Preoperative and Postoperative Rhinoplasty Guide

Hi, this is Dr. Nadiri. Welcome to this video. If we have met before in person or virtual. Hello again. If you are just somebody who's simply doing some research, I would love for you to watch this video. Watch the rest of our videos on our YouTube channel as well as our website. There's lots of information you can gain from it. This is a pre op video for rhinoplasty. I like to prepare my patients I like to over prepare my patients for a very successful outcome. So there are multiple videos that I want my patients to watch prior to going through rhinoplasty. One of them is on nose cleaning where I demonstrate how to use Q tips to gently clean inside the nostrils after surgery, how to use hydrogen peroxide and dilute hydrogen peroxide properly, and how to use ointment or antibiotic ointment inside the nostrils. Now doing this over 20 years, I have adjusted my technique over time and there are multiple videos on our site. Please make sure you're watching the most recent, not watching older versions. So the most recent videos talk about how I want you to start cleaning your nostrils right after surgery. Whereas the older ones would say wait several days. The more recent ones talk about using antibiotic ointment or prescription antibiotic ointment that actually starts a week prior to surgery. The older ones talk about packing your nose with Vaseline. So please make sure you're watching the correct videos. Now you're either doing research on rhinoplasty or you're planning on going to rhinoplasty. And you're scheduled and on my schedule. And in preparation, I want you to do a few things that are very important as you're leading up to surgery. I want you to remember the discussions that we've had. I've talked to you either by virtual, on telehealth or in person. And I've reminded you how perfection is impossible. If you think you can go into a store, look on a shelf and pick out an exact nose and get that ideal dream nose, I want you to just forget surgery. At least forget it with me, because it's impossible. That's never going to happen. When I do computer imaging and Photoshop imaging to show you my plans, my goals. It's simply plans and goals. During surgery, any surgeon will discover what your cartilage nature is, how strong the cartilage is, how resilient the cartilage is, how thick your skin is. And all of the preoperative assessments that we've done have to be modified based on real time information and feedback during surgery. And Then once the surgery is done and your surgeon takes off his gloves, whether it's me or anybody else, the nose continues to change and heal. And that's out of anybody's control, certainly out of your surgeon's control. But you do have some control. For example, if you follow my instructions to the T, you'll have a better outcome than if you just wing it. Now, one of the things, for example, is I'm going to change your diet before surgery. So two weeks before surgery and leading up to surgery and for two weeks after surgery, but the two weeks before is even more important. I change your diet dramatically. Getting rid of omega 3, omega 6 fatty acids and ingredients that make you bleed more. When you bleed less, the surgery goes smoother. There's less bleeding, there's less bruising, there's less swelling. So it's super important. And you can't just follow it 80%. You got to stick to it 100%. What are the things I cut out? Well, we have a separate video on this. I want you to watch that video. I have a list that I print out for you. It's on our website, but basically we're cutting out all seafood, nuts and seeds, anything that's derived from nuts and seeds. For example, spices like coriander and cumin come from seeds. Grapes have seeds. Tomatoes, cucumbers have seeds. You want to make sure you're avoiding those nuts. Almond flour, almond butter, peanut butter, almond milk. Those things you want to avoid. Processed foods that have omega 3s added fish oil, garlic, ginger. The list is pretty extensive. These things all thin your blood. More avocados, olive oil. For two weeks before surgery, we're changing your diet. If you're vegetarian or vegan, you're eating more rice and legumes, lentils and beans. If you're not vegetarian, you can eat all the steak you want, all the pork that you want, all the chicken that you want. But again, you're avoiding those ingredients that thin your blood more. Very important. So that's a part of it for all my patients, especially the ones with either oilier skin or thicker skin. But all my patients, I want you to really have nice, healthy skin prior to surgery. I love for you to use a good exfoliating skincare regimen or even those bure pore strips, the little piece of tape that you wet, put on top of the skin of the nostrils and the tip. And then after it dries, you remove it, and you'll see all the whiteheads and blackheads coming off with it. It's very nice Use it several times before surgery so you don't have clogged pores. Imagine putting a cast on your nose for a week and then after removing it, if you have a lot of whiteheads and blackheads, you may have broken out into lots of pimples and pustules. We don't want that to be there. I want you to have nice healthy skin so that if after surgery you need to tape your nose, you can do it immediately. Or even if you don't need to tape, you can start to go out and pub more confidently without having pimples on your nose. So pre op skincare with the pore strips really helps. Don't plug your skin with tons of makeup. Make sure it's nice and clean and healthy because after surgery I don't want you to use any pore strips for at least three months, maybe even a little bit longer, because that actually creates more swelling. When you take the pore strips off after surgery, it pulls the skin up and creates a little bit of extra swelling and extra scar tissue. But before surgery, they are fantastic. I love for you to use them. Don't use any chemical peels, don't get sunburned, don't show up to surgery with red irritated skin, but do a good skincare regimen beforehand so you have nice clean skin prior to surgery. No makeup, no lotions, no moisturizers, no sunscreen, no mascara. Don't have any of that stuff before surgery. Don't come into surgery with those things. It's not good. Facial hair in men. Not good. If you have a mustache especially, it's hard to judge what the angle between the tip of the nose and the lip should be. So make sure you're clean. Shaved goatees, beards. Facial hair on the chin in men makes it harder for the anesthesiologist to secure your breathing tube down to your chin. And it's more dangerous. So please, if you have a beard, try to shave it before surgery. It really helps. Clean shave definitely helps. Then as you go through the surgery and recovery, what you do after surgery matters as well. So just to give you an idea, the person that is more sedentary after surgery sits in a nice cold, air conditioned room and spends time on a computer or on a TV or just basically does desk work. It's going to have less swelling, less scar tissue and a more refined nose than the person who has to be more active, who chooses to be more active or has to be more active. If you're outside, in the sun, in the heat, being active, working out excessively traveling, flying all over the place, whether it's for leisure or work, drinking alcohol and partying, or again, being really active and exercising, you're gonna have more swelling. And more swelling translates into more scar tissue. So again, those are things that are out of your surgeon's control. But you do have some control. And if you follow my instructions, you'll get the best possible outcome. So please watch all those videos. There's another video that you'll see for after surgery where on some patients, especially those with thicker skin, I would love for you to tape your nose after surgery. So when the cast comes off and you see the nose, and if your skin is nice and healthy and clean, and you have now broken out into pimples and pustules, and sometimes that happens, I want you to start taping the nose yourself for several weeks to several months after surgery. That pushes the skin back down on the new cartilage and bone and prevents extra swelling, which then prevents extra scar tissue, and you'll get a nicer result. So watch the videos on taping as well. All of that. We prepare you. We over prepare you. I have so much instructions. We send you to a primary care doctor. We get medical clearance, we do labs. We want to make sure that you're perfectly healthy. I do these surgeries not in small private surgery centers, but facilities that are legitimate and safe with great anesthesiologists and great sterility. Now watch the videos. Multiple videos. Get your prescriptions. When you go to get your prescriptions filled, make sure you're getting it well in advance. One of the things that I've seen people do is they either don't pick up the prescriptions or they just pick up the bag. And don't look inside the bag to see what the pharmacist gave them. This has happened multiple times where there may be four prescriptions that we send to you or five prescriptions. These days there's going to be five prescriptions. There was a while back that I only sent four prescriptions. But if you're not checking the bag, you may have only been given two or three. I have seen patients that go home the night of surgery and they're missing their antibiotic or missing their pain medication. So please, please double check. Be super organized, make yourself a chart, whatever you need to do, and don't wing it, because we certainly are not doing that. And we want to be very, very proactive. And I want you to kind of go along with us and be proactive and kind of be anal and Double and triple check everything to make sure you have everything. So in your prescription bag, currently with my current regimen, there'll be an antibiotic which you will start the night after surgery. So this starts the night after surgery. So, for example, if it's a Friday, Friday morning you're getting your rhinoplasty, Friday evening you start your antibiotics. Make sure you have the antibiotic. The antibiotic will depend on your allergy, so not everybody gets the same one. Yours may be once a day, twice a day, three times a day. It all depends on your allergy and also your previous reaction to antibiotics. So please double check your antibiotic, but it starts the night of your surgery, not the night before surgery. The antibiotic ointment, however, starts a week before surgery. A week before surgery, you take a little Q tip, you put a little antibiotic and you rub it inside the nostrils. It's just going on the inside of the nostrils a little bit to basically let the antibiotic go back, drip back into your nostrils and kill some bacteria to reduce the risk of infection, especially in the front part where incisions are being made. So please do that and make sure you're on top of that. If you get any redness or allergic reactions, stop it, but let us know. Don't just stop it and not let us know, and don't continue it, but stop it and let us know. It's rare, but it can happen. Another prescription you'll have is pain medicine. It will be a narcotic pain medication. You don't have to take it, but I want you to have it. Because if you, God forbid, at 2:00 clock in the morning, you're feeling too much pain and discomfort, I don't want you to be out of luck. I want you to have it. I want you to be able to go to it. But the vast majority of my patients only take extra strength Tylenol or acetaminophen. That's it. That gets them through every six hours. They take that and they'll be fine. But again, you want to have the narcotic pain medicine handy if you need it. There is no ibuprofen, no Motrin, no aspirin, no Aleve, no NSAIDs, none of that stuff. All those make you bleed more, so please avoid those. If you take medications that are blood thinners, Plavix, Coumadin, Heparin, anything like that, you cannot be taking that around the surgical time. However, we send you for medical clearance prior to surgery with your prescribing doctors. You need to discuss this with them as well as with us. And if they allow you to go off of it, great. If they don't allow you to go off of that, you cannot, should not get surgery because you will bleed and bleed and bleed. So it's important to discuss these issues. Other medications, if you take important medications, whether it's for seizure, whether it's for hypertension, high blood pressure, whether it's for diabetes, all of those need to be coordinated with the prescribing doctor. If you have an internist, that does it, great. If you have a pulmonologist, cardiologist, psychiatrist, neurologist, whoever does it, you have to coordinate all this with them. Make sure that the prescriptions that we give you do not have an adverse effect with those. You got to be on top of this. It's really up to you to be on top of these things. And you have to notify us of any changes in your medications. But the important ones need to be continued. You can't just stop your hypertension medication or your seizure medication or your depression medication. Those things need to be considered important. And even the morning of surgery, with a very small sip of water, even though you're not supposed to drink plenty of water with a very small sip of water, if you're supposed to take it in the mornings, then you should continue to do it. If you have diabetes, then that needs to be discussed with your doctor because your sugar levels may get out of control around surgical time, and your doctor needs to be on board and manage it. So these are important things that we get you prepared, and we want to make sure that you're basically ready for surgery and there's no extra anxiety or stresses around surgical time. The other prescription is going to be nausea medicine. Now, nausea after surgery can happen, especially the first night. It's not a big deal. Even if you throw up, it's not a big deal. Don't panic. You just throw up and you'll feel better. Sometimes some of the swallowed blood irritates your stomach and you may vomit. Sometimes the anesthesia irritates you, sometimes the pain medicine irritates you. But you have very strong nausea medicine that we prescribe to you, so make sure you have that. I prescribe you a short course of a steroid that starts the next day. So the next following morning, you start taking six pills, and then the day after that, five pills. The day after that, four pills, and then three, two, one, until the pack is done. Done. Make sure you have that packet. It's called Medrol Dose pack. It may have a generic name, but that's basically what it is. And it's 65-4321, starting the following morning after surgery that you take, and that reduces swelling. These are the important things. Antibiotic steroids, nausea medicine. And you are going to also have the antibiotic ointment that you'll use as well. And pain medicine. Don't forget your pain medicine. Make sure it's in the bag when you pick it up. Basically, those are the major things that you need to make sure you have in your possession. There is a shopping list that will be emailed to you, and it's got a bunch of stuff. It's got a lot of things. You don't need to get everything on there, but there's a lot of suggestions. For example, if you play sports and you want to get back into sports, I don't want you playing any contact sports for three months. But even at three months, if you play something like field hockey or soccer or basketball, we show you basically these silicone face mask shields that you should really consider purchasing and using to prevent trauma to the nose. Now, you're definitely not going to do any contact sports for the first three months, but after three months, it's still important to protect your nose. It's an investment you've made and you certainly don't want to damage it. There are other things. For example, wedge pillows. You don't need a wedge pillow if you have a recliner or a kind of bed that raises up. Or you can can just take five or six or seven pillows and create a wedge for yourself. But after surgery, you want to be elevated. Sleeping flat creates more swelling on your face and creates more scar tissue. You don't want that. So after surgery for at least the first week, and I want it actually to continue a little bit longer, even the first month, I want you to be sleeping more elevated. I don't want you to sleep on your side. I certainly don't want you to sleep on your face. But even sleeping on your back when you're more elevated creates less swelling. Elevation is important. You don't want to just bend your neck forward because you'll get a neck cramp. You're basically propping up your entire upper body so that you're propped up when you're sleeping. Humidification. Having a humidifier in the room helps. Your most common complaint is a little sore throat from the breathing tube during anesthesia. You're also kind of mouth breathing a little bit after surgery. Since your nose is congested, that can dry out your throat, so a humidifier helps. Having a cup of Gatorade or Sprite or something, putting a straw on it and taking frequent sips also helps make your throat more comfortable. You can even use a little throat lozenge like a hals or cepocol, as long as again, it doesn't have echinacea and some of those herbal ingredients that make you bleed more. We do give you arnica and arnica helps with swelling and arnica can help reduce bruising as well as, and that's something you start after surgery as well. Some arnicas have herbal components. I want you to avoid those if possible. Pineapples. Pineapples are your friend. Pineapples have bromelain and bromelain in pineapples, fresh pineapples, pineapple slices and cold pressed pineapple juice actually works beautifully to reduce swelling. It's better than the actual bromelain pill. But if you don't like pineapples or it gives you ulcers in your mouth, you can take bromelain supplements. But the actual fresh pineapple will really help reduce swelling nicely as well. Again, everything that I'm telling you is on our website, it's on our written instructions, we email it to you. But I want you to kind of watch this video when you read it with your eyes. When you watch this video and hear me say it over and over and over again, it really helps solidify things and gets you a nice recovery. Remember when the cast comes off your nose, and that'll happen somewhere between five to nine days when the cast comes off, that is not the final result by any means. Don't analyze it, certainly don't overanalyze it. And please, please, please cut out any kind of negative feedback from friends, family, whether it's a mom or dad or aunt or uncle, cousin, husband, wife. Don't listen to them and ask them to politely just kind of keep their opinion to themselves because things will change dramatically in the next several months to even years to come. The full healing is a three to five year process, but certainly not at one week. The nose is more upturned, it is more piggy, you smile a little bit stiffer, there may be some asymmetries and all that will change. Now, even when it's done and fully healed, it's going to continue changing for the rest of your life. And we always tell patients, please focus on the 80, 90% of things that improved. Look at the overall improvements. If you're focusing on the things that did not improve, you're going to rob yourself from the happiness that you deserve from all the nice improvements you got. The nose is not a screw. I don't have a screwdriver. I can't tighten it or loosen it a half a turn or a quarter turn. Nobody can do that. Nobody can pick exact angles and proportions and things like that. There's a lot of hype out there. There's a lot of marketing being done out there by surgeons claiming certain things, and it's all impossible. This is all that I do. I don't do anything else. I've dedicated my entire career to one surgery and there's a combination of all art and science. And when you put it together, you'll get a nicer nose, but there's no magic. So if you're looking for magic, please cancel your surgery and walk away. But if you're looking for a more beautiful nose and more balanced nose, I look forward to seeing you and giving you that structure.