Which has more swelling? Primary surgery or removal of implant and grafts?

Posted on October 12, 2016 by Donald B. Yoo, M.D.

Q: 2.5 months post op after open rhino. Goretex on dorsum and nasal septum was harvested for tip height and added ear cartilage for projection. I am planning to have all these removed since I don’t want anymore unnatural implant on my nose but scared of what it will look like after. Its ok if it will just go back to pre op structure or better but I hope not worst than my original nose. Will there be more swelling after removal compared to what I experience during primary? Hope its swells less.

A: The synthetic implant on the bridge of your nose can be removed with minimal swelling, but removing the septal and ear cartilage grafts from the tip of your nose will create significant swelling.  After revision surgery, the nose will take longer to heal and for the swelling to fully resolve.

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I have a bump and line in the middle of my nose after rhinoplasty. How did this happen and can it be fixed?

Posted on October 12, 2016 by Donald B. Yoo, M.D.

Q: I had rhinoplasty about 4 months ago but I started noticing a bump and a horizontal line developing in the middle of my nose. This wasn’t much initially because of the swelling I guess, but it became more obvious with time, especially when I look at the mirror… My doctor said he never saw something like this over his 25 years of experience and suggested that I massage my nose and bone and wait for a while… He mentioned filler too but I want to know what happened and what my options are.

A: Although it’s difficult to provide a definitive, there may be an irregularity in the bone and cartilage of your dorsum.  At 4 months you are still fairly early in your recovery so your nose will change in appearance, so your bridge may or may not improve.  Revision rhinoplasty may be necessary to smooth the contour, but shouldn’t be considered until the nose is fully healed.

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11 days post op – Crease of nostril bleeding after crying, should I be worried?

Posted on October 12, 2016 by Donald B. Yoo, M.D.

Q: I’m 11 days post op and found out some bad news and cried for ~ 2 hours. After I saw the crease of my left nostril where my outer stitches were is slightly open and bleeding. This was the area where my stitches were and it was nicely healing before. No blood or open wound. I’m worried that perhaps my nose ripped away and may be at risk for infection, etc. Should I be concerned and what should I do to best remedy this?

A: There may have been a very slight separation in your incision line which resulted in the bleeding, but it should heal fine with appropriate care.  Cleaning the incision line gently with peroxide diluted in distilled water (1:1) and keeping the incision line covered with antibiotic ointment should allow it to heal quickly.  Certainly do follow up with your surgeon with any concerns to ensure the best healing.

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My nose tip is slanted and leaning towards the right, Is this abnormal?

Posted on October 10, 2016 by Donald B. Yoo, M.D.

Q: I had a rhinoplasty 15 days ago. I know I should be patient when it comes to my results, but this has got me very worried. A few days ago I noticed that my nose tip is slightly slanted to the right. I’m praying that my nose is just very swollen from my right side and that it will eventually subside. Also, the right side of my nose tip is more numb than my left side does this say anything to my concern?

A: It is very early in your recovery and too soon to be concerned about the symmetry of the results as swelling is always asymmetric and will resolve differently from side to side.  Numbness and “weird” sensations are a normal part of early recovery.

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My nose looks like a boot after rhinoplasty. Do you think it’s swelling or a deficiency of the surgery?

Posted on October 10, 2016 by Donald B. Yoo, M.D.

Q: I had a rhinoplasty refining the tip and using ear cartilage to add to the bridge. My nose looks like it comes from forehead directly. My bulbous tip is higher than the rest of the nose – my profile is not straight. It looks like saddle nose or a boot. It’s 10 days now, but there is not much of a difference. I’ve never seen this level of swelling in other people’s pictures before. Do you think it’s swelling or a deficiency of the surgery?

A: Augmentation of the nasal dorsum (bridge) often results in significant edema and swelling.  For some patients it will take 3-6 months for the majority of the swelling to resolve, and especially for you at 10 days post-surgery, you can expect the bridge will settle and lower.  The radix – the portion of your bridge connected to your forehead – will lower as the swelling resolves.

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I have a small ball on the top of my nose bridge after rhinoplasty. Should I be worried?

