Pre & Post Operative Instructions in Virginia

Shervin Naderi, MD, FACS

For Rhinoplasty and Revision Rhinoplasty:

BEFORE YOUR RHINOPLASTY SURGERY

• Make sure Dr. Naderi, or members of our staff, answer all of your questions & concerns, prior to your Rhinoplasty or Revision Rhinoplasty.
• Arrange your post-operative
  appointment before your Rhinoplasty. Patients will be seen in our office about
  one week after surgery for splint removal.
• Fill all your prescriptions prior to your Rhinoplasty: (Antibiotic pills, pain pills, nausea pills)
• Get all your necessary recovery supplies prior to your Rhinoplasty: (Q-tips, Hydrogen Peroxide, Bactroban Antibiotic Ointment, Vaseline Ointment, Gel Cold Compresses, Arnica pills, Saline non-medicated spray).
• You may take your blood pressure medication, heart medication, & seizure medication with a small sip of water the morning of your Rhinoplasty. All patients but especially Diabetic patients should always coordinate their medication management with their primary care doctors.
• Stop taking Aspirin 2 weeks prior to your Rhinoplasty – but first check with your primary care physician. Ibuprofen, Motrin, Alleve, Advil and all other NSAIDs can make you bleed excessively as well.
• Only take Tylenol or Celebrex for aches & pains within 2 weeks of your Rhinoplasty if OK’ed by your primary care doctor.
• Vitamin E, Fish oil, Flaxseed, Herbal supplements (Ginkgo, Ginseng, Echinacea, Garlic, Omega-3’s and many others) and health food store products, supplements or drinks often make you bleed excessively during nasal reshaping surgery as well. Avoid these 2 weeks prior to surgery. Read food labels. These supplements are often incorporated into packaged foods and drinks as well. If in doubt, check with your doctor.
• If you Take Coumadin, Pradaxa, Plavix or Aspirin, check with your family doctor to make sure these are OK to be stopped with enough time prior to your Rhinoplasty. (Need to stop at least 5 – 14 days before and up to 2 weeks after, depending on the medication type)
• Drink plenty of clear fluids the afternoon prior to your Rhinoplasty as well as after your Rhinoplasty to avoid dehydration and fainting spells.
• Do not eat or drink after midnight, the night before your Rhinoplasty. Important medications can be taken with a small sip of water.
• NO CHEWING GUM before surgery. Chewing gum increases stomach acid and counts as “eating” by the Anesthesiologists.
• Arnica is the only herbal supplement you may take around the time of your Rhinoplasty. Arnica can reduce swelling and bruising after a Rhinoplasty.
• Pineapple juice or slices can help reduce bruising and swelling as well.
• Take a shower the morning of your Rhinoplasty surgery and wash your face and hair with a mild soap & shampoo. DO NOT USE ANY MAKE-UP or products on your face after your shower.
• Do not wear jewelry to the Hospital. Remove piercings if possible.
• Wear loose fitting & comfortable clothes with a shirt that buttons down the front. (No tight shirts that can snag on your nose!)
• Make sure you have someone drive you to your Rhinoplasty surgery and pick you up after your nose job. Make sure you have a friend or relative stay with you for at least 24 hours after your nasal reshaping surgery. (You cannot drive, take a taxi or stay alone)
• Always check with your family physician, Internist and Psychiatrist, as well as eye doctor if it’s OK for you to have surgery and anesthesia. We require a clearance letter from them most of the time prior to scheduling any elective cosmetic or functional surgery.
• Lab work and Medical work-up and surgical clearance letters are often necessary prior to your rhinoplasty surgery. Get this completed well ahead of time in case further work-up or tests are necessary. Your primary care doctor’s History and Physical letter needs to be within 30 days of surgery.

