Rhinoplasty & Revision Rhinoplasty Post-Operative Instructions in Virginia, Washington D.C. and Maryland.

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Days 1–7 After Surgery

• Relax: Relax your mind and body. Too much physical movement or mental anxiety can increase blood pressure and bleeding. Relax, sleep, and recover. Do not overexert. Do not analyze results, take selfies, research online, or ask others for opinions about your results.
• Discomfort: Severe pain is usually not expected, but discomfort and pressure are common. Expect congestion, mucus, sinus pressure, possible toothache, plugged ears, and a sore throat from the breathing tube.
• Gentle Movement: Get out of bed and slowly walk around the room with assistance to help avoid lower-leg blood clots. Move your legs and ankles periodically while lying down and take occasional deep breaths.
• Cold Compress: Use cold compresses on your eyes, cheeks, and forehead, but not on the nose. Keep the nose cast dry. Use for 20 minutes on and 20 minutes off. The first 3 days are most important.
• Sleep: Sleep on your back with your upper body elevated about 45 degrees or more. Use 4–5 pillows, an airplane neck pillow, wedge pillow, or recliner. Do not sleep on your side or flat. Continue for at least 3–4 weeks or longer.
• Drip Pad: Bloody drainage is expected after surgery. Change the gauze drip pad as needed. It may initially require changing every 10–15 minutes but should slow over the next 2 days. Apply a little Vaseline to fresh gauze to prevent sticking. Stop using the drip pad once drainage slows.
• Medications: Review medication instructions and take medications appropriately. Antibiotics start the night of surgery. Steroids start the following day.
• Cleaning the Nose: Gently clean your nostrils 3–6 times a day beginning the night of surgery using Q-tips soaked with diluted hydrogen peroxide. Apply a thin layer of Mupirocin ointment after each cleaning. Keep nostrils clean and scab-free, but do not go deep into the nose.
• Do not dig inside the nose with a Q-tip because this can cause a nosebleed. Clean your own nose rather than having someone else do it. Do not explore or look inside your nostrils.
• If you run out of Mupirocin ointment, you may use Vaseline ointment.
• Gently use HOCL (Hypochlorous) spray 3 times a day starting 2–3 days after surgery. You may gently sniff but do not blow your nose.
• Cast: Do not cut, pull, or trim any part of the tape or cast. If it starts to come off, contact the office and send a photo. Report redness, bumps, or increasing itchiness because this may indicate a tape reaction.
• Stitches: Do not cut, pick at, or remove stitches. They are dissolvable. Dr. Naderi may trim irritating stitches at a post-operative appointment.
• Packing: You may have absorbable Gelfoam, actual packing, or clear stents. Do not cut any visible strings or remove packing or stents. Keep the nostrils clean and lubricated as instructed without penetrating deeply into the nose.
• Avoid hot showers because they can cause more swelling, bleeding, or fainting. Use lukewarm water.
• Avoid baths because you may become lightheaded and pass out.

Night Before Your Splint Removal

• Get your face and nose cast soaking wet for 20 minutes under lukewarm shower water the night before and again the day of cast removal. If you have dry skin, take a third shower.
• Let water hit the top of your head and forehead and drip over your nose. Do not let the shower spray directly hit your nose.

Day of Cast Removal

• Get your face and nose cast soaking wet for 20 minutes under lukewarm shower water.
• Hydrate well and avoid an empty stomach. Dress cool to help avoid fainting during cast removal.
• Do not be nervous. Have a positive attitude.
• Remember that this is not your final result. The nose will be swollen and will continue to change. Do not over-analyze.
• Avoid negative people, internet searches, and excessive photos.

After Cast Removal

• HOCL Spray: Continue using Hypochlorous antiseptic nasal spray gently to moisten blood clots inside your nose. You may sniff gently. Do not spray forcefully or blow your nose.
• Cleaning Internally: Continue to clean and lubricate as instructed.
• Cleaning Skin: Use cotton balls or cotton squares soaked with 2% salicylic acid toner and gently wipe the nose without pressure. Your skin may be oilier after surgery and pimples may occur.
• Sleep: Continue sleeping elevated on at least 3 pillows or more.
• Smiling: Continue to keep a stiff face and avoid excessive smiling and facial movement to help avoid premature tip drop.
• Trauma: Be careful around children, dogs, crowded groups, and hugs to prevent trauma to the nose.
• No Exercise for 4–6 Weeks: No gym, running, biking, or strenuous long walks. Increased heart rate, blood pressure, and body temperature can increase swelling and scar tissue.
• No contact sports for 3 months.
• Do not submerge your face in lake, ocean, or public pool water for 6 months.
• Sun and Heat: Avoid sun and heat for up to 3 months and stay mostly indoors to reduce swelling and scar tissue.
• Taping the Nose: If you have thick or oily skin, proper taping may improve healing. Ideally, tape 24/7 initially. During the first month, change tape carefully every 3–4 days and no more than twice per week. Some patients may tape only at night after the first month. Taping may continue for 1–6 months.
• Flying: Avoid unnecessary flights for 6 weeks to 3 months. Taping the nose when flying is recommended during the first 6 months.

