty that could last for several months. Bone is stable but the tissues above the bone can swell differently from one side to the other and across the bridge and even feel as stiff as bone. Ask the plastic surgeon that did your Rhinoplasty about icing and other ways to control the swelling at this stage.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Angie,
I’d have to see pics of the tip and you’d have to know what the surgeon did to the tip area but generally the nasal tip area can be shortened. Pics to drfpalmer1@aol.com. Be patient, we get thousands of e-mails and pics.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Angie,
It can’t be 35mm but 3.5mm for added height to the nasal bridge. This seems reasonable. No, lifting the tip will, in my opinion, not cause the tip to miraculously lift itself up against gravity and the cartilage graft nor will it cause cartilage absorption. It could very well dislocate, tear or otherwise damage the cartilage in the tip area. Just my opinion.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Mia,
You’re welcome. Let me clear up a few msiconceptions.
First remember that advice and perceptions that you read on chat boards and other plastic surgery forums are observations made by laypeople such as yourself. While this is helpful emotionally, they do not have the surgical knowledge and training to relate what they see to the anatomy of the nose and the Rhinoplasty procedure. The comments on the nostrils changing post Rhinoplasty is a perfect example.
The nostrils are formed by extensions of the tip cartilages. If the tip cartilages are modified during the Rhinoplasty in a very specific manner (not commonly done) the nostrils can be changed. The spacing between the nostrils and the columella (mid section of the nose) can be reduced by removing skin in that area as well.
Both of these techniques change the nostrils right away…there is no change over months. The nostril shape is what it is no disrespect to the person who stated otherwise. The nostrils may have appeared to change as the tip swelling decreased but that’s an illusion not a reality which can be documented by taking photos from the base of the nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dear Dr Palmer,
Could it be swelling on my mid tip, (from the end of the implant down to the nostril area) be why my nose looks so downturned? I feel like the area is so thick and protrudes forward, so my nose is kind of Witch like… I hope you know what i mean. The area is quite hard and thick right now. If that goes down would my nose curve differently? I just really want to avoid getting a revision.
Angie :: 1 year, 3 months after
Dr Palmer,
Thank you so much for your response. The swelling is definately makeing me self conscious so I am eager to see it go down, because right now i don’t see any changes!
out of curiosity, you mentioned I should way 3-6 months to see the swelling go down – Why does it take the nose so long to heal from a rhinoplasty? What is unique about that area of the body that it takes so long?
Alexis :: 1 year, 3 months after
Alexis,
Swelling in the body everywhere is removed by the lymphatic vessels. The ones in the nose are disrupted during a Rhinoplasty and take about 6 months to hook up completely returning the area to basically it’s normal state. The nose until tehn has to have the swelling go to the lymphatics of the face, so swelling tends to get trapped in the nose more than in other parts of the body.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Angie,
I understand. It sounds like the vertical (L section) of the implant maybe positioned in front of and on top of your nasal tip cartilages. That would explain the appearance you describe. This makes the skin over the nasal tip even more susceptible to erosion by the implant. If you come in for a consult, I could tell more. You may wind up needing the implant trimmed and a revision Rhinoplasty no matter what. I’m afraid it is what it is.
All my readers, please tell all your friends and anyone that’ll listen to please avoid using these L-shaped nasal implants. They cause erosion through the skin and can damage the natural tip cartilages. Virtually 100% of these implants will come through the nasal tip skin within 15 years. Some plastic surgeons, in other countries, like these implants because they are a quick and easy way to build up the nasal bridge but they aren’t worth the problems they cause. I advise they be removed as soon as possible to avoid damaging the nasal skin which could cause the nose to become deformed. We all know of a celebrity that has such a problem that was well publicized some years back. Once the skin is damaged. the nose can not be fixed with Rhinoplasty but requires major reconstructive surgery.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dear Dr Palmer,
I didn’t get a L implant though, i got an I with ear cartilage for tip. I’m thinking maybe the ear cartilage is pushing my nose down, especially since my dr put one below my tip to extend it. Thanks.
angie :: 1 year, 3 months after
Yes, Sorry. Too many posts at once to juggle. Yes, it is possible that the ear graft to your nasal tip is making the tip rotate down and appear too long. The graft will not lessen or dissolve over time however and manipulating the graft will increase the risk of the graft shifting which will make the tip of your nose look crooked. If at 6 months, you still think the tip is too long, you’d have to have a revision open tiplasty (Rhinoplasty) to modify, remove or replace the tip graft.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Thanks for your reply Dr Palmer. Would it be possible at all to get it revised in 3 months? Also this wouldn’t be a major surgery right since im basically reverting my nose to the length it was before.
Angie :: 1 year, 3 months after
Hi Dr. Palmer,
Tomorrow will be 2 weeks from my rhinoplasty. I have absolutely no bruising and haven’t had any for several days and my nose doesn’t seem very swollen at all. It’s almost perfect, but it’s not as perfect as it was the day the splint came off. Both the bone at the top of the bridge and the tip are slightly larger but they really don’t feel or look swollen. Is it possible to have the final result after only two weeks, or can the whole thing still refine even more, even though it seems final already.
Thanks again,
Karen
Karen :: 1 year, 3 months after
Dr. Palmer,
Sorry to bug you. I am 16 days post rhinoplasty (open, no bone breaking, no implant, just shave of small dorsal hump and correction of round tip). The swelling has not improved at all, in fact it appears worse. It even swells up bigger through out the day and feels hot. I read that 80% of swelling should be gone two weeks after surgery, why isn’t mine improving? What if its not swelling, and this is just how big it is now?
A friend of mine knew a girl who took a Medrose 5 day pack post rhinoplasty. Does that really help with the nose swelling? Does it work long term, or when your off does the nose just swell right back up again?
I’m looking forward to hearing from you. I just feel so upset because I’ve seen no change in the swelling at all and neither have my friends or family.
Alexis :: 1 year, 3 months after
Angie,
It’s best to wait until 6 months from your last surgery however, if the tip could be raised through a columellar incision only…it could be done at 3 months. I’d need to see your nose in person to make that determination. Call the office if you want to set that up. 310-652-9583
Best,
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Karen and Alexis,
This answer applies to you both. Karen, your nose is most likely undergoing typical post-op swelling which will subside on its own in several months. Call your Plastic surgeon with more specific tips on how he/she suggests you reduce the swelling after your Rhinoplasty.
Alexis,
16 days is still very early however if you feel that your nose is hot you should call and see your plastic surgeon ASAP to rule out a postop infection. While you’re there you can discuss the post-op swelling.
Your friend had a Medrol dose pack that’s 6-7 days of an anti-inflammatory steroid typically given to Revision Rhinoplasty cases or when there’s some reason to suspect an increased risk of post-op swelling and scar tissue formation…neither of which may apply in your case. Again discuss this with the plastic surgeon who did your Rhinoplasty.
Whoever wrote that 80% of the swelling, after a Rhinoplasty, is gone after 2 weeks either doesn’t do many Rhinoplasty surgeries or is just plain mis-informed. That staement is just plain silly. There’s no way to predict the timeframe at which a person’s nose will be less swollen. Typically it takes several months….that’s all that can be truthfully said.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Hi Dr. Palmer,
What you said about the L shaped implant is definitely a bad news for me
But I wanna thank you and respect you for your honesty about the issue. I am a bit confused as to why a lot of PS, including the ones in this country, still recommend and use these implants with their patients. And oh yeah, are you talking about MJ? Oh my gosh, I’m really scared now, ouch!
How I wish you practiced in my city or I lived in your city. I live in the East Coast (tri state area) but there is a chance I will be moving to Cali early next year. It will be a month tomorrow since the surgery, hopefully no damage is done yet before I get the chance to see you for evaluation. Quite frankly, I am not happy with the outcome at all eventhough its only been four weeks.
Just curious, do you perform a lot of these procedures or Asian rhinoplasty in your office? One last thing…do you have any recommendation on what I can use/do to keep my nose clean and moist inside. Thank you dr.
Jen :: 1 year, 3 months after
Jen,
Yeah it’s always tough for me to be the bearer of bad news but you have to know the truth for you to be an informed consumer.
Many plastic surgeons don’t use the L-shaped implant anymore but some still do. I’m not sure why other than it’s much easier for the plastic surgeon than using one implant for the bridge and another graft taken from behind the ear for the nasal tip. Much more effective and safe but it also requires more time and skill. It’s what I do but some plastic surgeons may not want to take the time and effort for this approach.
I frequently run across this L-shaped implant because of our international practice and I have trimmed many along with repair of the tip cartilages and placement of an ear cartilage graft to the nasal tip.
I recommend that my Rhinoplasty patients use nasal saline spray several times a day for the first couple of months. This can be obtained over the counter at many places.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dr. Palmer,
I just wanted to say thank you. This website is wonderful. So many people here I see turn to you for guidance and education, and I think it is generous of your to find the time to answer all of our concerns.
I have recommended your website to several friends, they all have been impressed.
Thank your for answering my questions.
Alexis :: 1 year, 3 months after
Alexis,
You’re welcome and thanks for the kind words. I just feel that someone, like me, needs to step up and be the voice of reason and truthful information for plastic and cosmetic surgery.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dear Dr Palmer,
If my tip is done through columellar incision, would it be an less invasive surgery, with a faster recovery? I feel like im deswelling slowly and don’t want to be back at square one again after getting tip shortened to original length.
Angie :: 1 year, 3 months after
Dear Dr. Palmer,
I’m having a difficult time getting this to post so I’m trying one more time. I just did a stupid thing. It’s been 2.5 weeks from my rhinoplasty and this morning I lightly sanded a piece of furniture by hand without wearing a face mask and I’m sure I breathed some of the saw dust in. When I realized what I had done I flushed my nose with saline solution, but I’m afraid I may have done irreparable damage to the nasal bone.
Thanks,
Karen
Karen :: 1 year, 4 months after
Karen,
I wouldn’t think that would cause any harm however, call your plastic surgeons office and explain what happened for his/her advice.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Angie,
Columellar incision will leave the tip swollen and this typically resolves over several months. It is, in my opinion, the best way to remove and secure any tip graft that may be required.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Thank you, Dr. Palmer. You truly are invaluable!
-Karen
Karen :: 1 year, 4 months after
Dear Dr. Palmer,
I just submited this a few seconds ago but for some reason it didn’t get posted. so i’m posting it again.
When I had rhinoplasty consultation, the Dr. seemed not to spend much time discussing what he was going to do with me. He was very brief and said ” So, she wants a special nose?”. He said he was going to remve the bump and take it up abit and did not even bother to draw lines on my pictures.( I had that done by a previous surgeon,). Back then I never realized that would increase the distance between my upper lip and nose and destroy the harmony my face had. He was a famou ssurgeon and I thought let him do what he thinks would look best on me.right now after 3 months, I see that the distance is a lot and My face has lost all its harmony. I look a lot worse than I did before the surgery.The new nose seems to look ok but does not fit my face and I really don’t know what to do at this point. I’ve heard that the tip falls down a bit as time passes, is that true? Could I still have any hope?
Thank you very much
You are a truely caring and kind Dr.
Hannah.
Hannah :: 1 year, 4 months after
Dear Dr. Palmer,
When I had rhinoplasty, my nose profile view was perfectly straight and ran smoothly from top to the tip. However, a while ago i accidentally hit my nose with my hand hard, which caused it to throb for a while. I called my Dr. and explained to him, he said that since there was no bruising/ swelling/bleeding, the bone has not moved and the only way the shape could be changed is if the bone moves. Right now the bump seems to be more close to the tip of the nose.( The carilage area where the bone ends and turns into the tip?) I’m really worried that I might have caused this damage. Is it possible for this bump to appear even if the bones didn’t move, due to the pressure? Is there such thing as cartilage damagage due to bumping the nose.? Or is this totally unrelated and Its just a part of the healing process?
I’d really appreciate your reponse.
Thank you,
Aya
Aya :: 1 year, 4 months after
Why thank you Karen. Glad I was helpful.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Aya,
I’m afraid that the cartilage actually is the tissue that extends down from the nasal bones to the tip of the nose in the middle and along the sides of the nose and this cartilage can and does crack when hit. It sounds like a cratilage fracture that heals with scar tissue making the cartilage deviate to one side or the other. This typically worsens over time (a year or two) and may require a revision Rhinoplasty, although I have used Radiesse Injections to fill in the area making the nose appear more straight. You can read more about radiesse here:
http://www.drfpalmer.com/radiesse-injections.html
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Hannah,
I’m afraid that I don’t agree with plastic Surgeons telling their patients that the nasal tip will drop significantly months after their Rhinoplasty. While it is true that the tip will drop from the position it appears during the first week Post Rhinoplasty when the tip is taped up and a cast is on the nose, it does not mean that the tip significantly drops from it’s position after the first month.
If the tip of your nose has been rotated upward, this will reveal the columellar portion of your nose and make the length of the upper lip appear longer. There are two courses of action if you don’t like this look.