THE NIGHT IMMEDIATELY AFTER YOUR RHINOPLASTY SURGERY

• Starting the evening after your Rhinoplasty, use Hydrogen Peroxide on Q-tips to clean all your nasal incisions (inside and outside as instructed). Use 4 to 6 Q-tips each time. Then cover the area with a thick layer of antibiotic ointment. Do this regimen at least 4-6 times a day for 4 weeks on all areas that are NOT covered by tape or cast. Do it frequently but gently. Use the Q-tip soaked with Peroxide as a “paint brush” and not a “scrub brush.”
• You must keep all areas around and inside of your nostrils blood and crust and scab free, clean and covered with ointment. This is your homework for the 4 weeks following your Rhinoplasty. There are many absorbable sutures inside your nose that must be kept lubricated for them to dissolve. Incisions and scars heal best when clean and lubricated. Work around the tape that may be covering your nostrils to get the nostrils clean but do NOT cut or trim any of the tape or sutures (stitches).
• Use Cold Compresses to decrease swelling around your eyes, forehead and cheeks: use cold compresses on your eyes, forehead and cheeks, not your nose . DO NOT place actual ice packs on your nose as these are heavy and will wet your nasal splint. Use gel-packs or frozen peas in a small sealed ziplock bag. “Ice, Ice, Ice” even if you do not see much swelling or bruising initially! The 3rd post-operative day is the worst as far as swelling and discomfort and icing frequently the first 2 days helps reduce that.
• Sleep with your head up on 3 or more pillows or in a recliner to reduce swelling. Do this for several weeks.
• Do not get your nose splint or tape wet until the night before your splint-removal appointment. You may take showers but wash your face in a way not to wet your Rhinoplasty cast for the entire week after surgery. Do get your face and cast soaking wet for 20 minutes under the shower head the night before and the morning before your splint/cast removal to help reduce discomfort.

