Rhinoplasty Aftercare Instructions

Good morning. We're going to talk about something that I've really wanted to make a video for many, many years now. My staff go over pre and post op instructions with all my rhinoplasty patients extremely thoroughly. That's the only one operation I do. All I do surgically is one procedure and that's really no surgery. So my staff are extremely versed at going over everything from pre op to post op with patients. We hand them written instructions, we even have all these documents on our websites people can refer to. But I think video is very important and you can refer to this several times during a pre and post op course to reiterate the important things. So I'm going to go over the checklist that we actually hand to the patients. This is a list that I've made of bullet points and I go over this with patients and I hand it to them. But we're going to go over it. It's going to go over pre op the week of, the month of, and we'll go through that like that. So first thing is always make sure all your questions are answered before surgery. You don't want to really have questions after surgery. You can always reach me, you can always call me or email me, but just make sure that everything is covered before surgery. That's the most important thing. We send everybody for labs. We don't just willy nilly go through surgery. Pretty much all of our patients go through an extensive workup. We want to make sure that they're healthy for surgery, that they don't all of a sudden get a heart attack or any other issues or bleeding problems. Everything gets diagnosed beforehand. When you see your family doctor, if you need further testing, for example, hematologic testing, if there's any bleeding disorders. Some patients may even need a psychiatric clearance just to make sure that they're able to go through surgery and deal with the stresses of an elective surgery. There's labs that we do, CBC with coags and platelets. All that stuff needs to be done before surgery, within 30 days of surgery, in fact, to us. And that's important. You have to, if you have an insurance part for the case, for example, if a septoplasty has been done, if there's a turbulent reduction being done and a portion of that is going through insurance, you have to make sure with your own insurance company that you have the necessary coverage. We don't want you to have any surprises. We don't want you to end up with any pills at the end of surgery. It's really important to just make sure you call your insurance company. My staff obviously will do that. But you also are responsible, and I want you to take that responsibility seriously so there's no surprises afterwards. This is a really important point. Really important. I have a separate video on my YouTube channel simply about this one point, and that is the ingredients that you eat and drink two weeks before surgery, two weeks after surgery. Ten, 15 years ago, I would only tell patients, you know, avoid aspirin, avoid vitamin E. But today, there's so many more products in our food that can be problematic. Flaxseeds, chia seeds, almonds, walnuts, fish, fish oil, omega 3s. The list is very extensive. Garlic, ginkgo, echinacea goes on and on and on. And all this creates more bleeding during surgery, which can complicate things. It can actually create more swelling, more scar tissue. It can affect results. So it's really important. Don't take it for granted just because you don't add chia seeds to your food or flaxseeds to your food. Don't assume that the sandwich that you just got from the deli next door doesn't have some flaxseeds in the bread. So always check that stuff. Your oatmeal could have omega 3s added to it, and you won't even be aware of it. So read all the ingredients for your prescriptions. I'm actually very, very conservative. So I have my patients start swabbing a special antibiotic ointment inside their nostrils even before surgery to start killing some of the bacteria. That's an important concept. We started about two weeks before surgery just to make sure that you start killing some of the bacteria, potentially some MRSA and other bacteria that reside in everybody's nose. The nose and mouth are full, full of bacteria. That's a normal thing for them. It's called the normal flora. And we have you kind of debride that by using ointment before surgery, and then you continue that after surgery as well. So that's important. Now people ask, what can I do for bruising and swelling? And again, avoiding those things that we talked about and that other video is important. But additionally, Arnica Montana is an herbal supplement that you can get from us Whole Foods, Trader Joe's variety of places. And arnica actually can reduce bruising. The other thing is bromelain, which is a part of pineapples. And I'd much rather you eat the pineapple or the pineapple juice than take a bromelain supplement, because the actual whole foods work a lot better. So that's important. Those two things can help with bleeding and bruising. Drink well, lots of water. Before surgery, you want to be well hydrated. About 12 or so hours before surgery, you can't eat or drink anything. But the night before, you really want to drink plenty of water so you're not dehydrated. A lot of patients can be nervous. They're not drinking enough, they're not eating