1. Rotate the tip downward with manipulations or a graft to the nasal tip which would require a revision Rhinoplasty. 2. Plump up the shape of the lips to hide this increased distance….I prefer using Alloderm for Lip Augmentation. You can read more about Alloderm and Lip Enhancement here:
http://www.drfpalmer.com/LipAugmentation.html
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
To the blogger about nasal manipulations, I think Tim?
Nasal manipulations refer to specific tissue squeezing after a Rhinoplasty that are designed to decrease post Rhinoplasty swelling and subsequent scar tissue formation. I have every one of my Rhinoplasty patients do these nasal manipulations starting at 1 month post op after their Rhinoplasty and are done for about 5 minutes every day. Typically, these are done for 6 months but may be required for a year or longer in complicated revision Rhinoplasty cases.
As I have mentioned before on my website and here in this blog, medicolegal issues prohibit me from giving specific post op instructions to any patients that are not under my medical care (that are not my patients). I can give general education but not specific treatment like my post Rhinoplasty nasal manipulations.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Dear Dr. Palmer,
I’m still concerned about the bone at the top of my bridge. It will be 3 weeks on Thursday. Some days the bone looks bigger then on other days. I know about the calcification, but I have googled this and can’t find the answer to this question: Will the swelling go up and down over the next few months, or should the swelling decrease only.
Thanks again,
Karen
Karen :: 1 year, 4 months after
Karen,
The swelling will increase and decrease over the next few months.
Dr. Francis R Palmer, III
Dr. Francis Palmer :: 1 year, 4 months after
Karen- just so you know your in company- i am three weeks out from my rhinoplasty as well and every other day my nose goes from SWOLLEN to SUPER SWOLLEN. Its terribly frustrating, I know. ButI think that it is just part of the process unfortunately!
Alexis :: 1 year, 4 months after
Thank you so much to both Dr. Palmer (again) and Alexis!. The reason I’m so nervous is out of guilt. I quit smoking before the surgery, but after the surgery, I started smoking again. My PS knows about it. They’ve told me it will delay healing, but I’m afraid of more than a delay, but of actually ruining the result. Guilt guilt guilt.
Karen :: 1 year, 4 months after
Dear Dr. Palmer,
I’d like to thank you greatly for your response. You mentioned that I might have a cartilage fracture. I’d like to know If any manipulations can be done to heal that. If I press on the bumpy spot on a daily basis, would that cause it to go down? Can the pressure from Taping help with this?
Also Could this be just part of the healing process and not a fracture? ( I don’t think I did a great job in describing the bump, it looks more like a slight wavy form from the profile view?)Would a Dr. Be able to determine that by looking at my nose?
I;m really worried.
Thank you so much, I really need your help!
Aya.
Aya :: 1 year, 4 months after
Karen,
Well I’m sure you’ve heard this a million times, but for more then the sake of your nose, quit for the sake of your LUNGS!
I’ll post again in a week or so and let you know how my healing is going.
Keep me posted on yours!
Alexis :: 1 year, 4 months after
Alexis: I sure will
This will be good.
-Karen
Karen :: 1 year, 4 months after
Dear Dr Palmer,
Its Angie again, i was wondering if you had time to review the pictures i sent you. Do you think i only need a small 1.5mm I impant? Because currently i have a 3.5mm size and i feel my bridge is too high and thick. Its been over a month and a half since my surgery. I am now thinking of getting a revision to change my implant, and ofcourse shorten the nose to my original length. Do you think my nose looks bigger than how noses generally look after a month and a half? All the pictures ive seen of noses after asian rhinoplasty looks nicer and smaller than mine. I feel quite dissapointed.
angie :: 1 year, 4 months after
Angie,
Hard to tell from the pictures, I’d have to see you in person. You could exchange the 3.5mm, which is a bit thick, for a thinner size 1.5 mm’s as you suggested.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
FYI Smoking after a Rhinoplasty really can mess things up if you inhale the smoke thru your nose….this includes smoking pot. I’d avoid doing that after a Rhinoplasty for at least 6-9 months for sure. Glad to see you guys chatting amongst yourselves. Sort of what I envisioned when I started the blog.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Aya,
It certainly can be from the trauma itself and not be a significant cartilage crack or fracture. Probably not worth a trip to the plastic surgeon at this point. When I see noses that have been injured like this, I advise a re-visit at 3-4 weeks after the injury has had time to heal. At that time, I’m able to better determine if the injury will or will not most likely result in a permanent aesthetic change to the nose.
No, I tell patients to avoid rubbing or pressing on the injured area. This tissue needs time to heal and pressing on it might just prolong the healing time.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Hi Dr. Palmer. Can you tell me exactly how smoking can mess things up. Is it too late now for me? My rhinoplasty was 3 weeks ago.
Thank you,
Karen
Karen :: 1 year, 4 months after
Karen,
I believe that the tar and other irritants in the smoke causes an inflammation in the healing tissues of the nose…especially if you take the smoke through your nose. It’s not too late to stop…a short term bout of smoking probably won’t have any lasting negative effects…it’s more likely if someone smokes for months after their Rhinoplasty.
I can’t say that every person that smokes will heal poorly after a Rhinoplasty but I have seen over the past 20 years that it can happen and if that’s the case, why take the added risk? If you’re worried, try some powerful anti-oxidants to counteract any potential damage. Try google search for ORAC foods. (wolfberry, acai berries etc.)
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Dr. Palmer,
I took your advice and spoke to my PS about the “funny” smelling mucus. I was put on 7 days 500mg Keflex QID. I finished the meds 3 days ago and the smell is slightly coming back. I don’t have any fever. I do notice that randomly during the day my nose becomes “flush”.
I 3.5 weeks post op. Still very swollen.
Any chance infection is still present?
Alexis :: 1 year, 4 months after
Dear Dr. Palmer,
Again thank for your honest response about the L-shaped implant. I think I have mentioned it before that since the surgery a month ago, I would wake up with my eyes burning. I am starting to think that the silicone is causing this. It hasn’t been that bad for a couple days but it’s still there. Do you think is due to swelling or an adverse reaction? The last thing I want is to do any damage to my eyes. The healing is going well and not a lot of swelling anymore. I would really appreciate your thoughts or opinion about this. I called my PS and told me to use eye drops til I see him next week for my follow up check up. Also once the implant is removed, how long do I have to wait for revision surgery?
Also can you tell me some signs of infections that can occur after surgery and ways to prevent them.
Thank you..
Jen :: 1 year, 4 months after
Jen,
For now follow your plastic surgeon’s instruction and have him/her decide whether or not you’re having an issue with the silicone implant. You’d have to wait 6 months from the time of the prior Rhinoplasty for a revision.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Alexis,
Hard to say but you may want another follow up visit with your plastic surgeon to look inside your nose and make an evaluation at this point after your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Dear Dr. Palmer: I have another silly question. I accidentally got a small chunk of bath soap up my nose tonight and it stung. I’ve rinsed it a few times with saline solution and it still stings. Can this damage the tissue and should I worry about this now? I’m finding this rhino recovery experience similar to having your first new baby because you worry about everything. But at the very least, maybe this post will at least bring you a chuckle.
-Karen (3 weeks post op)
PS: Have you ever considered publishing a book based on all these questions and your answers. You could call it “Everything You Want To Know About Your Rhinoplasty But Are Afraid to Ask.”
Karen :: 1 year, 4 months after
Karen,
The ph of the soap most likely caused a localized skin (mucosal lining actually) irritation. Rinsing it out thoroughly and then avoid touching or manipulating the area should allow the tissues to heal. If the stinging persists or you notice increased pain or tenderness see the plastic surgeon that did your Rhinoplasty.
To all my blog readers. There are no silly questions if you’ve just had a Rhinoplasty or any surgery and you’re scared. The bottom line is… if you have chosen your plastic surgeon wisely, it’s very unlikely that anything other than trauma to the nose will cause any real problems. The nose after Rhinoplasty is not that delicate…but hey don’t take this as a personal challenge to do too much after Rhinoplasty or any surgery. I tell all my plastic surgery patients…use common sense and ask yourself “is this something that could damage my surgery or inhibit my healing?”..if the answer is yes or even…I’m not sure then avoid simply don’t do that!
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Dear Dr Palmer,
I recently read that scarring and encapsulation of the implant that will already create bridge height, even after the removal of the implant. I hadn’t really heard of this before, im wondering if you’ve seen cases like this? I find that one side of my bridge is higher than the other, and now im scared what if its permanent? If i remove my implant or switch to a thinner size (1.5mm) my bridge will become lower and narrower right?
Thanks!
Angie :: 1 year, 4 months after
Angie,
That’s really not the case. The scar formation and encapsulation are quite minimal with a dorsal nasal implant and isn’t a factor.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Hello,
I am 1 month post-op. It was an open rhinoplasty. I had my nasal bones moved inwards,the sides of my tip trimmed to get rid of the ‘bulbuous’ look and the tissue inside my nostrils thinned out to give them a smaller appearance I flew to the States to have a rhinoplasty and flew back to England 1 week after. My first question is- will flying in an airplane so soon after have any long-term effects on my healing e.g moving the bone, increasing the swelling. Secondly, I was blowing my nose and picking the inside of my nostrils quite roughly to remove dried mucus inside within a few days of the rhinoplasty. Would this have had any affect on the results?
I’m worried that the middle of my nose below the bridge is still quite wide. My nose has an overall wide appearance even though the tip has been reduced. There is also not as much tip definition as before the surgery. Will this improve over the next 3 months? Or rather- how much change can I expect to see in the next few months. Enough to feel satisfied that I made the right decision? Right now I’m not looking in the mirror thinking “wow, this is exactly what I spent my $6,000 for. Please let me know
vanessa :: 1 year, 4 months after
Hi Dr. Palmer. The last couple of days I get a weird sensation in my nose, almost like it’s moving around and growing, like it has a life of it’s own. Is that normal? Also another question, tonight I was holding my glasses in front of my face (not on my nose) but when I went to pull the glasses away I sort of scraped the glasses on the top of my nose, just briefly. It will be 4 weeks on Thursday, could I have damaged it?
Karen :: 1 year, 4 months after
Karen – hey i mentioned i’d report back to you. I saw your blog too.
I bump my nose all the time, whether i’m putting a shirt on, being a klutz, what have you. I get nervous also! but i keep telling myself that they’d make us wear a mask if we were that fragile!
How’s your swelling going? Mine has gone down a little nit. But still swollen. I’m four weeks out too!
That pain sensation you were talking about, i get that sometimes to deep inside my nose, i thought maybe it was nerves healing?
I’m curious to hear Dr. Palmer’s reponse!
talk soon!
Alexis :: 1 year, 4 months after
Alexis,
I think you’re right on the mark. The nerves regenerate and you can have anything from a sharp jolt to mild burning sensation. The difference between this an say a smoldering infection (which is very rare in Rhinoplasty by the way) would be the frequency and the severity. Infection symptoms become more and more frequent and severe in a matter of hours and days.
That’s right, the nose is not that fragile but depending on whether, or not, cartilage grafts are sewn into the tip or not…a simple twist of the tip could pop all the internal sutures leaving the tip crooked months and years later…so I tell all my patients to extra careful with their nose for 1 month.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Karen,
I tell my Rhinoplasty patients that the nose is pretty stable after 1 month but as always if you’re concerned call the plastic surgeon’s office and speak with the plastic surgeon or the nurse just to ease your mind.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Vanessa,
I let my Rhinoplasty patients fly back all over the world at 1 week post op, so the flight shouldn’t be an issue. Swelling as you can see from all the bloggers here is quite common and hard to predict for months after a Rhinoplasty. As far as the $6,000, I hate to tell you that’s not that much for an experienced Rhinoplasty Plastic Surgeon…my fees are much, much higher.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Hi Alexis- My swelling goes up and down all the time, but I’m noticing that when it goes down, it goes further down each time, and I’m seeing a little more symmetry at the tip. I feel the weird sensation I described earlier, in the nasal bone at the top of the nose. Sometimes it feels like there’s a miniature person in there pushing and trying to get out.
Karen
Karen :: 1 year, 4 months after
Hello,
I had a rhinoplasty 30 days ago. I have had a gortex implant and ever since my surgery I have bright red on my nose between my eyes. My doctor does not think it is infected, but put me on amox-clav. This has not diminihsed the red at all. My doctor thinks I am having a bad reaction to the implant and thinks he may need to change the implant to something else. I’m very nervous that this red has not gone away and that it may never go away, even if he changes the implant. I would prefer he not go in there and change the implant, but hoping this red will somehow disappear. Can you shed any light on this?
Jamie Smith :: 1 year, 4 months after
Hi Dr Palmer,
I had a closed rhinoplasty about 3 1/2 weeks ago, and the swelling is still really bad around my eyes in the mornings. I’m assuming from the posts, that this is normal, but what I am concerned about is the tip of my nose feels numb. When I touch it, I have no feeling in that area of my nose. Is this normal?
