If packing is placed inside the nose during your rhinoplasty surgery, it is removed the next morning following surgery. The nasal splint is usually removed seven days after surgery. At that time, tape is applied to the nose for another seven days and then removed. The majority of the bruising and swelling usually resolve two weeks after surgery. Cold compresses are used to help reduce the bruising and discomfort. A short course of post-operative antibiotics and steroids are given to help prevent infection and excess swelling. Although discomfort is minimal, pain medication is available if required. Vigorous activity should be avoided for four weeks following surgery. Sun exposure and any activity risk of injury must be avoided. If you wear glasses, tape is used to avoid putting stress on the nose.
Additional Recovery Points
- The head needs to be elevated for several days following surgery to minimize swelling.
- Recuperation time is approximately 7-14 days during which time some bruising and swelling may be present.
- A nasal splint, applied to hold bone and cartilage in the new shape while the nose heals, is removed in seven days.
- Following surgery, discomfort is minimal and easily controlled by oral medication.
- A natural and aesthetically improved nose (without a “surgical” look) in proper proportion to your other facial features.
- Improved breathing with septoplasty.
- Ideal candidates for any facial plastic surgery are those seeking improvement rather than perfection.
These instructions should be carefully read and followed. They are designed to answer the most commonly asked questions regarding post-operative care.
Activity: The First Week
Limit your activity sharply during the first week following surgery. You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects. If you overexert yourself, bleeding may result. When you rest or sleep, keep your head elevated on 2-3 pillows and try to avoid turning on your side. Keep your emotions under control. It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better. Anger or crying will only add to the swelling or initiate bleeding. Restrict your diet to plenty of fluids and easily chewable foods. Hard to chew foods (like steak) should be avoided for one week. You may carefully clean around the nostrils with a Q-tip and hydrogen peroxide three times a day. Immediately afterwards, place a bit of pure Vaseline or antibiotic ointment around the nostrils to keep them from drying out. Swelling for at least two weeks will obstruct your nasal passages. A humidifier may help you sleep by allowing you to breathe through your mouth more comfortably. Do not blow your nose or sniff excessively, as this will only irritate the healing tissues. If you must sneeze, open your mouth. Also, avoid picking up babies, small children or pets; a flailing little arm may strike your nose.
You probably will hit your nose one or more times during the first week. This will hurt, but will cause no problem unless the force is excessive. With assistance, you may bathe in a tub; showering is allowed on the second post-operative day. Cover the nasal cast so that it remains dry. If the cast becomes wet, use a blow dryer to help dry it. It is all right to carefully wash your face with a mild soap and a clean washcloth or cotton balls. Avoid cigarette smoking or even being in an area of excessive smoke, as this irritates the nasal tissue and impedes healing. Also, avoid alcoholic beverages the first two weeks following surgery as this may increase your chances of bleeding.
Activity: The Second Week
It takes six weeks for the nasal bones to fully heal. Slowly resume your activity. After the first week, let your body tell you how much to do. Strenuous exercise may be resumed in 5-6 weeks. Build up to this level slowly. Semi-contact sports are to be avoided for four to six months. Swimming is allowed after six weeks. Do not let your nose become sunburned for six months after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with a SPF of at least 15.
Pain, Swelling, Bruising, or Bleeding
The first day or two, you will have some bleeding. Do not swallow the blood, as it will make you nauseated. Most patients complain more of discomfort from nasal and sinus congestion than from pain. Any pain should be controlled with the prescribed medication. After the first day, the pain may subside enough so that plain Tylenol or Extra Strength Tylenol may be sufficient. If not, call our office and we will prescribe a stronger medication. Swelling and bruising about the eyes and cheeks is variable. Swelling maximizes at about two days then subsides over the next week. An ice pack to the eyes for the first 48 hours may help decrease the swelling about the eyes and cheeks. This will clear completely and will not adversely affect the result. Bruising (discoloration) may persist a few days longer. Remember, this will all subside in time and has no bearing on your final result.
It is normal to have bleeding over the first 12 hours after surgery. It may be necessary to change the gauze a dozen or so times over this period. It is normal to have a pinkish-reddish discharge from your nose and throat for the first 3-4 days. This will gradually subside. If you have profuse nasal bleeding after this time, immediately lie down with your head elevated on 3-4 pillows. Iced washcloths on the back of the neck and over the eyes may help. Using nasal decongestants (such as Afrin) as directed will often help with bleeding. Please call our office if these measures do not suffice.
