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Ask Dr. Yang any questions about facial plastic surgery, including facelifts, necklifts, eyelid surgery (blepharoplasty), browlifts, otoplasty, and non-surgical treatments such as Botox and injectable fillers.
I had a rhinoplasty around 6 months ago and have been getting nose pain and headaches and sore red burning near eyes from top of my nose being sore for weeks. I had my eyes checked and all seems ok. I was given antibiotics for sinusitis or infection just in case. I have heard that this could be a sign of nerves regenerating or growing back, is this correct? I have had bone soreness and skin around that area, but no signs of infection. The doc thinks its a sinus issue. I had an osteotomy on one side of my nose.
Also I seemed ok a few months after the op and havent had any numbness etc. I will ask to see an ENT specialist just in case though and maybe an opthamologist although my opticians said my eyes are ok. Will this pain near my eyes go and soreness as well as headaches?
I don't know what is going on with your symptoms, based on your description. What does your plastic surgeon think? It sounds like you have not been in communication with your plastic surgeon, and instead have been to different specialists specific to the areas of concern (Eye specialists.)
I do think seeing an ENT specialist is a good idea. If you can choose an ENT specialist who is also a Facial Plastic Surgeon, you will get a rhinoplasty expert as well as a sinus expert. Most likely you will need an internal nasal exam with a tiny telescope to check to make sure that rhinoplasty didn't cause any unusual changes to the inside of the nose.
On a side topic, some patients with a deviated septum with a contact point from the septum to the side of the nose, also have a history of headaches. Perhaps you have something related, but only a detailed history and examination can yield more information to help figure out what is going on. Sometimes based on the History and Physical, the ENT specialist may order a CAT scan (a special type of X-ray) to look at the bones of the nose and sinuses to rule out any anatomic problems, which may have been pre-existing to the rhinoplasty, or may be developed afterwards.
Since my surgeon was on holiday, I managed to see one of his colleagues who does facial surgery and he examined me and my eyes from the outside saying he didnt think it was an infection and things looked ok and to see an ENT just to rule out anything serious. I have just finished a weeks course of doxycycline so will be booking an appointment with an ENT specialist soon.
Before surgery, I have never had any problems with headaches or eye soreness and my nasal septum has always been straight. My eyes have been helped by the doxy and also steam inhilation helped with sinus pressure from the sinusitis, but my eyes can still occassionaly become inflamed and sore, but my vision isnt affected. I had heard from another surgeon it could be nerves regenerating, but I will report back when I have seen the ENT specialist.
After thinking about your symptoms some more, I think that perhaps your ethmoid sinuses are infected causing the headaches and eye pain. Here is a diagram which shows the location of the ethmoid sinuses in relation to the eyes:
One common symptom of sinusitus is headaches. Cheek pain is related to infection of the maxillary sinuses, which are the sinuses behind the cheeks, and forehead pain is often associated with the frontal sinuses on the forehead above the eyebrows. Eye pain either the eye itself or a sensation of pain behind the eyeball, can be associated with ethmoid sinus infection. Imagine a pimple causing pain and swelling on the skin, now translate that infection into one of these bony pockets or sinuses. Because the infection is affecting the sinus, it is also causing a pain and swelling in the surrounding tissues.
Your rhinoplasty surgery may be indirectly related to the sinus infection. More likely it is indirectly related, meaning the swelling from the rhinoplasty caused enough swelling after surgery to block the opening to the sinuses (perhaps the ethmoid sinuses were the most affected) and started the sinus infection causing nose pain, headaches, and eye pain. Sometimes sinus infections are hard to clear if the antibiotic treatment is not long enough or not the right antibiotics to treat a sinus infection, and the chronic sinus infection never cleared over the past 6 plus months.
I hope this helps, and that you have already seen your ENT specialist.
Thank you again Dr Yang for taking the time to help with my important query with a detailed explanation. I know you are very busy, but your help is invaluable to those who are worried when things do not go to plan.
This problem has been causing a few sleepless nights for me as i wasnt sure if some serious damage had been caused by my decision to get nose surgery, although i wasnt told of any risks by the surgeon himself.
I was worried it could be cut damage etc..., but i am still waiting to see the ENT specialist due to lack of available appointments. I hope this is only a case of infected sinuses and that this problem resolves and isnt permanent. I do find that tablets bring some relief such as penicilins and steam inhilation, so maybe it is infection or inflamation. I guess we take our health and eyes/face for granted until something like this occurs, but i hope all is well and healed soon.