Thank you,
Jen
Jen :: 1 year, 4 months after
Jamie,
It sounds like you may need to see the plastic surgeon that performed your Rhinoplasty about the redness in your nasal tip. Only the plastic surgeon can determine if this is normal post Rhinoplasty healing or something else that may require treatment.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Jamie,
I don’t use Gortex in the nose for any grafts anymore as it has, in my opinion, a tendency to have more problems than other graft materials.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Jen,
Swelling and some numbness is normal for some months after a Rhinoplasty but if you’re concerned call and speak with the plastic surgeon who did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Jen – You probably see I have posted in here before as well. It definately helps to see other people are experiencing what I am. I am 4.5 weeks post op and my nose is HUGE in the morning! It is still swollen all the time, but mornings are the worst. I also have numbness in the tip, but it is slowly getting more feeling. In addition the skin on my nose has a wierd texture at the tip- it seems to get blemishes, which never happened before!
Dr. Palmer, realisticaly, with no steroids, when can I expect this swelling to subside? All my PS says is “time”. And to be honest, I’m getting antsy with the response!
Alexis :: 1 year, 4 months after
To: Alexis
Wow! What you said about the nose being really swollen in the morning is right on the mark! I myself am exactly 4.5 weeks post op and have a weird ‘blemishy’ texture and I’m breathing a huge sigh of relief. I’m think I gradually seeing the swelling gradually decreasing each month- but very, very, slowly.So that sometimes I think I’m imagining it. Like you I’m also getting worried and impatient and take pictures of it like every minute. But I guess, only time will tell.But they must say give it time for a reason…
vanessa :: 1 year, 4 months after
Hi all. Dr. Palmer, how long generally does it take for the calcification on the nasal bone to go away? My “hump” seems to be getting bigger although it was GONE the day the splint came off. It’s not even decreasing, it seems to be consistently increasing. And as a sidenote to Alexis, Vanessa, and Jen, mine is also swollen in the morning. I don’t have a texture on the skin of my tip, but I did have a little red patch on the bridge last week. It lasted a couple of days and then faded away. I thought it might have been an accidental ice burn but I’m not sure.
Karen :: 1 year, 4 months after
Alexis,
There’s no way to tell when your swelling will be gone. It’s so highly variable between Rhinoplasties. Nasal manipulations definetly help but you have to be instructed by the plastic surgeon that did your Rhinoplasty. If you try and figure it out on your own, you’re sure to mess something up inside…so please don’t.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Karen,
Be careful to always have a thin layer of cloth between the ice bag and the skin to prevent a burn. A white tee shirt or a pillow case works well. Without knowledge of what was done during your Rhinoplasty, I don’t have any idea what that bump is and when it will go down. If it’s your bone…it won’t. Bring that up with the plastic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Hi again Doctor, My PS said he “brought the bone WAY down.” And then he explained that as the bone heals, it calcifies or develops a layer of calcification, and eventually, the body rids itself of the calcification leaving just the bone. But I forgot to ask him how long that ridding process may take. I hope it’s not the bone, my PS seemed very confident that it couldn’t be. Thanks again!
Karen :: 1 year, 4 months after
Karen,
No offense but I never heard of such a thing. If the nasal bones are reduced or fractured during a Rhinoplasty they heal. No calcification as a build up that somewhow dissolves over time. If the bump is bone…it will stay.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Hmmm, how strange. What else could it be if it’s not bone? I’ll ask him again about the calcifying….maybe I misunderstood.
Karen :: 1 year, 4 months after
I have had 3 nose surgeries. Nothing was wrong with the first surgery other than the fact that i wanted it to be a little smaller (closer down to the face). The 2nd surgery, an ear cartilage graft was placed in the tip of my nose. i do not know why this was done. all i was told before surgery was that too much cartilage was taken off and a cartilage graft was needed. the doctor wasn’t specific as to where graft would be placed. i just though it would be placed somewhere inside nose, not the tip but i was a teenager and didn’t know any better. the outcome was a much LONGER NOSE. very disappointed.
anyway, i had 3rd surgery to shorten nose, left tip, remove hump which was still present after 2nd surgery. however i still have a long nose i think because of the graft in tip. is it possible to remove the ear cartilage graft in my tip or at least trim it, it seems kind of sharp pointy looking.
ej :: 1 year, 4 months after
i hit the tip of my nose, which has a graft in it. this happened about 1 1/2 year after surgery. i hit kind of hard in a downward and then back up again kind of hit. i was fanning off my face. i hope that the graft didn’t rotate out of shape into a downward position? would scar tissue form from hitting this or possibly just swelling and since it’s in the tip, the swelling will probably take a long time to go away?
ej :: 1 year, 4 months after
i have a question about nose hairs. i pulled out some with a tweezer and i may have pulled out too hard. when i look inside nostril where it flares out, at the top, something seems to be maybe droopy. when i touch it with a qtip it pushes in, kind of feels heavy. however, the outside doesn’t look any different. would this be possible?
ERYNN :: 1 year, 4 months after
Could be swelling of the underlying muscle or tissue over the bone in which case it will resolve over the months.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
EJ,
The cartilage graft could have been fractured or dislodged after your nose was hit. The tip grafts are typically sewn or glued in place at the time of the Rhinoplasty. Trauma to the nasal tip can cause the stitches to break or the glued spots to come loose. This may result in the tip graft rotating out of the proper position over the next months. If the tip starts looking crooked…this may have happened. This would then require a revision Open Rhinoplasty (actually a tip plasty) to replace the cracked or dislodged tip graft.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
EJ,
Yes, cartilage tip grafts can be removed to shorten elongated noses but this can also be done from the inside …the determining factor as to which way is used to shorten the nose would be whether or not you liked the shape of the tip after your Rhinoplasty. If you like the shape of the tip but think the nose is too long…I’d use the inside approach to rotate the tip up.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Erynn,
You may have caused some minor irritation to the follicles inside your nose by plucking them out. You may consider seeing an ENT doctor to examine the inside of your nose if the symptoms worsen or persist.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
THANK YOU FOR ANSWERING MY QUESTIONS. I APPRECIATE IT VERY MUCH.
AS PER MY PREVIOUS QUESTION ABOUT EAR CARTILAGE GRAFTS IN THE TIP, YOU STATED THAT THEY ARE EITHER SEWN OR GLUED IN PLACE DURING SURGERY. I HAVE ANOTHER QUESTION ABOUT THAT.
I DID TRY THE TAPING THING A WHILE BACK BUT ONLY FOR A COUPLE OF MINUTES BECAUSE I WAS SCARED I MIGHT BE DOING IT WRONG, SO I TOOK IT OFF. THE PROBLEM IS THAT WHEN I WAS TAKING IT OFF, I TRIED TO BE EXTRA CAREFUL BUT AS I WAS PULLING OFF I STARTED FROM THE TOP AND PULLED DOWNWARD. I THINK I SHOULD HAVE STOPPED WHEN I GOT TO THE TIP AREA, BUT I JUST KEPT PULLING AND IT KIND OF FELT LIKE I PULLED THE TIP A LITTLE WHEN THE TAPE CAME OFF. NOW I’M WORRIED THAT I MAY HAVE MADE CARTILAGE GRAFT LOOSE OR UNDONE. WHAT WOULD BE THE SIGNS IF SOMETHING WENT WRONG. WOULD IT BE A DROOPY TIP OR A MORE PROTRUDING TIP, LIKE A PINNOCHIO?
EJ :: 1 year, 4 months after
EJ,
There is no way to tell whether or not you caused a tear in the graft or in the method used to fix the graft to your nasal tip…you may want to visit the plastic surgeon that did the Rhinoplasty and explain the situation. At the very least, you’ll have peace of mind.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Dr.,
When I apply ice, the size of my nose decreases significantly – almost immediately and for about 10 minutes there after. Then it increases in size. I am 18 days post-op. Does this mean there is swelling, and the final product will look something like the “iced” nose – which happens to be what it looked like when the cast first came off ?
Thanks,
Karrin.
Karrin :: 1 year, 4 months after
Hi Dr.Palmer
I just had Rhinoplasty done here in Germany 2 weeks ago, my native country. I live in Olympia, WA but I visit Germany regurlarly to see my kids.
The surgeon I chose is experienced and has been recommended to me.I ‘m very unhappy about the result and I think it doesn’t fit my face at all. I even wish I had my previous shape back . It must have been a misunderstanding, because I just wanted a slight smaller , not shorter nose…but now my nose is shorter, sticks out more and even seems much bigger, my nostrils are showing more . I’m very depressed about the outcome . Now I’m trying to find a good surgeon to to a revision. The nose has be Please let me know if there is a reputable cosmetic surgeon in Olympia,WA., because it would be easier to get it done here , also for follow ups.
Or if I get the revision done by you , what is the price and where would I stay?
Thanks for your Information.
B.Bradshaw
barbara :: 1 year, 4 months after
Dear Dr Palmer,
My bridge is still very wide and too high, and i was wondering if thats due to scar tissue forming around my implant? Is scar tissue permanent or will it eventually go away? If i get a revision to switch my silicon implant to a smaller size would my doctor be able to remove some of the scar tissue during the revision surgery?
Also is there a way to make a nose tip narrower and less fleshy looking without performing alarplasty? My doctor says he sewed the two sides of my nose together to make it narrower, but i feel my nostrils look just as wide if not more so than before.
Thankyou.
Angie :: 1 year, 4 months after
I HAD MY 2ND RHINOPLASTY DONE WHEN I WAS 18 YRS OLD. PROBABLY ABOUT 4 OR 5 YEARS AFTER THIS, I HAD A FACIAL DONE WHERE THEY SQUEEZED OUT BLACKHEADS ETC. THE PERSON DID SOME SQUEEZING ON MY NOSE. AT THE TIME, I DIDN’T THINK ANYTHING ABOUT THE CARTILAGE GRAFT IN MY NASAL TIP, BUT NOW THAT I’M OLDER I;VE BEEN RESEARCHING IT MORE AND I’M WORRIED THAT THIS MIGHT HAVE RUINED THE TIP, MAKING IT DROPPY ETC. WOULD SQUEEZING ONE’S NOSE FOR PIMPLES BLACKHEADS AFFECT THE NOSE? I HOPE NOT
THANK YOU
EJ :: 1 year, 4 months after
Angie,
Little scar forms around the silicone dorsal implant. You’d have to ask the plastic surgeon that did your Rhinoplasty about what he used to narrow the nostrils. There are several methods to accomplish this goal that I’ve used over the years….
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
EJ,
Anything is possible, but that seems unlikely. It’s more of a twisting motion that can dislodge a tip graft. If there’s no tip graft, this wouldn’t be an issue.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Barbara,
You should e-mail my staff and send photos to drfpalmer1@aol.com They would be able to give you pricing and my availability. You won’t be able to have a Revision Rhinoplasty for 6 months after the Rhinoplasty you had in Germany.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
Dear Dr Palmer,
Are the little scars around the silicon implant permanent or can they be removed? If i change my implant to a smaller size or remove them completely, will the scars go away?
Thanks
Angie :: 1 year, 4 months after
The scar tissue should settle down and prpbably won’t require removal.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 4 months after
CAN A HEAVY BED COMFORTER CAUSE A HUMP? I PUT THE COMFORTER KIND OF OVER MY FACE WHEN SLEEPING, BUT THIS TIME IT FELL ON MY NOSE.
THANKS
EJ :: 1 year, 4 months after
Hi i just had a Rhinoplasty 7 days ago and i still see some liquid coming out of my nose and i still see some kind of swelling between my nose and upper lip and i wanted to know why i have some kind of liquid coming out of my nose..is that normal…Thanks
Reyna :: 1 year, 4 months after
EJ,
I would think the comforter is just fine.
Dr. Palmer
drfpalmer :: 1 year, 5 months after
Dear Dr. Palmer,
I had revision rhinoplasty in May 2006 (my original rhinoplasty was about 17 years prior). I seemed to heal beautifully and was very happy with the results. Then suddenly in February of 2007 I began having what I would call a “flare-up” to the left side of the tip of my nose. A very obvious, big, red bump would appear almost overnight, stay for about a week, then disappear. At first I thought I was getting a huge pimple or maybe even had a bug bite. This continued to happen about once a month, so in September I saw my surgeon and he gave me a steroid shot in the area. A month later the problem recurred, so he gave me another shot with a stronger dose. A month after that, same problem, so we tried an oral steroid. Now, not only is there no improvement, but things are worse; the WHOLE tip is swollen with the left side even bigger and rather sore, and it hasn’t gone away within a week as it has in the past. Any suggestions? To fill you in on the revision procedure, my doctor said he removed a lot of scar tissue, then morselized some cartilidge before putting it back in the area where this problem started (to the left of the nose tip). I’m concerned about continuing the steroids because of some things I’ve read online that advise against too much of it. Thanks for any advice you can offer.
Lisa :: 1 year, 5 months after
Lisa,
Without seeing you in person, I can’t be certain of what’s going on but from what you describe…it sounds like you have a suture or a graft in the nasal tip that is causing irritation and a localized infection. You may want a second opinion at this point if things don’t improve very soon.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Reyna,
That’s not uncommon however, if there is an odor or anything else that seems unusual, you should contact the plastic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Hi Dr,
I had a rhinoplasty done about 6 weeks ago, i am very happy with the results so far and understand that it will take months to see the final results. However, it seems my septum shifted during the healing process (i never had a problem with my septum before the surgery) and i can’t breathe out of my left nostril now. I am constantly stuffy and sneezing. I have to go back in for another surgery to fix the septum. Will this affect the shape of my new nose? And is this normal to have the septum shift place during healing? When i look up my left nostril it looks all closed up. Also, the tip of my nose is very hard, will i get flexibility back in the tip? Thank you so much for your time.
