Pre & Post Op
With rare exception, the procedure is performed under general anesthesia in a hospital or surgery center setting. The time of the procedure varies among individuals, but averages 2 to 3 hours.
A loose packing is sometimes placed just into the nostrils. The loose packing is removed painlessly the morning following surgery with a small tweezers by gently pulling downward.
Silastic splints are sometimes placed into each nostril during the surgery. This will make the nose feel very congested and stuffy. Most often, these splints are removed at one week following surgery.
A small bandage is placed between the bottom of the nose and the upper lip. A small amount of oozing is ordinary and expected. It should not concern you. The bandage may be changed one or a dozen times.
A small silicone splint is placed atop the upper two-thirds of the nose. The splint is removed in approximately one week. Do not allow it to get wet prematurely.
The First Week After Surgery
- During the day and evening of surgery, cold packs are used continuously over the eyes to minimize swelling and control bruising. We will provide small reusable cold packs that may be placed in the freezer and used as often as needed.
- Invariably, there is some nasal stuffiness during the week after surgery. The external edema (swelling) is reflected internally, but the mild blockage will improve steadily. The application, twice daily, of a small amount of prescription ointment (Bactroban) just inside the nostrils, acts to lubricate the surgically sutured area and prevents crusting. Any crusting that does form can be gently removed with a peroxide-dampened Q-tip. DO NOT BLOW THE NOSE. DO NOT USE NOSE DROPS.
- For the first few days, you may expect a small amount of pinkcolored water nasal discharge. Usually, a facial tissue touched to the nostrils is all that is required. Any continuous persistent show of bright red blood should be reported to me. Bleeding on the third, fourth, or fifth day occurs in less than one-percent of cases. First aid for such a rare occurrence is as follows:
- Lie down and elevate head. Place cold compress on the nose. If available, saturate a piece of cotton with nose drops or Visine, and place it in the bleeding nostril.
- During the first week, it is best to sleep with the head elevated by at least two pillows, both to decrease the amount of swelling and to aid in the resolution of any swelling that does occur.
- During the first week, you may notice that the nasal tip is slightly elevated. This is a constant, temporary factor following all rhinoplasties. The tip will slowly drop to its new lower position over several days or weeks.
- Exercise must be limited during the first week.
- Do not use Aspirin or other blood-thinning agents until after the first week.
After the First Week
- At the time of nasal splint removal, you will have your chance to see the new nose. It will appear quite swollen. It is not a time for critical evaluation since, over the next few weeks, daily changes progress toward the final result. At six months, the final permanent result is achieved in most patients.
- During the second week, the nose must not be bumped (elbows, doors, etc.). Though the bones are firmly healing in place, even a slight blow could cause movement.
- You should not wear glasses for about one month. If glasses must be worn, taping the central bridge of the glasses to the forehead will allow as little pressure as possible on the nasal bones.
- The nasal skin is somewhat insensitive following rhinoplasty. Full sensation always returns in three months time.
- Another universal observation is the presence of flaking or peeling of the skin, much like that caused by sunburn. This also abates in about two weeks.
- During the second week, physical activity may include stretching, brisk walking and isometric exercises. During the third week, you may begin running and swimming. Please do not participate in school physical education for one month following removal of the splint. We will provide a note if necessary.
- At the time the nasal splint is removed, any undissolved sutures will also be removed from the internal nasal area. You may be given a follow-up appointment. After that visit, your follow-up return examinations are based on an individual, case-by-case evaluation.
- Small irregularities may be felt below the smooth skin, especially over the nasal bones. These irregularities are common. Most noses, even without surgery, have palpable bone irregularity beneath smooth skin.