Avoid medications such as Vitamin E, aspirin, or ibuprofen for 2-3 weeks. Pain medication will be prescribed. Take it as needed. Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. If the prescribed medication does not control your symptoms, please let us know. Nausea may occasionally be related to the above medication. Taking the medication with food may help alleviate the nausea. After the first 24 hours, Extra-Strength or regular Tylenol may be sufficient.
Infection is unusual after rhinoplasty, but occasionally occurs. Fever over 100 ° F, excessive pain, and swelling with redness may signify a developing nasal infection and should be reported. Infections generally clear up quickly with appropriate antibiotic treatment.
The nasal packs will be removed on the next morning after surgery. The cast and any sutures will be removed after one week. Brown paper tape will then be applied to your nose. Dr. Nassif will remove the tape in one week. When the cast is removed, the nose will be quite swollen and the nasal tip will be turned up. This will settle down over the next few weeks, then more gradually thereafter. Nasal “exercises” are then demonstrated, if necessary. These are done to keep the sides of the nose narrow and in proper alignment. They should be performed 15-20 times per day and held for 30 seconds. They are to be continued for about six weeks. Remember that the nose does not assume its final shape until many months after surgery, depending upon the type of nasal skin you have. It will probably look better than prior to the operation within two or three weeks, but the final result takes longer. Be patient. Occasionally, an injection is necessary to reduce the swelling in one area. Any touch up surgery that may be necessary is not performed for at least six months.
Rhinoplasty 1 Day Follow Up Consultation – Maria – Dr. Nassif
Rhinoplasty 8 Days Post-op Follow Up Consultation – Maria
What to Expect Following Nasal Surgery
Certain physical changes are expected following nasal surgery. Some individuals experience all of the following and others only some. The degree to which each person is affected is variable and unpredictable. You may experience changes that are not included in this list.
Bloody drainage is common in the first 48 hours after surgery. Blood-tinged nasal discharge may persist for 1-2 weeks following surgery. Profuse bleeding is unusual. Should this occur, pinch your nostrils together firmly for 10 minutes without interruptions. If this does not stop the bleeding, call our office immediately.
Nasal swelling is expected and may not be readily noticeable until after the splint is removed. Most of the swelling subsides in 4-6 weeks, but subtle swelling may persist for 6-12 months. In certain situations, the doctor may inject a small amount of steroid into your nose to help reduce the swelling.
Bruises following nasal surgery usually manifest as “black eyes”. Most bruising will resolve in 2-3 weeks and may be concealed with makeup if desired.
Nasal breathing may be difficult for 2-3 weeks after surgery due to swelling inside the nose. This “stuffiness” will subside gradually and IS NOT improved with nasal sprays. Decongestive nasal sprays may actually cause damage to the nose and impair healing.
As noted above, blood-tinged nasal discharge is common following surgery and may persists for 1-2 weeks.
Itching, numbness, and a “wooden feeling” to the nose are common. All of these do subside, although, it may take months for your nose to feel completely “normal”.
Your rhinoplasty or ethnic rhinoplasty procedure is over. With each passing day, you’ll feel more energetic, and the delicate tissues in your nose are healing. Although you’ll be able to notice improvement in the shape of your nose right away, you won’t see the final results for up to twelve months. By taking proper care of yourself and your nose during the all-important healing phase, you’re assured of attaining the best results possible.
Recovery at Home
Once you leave the surgical facility, you’ll begin your recovery at home or at an aftercare facility. If you’ve prepared well, your recovery can be relatively stress-free and comfortable. Recovery time is highly individualized, but most rhinoplasty patients feel well enough to resume many normal activities and return to work or school in one to two weeks.
To ensure proper healing, your surgeon will provide you with detailed post-operative instructions, which you’re expected to follow closely. The instructions are designed to help minimize pain, swelling, and discomfort during the recovery phase. Make sure your caregiver has a copy of the instructions.
