Recovery Guide
Rhinoplasty Recovery Guide
The nose is the centerpiece of the face and has an important role in our facial aesthetics, symmetry, and confidence. All aspects of plastic surgery seek to provide form and function; the nose is an excellent example of that. While the goals of men and women differ, most patients are looking for a smaller nose or one that "fits" them better. It is of critical importance that while we create a nose that may be smaller and appear more delicate, that it still be strong and allow you to breathe well.
The aesthetic goals for your procedure are unique; we must look at not only your face but also your heritage since "beauty" varies widely across cultures. One of the joys of my role is to help you identify the shape and contours that you find beautiful, that still fit your face, and of course, remain strong and functional.
You will hear me discuss the quality of life frequently. As a Plastic Surgeon, I am judged by my surgical outcomes, and I like to measure "success" in quality of life. Rhinoplasty is a procedure that has a profoundly positive impact on quality of life, and I love watching my patients thrive.
Learn More About The Procedure
The Procedure
In broad terms, the average Rhinoplasty consists of an incision, reduction of the dorsum of the nose, and reshaping of the tip of the nose with or without cartilage "grafts" that can usually be taken from the nasal septum.
A Rhinoplasty can be subdivided into the management of the dorsum (bridge of the nose) and the tip of the nose. Nose surgery can be performed "open" (incision across the columella) or "closed." To further classify the approach, we can use different layers under the skin to approach the bone and cartilage of the nose.
Preservation Rhinoplasty may be a term you have heard as it has a number of implications for both layers of surgery as well as whether cartilage is "preserved" or whether a more traditional approach is used when reshaping the dorsum of the nose. All these factors are discussed during your consultation as there are good reasons to use each of these approaches depending on the goals for surgery.
Additional Procedures
Weir Excisions: Most procedures do not require incisions along the base of the nose, but if the nose is too wide at the base or the nostrils too large, small incisions can be placed at the base of the alar skin to further refine the shape of the alar rims and nostrils.
Nasal Sill Narrowing: If the overall base of the nose is too wide due to the wide nasal sills, then a small piece of skin can be removed, and the overall width of the nose reduced.
Dice Cartilage-Fascia Graft: If you feel that the dorsum of your nose is too low, which is common in many Asian noses, then cartilage and fascia can be used to build up a taller dorsum without having to use artificial implants that can lead to post-operative complications.
The 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 1-7: The skin glue, steri-strips, can clog your pores. After the splint is removed, it is not uncommon for blackheads to appear.
Day 7-30: 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.
Multi-Modal Therapy Medications
Tylenol Extra Strength (500mg) 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 (600mg) 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.
Gabapentin (100mg) take 1 every 8 hours for 14 days
- Do not wait for pain. Gabapentin makes up the foundation of your pain management and will decrease the number of narcotics needed.
Tramadol (50mg) take 1 every 6 hours as needed for pain. If you use antidepressants, this will be exchanged for Oxycodone (5mg).
- 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".
Zofran (Ondansetron, 4mg) take 1 every 8 hrs
- The dissolvable tabs can be placed under your tongue if you are feeling nauseous from the anesthesia.
MiraLAX (Constipation, OTC)
- Drink 1 full cap twice daily while using Tramadol/Oxycodone 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.
LASER: Acyclovir (400mg) take 1 by mouth twice daily.
- Prevents viral infection of the skin after laser resurfacing. You will begin this medication 1 day before surgery.
Medication Schedule
A proposed schedule has been supplied in order to simplify the scheduling of medication. We understand there are a lot of medications to follow, but rest assured, we believe Multi-Modal therapy provides the greatest comfort and decreases post-operative nausea, drowsiness, and constipation. If your pain has become severe or additional recommendations are needed, do not hesitate to contact our office.
| Medication | Times |
|---|---|
| Tylenol (1000mg) |
|
| Ibuprofen (600mg) |
|
| Gabapentin (100mg) |
|
| Tramadol (50mg) / Oxycodone (5mg) |
|
| Zofran (4mg) |
|
Follow Up Schedule
1 Week
Swelling will be reduced. The nasal splint on the outside and inside of your nose will be removed. If the surgery was performed "open," the little sutures will be removed during this visit in order to minimize scarring. You will take the nasal splint home with you and continue wearing the splint for 1 week at nighttime to protect the nose from inadvertent bumps while sleeping.
1 Month
Your incisions are healing well but will still appear redder around the surrounding skin. Bruising will be gone and there will still be small areas of swelling particularly around the tip. Overall, you will be feeling great!
3 Months
The incisions are fading and will continue to improve all the way until one year after surgery. You will be enjoying the results of your surgery!
6 Months
Feeling good, looking good! There are small nuances that we want to make sure are still progressing well, as well as continue to notice more and more definition in the tip of the nose.
1 Year
"Why do I have to see the doctor?" Rhinoplasty is a lifelong process of continuous assessment and reassessment. I want to ensure that you have healed well and that we have improved your quality of life. I also want to ensure that we continue to use the most cutting-edge techniques that provide high-quality, durable outcomes. I will need your help to continue this process to ensure that our patients receive the best possible outcomes. It is at this point all of the swelling should be resolved unless you have very thick skin.