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

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Post Operative Instructions for Rhinoplasty & Revision Rhinoplasty

DAYS 1-7 AFTER Rhinoplasty & Revision Rhinoplasty

• Relax: Relax your mind and your body. Too much physical movement or mental anxiety can increase bleeding. Relax and sleep and recover. Do not overexert. Do not analyze “results.”
• Gentle Movement is Important: Make sure to get out of bed and slowly walk around the room with some assistance to avoid lower leg blood clots. When in bed or on the couch, make sure to move your legs and ankles periodically. Take occasional deep breaths to keep your lungs clear.
• Cold Compress: Use cold compresses on your eyes, cheeks, and forehead (not nose), without getting your nose cast wet. Twenty minutes on and 20 minutes off. First 3 days are the most crucial for icing.
• Sleep: Sleep on your back with your upper body elevated about 45-60 degrees. Try using 4-5 pillows, an airplane neck pillow & a wedge pillow) or recliner. Do not sleep on your side. DO NOT SLEEP FLAT. Keeping your body more upright will minimize swelling. Do this for at least 1-2 weeks or even longer. Lying flat will increase swelling and scar tissue.
• Drip Pad: You will have some bloody drainage after surgery. Change your gauze drip pad as needed. It may be every 10-15 minutes at first but should slow down over the next 2 days. Use a fresh gauze with lots of Vaseline ointment on each new gauze. Do not use q-tips inside the nose the first 2 days. Ointment, ointment and more ointment on the drip pads!
• Medications: Review Medications instructions and take them appropriately. Antibiotics start the night of surgery but steroids start the following day.
• Cleaning of the Nose: If you have stopped actively bleeding, gently clean around your nostrils 4-6 times a day starting 3 days after surgery with Hydrogen Peroxide soaked Qtips. Apply a thick layer of ointment (Vaseline, Aquaphor) after each cleaning. Keep the nostrils clean and scab-free but do not go deep into the nose. We do not want the blood and mucous hardening and scabbing. Keep it moist. Lots of ointment. Do NOT go digging inside with the Q-Tip as you may stir up a nose bleed! Do this yourself. We do not want parents or anyone else doing this for you. You must do your own “Cleaning”. Do not explore or look inside your nostrils. Please review cleaning video.
• Cast: Do not cut, pull, or trim any part of the tape off the cast. Leave it alone. If it starts to come off, email us a photo. We may remove and re-tape your nose. If the skin becomes red or bumpy or increases in itchiness please let us know as this can be an allergic reaction to the tape.
• Stitches: Do not cut, pick at, or try to remove the stitches. They are dissolvable and will dissolve on their own. Dr. Naderi may trim any irritating stitches at your post-operative appointment.
• Packing: You may have “absorbable gelfoam” which does not cause pain and does not need to be removed. Do not manipulate it. This is not packing. Cover the nostrils with a thick layer of ointment. If you have actual “Packing” apply a thick layer of ointment over the nostrils to keep packing moist. Do not attempt going inside the nose. Do not cut or trim the string. The more you ice, the more you stay elevated, the more you relax, and the more you apply ointment the better!

NIGHT BEFORE YOUR SPLINT REMOVAL (1 WEEK POST-OP APPOINTMENT)

• Shower: Get your face and nose cast soaking wet for 20 minutes under the shower with lukewarm water (NOT HOT WATER) the night before and the day of your cast removal (2 showers) so that we can remove your cast easily and painlessly. If you have dry skin take a third shower. Let the water hit top of your head and forehead and drip over your nose. Don’t let shower spray directly hit your nose.

AFTER CAST REMOVAL (FOR THE NEXT 30+ DAYS)

• Saline Spray: Use Saline Nasal Spray gently starting 10 days after surgery to moisten blood clots inside your nose. You may sniff gently. Do not blast it in there. Be gentle. Most of it will drip out due to internal swelling. Do not cause a nose bleed.
• Cleaning Internally: Continue to clean and lubricate as before. If you did a fantastic job the first week after surgery, Dr. Naderi will ask you to cut back. If you failed to clean and lubricate properly, he will ask you to do a more thorough job.
• Cleaning Skin: Use cotton balls or cotton squares soaked with 2% Salicylic Acid Toner and gently wipe the nose with no pressure. Use frequently. Be gentle but do not let your skin get crusty. Your skin will be more oily after surgery. You may have pimples.
• Sleep: Continue to sleep elevated on at least 3 pillows or more.
• Smiling: Continue to keep a stiff face and avoid smiling and facial movement to avoid premature tip drop.
• Trauma: Be careful with kids and dogs and crowded groups and hugs to prevent trauma.
• Exercise: NO gym! NO running. NO biking! NO exercise at all! NO long walks. The more you raise your heart rate and blood pressure the more you will swell and create scar tissue! (No contact sports for 3 months. No submerging face in lake/ocean for 6 months)
• Sun & Heat: Avoid sun and heat and stay indoors to avoid swelling up and creating more scar tissue.
• Flying: Avoid unnecessary flights (vacation, etc) for 3 months. We recommend “taping” of your nose when you fly back home if you are an out of town patient. Click to see taping video.

