Rhinoplasty after Injury Update: Who to repair right away and when to wait

Nasal Fracture Update: Who to operate on right away and who to delay repair:

Plastic Surgeons routinely see patients referred from the Emergency Department for nasal fractures. Very often, they have been told it is important to have surgery right away before the bones set. Patients show up anxious and concerned and feel a time pressure to have immediate surgery. While the Emergency Medicine physicians are well meaning, the need for emergency surgery is no longer required with current, advanced rhinoplasty techniques. In fact, in most cases, NO SURGERY IS NEEDED AT ALL.

Right after a significant facial injury with a nasal fracture, there is much swelling and bruising possible. In all but the worst injury cases, it is really impossible to tell if there is a true serious deformity or it is mainly soft tissue swelling. Now, my current recommendation is to wait 6-8 weeks for all healing and swelling to go down and to then evaluate the nose shape and function. In most cases, patients have healed very well, the change in nasal bone shape is minimally visible. In cases where there is a bump, curve or ridge, or there is breathing obstruction, delayed surgery is much easier with far more predictable results than operation go a newly injured patient with serious swelling and bleeding.

Here is much updated revision tree for who to operate on and when for nasal fractures:

Surgery Right away- clear deviation, medically healthy and stable, seen within first few days of injury:

Relatively easy to repair in OR to re-align bones as rather are still mobile, but often bones are in small fragments and do not stay where expected. Injured septum can be bloody and weakened and tough to manipulate and keep in place. Thicker swollen skin and tissues make it tough to see what changes are made in surgery and difficult to predict the final outcome.

There is more healing and outcome variability than delayed repair- some may need future touch ups for curves, bumps or other healing issues.

Delay Surgery until after full healing:

1-Much swelling, not so much clear deformity-- shape may improve with swelling resolution and avoid surgery

Better to wait

2-Medical issues or associated injuries that require management- other facial fractures or body injuries, concussion, brain injury. Heart or neurologic issues or unstable medial issues such as diabetes, asthma or blood pressure- get these conditions under control first, then re evaluate for repair

Treat more important issues than nose shape first.

While it is easier to move nasal bones early after a fracture while they are still mobile and no set, it is harder to move them precisely

A delayed rhinoplasty is more involved than an early fracture repair, but the tissues are less inflamed and swollen so there is far more precision in what can be done surgically. Bones and cartilage are now healed and stable, so more predictable surgical outcomes.

Summary:

After a nose fracture, you can visit with a plastic surgeon to help decide if surgery is needed or just icing, rest, and watchful waiting. Severe deformities might require prompt intervention such as surgery to re position the bones back to normal. Mild shape changes may not need surgery at all, and it is best to wait a couple of months then re evaluate.

Dr. Michael Suzman is a Board Certified plastic surgeon who practices in Greenwich CT and NY and has performed rhinoplasty surgery for 20 years.

Nasal Fracture Update: Who to operate on right away and who to delay repair:

Plastic Surgeons routinely see patients referred from the Emergency Department for nasal fractures. Very often, they have been told it is important to have surgery right away before the bones set. Patients show up anxious and concerned and feel a time pressure to have immediate surgery. While the Emergency Medicine physicians are well meaning, the need for emergency surgery is no longer required with current, advanced rhinoplasty techniques. In fact, in most cases, NO SURGERY IS NEEDED AT ALL.

Right after a significant facial injury with a nasal fracture, there is much swelling and bruising possible. In all but the worst injury cases, it is really impossible to tell if there is a true serious deformity or it is mainly soft tissue swelling. Now, my current recommendation is to wait 6-8 weeks for all healing and swelling to go down and to then evaluate the nose shape and function. In most cases, patients have healed very well, the change in nasal bone shape is minimally visible. In cases where there is a bump, curve or ridge, or there is breathing obstruction, delayed surgery is much easier with far more predictable results than operation go a newly injured patient with serious swelling and bleeding.

Here is much updated revision tree for who to operate on and when for nasal fractures:

Surgery Right away- clear deviation, medically healthy and stable, seen within first few days of injury:

Relatively easy to repair in OR to re-align bones as rather are still mobile, but often bones are in small fragments and do not stay where expected. Injured septum can be bloody and weakened and tough to manipulate and keep in place. Thicker swollen skin and tissues make it tough to see what changes are made in surgery and difficult to predict the final outcome.

There is more healing and outcome variability than delayed repair- some may need future touch ups for curves, bumps or other healing issues.

Delay Surgery until after full healing:

1-Much swelling, not so much clear deformity-- shape may improve with swelling resolution and avoid surgery

Better to wait

2-Medical issues or associated injuries that require management- other facial fractures or body injuries, concussion, brain injury. Heart or neurologic issues or unstable medial issues such as diabetes, asthma or blood pressure- get these conditions under control first, then re evaluate for repair

Treat more important issues than nose shape first.

While it is easier to move nasal bones early after a fracture while they are still mobile and no set, it is harder to move them precisely

A delayed rhinoplasty is more involved than an early fracture repair, but the tissues are less inflamed and swollen so there is far more precision in what can be done surgically. Bones and cartilage are now healed and stable, so more predictable surgical outcomes.

Summary:

After a nose fracture, you can visit with a plastic surgeon to help decide if surgery is needed or just icing, rest, and watchful waiting. Severe deformities might require prompt intervention such as surgery to re position the bones back to normal. Mild shape changes may not need surgery at all, and it is best to wait a couple of months then re evaluate.

Dr. Michael Suzman is a Board Certified plastic surgeon who practices in Greenwich CT and NY and has performed rhinoplasty surgery for 20 years.

$nasal fracture with deviation$

$nasal bump after nose fracture$

Rhinoplasty required for bone and septum repair and straightening

$nasal bump after nose fracture$

Rhinoplasty required for bone and septum repair and straightening

Dr Suzman rhinoplasty before and after photos

Nose now straight after rhinoplasty repair of nasal fracture and deviated septum from sports injury

Rhinoplasty after Injury Update: Who to repair right away and when to wait

Nasal Fracture Update: Who to operate on right away and who to delay repair:

Here is much updated revision tree for who to operate on and when for nasal fractures:

Surgery Right away- clear deviation, medically healthy and stable, seen within first few days of injury:

Delay Surgery until after full healing:

Summary:

Nasal Fracture Update: Who to operate on right away and who to delay repair:

Here is much updated revision tree for who to operate on and when for nasal fractures:

Surgery Right away- clear deviation, medically healthy and stable, seen within first few days of injury:

Delay Surgery until after full healing:

Summary:

Tags