Preparing for Rhinoplasty (Pre and Post Op Instructions)

Hi, folks. It's time for surgery. You've seen me, we've talked, we've had at least one consultation. Typically, for you to have surgery with me, we either start with a facetime consultation for our long distance patients and then continue down into an actual consultation in the office, face to face to day before surgery, or I've seen you many months before in the office, examined you, seen you back again for your appointment, pre op, or this is somewhere in between. You're just doing research. You're trying to kind of figure out whether you want to do surgery, trying to figure out if the surgery is the right thing for you. How does it work with your lifestyle, with your downtime, what's it like? You may have had friends who've had rhinoplasty. You've seen them all bruised up and in pain and you're kind of scared and hesitant. Well, let me tell you how I do it, How I require my patients to follow which type of instructions for the best possible outcome in healing. Now, my surgery coordinators are the ones that will guide you through the entire process. But I want to kind of be involved with you in the beginning in this video to show you exactly what I expect of you. Now, my fantastic surgery coordinators have put a list of questions and concerns that they get all the time. Patients before surgery, after surgery. No matter how much instruction, how much videos we have, they still have occasional questions which stump us. And we've put all that stuff together. We have an FAQ section on the website and they're always available. I'm always available. You can always reach us whether it's day or night, any issues, you don't have to worry about it. We're always here for you. But let's get started. So the most important thing about rhinoplasty is expectation. Everybody says, what's the most common complication? It's not bad outcome. It's not bleeding, it's not infection, it's none of that stuff. It's not anesthesia, it's expectation. If you've seen models on Instagram, if you've seen these noses that are makeup and contoured and then there's like filters or you've seen a cousin's nose with very different anatomy than yours and you feel like, oh, well, this is the nose that I want, this is the nose that I deserve. This is the nose that I expect. Well, that may not work with your nose, with your anatomy, with your face, with your skin, with your cartilages. So expectation is really important. I talk until I'm blue in the face, telling you that I'm going to create a nose that's perfect for your face. But there's no such thing as a perfect nose. The two sides of the face are so different. They're so asymmetric. Perfect symmetry, perfect smoothness, consistent results that are going to be there the rest of your life. It's just not possible. The nose that you get from the first week to the first month to the first year to 10 years, to 20 years, to 30 years, continues to change with you. But you're always going to get a better nose. That's the goal. The goal is to give you a better nose, a much better nose than the one that you walked in with. And if that's your expectation, keep going. If that's not your expectation, stop the video, call the office, get a refund and ask for a magician, because that's not possible. But if you're going to take this journey together, let's get prepared now, before surgery, obviously get all your questions answered. If you have family members, parents, loved ones, spouses that are going to be involved in taking care of you after surgery, please bring them with you before surgery because I want them to be prepared as well. I don't want there to be any misunderstandings afterwards and for them to be lost. So bring them with you, ask the questions, get it over with before surgery, just so after surgery you can focus on recovery. We are pretty, I would say, anal about how we get people prepared. We go above and beyond. There's something called the ASA and we go beyond the ASA guidelines. When somebody comes in, young, 19 year old, healthy, most surgeons, most plastic surgeons don't do an entire medical workup. We always do. We send you to a primary care doctor, we get medical clearance, we do a history and physical by a primary care doctor, we get labs, specific labs, the regular health and physical labs that you may have gotten for college. Usually doesn't have all the components that we require. And if there's a history of anything else, bleeding disorders or cardiac issues or diabetes, anything else, there's going to be further testing required. So make sure that you get all that stuff done beforehand. Please don't wait till the last second. We don't want to be having to chase your physician. The medical clearance on the 11th hour, the day before surgery, uncertain whether the surgery is going to proceed or not. So get that done beforehand and work with our staff on that. If you are using insurance for part of the procedure and if you have a deviated septum, which almost Every single person has a deviated septum. But if it's bad enough and it's common, causing obstruction to the airway, that may be able to be submitted through insurance. The cosmetic stuff is cosmetic. Whether you're making the tip