THE WEEK AFTER YOUR RHINOPLASTY SURGERY

• All Rhinoplasty patients need to be seen in our Northern Virginia or Chevy Chase office about 5-10 days after Surgery for Splint (cast) removal.
• Make sure you are well nourished. You need energy and protein to heal properly after a Rhinoplasty. This is no time to diet!
• Typically you can wear water-based makeup as soon as a week out from your Rhinoplasty once the small nasal cast is removed.
• Your nose skin may be oily or sticky for some time after Rhinoplasty. It also may be dry and peeling. That is normal. Do not aggressively rub, massage or wipe your nose after the Rhinoplasty for at least 4 weeks.
• No “Biore Strips” after your Rhinoplasty for at least 3 months.
• You may use an astringent to soak a cotton ball and GENTLY wipe your nose without any pressure on the tip after your cast has been removed.
• The night before your post-op-week-one appointment and cast removal, get in the shower and thoroughly wet your face and nasal splint for 20 minutes before coming to the office to see Dr. Naderi the next day. (Do not remove the cast yourself). This will make removal of your cast easier.***
• On the morning of your post-op-week-one appointment, get in the shower again and thoroughly wet your face and nasal splint for at least 20 minutes straight before coming to the office to see Dr. Naderi. (Do not remove the cast yourself). This will make removal of your cast easier and less painful.***
• Do not cut any part of the nasal tape or cast off yourself. If you have any questions or concerns such as an itchy or irritated area under the tape, call the office and make an appointment to see Dr. Naderi within 24 hours.
• No lifting over 10 lbs and avoid bending over for 14 days.
• You may NOT exercise for 2-4 weeks. Refrain from intense sexual activity for up to 2 weeks if possible. No contact sports for 3 months.
• You may wear contact lenses at any point but no eyeglasses or sunglasses on your nose for at least 1 month.
• Elevation of your blood pressure or heart rate will cause more swelling and may cause a nose-bleed.
• Sleep with your head up on 2-3 pillows or on a recliner for at least 2 week or longer after surgery to reduce swelling. This really helps!
• You may have bruising after surgery. It may take up to 3-4 weeks or more for resolution but often after 7 days the bruises are practically all gone or you can cover the areas with water-based make-up.
• YOU WILL HAVE SWELLING. THIS IS A NORMAL PART OF THE HEALING PROCESS. Your nose will continue to change and heal for many years after your rhinoplasty. Swelling continues to go down for many years later. There is no such thing as “final results” and your nose will continue to heal well beyond 12 months after your nose job surgery. The old saying that “you see your final nose job results after one year” is simply not true. It truly takes 3-5 years for most of the swelling to go down but you should have a better nose from day 1!
• However, after 10 days, most of your casual friends and relatives should not be able to tell that you have had a “nose job” and you can start to enjoy the initial results of your Rhinoplasty from this early period! In most cases, you can go back to school or work after 7 days and enjoy your initial early rhinoplasty improvements. Be patient.
• MOST PATIENTS’ “DOWN-TIME” IS ONLY ONE WEEK.
• You WILL have scar tissue inside the nose. It is a part of surgery and healing. It is also what makes Rhinoplasty healing somewhat unpredictable. You may need occasional steroid injections into your nose after surgery to reduce scar tissue and swelling.
• Remember, your nose is a living, healing, changing structure after a Rhinoplasty. Your nose is not made of stone or metal. Expectations of perfect symmetry, perfect smoothness and unchanging results are unrealistic. Expecting meaningful improvement is realistic and the goal of Rhinoplasty.
• BE PATIENT and feel free to ask questions. You may have slight asymmetries or irregularities and numbness. These will change with time. Your smile, your voice and your smell and breathing can change somewhat. Your nose will feel stiffer than a non-operated nose. This is all normal and will change with time as the healing proceeds.
• IT IS ALSO NORMAL to get depressed or anxious before and especially after your Rhinoplasty. Understanding this will help you get through it. Sometimes an anti-depressant or Valium prescribed by your family physician can help you get through this period. Do not feel ashamed or frustrated. Everyone goes through this to different degrees.
• DO NOT LET YOURSELF GET AFFECTED BY NEGATIVE COMMENTS FROM FAMILY OR FRIENDS. They simply may not understand the process of rhinoplasty, no matter how well intentioned. Trust what Dr. Naderi genuinely tells you. He has your best interest at heart.
• You will be seen 1 to 2 times during the first week after your Rhinoplasty or Revision Rhinoplasty and then most likely at 1 month, 3 months, 6 months and a year after surgery, for follow up with Dr. Naderi. For local patients, Dr. Naderi prefers to see you yearly or every 5 years after that as well. For long distant or international patients, we can work around your schedule to decrease the need for frequent follow-up flights.
• Purchase a non-medicated Nasal Saline Spray and starting 3 days after your surgery gently spray 2 puffs on each side, followed by GENTLE sniffing, to soften up the dry blood and crusts inside your nose.
• Do not dig inside your nose nor blow too hard for what you may think are crusts or scabs. You may be digging into incisions or scar tissue and may cause a nose bleed. You will have swelling and scar tissue on the inside and you may feel a difference in nasal airway passage opening from left to right. 50:50 is often not possible.
• Remember, especially in Revision cases but even primary rhinoplasty, perfection is impossible. The goals are improvement which you should have in the hands of Dr. Naderi. Also remember that the “computer imaging” is simply a discussion tool and not a replica of results. Results will continue to change and things like excess heat, sun, working out, flying, trauma, all will create more swelling and scar tissue and unpredictable healing.
• Keep a stiff upper lip. Smiling pushes the nasal tip down prematurely. Avoid excess smiling for 2-4 week. The tip position should drop down a bit over time and you do not want to accelerate that process.
• Brush your teeth with a baby toothbrush. Use a small spoon and fork to eat. Use straws to drink.
• IF THERE IS A NOSE-BLEED OR ANY QUESTION OR CONCERN ABOUT COMPLICATIONS, PLEASE CALL US EARLY IN THE DAY AND DO NOT WAIT TILL THE AFTERNOON OR EVENING WHEN OPTIONS ARE MORE LIMITED. GO TO YOUR NEAREST EMERGENCY ROOM IF NEEDED BUT PREFERABLY TO THE INOVA FAIR OAKS HOSPITAL ER.

