The following instructions are based on our experience with thousands of rhinoplasty surgeries. This information will answer most questions that arise regarding what you should and should not do after surgery. You and your family should read through this information several times so that you become thoroughly familiar with it. Follow these instructions as faithfully as possible, because those who do so generally have the smoothest post-operative course following their rhinoplasty.
Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount of swelling varies from person to person. Because of the looseness of facial tissue, the swelling is more pronounced in this area, and your facial features may appear distorted. Medication will be recommended to minimize swelling. Continuous adequate hydration and elevation will help.
Typically, the swelling will peak the second or third day after your surgery. Generally, it will be worse when you first arise in the morning—proof that it’s better to remain elevated as much as possible. This is not serious, and is not an indication that something is wrong. Swelling always eventually subsides, and your face will return to normal. You can help the swelling to subside in several ways:
- Keep your face elevated with your head above the heart, even while sleeping. A recliner comes in handy. Pillows will work, but your head may slip off your pillow while sleeping. This will only cause increased facial swelling and may prolong your nasal stuffiness. The main goal is to keep your head above your heart, as swelling, bruising, and blood all follow gravity and flow downhill towards the heart.
- Avoid bending over or lifting for about two weeks. Besides aggravating swelling, these activities may raise the blood pressure and cause bleeding.
- Avoid hitting or bumping your new nose. Do not pick up small children or pets, and you may need to sleep alone for two weeks after your operation.
- Continue to sleep with the head of your bed elevated for at least two weeks, or until your swelling and stuffiness have subsided to your satisfaction.
- The application of cool therapy to your eyes and forehead may soothe discomfort and somewhat reduce swelling for the first couple of days. Apply gel ice compresses or baggies of frozen peas across each eye as continually as possible during the first night and next day when you return home. But be very careful that the weight of the compress(es) does not put pressure on the splint or cause the tape to become wet with condensation.
- Avoid tanning your face for several months.
- When showering, try to minimize water exposure to the nasal dressing. Wash below your neck first, then shampoo and wash your face and promptly exit the shower. Dab your face and dressing dry gently. Do not soak the dressing. Water coming in contact with your face should come from the tap, not from bath water or basin.
- Avoid constant “sniffing”, that is, constantly forcibly attempting to pull air through the nose as some people do when their nose feels blocked. This will not relieve the sensation of blockage; it will only aggravate it because the suction created on the inside will cause more swelling.
- Do not forcibly blow your nose for several weeks after surgery, or until instructed to do so. This could precipitate bleeding.
- Beginning the morning after your surgery, attempt to flush out each nostril with Afrin exactly four times each day. This will reduce bleeding, swelling, obstruction, and crusting. Failure to use the Afrin as instructed will result in complete nasal obstruction from large crusts and scabs, which can be uncomfortable to remove. In theory, the Afrin should pass all the way through both nasal passages and be expelled through the mouth. For the first few days, the Afrin will not readily pass all the way through the nose. This is expected. So, in order to minimize crusting until you can sniff the Afrin all the way back, simply lie flat on your back, and apply two big drops of Afrin into each nostril, and allow it to percolate into the nose for a few minutes. After a few days, you will succeed at sniffing the Afrin all the way back through each nostril. Typically, one side will open a day or two before the other side. Avoid any forcible blowing of the nose for several weeks. When you eventually do sniff, DO NOT compress the opposite nostril as you might normally do. If you attempt to do this, you might tear some delicate internal sutures. Also note: manipulating your nasal tip might cause a twisted nasal tip.
- The night of your surgery and for the first day or two following, there will be nearly constant blood-tinged nasal drainage. This is entirely normal, since no nasal packing is typically used. It may be quite bloody soon after you arrive home from surgery as the vasoconstrictors used during surgery wear off. Simply remain calm, quiet, and elevated, and change the drip pad as instructed as often as necessary. As long as you remain calm and quiet, within a few hours, the bleeding will slowly diminish in quantity and will become more watery. Apply and change the 4x4 gauze as necessary, as we will teach you in recovery. Do not use a tissue. If you are tempted to use a tissue, it’s time to re-apply the drip pad. Tissue is paper, and paper has wood chips in it. Frequent dabbing with a tissue can actually abrade the delicate nasal skin. Most people can discontinue using the drip pad after a day or two.
It is not unusual to have varying amounts of bruising around your eyes and face. Like swelling, the discoloration may become more pronounced after you have been discharged. It usually lasts no more than a week, all the while decreasing the intensity. However, in some cases, individuals may have bruising that seems to last for a few weeks. The measures that help swelling to subside will also help discoloration. You can camouflage the discoloration to some extent by using makeup after the splint is removed.
If hemorrhage occurs, lie down with your head elevated on pillows or in a recliner. Try not to get excited. Be sure to take your pain medicine if needed to avoid increased blood pressure secondary to pain. If you are worried, call us.
Do not take any blood thinning medications such as aspirin or Advil until they are cleared by our office.
Self-Cleansing of the Nose
Interestingly, your nose is self-cleansing. If you simply patiently follow our instructions, your nose will take care of itself. You do not have to do anything besides follow our instructions. It can be hazardous to perform any other interventions. But be patient—this process takes weeks and weeks.
The first week, the only things that should enter your nose are air and Afrin. Period. After the Afrin has done its job, you will transition to Nasal Saline and perhaps Ayr Saline gel for several weeks. No fingers, Q-Tips, tweezers, Vaseline, scissors, etc. EVER!
After a few weeks, you will notice some crusts, bumps, and ridges or irregularities inside your nostrils. These are completely normal, and will resolve slowly on their own. It may be tempting to try to remedy these yourself, but doing so could very easily disrupt your nasal tip permanently. The sutures stabilizing your nasal tip are tiny threads sewn through delicate cartilage, about as flimsy as a contact lens made of candle wax! If you are concerned, let us look at it before attempting any form of picking or self-surgery.