I went to see the ENT a few days ago and he looked inside my nose with a camera and couldnt really find anything much and did no tests or scans, then said i have rhinitis (which i doubt) and infection and was given nose steroid spray and a course of doxycycline for several weeks. I have used doxy before and amoxicillin for about a week and the problem returned with spre red painful eyes. I am wondering what do i do next if these tablets dont work, will i be left with sore burning eyes forever and what else i should ask any docs to do such as tests, medication or swabs etc...?
I think maybe he should have at least done some tests or scans? I dont think its right to just give someone pills or a nose spray and send them away? Would medication through an IV help if these tablets dont help as i think its just for management as the problem returns?
Any help would be good as I do wonder if the surgery has caused this as i have never had this problem before?
If this is your first visit with this particular ENT doctor, they may not order a bunch of tests and scans right away. Based on your history and physical exam from the appointment, your doctor felt that the combination of the nasal spray and antibiotics may help to clear the problem. Based on how you react to the initial treatment, your doctor may make a decision on if and when to obtain a CT scan of your sinuses.
The nasal spray will help to shrink the lining on of the inside of the nose, and potentially the opening which drains the sinuses. The antibiotic should help to kill the bacteria that is causing the rhinosinusitus (nose and sinus infection.) If the sinus can open up and get air into it along with clearing the infection, then potentially it may break the cycle. Without the nasal spray to shrink the swollen nasal lining, the antibiotic may kill the bacteria causing the infection which makes you temporarily feel better, but the mucus is still trapped in the sinus without an opening to get out due to the swelling, so as soon as you stop the antibiotic, the trapped mucus may get reinfected and cause the signs of sinusitus again.
I hope that makes sense, and let's hope this simple change in medical treatment does the trick.
I have recently noticed that my right eye gets more inflamed than the left and is slightly protruding and this is also where I had an osteotomy done and a growth type lump removed, not sure if this was bone or cartilage. Could the osteotmy in any way cause eye irritation as time goes on and the area is stiff and the skin around the nose and eye is more tight than the left side? I am also asking my doc for an eye and nose swab to be done for any infections. My other eye where no osteotomy was done is a lot less irritated and not red and doesnt have as many visible red veins either. Oh and should i ask for a scan of my face area in case the osteotomy may have trapped or irritated my naso lacrimal sac or some nerves or something causing the eye irritation?
I think you should definitely communicate your concerns to your ENT doctor and your observations. A regular sinus CT scan will usually cover the area of the osteotomy, as well as a full scan of your sinuses. Your ENT will decide on if something needs to be cultured or not. That is typically done when the patient has not yet started antibiotics, or is not getting better on the current antibiotics and pus is seen inside the nose. A very small cotton swab can be used to sample the mucus/pus and sent to the lab. If the ENT doesn't see any pus, there may not be anything to culture.
I finished my antibiotics course and saw an opthamologist who said i have slight blepharitis. But I dont think thats caused most of my eye issues. Most of the burning has gone, but i still get stinging and tingling at times, are these signs of nerve regeneration? WHat are the usual symptoms of nerve repair? Do you think I have some permanent nerve damage as i dont have problems with movement? I cant see how the lower eye lids wouldnt be affected during a rhino surgery as they are so close and share the same skin and nerves no doubt. The inner eye pink bits get sore less than before, i wonder if its also scar tissue healing and since i am 8 months post op that maybe i need time to heal? I hope its not permanent damage and i have heard a few others complain of the same issue, although rare.
I can't explain your eye symptoms, but I think that nerve regeneration and scar tissue healing are definitely possibilities. It would be difficult to say for sure, even if you saw me in person as a patient, but even more difficult to say as an anonymous poster on the internet.
I'm assuming the doctors you have seen have all be board certified in their field, so I would defer to their opinion, since they had the opportunity to examine you personally.
I went to see my surgeon who thinks the nose surgery and osteotomie wont make my eye protrude or look higher than the other side, is this true? I am having tests done to rule out any other problems, but the eye bulging happened around the same time after i had my surgery but i had blood work and its all fine. Could my doc be making excuses and can breakig nasal bones alter the height or position of the eye and or make it protrude slightly? Thanks.
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