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Plastic Surgery/Re: Post-Rhinoplasty Swelling

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Question
Dear Dr. Tobin,

I have had three rhinoplasty surgeries. The first one was in Summer 2009 and was a septorhinoplasty to correct deviated septum and remove hump on the bridge. The second surgery was October of 2010 to completely remove the hump as there was still a bit left as well as shave a bit of the cartilage on the right side of my nose.

In January of 2011 I got in a car accident and the airbag hit my in the face pretty badly. My nose was pretty badly swollen up on one side and after a year or so it looked crooked, thus initiating my third and hopefully final surgery. In this, my doctor (same surgeon for all three) performed an osteotomy on the right side and he also took out scar tissue which was next to the tip on the right side.

When the cast came off, my nose looked excellent, perfectly straight and symmetrical. For two days, it looked great. However, beginning on the third day after the cast came off and since then (it has been a week since the cast is off, two weeks after surgery), the area where the scar tissue was removed has swollen up a lot.

Is it normal for swelling to start up a couple days after the cast is removed? How long should I expect major swelling to last for, given that it's my third surgery? How can I tell if there is swelling or if scar tissue is forming in the same location?

One more question: is the appearance of the nose immediately after cast removal a good indicator of its final appearance after all healing is complete?

Answer
It's indeed unfortunate to sustain an injury so recently following a rhinoplasty, which was, in itself, a revision.  Whenever it becomes necessary to re-operate the nose, it is normal to expect that swelling will be increased and may last longer.  When a surgeon applies a splint or cast following rhinoplasty, he has two goals.  One is to protect the nose and the other is to minimize swelling.

In your case, it sounds like the cast did effectively minimize swelling.  It's not unusual to develop additional or increased swelling after splint removal.  This could be perfectly normal.  However, it is important to be sure there is no other additional cause for the delayed swelling.  Possibilities include infection or bleeding (hematoma) as well as fluid collection (seroma).  Your surgeon can determine, on examination, if these complications are present and so it is important for him to examine you in this regard.

Unfortunately, the hardest question to answer is how long the selling will last  In part, it depends on your activity.  A lot of vigorous activity can prolong swelling.  Some people just swell more than others.  Keeping your head elevated and gentle compression of the nose can help to resolve swelling.  As a general rule, we tell our patients that most of the swelling will be gone by 3 months, but it can take up to a year.  Of course, as I mentioned, each time you re-operate in the same area, it will take longer for the swelling to resolve.

As to your final question, yes, the appearance after splint removal is an indicator of the final appearance, but there certainly can be changes due to scar formation and resolution of swelling.

I hope this information helps, but again, it is important to see your surgeon to be sure that your recovery is not being hindered by complications.

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Howard Tobin MD FACS

Expertise

I can answer questions related to Cosmetic Surgery. I cannot answer questions related to reconstruction, burn treatment, cleft palate surgery or traumatic surgery. My practice is, and has been for 36 years, limited to Cosmetic Surgery. For further information, go to www.newlook.org

Experience

As mentioned above, I have exclusively practiced cosmetic surgery for over 36 years. My practice encompases all aspects of cosmetic surgery

Organizations
American Academy of Cosmetic Surgery (past president) American Society of Liposuction Surgery (past president) Cosmetic Surgical Society of Texas (past president) Fellow American College of Surgeons Texas Medical Association see cv on website www.newlook.org for further details

Publications
Seventy three published articles. see cv on website www.newlook.org for further details

Education/Credentials
Graduate of Princeton University and Baylor College of Medicine Internship - University of Virginia Residency - Baylor Medical College Affiliated Residencies Fellowship - University of Cincinnati see cv on website www.newlook.org for further details

Awards and Honors
American Medical Association - Physician's Recognition Award; 1969- present American Academy of Otolaryngology - Head and Neck Surgery Honor Award, October, 1983 American Board of Cosmetic Surgery - Certificate of Appreciation - 1987 American Academy of Cosmetic Surgery - Best presentation at 1987 annual meeting: "Revision Mammaplasty with Replicon Prosthesis" Accreditation Association for Ambulatory Healthcare Certificate of Appreciation 1989-90 American Academy of Facial Plastic & Reconstructive Surgery Honor Award for distinguished service, 1989 American Academy of Facial Plastic & Reconstructive Surgery Appreciation Award for authorship of monograph on outpatient surgery , 1993 Certificate of Excellence in Continuing Medical Education in Cosmetic Surgery, 1993 - American Academy of Cosmetic Surgery. International Academy of Aesthetic Surgery & Aesthetic Medicine - Honor Award, 1994 American Academy of Cosmetic Surgery - Recognition plaque following term of Presidency - 1995 Accreditation Association for Ambulatory Healthcare Special Citation of Appreciation for Service; November 1996 International Academy of Aesthetic Surgery & Aesthetic Medicine - Appointed honorary North American President, 1995 1997 American Academy of Cosmetic Surgery: Award for excellence in cosmetic surgery; Jan 2003 Cosmetic Surgical Society of Texas Appreciation Award for Leadership; 2004 Honorary Member Mexican Academy of Cosmetic Surgery 2007

Past/Present Clients
A past sponsor of the Miss Texas USA pageant, he has also served as a judge for this and other pageants. His patients include many pageant contestants and winners up to the Miss Universe title

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