MEDICATIONS AFTER Rhinoplasty & Revision Rhinoplasty

• Pain: You will be prescribed a pain medication for post-operative pain control. Good pain control reduces bleeding after surgery. If your discomfort after surgery is not strong you are welcomed to take Tylenol in place of the prescribed medication. Do not take the Tylenol with the pain medication, as most often the medication you are prescribed will have Tylenol in it. Do not exceed 4,000 mg of cetaminophen in any 24-hour time period. Take medication with food to minimize risk of nausea. Keep in mind some discomfort and pressure or throbbing is to be expected. Do not take too much narcotic pain medications as it has side effects such as nausea and constipation. Narcotic medication refills are seldom given and cannot be “called in” by phone.
• Antibiotics: Antibiotics should be started the night of your surgery after you get home. Continue until completely finished. Take a probiotic additionally for gut health.
• Steroids: “Medrol Dose Pack” to be start the DAY AFTER your surgery. Follow the instructions on the medication box until finished. Start with 6 pills the day after surgery and continue 5, 4, 3, 2, 1 over a 6-day course until done.
• Nausea: Nausea is not rare after general anesthesia and it is a known side effect of some stronger pain medications. Take your nausea medication as needed. Some people may vomit and then feel better. Relax. You won’t damage your nose too badly if this occurs.
• Constipation: You may experience constipation if taking narcotic pain relievers. Miralax or other over the counter laxatives are recommended. Do not wait to take until you are constipated. Begin taking laxatives with the first narcotic pain pill.

NUTRITION AFTER Rhinoplasty & Revision Rhinoplasty

• Diet: Eat as tolerated and take small bites. Soft foods are easier to swallow since you will not be able to breathe through your nose and chewing may be uncomfortable. Dark green leafy vegetables and pineapple juice can help reduce bruising and swelling. Eat lots of pineapples. Continue following your dietary and supplement restriction from before surgery for 2 more weeks after surgery. Milk shakes or protein shakes give you hydration and protein.
• Hydration: Stay hydrated by drinking 6 to 8 glasses of water or sport drinks (Gatorade) a day. Use straws when drinking fluids. Larger straws are easier than thin ones.

ACTIVITY AFTER Rhinoplasty & Revision Rhinoplasty

• Physical Activity: Refrain from any physically exerting activity. No bending over, straining, or lifting more than 10 lbs for the first week after surgery. DO NOT RAISE YOUR BLOOD PRESSURE OR HEART RATE. Being too active increases bleeding, swelling and scar tissue. Relax.
• Exercise: No exercise or straining for at least 1 month until Dr. Naderi examines you. Anything that can raise your heart rate increases swelling which causes more scar tissue. Leisurely slow indoor walking is acceptable and can help bring swelling down but do not be tempted to powerwalk/speed walk.
• Return to Work: Most patients return to work after their cast is removed at their oneweek appointment. This however depends on their job responsibilities and amount of face-to-face interaction and bruising.
• Avoid Major Events or Photographs for 1-3 months: While most go back to school or work after 1-2 weeks, we recommend you avoid job interviews, TV interviews, headshot photographs for a longer period. Give yourself time to feel good about your results.
• Driving: Do NOT operate a vehicle or make important decisions until you have been off narcotic pain medications for 24 hours or more. Use good judgment.
• Smiling: Refrain from excess smiling and laughing. Do not open your mouth too wide. These actions cause the tip to drop prematurely. Try to keep a stiff upper lip and face without much movement for a month. Avoid dentist visits for 3 months if possible.
• Travel: Avoid unnecessary air flights, such as vacations and leisure trips. Pressure changes from flying increases swelling and scar tissue. Delay flights as long as possible. For long distant patients we may re-tape your nose for your flight back.
• Sneezing: If you have to sneeze, do so with your mouth open to reduce pressure.
• Blowing Your Nose: No nose blowing and no nose wiping for a month. This may give you a nosebleed or dislodge grafts.

BATHING & SHOWERING AFTER Rhinoplasty & Revision Rhinoplasty

• Showers: You may take lukewarm showers from neck down, but do not get your face wet the first 5-6 days after surgery. NO HOT SHOWERS as it may cause a nose bleed or dizziness. No baths as you may vasodilate and faint. You must keep your nose cast dry until the night before the cast removal appointment.
• Hot Tubs/Baths/Swimming Pools: No tub baths or Jacuzzi for 1-2 weeks which may cause swelling, bleeding and fainting. Do not submerge your head under public pool, lake or ocean water for 6 months till internal incisions have healed and sealed.

