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Do not have anything to eat or drink after midnight the night before surgery. If you normally take medications, we will let you know which medicines you may take the night before and the morning of surgery, and you should take them with a small sip of water.
Carefully remove all makeup and mascara before you come in for surgery. A rhinoplasty is a surgical procedure, and makeup interferes with sterility.
Leave your jewelry at home and don't wear perfume.
Wear loose clothing that is easy to put on and remove, such as elastic-waisted sweat pants. Wear a shirt that does not need to be pulled over your head.
When you arrive in the morning, the person who drives you to the office should escort you inside, so that he can receive instructions on when to pick you up after surgery.
Once at the office or surgicenter, you will be given more pills to make you sleepy. It is unlikely that you will remember anything at all after that. Here is what you will miss: you will be taken to the operating room and made comfortable in the operating chair. We will start your IV and give you more sedatives. Machines will monitor your blood pressure, heart beat, and oxygen level throughout the procedure. There will be no surprises, and the next thing you know, the operation will be over.
The first night after surgery
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At the end of surgery, your nose will be bandaged with a small metal splint on your nose, held in place with skin-colored tape. You will wear this splint for one week.
After surgery you will be allowed to relax or sleep in the recovery room while the sedatives begin to wear off. Then you will be escorted home with your family member or sitter.
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You will be tired as the medications wear off, and you will rest in bed with your head elevated. A washcloth soaked in ice water will be wrung out and placed over your eyes and along the sides of your nose. Changing this cloth every ten to fifteen minutes all night long is the job of your sitter. The cold cloths are extremely valuable in reducing swelling and bruising from the operation. We use the cold washcloths instead of ice in a plastic bag because the ice is too heavy to place on your nose after surgery.
It is also your sitter's job to keep you comfortable, to make sure you get the medicines you need, to help you to the bathroom when necessary, and to get you something to eat as your sedatives wear off. Wait until you are hungry to eat or drink, and avoid hot foods or foods that require much chewing. You may use a straw for thin liquids only. Don't pull a milk shake through a straw; it's too hard on your face for the first week after surgery. Do not smoke.
Your sitter will call the office if you have any difficulties during the night. Don't let your friends turn the night after surgery into a social hour, on the telephone or in person. You need to be relaxed, quiet and comfortable during this first night in order to start the healing process.
A folded 2" x 2" cotton pad will be placed under your nose and taped into position as a drip pad after surgery. This "mustache dressing" will catch any drainage. It is normal for some red blood to appear on the pad and for the pad to need changing several times during the evening. When removing this dressing, some hydrogen peroxide applied with a Q-tip will promptly loosen it if it sticks. Starting the morning after surgery, you probably will not have any more drainage, and you can dispense with the mustache dressing. If you do continue to have some nasal drainage for a couple days, replace the folded gauze pad rather than continually mopping your nose with a Kleenex.
The morning after surgery
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In the morning your surgeon will check you again. You will be instructed in the care of your nose. Don't try to predict the final appearance of your nose from what it looks like with the splint on. Do not use the hydrogen peroxide on your nose until you are shown how the morning after surgery.
Nasal breathing after surgery
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You probably will not be able to breathe well through your nose for one week after surgery.
As with any operation, there will be some swelling afterward, and the swelling that occurs on the inside of the nose will partially obstruct your breathing. Also, crusting will occur along the incision lines inside your nose where you cannot clean for the first week.
The result of these factors is a stuffy nose. If you find that you can breathe somewhat through your nose after surgery, that's fine. Sniffing is okay, too. Just don't blow your nose for about two weeks after surgery. Blowing your nose is harder on the healing tissues than sniffing.
Your surgeon will gently lift out the crusting at your one week visit, and you will probably be able to breathe much more easily through your nose at that time. As the swelling inside and outside your nose subsides over the following weeks, your nasal airway will improve even further.
An antihistamine/decongestant can be used only by those who find that they have an excess amount of mucous drainage after the operation. Use this medication only if needed to help decrease nasal secretions if they are bothersome during the first week after surgery. Antihistamines may make you drowsy. They will NOT clear your nasal passages to allow you to breathe through your nose.
Mouth breathing can dry your lips, so you might want to carry and use some Vaseline or lipstick. You may also find it more comfortable to sleep with a humidifier in the bedroom and a cup of water on the night stand.
Swelling
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Every surgical procedure is accompanied by postoperative swelling. You'll be swollen the morning after surgery, and the tissues usually continue to swell until the second or third day after surgery. Swelling is a normal reaction of your body to promote healing after the operation. The swelling will be most noticeable above the splint, between your eyes. By the end of the first week, most of the swelling will be gone, and most patients feel comfortable going out in public at that time.
The swelling and bruising will usually be subsided enough at the end of one week that you can go right from the appointment where your splint is removed, to the grocery store, and you won't be stared at, much. When your splint is removed, you and your surgeon will be able to tell where the rest of the swelling is, but many other people won't be able to see it.