Caring for Your Nose
The gist of post-operative instructions is to protect your nose while it heals. Avoid touching, bumping, or rubbing it, and minimize smiling because it causes movement in your nose. In addition, you need to avoid sniffing and blowing your nose for at least ten days. What if you have to sneeze after surgery? It’s difficult to stifle a sneeze, so to protect your nose, express the sneeze through your mouth, and don’t try to muffle it.
What about cleaning your nose? You’ll be instructed on how to gently clean the exterior of your nose as well as the interior, just inside the nostrils where the incision are. You may also be advised to use a saline spray to help keep the inside of your nose clean.
Sleeping on Your Back
It’s important to sleep on your back for a few weeks following surgery to prevent pressure on your healing nose. Sleeping on your side with your nose pressed against a pillow could push the healing structures out of shape. You may want to sleep in a recliner to ensure that you stay on your back.
Minimizing Swelling and Bruising
To minimize swelling, you will likely be instructed to keep your head elevated while you sleep. Most surgeons will also advise you to avoid bending over or lifting anything heavy for at least two weeks following surgery because these activities can aggravate swelling and can also raise your blood pressure and cause bleeding. Your surgeon may also prescribe steroids to help reduce swelling. Your surgeon may suggest using ice, frozen peas, or cold compresses to help reduce bruising around the eyes.
Your surgeon will give you a timetable for resuming rigorous activities. No doubt, this list will include instructions to avoid all contact sports and strenuous exercises for four to six weeks. Don’t lift any objects that weigh a few pounds. Be cautious with small children and pets that may bump your nose. If you participate in any activities that don’t appear on your surgeon’s timetable, be sure to ask when it’s okay to resume them.
Food, and Drink
Following rhinoplasty, a soft diet is recommended. It’s best to avoid chewing gum as well as foods that are hard to chew because they cause too much facial movement. As for beverages, it’s important to avoid alcohol because it thins the blood and can lead to bleeding. Avoid drinking any beverages that contain caffeine.
Avoid Wearing Glasses
To help your healing nose maintain its shape, you won’t be able to wear eyeglasses or sunglasses on the bridge of your nose for approximately four weeks. Your surgeon will provide you with alternative ways to wear glasses, such as taping them to your forehead or having them refitted so they rest more on your ears rather than on your nose.
The level of pain patients experience after rhinoplasty varies; however, most patients experience only mild discomfort. Many rhinoplasty patients do not need any post-surgical pain relief, but those who do often find over-the-counter pain relievers to be adequate. In some cases, prescription pain medication may be necessary. The pain relievers your doctor recommends may include opioid and non-opioid medications.
You must have a prescription from your surgeon to acquire opioid pain relievers, which are also called narcotics or opiates. Opioids are effective in controlling moderate to severe pain and are usually prescribed to help you remain pain-free during the first few days following rhinoplasty. Commonly prescribed opioids include Tylenol with codeine, Darvocet, and Vicodin. These drugs are safe when taken as directed so it’s important to follow your doctor’s instructions. Because opioids can cause constipation, your surgeon may also recommend an over-the-counter stool softener.
Some non-opioid medications require a prescription from your surgeon, but many don’t. These drugs are non-narcotic and are intended to control mild to moderate pain. Non-opioids include acetaminophen, which is found in Tylenol and Extra-Strength Tylenol, and are often recommended for pain relief following surgery. Remember that many over-the-counter pain relievers contain aspirin, ibuprofen, or naproxen sodium, all of which are discouraged following surgery because they can thin the blood and increase bleeding. Be sure to take only the pain relievers your surgeon has recommended. It’s important to take these medications as recommended because exceeding recommended dosages may harm the liver and/or kidneys.
Side Effects of Rhinoplasty
Following your procedure, you will experience side effects commonly associated with rhinoplasty. These side effects are considered normal and are usually temporary.
- Swelling: Expect swelling of your nose and the surrounding tissues to peak approximately thirty-six to forty-eight hours after surgery. You can expect more pronounced swelling if osteotomies (cuts or fractures to the nasal bones) were made during your procedure. Swelling is usually greatest when you rise in the morning. This side effect begins to subside within the first two weeks but will take at least a year to disappear completely.
- Bruising: Bruising may occur between the eyes and on the cheeks, especially if you’ve had osteotomies performed. Bruising peaks approximately two days after surgery and then disappears, usually within two weeks.
- Pain: The pain associated with rhinoplasty is usually mild. Most of the pain will probably disappear by the second or third day after surgery.
