Rhinoplasty Recovery: What Your Nose Looks Like 1 Month vs. 1 Year After

Kirstin (00:00):
So is your answer do it?

Dr. Koehler (00:02):
No. The answer's no.

Kirstin (00:05):
Don't do it. No surgery before your wedding.

Dr. Koehler (00:07):
The answer is a hard no. It's your wedding. No.

Kirstin (00:10):
Unless you want boobs, then we'll give you boobs before your wedding.

Dr. Koehler (00:14):
Yeah, we'll do boobs.

Announcer (00:17):
You're listening to Alabama the Beautiful.

Kirstin (00:20):
I'm Kirstin Jarvis and I'm here with Alabama cosmetic surgeon, Dr. James Koehler. Hey, Dr. Koehler.

Dr. Koehler (00:25):
Hey, Kirstin.

Kirstin (00:27):
Today we are going to talk about life after your rhinoplasties.

Dr. Koehler (00:32):
Okay.

Kirstin (00:33):
The nose that you leave surgery with isn't necessarily the nose that you keep, and rhinoplasty is the one where the real result can take up to a full year. So we're going to talk about what that year looks like.

Dr. Koehler (00:46):
Okay. Sure. Sounds good.

Kirstin (00:48):
All right. Let's talk about the first week. So what's up with the splint and swelling and breathing and all that fun stuff?

Dr. Koehler (00:58):
Well, again, like everything, it varies depending on circumstances, but just about everybody comes out of surgery with a little plastic splint and some tape on the outside of their nose. And that usually comes off at a week, but that's to help with the swelling. It's like after we've lifted everything up and that kind of helps prevent blood from accumulating between the cartilage bones and skin. So it's just a little kind of a pressure dressing and that comes off at a week. But sometimes depending if it's also a functional rhinoplasty where we're having to do work on the septum or the turbinates to help with breathing or if we have to harvest cartilage grafts, sometimes, sometimes we have to put little silicone stents inside the nose. And that's not very common, but occasionally we need to do that for really crooked nose that we have to do a lot of work on the septum.

(01:57):
So occasionally we'll put those little splints in. And so breathing, they've got little holes cut out in them so you can sort of breathe through them, but after surgery, you have to keep those little holes clean by putting some little peroxide in the holes so that you don't get kind of crusted mucus and blood in there. So it can be difficult breathing through your nose in that when the swelling kicks in and stuff like that, it can be hard to breathe through your nose for a while.

Kirstin (02:23):
What does the rest of your face look like?

Dr. Koehler (02:27):
This just depends. If we have to do osteotomies where we're actually making little cuts in the bone or breaking the nose, which we are making a controlled fracture of the nose, if we're having to narrow those nasal bones, then you might have more swelling and bruising. But in some cases we're just doing work on mainly the tip of the nose. And in those cases there's usually hardly any bruising, if any. So each nose is different and we don't do the same thing to every nose, so it can change from case to case.

Kirstin (03:04):
So what does the first few days really look like? Do you feel congested? Are you mouth breathing? Do you have to sleep propped up or what is activity like?

Dr. Koehler (03:15):
Yeah, we usually have people propped up on a few pillows and applying some ice packs to the external surface for comfort and to help with swelling. Breathing depends. Again, if we don't do any work inside the nose to the septum, then the breathing might not be affected very much. But if we do harvest cartilage grafts or do septal work, then breathing is definitely affected and you might be more of a mouth breather for a little bit until that swelling subsides. And usually the swelling kind of peaks about the third to fifth day, somewhere in that range. And so as the week progresses, you might actually find that your breathing is even more challenging, but then as the swelling starts to go down, it gets better.

Kirstin (03:58):
When does the splint come off and the patient get to see their nose for the first time?

Dr. Koehler (04:03):
Depending if it was an open or a closed approach, which means a lot of the noses that I do, we do through an open approach, which means there's an incision made up underneath the nose. So there's three sutures that come out that day as well. The rest of the sutures are all internal and they're dissolvable, so those don't need to come out, but the splint comes off and the sutures come out at a week.

Kirstin (04:26):
When can they go back to work or school without anybody noticing that something's off?

