Healing after nose surgery

Successful rhinoplasties require performing nasal analysis that is both complete and very precise.

That nasal analysis targets all deformities, aesthetic and functional. A surgical plan is then created to identify deformities and provide long-term function.

Dr. Cuno follows his patients over many years post-surgery and works to maximize his long-term result. Regular post-surgical follow-ups are critical in ensuring a good result and we encourage follow-ups for as long as needed, even several years, to ensure long-term aesthetic and structural function, as well as your long-term satisfaction.

You need to be aware of treatment milestones. For example, at one-year post-op, your nose is only about 50% healed with the remainder of the healing occurring over your lifetime. Follow-ups try to resist the forces of scar contracture that can occur over time.

Postoperative care can have a major impact on your long-term outcome and satisfaction. We may frequently ask you to :

  • do nasal exercises or
  • tape your nose to decrease swelling

Occasionally you will receive steroid injections in certain areas to decrease scarring and swelling.

What can be done to reduce post-operative swelling/oedema

The application of ice is recommended for the first 48 hours after surgery to minimize swelling and hematomas. After 48 hours this will probably not change anything.

Head elevation helps reduce facial swelling and sleeping with the head raised may be beneficial for the first 2 weeks post-operatively.

The main function of the nasal splint is to reduce post-operative swelling, which is the reason some colleagues leave the cast on for two weeks. After taking the splint off at one week, there is often a transitory increase in nasal swelling.

Nasal taping will often be recommended on a case by case basis.

In vitro and in vivo studies demonstrate that bromelain (pine-apple extract) exhibits various fibrinolytic, antiedematous, antithrombotic, and anti-inflammatory activities. We often prescribe this a supplement.

We also often prescribe a short course of oral corticosteroids to lessen the burden of swelling (unless there is a contra-indication).

In some of our cases we offer complementary light biomodulation to hasten healing with low-level-light therapy (red light LED).

What can be done to minimize bruising?

We pay much attention to prevent bruising, the extent of which is related to the underlying surgery and technique. Osteotomies (controlled breaking of the nose during surgery) tends to cause more bruising. Several techniques are used during surgery to minimize this inconvenience:

  • there are arguments that the injection of tranexamic acid around surgery may decrease bruising
  • pausing and compressing with the use of cold gauzes right after osteotomies help reduce bruising
  • use of a careful atraumatic technique
  • other medications may be used during surgery

Avoiding any of the medications listed in the section “before rhinoplasty” is of great help.

Once bruising is present it can be camouflaged with concealers.

Topical or systemic arnica montana, a herbal supplement, can be of benefit to minimize bruising and discoloration post-operatively.

Topical Vitamin K (phytonadione) preparations have been shown to speed resolution of bruising and actinic purpura, applied after treatment.

Topical heparanoids help resorb ecchymosis (blue spots).

What can be done to help give more definition in the case of thick nasal skin?

Thick skin can be a challenge and may not allow for adequate nasal contouring and definition. In some cases, we may inject corticosteroids under the skin to help reduce scarring and skin thickness in certain areas, but is generally done in the nasal tip.

What can be done to minimize irregularities in the context of thin-skinned individuals?

Each irregularity may be visible in patients with thin skin. We use grafts for camouflaging during surgery.

After surgery, an injection of hyaluronic acid may help camouflage certain irregularities. Early on, hyaluronic acid can raise skin flaps and may allow for scar tissue to form and avoid long-term defects.