Two forms of swelling
There are essentially two forms of swelling that take place after rhinoplasty. After rhinoplasty surgery, there is the immediate swelling related to the trauma of the surgery and then there is swelling related to retention of fluid.
Swelling before and after Rhinoplasty
Rhinoplasty invariably results in swelling
The immediate swelling is evident and it is simply secondary to inflammation caused by the rhinoplasty surgery. This type of swelling may occur simultaneously with bruising. Although every patient heals differently after rhinoplasty, the degree of this type of swelling can be, in part, tempered by the rhinoplasty technique. I try to help limit the immediate swelling and bruising by performing the rhinoplasty with a certain meticulous dissection of the tissue. In the vast majority of my cosmetic rhinoplasty cases, I perform an open approach.
The approach, whether open or closed, does not in itself cause immediate swelling. I have seen a large amount of swelling with the closed technique and vice versa.
Help with swelling postoperatively
In rhinoplasty, the skin has to be elevated off of the underlying cartilage and bone. The skin of the nose has to be elevated in either approach to rhinoplasty. It is the manner in which the skin is elevated which can help to limit the degree of immediate swelling after rhinoplasty. As with every other maneuver employed in rhinoplasty, every millimeter matters.
The exact level at which you are elevating the skin off of the cartilages also matters. If you can imagine, this may be a fraction of a millimeter. I take great care at the level at which I perform my elevation of the skin in order to help limit the amount of immediate postoperative swelling and bruising.
Additionally, when resetting the bones, I employ a technique that I have found to help with swelling postoperatively. Also, the immediate application of ice helps with this type of swelling after surgery. I have all my patients use as much as they can tolerate for the first twenty-four hours after surgery. Following the first day after surgery, the ice becomes ineffective in controlling bruising and swelling.
This type of swelling is different from the swelling of the skin, which occurs after surgery, which often takes months to resolve. This second type of swelling to which I am referring is related to fluid retention under the skin. At the time of a rhinoplasty, cartilages and bone are shaped, and grafts reshape the nose to achieve the cosmetic outcome. The skin then has to “re-drape” over the new shape.
The skin, in essence, has to mold itself over the new shape of the nose. In doing so, fluid is retained underneath the skin and over the cartilages. It can then take up to several months for this healing process to transpire. Gravity and your body’s fluid retention are the two main factors that control swelling at this point after surgery. You will notice that the upper part of the nose towards the bones is the first area where refinements are noted after surgery. The tip, being the most gravity-dependent, is the last to show resolution of the swelling. These changes are normal and occur in every patient to some degree.
Swelling influencing factors
There are factors that do influence the amount of this second type of swelling after surgery, the main one of which is the thickness of the skin: the greater the thickness of the skin the greater the degree of swelling. I counsel all my patients upon their consultation as to their noted skin thickness and try to prepare them for the expected amount of swelling that may be typical in their case. At this point in the surgery, in order to help resolve the prolonged swelling, I tell my patients to limit their amount of dietary salt intake. Since this second type of swelling is mostly due to fluid retention underneath the skin of the nose, I have noted that the reduction of salt from the diet helps. Regardless, this second type of skin swelling may take months to fully resolve and unveil the refinements made during the rhinoplasty.