Nadia :: 1 year, 5 months after
Hey Nadia,
Hummm, something doesn’t sound quite right. No, the septum shouldn’t shift during the healing phase, no you shouldn’t see your septum red and swollen and no you typically wouldn’t need another surgery so soon to work on the septum. Are you sure you don’t have a septal hematoma? You may want to see an ENT surgeon in your area for a second opinion on the matter.
Tip hardness typically softens over time.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Hello Dr Palmer
I have a few more questions. I ‘ve been crying quite hard for long periods lately. Would this effect swelling? i.e increase it temporarily for a few days. Also, I’m 2 months exactly post-open rhinoplasty. I know that they say wait at least 3 months. But how drastic will the changes be in the next month? Right now my nose basically looks the same as it it did before the rhinoplasty with not much improvement. The surgeon that I went to is quite well-reputed and has been featured in the media and various magazines. He specializes in refinement rhinoplasties and avoids really drastic changes. Is there any such thing as delayed healing? Is it possible that it might take more than 3 months for my nose to stabilize and for me to see the changes more clearly? I would greatly appreciate your feedback as I am starting to get a bit anxious. Thanks.
vanessa :: 1 year, 5 months after
Vanessa,
Crying will cause more swelling. I have no way of knowing what the final result of your Rhinoplasty will be. The more conservative the Rhinoplasty…the less the change. In either case, you’ll need to wait 6 months for a more reasonable idea of the final result, so why not try and relax and give yourself the benefit of the doubt and hope for a great result.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Hi Dr. Palmer,
When should one feel safe wearing light reading glasses. I’ll be 9 weeks post op tomorrow and I’ve been wearing my glasses on and off for a couple weeks now. The glasses leave temporary indentations on the sides of my nose, I assume because there is still some slight swelling there, but can the glasses cause any real damage? Thanks as always, Karen
Karen :: 1 year, 5 months after
Karen,
Exactly. The glasses leave indentations and that’s why I don’t sugest my Rhinoplasty patients use glasses for a full 6 months after their Rhinoplasty. Yes, glasses can cause permanent indentations or hummps on the nose. They are a real no..no after a Rhinoplasty but as always, check with the plastic surgeon that did your Rhinoplasty for his/her opinion on the subject.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Dr Palmer
Thanks for the kind words of advice
vanessa :: 1 year, 5 months after
You are welcome. happy Holidays.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Hi, i had rhinoplasty done last november 29. Cartilage was taken from my ear to augment the bridge of my nose. Since then, I’ve noticed that it seems the cartilage has moved towards my right eye. My doctor tried to move it but it was very painful. I was told I have two options, either he’ll put me in local anesthesia and try to move the cartilage in it’s proper position or do an open surgery again to move it. I don’t want a revision rhinoplasty. The first is trumatic enough. It’s unnoticeable actually unless you stare in my eyes. What can i do to correct it’s position?
Marce :: 1 year, 5 months after
Hi everyone, I’m exactly 18 days post op. I had an open rhinoplasty and ear cartilage was used to enhance my bridge. I find all your comments and concerns very informative and Dr. Palmer you have been very helpful, God bless you.
Marce :: 1 year, 5 months after
Dr. Palmer, I realy appreciate your feedback on my other questions. But I have another question- this time it’s about nostrils. Part of the rhinoplasty included “debulking” the nostrils. That is, reducing the thickness without actually cutting the base of the nostrils. I think he worked inside my nostrils and scraped some of the flesh. I’m sure you know more about this technique. I was wondering- would the nostrils be swollen in the same way the rest of the nose is? That is- would they take 3-6 months to go down and for the difference to show? Because right now- they look really flared when I smile and like they’re hanging in mid air. I think I can still feel the bumps where the incision was made in each nostril.
Lastly- I know that the tip is usually swollen and this takes time to go down. But what about swelling around the bone where it was broken. Does this take time to go down as well. Would really appreciate your feedback.
Thanks.
vanessa :: 1 year, 5 months after
Vanessa,
I do not do that type of nostril surgery and am not sure what was done. That’s a question for your surgeon.
Yes, there will be swelling around the bone for some months.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Marce,
You’re quite welcome.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
i just had surgery 23 days ago for a rhino tip. my nose feels really hard and is still tender to touch? is this normal? also the swelling is more in the morning and throughout the day will the swelling go down some more?
alie :: 1 year, 5 months after
Alie,
Sounds like normal post rhinoplasty tip swelling…should slowly soften and swelling decrease in the next sevral months.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Hello Dr. Palmer,
I had a revision Rhinoplasty preformed on me exactly 2 weeks ago, the reason I had it done was to eliminate the bony bumps I had on both sides of my bridge.
Right now the left side of my nose looks great and flows nicely with my eyebrows and the rest of my face, but the right side of my bridge still looks as bumpy as it did when I went in… Is this swelling, and will it eventually go down like the other side?… And what can I do do heal quicker – ice it maybe?
Caroline :: 1 year, 5 months after
Her Caroline,
Good question. Not sure why one side of the nasal bridge is still bumpy and the other’s not. Perhaps you need to ask the plastic surgeon who did your Rhinoplasty. Be specific with your questions about what was done to the bone along the nasal bridge during the Rhinoplasty, so you can relax during the healing phase. Best of luck.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 5 months after
Hi Doctor,
I had a open rhinoplastly performed on my nose about 2.5 years ago, to reduce the width of my nose.
However after the operation, although the width of the nose was succesfully reduced, the tip of my nose appeared very bulbous.
A year later I had secondary rhinoplasty on my nose to remove the bulbous appearance of my nose and restore the pointed nose I orignally had.
It has been six months now, since I had my the revision surgery on my nose, however it still appears to be bulbous.
I sought a consultation from another well known plastic surgeon who said that there would still be swelling on the nose which could still take another year to heal. Morever, he said that even if I were to have another rhinoplasty on my tip, it would be highly unlikely that the appearence of my nose could be improved, and that he has had patients that have had tipplastys that have taken over 2 years to heal.
Do you thinks it is perfectly normal to still have a bulbous nose that would be because of swelling, or should it have subsided. Also, could it still take a year for the nose to heal, and should I try and find a doctor that can perform another rhino, or should I wait and the nose should heal.
I would really appreciate your help on this.
Regards,
Adrian
Adrian :: 1 year, 5 months after
Dear Dr. Palmer,
Could you please do me a big favor and post the link to a picture of a cartilage fracture after a rhinoplasty procedure. This would mean so much to me. I had rhinoplasty about 5 months ago and bumped my nose accidentally a while ago. There has been a small lump that I could feel which has NOT been getting better with time. My profile is no longer straight.I see no improvement and before I bumped my nose, it was perfectly straight from the profile view. I know that the only way to determine if i have a cartilage fracture is for me to a see a plastic surgeon but please just send me a pic if you can so I could have an idea of how a cartilage fracture looks like and If I should be concerned at all.
Thank you so much, I’m really looking forward to hearing from you,
P.S: I have tried taping, pressing on the circular lump but I see no change.
Ashley
Ashely :: 1 year, 5 months after
Dear Dr. Palmer,
I’m so sorry It’s me again, Ashley. I had my rhinoplasty about 4 months ago and I still have throbbing in one side of my nose sometimes. This usually happens when I blow my nose or wash it with saline salt water or take a shower. Sometimes there is a small amount of dried blood in it.( This has only happened recently( about 2 months after the bumping).Should I be concerned at all?
Thanks.
Ashely :: 1 year, 5 months after
I think i may have ruined my cute new nose! I may have picked too hard, or pinched my nose too much when taping up my nose to lift the bottom at night or I don’t know what, but my nose is thinner than it was just yesterday! The tip looks thinner and my nostrils are closer together than they were yesterday too! I just had this job done 3 weeks and 3 days ago, why is the end of my nose shrinking? My doc shaved the bump then broke the bones to bring them together. I’m pleased with this. He also shaved ever so slightly the two small humps at the end of my nose where my nostrils end (not the center of the tip, but just to the sides of the center). All of these procedures were done from the inside. Could I possibly have damaged my tissue inside? Is it possible for me to have damaged my doctor’s masterpiece??? It’s only been three weeks and I feel like the end of my nose is too small now. My nostrils are too close together. Could I have done this with the tape just over night? Why is the end of my nose loosing its cuteness and getting thinner? Could I have cause this to happen? It seems at thought the end just deflated in a day
Libby :: 1 year, 6 months after
Hey,
I have a question for Alexis. How’s the healing going? I remember we were about the same time in months of healing. Hope you get to read this. Thanks.
vanessa :: 1 year, 6 months after
Hello,
I had Rhinoplasty on December 6th to fix my open roof deformity; and the bony sides of the bridgee shaved down.
The open roof deformity is no longer there, it’s nice and closed… The left side of my bridge is no longer bony it’s straight with the rest of my nose… But the right side of the bridge still looks and feels hard and bony like before, my PS said that my nose was still swollen, (which I am hoping it is) But it feels as stiff as bone… Will I stay like this or will it go down?
Judith :: 1 year, 6 months after
Hi to both Alexis and Vanessa. I’m at about the same healing time as both of you (about 2.5 months). Mine seems about the same to me, the bump on the nasal bridge kinda moves from side to side and the tip still seems a little puppet-like at times, other times not. I think we’re at the stage where visible change seems to take forever. How are you both doing?
Karen
Karen :: 1 year, 6 months after
I HIT MYSELF ON THE NOSE WITH MY HAND BY ACCIDENT. WOULD THIS CAUSE CARTILAGE DAMAGE OR SCAR TISSUE OR JUST SWELLING? IF JUST SWELLING, WOULD IT TAKE MANY MONTHS TO GO AWAY LIKE IT DOES WHEN YOU GET SURGERY? ALSO, IN GENERAL WHEN ONES NOSE IS HIT DOES THAT CAUSE DAMAGE THAT WOULD CHANGE THE NOSE’S APPEARANCE PERMANENTLY OR CAUSE SCAR TISSUE
THANKS
EJ :: 1 year, 6 months after
IS APPLYING ICE ON NOSE FOR SWELLING REALLY NECESSARY? IF ONES NOSE IS HIT BUT NOT TOO HARD AND IT DOESN’T THROB OR HURT, THEN IS ICE NECESSARY. IF I DIDN’T APPLY ICE, WOULD IT CAUSE PERMANENT DAMAGE.
EJ :: 1 year, 6 months after
Hey Dr Palmer,
I wrote to you a few months back regarding the swelling even after more than 3 years of the last of the multiple rhinoplasty I had to undergo. I have contacted a few homeopathic specialists and thou the medications do help a bit, I have one question which I feel you can help me with – Is this post swelling just a part of slow healing considering there were multiple operations and my last rhinoplasty involved cartilage graft, plus reshaping of bone of the nose or is it actually lymphedema which can be life long without any cure and just can be managed. (I just have been surfing from a long time on the keywords you provided me in you last answer).
shreya :: 1 year, 6 months after
Hi Dr.,
I just had rhinoplasty done 12 days ago. I love the way my nose looks however I have two concerns. 1) The dissolvable stitches seem to be taking forever to disappear (when I thought I could be back to work after 1 week) and also, 2) I am having a hard time smiling like I used to. Rather than a nature looking smile, it looks like I’m trying too hard and is making the nose job more obvious! Help!
I am going back to work after 7 days, should the dissolvable stitches be gone by then??
Sally :: 1 year, 6 months after
Dr. Palmer,
I had the L shaped silicone implant 3 months ago. I am not happy with it and wants its removed and just have the tip done. Can you do both procedures (silicone removal and tiplasty) at the same time? Also, how long do I have to wait? Thanks.
Lisa
Lisa :: 1 year, 6 months after
EJ,
Sounds like you might have caused some localized trauma to your nose…yes..ice does help with swelling.