nicer, the bridge nicer, that's cosmetic out of pocket. But the internal stuff, the septoplasty, vestibuloplasty, turbulence, things like that, that improve breathing, potentially could go through insurance, but depends on your insurance. While everybody these days may have insurance coverage, we don't all have great insurance. We may have high deductibles, high coinsurance, and in those situations actually ends up hurting you. To use your insurance, my staff will guide you, our insurance people will guide you. But please, it's your responsibility to check your benefits as well and make sure there's no uncertainty proceeding. Most patients don't use insurance. It's all out of pocket, but there's definitely a large number of patients that do. So please check your benefits and see if that's something applicable to you. I am really strict about my instructions before surgery. I prepare you with a very specific diet and it's on our website. We have handouts, we have information on the website. I even have videos on YouTube. If you scroll through our site, you'll see there's lots of foods that create more bleeding. Anything with omega 3s, all the heart healthy things, all the things that are good for you, and they put you on a Mediterranean diet, like omega 3s, nuts and seeds and flaxseeds and chia seeds and almonds and walnuts and fish and sushi and avocados and olive oil. All this stuff that makes your blood thinner so you don't get a clot in your heart and don't get a heart attack actually is bad for surgery. We don't want you to bleed so much. So I put you on a strict diet. Two weeks before, two weeks after. It's really important. It probably is the most important thing you can do for your healing. If you bleed too much during surgery, you tend to swell more. After surgery, more swelling translates into more scar tissue. So the one thing that you can do, you can't change your DNA, but you can change your diet. So make sure that you follow those instructions. And especially for the guys out there, you know us guys, we don't like to follow instructions. So please follow the instructions. The only medication you really start before surgery, and it's not really medication, it's a supplement. It's arnica. Arnica Montana is basically an herbal supplement. That can reduce bruising and swelling. You can even eat pineapples if you want. Pineapples have bromel in it as well. But there's really no other medication that you need to start before surgery. I used to say put ointment, antibiotic ointment in your nostrils before surgery, but we put a stop to that because it wasn't really making a difference. If you've had a history of MRSA or MRSA infections, you will have to be sent to your family physician to be swabbed to be cultured. If that's the case, then you may have to use antibiotic ointments inside your nose, back to back ointment inside your nose, or even take oral antibiotics prior to prior to surgery, managed by your primary care physician. Otherwise, there's nothing you need to do in your nose before surgery. You'll just start using Vaseline ointment. After surgery, hydration is important. Obviously before, during the entire process, make sure you're well hydrated. I'm not really worried about nutrition. Most people are not malnourished that come to see me. But again, hydration is important. You don't want to get dehydrated and then faint or pass out, especially right after surgery. I have no exercise restrictions before surgery. You want to run a marathon, go ahead. But after surgery, that's a whole different story. We're going to talk about that. But before surgery, do whatever you want. As long as you're not in the sun and you're not sunburned. I don't want you to show up to surgery with a pink sunburn or a flaking sunburn. I'm going to have to raise the skin of the nose. We don't want the skin to be irritated by the sun. Now, day of surgery, just make sure you know where you're going. I only go to two places. I have my team, I have my routine. I don't go to 10 different places. But still, you want to make sure you go to the right location, right hospital. I don't operate out of the office. I don't operate out of small, private surgery centers. They're the hospital or the hospital own surgery center. And by doing so, it's a bigger team, more regulations, safer, more sterile. That's where we're going to go. But my patient coordinates will tell you which one you're going to go to. Please. If you're new to the area, especially if you're coming from out of town, if you're from other countries, coming in the day before surgery, take A moment. Do a Google map. Try to see how far you are from the location. Attire before surgery, dress comfortable. I want you to be in comfortable clothing. Make sure you're not wearing button down shirts. Make sure you're not wearing a shirt that actually pulled over your face. You want a button down shirt. You want a zip down shirt. So you don't want to be pulling a sweatshirt over your head. You don't want to be pulling a turtleneck over your head. You want something that buttons down or zips down so you don't have to snag your nose after surgery. Just dress comfortable. Please, please, please, women. No makeup. No makeup, no lotions, no