When Is Bruising the Worst after Rhinoplasty?

When to expect the peak of bruising? 


F, 32, Vermont

Bruising is a normal part of rhinoplasty. There's no avoiding it. But there are a number of things which can minimize the bruising and make the recovery as speedy as possible.

Before you choose a plastic surgeon, it's very important to do your due diligence and find one who has a long history of successful rhinoplasty procedures, plenty of before and after photos, and satisfied patients.

During the procedure, your surgeon should administer an anti-inflammatory agent to keep swelling down, and he or she may also prescribe a steroidal anti-inflammatory for a couple days following the procedure.

Once you're back home post-procedure, it's extremely important to take steps to keep the swelling down and accelerate the healing process. For at least two days you'll want to apply cold packs to your face to reduce inflammation.

It's also a good idea to avoid alcohol and hot beverages for a few days following the procedure as these can expand blood vessels in the skin and increase bruising. You'll also want to avoid over-the-counter pain medicines like ibuprofen, naproxen sodium and Aspirin until the fourth day.

You can expect the bruising to be its worst three or four days after your surgery, and slowly begin to improve from that point forward. At first, your bruises will likely be a deep purple color, then gradually fade to a brownish orange color before disappearing completely. The total amount of time it takes for a face to return to its normal self depends on the patients age, their health, individual specifics, and the specifics of the procedure.

The amount of swelling to be expected post-procedure depends on a number of factors. These include the skill and experience of your plastic surgeon, the details of the procedure, your body's own inflammatory response and the degree of care taken to reduce inflammation postoperatively.

If your nasal bones had to be broken and reshaped then your recovery procedure will take longer than procedures where no bones are broken.

In most cases, by the end of the second week the swelling will subside to the point where casual observers may not even know you’ve had rhinoplasty. By the third or fourth month you should look more or less back to normal but with a slightly larger nose, and by the end of one year your new nose shape should be final.

As you can see, full recovery from rhinoplasty is a long process. However, the results are usually extremely positive and for many people, life-changing. 

In my experience the thing that worries patients the most about rhinoplasty is the thought of a prolonged recovery period marked by severe swelling and bruising. In most cases the bruising peaks after the first three to seven days post-surgery, and gradually begins to subside after that. How long the swelling lasts before your face is clear of bruises depends on many factors, including the specifics of the rhinoplasty surgery and the skill of the plastic surgeon.

I can't give you any specific advice without a clinical consultation because the recovery process can vary widely from case to case.

For example: If your rhinoplasty surgery required the nasal bones to be broken (as may be required to correct a deviated septum or to reduce difficulty breathing through the nose) then the bruising and swelling may be more severe.

Because there are so many different kinds of rhinoplasty there's no single answer as to how long the recovery process will take. Some rhinoplasties don’t require any bones to be broken, while others meant to refine and contour the nasal tip generally involve less bruising. Still others, such as procedures to straighten a crooked nose, reduce a dorsal hump, or correct an injured or broken nose, may incur far greater amounts of swelling.

To minimize swelling I suggest carefully following your plastic surgeon's advice for a smooth recovery. Apply cold packs to your nose and under-eye area for the first two days.

And remember to consult with a plastic surgeon who has extensive experience with rhinoplasty procedures.

Dr. Alexander Ovchinsky has 10 Revision Rhinoplasty before & afters:

Revision Rhinoplasty before image performed by Dr. Alexander OvchinskyRevision Rhinoplasty after image performed by Dr. Alexander OvchinskyRevision Rhinoplasty before image performed by Dr. Alexander OvchinskyRevision Rhinoplasty after image performed by Dr. Alexander OvchinskyRevision Rhinoplasty before image performed by Dr. Alexander OvchinskyRevision Rhinoplasty after image performed by Dr. Alexander OvchinskyRhinoplasty (nose job) before image performed by Dr. Alexander OvchinskyRhinoplasty (nose job) after image performed by Dr. Alexander Ovchinsky

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I can't offer you any direct medical advice without an examination, but generally speaking the bruising and associated swelling usually peak within two to four days days after rhinoplasty. Most bruises after nose surgery start off as a deep purple color and are located around the nose and under the eyes. With time the bruising will eventually fade to a brown or yellow color. In most cases the swelling after rhinoplasty begins to subside after approximately one week.

Bruising is a natural part of the recovery process. Even with the best surgeons in the world, patients should still expect post operative bruising and swelling. Diligent home treatment is extremely important following surgery. Be sure to apply a cold pack to your eyes and swollen nose for the first two days after your surgery to keep nose pain and swelling to a minimum. Remember to be gentle when applying ice or frozen peas to your bruised nose, and avoid Advil (ibuprofen) and other over-the-counter pain medicines for the first two or three days.

You may also experience some nasal congestion as a result of nasal injury and swelling, but this is normal. You should talk to your surgeon about taking nasal decongestants postoperatively. Depending on the specifics of your rhinoplasty procedure, you may also experience the draining of mucus and other clear fluids. This is a normal part of trauma to the mucosal tissue and the draining of serous fluids.

If you experience fever or any pain and swelling that appears to be worsening it could be a sign of infection, in which case you should contact your plastic surgeon immediately.