Medications

• Pain: Take the prescribed pain medication as directed. If discomfort is mild, Tylenol may be used instead. Do not take Tylenol together with pain medication that already contains acetaminophen. Do not exceed 4,000 mg of acetaminophen in 24 hours. Take medication with food to reduce nausea.
• Some discomfort, pressure, or throbbing is expected. Avoid taking excessive narcotic pain medication because it can cause nausea and constipation.
• Narcotic pain medications are not refilled.
• Antibiotics: Start antibiotics the night of surgery after returning home and continue until completely finished. Take a probiotic additionally for gut health.
• Steroids: Start the Medrol Dose Pack the day after surgery. Follow the instructions on the medication box until finished.
• Nausea: Nausea can occur after general anesthesia or from stronger pain medications. Take nausea medication as needed.
• Antibiotic Ointment: Apply Mupirocin starting 1 week before surgery and continue after surgery as instructed.
• Constipation: Narcotic pain medication may cause constipation. MiraLAX or other over-the-counter laxatives are recommended. Begin laxatives with the first narcotic pain pill rather than waiting until constipation occurs. Hydration and gentle walking may help.
• If you experience medication side effects, stop taking the medication and contact the office immediately for guidance or substitution.

Nutrition

• Diet: Eat as tolerated and take small bites. Soft foods may be easier to swallow because nasal breathing and chewing may be uncomfortable.
• Dark green leafy vegetables and pineapple, including the core, may help reduce bruising and swelling.
• Continue the dietary and supplement restrictions from before surgery for 2 more weeks after surgery.
• Milkshakes or protein shakes can provide hydration and protein. This is not the time to calorie-restrict or diet.
• Hydration: Drink 6–8 glasses of water or sports drinks such as Gatorade each day. Use straws when drinking fluids.

Activity

• Physical Activity: Refrain from physically exerting activity. Do not bend over, strain, or lift more than 20 pounds during the first week after surgery.
• Exercise: No exercise or straining for at least 4–6 weeks until cleared by Dr. Naderi. Slow indoor walking is acceptable, but avoid power walking or speed walking.
• Return to Work: Most patients return to work after the cast is removed, depending on job responsibilities, face-to-face interaction, and bruising.
• Avoid Major Events or Photographs for 1–3 Months: Although many patients return to school or work after 1–2 weeks, avoid job interviews, television interviews, headshots, and similar events for a longer period when possible.
• Driving: Do NOT operate a vehicle or make important decisions until you have been off narcotic pain medication for at least 24 hours.
• Smiling: Avoid excessive smiling, laughing, or opening your mouth too widely. Keep facial movement limited for about one month. Avoid dental visits for 3 months if possible.
• Travel: Avoid unnecessary air travel when possible. Delay flights as long as possible, ideally up to 3 months. If flying is necessary, tape the nose properly.
• Sneezing: If you need to sneeze, do so with your mouth open to reduce pressure.
• Blowing Your Nose: Do not blow or wipe your nose for one month. You may gently sniff.

Bathing and Showering

• You may take lukewarm showers from the neck down, but do not get your face wet during the first few days after surgery.
• Do not take hot showers because they may cause a nosebleed or dizziness.
• Do not take baths because you may become lightheaded or faint.
• Keep the nose cast dry until the night before the cast-removal appointment.
• No tub baths or Jacuzzi for 2–3 months.
• Do not submerge your head under public pool, lake, or ocean water for 6 months while internal incisions heal.

What to Expect With Healing After Rhinoplasty

• Swelling: Swelling may persist for many months. The nose, cheeks, lips, forehead, and area between the eyes may all appear swollen. Swelling may temporarily worsen after splint removal.
• Exercise, physical activity, sun, heat, airline travel, and alcohol can worsen swelling.
• Major swelling may take up to a year to improve, with full resolution potentially taking 3–5 years.
• Tip Position: The nasal tip will drop over the next few months. What you initially see after cast removal is not the final result.
• Asymmetries: Minor asymmetries and irregularities may occur as swelling, bone, and cartilage heal.
• Bruising: Bruising around the eyes is normal. Most bruises disappear after about 3–4 weeks and may change from purple or blue to yellow or green as they resolve.
• Stiffness: The nose and smile may feel stiff initially because of swelling. This should improve over weeks to months.
• Breathing: Internal swelling can temporarily restrict airflow. One side may breathe better than the other. Breathing may improve over several weeks or longer.
• Drainage: Bloody-colored drainage, thick mucus, bubbles, clogged ears, and sinus pressure may occur after surgery.
• Skin Changes: Skin may become crusty, dry, oily, red, or develop pimples.
• Tip Numbness: Numbness of the nasal tip is normal and should improve with time, although some subtle numbness may remain.
• Incisions and Scars: Incisions and scars will initially be more visible. They improve with time but do not completely disappear.
• Hyperbaric Oxygen Therapy: Some patients may benefit from hyperbaric oxygen treatments to aid healing after surgery.

Do Not

• DO NOT be aggressive with Q-tips. Deep or aggressive cleaning can cause a nosebleed.
• DO NOT wear sunglasses or goggles for at least 3 months.
• DO NOT put pressure on the nose tip.
• DO NOT use Bioré Strips for at least 6 months after surgery.
• DO NOT take early selfies and compare your results to others.
• DO NOT expect perfection.

Emergency Situations

• Call the office at 703-481-0002 or go to the nearest hospital for concerning symptoms. Call 911 for a severe emergency.
• Signs of Infection: Spreading redness, worsening swelling, increased drainage or pus, worsening pain, pustules, warmth at the incision site, or temperature over 101°F.
• Excessive Bleeding: Dressings saturated with bright red blood requiring very frequent changes, changes sooner than 5 minutes, or bleeding from the mouth.
• Allergic Reaction: Allergic reaction to medications, tape, or cast.
• Other Emergency Situations: Shortness of breath or difficulty breathing, chest pain, lightheadedness that does not quickly resolve, severe vomiting, severe pain, or asymmetric swelling in the legs.