How Do You Clean Your Nose After Rhinoplasty?

Hi everybody. We're going to demonstrate cleaning and nostril care after surgery. We have a patient who's had a rhinoplasty, and you can see my typical splint. The splint is basically brown tape and a hard cast, and there's a drip pad on the bottom. Now I'm going to show you how you clean the nose right after surgery.

What you need is hydrogen peroxide, which you prepare and have at home. You'll need the antibiotic ointment. That's a prescription, mupirocin or Bactroban ointment, and that's something we send to your pharmacy for you. You'll need Q-tips, just regular old Q-tips or long Q-tips, something with a cotton applicator head, and some gauze. It's nice to get your own gauze, but when you leave the hospital, they'll send you home with some of it as well.

Now, the drip pad. In the beginning, right after surgery, there is a little bit of bloody drainage. You may be changing it every 10 to 15 minutes. But as the night goes on, and the following day, the drainage will slow down to a point where you have to change it maybe every two hours, and at some point, once the drainage really slows down, you don't have to wear it at all. In the beginning you are changing it a little bit quicker, and it is getting a little bit bloody. It should not look like somebody opened a faucet and blood is just pouring out. If that's happening, go to your nearest emergency room and call me. That's extremely rare. That happens once every several years. But a little bit of bloody drainage is very normal.

Now let's demonstrate the cleaning. What's the best way to use the peroxide? The way I like to use the peroxide is you take the cap, and you take a little bit of water and a little bit of peroxide. That's called dilute peroxide. I'm mixing it half and half, one to one, roughly. That's the best way to do it, because it's not going to burn. You could use full-strength peroxide, but full-strength peroxide can burn a little bit more, so half and half is nice. Don't put the water into the entire bottle, because you're going to deactivate the entire thing. Just use a little capful at a time. Don't double dip. Always use clean Q-tips. So you dip the Q-tip in there and you get it ready.

Now, here's how you do this. Normally we have a sling on, but if the sling is not available, you can definitely tape this to your cheeks. There is a sling that goes behind the ears and holds the cotton drip pad in place. Take your drip pad off. Each time we take the drip pad off, there should be some ointment from the last time, so you want to clean that. Right after surgery, the first day or two, this is going to be a little bit bloody. So you're going to take your Q-tip. Look, it goes right inside the nostril and you roll it around. I'm rolling it around. I'm not digging around. I'm just rolling it around. I go on the other side, roll it around, pick up any extra blood. She's done a great job of cleaning, so there's barely anything there, but you're just going to clean stuff up.

You don't want the nostrils to be caked up. You don't want the nostrils to be gunked up. You don't want the nostrils to be full of dry blood and mucus and brown, yucky stuff, because that acts like a little bath for bacteria to hang out in, and you can get an infection easier. So I want clean nostrils. But also, don't go scrubbing inside. Don't go banging around. And you should be doing the cleaning yourself, even if you're 14 years old, 16, 18, whatever your age is. Even if you're a teenager, I don't want mom and dad doing this for you. Do your own cleaning, because if you hit something, you'll stop and you'll pull back. If somebody else, the caregiver, does it for you, they may damage something or pop a stitch.

So look again at what I'm doing. I go inside the nostril. You can still see the Q-tip head. The Q-tip head has not disappeared. It's just the head of the Q-tip that goes inside the nostril and rolls around. Same thing on this side. It rolls around. Now, there is usually tape covering the columella, the skin here. If this tape falls off, it's not a big deal. You do the same rolling around that area. Roll around the upper lip a little bit. Sometimes you get a little bit of blood here. Clean it up. It's very gentle. You could use five, six, seven, eight, ten Q-tips at a time. Be frequent, be consistent, but don't be aggressive. That's what you don't want to do.