If you have any specific questions about your recovery process I suggest you contact your surgeon directly. In most cases, plastic surgeons administer anti-inflammatory medications in the operating room during the procedure and prescribe a corticosteroid postoperatively to reduce inflammation.

Always remember to consult with a board-certified plastic surgeon for the best results.

Many individuals are fearful of undergoing rhinoplasty not so much because of the pain, but rather the degree of bruising that may occur afterward. Images of post-op patients with extensive bruising found online can be disconcerting for those considering surgery. This is perfectly understandable as the reality of being unable to attend social events or return to one’s everyday activities because of lingering facial bruising can be overwhelming.

While some patients enjoy a speedy recovery with minimal or no bruising around the incision areas or eyes, some bruising and black eyes can be expected for the majority of people. Bruising generally peaks several days after surgery and remains visible for several weeks, sometimes up to a month.

In rare cases, however, bruising may persist longer and 'stain' the skin. Red blood cells have a pigment called hemosiderin in their haemoglobin. During surgery, inadvertent trauma to the blood vessels can cause quantities of this pigment to be deposited. The hemosiderin stains the skin, and these stains can outlast the healing time of normal bruises.

Post-operative bruising is strongly influenced by the rhinoplasty techniques used during surgery. Factors such as if nasal bones were broken, or if soft tissue dissection was included in the procedure, increase the risk of bruising, particularly around the eyes.

Placing yourself in the care of a board-certified facial plastic surgeon will minimize the risk of excessive bruising. A qualified surgeon will inform you of any potential risks or complications involved based on your unique characteristics, and provide you with the information you need to expedite your recovery.

There are several things you can do to diminish the risk of bruising following rhinoplasty. Avoid aspirin, alcohol, and certain herbal supplements for at least one week before and after surgery, as they can thin the blood and increase the risk of bleeding.

Ice packs and cold compresses are essential in the first 48 hours of your recovery, as they minimize bruising and swelling. Some surgeons also recommend foods containing bromelain -- such as pineapple juice or papaya -- as well as Arnica Montana to help with post-op bruising. Your surgeon will provide you with instructions on how best to heal after surgery.

Dr. Robert Brueck has 1 Nose job before & after:

Nose job before image performed by Dr. Robert BrueckNose job after image performed by Dr. Robert Brueck

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Bruising following almost any form of plastic surgery is part of the body's natural response to trauma. Regardless of the skill of the plastic surgeon or how gentle he or she is, rhinoplasty patients will likely experience some bleeding beneath the skin. Bruising occurs when blood cells settle, causing the skin to appear black and blue before changing to a yellow color as they gradually subside.

For most patients, bruising under the eyes and around the nose will peak several days after rhinoplasty and last 7 - 10 days. However, some patients may experience discoloration that lingers for two weeks, occasionally even as long as one month. This isn’t anything to be concerned about, as each individual is unique and the healing process varies from person to person.

Factors such as age figure prominently in the extensiveness of one's bruising. Rhinoplasty patients under age 30 generally experience minimal bruising, while those over 40 experience more substantial bruising that takes longer periods of time to fade. Other factors such as general health, wellbeing, diet prior to surgery, existing health conditions or a genetic propensity to bruise easily will also influence how intensely a person bruises.

There are, however, ways to minimize bruising or help bruises to fade more efficiently. Many  plastic surgeons who specialize in rhinoplasty recommend patients take Arnica Montana or Bromelain supplements before and after surgery, both natural supplements that help to reduce bruising and swelling. Cold compresses -- such as a bag of frozen peas wrapped in a soft cloth -- are also helpful.


Finally, there are cosmetic surgical techniques available that work to dissipate extensive bruising. One recent study demonstrated how vascular filter IPL treatments and specific laser treatments -- such as pulsed dye --  break bruises up more rapidly. If you are considering rhinoplasty and concerned about bruising, talk to your surgeon about what to expect and what can be done to help with your recovery.

Between the 1st week ti the 3rd week. 

Typically the worst time is around 3-5 days right after surgery.  By 7-10 days, most of the bruising is typically gone in our patients. 

Bruising usually peaks at about 72 hours following a Rhinoplasty. After that point the bruising usually begins to subside. Many patients may return to non-strenuous work after about 1 week. 

Swelling and bruising generally peak at 48-72 hours after a rhinoplasty.  We give our patients steroids intraoperatively and have our patients take a medrol dose pack postop to reduce the amount of bruising and swelling.  It is very important to put ice/frozen peas on the eyes for the first 48 hours.  Arnica tablets and LED therapy also reduces bruising and swelling.  

Dr. Gary Breslow has 12 Nose job before & afters:

Nose job before image performed by Dr. Gary D. BreslowNose job after image performed by Dr. Gary D. BreslowNose job before image performed by Dr. Gary D. BreslowNose job after image performed by Dr. Gary D. BreslowNose job before image performed by Dr. Gary D. BreslowNose job after image performed by Dr. Gary D. BreslowNose job before image performed by Dr. Gary D. BreslowNose job after image performed by Dr. Gary D. Breslow

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