Nasal Surgery (Rhinoplasty)

Post-Operative Instructions

Some oozing from the nose is expected for a day or two, and a small gauze "mustache" dressing is worn as a drip pad. This can be changed or removed as necessary. Try not to swallow any blood, as this can cause nausea.

On the second day after surgery you may begin to gently clean your nostrils. Small amounts of dried mucus and blood can collect, and by following these instructions you will be more comfortable, breathe easier, and have less swelling.

1. Mix equal amounts of lukewarm water and hydrogen peroxide in a small glass.
2. Dip a cotton swab in this solution and very gently cleanse the edge of the opening and the rim of your nose.
3. Wait a few seconds for your nose to dry, then apply a thin coat of Vicks Vaporub with another cotton swab.

The inside of your nose can be irrigated as often as you like with Ocean Spray, a balanced salt spray available over the counter. This will keep your nostrils moist and help loosen any crusts. Be very gentle. Do not forcibly cleanse or pull on crusts. Let them loosen on their own.

A pediatric suction bulb (available in any drug store) can be used to suction nasal secretions. Once your splint is removed, very gentle non-forced blowing of the nose can be performed. Hold the top of the nose while doing this to decrease swelling.

You may find that you need to be a "mouth breather" for a short time. Try to avoid activities such as tweezing the eyebrows, which can induce sneezing. If you must sneeze, do so with the mouth open.

You may find that brushing your teeth with a child's toothbrush is more comfortable during your early recovery.

If reconstructive septal and/or turbinate work is done, you may have packing inside your nose consisting of small, sponge tampons with a small breathing tube in the center which allows you to breathe more comfortably. Removal of these packs can be up to four to five days later.

A form-fitting tape-splint dressing is also worn across the nose for four to five days, and is removed at the same time as any packing. The nose is then lightly taped for a day or two to decrease swelling.

Our self-taping program, which involves taping your nose every night for two to six weeks, will rapidly decrease nasal swelling and improve the shape.

As a result of taping, the skin on the nose may peel or develop clogged pores and whiteheads or blackheads. Using Cetaphil soap substitute three times per day will help clear up skin problems. With moderate irritation, withhold nasal taping for two or three days and apply 1/2% hydrocortisone cream (available over the counter) two or three times per day until it clears up.

Reclining or sleeping with your head elevated on two pillows and the use of icy cool compresses will help to resolve swelling and bruising. Prepare compresses as follows:

1. Fill a plastic bowl with ice cubes, water, and a shake of salt. Soak and wring out gauze pads, a small washcloth. Place these over your surgical site—ten minutes on, five minutes off—while you are awake.
    
2. Ice bags should never be used against the skin, as the area may be numb due to the surgery and you can injure the skin.

Showers may be resumed on the second day following surgery, but you should cover the splint and dressings with a towel or shower cap to keep them dry. Don't worry if they get a bit damp from the ice water compresses. Do not remove dressings if they become loose. Simply apply additional paper or scotch tape to hold them in place.

Infrequently, dark rings occur around some patient's eyes, especially those with darker pigment to their skin, but these resolve with time. Once your nasal splint is removed, you can use cover make-up around your eyes if you desire.

Depending on the thickness of your skin, particularly at the tip, nasal swelling may persist for weeks or months. Our taping program is very helpful in eliminating swelling, and instructions should be followed regularly for optimum results. In rare cases, however, total resolution may not occur for one to two years. Your swelling will be more apparent in the morning when you get up and should subside as the morning progresses.

Avoid excessive bending and heavy lifting for at least two weeks to minimize swelling. In addition, eliminate added salt and spices from your diet. Sunbathing, saunas, and extremely hot showers can also contribute to swelling and should be avoided for six to twelve weeks.

Normally, swelling resolves as follows: half in two to three weeks, another fourth over eight to twelve weeks, and the last fourth by six to twelve months.

Infrequently, a patient may feel (but rarely see) slight irregularities in the nose during the healing process. Bone, cartilage, and some layers of skin have a propensity to develop small, temporary lumps under the surface of the skin while healing. These lumps occur most often at the inside of the eyes near the nose, the bridge of the nose where the bones join the cartilage, and just in back of and to the sides of the tip, and may be callous tissue, enlarged glands, or thickened incision lines. In most cases, they disappear in time. Swelling in these areas starts at about ten days after surgery and usually resolves in four to six weeks. Combined with our regular taping program, light digital pressure can help speed their resolution. Gently use the tip of your index finger and press down for ten seconds, once an hour.

You may also notice some temporary nasal congestion or increased sensitivity to smoke and air conditioning for several weeks. In cases where extensive structural work will be performed inside the nose, we may prescribe a spray to be used before surgery to lessen postoperative swelling and stuffiness.

If you wear glasses, they can be worn over your tape splint, but once the splint is removed they must be taped to your forehead or held in place by a special cheek-resting device for two weeks.

Most patients tell us they feel better than expected following their surgery and are able to return to work and social activities within seven to ten days.

Light exercise can be resumed at two weeks. Heavy contact sports, such as swimming, volleyball, football, basketball, and wrestling must be delayed for six to twelve weeks. Resumption of activities depends, to a great extent, on how you feel, how quickly your swelling resolves, and whether the activity will increase your swelling or jeopardize the results of your surgery.

If you must travel by air within six weeks of surgery, take one Sudafed an hour before landing. This will decrease air or fluid collection in your sinuses due to changes in air pressure.

NASAL TAPING INSTRUCTIONS
Gentle "pressure taping" of the tip of your nose at night will help decrease swelling and improve the shape.

Instructions— Wash your nose with cetaphil or mild soap and water and dab dry. Wait ten minutes. Cut three 1-1/2 to 2 inch strips of paper tape. Apply the first strip across the top of your nose just in back of the tip, and press down tightly. Place the second pieced just underneath the tip, elevate the tip and pinch the end of the tape tightly but gently. Do not hurt yourself. If this causes pain, apply in a more gentle fashion with less pressure. Apply the third piece over the second piece. This should be performed each night for the next several weeks. If your skin becomes irritated or breaks out, then stop taping until irritation disappears.

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