sunscreen, nothing. Take a shower. Take actually a really good shower. Use an antibiotic soap. Use an antibacterial soap to wash your face. And don't put anything back on. I've seen so many times people come in with mascara on, with eyeliner on, with makeup on. And they tell me while they didn't add it, they probably just didn't take it off from the night before. Make sure it's off. You want to come in with nothing on your face. If you come in with mascara, with eyeliners, with makeup, it can get in your eyes. You can get corn abrasions. And then during the casting, during, when I put the tape on the nose, it may not stick. It may not stick. So you want to make sure your skin is spit and span, perfectly clean. And for people that wear weaves or wigs, please don't bring those to surgery. We don't want that. Take it off, take a shower, wash your hair and come in nice and clean so we reduce risk of infection. You have to have somebody be with you. You have to have an adult be with you during surgery. You can take a Uber or a taxi to there, but you can't leave with one unless you have somebody with you. You're perfectly fine to leave with a taxi or an Uber drive, but you have to have an adult supervisor, friend, family member with you. You can't leave with an 8 year old child. You have to have somebody over 18. And an Uber driver is not somebody the hospital is going to check you out to. So you may want to make sure you get that stuff settled for people from out of town, people that don't want to tell anybody they're getting surgery, people that want to keep this perfectly secret. What I want you to do is talk to my patient coordinators and we have nursing services, we have car services that we can hook you up, up with. So Please arrange that well before surgery. The day of surgery. Relax. We've talked so much. We've exchanged emails, we've talked, we've met each other, we've crossed the T's, dotted the I's. Day of surgery. Don't come in there with a ton more questions. If you're anxious, if you're nervous, your blood pressure is higher, anesthesia is more difficult. You're gonna wake up more emotional. You just want, at that point, say, I've done my research, I've done my homework. Let's do this now. After surgery. These are important things for after surgery. You want to sleep elevated. That's the other most important thing. After diet, activity. And the way you sleep is important. You want to be propped up. Don't lay flat. If you're laying flat, your face is going to swell up even without surgery. Try it tonight. Lay completely flat. In the morning when you wake up, your eyelids are swollen, your face is swollen. You don't want to lay flat. You want to be at least 45 to 60, 60 degrees. The first week, maybe the second week, maybe a little bit while longer, sometimes even for a few months. I'll have patients sleep on two or three pillows so they're not perfectly flat. So make sure you do that. Hydrate, hydrate, hydrate. After surgery, you want to make sure again, you're not dehydrated because the surgery makes you weaker. Anesthesia makes you weaker. I don't want you to get up and faint and hit your head somewhere. Eat bland stuff right after surgery. You may be a little nauseated from the anesthesia or sweet blood. Don't eat anything that's heavy, not fatty or proteinaceous. Eat some carbohydrates, a little bit of bread, a little bit of soup, a little bit of milkshake. Something bland. Don't go crazy with the food in the beginning. Ice, ice, ice, ice, ice. The icing is frozen peas, crushed ice. You can get gel packs and things like that, but I don't want any heavy ice packs sitting on your face. And you're certainly not icing the nose. You're icing your forehead. You're icing your eyeballs, you're icing your cheeks. You're I icing everything around the nose, keeping the nose dry so the nose does not get wet. But you're basically bringing down the swelling around the face. Even if you don't see swelling, even if you don't see bruising, it's coming. Day three is your worst day. Day three is the most swollen. So make sure the first two days you ice, ice, ice as much as possible. Don't be lazy. I rarely pack the nose. It's really rare for me to pack the nose. I may put some kind of absorbable, foamy whipped cream style stuff in there, but I don't necessarily pack the nose. Just leave it alone. I'm going to tell you exactly what it is. Just leave it alone. The most important thing that we're going to do is we're just going to cover with ointment. If you have an actual packing, I have you come in here, you know, two or three or four days after surgery just to kind of relieve that, take it up. Even when I use packing, it's much smaller than the average packing. It's not that painful, it's not that uncomfortable. But it's rare. And I reserve it for people with really bad septums that I need a little bit of support. Now, most of my patients don't take any pain medicine. Most of them say it wasn't that bad. But pain is subjective. Everybody's different. We give you your medications, make sure you fill your medications before surgery. You don't want to have to run around to a pharmacy trying to find your medications after surgery. Have everything ready, your prescriptions filled with