All operations especially for rhinoplasty cosmetic surgery require procedures that result in an immediate increase in skin thickness. This is referred to as edema or post-operative swelling. The increase in blood flow associated with the healing process increases the thickness of the skin temporarily.
Add to that the inherent preoperative skin thickness that a patient exhibits and the answer to the question is yes. A resounding yes! The dissection process with closed rhinoplasty as well as with open rhinoplasty, separates the nasal skin from almost the entirety of its underlying cartilaginous and bony structures. The blood supply to the nose is so extensive that this skin separation poses no real problem for healing. Unlike other areas of the body when the blood supply is disrupted, there is oftentimes a chance for slough or loss of skin. This is not common with the nose.
A history of fillers may affect this process. These facts are yet undetermined. When the skin is separated and the surgeon performs his alteration of the bone and cartilage – the skin is then allowed to re-drape over the newly reduced internal structures. It takes time for the shrink-wrapping process to be completed.
RHINOPLASTY
With preservation rhinoplasty, these facts are altered to a different degree. I can address that in a different blog. It is impossible to determine the rate of reattachment and resolution of the created swelling following rhinoplasty.
Every patient will address this issue at their speed and rate. The thicker the skin to begin with the longer it will take for the swelling to resolve to observe the result. Also, if the patient has undergone previous surgery resolution of the post-operative swelling will take longer. A minimum of a year and possibly longer may be required. With some patients, the resultant cartilage may be inadequate to achieve optimal results and therefore aggressive cartilage grafting may be required.
Also, despite our best efforts to keep things smooth and free from irregularities as the swelling subsides, certain irregularities may manifest. Massage, taping, splinting, and sometimes an anti-inflammatory injection may be required to address some of these irregularities.
The preoperative consultation and the limitations of the surgery including all the above eventualities our essential to inform the patient and create realistic expectations. Perfection is unattainable. In the absence of unexpected occurrences excellent or acceptable results should be achievable.
THOMAS TREVISANI, MD
BOARD-CERTIFIED PLASTIC SURGEON
MEMBER OF THE AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY
