One of the main fears patients have regarding rhinoplasty is that they will bruise severely and that the bruising will result in them needing extended time off from work and away from friends.
While this is a very valid concern, here at Profiles we are very happy to be able to say to our patients that the vast majority of our patients experience minimal bruising and even those who do experience any bruising are almost always able to return to work at the 6 day point after surgery when the nasal cast is removed.
In our experience the most important factor in minimizing bruising is your surgeon. The reason for this is that bruising in rhinoplasty generally occurs when your surgeon has to make cuts in your nasal bones to narrow the bridge width. Bruising occurs because when making the cuts in your nasal bones your surgeon very often ends up cutting and shredding through the periosteum which covers the upper and lower surfaces of your nasal bones.
So let’s be clear: the periosteum, which lines your nasal bones is the major blood supply to your nasal bone and this lining is tightly adherent to your nasal bones. If your surgeon cuts the nasal bones without elevating the periosteum, he/she will invariably be shredding through the periosteum resulting in bleeding and bruising. At profiles, your surgeons always take the extra time to elevate the periosteum so when it is necessary to cut the nasal bones, they are doing all they can to minimize the trauma to your periosteum and thereby reducing your bruising.
So the most important factor in how much you bruise is ultimately the care your surgeon takes in doing surgery. There are then a number of patient factors that can contribute to bruising:
1. Age- older patients tend to have more fragile blood vessels and therefore tend to bruise slightly more
2. Bleeding tendencies/disorders- if you, or any family members have any history of excessive bruising or bleeding after procedures or in general, it is important that you discuss this with your surgeon so proper testing can be done
3. Medications- some patients need to take medications that thin the blood. This does not mean you cannot have surgery, but again your surgeon will need to know and make proper arrangements after discussion with your treating physician
Obviously, however, none of these factors are within your control.
Finally, there are a number of tips that physicians will recommend in order to limit the extent of bruising and swelling:
1. Avoid any non essential medications that thin the blood for a minimum of 2 weeks before surgery and do not resume them until your physician directs you to. These medications include (but are not limited to): aspirin, ibuprofen, and other over the counter anti-inflammatories.
2. Avoid high dosing any multivitamins/herbal remedies/teas etc that contain high levels of Vitamin E, Ginseng, Ginko and fish oils– these can cause you to bleed more freely.
3. Ice packs, or even better, frozen peas, applied to the cheeks for the first 2 days after surgery
4. Keeping your head elevated will, at least help reduce swelling and may also decrease bruising
5. Avoid smoking
6. Herbal supplements such as bromelin, papaya extract, vitamin K “oxide” and arnica may be of marginal benefit, but to date there are no well designed studies that show markedly less bruising in those patients who take these or other supplements.