you at home. The pain medicine, you can take one to two pills every four to six hours. That means you can take one every six hours or two every four hours as needed. But remember, there's going to be probably a little bit of discomfort. Don't expect it to be zero pain free. Otherwise you're out cold, probably going to suppress your airway and breathing, and that's not healthy. You have surgery, there's always a little bit of discomfort, but you have the pain medicine and most patients don't even need it. Now, if you don't need the narcotic and you just want something that's a little bit of pain control, but not, you know, that strong, doesn't make you nauseated, it doesn't get you constipated like a narcotic would take. Tylenol, no aspirin, no Motrin, no ibuprofen, no NSAIDs. Those make you bleed more. So it's either Tylenol or what we give you. Don't combine them. You can alternate back and forth every six hours, but don't combine them because the dose of Tylenol will be too much. Antibiotic. As soon as you get home that evening when you get some food in, you start the antibiotic. The antibiotic starts that evening. To make sure we avoid an infection. So do that and finish it. Don't stop halfway. If there's any issues, let us know. The next morning you start something called a steroid dose pack. It's a Medrol dose pack. Basically it's a package. It comes with pills. The first day you take 6, the next day, 5, the next day, 4, 3, 2, 1, until it's done. So you start with the 6 and then 5, 4, 3, 2, one until it's done. Typically comes in a packet. But if your pharmacy sends you a generic form that's all jumbled together, that's how you do it. Start the next morning after surgery and take it all together. 6, 5, 4, 3, 2, 1, until it's done. Over the next several days. So you're gonna have a little drip pack. It's basically a piece of gauze. So what I'm going to show you is you have, after you go home from the hospital, you have a piece of gauze that's rolled up like this and it's sitting like this under your nose. Now there's a sling that holds it in place from ear to earth. This should be touching right underneath your nose, not on upper lip, it's right underneath your nose. It gets bloody in the beginning. Every 5, 10, 15 minutes may be getting blood colored. You take it off, put a new one on. As the night goes on, it'll be every hour, every hour and a half, every two hours. After about two days, the drainage slows down to a point. You can get rid of the whole thing. Most people get rid of it. Some people like it, some people keep it because they like that little bit of support there. So if that's the case, just keep it. The important thing is every time you take it off, when you put the new one on, make sure you take your ointment, your Vaseline ointment, and put a big glob of it, a big chunk of it on the, on the new gauze. So when you put the gauze here, the ointment just gets underneath the nose because lubrication, lubrication, lubrication is really important. So that's called your drip pad or a mustache dressing. That's what that is. Now when you leave the hospital, they give you a supply of them, they give you a stage of them. You go homeward, keep a stiff face, don't hang around people that are comedians and are going to make you smile. You don't want to have too much facial movement because the nose is going to move around. You're going to pop sutures, move grafts. You want to have a stiff face. If somebody makes you laugh, if you obviously have to yawn or do anything, just grab your face so it doesn't stretch out too much. You grab your cheeks and you squeeze so your face doesn't move too much during yawning or smiling. And try to avoid it as much as possible. So you're going to wear a cast. It's basically a tape. Videos on YouTube showing exactly what it looks like. You're going to have that on your nose for a week, five to seven to eight to nine days. But typically it's about a week that's on there. Keep it dry, please don't trim it up. Seeing people say, you know, they come in for cast removal at one week and I see the tape has gone around here, the tape has gone around there. And I ask them what happened. They say it got bloody, it got gooey, I have to trim it. No, leave it alone. That's my cast. Don't touch it. When it comes off, you'll see the nose, but please, until that point, don't decorate it, don't touch it. Leave it alone. It's doing its job. Keep the cast dry. If you have oily skin and you start to see it slide off and get off the nose, let us know quickly because I may have you come in, take the cast off and re tape the nose. If it's not sitting on the nose, especially over the tip. If the tape peels off in this area, it's fine. But the area around the tip, if you, if the cast is sliding off due to oily skin or maybe you're in humidity, the cast is not doing its job. So call us, come in, we'll take it off. That's rare, but make sure you're not messing with it. Make sure we're in the shower. Don't get it wet just so it stays there. You're going to have you avoid sun and heat and humidity. I have you avoid getting into the shower that's too steamy, too hot. Have you avoid getting it wet. If you want to wash your hair, you're basically kind of letting