Now, once you've done the cleaning, and this starts right after surgery, as soon as you get home you want to start cleaning, because that bloody drainage is going to crust up and get hard if you don't. Then you take the antibiotic ointment, and you take a good amount of it. Look, I'm not shy with the antibiotic ointment. I'm taking a good amount. You can see how much I took. I take this antibiotic ointment and I start in here and smear it on. I'm basically icing a cake. I'm smearing it on there. Then I'm putting it on the same Q-tip that went in there, rolling it around a little bit, doing the same thing, and then taking the excess off, so the nostrils are open. They're not packed in.

I have had periods of my career where I've said, you know what, just pack it full of Vaseline, don't worry about it, leave it alone. That's because sometimes a few patients got a little too aggressive with the cleaning at two o'clock in the morning and had nosebleeds, and we had to go back to surgery. But then patients leaving the nostrils packed full of Vaseline were coming in with a little more frequency of infections, because they were not cleaning the nostrils. So we're going back to good cleaning. But be gentle, be careful, be diligent, but be super gentle. So the ointment went inside, rolled around a little bit, and that's it.

Again, you can clean around the nose too, with the same Q-tips. You can clean the upper lip a little bit. Sometimes blood can even get trapped underneath the tape here, and patients call and say, oh my God, the tape is black. I say, that's just because there's blood there. It's not a big deal. Blood can track up there. You're just doing a little bit of cleaning. Again, look, a little bit of cleaning. Sometimes you get a little blood tinge on it. Not a big deal. Just be gentle with it.

Once you're done with that, in the beginning, we're talking the first day or two, you roll up another piece of gauze. Look, I'm making a cigar. You just take one gauze, roll it up like that, and then put a little bit of ointment right in the middle of it. Don't put too much, just right in the middle, right there. Then you put this on. This is for the first couple of days, until the drainage slows down. Then you put your sling on, or you put your tape on, whatever you want to do to hold this in place. So you're doing this for a couple of days, but after that initial drainage and bleeding slows down, you don't need to wear it anymore. The times I tell patients to leave it on the whole time is when their drainage is more excessive.

Sometimes patients catch a cold afterwards, and I don't want them dabbing their nose. I don't want them to have a Q-tip or a cotton ball or a Kleenex in their hand and constantly go boop, boop, boop. Don't do that. Don't be dabbing. If you do have some drainage, let it come to your upper lip and wipe your upper lip. You do not want to be manipulating the nose, dabbing the nose, wiping the nose. Any kind of drainage comes to the upper lip, and you're dabbing the upper lip.

So again, the cleaning starts as soon as you get home. You get back to your hotel, you get back to your house, wherever you're going to go, you're going to start the cleaning. Every time you swap out that gauze, do a little bit of cleaning so it doesn't get gunked up and caked up.

There's also a saline spray that I ask you to use, and that's going to wait till day three. On day three, you can gently start using the saline. No blowing of the nose, but you can do a gentle sniff if you need to, just a very gentle sniff as you're spraying the saline. Most of the saline is actually going to drip right back down to your lips and mouth, so do it over a sink so it doesn't get all over your shirt. Take the bottle. Don't put the bottle too far up your nose. Don't bang it up in there. That saline is basically just salt water, and it goes in there and softens up some of the blood on the inside and some of the crusts and scabs on the inside, so it doesn't get all crusted up. The goal is to have a nice clean nose, so that you can breathe sooner and not have a soupy bacterial mess up inside. I want the nostrils to be nice and clean. I want the inside to be nice and clean. Stick with that. Be gentle, be frequent, but don't be aggressive.

So that's basically the wound care. This cast will be there for somewhere between five and ten days, usually around six or seven, but anywhere from five to ten days. You come in, we'll get the cast off, and you still continue the cleaning for a few more weeks after that. But again, you're not packing the nose full of Vaseline. You're cleaning it, doing a good job with the half-strength hydrogen peroxide and putting a nice thin layer of that antibiotic ointment inside. If there are any issues, we're always around. We're always here, 24/7. You can always reach us. This is a good, quick cleaning video. I have extra videos talking about the other ways of preparing for surgery. We have so many instructions to make sure you have the best possible outcome. We want to make sure you have the best possible nose, and following the instructions really helps.