Due to nasal obstruction, discomfort, and elevation, sleeping can be difficult after surgery. This will get easier night by night. If you’re still having troubles with insomnia after a night or two, you can try over-the-counter Benadryl 50mg, or Tylenol PM. No Advil PM. If you desire a prescription sleeping medicine after a night or two, just let us know. However, it can be hazardous to combine various sedatives such as narcotics with sleeping medicines. Decide for yourself what your chief concern is—pain, insomnia, or anxiety—and we will work with you to make you as comfortable as we safely can.
It’s not unusual for an individual to go through a period of mild depression after the surgery. No matter how much they wanted the operation beforehand and how much they were told about what to expect post-operatively, they are shocked when they see their face swollen and perhaps discolored. If this is how you feel, be realistic and realize that this is a very temporary condition which will subside shortly. The best treatment consists of staying busy with the details of post-operative care and trying to divert your mind.
Keep a Stiff Upper Lip
The upper lip is a key area in rhinoplasty surgery, since much of the work is done near this area. Therefore, you should not move it excessively as long as the bandage is in place so that the healing tissues are not disturbed. This means:
- Avoid excessive grinning and smiling.
- Do not pull your upper lip down (like women do when they apply lipstick).
- Apply lipstick with a brush.
- Brush upper teeth with a soft toothbrush. The lower teeth may be brushed as usual.
- Avoid gum or foods that are hard to chew. Soups, mashed potatoes, stewed chicken, yogurt, or any easily chewable food is permissible. French bread, steak, etc. should not be eaten.
No Sunglasses for Six Weeks!
Contact lenses may be inserted a day or two after surgery.
Dryness of the Lips
If your lips become dry from breathing through your mouth, coat them with Vaseline or Aquaphor. But under any circumstances, avoid ALL moisturizers within an inch or so of the splint tape. This may cause premature loosening of the tape and destabilization of the rhinoplasty.
Generally the body temperature rises a bit after surgery, but not normally much above 100°. This rise results from becoming mildly dehydrated due to not drinking enough water. Patients will often think they have an increased temperature because they feel warm. If concerned, use a thermometer and report any persistent temperature above 100°.
It’s not unusual after a person has an anesthetic or any type of operation for him or her to feel weak, have palpitations, break out in cold sweats, or get dizzy. This gradually clears up in a few days without medication. It’s best relieved by promptly lying flat on your back for several minutes. Call us if it persists or concerns you.
Returning To Work Or School
The average patient is able to return to work or school the day after the bandages are removed—that is, eight days following surgery. However, that is entirely up to you. If you don’t mind returning with the splint on your nose and you’re not required to physically exert yourself, you can go back to work or school within three days of surgery. When you should return to work depends on the amount of physical activity and public contact your job involves in addition to the amount of swelling and discoloration you develop.
We all love our pets, but over the years, we have noticed that a few patients who tend to sleep with their pets in close proximity will sometimes have some extra inflammation or perhaps even early infection. We recommend that if your pet sleeps on your bed, you take appropriate precautions until a few days after all your sutures are removed. Pets must sleep on the floor or, if necessary, in a separate room. Make sure all of your bedsheets, pillowcases, etc. are freshly washed.
Injury to the Nose
Many individuals sustain accidental hits on the nose during the early post-operative period. You don’t need to worry about this unless the blow is hard enough that bleeding or considerable swelling ensues. Report the injury to us if you’re concerned.
Patience and Perfectionism
Often, patients are pleased and relieved to first see their nose when the splint is removed. They expect their nose to be swollen, but are relieved to see positive changes. After about a week or so, a great deal of swelling dissipates—and then reality sets in. It takes an entire year, sometimes even longer, for the final result to be achieved.
As things settle, various small lumps and bumps, uneven swelling, etc., can understandably cause concern. The most common concerns are persistent swelling, numbness, firmness, lack of definition of the tip and the area above the tip, and bumps and irregularities inside the nostrils. When this occurs, we will advise you as to certain types of massage which can be of some benefit. But realize and accept that it takes time.
The nationwide average is that 10% of all rhinoplasties require some revision. Our actual rate is substantially less than 10%. But no surgeon or nature can create a perfectly proportioned or perfectly symmetrical nose. Every surgeon in the world has to revise a nose occasionally. Of course, every effort and all of our training and experience will be used to the utmost to giving you the best possible result. But occasionally some revision is required, and this must be postponed for at least one year.
Some anxious patients will fear that a revision may be necessary, but the vast majority of the time, things settle down nicely and no additional work is necessary after all. The most common revisions we encounter involve merely a small rasp of a bony prominence due to warping, a small trim of some cartilage, a small injection of cortisone, or a filler such as Restylane. Occasionally you may incur additional financial costs, such as cost of the operating room or cost of the filler. This does not indicate your rhinoplasty was not successful or was not performed properly.
Remember the things you were told before your operation, including:
- When the bandage is first removed, your nose will appear fat and turned up too much. This is due to operative swelling over the nose and in the upper lip. This swelling will subside to a large extent within a week; however, it will take up to one year for all the swelling to disappear and for your nose to reach its final contour.
- The discoloration will gradually disappear over a period of 7-10 days in most cases. We have yet to encounter a case where it persisted permanently.
- The thicker and oiler the skin, the longer it takes for the swelling to subside.
- Your upper lip may appear stiff for a while, and you may feel that it interferes with your smile. This will disappear within a few weeks.
- The tip of the nose sometimes feels “numb” after a rhinoplasty, but this eventually subsides.
If you have any further questions, please feel free to call us. You can reach us 24 hours a day, and we are here to help you. We hope this helps you and reassures you during your recovery.