Dr. Francis Palmer
drfpalmer :: 1 year, 6 months after
Shreya,
Most likely not lympedema…a genetic disorder of the lyphatic system but definetly from the multiple Rhinoplasty surgeries. Time and homeopathics should help.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Lisa,
You should wait another 3 months for a total of 6 months after your last Rhinoplasty. Yes, I frequently will modify and/or remove the L-shaped silicone graft and perform a tip-plasty at the same time using ear cartilage from the back of one of the ears. You can send photos by e-mail to my staff at drfpalmer1@aol.com or call the office at 310-652-9583 to schedule a consultation for me to take a look at your nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Sally,
Sounds normal after a Rhinoplasty, especially if your plastic surgeon dissected along the front of your nasal tip. Your smile should improve over the next few months. Discuss this with the plastoic surgeon that did your Rhinoplasty just to be sure.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Judith,
Not sure. I’m not certain what your plastic surgeon did to close the open roof deformity, so I think you’d have to ask the plastic surgeon that question. Bone grafts, silicone grafts and re-breaking your nasal bones all have varying degrees of swelling. Not sure which one you had done on your nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Libby,
You may want to have this conversation with the plastic surgeon that did your Rhinoplasty. I personally do not allow my Rhinoplasy patients to tape, massage, pich or otherwise touch their noses for 1 month after their Rhinoplasty. Doing so before that, in my opinion, may rupture internal sutures or tear cartilage that will change the shape of the nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Ashley,
It sound like you are over doing it to me. Throbbing is a sign of increased pressure, so don’t blow your nose…I don’t let my Rhinoplast patients blow their noses for 6 months at least. Ditto on the saline washes. Ask your plastic surgeon if you can stop those things for a few months and see if things improve.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
AShley,
Sorry, can’t send you a link for that…doesn’t exist. Cartilage nasal fractures are radiolucent so they won’t show up on X-Ray and heal over months and years by depositing scar tissue around the cartilage crack. The sacr tissue causes the cartilage to bend and warp making the nose crooked. Every cartilage fracture and every nose will look different from month to month.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Adrian,
Yes and no. Yes, you should seek another opinion but if 2 well trained Rhinoplasty surgeons tell you it’s not a good idea to have another Rhinoplasty…then that’s that. Too many lesser surgeons will be happy to take your money, do another revision Rhinoplasty and you’ll look possibly worse.
You may want to schedule a consultation with me for analysis of your nose. drfpalmer1@aol.com 310-652-9583
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
I was cleaning my nose with a q tip and realized that i can put the q tip very very very far into my right nostril (but not my left) and cannot feel anything. I’ve had my nose done 4 weeks ago. Also, the right side has been runny. What does this all mean? Will that cavity close up eventually?
q tip :: 1 year, 6 months after
how long does the septum usually stay swollen on the outside between the nostrils?
septum :: 1 year, 6 months after
Dear Dr. Palmer,
I had rhinoplasty 5 months ago and I’ve noticed that in pictures, the tip of my nose still looks very bulbous. It’s funny cuz before the surgery, I did NOT even have that problem, i only wanted a smaller, more straight nose. I’ve heard that there are some injections which help to reduce the swelling faster. My question is:
1) Could I get those injections from an ENT and would it be safe?
2) Is is normal that I’m having such a bulbous tip after 5 months?
3) I know this is kind of unrelated, but which plastic surgeon is the best in the area according to your opinion? ( I’m thinking about getting revision rhinoplasty.).
Thank you Dr. You are wonderful, we all appreciate that you take the time to answer our questions, it’s such a relief!;)
Happy new year and best wishes.
Ashley :: 1 year, 6 months after
Hi there,
I had rhinotplasty and septoplasty 2 weeks ago and I’m a little concerned that my nose looks a little asymettrical, especially in the nostrils. I trust my surgeon, but am actually more concerned that I may have compromised the final result. I had a cold straight after surgery and blew my nose very very lightly on 2 occassions and on one occasion used a Q-tip to clean the inside of my nose gently (making sure to use one smaller than my nostrils).
I was also wondering if it may be caused by the fact that my surgeon only broke the bones on one side of my nose to thin the nose so was wondering if the slight difference may be attributable to this (in which case i trust that it will rectify itself in time) or if it is likely to have been caused by my post operative actions? If so is there anything I can do in this point to mitigate the damage? I was also wondering if i may have possibly caused the asymmetry in the way I taped my nose with micropore… for example if i taped more on one side than the other or if it could have been caused by slightly leaning my head to one side while asleep (even if on my back)?
I would really appreciate your view as my plastic surgeon is on holidays!
Sarah
Sarah C :: 1 year, 6 months after
Hi again,
Just looking at your previous comments thought you might need more information about my surgery… I did have the size of the nostrils reduced and the overall nose thinned slightly and the tip raised but the main concern was removing a bump on the side of the nose. Also ithe closed method was used. When I went in to have my splint removed a week ago my doctor told me that he had never seen anyone heal more quickly (the scar was already almost invisible) but that there was still a lot of swelling. He then told me to keep taping the nose for another week all the time and just at night for a further 4 weeks.
Sorry to barrage you with questions but I am very anxious to ensure I haven’t ruined my nose… in addition to the difference in nostril size from the front it seems to bend a little to the left.
Sarah C :: 1 year, 6 months after
Sarah,
Although I do not let my Rhinoplasty patients blow their noses or clean the inside with Q-tips for at least 4 months after their Rhinoplasty, it doesn’t sound like you did enough to cause any harm. As far as the swelling…this is typical. The fact that only 1 side of the nasal bones were fractured, may cause the nose to list towrd one side but this is something that you’d have to discuss with the plastic surgeon that did your surgery. Only he/she would be able to comment on that.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Ashley,
Without seeing you or pictures of your nose, it’s difficult to say why the tip is bulbous. At 6 months after your Rhinoplasty, it’s typically safe to consider another revision. Kenalog injections to the supratip area may decrease the subcutaneous scar tissue if you have created an excess in that area. Revision Rhinoplasty is a quantum level more difficult than primary Rhinoplasty, in my opinion, and you may want to seek out plastic surgeons with many years experience for consultation. You can e-mail us pictures at drfpalmer1@aol.com or call to schedule a consultation at 310-652-9583.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Q-tip…I don’t recommend using Q-tips in the nose for my Rhinoplasty patients for at least 4 months after the surgery. Rarely does any good and can cause tissue trauma to the inside of the nose that’s already swollen…hence the decrease in size of one nostril that you feel with the Q-tip. Having said all that, I encourage you to contact the plastic surgeon that did your Rhinoplasty for more specific instructions on post Rhinoplasty nasal care.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Dr Palmer,
I am 5 weeks post op I had an open rhinoplasty to remove a dorsal hump, also she refined a bulbous tip and hanging tip. I am satisfied with the results but still have days where Im very swollen. I have two questions:
1- I have significant swelling on the right side of my nose just beneath my eye it feels hard like a bone. My Dr. has asked me to massage this area. Will it go away?
2- From my right nostril I have some clear fluid draining that has a bad odor to it…What could this be?
My fear is that the packing which was only placed in the right side has not been fully removed or something and is causing a blockage. To top it off I also have a sore throat and Im wondering if this could be from the drainage going down the back of my throat at night.
Thank You,
Gigi
Gigi :: 1 year, 6 months after
Gigi,
Not sure what the hard lump is by the eye. The malodorous discharge doesn’t seem right and you should see your plastic surgeon to have her take a look and answer that question.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Hi, I had a Septorhinoplasty 2 weeks ago. On the cosmetic side, the surgeon said he has taken some of the cartilage off the bottom tip of my nose and used this on top of my nose to give it abit more height, also, he has raised the tip of my nose. I am quite happy with the result and there wasnt much bruising at all, i suppose cos he didnt have to break my nose, but my question relates to the swelling. My nose doesnt seem swollen, could it be possible i am seeing the final results already? I am wondering if its possible to get the final result in 2 weeks or will my nose be abit smaller if i wait another 6 months – Thanks
Lisa :: 1 year, 6 months after
Hey Doc,
I’m 6 weeks post-op from a revision rhinoplasty (second one)/ septoplasty. My nose was deprojected, my nostrils lowered using composite/rib grafts, my base (?) thickened due to an “inverted v” flaw, and my columella was straightened I guess. I’ve got a few questions and I’d appreciate your opinions.
1) I’m pretty satisfied with the results so far, however, my nose seems curved rather than straight from the profile view. Before, it was straight. Would you attribute this mostly to swelling? And, at 6 weeks, would you say there’s a significant amount left?
2) At my columella it’s pretty red where the composite graft “mends” (for lack of a better word) with the rest of my columella. How long would you say it takes these grafts to fully heal?
3) I was supposed to have weir incisions done to reduce the width of my nostrils. He said he had to postpone that part of the operation due to “blood flow” concerns. Is that BS? Now, he says I have to wait 6 months for that.
4)Are weir incisions pretty drastic as far as reducing the width of nostrils? I tried researching online but the information is pretty scarce for some reason. My nose is definitely bottom-heavy due to how wide my nostrils are.
5) The tip seems a little elevated, would you guess that’s from swelling? As far as I know, the tip was not supposed to be raised, only deprojected.
6) My nostrils still seem a bit “raised”. Should they have fully “dropped” by now, from the composite grafts? Or, does that generally take a bit longer?
Sorry for all the questions. I’d ask my doc but, while reputable and skilled, he’s difficult to talk to.
Thanks a lot!
Steve :: 1 year, 6 months after
Oh, and last one I promise:
7) Do weir incisions effect only the horizontal length of nostrils? Or, can it effect the vertical length as well?
Steve :: 1 year, 6 months after
Hi Dr. Palmer,
To be more clear about how my Plastic Surgeon was going to fix the open roof deformity; he entered through the left nostril, said he would break the nasal bones, and push them together, after that he would file down 1mm on each side.
Left side looks good (where he entered), other side looks bumpy (like before), I can still see subtle lines along the nose (look like bruises, and redness right on the bridge)… Will the right side of the bridge go down eventually? I would ask my PS, but he is just too carefree about his answers….
Judith :: 1 year, 6 months after
Judith,
It sounds like the left nasal bone was broken and shifted inward to reduce the open roof deformity…the right nasal bone could not be broken from entering the nose from the left and therefore may not have been broken or shifted. Ask the plastic surgeon for clarification. Carefree, as a plastic surgeon, is something that you get to be before you operate or accept someone as a patient….
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Steve,
From what you describe you’ve had a very complicated revision Rhinoplasty using rib grafts (something I don’t like to use…just my personal preference) so you will have to hash this out with the plastic surgeon that did your Rhinoplasty. This level of complicated surgery can’t be evaluated by another plastic surgeon, even one like myself with over 20 years experience doing Rhinoplasty and revision Rhinoplasty. I just have no way of knowing what was done to your nose during that surgery.
Weirs (internal ones) don’t effect blood supply to any appreciable amount and reduce the horizontal dimension of the nostrils. External weirs leave, in my opinion, unsightly scars and for that reason, I don’t do them.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Lisa,
It’d be a miracle if your nose looked completely healed at 2 weeks after even the most simple of Rhinoplasty surgeries. My money would be on further healing until about 6 months post-op. Hey, be happy it looks great so soon.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Hi Dr Palmer,
I had a closed rhinoplasty 7 months ago, my surgeon said he used the golman’s tip procedure. I still feel as though my nose is still bulbous. Will there still be swelling or is this unlikely after this amount of time.
Thank you,
amy :: 1 year, 6 months after
Dr Palmer,
Thanks for your advice! You’re right it’s much more even now that it has been 3 weeks! Best decision I ever made!!!
Sarah
Sarah C :: 1 year, 6 months after
Amy,
Goldman tip technique is an older tip thinning procedure where the tip cartilages are cut…often gives the vertical line appearance that can be seen in some noses. See how you like it and if it’s not right, you may consider getting a second opinion.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Hi Dr. Palmer,
It’s been a little over three months for me and some days my nose looks really great, but the last three days it’s been swollen at the tip and along the sides of the nose leading to the tip. I also started working out again in the last few days, pretty heavy cardiovascular on the treadmill. Could the exercise be making my nose swell, and if so, is that OK? Is it normal for my nose to still swell to the bulbous look at three months?
Thanks so much as always,
Karen
Karen :: 1 year, 6 months after
Just one more thing: it seems to swell sometime in the strip between the nostrils and up towards the tip, is that normal at three months?
Karen
Karen :: 1 year, 6 months after
Karen,
The cardio is probably to blame but at 3 months the structures inside the nose should be stable after your Rhinoplasty. You might consider icing the nose after workouts to minimize the swelling. Other advice from your plastic surgeon that did the Rhinoplasty. Columellar swelling OK…red or painful skin, isn’t…should that occur, see your Rhinoplasty surgeon ASAP, especially if you have internal sutures or grafts in that area of the nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Thanks Dr. Palmer!
The columellar isn’t red or painful. Another topic: awhile ago I mentioned to you that my PS told me that the bone at the top of the nose develops calcification, and you had never heard of that. I asked him again, and he apparently I misheard him, he hadn’t said calcification, he said calcium. He explained to me that when the bone heals it develops some calcium over the top which eventually sheds or your body somehow gets rid of. He said if I look, sometimes I may notice a little largeness on one side, then the next day it may seem to shift to the other side, and back and forth. Have you heard of that? Also, how long should I wait before I see the final result at the bone at the top, and the final result at the tip? Is there a different time frame, or is it generally a full year for both.
Thanks again and sorry for such a long post.
Karen
Karen :: 1 year, 6 months after
Karen,
Once again, no. What moves from side to side is nothing more elaborate then tissue swelling. Calcium would not be absorbed so readilly and in my opinion is not formed over the nasal bones to any appreciable amount after a Rhinoplasty in normal circumstances. Just my humble opinion after over 20 years of doing Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Karen,
Final results vary depending on what was done during your Rhinoplasty. I don’t know the answer to that question, so the outside range would be 6 months to 12 months after your Rhinoplasty. Could be as soon as 3-4 months in best case scenario.