the water hit the back of your head, but you're not letting it hit your face until we're ready for you to do that. To get the cast soaking wet to come off. But before that, just keep it nice and dry. Washing the hair again, be careful. If you have really long hair, it's hard to do. You may have to go to a hair salon, but just you know, remember, you're going to have a bad hair week for about a week or so until the cast comes off. The sutures or the stitches are all dissolvable. They all go away on the inside. Keeping the cartilages bent and grafts in place, it takes up to six months on the outside. May take a couple weeks for them to kind of, you know, fall out, but they're all dissolvable. Keep it covered with ointment if they're dry. If the nostrils are dry, it just doesn't dissolve as well or at all. So make sure you're definitely keeping it wet. Now, the day before you come in to get the cast off, let's say on Friday, you're supposed to come and get the cast off. Friday morning, you're going to take a shower. To walk into the shower, let the water hit your forehead and drip over your face. So don't let the water directly hit your nose, but let it hit your forehead, drip over your face. Lukewarm water, not really hot, steamy water. If you're in a hot shower, you tend to swell up more. You may even get a nosebleed. So lukewarm water drips over your nose for 20 minutes. Get it wet the night before, do the same thing. So you're taking two showers the morning of and the night before. If you're somebody with really dry skin, do three showers. Do two the day before just to make sure when you come in, the cast is not stuck on. When it's really stuck on, it's a little bit less comfortable or more uncomfortable to take it off for you. So make sure you do that now. Cleaning, cleaning, cleaning. I don't care if you have to go inside the nose. Don't do that, please. I've got videos and I've seen people actually put the Q tip too far inside the nostril and poke a stitch or poke a sutra and give themselves a nosebleed. Don't do that. The cleaning is not as important as lubrication. You really want to keep the nose moist. Don't pack it with the ointment, but keep the opening moist. And people just never do enough. I mean, it's rare for somebody to do enough. I want you to see how much ointment I'm putting there. I want you to see the amount of ointment. Watch this. That goes into. Look. That's the amount of ointment. It's like a small walnut. I mean, that's what it is. And you basically are covering the base of the nose, you're not shove it in there. But basically the bottom gets covered so your nostrils are covered with ointment. That's how you're going to be doing it now. Most of the time it's just vaseline ointment. At some point I may have you switch to an antibiotic ointment, but you start with the vaseline ointment. So hydrogen peroxide, that's for cleaning. Be careful with it. If there is some dry blood, you dip a Q tip in it and gently, gently, gently dab. You've seen my videos online, but please don't start digging around. It's not. You know, some people are very anal about cleaning and they over clean. I've seen people actually take and rip sutures out with over cleaning. Don't over clean, just lubricate them enough. The cleaning is just a the nostrils around the opening. Be gentle with it. Healing goes back to expectation. Cast comes off at a week. You have a nice nose, put some makeup on or most of the time you don't even need to. You go out to a supermarket, if you go to a movie theater, if you go to a restaurant, strangers won't even look twice. They'll just think you look normal. Close friends and family for the first week definitely can tell something's up. You look a little odd. The tip is more piggy for the first week, to two to three to four weeks. It takes about a month for the tip to drop into a more natural position. The first month, definitely more piggy. It sticks out further from your face, comes back towards your face. Within six months, it's swollen. You smile kind of like this. Your upper lip doesn't move much. That takes months to come back. The tip of the nose is numb and believe it or not, even though you have the swelling at one week, when the cast comes off, guess what happened? There's no more cast on. The nose swells up more. So you really want to avoid swelling. So as soon as the cast comes off the next month you're going to do all the stuff they did the last week. Avoid the gym. Avoid treadmills, ellipticals, bikes, no long walks. If you're walking, I tell people it's as if you're window shopping in a mall. You want to be in a cool air conditioned environment. You don't want to be in the sun or heat. You don't want to be outdoors if it's hot outside. And you certainly don't want to be walking in an exercise size pattern. You don't want your heart heart rate or pulse to go up. Anytime your heart rate goes up, your pulse goes up, your cardiac output goes up. You flush more. As you flush, you swell more. You're creating more swelling and scar tissue. Don't create more scar tissue. You're going to heal the way your body lets it, but don't make it worse. So follow my instructions. Be a couch potato for that first month. Cool, air conditioned rooms, not