For Resurfacing patients (Laser, Chemical peel, Dermabrasion…)

Clean the areas 4 – 6 times a day starting the day after your surgery with cool tap-water soaked cotton balls. Pad dry, then cover with a THICK layer of Vaseline ointment or Aquaphor. Also get in the shower and let plain cool water clean your face another 2 times a day. Do not use soap or cleaning products on your face. Do not let your face dry or scab. Call if you have excess pain, rash or individual ulcers or pustules on your face as this may be signs of allergic reaction, infection or a herpes outbreak. Take your antibiotic and antiviral medicines as prescribed. Stay out of the sun completely. For the next 3 months you must use sun-block and a hat. Most of the time you will be using a “bleaching” cream skin preparation for 4 weeks prior to your procedure. Stop this the day before your procedure and do not restart until 2-4 weeks after your procedure as instructed by Dr. Naderi. Stop Retin-A products 3 days prior to the procedure and do not restart for at least a month. Start your Anti-viral medication 72 hours prior to the procedure and continue for the full 10 day course. You may have redness and color changes in your skin that may take a long time to resolve. Occasionally these changes may be permanent.

For Eyelid Surgery patients:

You may have swelling, blurry vision, excess tearing or dry eyes for several weeks. Rarely these symptoms may be permanent. Pain, burning, or scratchy eyes may be a sign of inadequate lubrication and require immediate attention. LUBRICATE, LUBRICATE, LUBRICATE using the antibiotic eye ointment prescribed for the first week then use Artificial Tears during the day and Lacrilube ointment at night thereafter. Use cool compresses on your eyes as much as possible the first 2 days. Clean your incisions, if there are external sutures present, with half strength hydrogen peroxide 4 times per day and after each cleaning apply antibiotic EYE OINTMENT instead of regular antibiotic ointment. Do not get Peroxide in your eyes! Also place the prescribed eye ointment & eye drops inside your eye WITHOUT pulling down on the lower eyelid. DO NOT use contacts, false lashes, or makeup until instructed by Dr. Naderi. Call immediately if you have excessive pain or sudden swelling or change in vision.

For Facelift & Neck lift patients:

Empty the drain bulbs as shown by your recovery room nurses at the hospital. You will have a dressing with drains for the first night. These will be removed on your next day follow-up appointment. You will be instructed to wear a chin-strap for an additional few days. Watch for ‘goose egg’ shaped areas of swelling as these may be fluid or blood collection. Clean your incisions around the ears and apply ointment 4 times per day without pulling or moving on the ear. Get in the shower at least once a day starting 2 days after your surgery and wash your hair gently with baby shampoo. Make sure you also do this prior to your one-week appointment to help make your suture & staple removal more comfortable. Wear shirts that button down the front to prevent tearing your earlobes. DO NOT rub your face or neck, nor turn your head from side to side, to allow the lifted skin to adhere back down to the underlying muscles and tissue. Turn your head, neck and shoulders as one unit. For men: DO NOT SHAVE for 3 days before and 10 days after your facelift or neck lift surgery. You may not drive for at least one week. Call immediately if there is excess pain or swelling as this may be a sign of acute fluid or blood collection under the skin. Five to 8% of all patients will get fluid collections that need to be evacuated. YOU MUST NOT SMOKE or use Nicotine products for 3 weeks before and 3 weeks after surgery! Large parts of your skin will likely die if you smoke or use Nicotine, as Nicotine compromises blood flow to the skin!!! This is not something to be taken lightly! Sometimes lumps and bumps under the skin can develop that may require steroid injections.

For Otoplasty (Ear pinning Surgery) patients:

You will have a large head wrap that will be removed the next day after your otoplasty. You will wear an elastic post-op Velcro strap around your ears for one week after surgery. This needs to be worn at all times other than when you clean your incision or shower. Purchase a sport type elastic head-band. You will wear this for 3 additional weeks at bedtime to avoid inadvertent trauma to the ears. Clean the incisions and apply ointment 4x/day without pulling on the ear. Take your antibiotics as instructed. Infections of the ear cartilage may be serious and require long term antibiotic treatment. You may feel your internal sutures or they may protrude from under the skin.

