How long before I see the result with my rhinoplasty?

This is perhaps the most common question presented to me during the pre and post-operative care of a rhinoplasty patient. The answer is not that simple. The nose, and particularly the tip of the nose, is an area of the body that tends to hold onto swelling for prolonged periods. Unlike other areas where after 2-6 months all of the results are seen, nasal healing is measured in years. When I perform a rhinoplasty there are some specific things I look for during the post-surgery visits. At one week, when I typically remove the splint I am able to see the basic shape but with no definition. The only thing I can see at this point is the shape of the bridge. I want to be sure that it has a gently curve for a female nose and is relatively straight for a male nose. There is not much else. The next time I see patients is at 3 weeks. At this point a significant amount of the swelling has resolved and I am able to see more definition in the bridge and the tip as well as tip position. Fine shaping is not visible at this time but now the nose looks good enough that there is no sign of recent surgery. Most people think they look perfect at this phase but the reality is that it is just the tip of the iceberg. In fact many of the pictures you see on my web site are at the 3 week period. The next time I see patients is at 3 months. At this point the nose looks very close to the 3 week period but a little more definition is present. After this time most patients do not want to take time out of their day to come for further follow up but the next visit would be at 6 months. At this time the bridge and sides of the nose have lost all of their swelling, the tip now has good definition. The last visit would be at 2 years at which point the tip has full definition.

The above discussion is made for most primary rhinoplasty procedures. There are factors that can increase or decrease this timeframe. Having thicker skin of the nose can certainly prolong swelling. Open rhinoplasty technique will also delay the resolution of swelling. And secondary operations will certainly almost double the length of time for healing. Steroid injections can influence healing but I would only use them in circumstances where I believe there is a lag as there are risks involved.

I have included a case to illustrate the process. The patient is a young lady who had several complaints with her nose. She did not like the hump, the curvature to the right, and the thickness of her tip. She was happy with the overall angle/length of the nose and I agreed. I also pointed out that her lip had a poorly defined angle with the start of her nose and she agreed to let me improve it as well as the size of her nostrils. The first picture is on the day of surgery. The second picture was taken at 2 months. At that point many of the changes can be seen. The hump is completely gone with a clean shape. The tip is slightly thinner/ defined and the curvature of the septum is also improved to the point that it is barely visible. The nostrils appear smaller but the lip/nose angle has no discernible improvement. The patient was very happy with the result and had no complaints. I was fortunate to have her come back at 2 years for a different procedure and took the opportunity to take a long term follow up where you can now see all of the changes. At this point there is excellent definition of the bridge and tip. The lip/nose angle is excellent and the curvature is completely resolved. I use this example to illustrate just how much change occurs even after the patient thinks everything is done. I think most people would be satisfied with the 2 month result but the fact is that much improvement is still on the horizon. Overall there is no procedure where some positive changes are seen so quickly but all changes take so long. Be patient. It is worth the wait.

 

 

Dr. Hochstein's Patient

Before Surgery	2 Months After Surgery	2 Years After Surgery
Before Surgery	2 Months After Surgery	2 Years After Surgery

Leonard M. Hochstein, M.D.

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