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Rhinoplasty: Cast & Swelling at 1 week

Swelling following rhinoplasty surgery occurs both on the outside and inside of the nose. All patients feel congested and have nasal congestion and postnasal drip immediately after rhinoplasty surgery, which is normal. Normally, patients are socially acceptable within 2 weeks. Most nasal swelling after rhinoplasty resolves within one month. The final 20% of rhinoplasty swelling takes a much longer time to resolve, up to a year or longer after surgery. Fortunately, this final swelling is usually only evident to the surgeon and patient.

Patients are anxious at the one week office visit to the plastic surgeon, and they have great expectations when the nasal cast is removed. Keep in mind, the nose may be very swollen and the nasal cast may appear to contribute to an unnatural appearance to the nose. This brief unnatural appearance from casting resolves pretty quickly. Most nasal plastic surgeons keep the the nasal cast for at least one week following surgery.

Rhinoplasty swelling varies greatly and is largely based on the areas of the nose treated, surgical approach to the nose (open or closed/endonasal), skin thickness, postoperative care, and your healing ability. The more extensive the surgery, the more you will swell and the longer the swelling will last. The tip of the nose holds onto swelling longer than the other parts of the nose. Open rhinoplasty, where there is an external incision at the base of the nose, typically swells more and longer than closed/endonasal rhinoplasty. Patients with thicker skin will also have more swelling than thin skin patients.

Keeping your head elevated, maintaining the nasal splint/cast, ice, arnica montana, and following your plastic surgeon’s guideline may help reduce rhinoplasty swelling. Persistent swelling may also be reduced by steroid treatment into the nose. Don’t hesitate to speak to your plastic surgeon about any swelling.

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    Houtan Chaboki, M.D.