Dr. Francis R Palmer….off to OR.
drfpalmer :: 1 year, 6 months after
Hello Doctor,
Is is possible to have a swollen nasal bridge during the recovery process? I mean, Ive hard of a swollen tip due to the cartillage, but never ’swollen bone’.
I had Rhinoplasty a month ago to straighten out the nose, (I have broken it twice), and I had a thick brige and tip, tip looks great now, but the nasal bridge looks crooked and thick… Is it possible that it’s swollen? (I had Rhinoplasty in early December).
Thank you for your help!
- If it is swollen, could I ice it or tape it?
Pj :: 1 year, 6 months after
Pj,
Very much so…for the first 3-4 months. It may even change from side to side…day to day. If you’re concerned it’s something other than swelling…talk it over with the plastic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Hi Karen,
Just reading your message now. I’m just over 3 months now and am finally beginning to see the new shape. Like you- sometimes, it looks really different from other times, apparently because of the swelling and it makes me think that the changes I thought I saw just a few days ago are all in my head! Sometimes it seems like it looks good. Sometimes it doesn’t. So I’m gonna hang on in there for 1 more month or 2.
vanessa :: 1 year, 6 months after
Hi Vanessa, I think my nose looked better a month ago then it has the last week. Right now it seems thick, all the way from the top down to the tip. I’m feeling more nervous about it now then I did before.
Karen
Karen :: 1 year, 6 months after
Hey Dr.,
I just got rhinoplasty done a week ago and I know it’s still early and a lot of the swelling still needs to go down…however, I’m getting really concerned b/c my smile has completely changed! It’s as if my top lip is so tight I can’t even show my teeth when I smile and I look like the Joker from Batman for crying out loud…! Please tell me that this is something that will probably go away right???
Sincerely,
Diego
Diego :: 1 year, 6 months after
Diego,
Holy Crooked Smile Batman…..this should be temporary swelling, but since you’re really concerned…call the plastic surgeon that did your Rhinoplasty and ask why this is happening. At the very least, the answers should make you fell better.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Dear Dr. Francis,
Thanks so much for the quick response, I have an appointment on Friday to get all my answers! If nothing else if unfortunately there IS a permanent problem do you think there’s a way to fix a smile like that? Sorry for being so overly-concerned it’s just that I’m so scared of being one of those people who comes out of cosmetic surgery losing the GOOD features I actually had! Thanks again!
Diego
Diego :: 1 year, 6 months after
Diego,
It’s impossible for me to say because I really have no idea what your plastic surgeon did during your Rhinoplasty. However, it does seem unlikely after performing Rhinoplasty for over 20 years that the plastic surgeon could have permanently injured the nerves to your upper lip..of which there are many. Based on that experience and knowledge, I’d make an educated guess (and once again it’s a guess because I wasn’t there at your Rhinoplasty) that this is a temporary thing.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Dear Dr. Palmer,
Thanks doc! you definitely put me at ease
I was getting too worried to soon 
! Thanks again doc!
Diego
Diego :: 1 year, 6 months after
Diego,
No problem.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Dear Doctor,
I recently had a revision done just to add a cartilage graft to even out the side of my nose which was slightly depressed. After my primary, I noticed that when I laughed really hard and for a long time, sometimes something along my septum, very close to the columella would move. After my revision, it is moving a lot more. When I lay my head to the right side, for example, it sort of falls down and when I move back up, it goes back in place. I can actually put my fingers inside and move it back and forth (don’t worry, I don’t do that all the time!)
I was wondering if this is serious and whether I should let my surgeon know. I am 2 weeks post op so could it still be healing?
Thank you
Jessica :: 1 year, 6 months after
Jessica,
Nothing should be moving. You may want to ask the plastic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 6 months after
Dear Dr Palmer
Hope you are well.
I wondered if you could advise me on something. I am due to have my revision in April. My dermatolagist recently put me on a course of roaccutane. Am I ok to take it during my rhinoplasty? I have heard some worrying things. My revision surgeon says that it is fine. What are your views?
Thanks
Pat :: 1 year, 7 months after
Pat,
I’m not sure….I’d ask the dermatologist if there are any scar issues with this drug during and after you’ve completed a treatment cycle. Accutane has been documented to increase scar formation in facial resurfacing even a year after the course of meds have been completed. Now, the question is whether a revision Rhinoplasty would suffer the same fate with an increased incidence of internal scarring. Hard to say….any reason not to wait until 12 months after you’ve finished the accutane?
Dr. Francis R Palmer, III
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Hi again Dr Palmer
I wish that I had the patience, but I am having severe breathing problems because of my primary, so much so that I am having difficulty sleeping. April will be a year after my primary.. April will also be when my course of roaccutane stops, but I don’t think I can go another year waiting for a revision, physically or mentally. It’s like a vicious circle, becuase it was the stress of coping with my failed primary that contributed to my acne developing.
I have asked my dermatologist, he is unsure too. He mentioned that skin resurfacing is a definite no but was unsure about surgery. My revision surgeon has said that there is no problem, he mentioned that he has operated on some patients who had or were using accutane because apparently it makes thick skin easier to work with. However in the past few days, I have read that the tissues in the tip need oils to heal. The jury seems to be out, as I have asked a number of surgeons and medical bodies, and all have conflicting views.
When you say that it may increase the likelihood of internal scarring, do you mean scar tissue?
Thank You
Pat
Pat :: 1 year, 7 months after
Pat,
Yes, internal scar tissue which could decrease the aesthetic result. Not sure what to tell you, my gut…is that I’d not operate on your Revision Rhinoplasty if you were consulting with me until a year after you’d completed the course of accutane. Just my opinion.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Dr. Palmer i wrote you a while back, I just had my 3 months post op pictures (open rhinoplasty to shave small dorsal hump and refine tip). When looking at the photo’s my PS confirmed what I thought, my bridge appears wider. He explained he didn’t know why it is like that, unless by shaving the hump it now appears wider. He told me to wait till it has been a year and then at that point we can decide if it needs revision work. What are reasons that my bridge could appear wider? He said he did minimal work on my bridge. Could it still be swollen 3 months out?
Alexis :: 1 year, 7 months after
Alexis,
Could be..could also be an open roof where the edges of the bone are wider once the top has been shaved off. Like taking the top of a pyramid off…the sides become wider, the more this occurs. I’d have to see and feel the bridge of your nose in order to make that distinction.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Dr. Palmer,
I really want the L-shaped silicone removed, not very happy with it. My question is…do PS usually charge their patients again to have it removed? And also will my nose look the same as it was before I had the surgery?
Thanks.
Jen :: 1 year, 7 months after
Jen,
No idea if your plastic surgeon willl charge you to remove the L shaped silicone graft. No, in my opinion, the placement of an L-shaped silicone graft changes the tip anatomy and will require a tip-plasty and perhaps an ear cartilage graft to the tip in order to restore tip shape and support once the silicone graft is removed.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Dr. Palmer,
I am supposed to be having rhinoplasty done on the 20th of February and my wedding is on the 15th of June. This gives me 4 months to heal. Taking into account your experiences in regards to plastic surgery, would you suggest i postpone the surgery until after the wedding or go ahead with the surgery as it is currently scheduled.
I asked my plastic surgeon and he said that come the time of the wedding, the only person that will notice the swelling of my nose is me and me only and that I can go ahead with it without any worries.
I was just hoping to get a second opinion.
Nicole
Nicole :: 1 year, 7 months after
Dr Palmer,
You said in one of your blogs that you don’t let your patients blow their noses until 6 months after. What happens if you blow your nose?
vanessa :: 1 year, 7 months after
Hi Dr Palmer
I was reading through people’s questions over the months, and your answers. I came across one where you said “severe problems can arise if a revision Rhinoplasty is performed before a minimum of 6-12 months after the initial surgery”.
What are the severe problems that you talk about?
Also, are there some circumstances where the quicker a revision is performed, the better? I have read somewhere that if a nose has been overshortened, then waiting a long time to revise may cause the skin to shrink too much which is then difficult to stretch/lengthen during a revision. Is there any truth in this?
Thanks as always (“,)
Pat :: 1 year, 7 months after
Karen,
Thanks for getting back to me. I’m really glad because the reason I came back on this blog is because I’m having the same problem you’re having. My nose seems to be thicker than it was a month ago too! I remember I was feeling quite happy about it. My surgeon’s really laid back about the whole thing. He just says the swelling will stabilize and the tip definition will improve over the next few months. I don’t know if that helps?
vanessa :: 1 year, 7 months after
Hi Dr. Palmer,
Sorry, me again. It’s hard to get an objective answer from my surgeon because I don’t know if he’s trying not to panick me and just taking a ‘wait and see’ approach. That’s why I keep blogging. Basically, I was wondering- what sort of things cause delayed healing? Continuous blowing? Excercise? I’ll health? Bad diet? Extremely cold/hot weather? Since you said it can vary from a quick result (3-4 months)to 6-12 months. Does the thickness of the skin also determine how long it takes to settle? I have quite thick skin…
vanessa :: 1 year, 7 months after
P.S This is one of the best blogs!
vanessa :: 1 year, 7 months after
Vanessa,
Yes, blowing the nose causes a great deal of increased pressure in the nose and the blood vessels that suppy the nasal tissue…which can cause increased swelling. Grasping the nose and twisting may also dislodge cartilage sutures and grafts. For these reasons, I advise my Rhinoplasty patients not to blow their nose for 6 months…if there are dorsal or tip grafts, it’s been a difficult Revision Rhinoplasty (they had 5 or even 9 previous Rhino’s elsewhere and I did the latest revision)it could be 9 months or longer.
Different Plastic Surgeons have different levels of experience and therefore do things differently. I have great success with my Rhinoplasty patients…I may be more strict about the post op course but hey, in the end everyone wants a good looking nose after their Rhinoplasty. The effort is worth it.
Thanks for your kind comments about my blog.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Hey Pat,
I think you may have read that comment out of context. If the nose has been over-resected and shortened..the skin won’t just keep shrinking. If the septum has been damaged due to trauma and dies…the nose could shrink but that takes many months.
Now, here’s the reason you can’t/shouldn’t have a Revision Rhinoplasty before 6 months…and that’s the minimum and would only be done at that time if your nasal skin appears ready to handle another surgery.
Rhinoplasty causes disruption of the nasal skin’s blood supply. This takes about 6 months to recover…hence the 6 month wait to do another Rhinoplasty which will disrupt the skin’s blood supply once again. There have been cases where Rhinoplasty Revisions were performed sooner then the 6 months and the skin had permanent cobble stone appearrance in the skin from problems with the blood supply.
I won’t do a Revision Rhinoplasty sooner than 6 months on someone else’s patients and would only do it if I felt the blood supply was adequate enough to go through another nasal surgery. Permanent problems with the nasal skin will make you more upset than any imperfections in your nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Nicole,
That’s a slippery slope…having a Rhinoplasty 4 months before such a huge event. The average healing time for a first time simple Rhinoplasty is 6 months. I didn’t see you in consultation, so I have no idea whether yiu have thick skin, strong cartilage, require grafts or other factors that nay make your Rhinoplasty even more difficult.
Because of the incredible pressure and intense scrutiny that many to be brides place on themselves, I personally wouldn’t agree to do your Rhinoplasty within that time frame. There is liitle upside and a huge downside…the nose at the day of your wedding is swollen, crooked or you just plain don’t like the way that it looks.
Have a wonderful time planning and enjoying your wedding…then after the honeymoon when you are not pressured, revisit the idea of a Rhinoplasty.
Just my humble opinion.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Hi Vanessa, I have a friend who had rhinoplasty one year ago October by the same PS that did mine. She swears her nose was thick and very swollen at six months, and swollen even at nine months, and then she started feeling like her nose was finally “losing weight.” She says it really did take a full year for her nose to reach the final result. So I keep hanging onto her every word, because some days my nose looks pretty good, others it doesn’t. Tonight for instance, it really looks like a sausage on my face. I’ve even been measuring my nose with a tape measure at certain areas since right after the splint came off,(I know I sound fanatic) but the measurements don’t change! They haven’t changed in months, and that concerns me for one, but also, if the measurements don’t change, why does it look bigger some days then it does others? Anyway, keep coming back to this post, and we can compare notes. It may help our anxiety a little.
Karen
Karen :: 1 year, 7 months after
Hi Dr. Palmer,
Lots of us talk about our nose looking thick and swollen, but sometimes my nose looks “longer” than other days, not so much from the profile, but from the frontal view. Am I the only one feeling that way or have you heard this before? Why would it look longer?
Thank you so much for your dedication and commitment!