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Most of the remainder of the swelling will disappear in the following several weeks, but the last five percent may linger until as long as one year after the operation. You may notice subtle improvements in the appearance of your nose long after surgery. Patients with thick, oily skin will swell more and will hold onto their swelling longer than patients with thin skin.
You can minimize the swelling and speed its resolution by sleeping with your head elevated during the first week after surgery. Place a couple of pillows or a folded blanket under your mattress at the head of your bed. You may notice that the swelling is more noticeable when you awaken in the morning, and it subsides when you are up and about, as gravity pulls the swelling out of your face.
The iced washcloths are a great help the first night of surgery. After the first night they have less effect in minimizing the swelling, so continue to use them if they are comfortable, but don't feel that you must use them after the first night.
Bruising
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A bruise is simply a tiny amount of blood spilled under the skin. You may bruise under your eyes after surgery. The iced washcloths through the first night will help minimize your bruising. Just like a bruise anywhere else on the body, bruising from nasal surgery will spread, change color, fade, and finally disappear. In most people it is almost gone at the end of one week, and completely gone in ten to fourteen days. It is a normal consequence of the operation and not a cause for concern. You may disguise the discoloration with makeup if you wish.
Do not worry if the swelling or bruising is more pronounced around one eye than the other. Only rarely is the amount of bruising or swelling exactly the same on both sides. The differences will resolve as the swelling and bruising diminish.
Discomfort
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The amount of discomfort from a rhinoplasty is surprisingly small. You will be given a prescription for a pain reliever to use in case you do experience discomfort. Use Tylenol or the iced washcloths for minor pain. Remember, aspirin can increase bruising and the tendency to bleed. No aspirin or aspirin-containing products should be used until two weeks after surgery.
Swelling, bruising and some discomfort are inescapable consequences of any surgical procedure. You must be willing to accept their minor inconveniences in order to obtain the more lasting benefits of the operation.
Depression
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Your nose will be swollen and bandaged. It may be bruised. You may be weak for a couple of days after the surgical sedatives wear off. You probably aren't used to sleeping on your back with your head elevated. You will not be able to exercise, and your daily routine will be disrupted.
Considering all of these factors, a brief period of depression after a rhinoplasty is completely normal. Because a rhinoplasty is a totally elective operation, unlike an appendectomy, we tend to forget that it is a real surgical procedure and not as easy as having a haircut.
These temporary setbacks, however, are a necessary part of obtaining the lasting benefits of your operation. Going through surgery is stressful, even if the changes made were greatly desired. Just remember that the depression is normal and will resolve quickly. Find a good book to read, watch television, or find some other way to distract yourself. The depression will pass quickly.
Pay attention to your upper lip
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Your upper lip will be a little swollen after surgery. The place where the nose joins the lip is an important part of rhinoplasty surgery, so take care to protect your upper lip after the operation.
For the first week after surgery:
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Do not engage in long conversations or excessive talking.
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Avoid overly humorous friends and recordings.
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Be careful brushing your upper teeth. Sneak the toothbrush over the teeth without curling your upper lip upwards.
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Think about how hard you manipulate your upper lip when you put lipstick on with a stick. It is better to use a brush or your finger for the first week.
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Do not chew gum or eat foods that are difficult to chew. Do not drink thick liquids through a straw.
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If you continue to have nasal drainage, wear the 2" x 2" mustache dressing rather than continually dabbing yourself with a Kleenex.
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Limit your activities
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Avoid all exercise for the first two weeks after surgery, and avoid strenuous exercise or weightlifting for four weeks. Too much exercise too early can raise your blood pressure and cause a nose bleed.
Joggers may walk briskly after two weeks and jog after three weeks. Tennis players may hit ground strokes after two weeks and play after three weeks. Remember your sun block.
Work back into your regular exercise routine slowly. Check to see that your ski or swim goggles or your racquetball eye protectors don't press into your new nose.
Things to avoid
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Avoid bending over, lifting heavy objects, or heavy housework because such activities increase the blood pressure to your face and may start a nose bleed. If you are prone to constipation, you may begin taking a stool softener a couple of days before surgery.
Avoid prolonged sun exposure for one month after surgery. Wear a hat and a strong sun block. Remember that the sun's rays passed through clouds or reflected off of snow, water, or sand can still give a strong exposure.
Blowing your nose
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Do not blow your nose for two weeks after surgery. After two weeks you may blow gently, through both sides at the same time. Sniffing is okay, even right after surgery when you still have your splint on.
Sneezing
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Most people sneeze after nasal surgery; it's one of the body's responses to irritation in the nose. If you must sneeze, sneeze with your mouth open. Do not allow the sneeze to come through your nose, and don't try to stifle it. If sneezing becomes a recurring problem for you in the first few days after surgery, the antihistamine/decongestant may help.
Protect your new nose
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Have someone assist you with walking and bathing until the surgical sedatives have worn off completely. Remember that the Valium, the pain pills, and the antihistamine can make you drowsy. Try to sleep on your back for one week after surgery, and sleep alone to avoid the risk of your partner bumping into your new nose during sleep. You should also abstain from sex for two weeks. Sex is exercise, and it increases the blood pressure to your face.
