Rhinoplasty Done Abroad - When the Healing Doesn’t Add Up

Rhinoplasty is one of the most technically demanding procedures in plastic surgery. The outcome depends not only on what is done in the operating theatre, but also on how the nose is supported, documented, and followed up during recovery.

In the first few months of establishing my practice back home in Singapore, I’ve already seen several patients returning from overseas rhinoplasty with concerns that seemed unrelated at first, but shared common patterns.

Case 1 - Persistent Swelling, With No Splint in Sight

Several patients presented worried that their noses remained swollen weeks after surgery. While this is not uncommon, what stood out was that some had not been given any external nasal splint at all.

A splint is not just cosmetic. It helps to:

• stabilise the nasal bones,

• reduce dead space,

• control early swelling, and

• guide the nose as it heals.

Swelling after rhinoplasty can be prolonged even in ideal circumstances. Without external support, and without clear explanations, patients are often left wondering whether what they’re seeing is normal, or whether something has gone wrong.

Lesson: Persistent swelling is not always a complication, but lack of structure and guidance makes recovery far more uncertain than it needs to be.

Case 2 - “Autologous Cartilage,” But the Clues Didn’t Quite Match

Another patient was told that autologous cartilage had been used during her rhinoplasty. She did have an incision in the ear, although its position was somewhat unusual as it was placed more anteriorly rather than behind the ear, which is more typical. While this is not entirely unacceptable, it prompted closer assessment.

On examination, transillumination of the ear was negative. When conchal bowl cartilage is harvested, the ear often becomes more translucent, and transillumination is typically positive (ie. light can shine through where cartilage had been taken from). The absence of this finding made it less clear what type, or how much cartilage had actually been used.

Without an operative report, it became difficult to answer practical questions patients naturally ask after surgery:

• What material was used?

• Where was it placed?

• How might it behave over time?

• What should be monitored during healing?

This doesn’t imply that anything was necessarily done incorrectly, but it highlights the challenges of how a lack of documentation can complicate postoperative care and future decision-making.

Lesson: Knowing what graft material was used matters, especially if concerns arise later or revision is ever considered.

Case 3 - A Wide Nose, But No Signs of Bone Work

One consistent pattern across multiple overseas rhinoplasty patients was the absence of bruising around the eyes, suggesting that nasal osteotomies may not have been performed.

In Asian noses, the nasal bones are often:

• wider,

• flatter, and

• a significant contributor to overall nasal width.

If bone work is not addressed when indicated, the result may be:

• increased bridge height, but

• unchanged bony width,

• making the nose appear larger rather than more refined.

  
  

This again is not about right or wrong technique, but about matching the surgical approach to the underlying anatomy. When patients later ask why their nose still feels wide despite surgery, the explanation often lies here.

Lesson: Rhinoplasty is about proportion, not just projection. In many Asian noses, bone work plays an important role in achieving balance.

Why These Patterns Keep Repeating

Across these cases, the issues were rarely dramatic complications. Instead, they reflected:

• unclear expectations,

• limited explanation of recovery timelines,

• missing operative details, and

• little guidance once patients returned home.

When something doesn’t feel right, patients are left anxious, even when healing may still be within normal limits.

Takeaway

Recovery after rhinoplasty is a process, not a moment. Swelling, uncertainty, and questions are common, but they should be anticipated, explained, and monitored.

If you’ve had rhinoplasty abroad and are unsure whether your healing is progressing as expected, an early review can help clarify what is normal, what needs observation, and what, if anything at all, requires intervention. Understanding the why behind recovery often brings as much reassurance as the examination itself.

Written by Dr Ng Zhi Yang, Singapore Plastic Surgeon, and Founder & Medical Director of Doctor Stitch, a specialist-led cosmetic surgery aftercare service.