Dr. Koehler (04:35):
Well, that also depends. I mean, if you had a really significant hump, it doesn't matter if the swelling's all gone, people are going to notice, even if it looked perfect. So it depends on what all's done to the nose. But if you have bruising, bruising can take two or three weeks to sometimes go away. So yeah, some people look really good after two weeks, but other people it might be more like four to six weeks before they're really looking really presentable in public. I'd say a lot of people look pretty good after a couple of weeks, but you're still not 100%. Nose is still swollen. It's going to look different. I mean, that was the whole reason you had it done. So I think people are going to notice unless we're doing very subtle tip work or something like that. Well then maybe people actually aren't as observant as you'd think they are.

(05:25):
I mean, that's the one thing I've realized over the years is I think patients are often more concerned about what other people are thinking. And most of the time a lot of people don't even really notice or they notice something, but they're not even really sure what's different.

Kirstin (05:40):
Okay. What about wearing glasses, blowing your nose, bending over? Are those things off limits the first few weeks?

Dr. Koehler (05:49):
Yeah, lots of loaded questions here. Depends on what we do. If we do osteotomies, then we would typically tell people not to wear glasses for about six weeks, four to six weeks, because we want those nasal bones to get a little bit of a callous there so that they won't be moving around and we just don't want glasses resting on that. But if there was no work done to the dorsum of the nose, then they could probably wear glasses right away. So your doctor will advise you, depending on what's done to the nose, what those restrictions will be. But we definitely, typically no nose blowing, you can sniff in and we'll have people use saline irrigation to clean out their nose and it'll help them with breathing and also get rid of any kind of crusted blood and mucus that builds up in there.

Kirstin (06:40):
Okay. So in the first few months when your nose is starting to slowly reveal itself or your new nose, I guess, why does a nose take so much longer than other surgeries to look finished or to get to its final destination, I guess?

Dr. Koehler (06:57):
Well, it's not necessarily different from certain surgeries. When we do abdominoplasty surgery, we tell people you're not going to see the final or liposuction for that matter, you're not going to see the final result for about six months. And really at six months, the nose is pretty close to where it's going to be. Now there will be, because it just has to do with lymphatic drainage of the nose. So there's been a lot of debate over, well, if you do the open approach where you make the incision underneath, does the nose stay swollen longer versus if you do it all from incisions on the inside? And people say that if you do it all from the inside that you have less swelling because you're not disrupting some of the lymphatics in the columella region of the nose. But regardless, we do know that the tip of the nose does change over the course of a year.

(07:51):
So it's very subtle. So really when you see your nose at even three and six months, I mean it's going to be pretty close to where it's going to be. But as a patient and you're looking at yourself, because again, we're looking at things a lot more critically now that we've had something done, we look in the mirror, you will notice changes, particularly with the tip of the nose. That's where the swelling takes the longest to go away. And yeah, it can take up to a year to really see the final changes of that.

Kirstin (08:22):
Okay. Let's see. When can people get back to workouts or sports? If you have somebody that plays recreational basketball, when can they get back to their real life?

Dr. Koehler (08:35):
Usually in six weeks for just about anything that we do, people can start getting back to regular activities. But I mean, if you were a collegiate wrestler and got your nose done, I'd be like, "I wouldn't want you going into the mat right then." It takes time for things to fully heal. So if you're in contact sports or something like that, you might have to take extra precautions. But for regular, like going to the gym, your regular daily activities, in six weeks, you're fine to do whatever you like.

Kirstin (09:05):
Cool. Okay. So six months to a year out when the real result is revealed, how different is the nose at one year versus one month?

Dr. Koehler (09:18):
Oh, it's pretty significant at a year. The difference between one month and a year is actually quite significant, but the difference between six months and a year can be very subtle. But in a month, I mean, things are still kind of swollen. It can still look really good, but it's just not how it's going to ultimately look. So I mean, a lot of times when we see people four to six weeks out from surgery, they're already very happy with the way their nose looks and we just tell them, "Hey, guess what? It's going to look even better. There's still swelling there." In particular, sometimes people, if they don't really have a whole lot wrong with, let's say the tip of their nose, and maybe we're just doing a lot of work to the, they have a big bony hump or something like that and we take it down.

