Rhinoplasty is a surgical procedure performed to reshape the bone and cartilage structure of the nose. Following the surgery, the surgeon may place a temporary dressing inside the nasal passages, known as nasal packing. This packing supports the newly altered internal structures and helps manage the initial stages of healing. The duration the packing remains in place is a primary concern for patients, as it directly impacts post-operative comfort and breathing.
The Purpose and Different Types of Nasal Packing
Nasal packing serves several important functions immediately after rhinoplasty. The primary role is to achieve hemostasis by applying gentle pressure to the internal nasal lining, which helps to control post-operative bleeding. This pressure also prevents the accumulation of blood, known as a septal hematoma, which is a complication that can compromise the blood supply to the septum.
The packing also acts to stabilize the internal architecture of the nose, particularly after adjustments to the septum or turbinates, by holding the tissues in their new position during the first hours of healing. Surgeons choose the type of packing based on the complexity of the operation and their protocol. The two main categories are non-dissolvable and dissolvable materials, which determine the removal method and timeline.
Non-dissolvable packing, which includes traditional gauze or sponge-like inserts such as Merocel, must be manually removed by a healthcare professional. These materials provide firm support and absorb blood, but they often cause temporary complete nasal blockage. Conversely, dissolvable or bioresorbable packing, made from materials like collagen, gradually breaks down and is either absorbed by the body or naturally expelled through nasal drainage.
When Nasal Packing Is Removed
The timeline for removing nasal packing depends on the type of material used and the extent of the surgical procedure. Non-dissolvable packing is typically removed quickly to minimize discomfort, congestion, and the potential risk of infection. For many surgeons, this type of packing is removed within 24 to 72 hours following the operation.
Some modern surgical techniques aim for earlier removal, sometimes within a few hours while local anesthesia is still active, to improve patient comfort and breathing. In more complex cases involving significant septal work, internal non-dissolvable splints may be used instead of or in addition to packing. These splints provide longer-term support to the reconstructed septum and are often left in place for five to ten days.
The use of dissolvable packing eliminates the need for a manual removal appointment. Patients will notice an increase in nasal drainage as the material begins to dissolve and is naturally expelled over several days. The specific removal schedule is determined by the surgeon’s preference, the patient’s healing rate, and the unique details of the rhinoplasty performed.
What to Expect During and Immediately After Removal
The manual removal of non-dissolvable nasal packing is a quick process. Patients often describe the sensation as uncomfortable pressure or tugging rather than severe pain. To manage discomfort, surgeons sometimes recommend taking prescribed pain medication approximately an hour before the removal appointment. The healthcare provider will gently pull the material out of the nostrils, which takes only a few moments for each side.
Immediately following removal, patients often experience sudden relief and a rush of air as the nasal passages open. A temporary increase in watery drainage or minor blood-tinged discharge is common. Patients are instructed on immediate aftercare, such as resting with their head elevated and avoiding forceful actions like blowing the nose. To prevent complications, patients are advised to begin gentle saline nasal irrigations shortly after removal. While the removal provides immediate relief, the feeling of congestion may persist for several weeks due to internal swelling.