Rhinoplasty Surgery
Rhinoplasty Surgery
Preoperative Preparation
see also pre and postop instructions
The Procedure:
Rhinoplasty may be done under IV sedation, local anesthetic, or general anesthesia depending on the type of operation being performed. Dr. Shah and the anesthesiologist will advise on the type of anesthetic which is best for you.
Immediately After the Procedure:
1. Packing: A small amount of loose packing is sometimes placed just into the nostrils, especially if your surgery is also to relieve a nasal breathing obstruction. This loose packing is removed painlessly the morning following surgery with a small tweezers by gently pulling downward. Dr. Shah usually sees the patient the next day to assist in the removal of packing and to review instructions.
2. Nasal Bandage: A small bandage is placed between the bottom of the nose and the upper lip. This is changed as often as needed during the day. A small amount of oozing is ordinary and expected. It should not concern you. The bandage may be changed one or a dozen times. The loosely closed incision allows blood to escape rather than flow back up into the nasal tissue. Most of this oozing stops by the evening of surgery or by the following morning. It is seldom necessary to leave the hospital with a drip pad. If you have surgery as an out-patient, the pad can ordinarily be discontinued the morning following your operation. A small amount of red-pink serum is to be expected. Just dab it away.
3. Dressing: A small silicone splint is placed atop the upper two-thirds of the nose at the completion of the rhinoplasty. This splint acts both as a protector for the freshly operated nose and helps to maintain the position of the newly sculpted nasal bones. The splint is removed in one week. Do not allow it to get wet or it may separate prematurely.
The First Week After Surgery:
1. Ice: During the day and evening of surgery, cold moist compresses are used continuously over the eyes to minimize swelling and control bruising. There are several techniques for icing which are effective. The one glove technique is preferred, but the frozen pea method, or cool compress methods are acceptable as well.
2. Puffiness: Puffiness or swelling of the eyelids is always most pronounced on the second morning following any facial plastic surgery (i.e., surgery on Monday, most swelling on Wednesday). It usually regresses quickly in the next few days. This normal and expected observation is no cause for concern.
3. Bruising: Bruising and discoloration around the eyes is extremely variable. However, the majority of patients do experience minimal black and blue. Careful adherence to the recommended pre-operative medication instructions is imperative. A few patients, despite taking all precautions, will develop marked bruising in the eyelids. Even this bruising is usually resolved by the end of the first week.
4. Nasal Stuffiness: Invariably, there is some nasal stuffiness during the week after surgery. The external edema (swelling) is reflected internally, but the mild blockage will improve steadily. The application, twice daily, of a small amount of prescription ointment just inside the nostrils, acts to lubricate the surgically sutured area and prevent crusting.
Any crusting that does form can be gently removed with a peroxide dampened Q-tip. However, it is imperative to avoid extensive manipulation in this area. DO NOT BLOW THE NOSE. DO NOT USE NOSE DROPS.
5. Nasal Discharge: For the first few post-operative days, you may expect a small amount pink-colored water nasal discharge. Usually, a facial tissue touched to the nostrils is all that is required. Occasionally, reapplication of a small gauze bandage beneath the nostrils may be more convenient. Any gauze continuous persistent show of bright red blood should be reported to me.
Bleeding on the third, fourth, or fifth day occurs in less that one-percent of cases. First aid for such a rare occurrence is as follows:
Lie down and elevate head. Place cold compress on the nose. If available, saturate a piece of cotton with nose drops or Visine, and place it in the bleeding nostril.
6. Pain: Discomfort following rhinoplasty is usually limited to the two or three hours just after the procedure. It may best be described as a headache. Severe pain is rarely a consequence of facial plastic surgery. The prescription for pain tablets that you have received is more precautionary that necessary, but please have it filled and available at your home bedside. Take codeine with milk to avoid any stomach upset.
7. Sleeping: During the first week, it is best to sleep with the head elevated by at least two pillows, both to decrease the amount of swelling and to aid in the resolution of any swelling that does occur.
8. Nasal Appearance with Cast: During the first week, you may notice that the nasal tip is slightly elevated. This is a constant, temporary factor following all rhinoplasties. The position of the nasal tip at this time has little relationship to the final result. The tip will slowly drop to its new lower position over several days or weeks.
9. Exercise: Exercise must be limited during the first week. While relaxed ambulation about the home and local shopping, dining or visiting is encouraged: any lifting, pulling or straining must be avoided, as it may cause bleeding.