(10:02):
Well, when we do the dissection for the rhinoplasty, we're lifting things up. And so the tip of the nose is now more swollen. And so people who didn't really have a big nasal tip feel like they've got a bigger nose because the tip is swollen and they didn't really have an issue with it to begin with. Whereas if you start with somebody who let's say has, like we did a lot of reduction to the tip and all that, even with the swelling in place, the nose still looks smaller, if you understand what I'm saying. So if the tip was normal and then you throw in the swelling, it's going to look bigger. But if we've reduced the tip, depending, I mean, a lot of times those noses actually already look smaller, but they're going to look better with time.

Kirstin (10:45):
Do people ever breathe better after they're healed or like a year down the road?

Dr. Koehler (10:50):
Well, that's a big discussion that we have with rhinoplasty patients because if we're doing things to cosmetically improve the appearance of the nose, we always have to take into account the function of the nose. And so there's definitely things that we do at surgery to try to preserve breathing best we can, but having some problems with nasal breathing after rhinoplasty, it can occur, especially if you're making the nose smaller. So we're trying to preserve the nasal valve and to preserve breathing. And in certain cases, we do extra maneuvers, cartilage grafts and other things to help people breathe better. So if part of that rhinoplasty was straightening their septum and doing some cartilage grafts, absolutely. There are people that have rhinoplasties that are like fixing the breathing part was a part of their surgery. In particular, sometimes revision rhinoplasties where people maybe had too much cartilage removed and when they breathe, their nose kind of collapses.

(11:51):
And so then we have to go in and put cartilage grafts in and other things to open things up. That can make a big difference for patients in terms of their ability to breathe.

Kirstin (12:02):
I did a similar podcast with Dr. Gardner talking about life after a tummy tuck, and we talked about numbness along your scar line and the lower part of your belly. When you do a rhinoplasty, is there anything that ends up numb for a couple months?

Dr. Koehler (12:17):
Yeah. I mean, the nose can feel different. A lot of people describe it's like a woody feeling. It feels firmer too because as things are healing, the nose doesn't feel as soft and supple, it feels firmer. And definitely sensation can feel a little different. But realistically, how often are you touching your nose? It's not something that you typically notice unless you're actually touching it, but all that sensation returns. So I've never seen a case where people are like, oh, I permanently can't feel the tip of my nose or something like that. It all comes back.

Kirstin (12:50):
Yeah, that would probably be, if I needed a new nose, that would probably be the least of my worries too. Just the fact that you look better is a huge difference. So how do people tell you that it makes them feel when they take photos or look back on old pictures of themselves as far as how it changes how they feel about themselves?

Dr. Koehler (13:12):
Well, a little bit of that depends on how they felt about it before, because for some people, even when we take the splint off and the nose is swollen and everything else, I mean, some people have the tears in their eyes because it's something that this has bothered them their whole life. And the change, even though they're swelling, is already so significant that they just are just so excited about it. So the reaction people have will certainly vary. And we see similar things in people who've lost lots of weight and get body contouring, and now they can kind of feel like they've got their body back again. So that's the fun part of doing these cosmetic procedures is it is, yes, we're wanting to look good, but for some people it's like they're happy with themselves, but there's something about the reason they sought out that procedure is that it's something that really bothered them.

(14:01):
And when you can fix that, it can make them extremely happy. So yeah, now there are some people that already start off with a pretty good nose and they're seeking for that perfection. Some people are just not good candidates for surgery when they're like, "Oh, I want my nose up one degree or something like that." We're like, "Okay, well, it's not that exact." So for people who have realistic expectations and it's something that's really bothered them, it's a very gratifying operation.

Kirstin (14:34):
Are there any misconceptions that people come in semi-commonly with and talk to you about during a rhinoplasty consult?