a lot of activity. You can certainly walk around the house. I want you to get the circulation going in your legs and not just sit on the couch. But I don't want you exercising, doing too much. Avoid trauma. Kids, dogs, cats that are very rambunctious, especially kids, small kids, groups, bars, things like that, dribbling and basketball. Avoid all that stuff because it may get. Your nose may get hit and it's a heartbreak. Now again, the nose is not going to fall apart if it gets hit six months later. But in the first few months it's important not to get any trauma to it. When the cast comes off, your nose is going to swell up, your face is going to get oily. You're going to be pretty oily. You may break out and acne. Use an astringent for the nose. The rest of the face you can use a scrub, you can use acne, pads, whatever you want to do. But on the nose, be gentle. You're taking a cotton ball, soaking it in a toner or astringent. Neutrogena and Johnson and Johnson have really nice toners that have 2% salicylic acid and helps with acne. And once it's soaked, you just basically are brushing the nose with no pressure on the tip for the first month. You don't want any pressure on the tip, so you're basically barely feathering the nose. Be careful, that's how you're cleaning the nose. Saline spray for the inside. There's a saline. It's just saline. There's no aphrine, there's no medication, there's no decongestant. It's just salt water. Purchase that because after about 10 days or so I have you squirted inside your nose. Tilt over the sink because most of it is going to drip out of the over your clothes, so be careful. But some of it slowly will start to melt down. There's going to be dry blood and boogers and crusts and scabs inside the nose and the saline will slowly kind of wash it up. You don't want anything aggressive. No nose blowing for at least a month. But with the saline, you can do a little bit of sniffing. So glasses, avoid them for a month until I see you back. Exercise, traveling, flying, avoid it. If you have to fly, we'll about talk, talk about that. But please cancel any unnecessary flights. If you're going on a leisurely trip, cancel that. Anytime you get in a plane, anytime you fly, you create more swelling and scar tissue. We can talk about taping of the nose. Patients with thin skin are not really necessary for them to tape, but people with thicker skin, taping is Fantastic. I have two videos on YouTube showing you how to tape the nose. Start looking at those because taping of the nose and you'll be taping for three to six months, months afterwards, sometimes around the clock. If you are home and don't have anything to do, you work out of home. But if you work outside the house and you basically take it off in the morning, and when you get back home in the afternoon or evening, you take the nose. So the nose is taped for a good eight or 10 hours and that's basically reducing the swelling and scar tissue, allowing you to have a nicer result. So we'll talk about that as well. There's videos, watch those on YouTube. Avoiding the sun is important. Avoiding the heat is important, important. And then there's really no final result. People go, well, when am I going to see my final result? There's really no final result. When do you see your final result on your face? It changes your entire face. Your nose, your lips, your eyes, your cheeks, your everything, Your breasts, your butt. Everything changes for the rest of your life. So enjoy from day one. Don't take a million selfies. Don't overanalyze it, don't over examine it. I've seen people send me all these close up, super close up selfies of the nose showing the most subtle asymmetries. That's normal. Please don't get into that habit. If you think that's who you are, just don't do the surgery. It's better not to do the surgery than to go through it and then overanalyze it. You're going to have a nice face, you're going to have a nice nose, but nobody's perfect. It's not going to be perfect. It's going to change. And even if it's Perfect at day 45, as it heals, it can change a little bit. We're going to monitor it 5% of the time. Maybe something needs to be be done as a little touch up, but it's rare 95% of time, it's good. You just leave it alone. Even though it's not perfect, it's good. You leave it alone. You enjoy it, and you focus on beauty. I've seen people get so focused on their nose, they're ignoring the rest of their face. There could be other things happening on their face that could use improvement, but they're just focused purely on the nose, and they're on their seventh revision, going from surgeon to surgeon to surgeon. Meanwhile, they're ignoring everything else about their face and views. So, please, put it all together. Keep it real. We're very honest, very bold. We don't sell you this procedure. This is a journey you and I are going to be taking together with my team, and we're going to make this together. And if you follow your instructions and follow my instructions and communicate with us and tell us your fears and hesitations, we're going to help you through it. And if you decide to do it, I'll see you. If you decide to back out, perfectly fine. No hard feelings. I want us to be friends.