WHAT TO EXPECT WITH HEALING AFTER RHINOPLASTY:

• Swelling: Swelling is to be expected for many months following a rhinoplasty. Your nose is swollen. Your cheeks, lips, forehead and between the eyes are all swollen. It is all to be expected. Your face may look “odd” to you. This is normal. You may even experience shock, panic or crying. These are normal reactions in a minority of patients. The more you ice the cheeks, eyes, and forehead the first 2-3 days, the easier and faster your recovery will be moving forward. DO NOT BE LAZY WITH THE ICING. Less swelling means less scar tissue and the faster you recover with nicer results. Swelling gets worse after splint removal. The nose will change hourly & daily for years to come. Exercise, physical activity, sun, heat, airline travel, and alcohol can worsen swelling. Avoid things that create more swelling. After the first week icing does not help much. It takes up to a year for major reduction in swelling but 3-5 years for full resolution of swelling. You can still enjoy your new nose even after a week but know that it will change so do not over analyze it. We may recommend taping of your nose after cast removal in some cases.
• Tip Position: Your tip will drop down over the next month and slightly beyond. Do not worry. What you initially see with cast removal is not the final results. It is impossible to know exactly where your tip will end up but it will not remain as upturned as right after cast removal.
• Asymmetries: Nothing on the human face or body is perfectly symmetric from left to right side. There will be swelling 100% of the time and minor asymmetries inside and outside the nose 100% of the time. These are normal. New slight irregularities may result along where bone and cartilage edges are healing. These are normal. Most of these subtle irregularities or asymmetries are to be left alone. A very minor “touch-up” revision may be required to smooth things out in about 5-10% of cases after a year. Sometimes repeat temporary fillers can improve things avoiding another surgery. We monitor your healing. But do not expect “perfect.” Some irregularities or asymmetries cannot be improved even with repeat surgery. Do not lose sight of the big improvements.
• Bruising: It is normal to have bruising around the eyes. Most bruises disappear after about 3-4 weeks. The bruises will go from a purple/blue color to a yellow/green shade as it starts to resolve.
• Stiffness: Your nose and smile may be stiffer with initial swelling. This should improve over the next few weeks to months. But your nose will not be as soft or squishy as the original. It has better structure.
• Breathing: Internal nose swelling from the surgery can restrict airflow through the nose. One side of the nose may be easier to breathe through than the other. While some patients may get improved nasal airflow after a few weeks, some take longer. Nasal steroid spray use as well as anti-snoring stents starting a month after surgery may help. Most patient end up breathing better than before but not all.
• Drainage: You will have bloody colored drainage after surgery. The Drip Pad will help catch this drainage. You may have thick mucus with bubbles forming. Your ears and sinuses may be clogged or “popping.” Once you start cleaning and using the saline sprays the nostrils should clear it up but do not be aggressive as that can start a nose bleed.
• Skin Changes: Your skin may be crusty, dry, or oily. Your nose may be runny or dry. Your skin may be more red. You may have pimples.
• Tip Numbness: It is normal for the tip of the nose to be numb. This is temporary and will improve with time.

DO NOT AFTER Rhinoplasty & Revision Rhinoplasty

• DO NOT use Q-tips inside the nose for the first 2-3 days. Be gentle with Q-Tips even afterwards. Aggressive or deep cleaning can start a nosebleed and require a trip back to surgery and additional costs to you!
• DO NOT wear sunglasses or goggles for at least a month. You can use Rhinoshield to help reduce dents from glasses after a month. Click here and use discount code: “NADERI100” for 30% off
• DO NOT put pressure on the nose tip.
• DO NOT USE “Bioré Strips” for at least 3 months.

EMERGENCY SITUATIONs AFTER Rhinoplasty & Revision Rhinoplasty

(Call 911 in severe emergency)

• CALL THE OFFICE (703-481-0002) OR GO TO THE NEAREST HOSPITAL (Prefer INOVA Fair Oaks)
• Signs of Infection: Spreading of redness, worsening of swelling, increased drainage or drainage of pus, worsening pain, warmth at incision site and temperature over 101°F.
• Excessive Bleeding: If the dressings are saturated with bright red blood and you are having to make very frequent dressing changes sooner than 10 minutes or bleeding from mouth.
• Allergic reaction to medications or tape/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 your legs.

SHOPPING LIST FOR AFTER SURGERY

• Anti-Snoring Vents (Snore Bastion) Prevents the nostrils from swelling or scarring down and improves symmetry.
• Nose Guard/Face Shield (Sports Knight): Protects patients who play sports.
• Rhinoshield: Protects patients who wear glasses. Discount code NADERI100
• Steroid Spray (Nasacort): Helps to reduce internal swelling.
• Sinus Rinse (NeilMed): Helps to clear out any nasal congestion from mucous, dry blood and scabs.
• Detachol: Adhesive remover makes it easier to remove tape without pulling on the skin.
• Surgical Tape (3M Micropore): Helps reduce swelling.
• Silicone Scar Gel (Scarfade or Silagen): Helps to improve incision scars.
• Acne Toner: For cleaning your nose skin after surgery.

DR. NADERI WILL DETERMINE IF YOU NEED ANY OF THE ABOVE ITEMS TO ASSIST IN HEALING POST-SURGERY