Posted on October 10, 2016 by Donald B. Yoo, M.D.

Q: In September of this year I underwent rhinoplasty to remove a hump on my nose bridge. Aesthetically I’m very pleased with the way my nose looks but I’ve noticed that there’s a small ball-like thing in the top of my nose bridge on the right side. It feels like if you press it, it moves slightly up and down. I don’t think you can see it but you can definitely feel it. Should I be worried or is this a common thing that will go on its own? Thanks.

A: Your nose will continue to undergo changes as it heals over the course of this year and the swelling decreases.  The “ball” you are noting should likely improve as the swelling resolves.  You will achieve the best results by following up closely with your surgeon.

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How much will my nose change from 3 months post op Rhinoplasty to final result?

Posted on September 25, 2016 by Donald B. Yoo, M.D.

Q: I’m 3 months post op rhinoplasty. My nose looks different from the day if cast removal. My nose tip was shorter. My nose tip now seems longer at 3/4 view and smiling. Could this be swelling? How much will my nose change from 3 months post op to final result?

A: As swelling resolves, the tip of the nose will typically deproject (get closer to the face) and counter-rotate slightly.  In general at 3-6 months 60-80% of the swelling will have resolved and the remainder will resolve over the course of 1 year.  Bring up your concerns with your surgeon and follow up closely with him/her to ensure the best results.

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6 Days Post-op and All Bruising is Faded to Yellow. However I Notice a Purple Bruise Under my Cast?

Posted on September 25, 2016 by Donald B. Yoo, M.D.

Q: I had primary rhinoseptoplasty with turbinate reduction and tip definition/bridge straightening 6 days ago. Went well and healing well. Cast comes off tomorrow. All bruising is yellow now–worse on right side near the worst of the c-curve. From under the cast I can see a deep purple bruise about an inch long running parallel and under the cast that has remained purple. Dr mentioned he had to do some bridge filing. Why might this bruise be in this location and hasn’t faded at similar rate?

A: Bruising and swelling are almost always asymmetric.  Don’t worry too much about uneven bruising.  Bruising is simply the product of red blood cells being broken down.  The skin on the bridge (dorsum) is very thin relative to say the skin over the nasal tip or cheek.  In order to “file” the bridge he had to lift the skin over it, and in so doing probably broke a few blood vessels (which is completely common and normal).  Ask your Dr. when you follow up if he recommends Arnica.

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Question About Splints and Packing After Rhinoplasty?

Posted on September 17, 2016 by Donald B. Yoo, M.D.

Q: Do all surgeons put splints into a nose after rhinoplasty that consisted of breaking bones, removing a bump from the top of the nose, making the nose narrower, and straighten the nose? Why would you and why would you not put splints and/or packing after rhinoplasty? I see that some people don’t get packing but a lot have splints after rhinoplasty. I would like to understand the benefit and reasons why some surgeons put them in while others don’t.

A: Surgeons typically will use splints or packing whenever work is done on the septum.  If no work is done on the septum, then neither of those two things is necessary.  The benefit is the same benefit as the splint or cast that goes on the top of your nose after rhinoplasty – it limits the amount of swelling and it provides some support to the septum as it is healing.  The question of packing vs. splints relates more to the surgeon’s personal preference.

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I Have an Upward Tilted Nose. Is There Any Correction Other Than Surgery?

Posted on September 17, 2016 by Donald B. Yoo, M.D.

Q: Hello, my name is Brian. I have a slightly upwardly tilted nose. Whenever I look around when I’m in public I see that every other guy has a nose where the nostrils come back at about a 90 degree angle or maybe a little less. I don’t necessarily feel bad about my nose because it really isn’t bad. If you saw me right in front of you and facing you, you could see a little bit of the bottom of my nostrils. How come I have this and nobody else does?

A: Unfortunately there is no great nonsurgical way to counter-rotate your tip (give you closer to a 90-degree angle).

Fortunately, with surgery this can be accomplished and give you excellent results.  Everyone’s nose is different, and you were blessed with one that is slightly rotated up.  While you may want closer to a 90-degree angle, believe it or not, others seek a 100-degree angle or even more.  Everyone has their own sense of beauty.

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