Karen
Karen :: 1 year, 7 months after
Karen,
That is so funny…measuring your nose with a tape measurer. Don’t worry, I’m pretty obsessed about it to. I’ve got all these pictures of myself on my camera phone and digital camera. Anyone who didn’t know me would think I’m very vain! This blog really helps. Thanks for your advice. I guess I’ll keep hanging on in there. I just don’t understand how the swelling can be “going down” over the months and it looks bigger and bigger??
vanessa :: 1 year, 7 months after
Hello Dr,
I had Revision Rhinoplasty 2.5 months ago, it was to close my open bridge deformity so that the sides would look nice and straight as opposed to bumpy (like a boxers nose)…
Anyway, my nose still looks bumpy like before! and it’s red on the bridge, should I be icing it daily? And will my nose eventually look like what I had in mind?…
Thanks a lot,
Amy
Amy :: 1 year, 7 months after
Also, can I resume with excercising yet?
And do you know any technique on how to clean out the nose at this point, since I can’t blow it for another 4 months?
Thanks a lot,
Amy
Amy :: 1 year, 7 months after
Hi Dr Palmer,
Just a quick question!! When can i start using sunbeds again after my closed rhinoplasty?
Thank you!
Amy :: 1 year, 7 months after
Dear Dr. Palmer—
So….I’m here again with concerns. I am almost 6 months out from that open rhino now, where I had only tip work done, no bone work.I had a weird looking tip, line down the middle and some bumpy protrusions that were out of place. So now the tip looks smoother, no big protrusions and no line down the middle (yeah!) but (of course there’s a but!) my tip is still big and bulbous and hard. Is this normal at 6 months yet? Can there really still be swelling in that area at this stage in the game? Also, my columella is still fat and sticks out further than it should or did (from profile angle). It wasn’t fat beforehand and my PS did not put any artificial anything in there, so why so fat yet? Can this still be swollen yet, also? If so, is there anything I can do to hurry it up? And lasty (sorry!), I can still see the incision line on each side of my columella (not so much from the front), do you think that scarring will improve with time yet? The scar is hard and red and sticks out pretty far, it makes it look obvious that I’ve been cut, in my opinion. Thanks so much for your time and thoughts on my situation….I saw my PS the other day and asked him all of this, but he was a bit defensive and wouldn’t really answer my questions directly, pretty much told me to stop being so “nitpicky” (I agree I am focused on details here, but I just want his opinion on how things are looking, since he’s done this sort of thing for 20 some years!). Thanks again, you’re a gem 
LB
I’m back!! I posted about 5 months ago, when I was only about 2 weeks out from an open rhino (silly, impatient girl!). You fabulously eased my mind, big thanks for that
LB :: 1 year, 7 months after
Hey Vanessa, I guess our noses still look swollen sometimes, but does your nose ever FEEL a little sore? Sometimes (like today) my nose feels sorta sore and raw and a little under pressure. It doesn’t hurt to touch it, just a little sore on the inside. -Karen
PS: Dr. Palmer, can you comment on this too? It’s almost 4 months post op. Thanks!
Karen :: 1 year, 7 months after
Karen,
The length of the nose is dictated by the rotation of the nasal tip. Less rotated tip=longer nose and vice versa. This will not change over the post-op course…I probably would not measure my nose often…remember hwt I preach “you don’t need a perfect nose, just opne that appears sleek and refined”. Don’t over obsess about your nose as this often leads to multiple unwarranted Rhinoplasty surgeries.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Amy,
Sun beds or suntans to the nose will increase the blood supply and swelling to the nose. Best to wait at least 6 months…after your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Amy,
Bumpy is one thing, red is quite another. If your nose is red, you really need to see the plastic surgeon that did your Rhinoplasty to rule out lingering infection or irritation fron sutures and/or grafting materials. Ask the plastic surgeon his/her suggestions about when you can exercise etc. Each plastic surgeon will have his/her own set op post Rhinoplasty guidelines and you should follow your plastic surgeons during this eatly post Rhinoplasty stage.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
LB,
The tip may be swollen for 9-12 months after an open Rhinoplasty (tiplasty) with the average being 6 months. Not sure what the plastic surgeon did to your nasal tip during the open Rhinoplasty, so I’m at a loss as how to advise you from here forward. The plastic surgeon should explain things to you so that you have an idea if the tip is what it will untimately be or if there is still residual swelling. This is a reasonable question.
The scars. Scar heal in different ways. As the plastic surgeon if he thinks some topical steroid or silicone ointment may be in order. I have also done Rhinoplasty for over 20 years and still take the time to see my Rhinoplasty patients once a month to review their progress, teach/re-teach nasal manipulations or just explain how things look aesthetically. It’s what they pay me for….
For my readers, these seeemingly minor differences are why some of use charge more money for our Rhinoplasty surgery than others. Experience and follow up care. Is it worth the extra cost? Most people would think so, especially after they’ve had Rhinoplasty and have many unanswered questions.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Karen, yeh- my nose does sting a little from time to time on the inside.
vanessa :: 1 year, 7 months after
Dear Dr. Palmer,
Could taking Climara Pro (hormone replacement therapy) interfere with my rhinoplasty healing in any way? I am 4 months post op. I just want to make absolutely sure before I start this therapy. Thanks so much for all your help. Karen
Karen :: 1 year, 7 months after
Dear Dr. Palmer
At 8 months after my septoplasty, the tip is still very stiff and tender. There is still internal swelling. Any idea when I may have some relief from the stiffness and swelling??? I am worried that perhaps I am accumulating excess scar tissue at the tip. Would injections help?
Thanks. Stacey
Stacey :: 1 year, 7 months after
Stacey,
They might but without seeing you in person, I really have no way to know. Have you discussed this issue with the plastic surgeon that did your Rhinoplasty?
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Hey Stacey,
By the way, you had to have a Rhinoplasty with tip work in order to have post Rhinoplasty tip stiffness. A Septoplasty would not, by itself, effect the nasal tip but rather just the internal septum.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 7 months after
Hi – I had a nose job over 20 years ago to remove a bump. I went back for rhinoplasty recently to have my nose made smaller. It went well, until at a checkup, the nurse seemed to think my nose was crooked and pushed it so hard I nearly threw up. From that point on, my nose looked crooked and like it was broken from front view. I had to wait 6 months and they redid my nose. I said I did not want the profile changed, yet they did change it, stating I had had a deviated septum which they were not aware of. Now, after having a strait nose all my life, I have a sort of ski lift. People say I don’t look like the person they knew. Oh well. It is done and I will not go for another surgery after having three in my life.
1) The last surgery was 1.5 years ago and my nose is still considerably swollen on both sides. Is this normal? (My doctor says it is, but I am not so sure.) Is there a way to expedite the swelling out?
2) Also, one nostril is literally 3/4 inches higher than the other (only noticeable from front). What is the probability this could change significantly when and if swelling ever goes down?
Thank you
Sher
Sher :: 1 year, 7 months after
Oops – I meant to write that one nostril is 1/4 inch difference, NOT 3/4 inch.
Thank you
Sher
Sher :: 1 year, 7 months after
Just a quick question to Dr. Palmer- does the swelling take longer depending on how much work you have had done on the nose. i.e if you have had work done on your tip and bone will this take longer to heal than someone who’s just had work done on the tip?
vanessa :: 1 year, 8 months after
Hello Dr. Palmer,
I had a septo-rhinoplasty about 10 days ago, and it all went very well. I had a bump removed and some work done on the tip. I can now breath better than before, and my nose looks much smaller and feminine. There is just a tiny problem though. Everytime I take pictures of my nose from the side, it seems like there’s a tiny bump forming on it. I cannot see it in the mirror, but it shows in every picture I have taken of my profile since the cast removal. Could it be just the swelling and should I wait a little before taking this issue up with my surgeon?
seema :: 1 year, 8 months after
Vanessa,
Yes, exactly as well as how many times the nasal tissue has been operated upon. That’s why more complicated and Revision Rhinoplasty takes longer for the swelling to subside.
Dr. Francis Palmer
drfpalmer :: 1 year, 8 months after
Seema,
10 days is way too soon to worry about small lumps and bumps. Swelling will subside over the next sevral months but ask the plastic and cosmetic surgeon who did your Rhinoplasty at your next follow up appointment.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
Sher,
It would be a bit unusual for the swelling to still be there after 1 1/2 years but not imposssible. The nostrils will not change at this point, regardless of whether, or not, there is residual swelling.
Rough manipulations that are painful can cause damage to the nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
Thanks Dr. Palmer. Hindsight is 20/20 as they say. Now that I have been through this process, I wish that my visits with the PS were monthly. Would have alleviated anxiety. Your response helped. All the best!
Stacey
Stacey :: 1 year, 8 months after
Thanks Stacey.
Dr. Palmer
drfpalmer :: 1 year, 8 months after
Dear DR. Palmer
I have 2 rhinoplasty operation 5 years ago using the silicon implant with the combination of alarplasty, the result is pair sharp pointed nose, i am planning for revision rhinoplasty and alarplasty using costal rib graft or goretex with the combination of tip plasty using ear cartilage, because i want to be in a natural near perpect nose & tough even by hitting.
1. How long it can be healed?
2. If it is fully healed, it can be serve as tough nose
and or original nose durability, specially when hitted?
3. Can the rib graft & earbone gives me much sharp bridge and pointed tip than to my current silicon implant?
4. which is tough goretex or rib bone when hitted?
5. Can these natural operation gives me much more beautiful results?
THANK YOU VERY MUCH DR.PALMER I BELIEVED IN YOUR KNOWLEGE AND THE GOD WILL ALWAYS SUPPORT US.
PLEASE HELP ME DR.PALMER i will wait for your reply
GUDLUCK
SQUALL :: 1 year, 8 months after
Squall,
Let me first say that when you have a revision Rhinoplasty about 6 months later, your nose should be stable. Now, in my experience performing Rhinoplasty and revision Rhinoplasty the best to re-shape the tip area is a conchal cartilage ear graft.
The best material to re-shape the nasal bridge is a silicone straight nasal graft…not the L-shaped graft.
Gortex, which I used on many Rhinoplasty cases in the 1990’s, has a bad habit of becoming infected years after the Rhinoplasty for no apparent reason. For this reason, I do not use Gortex in noses anymore. Rib cartilage, ear cartilage, banked cartilage and bone when used on the nasal bridge all have the problem of dissolving unevenly over years and for this reason, I no longer use these materials.
You can e-mail us photos of your nose at drfpalmer1@aol.com and you can always call and schedule a consult at 310-652-9583.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
Dr. Palmer,
I have a silly question..Since your office is in Beverly Hills, are all the people who come to see you rich? Can the average American people like me afford your service? Lately I’ve been watching the show “Dr. 90210″ and it seem like the patients they show are people who have more money than most of us
Just can’t help but wonder..cause I’m thinking about seeing you for a revision rhinoplasty. Thanks.
Jen :: 1 year, 8 months after
Hey Jen,
I have for the past 20 years had patients that are everything from teens to schoolteachers and yes celebrities, socialites, royalty and captains of industry.
There are numerous finance plans for those who need assistance and our patients do use this service. You can visit our website at
http://www.drfpalmer.com/PlasticSurgeryFinancing.html
or call the office for more information at 310-652-9583.
Never select plastic surgery or a plastic surgeon based on cost. Find a plastic surgeon capable of doing what it is that you require…
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
Just a quick question Dr. Palmer- does going to the sauna affect the nose? I’m 5 months post open rhinoplasty and whenever I go, my nose feels like it’s burning inside and I get this weird smell that lasts for days.
Also- another- you said in one of your blogs that the vessels in your nose re-attach themselves only after 6 months. Next month will make it 6 months for me. Should I expect any major changes in the way the nose looks? Will tip definition still continue to improve for up till 9 months?
vanessa :: 1 year, 8 months after
Thanks Dr. Palmer, and does revision rhinoplasty usually costs a lot more? Sorry for asking alot, I’m just so unhappy with my rhinoplasty and feel like I really wasted so much time and money.