Dr. Koehler (14:42):
Well, the one thing that I wouldn't say this is maybe a common thing because I really don't think it's like this, but the thing about noses is, and we already kind of addressed this, is that we also have to deal with the function of the nose. And so sometimes people will show me pictures. They're like, "I want my nose to look like this." And I'm like, "Your nasal structure is not compatible with that result." You have nasal bones and nasal cartilages, and they're built distinctly different than the person in the picture you're showing me. And it's not a piece of clay that you can mold. I mean, we have to leave a certain amount of cartilage behind. We have to leave certain amount of bone behind. So yes, depending on the circumstances, you can sometimes see very dramatic differences, but sometimes people have very thick skin and you're always going to have thick skin.

(15:36):
And yes, sometimes we can try to thin out the underlying subcutaneous tissue to thin it out a little bit, but you got to be very careful with that. So sometimes there's limits to what you can do, and that's all part of the consultation process and the realistic expectations. So I guess what I'm saying is that if you've got a really large nose, yes, we can change the proportions and make it look much more proportioned, but I can't give you a little tiny nose. You've got a big nose with big cartilage and big bones and there's only so much we can do.

(16:07):
And that's all part of building those realistic expectations. And sometimes people come in and they think, "Oh, you probably can't do much for this." And then we're like, "Actually, no, this is a situation where we can actually make a very big change." So I don't want to make it sound like some people are like, "Well, there's no hope for me. I've got this nose that I don't like." I mean, all I'm saying is that this is where the consultation process is where you can kind of figure out what can be achieved in your specific circumstance.

Kirstin (16:36):
If someone came to you and said, "Dr. Koehler, I'm getting married. I'm doing a glow up. I want to look absolutely beautiful."

Dr. Koehler (16:44):
Stop, But it's in two weeks or something like that?

Kirstin (16:47):
It's in three months. What would you tell them? In three months?

Dr. Koehler (16:53):
I've experienced this with lots of different operations and I would tell you that surgery's surgery and nobody can guarantee you that swelling's going to be a certain way, you're going to look a certain way, and you're already dealing, especially with a wedding, a highly emotional time in your life. The last thing that you need is the stress of, is my nose going to be looking good enough for the wedding? I would say a no, hard no. You're not getting married. Your husband, the guy you're marrying loves you for who you are. I mean, this is something that you should be doing for yourself. And we got AI now. You can go ahead and probably just change that appearance on your photos if you'd like, get your nose done later. It's just too much pressure. It's pressure for the surgeon. It's pressure for the patient. And when you're dealing with important events and close timelines, I always get a little nervous.

(17:47):
If everything goes perfect, well, great. Everyone's happy, but there's always these chances. And then you just don't want to be in that situation.

Kirstin (17:56):
So is your answer do it?

Dr. Koehler (17:58):
No. The answer's no.

Kirstin (18:01):
Don't do it. No surgery before your wedding.

Dr. Koehler (18:03):
The answer is a hard no. It's your wedding. No.

Kirstin (18:06):
Unless you want boobs, then we'll give you boobs before your wedding.

Dr. Koehler (18:10):
Yeah, we'll do boobs. But you can cover their breasts up and in three months is plenty of healing time. The face is just, it's a little different. It's out there.

Kirstin (18:24):
For sure.

Dr. Koehler (18:25):
There's certain things that yes, you could do, but something like that, like a facelift, a rhinoplasty, when you got a big, big event and you got a short timeline, I always get a little nervous about that.

Kirstin (18:39):
Agree. Okay. Do you have anything to add about life after rhinoplasty? Any fantastic educational info?

Dr. Koehler (18:48):
Educational information about rhinoplasty.

Kirstin (18:51):
Or excellent testimonials.

Dr. Koehler (18:55):
I'm trying to think of anything in particular, but yeah. I mean, all I can say is, like we talked about before, I think when you're doing it for the right reasons and it's something that's really bothered you, it can be a transformative thing and it can be a very positive experience. But that's all I'd say.

Kirstin (19:13):
Agree. All right. Do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Koehler.

Dr. Koehler (19:27):
All right. Thanks, Kirstin.

Kirstin (19:28):
Bye.

Dr. Koehler (19:29):
Bye.

Announcer (19:32):
Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @easternshorecosmeticsurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.