Rhinoplasty reshapes the nose to enhance facial harmony or improve breathing. While the procedure offers aesthetic and functional benefits, bruising and swelling are expected side effects. Discoloration around the eyes, often called “black eyes,” is a normal, temporary part of the healing process.
Understanding Post-Rhinoplasty Bruising
Black eyes after rhinoplasty result from surgical manipulation of nasal structures. Reshaping nasal bones and cartilage disrupts delicate blood vessels, causing blood to leak into surrounding soft tissues and pool under the thin skin around the eyes. When bone work, such as narrowing the bridge or removing a dorsal hump, is performed, bruising can extend to the eyes and cheeks. This leakage leads to visible discoloration, appearing dark blue, purple, or black in the days following surgery.
Immediate Steps for Bruise Reduction
Applying cold compresses effectively reduces bruising and swelling. For the first 48 to 72 hours post-surgery, gel packs or ice water cloths can be applied to the eyes and cheeks, but not directly on the nose to avoid pressure. These compresses should be used for approximately 20 minutes at a time, followed by a 20-minute break, to constrict blood vessels, minimize blood leakage, and reduce bruising severity.
Maintaining an elevated head position is important during initial recovery. Sleeping on your back with your head elevated at a 30 to 45-degree angle, using multiple pillows or a wedge pillow, helps fluid drainage away from the nasal area. This reduces fluid buildup and swelling. Avoiding activities that increase blood pressure, such as bending over or heavy lifting, is advisable as these can worsen swelling and bruising.
Follow your surgeon’s medication instructions. Prescribed pain relievers and anti-inflammatories help manage discomfort, but avoid blood-thinning medications. NSAIDs (like aspirin, ibuprofen, and naproxen) and certain herbal supplements (like fish oil, Vitamin E, and ginkgo) should be discontinued for at least two weeks before and after surgery, as they increase bleeding and bruising risk. Staying well-hydrated and maintaining a nutritious diet also supports healing.
Recovery Timeline and Management
Bruising after rhinoplasty follows a general timeline. It typically peaks around two to three days post-surgery, appearing dark blue or purple. Over the next one to three weeks, the discoloration gradually fades, transitioning to green, then yellow or brownish hues. Most noticeable bruising resolves within seven to ten days, often coinciding with the removal of external splints.
After the initial 48-72 hour cold compress phase, switching to warm compresses can be beneficial. Warm compresses, applied gently, promote circulation and reabsorption of trapped blood, aiding bruise resolution. Ensure the compress is not too hot, especially since sensation might be temporarily decreased in the surgical area.
Protecting healing skin from sun exposure is important. Nasal skin becomes sensitive after surgery, and direct sunlight can increase swelling, prolong discoloration, and potentially lead to hyperpigmentation or permanent darkening of scars. Avoid direct sun exposure for several months post-surgery, using high-SPF sunscreen and wide-brimmed hats when outdoors. Subtle residual swelling, particularly in the nasal tip, can take several months, or even up to a year, to fully resolve. Gentle massage, if specifically recommended and demonstrated by your surgeon, may help with persistent swelling.
When to Consult Your Surgeon
While bruising and swelling are normal after rhinoplasty, certain signs require immediate consultation. Report a sudden, significant increase in pain or swelling. Fever or chills, or pus or foul-smelling discharge from incision sites, could indicate infection and require prompt medical attention. Excessive or persistent bleeding that soaks through dressings or is not alleviated by self-care measures also warrants evaluation. Although rare, vision changes or severe headaches are serious symptoms that are not typical for routine recovery and may indicate a complication.