Rhinoplasty Post‑Op Instructions

Post-operative instructions, rhinoplasty. Day of surgery. We will meet at the surgery center where you will have the chance to be introduced to your team, including the anesthesiologist. The anesthesiologist will review all necessary documentation provided to ensure accuracy and that we deliver a smooth, safe anesthetic and recovery. Minimizing the risk of post-operative nausea and wooziness starts in the pre-operative area. You will be given an IV to remain well hydrated and the anesthesiologist can provide medications during the procedure.

To keep you safe during surgery, you will have a breathing tube or an LMA during the operation. This may cause scratchiness and discomfort for the first couple of days post-surgery. Chloraseptic or a nice Throat Coat tea can help with the discomfort so that you have very little discomfort after. I like to use long-acting local anesthetics during your surgery. It is common to only require a single pain pill the night of surgery. Tylenol and ibuprofen are all that is typically required, though you will have more pain medications available.

When your surgery is complete, the nurse will contact your family member to let them know your procedure is done and the time for pickup. If the surgery runs longer than anticipated, this is not a bad thing, though it can cause some anxiety in your family. Your face is unique and we must take our time to ensure that every little detail is accounted for, as the work done during your surgery must last for the rest of your life.

Evening after surgery. In preparation for surgery, I recommend preparing a few dishes that are comforting and soft. You may feel sore and have a poor sense of smell that can make eating at first less than appealing. I recommend getting up and moving around at home. Surgery can increase your risk for blood clots in the legs, and we want to ensure the blood is kept flowing. During your first evening, please ask for assistance from your loved one since you may not feel as stable as you would normally.

If you are a stomach or side sleeper, I recommend getting some wedge pillows and/or place a pillow behind your knees to help simplify sleeping on your back. In order to resist the temptation to roll over, it is encouraged to sleep flat on your back or slightly reclined with a few pillows. You can also place pillows in a recliner chair. Avoid sleeping on the side of your face or, worse, sleeping in a chair where your head falls forward. Swelling will follow gravity. If your face is below your head, the swelling will be worse. A deeply reclined chair is a great option in order to avoid the tendency to roll over while sleeping.

Recovery. Typical downtime from a rhinoplasty procedure is within 1 week. Our post-operative dressings are very minimal. There will be some bruising and swelling, but you will be able to enjoy your nose 1 week after surgery. Luckily, this is not due to discomfort, as we use a long-acting local anesthetic to improve recovery. And frankly, facial surgery is not typically painful.

Incision care. During your first week post-operative, you will have very small sutures along your incision, if at all. All of these will be removed during your 1-week follow-up. In this first week, apply bacitracin or Neosporin antibiotic ointment to the incision area twice daily. As your nose is swelling and can be sensitive around the area, be very gentle when donning or doffing your shirt. A button-up shirt can help decrease this risk. Your incisions will be at maximum strength about 6 weeks after surgery.

Skin care. Day 1 to 7: the skin glue/Steri-Strips can clog your pores. After the splint is removed, it is not uncommon for blackheads to appear. Day 7 to 30: a gentle cleanser or light exfoliation, such as a growth factor serum, can help minimize inflammation and reduces the risk of blackhead formation. Apply SPF if you plan any outdoor activities. Resist the urge to scrub your nose, as the cartilage is still healing and scar strength does not reach a maximum until 6 weeks after surgery.

Multimodal therapy medications. Tylenol Extra Strength, 500 milligrams. Take 2 every 6 hours for 5 days. Do not wait for pain. Tylenol makes up the foundation of your pain management and will decrease the number of narcotics needed. Ibuprofen, 600 milligrams. Take 1 every 6 hours, scheduled, for 3 days. Do not wait for pain. Ibuprofen makes up the foundation of your pain management and will decrease the number of narcotics needed.

Tramadol, 50 milligrams. Take 1 every 6 hours as needed for pain. If you use antidepressants, this will be exchanged for oxycodone, 5 milligrams. It is okay to wait until you have pain. Tramadol is a long-acting narcotic that will begin to work in about 30 minutes and can last up to 6 hours. Oxycodone is a fast-acting, strong medication that can exacerbate nausea and/or make patients feel loopy.

MiraLAX, constipation. Drink 1 full cap twice daily while using Tramadol until first bowel movement. MiraLAX brand is preferred, though any stool softener is fine. We want to avoid constipation, as bearing down can increase your blood pressure in the first week and can put you at risk for bleeding, in addition to being uncomfortable.

Zofran/Ondansetron, 4 milligrams. Take 1 every 8 hours. The dissolvable tabs can be placed under your tongue if you are feeling nauseous from the anesthesia. This medication will be prescribed as needed.