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 Cosmeti