The removal of the external cast and internal splints typically occurs five to eight days after the procedure. This appointment is the first opportunity to see the initial changes to the nasal structure. The cast and splint protect the newly refined bone and cartilage and help manage initial post-operative swelling. Understanding the process and the appearance of the nose immediately afterward is important for a smooth recovery.
The Procedure for Cast and Splint Removal
The removal process is performed by the surgeon or a nurse in a sterile office environment. It begins with the gentle loosening of the tape securing the external cast, often using warm water or a mild adhesive solvent to soften the materials. A thermoplastic cast is carefully lifted away from the skin once the adhesive bond is sufficiently weakened.
Patients typically describe the sensation as pressure, tugging, or relief, rather than pain, as the constricting materials are lifted. If internal splints were used to support the septum, they are gently removed using forceps. Any dissolvable sutures present at the base of the nose are either trimmed or removed, followed by a gentle cleaning of the skin and nasal passages.
Immediate Post-Removal Appearance
Immediately after the cast is removed, the skin that was compressed beneath it may appear shiny, flaky, or red, often with a sticky residue from the surgical adhesive. The temporary loss of external compression causes a rapid rush of fluid into the tissues, resulting in a temporary increase in swelling.
The nasal tip is particularly susceptible to this fluid accumulation, frequently appearing bulbous, wide, and slightly upturned compared to the final desired result. Bruising previously contained beneath the cast may have migrated downward, causing discoloration beneath the eyes and across the cheeks. This initial presentation is a temporary, highly swollen state and does not reflect the ultimate outcome of the surgery.
Managing Swelling and the Recovery Timeline
The initial swelling begins to subside noticeably within the first two weeks, allowing most patients to feel socially comfortable returning to public activities. However, the majority of the swelling, approximately 80%, may take three to six months to resolve completely, revealing a clearer definition of the nasal bridge.
The nasal tip is the slowest area to heal due to its thicker skin and limited lymphatic drainage, and it can take 12 to 18 months for all residual swelling to dissipate. To manage this, some surgeons recommend “taping,” where small strips of medical tape are applied to the nose overnight. This light compression helps the skin re-drape and encourages the continued reduction of fluid within the soft tissues.
Essential Post-Removal Care and Restrictions
The skin must be cleaned very gently to remove any adhesive residue, using mild soap and avoiding harsh scrubbing or exfoliating products for several weeks. Direct sun exposure should be avoided for several months, as UV rays can worsen swelling and potentially cause permanent discoloration of the healing skin.
Restrictions on physical activity are put in place to prevent trauma or compromise the results. Strenuous exercise, heavy lifting, and any activity that significantly raises the heart rate are restricted for four to six weeks. If corrective lenses are required, patients must avoid wearing traditional glasses that rest on the nasal bridge for up to six weeks, instead using contact lenses or taping the glasses to the forehead to relieve pressure.