For chin implant patients:

Rinse the inside of your mouth gently with half strength hydrogen peroxide 3-4 times a day and after meals for 10 days. Consult your dentist as this may stain your teeth. Take your antibiotics as there is always a slight chance of infection with implants. DO NOT manipulate your face or sleep on your face for 3 weeks to prevent shifting of the implant. Infections of implants may require long term antibiotic treatment or removal of the implant in some cases.

For Fat Injection patients:

Wash your face 3 times a day gently with a mild soap like Ivory Soap. Keep some antibiotic ointment on the very tiny incisions 3-4 times a day. Wear your elastic or Ace wrap around the fat-harvest site as instructed for the week after surgery to prevent fluid collection.

For Scar Revision & Mole or Skin Cancer patients:

Keep your incisions clean and scab and crust free. Dr. Naderi may ask you to clean the area with dilute hydrogen peroxide then cover with Antibiotic ointment 3-4 times a day. Alternatively, he may have taped the area with Steri-strips or brown Micropore tape. In such cases, leave the tape on if clean. If the tape is coming off on its own, then take the tape off, wash, dry and re-tape in the same manner as before. Continue this for 3 weeks after surgery. Call with questions or signs of irritation or allergic reaction or infection. Ask when in doubt. Your sutures (if any) will often be removed 3-7 days after surgery. If Dr. Naderi wants you to tape the area, do not apply ointment as this will not allow the tape to stick. You may be asked to apply Silicone topical gels to the scar daily, for 4-12 months, starting 3 weeks after surgery.

For neck liposuction & Submentoplasty patients:

Your dressing will be removed the day after surgery and you will be given an elastic Velcro strap to wear at all times for a few days after surgery. Avoid excess head or neck movement. Call if you see any swelling under your chin as this may represent fluid collection. Slight little lumps and bumps are normal for a few weeks. Steroid injections may be necessary. These often do resolve over time.

For Lip Implant patients:

Clean your incisions with half strength peroxide and use antibiotic ointment on the area 3-4 times a day. Avoid excess mouth or lip movement and do not use straws nor smoke for 3 weeks. Use a small tooth brush to brush your teeth. Take your antibiotics. Start the antibiotics 48 hours before surgery and continue until finished.

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Jessica Kulak, MD

For Chin Implant:

AFTER YOUR CHIN IMPLANT SURGERY

• Any dressing applied to your chin is to remain in place until the next follow up visit, in about 5 days.
• Crushed ice in a plastic bag wrapped in a terry cloth towel may be applied to the chin for 20 minutes every hour for relief of pain and swelling during the first 2 days after surgery.
• You may wash your hair and face the next day after your Chin Implant.
• SLEEP on your back with your head elevated about 30-40 degrees. You are encouraged to sleep this way for approximately 3-4 days to minimize bruising and swelling.
• EAT soft foods for 1 week. I.E. (Jell-O, pudding, mashed potatoes) Chewing can cause an increase in pain and swelling.
• TALKING should be minimized. Excessive talking, laughing and chewing can cause increased pain and swelling.
• To avoid an upset stomach, eat something before taking any medication.
• Take the PAIN MEDICINE prescribed as needed or Extra Strength Tylenol as needed. DO NOT DRINK ALCOHOL while taking the pain medication. 
• Continue taking your antibiotic as prescribed until it’s finished.
• You may take the sleeping pill prescribed as needed.

