I recently read a blog post by a plastic surgeon in Manhattan who specializes in rhinoplasty. The surgeon made a point that I have seen echoed by quite a few other plastic surgeons on RealSelf.com when answering questions from patients going through rhinoplasty recovery.
The question being posted across multiple online forums is: How different will the nose look 1 year after surgery as compared to 3 months, or 6 months? In other words, “If my nose looks great at 3 months, will it still look good a year from now? Or will it look overly defined and tight as more time passes?”
My opinion is this – there is no definitive answer. Each nose is different and no one can predict how your nose will change over time. However, one thing is glaringly clear to me about rhinoplasty recovery: If the nose doesn’t look good at 3 months, it isn’t going to look good in a year.
According to most plastic surgeons, it can take up to a full year for post-rhinoplasty swelling to fully subside. So, patients should wait until they have completed their time of rhinoplasty recovery before deciding how they feel. However, do not think that this 1 year waiting period means that your surgeon has no idea what the final result will look like. A professional surgeon has a clear idea of what the final result will look like, it just takes time for your nose to adapt to the changes, which can be disappointing or unsatisfying in the mean time. Basically, wait to judge the “final product” when it actually is the final product.
When performing an invasive surgery, such as a rhinoplasty, gentle compression on the tissue at the conclusion of the procedure can give a reasonable idea of the final appearance of the nose. In other words, if you squeeze the nose, since there is no edema/swelling, you will be able to get a pretty good idea of how the nose will ultimately appear. If irregularities are noticed at this time, corrections can and should be performed.
Taping and splinting the nose post-op always helps to reduce swelling, as do herbal medications such as Arnica and Bromelain. Nonetheless, when the splint comes off, the nose is certainly still more swollen than the final result will be, but an approximation of the final result should be present. This was the case with a patient whose splint I removed this afternoon, 6 days after surgery. Within a month, healing will continue in the proximal mid-third, where the fracturing and take down of the dorsum is carried out, and be nearly complete. Not completely complete, however, but close enough! The tip in particular, especially after an open rhinoplasty approach, will take longer to delineate its final result. But again, the nose reverts back to how it looked on the table at the conclusion of the procedure! So, hold tight during your rhinoplasty recovery. Give your nose time to heal before you decide whether or not you are pleased with the results.
Recovering After Breast Augmentation
The same holds true with breast augmentation and augmentation mastopexy (breast lift). When the patient is in the sitting position during the procedure, they are evaluated for correct placement of the prosthesis and shape of the breast. Proper manipulation is carried out at that time and then, barring unforeseen complications, everything should look good after the swelling subsides and recovery takes its natural course.
The fact that the breasts look good on the table is important because, sometimes, the prosthesis will appear higher or fuller immediately after surgery due to swelling and upward migration of the prosthesis from muscular contraction. Unless you are using a very small prosthesis, this almost universally occurs with a subpectoral augmentation. Upward displacement certainly can cause an unnatural appearance and is commonly referred to as the shelf. If at the time of surgery, you are pleased with the positioning of the prosthesis, then you can reassure the patient that with massage and superior banding (across the top half of the breasts) it will revert to its operative position in most cases. But, if in the course of an augmentation or a mastopexy, the appearance is not ideal, then no amount of breast augmentation recovery time will make the final result look better. The most common erroneous statement made on the operative table is “things will settle down.” If the breasts do not look great on the table, then they will certainly not look great 6 months into the breast augmentation recovery period.
Of course, some things are outside of the surgeon’s control, but the actual surgical techniques used during the procedure are not. This is where we need to strive to obtain the best technical results possible and, at the same time, perform only those procedures where one feels they can achieve the very best results. That is why over the years I have narrowed my surgical focus to a select set of case-types.
As plastic surgeons, for the most part, our results are always on display. So as a patient, always make sure your surgeon is someone who does not just settle, but attempts everyday to achieve the very best results possible.