- Nasal blockage: Congestion is to be expected following nasal surgery and may feel similar to the effects of a head cold. Cold-like symptoms are common for about six weeks after surgery.
- Drainage: Following surgery, you can expect some nasal drainage to be tinged with blood, especially during the first day or two. You may notice an increase in nasal drainage when you rise to an upright position after being in a reclining position. This is normal and is not a cause for concern.
- Stiffness in upper lip: Your upper lip may feel stiff, making it more difficult to smile. This feeling will usually dissipate within a few weeks.
- Numbness of tip: The tip of your nose may feel numb, but the numbness usually disappears within a few months.
- Depression: Don’t be surprised if you discover that you feel a little blue in the days following your surgery. This is a common occurrence following surgery, when bruising and swelling are at their worst. This emotional letdown may be due to the fact that your face temporarily looks worse than it did prior to surgery, but it may also be attributable to stress, fatigue, or metabolic changes in your body. Rest assured that these feelings usually disappear within a few days.
Potential Complications of Rhinoplasty
There are risks associated with surgery of any kind, including rhinoplasty. However, you should know that when your procedure is performed by a qualified facial plastic surgeon, complications are uncommon. In the rare instance that you experience a complication, you may require some form of treatment.
- Infection: Infection is a risk associated with any kind of surgery, but it is rare following rhinoplasty. Antibiotics are routinely prescribed to prevent infection.
- Bleeding: Excessive post-operative bleeding can occur.
- Burst blood vessels: Small burst blood vessels may appear as tiny red dots on the surface of the skin on your nose. This is more common if you have rosacea, or if you’re having revision rhinoplasty. Although it may be permanent, it can be treated with vascular lasers.
- Scarring: If an incision is made on your columella, or if incisions are made to reduce the width or length of your nostrils, there is a minimal risk of obvious scarring.
- Irregularities under the skin: It’s possible for irregularities under the skin to be visible. Any underlying irregularities are more visible if you have thin skin.
- Asymmetry: This may occur due to no fault of your surgeon. Post-operative scarring within the nose can cause it to appear uneven from one side to the other. In addition, the nose is a three-dimensional object that can heal in unpredictable ways.
After your rhinoplasty procedure, you’ll need to return to your surgeon’s office for several follow-up appointments. If packing was used in your procedure, it’s usually removed within a few days, and often the day after your surgery. Even if packing isn’t used in your procedure, you may be asked to return for a follow-up visit within a few days so your surgeon can evaluate how you’re healing and so that the inside of your nose can be cleaned. Cleaning the inside of your nose is usually done gently with Q-tips swabs and half-strength hydrogen peroxide.
The splint placed on your nose and any nonabsorbable sutures are generally removed in your surgeon’s office at one week. Removal of the sutures and splint isn’t painful and usually takes only a few moments. Once the splint is removed, you’ll have a chance to observe the new shape of your nose. However, it’s important to remember that your nose will still be swollen at this time, so you won’t be looking at your final results.
During this appointment, your surgeon may also retape your nose to control swelling. You may also receive instructions on how to perform simple nasal exercises along any osteotomy sites to decrease swelling or to mold the nasal bones. In follow-up appointments, you may also be instructed to continue taping your nose nightly for four to six weeks to further minimize swelling. The frequency of additional follow-up appointments depends on your surgeon. Considering that these appointments help to ensure that the healing of your nose is on track, and are generally included in the price of your surgery, it’s important to go to all post-operative visits.
Getting Back to Normal
As the weeks and months pass after your surgery, your life will return to normal. Be sure to follow your surgeon’s timetable for returning to work or school and for resuming various activities. This will help protect your nose from injury and will allow it to heal as quickly as possible.
How Long Does Rhinoplasty Last?
You should be aware that your nose may change throughout your lifetime due to aging. This is normal and occurs whether you’ve had rhinoplasty or not. The good news is that once your nose has completely healed, it doesn’t require any long-term follow-up care. However, it is recommended that you visit your surgeon annually to have photos taken of your nose. This way, you and your surgeon can track the changes to your nose.
For more information about rhinoplasty in Beverly Hills or to schedule a consultation with Dr. Nassif, please contact the Nassif Plastic Surgery Specialists at (310) 904-6999.