What are the potential complications and recommended treatment for a postoperative patient with a swollen and elongated nose that changes shape when pressed, has slight redness when pressed, and no pain, following recent nasal surgery?

Postoperative Nasal Swelling with Compressible Elongated Deformity

This presentation is consistent with postoperative edema and soft tissue swelling that is still resolving, and the compressible nature without pain or significant redness indicates this is not an acute complication requiring urgent intervention. 1

Clinical Assessment

The key features described suggest benign postoperative changes rather than complications:

• Compressibility with return to baseline shape indicates soft tissue edema rather than structural deformity, hematoma, or infection 2
• Absence of pain argues strongly against infection, abscess formation, or significant tissue injury 3
• Minimal redness only with pressure is consistent with normal vascular response in edematous tissue, not cellulitis or active inflammation 1
• Elongated shape on lateral nasal sidewall likely represents localized edema in the area of surgical manipulation 1

Expected Postoperative Course

Nasal swelling following surgery follows a predictable timeline:

• Significant edema can persist for weeks to months after nasal procedures, particularly in areas where tissue planes were disrupted 1
• The compressible nature of the swelling confirms this is fluid accumulation in soft tissues rather than a solid mass or structural problem 2
• Asymmetric swelling patterns are common postoperatively and do not necessarily indicate complications 1

Management Approach

Conservative Management (Recommended)

Continue observation with conservative measures as the primary approach:

• Cold compresses can help reduce edema in the early postoperative period 2
• Head elevation when sleeping reduces venous congestion and promotes lymphatic drainage 2
• Avoid manipulation or repeated pressing of the area, as this can prolong inflammation 1
• Nasal saline irrigation may help if there is concurrent mucosal edema, though this addresses internal rather than external swelling 1, 4

Follow-up Timeline

Schedule reassessment at 3-12 months postoperatively to document resolution and assess final outcomes, as recommended for all sinus surgery patients 1

• If swelling persists beyond 3 months without improvement, consider imaging to exclude fluid collection or other structural issues 1
• Document progression with serial photographs to objectively track changes 1

Red Flags Requiring Urgent Evaluation

While the current presentation appears benign, seek immediate evaluation if any of the following develop:

• New onset of pain or tenderness, which could indicate infection or hematoma 3
• Increasing redness, warmth, or purulent drainage, suggesting infection 5
• Fever or systemic symptoms 5
• Progressive enlargement rather than gradual resolution 2
• Nasal obstruction or breathing difficulty 6

Pitfalls to Avoid

• Do not assume all postoperative swelling requires intervention - most resolves spontaneously with time 1, 2
• Avoid premature surgical revision before allowing adequate time for tissue healing and edema resolution, typically 6-12 months 1
• Do not dismiss patient concerns - provide reassurance with clear timeline expectations and scheduled follow-up 1