AFTER YOUR FACE LIFT SURGERY

• Go over your suture lines in front of and behind your ears 3 times daily with peroxide on a q-tip around the front and back of your ear. Dry with a q-tip. Then apply a small amount of Bacitracin Ointment with a q-tip.
• DO NOT do the above on the stapled incisions.
• You may wash your hair 2 days after your facelift. Use the Neutrogena shampoo as instructed. Comb your hair with a large toothed comb. You may use a hair dryer to dry your hair but it must be set on the cool setting.
• Continue to wash your hair daily using the Neutrogena shampoo or baby shampoo.
• NEVER WASH your hair the day of suture or staple removal.
• SLEEP on your back with your head elevated about 30-40 degrees. You are encouraged to sleep this way for approximately 10 days to minimize bruising and swelling.
• After you return the Aquacool machine. Wear your chin sling at all times for the first week. You may wear it under your cold wrap or Aquecool masque. You may take it off to shower. Then wear it only at bedtime for the second week.
• EAT soft foods for 1 week. i.e. (Jell-O, pudding, mashed potatoes) Chewing can cause increased pain and swelling.
• TALKING should be minimized. Excessive talking, laughing and chewing can cause increased pain and swelling.
• Take the PAIN MEDICINE prescribed as needed or Extra Strength Tylenol as needed. DO NOT DRINK ALCOHOL while taking the pain medication.
• You may take the sleeping pill prescribed as needed.
• To avoid an upset stomach. Eat something before taking any medication.
• DO NOT USE make-up for the first four days, then for another week avoid make-up directly on the healing incisions.

AFTER YOUR EYELID SURGERY

• You may wash your HAIR and FACE the next day after your eyelid surgery. Continue to wash your hair DAILY using your normal shampoo and cleanser. Do not cleanse the eye area.
• Apply ICED compresses made of gauze sponges (not an ice bag) to your eyes for 20 minute periods every hour during the first 2 days after surgery.
• Stay up (sitting, standing, walking around) as much as possible after you return home- this is important!! Of course, you should rest when you tire.
• SLEEP on your back with your head elevated about 30-40 degrees. You are encouraged to sleep this way for approximately one week to minimize bruising and swelling.
• To avoid an upset stomach, eat something before taking any medication.
• Take the pain medicine prescribed as needed or Extra Strength Tylenol as needed.
• Continue taking your antibiotic as prescribed until it’s finished.
• You may take the sleeping pill prescribed as needed.
• DO NOT tweeze your eyebrows for 2 weeks.
• You may begin wearing eyeglasses, or sun glasses, the day following surgery. Contact lenses can be worn one week after upper eyelid surgery, two weeks after lower eyelid surgery.
• Rarely, the whites of one or both eyes may become partially discolored. This is normal and will resolve.
• Occasionally, the swelling will cause the lower lid to be separated from the eyeball proper. This condition will resolve as the swelling subsides.
• Patients often experience some blurring of vision for 2-3 days after surgery. This is generally due to swelling and/or ointments that have been used during the surgery and your vision will resolve.

AFTER YOUR PLATYSMAPLASTY AND SUBMENTAL LIPOSUCTION

• You will go home with a dressing around your face and neck. You must leave the dressing on until you see the doctor the day after your surgery.
• You may wash your hair and face the day after your surgery. Use the Neutrogena shampoo as instructed. You may use your own facial cleanser and shampoo.
• Wear your chin sling at all times for one week. You may take it off to shower.
• SLEEP on your back with your head elevated about 30-40 degrees. You are encouraged to sleep this way for approximately 2-3 days to minimize bruising and swelling.
• EAT soft foods for 2-3 days. I.E. (Jell-O, pudding, mashed potatoes). Chewing can cause an increase in pain and swelling.
• TALKING should be minimized. Excessive talking, laughing and chewing can cause increased pain and swelling.
• To avoid an upset stomach, eat something before taking any medication.
• Take the pain medicine prescribed as needed or Extra Strength Tylenol as needed. DO NOT DRINK ALCOHOL while taking the pain medication.
• Continue taking your antibiotic as prescribed until it’s finished.
• You may wear makeup the day after surgery.
• You may DRIVE the day after surgery. Do not drive if you have taken any of the pain medication.

“Good luck and enjoy your experience. Cosmetic Surgery is an elective luxury and you should enjoy it. We are here every step of the way to prepare you and make this as easy as possible for you.”

• Call 703-481-0002 or 301-222-2020 with questions or comments.
• You can email us with less urgent questions at [email protected]
• Call 911 to be taken to the nearest Emergency Room if you have an emergency or cannot reach your doctor.
• Visit our websites, www.NaderiCenter.com or www.VirginiaRhinoplasty.com or www.RhinoplastySpecialistSurgeon.com for additional information.