Jen :: 1 year, 8 months after
Jen,
Revision Rhinoplasty is always more difficult than a primary Rhinoplasty and typically will cost more. You are welcome to e-mail us pictures of your face and nose at drfpalmer1@aol.com and even set up a phone consult to review these photos. You can call the office at 310-652-9583 to set that up.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
Vanessa,
I’d avoid the sauna if it causes youe nose to sting and have a strange odor…which is an infection until proven otherwise. You may want a follow up with the plastic and cosmetic surgeon that did your Rhinoplasty just to be sure all is OK. Lymphatic vessels take up to 6 months to hook up after an open Rhinoplasty…quicker with a closed Rhinoplasty and yes, depending on what tip technique you had, it could be 6-7 months until tip is well defined.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
Dear Dr.Palmer
I Had septo plasty 3 months ago on Jan 15th and also had extensive tip surgery such as narrowing the nose and bringing it back. I noticed a huge difference in the swelling from Jan 15th and now, however my nose looks about the same size now than it did before surgery (maybe a little bigger) is this due to the swelling, this was a Revision rhinoplast and The doctor told me the swelling is going to take longer for it to subside. my question is the size doesnt seem to be going down any further or maybe just not noticable,is this something i should be worried about, i had a very wide tip before. Also, in the mornings when i wake up my nose is very swollen (eventually goes down as the morning goes on) is this normal? i’ve emailed my doctor but hes on vaca for 2 weeks. have you ever heard stories of peoples noses becoming bigger and staying that way after surgery? just wondering if you could help me out on this one
thanks alot
bill
billy :: 1 year, 8 months after
Bill,
If your nose swells up during the night and gets smaller throughout the day, your nose isn’t healed from the Revision Rhinoplasty. I have no way of knowing how samll your nose will be after after all the swelling is gone….and yes, a nose can be larger than it was before a Rhinoplasty if excess scar tissue forms around the nasal tip or just above the tip (“Polly Beak” deformity). You may want to ask the plastic and cosmetic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
Dr palmer
I have a friend who 2 and a half months ago got extensive tip surgery done. right now hes back into wrestling and i’m trying to tell him that its not a good idea, can to much pressure on the nose 2 months after surgery produce scar tissue? if so when is it safe for him to start wrestling again. he also had a deviated septum which was fixed? can to pressure also deviate it back over again in the long run.
thanks alot
sally
billy :: 1 year, 8 months after
Billy or Sally,
Wrestling, in my opinion, should be avoided for 6 months…about the time it takes to secure the nasal tip after extensive tip work during a Rhinoplasty. The tip work most likely included sutures to reshape the tip cartilages….wrestling can cause a twist or trauma to the nose that might tear or pop those sutures resulting in a deformed tip. I warn my Rhinoplasty patients that box, wrestle or do mixed martial arts that those activities could cause damage to the nose that would require Revision Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 8 months after
i hit my nose not directly on bridge but off to the side. i hit it with my hand pretty hard. can swelling be hard or is that sound like scar tissue?
EJ :: 1 year, 9 months after
EJ,
If you hit your nose that hard, you need to follow up with the Plastic SDurgeon that did your Rhinoplasty to rule out nasal trauma.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Dr. Palmer,
I was reading what you said about scar tissue forming for people with thick skin. Apart from nasal manipulations- how else can you prevent scarring occuring and how do you know if scar tissue has formed? Next month I will be 6 months post-rhinoplasty and my nose still looks like it’s very big. I’m worried it will remain this way and I don’t think my surgeon will give me an objective answer if I ask him.
vanessa :: 1 year, 9 months after
Vanessa,
Kenalog injections to the subcutaneous tissue just above the nasal tip is another way to decrease and control the amount of scar formation after a Rhinoplasty. You’ll have to see the plastic and cosmetic surgeon that did your Rhinoplasty for some guidance or for a referral to someone else that’ll do the evaluation and injections if they are warranted.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Dr. Palmer
I had an open rhinoplasty about 10 weeks ago. Every morning I wake up with swelling but have decided this is pretty normal after reading your answers to the patients above. I do have a concern. For the past several weeks I am having problems with feeling like there is fluid in my ears and sometimes dizzy. It comes and goes. Have you heard of this before?
Sherry :: 1 year, 9 months after
Please help. I Went for tip lift and narrowing of the tip 5 month ago and instead the doctor gave me a flat underprojected nose it is horrible. I went back to his office and asked him too fix the problem but he straigt out said no that his work was beautyful
Juac :: 1 year, 9 months after
Hey Juac,
I’m sorry to hear that. You can see me in person or e-mail pics of your nose to drfpalmer1@aol.com or call for an appt at 310-652-9583. In 1 month, you’ll be 6 months post-op from your original Rhinoplasty and if it’s appropriate, you could have a revision Rhinoplasty to lift and define your nasal tip. After I see you or your photos, I’ll have a better idea of what’s required.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Sherry,
I would not think that your middle ear fluid and dizziness is related to your Rhinoplasty. You should see an ENT doctor in your area as soon as possible for a workup.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Doctor i have a question me and my sister we get injected with silicone injeccions the 2002 a friend invite us to the apartment of a friend and a lady was injecting silicone and we ask what is that she say is a sintetic polymer i think,and make you body look nice is any complicacions with that, no she say well and we dont know anything about that and we deside to get injected and the problem now my sister start to have pain and the hips and im scare and i think when i sit to much my buttocks star to hert and after few months ago we start to look for information on the computer, and we get scare and the problem we are very goog loocking sister and how we can get remove that with out scar please advise and also we know where tha stupid lady live, she come from Peru to inject people here but we dont know where she stay here, please sendme tha information to my email thanks i feel so sad how i let some body abuse of my on experience an do that.
lucia :: 1 year, 9 months after
Lucia,
Silicone can cause inflammation and redness of the skin. Both you and your sister need to see a Dermatologoist in your area for evaluation.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Hi Dr. Palmer,
I had a rhinoplasty about 5 weeks ago, and since then, I have been experiencing significant nasal congestion. Although there was a lot of work done on my nose (surgery took over 4 hours), I am a little concerned by not being able to breathe through my nose at all without the aid of a nasal spray (Afrin), which works quite well. For the past 3 weeks, I have been spraying every morning and night. I’m not sure if this is a safe thing to do, but my real question is, how much longer should I expect the stuffy nose to persist?
Thanks!
-Jason
Jason :: 1 year, 9 months after
Jason,
Please contact the plastic and cosmetic surgeon that did your Rhinoplasty right away and tell him/her that you’ve been using Afrin in your nose twice a day for the past 3 weeks. Some surgeons believe the vessel constriction that Afrin creates can inhibit healing after a Rhinoplasty. As a separate issue, nasal spay degongestants can cause a rebound increase in nasal swelling and a dependency on the product. Your plastic surgeon can explain this to you or refer you to an ENT surgeon for more information and possible treatment.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Hi Dr. Palmer,
I’m writing to you because I am a little worried about my nose. I had a rhinoplasty one month ago (my third rhinoplasty) and I don’t know what to do to reduce the nasal swelling. My surgeon is not very kind and he never answers my questions or doubts. Should I massage my nose or not? Should I apply ice to reduce the swelling?
Thank you very much for your attention and kindness.
Mireia
mizunzu :: 1 year, 9 months after
Dr. Palmer,
I had a septorhinoplasty 4 months ago, and I feel that at this point my swelling is much greater than it should be. Because of this I am also concerned about pollybeak deformity. My doctor gave me a cortisone shot 1 month post-op, but refuses to give me any more.
Basically I am wondering whether or not I could get a second opinion from another doctor, and whether or not another doctor would be able to administer a cortisone shot?
Thanks.
Corey :: 1 year, 9 months after
DR Palmer
I had my surgery nearly 4 weeks ago. I was silly and noticed a whole lot of blackheads, so bought some nasal strips, they are just fabric but turn hard after 15 mins and are supposed to remove black heads. I only oused it on the middle/ lower half of my nose, but after i removed the strip the swelling(That i didnt realize i’d had)had seemed to of been pushed down into the tip of my nose, its been a week now and the tip of my nose feels stiff and numb and looks big and pointy. if i apply a small amount of pressure to the tip the swelling temp gos. But how long is it before it goes altogether? Or is there anything i can do to get it back where is was? Thanks
jo :: 1 year, 9 months after
I am on my 9th day after a rhinoplasty
I had to take my cast of a bit early…myself because I have developed allergies to the glue which the cast was attached with. My eyes are all red and swollen and Claritin is not helping. What do I do?
Stella T :: 1 year, 9 months after
Jo,
I think you should mak an appt and see the plastic and cosmetic surgeon that did your Rhinoplasty and explain what happened. let him/her examine your tip and make recommendations.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Stella,
Cal the plastic and cosmetic surgeon that did your Rhinoplasty and see what he/she wants to give you. He/she may recommend a medrol dose pack.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Corey,
You, as a patient always have the right to another opinion. That plastic and cosmetic surgeon may or may not think another kenalog shot is in order…you’d have to go and see what happens.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Mireia,
You’ll have to get your specific post rhinoplasty instructions from the plastic and cosmetic surgeon that did your Rhinoplasty. That’s the only person that can councel you during the early post-op phase. For what it’s worth 100% of my Rhinoplasty patients do post Rhinoplasty nasal manipulations according to my instructions for 6-12 months.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Hi Dr. Palmer.
I had a rhinoplasty performed in September 2004. However, the result was that I was left with a thin nasal bridge but a slightly-bulbous tip. I know it has been almost 4 years, but would Kenalog-40 be an effective option at this point to help reduce some of the thickness to the tip and the area just above it, or would a tip revision be a better alternative? I feel like I have a slight pollybeak nose. Thanks, Bill
BILL :: 1 year, 9 months after
Good news to Karen- after six months of waiting my nose is starting to resemble something looking like a normal, flattering nose! Judging by the less frequent blogs from the regulars, everyone else must be a bit happier too and out in the sun enjoying their new noses! I was pretty tempted to do so too but decided to do one final blog, sharing this information.
Dr. Palmer-thanks for all your advice and support. Best of luck!
vanessa :: 1 year, 9 months after
Hi – I had my nose tip refined a year ago. Then about 3 weeks ago had the top of my nose (bone) narrowed – closed rhinoplasty. My nose looks so perfect and I’m really thrilled with the result. What are the chances of it changing shape (scar tissue)? I so hope it stays like this.
Roslin :: 1 year, 9 months after
Hello Dr. Palmer,
I had a rhinoplasty (my third one) 5 weeks ago. Everything seems to be ok, but I’m concerned about the following matter:
I wear braces and I have to put some rubber latex on during the nights to keep my bite stable. The fact is that I cannot open my mouth, so when I yawn all the pressure of the air goes out from my nose. I’d like to know if when I yawn during the nights through the nose (because my mouth is closed), my nasal bones can be affected or shift their position (they were fractured during the surgery).
I’d like to know if I can use these rubbers during the night (and yawn through my nose eventually) or I should wait a little bit more to avoid nasal bones damages. If so, how many weeks more?
After 5 weeks post-op, how fragile are the nasal bones?
Sorry!!! But I’m really concerned about damaging my nose.
Thank you very much for all your advice, support and kind attention.
Mireia
mizunzu :: 1 year, 9 months after
Mizunzu,
The nasal bones should be stable at 5 weeks. Yawning should not be an issue but you may want to call the plastic and cosmetic surgeon that did your Rhinoplasty and ask him/hr.
Dr Francis R Palmer
drfpalmer :: 1 year, 9 months after
Bill,
4 years is a bit too long for kenalog to be effective. Best done as the scar tissues are forming after the Rhinoplasty….this means within the first 6 months postop. You may need Revision Rhinoplasty to remove the excess scar tissue followed by nasal manipulations and kenalog 10 (40 is too strong in my opinion) if needed within the first 6-9 months after the Revision Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Roslin,
Scar tissue can build up anytime within the first 6-9 months after the Rhinoplasty…that’s why I have all of my Rhinoplasty patients do daily nasal manipulations and follow up for possible kenalog 10 injections if needed. I suggest you keep in touch with the plastic and cosmetic surgeon that did your Rhinoplasty to keep that tip just the way you like it. Best of luck.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Dear. Dr. Palmer,
Can you tell me how the collumela lift is performed? I had this done a couple of weeks ago but can’t figure out how it was done.
Thank you.
Jane :: 1 year, 9 months after
Jane,
There are several ways to tuck the columellar area…basically an incision is made behind the columella and cartilage and/or skin is then trimmed. A suture can be placed inside to rotate the nasl tip up during this procedure. Typically done as a closed Rhinoplasty. For more specifics, you’ll have to ask the plastic and cosmetic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Hi Vanessa (and Dr. Palmer), that is great news. Mine is looking great too. The tip is more refined and it’s so cute. I really love it. Thanks to both of you for all your support through the craziness. – Karen
Karen :: 1 year, 9 months after
Karen,
No problem. Glad you’re happy.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Hi Dr. Palmer,
How long does it take for the nasal passages to heal after a septo/rhinoplasty? At 10 months post-op, I have scabs on the inside of the tip area and have a constant stuffy, sniffly feeling, although I can breathe through both nasal airways. I am concerned about a perforated septum at this point. How long does it generally take for the nasal passages to heal?
stacey :: 1 year, 9 months after
Stacey,
This just doesn’t sound right. You may want to see the plastic and cosmetic surgeon that did your Rhinoplasty and/or an ENT surgeon for a complete evaluation of the inside of your nose.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 9 months after
Thank you for your response Dr. Palmer. Just one more quick question. I had the size of my nostrils reduced and they seem very asymetrical. I am 3 weeks post-op. There is a hard bump on the inside bottom of the right nostril, which kind of pushes everything up. Is this normal? Could this be caused by swelling from the stitches?
Thank you for your time and very informative website.
Jane :: 1 year, 10 months after
Just a quick question, Dr. Palmer(I keep asking my surgeon but he doesn’t seem to want to be specific). After six months does the nose still continue to swell and go down at random intervals. Because I was happy at six months but now I’m not happy with it again…
vanessa :: 1 year, 10 months after
…And also, after six months- does it swell more when you’re stressed the way it does in the first one or two months..?
vanessa :: 1 year, 10 months after
Jane,
At 3 weeks, it could be swelling…wait until 3 months or so then you can ask the plastic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 10 months after
Vanessa,
After 6 months the degree of swelling should be decreasing. In a primary Rhinoplasty the swelling goes away quicker than in a Revision Rhinoplasty. Remember that internal scar also forms a