Swelling and recovery time after rhinoplasty

Why do swelling and bruising occur after rhinoplasty?

Rhinoplasty is surgery on the bones and cartilage of the nose and the skin that covers them. When an osteotomy is performed, cutting the nasal bones to change their shape, the surrounding tissue is injured, which can cause swelling and bruising. Rhinoplasty is described as surgery that can involve considerable postoperative discomfort, particularly swelling around the eyes (periorbital edema) and bruising (ecchymosis) ^[4].

Swelling and bruising around the eyes are cited as the symptoms that rhinoplasty patients find most distressing ^[1]. Their severity is influenced by many factors, and a variety of methods to prevent or reduce them have been reported ^[1].

What is known about recovery time

Many people wonder when the swelling will go down, but most of the studies reviewed here measured eyelid swelling and bruising during the first week after surgery. For example, the steroid meta-analyses compared changes at around days 1, 4, and 7 after surgery ^{[2, 3]}. How long swelling in the nose itself lasts cannot be confirmed with figures from these sources.

Swelling of the nose is generally known to go down more slowly than bruising around the eyes in many cases, but the timeline depends on the extent of surgery and how quickly each person heals. So the most accurate recovery schedule is the one your surgeon, who chose the surgical method, gives you based on your individual situation.

Methods studied for reducing swelling and bruising

A 2016 systematic review examined 50 papers on methods for reducing swelling and bruising after rhinoplasty ^[4]. Of these, 14 dealt only with steroids, 10 with other medications and herbal supplements, 9 with ways to reduce bleeding during surgery, 4 with postoperative care, and 13 with surgical techniques ^[4].

The points on which the literature in this review agreed are listed below, and the review stated that more research is needed on whether the lateral osteotomy should be done from the skin side or from inside the nose ^[4]. Controlling blood pressure and cooling during surgery are up to the surgical team, so what you can do yourself is follow the positioning and daily-life instructions you are given.

• Reduced swelling and bruising: steroids, keeping blood pressure low during surgery (intraoperative hypotension), cooling during surgery, and keeping the head elevated after surgery
• Increased swelling and bruising: packing inside the nose (nasal packing) and lifting the membrane that covers the bone before the osteotomy (periosteal elevation)

Research findings on steroids

Steroids (corticosteroids) are medications that reduce the inflammatory response, and they are one of the most studied methods for swelling after rhinoplasty. In a 2015 meta-analysis that pooled 9 clinical trials with 312 patients, swelling of the upper and lower eyelids in the steroid group was statistically reduced compared with the control group over the 7 days after surgery, and eyelid bruising was significantly reduced during the first 4 days ^[2]. When steroids were given in multiple doses, swelling and bruising from day 4 onward were reduced more than with a single dose ^[2].

A 2016 meta-analysis of 8 randomized controlled trials with 336 patients reported that steroids reduced swelling and bruising at their peak and on the day after surgery, and did not increase bleeding during surgery ^[3]. However, no clinical benefit for swelling and bruising was seen on day 7 after surgery ^[3]. The authors rated the quality of evidence for the short-term effect as high and suggested that future studies also assess patient satisfaction and long-term cosmetic results ^[3].

A 2020 meta-analysis comparing one particular steroid with saline (10 studies, 374 patients, mean age 25.8 years) also reported reductions in bleeding during surgery, swelling, and bruising ^[5]. These results were seen in groups of study participants, and whether to use steroids, and how, is judged by your surgeon, taking into account any medical conditions, the medications you take, and the surgical method. Avoid obtaining and taking medication on your own to bring down swelling.

Osteotomy technique and swelling

How the bone is handled is also related to swelling. In a meta-analysis comparing osteotomy with a piezoelectric (ultrasonic) instrument with conventional osteotomy (6 trials, 327 patients), piezoelectric osteotomy caused less damage to the lining inside the nose and reduced eyelid swelling and bruising over the 7 days after surgery and pain over 3 days, but the operation took longer ^[6].

However, compared with conventional osteotomy performed under direct vision, there was no significant difference in swelling and bruising ^[6]. A review of methods for reshaping the nasal bones also stated that, in comparative and cadaver studies, newer methods showed promising results for protecting the lining and reducing swelling and bruising, but that they should be validated through randomized controlled trials and long-term follow-up before routine use ^[7]. Rather than assuming that a particular instrument will reduce swelling, it is best to confirm during your consultation which method will be used in your planned surgery.

Skin and individual differences

Swelling can also vary with the characteristics of your skin. A review of rhinoplasty in African American patients said that understanding the thick, oily skin commonly seen in these patients helps in managing swelling after surgery ^[8]. Because it focuses on a specific group, its findings cannot be applied directly to Korean patients, but it is worth asking during your consultation how the thickness and condition of your skin might affect your recovery.

The meta-analyses above also did not report the race or nationality of their participants in their research summaries, so it is hard to apply their figures directly to any one person. Even after the same surgery, how quickly swelling goes down differs from person to person.

What to check during your consultation

Recovery differs from person to person, so it helps to ask about the following before surgery.

• Whether an osteotomy is included, and how it will be done
• Whether packing will be placed inside your nose, and when it will be removed
• What will be done during and after surgery to reduce swelling and bruising
• Whether you can keep taking your current medications and dietary supplements
• When you can expect to return to daily life and social activities