Expectation vs. Reality: Recovering From Rhinoplasty

Prospective patients, be aware: rhinoplasty — the cosmetic or reconstructive surgery that addresses nose shape, nose size, and/or breathing concerns — functions on its own timeline. While the healing process is relatively straightforward, it can take 12 months or more for the true result of the surgery to emerge. Needless to say, patience is required.

If you’re looking for instant (or instant-ish) gratification, non-surgical liquid rhinoplasty, which involves injecting filler to sculpt the nose, may be an option. David Shafer, MD, a board certified plastic and reconstructive surgeon in New York City, actually prefers the non-surgical alternative for many patients, though he concedes that “there are some things surgical rhinoplasty can do that liquid can’t.”

During your initial consultation, your surgeon should listen to your desired results, explain what is (and isn’t) achievable, and recommend the best way to create it. If a surgical rhinoplasty turns out to be right for you, set a calendar alert for one year post-surgery for the full reveal. In the meantime, here’s what the days in between will look like during your recovery from rhinoplasty.

The First Few Days After Rhinoplasty

Plan to go home the same day as your rhinoplasty surgery (with the help of a friend or loved one) and to spend the first two to four days post-op taking it as easy as possible. “You don’t have to be bedridden, but you should definitely be resting,” says Samuel Hahn, MD, a double board certified facial plastic and reconstructive surgeon in Cockeysville, Maryland. “Even though rhinoplasty is not a big area of surgery, your body still needs proper rest to recover.”

He directs patients to limit exertion to “non-strenuous daily activities.” You may be able to return to at-home tasks, like working on a computer or talking on the phone, quite quickly, but there is to be no heading to the gym just yet. “The first couple days, you’re going to be constantly aware that you just had surgery,” Dr. Shafer says. “You’re going to have swelling, you’re going to have some discomfort, you might be taking some pain medication.”

Due to swelling in the nasal passages, you’ll feel congested and will likely have to breathe through the mouth. For those early days (and weeks) to come, you’ll have to sleep on your back to avoid pain and help decrease swelling. Swelling will start about 24 to 48 hours after surgery. As the swelling goes down, bruising around the nose and under the eyes may appear — though it’s important to remember that every patient is different. “Some might have no bruising, another might look like they took a punch to the face,” Dr. Shafer says. Most patients fall somewhere in-between those two extremes.

It’s important to understand that swelling and bruising subside over the course of several months, and your new nose won’t be visible in these early stages. The good news? The most discomfort is during this initial, brief recovery period. “After several days, the worst of it is over,” Dr. Shafer confirms.

Pain Management After Rhinoplasty

Plastic surgeons’ approach to pain management is informed in part by the addictive nature of opioids. You’ll likely receive a few days of prescription pain medication to take as needed during that initial recovery period only. After that, over-the-counter pain meds should suffice. Following the first 72 to 96 hours, sensations of pain will start giving way to feelings of pressure. “Most people will start to feel pressure between their eyes, forehead, and cheeks,” Dr. Hahn explains. “Then the pain starts lessening.”

Resuming Normal Activities After Rhinoplasty

After the initial downtime, rhinoplasty patients can resume non-strenuous tasks as their body feels able. In those first few weeks, Dr. Shafer suggests avoiding any activities that raise the heart rate or blood pressure, which can increase swelling.

After about two to three weeks (and, importantly, a follow-up visit where your surgeon will give you clearance) expect to be able to return to the gym, starting slowly with light cardio. After about four weeks, Dr. Hahn’s patients often resume strength training, yoga, or any other activity that puts stress on the face. As with any recovery period, listen to your body (and your surgeon) and take your time before returning to vigorous activity.

Final Rhinoplasty Results

Your plastic surgeon should take care to explain exactly what to expect from surgery, recovery, and results — and, when it comes to results, that means setting a realistic timeline. “I go over expectations with patients multiple times, so they have a good understanding of what to expect,” Dr. Hahn shares. “If you give a false presentation of what their results may be, you may have an unhappy patient even if it’s a good surgery.”

Because the nose is a particularly vascular part of the body, with a lot of blood flowing to and from the it, postoperative swelling can linger. Dr. Hahn estimates that most patients will have visible swelling for three or four weeks after surgery. After that, it’s usually a few more months of subtle swelling that, he says, “they themselves alone will notice.”

It can take up to a year for the final results to be fully visible and settled. For a patient who requested subtle adjustments to the nose, those changes often take the longest to become noticeable. “The tip of the nose tends to remain swollen the longest,” Dr. Hahn notes. “Especially for someone who wants tip work done, I advise them that they won’t see the final results for quite a while.”

As the nose is settling, Dr. Shafer says other procedures like neurotoxins and fillers are still available to you. Keep in mind that, should you want to continue to tweak the appearance of the nose with a liquid rhinoplasty, your injector should be aware of and experienced in treating surgical rhinoplasty patients. “Once you’ve had surgery, it changes the anatomy of the nose, and you need an experienced doctor to avoid complications,” Dr. Shafter cautions. Of course, once the swelling goes down and the bruises have faded, you may not ever need anyone to touch your new nose again.