Rhinoplasty Post Operative Care

You can download this information above as a printable file here: Rhinoplasty post-op. pdf

Pre-surgery

Avoid for 2 weeks before surgery – smoking, aspirin, ibuprofen, Nurofen, Naprosyn, naprogesic, excessive alcohol, vitamin E, garlic tablets, Ginko biloba, ginseng and horseradish

Post-surgery

You will have an external splint on the outside of your nose. Please keep it dry. It will be removed with any external stitches 1-2 weeks (or later) after your surgery.
Expect your nose to be congested as if you have a cold. This is normal swelling of your air passages and can last many weeks.
Do not blow your nose for 1 week as this may cause bleeding. After 1 week proceed to gentle nose blowing.
If you need to sneeze, open your mouth widely to release most of the force.
Avoid straining such as heavy lifting, straining on the toilet or physical exertion.
Bleeding on and off is normal during the two weeks
The tip of the nose and your front two teeth may feel numb for some time. This is normal and will recover.
Internal splints are sometimes necessary. If these are placed they will be removed in approximately 1 week.
You may feel tired and run down for the first few weeks.
Please do not smoke as it slows down wound healing.
Take pain medication as needed. Paracetamol and ibuprofen is okay to take post-surgery. Do not take both ibuprofen and meloxicam/celecoxib.
It is common to have bruising and swelling around the eyes.
The shape of the nose will often take many months to settle and for swelling to subside. The final result may take 6 to 12 months to achieve. Please be patient.
The shape of the external nasal splints does not reflect in any way the shape of the nostrils or nasal shape underneath.
Most patients take around 10 days off work.
Avoid swimming for 2 weeks
You can carefully wash your face around the external splint after surgery, just avoid getting the splint wet as it may fall off early.

Tips for your comfort

Rest as much as you can, keep your head elevated at all times. Do not lean over. It is best if you can sleep with your head up using 3 to 4 pillows.
Use ice packs to reduce bruising and swelling around the eyes and cheeks. Do not apply pressure to the nose.
Most patients need 14 days off work
Avoid exercise or any aerobic activity for 2 weeks.
Do not rub your nose.
Avoid the sun and accidental knocks for 8 weeks.
You may shower but keep your nose dry while the external dressings are in place.
Avoid spicy foods, big meals and excess alcohol as they can make your nose bleed.
If you have splints in your nose you may notice your ears may pop or bubble when you swallow. This will settle down when the splints are removed.

Rhinoplasty post-operative medications

IT IS VERY IMPORTANT THAT YOU PURCHASE THESE MEDICATIONS WELL IN ADVANCE OF YOUR SURGERY. DO NOT TAKE THESE SCRIPTS TO THE PHARMACY AFTER YOUR SURGERY.

Cephalexin, Amoxicillin (or alternative oral antibiotic if you are allergic to both of these)

Use as directed. Start the day after surgery.
This is an antibiotic and helps prevent infection.

Antibiotic ointment (usually chlorsig eye ointment)

Use a cotton bud to gently role this around the inside of your nostrils and over any stitch lines outside the nose.
3 times a day (every 8 hours)

Meloxicam or Celecoxib

This is for pain relief only, not to reduce facial swelling. Use as directed.
Do not use ibuprofen as well as either of these two medications.

Endone (oxycodone) – as needed

This is for pain relief. You are allowed to take paracetamol in addition to this medication.
Oxycodone is one tablet as needed every 6 hours

Drixine (oxymetazoline) – as needed

This is both a decongestant nasal spray that stops bleeding if that becomes troublesome. It is not always needed. It also helps open the airway to breathe better.
3 sprays in each nostril every 8 hours as needed

FESS Saline spray and high volume sinus rinse

This is a sterile salt water nasal product. Use it liberally to help moisten the nose and remove small crusts and dry blood.
3 sprays in each nostril every few hours.
An alternative is a sinus douche saline product such as Flo or Neilmed sinus rinse. If you are also having sinus surgery a sinus douche is preferred over the saline spray.
Most rhinoplasty patients should start on a gentle saline spray for the first few days then they can gradually start using a high volume sinus rinse.
Always rinse gently. The rinse is intended to be a high volume but not a high pressure. Too much pressure will force fluid up into your ears and block them.

Prednisone

This is a corticosteroid that helps reduce nose and facial swelling after surgery. It is best taken in the mornings.

Potential side effects of prednisone

Common:

Increased appetite
Sleep disturbance or nightmares
Agitation
Mood swings
Disturbed sugar control in patients with Diabetes
Weight redistribution to the face (15% of patients after 3 months of treatment)
Abdominal discomfort
Skin thinning (after many years of use)
Osteoporosis (after many years of use)

Uncommon:

Delayed wound healing
Cataracts, glaucoma

Rare:

Avascular necrosis of the hip. A very rare arthritis that may require surgery

Contact Dr Roth at once if you have any of the following concerns

Fever more than 38.5C
Excessive bleeding
Excessive or increasing pain
Increasing redness around the skin or incision
If you are concerned about any aspect of your recovery

Frequently asked questions

What do I do if the external splint is coming off?

It’s best to try and keep this on for the full required length of time. Sometimes if you become hot your skin will sweat and this will loosen the splint. You can add some micropore tape over the top of the splint to help re-attach it firmly to your cheek skin.

When do I start using my salt water nasal rinsing after surgery?

You can start using your rinse immediately after surgery. Generally after very delicate nasal work (rhinoplasty, septoplasties) Dr Roth will recommend FESS nasal spray initially before progressing to a douche on day 2. Always use the douche very gently in the first post-operative week. You can use your rinses as often as you like, the more often the better.

When can I fly after surgery?

After nasal surgery there is no danger in flying immediately afterwards but there is a risk of nose bleeds if you are moving around. Generally it is best to wait 7 days before moving around or taking a flight so as to avoid stirring up a nose bleed at the airport or on board.

When can I wear glasses?

If the bones have been broken as part of your rhinoplasty, it may take 3-4 weeks before it is safe to wear glasses. This device can be helpful to purchase if you are reliant on glasses use – https://www.nosecomfort.com/NoseComfort_Plus_Eyeglass_Nose_Support_Rhinoplasty_p/ncp-01.00.htm

What happens at my first and second post-operative visits?

You can drive yourself to these visits. You do not need to take pain relief beforehand. Dr Roth will inspect the incision sites. Internal splints may be gently removed at the first visit Your external dressings will be removed at one of these visits..

These first two post-operative appointments are not the time to bring family members or friends to the consultation to meet Dr Roth for the first time or look at your results. You cannot film the splints being removed.

If you are concerned at any time after your surgery, please contact Dr Roth’s rooms on (02) 9982 3439 or via email on [email protected]. If it is out of business hours and you need urgent care, please attend your nearest emergency department or GP. If your surgery was performed at Castlecrag Private Hospital or North Shore Private Hospital you may also contact the ward nursing staff who are there 24 hrs a day. Note that these hospitals do not have an emergency department, have no medical staff on site overnight and cannot provide assistance in the case of emergencies once you have left the hospital.