Bruising After Rhinoplasty: What You Need to Know

When recovering from rhinoplasty, bruising is common. It’s just one side effect of the healing process that cannot be avoided. There are, however, things you can do to potentially reduce bruising, or help it go away sooner. Learn what to expect from bruising after rhinoplasty.

About Bruising After Rhinoplasty

Some bruising after a nose job is unavoidable. How much bruising you personally experience depends on the experience of your surgeon, the extent of your surgery, age and genetics. Surprisingly, there are those who experience little to no bruising, just as there are those who experience extreme bruising which is beyond the surgeon’s control.

The following factors increase your risk for bruising after rhinoplasty:

• The experience of your surgeon
• The extent of your surgery and the technique used
• Your age
• Bleeding disorders
• Taking blood thinners prior to surgery
• Smoking or drinking

Bruising most commonly occurs around the under the eyes. Bruising will typically be at its worst 2-4 days after surgery, and usually subsides within 1-2 weeks.

Why You Bruise After Cosmetic Surgery

During rhinoplasty surgery, blood vessels in and around the nose, cheeks and under the eyes get damaged. When blood gets trapped under the surface of the skin, a blue or purple color appears. As bruises heal, they may change color, becoming more yellow.

There are several factors that determine the extent of bruising post-rhinoplasty including:

The experience of your surgeon

A skilled and experienced board certified surgeon will complete your cosmetic nose surgery more efficiently, leading to less disruption of blood vessels. Minimizing trauma to the area is the single most effective thing one can do to avoid the risk of bruising.

The extent of your surgery and the technique used

Rhinoplasty may entail reshaping cartilage, moving or reshaping nasal bones, the addition or removal of soft tissue, or all of the above. More extensive surgery increases the likelihood of bruising.

Your age and genetics 

With age, blood vessels become more delicate and skin gets thinner. Both of these factors increase the risk of bruising. Genetics, circulation, and nutrition also influence post-surgical bruises.

Use of blood thinners

Before your surgery, your doctor will recommend you stop taking blood thinners or other medications that increase bleeding. Follow your doctor’s advice regarding when you should resume these medications.

Smoking

Smoking disrupts the body’s capillaries and reduces circulation. You’re not only more likely to bruise if you smoke, but your bruises will last longer.  Smoking also increases the risk of irreversible tissue damage or necrosis of the skin.  People who smoke should not undergo rhinoplasty surgery.Post-Operative Care

Following your doctor’s recommendations for post-surgical care can make a difference in how much bruising you experience, and how long your bruising lasts.

How Long Does Bruising Last? 

Bruising is usually at its worst 2-4 days after surgery. By the end of the first week, you should notice a visible change and reduction in bruising. To help your bruising subside more quickly, try the following tips:

Follow Post-Operative Instructions

Closely adhere to your doctor’s post-operative instructions, even if they differ from the advice below.

Elevation

Keep your head elevated above your heart to reduce blood flow and limit pooling of blood in the capillaries. Try sleeping on your back with your head elevated by pillows, at least for the first 1-4 nights.

Cold Compress

Apply an ice pack, small bag of ice or bag of frozen vegetables to the under-eye area. Wrap the cold item in a thin towel to protect your skin. Ice for up to 10 minutes, taking at least a 20-minute break between icing sessions.  Do not place anything directly on the nose.

Use Bruise-Reducing Creams

Arnica, Comfrey, Vitamin K and Vitamin C creams may be effective in reducing the appearance of bruises. Use each as directed up to twice daily.

Avoid Eyewear

While you may be tempted to wear sunglasses to hide your black eyes, glasses only put more pressure on the bridge of the nose and sometimes the cheeks. This can prolong swelling and bruising. In severe cases, eyewear can cause indentations or movement of the bones.

Avoid Blood Thinners

Ask your doctor for advice on when to continue use of non-essential blood thinners and other blood thinning medications.

Avoid Smoking and Drinking Alcohol

Smoking decreases blood flow to the area which prolongs the healing process. Alcohol relaxes and opens blood vessels. Too much can lead to increased bruising.

Stay Hydrated

Staying hydrated prevents water retention, which reduces swelling and associated bruising. Hydration also improves blood flow for quicker healing.

When to See Your Surgeon

Most bruising subsides within 2 weeks. Severe bruises may take slightly longer to heal, but you should still see significant progress by week 2.

Sometimes, bruising can be an indication that something is wrong. If any of the following occur, call your doctor for advice:

• If bruising continues to worsen after the first week
• If bruising is accompanied by severe pain that increases or fails to get better
• If swelling becomes lumpy
• If you see blood in your urine or stool

More often, bruising after rhinoplasty is just a normal and healthy sign that your body is going the process of healing.

Cameron Craven MD, FACS is board certified by the American Board of Plastic Surgery. Dr. Craven specializes in the full spectrum of cosmetic surgery including breast augmentation, liposuction and body contouring, facial rejuvenation, laser surgery, eyelid surgery, and rhinoplasty, as well as reconstructive surgery for skin cancers.