Rhinoplasty Recovery: Will Steroids Reduce my Swelling?

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Rhinoplasty Recovery:

How do you decrease swelling during your rhinoplasty recovery? When I complete a rhinoplasty on one of my patients, their nose unquestionably looks fantastic on the operating room table. After I close the small incisions, I then place Doyle splints inside the nostrils, and then surgical tapes and a Aquaplast splint on the outside on the nose along the bridge. These tapes and splints serve many functions, but their primary function is to help reduce swelling during the post-operative period.

Nasal swelling following rhinoplasty has a very predictable course. It also has a very predictable timetable for resolution. I tell all of my patients, prior to surgery, that they will need to expect nasal swelling after surgery and also that they will need to be patient as it resolves. Typically, swelling resolves in the upper third of the nose over three to six months, in the middle third over six to nine months, and over the lower third (the tip) over nine to twelve months. These time periods are, of course, simply estimates. Everyone heals differently. Patients who tape their noses for longer periods of time will have a relatively quicker resolution of swelling. However, as a plastic surgeon I often am investigating other options that may assist in an even quicker course of swelling resolution. For instance, there is some anecdotal evidence that use of hyperbaric oxygen helps reduce swelling during rhinoplasty recovery.

Corticosteroids have been used for decades in medicine, as a systemic medication that helps to combat swelling. The mechanism of action of steroids, is to inhibit the inflammatory pathways through their actions on white blood cells and their chemical mediators. With respect to corticosteroid use during plastic surgery procedures, and following during the recovery period, the data to support their use has been unclear. Recently, Pulikkottil, et al. reviewed the relevant literature about corticosteroid use in rhinoplasty surgery (Plast Reconstr Surgery, Vol 132, No 3, 352e, September, 2013). Although some of the studies reviewed did show some improvement of swelling for patients who received high dose corticosteroids, the data overall were not conclusively in favor of routine use. Currently, corticosteroid use during and after rhinoplasty surgery should probably be used only on a case by case basis.

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