10. Avoid Blood Thinners: Do not use Aspirin until after the first week. Please refer to blood thinner sheet. Alcohol is a potent blood vessel dilator and, in the post-operative condition, can promote swelling of the surgical area and even bleedings. It is best to avoid Alcohol intake for at least one week following surgery.
11. The nasal splint will be removed at the end of the first week. Please call several days in advance for the appointment.
After the First Week:
1. Nasal Appearance: At the time of nasal splint removal, you will have your chance to see the new nose. It will appear quite swollen but, in most cases, even in this swollen condition, the improvement can be appreciated. It is not a time for critical evaluation since, over the next few weeks, daily changes progress toward the final result.
In most cases, the appearance at six to eight weeks approximates the final shape. Many factors determine how quickly, or slowly, the nose assumes the final appearance. The most influential determinant is skin type. Skin that is thicker and oilier is certain to retain edema and swelling longer that skin that is drier and thinner. Individuals vary in healing potential. The nose will continue to heal over a long period of time with subtle changes occurring over years of surgery. Our goal is to provide a long term result which will last the person’s entire life.
2. Activity: During the second week the nose must not be bumped, (elbows, doors, etc.). Though the bones are firmly healing in place, even a slight blow could cause movement. Avoid any situation where a potential for ‘ nasal trauma exists. Exercise which increases the heart rate can begin at 14 days post-up. Exercise during the first week post-up can cause bleeding. During the second week post-up it will increase edema or swelling. At 14 days, you can begin fast walking and light weights. At 21 days, you can begin running and heavier weighty. At 30 days, full exercise can begin. A frequent question is “…when can sexual activity resume…” As a moderately exertional activity (caloric expenditure), sexual activity can safely be resumed at 12-14 days following facial plastic surgery.
3. Wearing Glasses: You should not wear glasses for about one month. If glasses must be worn, taping the central bridge of the glasses to the forehead will allow as little pressure as possible on the nasal bones. If desired, a nasal splint will be provided that will disburse the weight of the eyeglasses, allowing you to wear them on the bridge of the nose.
4. Sun Exposure: It is wise not to sunbathe for about 60 days. A sunburn will cause the nose to swell and delay the final result. Walking about between sun and shade or sitting with a hat, is permitted. It is always best to apply a waterproof factor 25 sunblock to the nose if strong sun exposure is anticipated. The nasal skin is somewhat insensitive following rhinoplasty. This can be appreciated by touching the skin which will seem slightly – numb. Full sensation always returns in three months time; the tip regains full sensation last. The advice concerning sun exposure also applies to the winter cold. It is possible to experience frost-bite if exposed for long periods to sub-freezing weather during activities such as skiing. Both sun and the winter cold are natural enemies to the skin and prolong the usual post-up course.
5. Skin: A natural reaction of all types of nasal skin to this surgery, is a pronounced increase in nasal oiliness. Even skin that is usually dry will need to be wiped with an astringent on a cotton pad once or twice a day for two weeks or more. Another universal observation is the presence of flaking or peeling of the skin, much like that caused by sunburn. This also abates in about two weeks. Most discoloration is resolved in 7-10 days. However, though unusual, this may persist longer as pigmentation beneath the eyes. Occasionally, olive-skinned patients may retain this pigment for several months.
6. Small irregularities may be felt below the smooth skin, especially over the nasal bones. These irregularities are common. Most noses, even without surgery, have palpable bone irregularity beneath smooth skin.
7. Out of Town Patients: You must remain in the Chicago metropolitan area for at least one week following surgery. We will help make arrangements for out-of-state and foreign patients if you have no local residency.
8. Friends and Family: Whether you are contemplating or have decided to undergo plastic surgery, be prepared to hear all manner of stories and judgments friends from friends and relatives. If you ask an opinion about your surgery, most people: will not be supportive. Many will have some tale of difficulty to tell you; it is an unfortunate fact of human nature. Occasionally, relatives and friends who are told you have made a definite decision about facial surgery are more supportive. After surgery, almost everyone will forget their negative statements. They will admire the results and see, for the first time, what you were talking about.
9. Improvement not Perfection: Observe, in yourself and in those around you, that the two sides of the human body are not the same. Aesthetic surgery can never make them exactly the same. Our purpose and goal in facial aesthetic surgery is improvement and not perfection.
10. Nasal exercises may be required in very select cases to maximize result.
“The nose should fit the face”
A strong jawline would suggest a stronger nose.