Wear shirts or sweaters that fasten in front or in back and do not need to be pulled tightly over your head for the first week. Avoid picking up small children who may strike you unexpectedly.
What if I do bump my nose or get a nose bleed?
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First of all, you should know that fewer than one in 200 of our patients experience nosebleeds, so it is extremely uncommon. You can control most nose bleeds after surgery quite easily by yourself. Lie down with your head slightly elevated and place an iced washcloth over your face as you did the first night. Try to relax. As your blood pressure reduces, the nose bleed will subside. Spray some plain Neosynephrine nose spray into each nostril if you have the spray available. Sniff very lightly. Do not blow your nose.
If your nose continues to bleed, repeat the nose spray and keep resting. If this procedure does not control the bleeding, or in any case if you are worried, call the office.
Most bumps to the nose are very minor and require no treatment. Look at your nose in the mirror. If it looks unchanged, nothing needs to be done. If you think something may have been displaced, call the office and come in to have it checked.
Almost everyone bumps his nose some time during the week after surgery. I've never seen it adversely affect the final result.
Wearing eyeglasses
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When you are wearing the nasal splint, the splint will protect your nose from your eyeglasses. So you may put your eyeglasses right on the splint. After the splint is removed, eyeglasses usually rest on the nose in a location where they won't hurt your new nose at all. Your doctor will want to see your glasses when you come in to have your splint removed, so that he can confirm that they won't cause a problem.
Contact lenses may be inserted the morning following surgery.
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Driving
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You may drive as soon as your postoperative fatigue subsides, usually within about a day or two after surgery. Do not drive if you are taking the prescription pain medicine or the Valium, or if you feel the surgical sedatives haven't completely worn off yet, or if you feel the swelling is interfering with your vision
. Alcohol and smoking
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Avoid alcohol for two or three days after surgery. Do not drink if you are taking the Valium or the prescription pain pills.
If you smoke, you should minimize your smoking during the week after surgery. Smoking is not good for your nose, it's not good for your lungs, and it's not good for your heart. Plan on quitting.
Washing your hair
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The nasal splint is mostly waterproof�after all, you had the iced washcloths on it during the entire first night after surgery. So it won't dissolve if you get a water on it, but still, try to keep it as dry as you can. When you're in the shower, tilt your head back while facing away from the shower head to wash your hair, or have someone else wash your hair in a sink. Use hand-held hair dryers on a medium or cool setting. When you wash your face, don't get soap close to the splint's tape, and don't press hard enough on your cheek to move the skin next to the tape; you might loosen the splint. You may wish to use cotton balls or a makeup sponge for the first week.
For general showering or bathing, do not use hot water, which dilates blood vessels and may promote bleeding.
Fever
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You may experience a brief rise in temperature and some chills for a day or two after surgery. Your temperature should not rise much above 100 degrees.
Call the office if you develop a sustained fever, drainage from the nose that isn't just clear mucous, or a markedly tender, reddened area of skin.
Your one week visit
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At your one week visityour surgeon will gently remove the splint and any crusts in your nose, and you should be able to breathe more easily through your nose immediately. Do not be apprehensive about this appointment. It will not be uncomfortable. On the contrary, you'll probably feel much better afterward.
Do not expect immediate results and a normal looking nose at this unveiling. Healing is a gradual process.
About seventy percent of the swelling will now be gone. your surgeon will point out the remaining swelling and explain where you can expect to see improvement with time. By the time another week has passed, your nose will probably be looking very natural. You and your surgeon will be able to tell where the rest of the swelling is, but most other people will not.
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After the splint is removed, you may notice that your nose is turned up more than you anticipated. That appearance is caused by swelling that is still present where your nose meets your upper lip. The nose drops slightly during the healing process and will return to its proper position.
Clean your nasal skin gently with cotton balls and a mild soap several times a day for the next week. It has been hidden under the tape for a week and needs to be cleaned. Also, when the splint comes off you may wear makeup right away if you wish. Apply and remove makeup gently. Don't rub or push on your nose for several weeks.
After the tape is removed, you will be able to see the incision in the skin at the bottom of your nose. Clean the incision very gently with hydrogen peroxide on a Q-tip three times a day for the next couple of days. These cleanings will help the incision heal and fade rapidly.
The very tip of your nose may be numb. The numbness goes away after several months.
After the splint is removed, you may clean the inside of your nose gently with Vaseline on a Q-tip. The Vaseline will keep the inside of your nose moist and make it more comfortable. Do not place the Q-tip so far up that you lose sight of the cotton tip. (And don't clean your nose during the first week when the splint is still on; the Vaseline will loosen the tape.)
Any other problems or questions?
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Reread this section on the care of your nose and your questions will almost certainly be answered. If not, call during office hours for routine questions or anytime for more urgent problems.
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