enough. Before surgery, you want to drink plenty of water beforehand. And then within 12 hours of surgery, there's no drinking, there's no eating, there's nothing. Now, if you take any special medications, heart medications, seizure medications, that stuff you can take with a small sip of water even the morning of surgery, but everything else needs to stop. If there's other medications that need to stop, such as blood thinners, aspirin, things that your doctors put you on, diabetes medications, those doses need to be adjusted. You have to coordinate it with your family physician and let us know. This is an important point. Dress comfortably to surgery. You want to show up very comfortable. Don't dress up. No makeup. I stress this so many times and then I see women show up with mascara, eye makeup. It's really important. Just show up to surgery after you've taken a shower, wash your face with nice soap and water. Don't put any makeup, don't put any products on. Dress comfortably. You want to have either a zip up shirt or a button up shirt. You don't want something that goes over your face and can snag on the nose. After surgery, you need somebody to drive you to surgery. We do have nursing services and driving services for people that come from out of town. Have a lot of patients that fly from other countries, continents, across the world. They don't have anybody here to drive them. We do have nursing services that can be provided for you, but if you have somebody that can drive you home and stay with you for the first 24 hours, that's important. Try to be relaxed. Ask me a thousand questions. See me multiple times, but do it well before surgery. The morning of surgery is not the time to be going over last minute stuff, even though we can. Obviously, I don't want you to be stressing yourself out over little details. The morning of surgery, you want to have a big smile on. Obviously you'll be a little bit anxious, but I want you to think happy thoughts. Think about your favorite vacation spot. The more calm you are, the lower your blood pressure is, the easier anesthesia becomes. You shouldn't come in all nervous and anxious and trying to go over last minute details. Again, this is why we're here. We see you as many times as possible before surgery in my office just to make sure that there's really no more questions and warning of surgery when I see you. So that's basically before surgery. Now, the next week after surgery and the first night after surgery is very important. We want to go over main things. Most important thing is you'll have your surgery. You'll come into the surgery center of the hospital about an hour or two before your surgery time. We go back. The surgery will take an hour, two hours somewhere there, give or take. You go into recovery room. You may be in recovery room for another half an hour, an hour, even a little bit longer, and then you get discharged home. Now, at night that you go home, it's important to rest, but I don't want you to lay flat. The more you lay flat, the more swelling and bruising can be created, especially swelling. So really, when you go home that night, what you want to do is sit up in a chair. If you have a recliner, like a La Z boy, it's great. But you just want to be up as much as possible. You're really not going to be in that much pain. Most of my patients, 80% of them, don't take any pain medicine. I don't routinely pack the nose for most people, so it's really not that painful. You'll have some throbbing. But the beauty of not packing is not that much pain. So you can sit up, maybe watch some tv, read a book. Icing is important that the way I have you ice your eyes is take two Ziploc sandwich bags, fill them with peas, frozen peas from your freezer, and you just lay them on the eyes and cheeks. It's across the eyes and cheeks. It's definitely not on the nose. You want to keep the nose cast and tape dry. But your forehead, eyes and cheeks and the surrounding area need to be iced. The more you ice, the better. So have several of these bags and just keep freezing and putting it on. Other than that, you're sitting up. I mean, if you want to go for a gentle stroll in your house or even around the neighborhood, it's fine as long as you're not groggy, as long as you're not woozy, you're not dizzy. Some of the pain medications can make you dizzy. The anesthesia itself, even though you're awake afterward, you're still a little bit hungover for about a day or two. Just be aware of that, especially when you get into the Shower or bathtub. When it gets warm and steamy, you got to be careful because people, blood pressures can drop and they can get a little bit dizzy. But other than that, I'm okay with you even going to work the next day if you wanted to. Most people, 90% of people want to be hidden for about a week or so. When the small little splint on the nose is there, a week later, the splint comes off. You see the results. It's beautiful. It's better than what it was a week ago. There's obviously going to be swelling, there's going to be bruising. You cover with makeup, but at that point you can go. Most people can go back to work. As long as you're not in sales, one on one contact with people, you can put some makeup and cover it. For men, it's a little bit more difficult, but men can come up with more excuses such as sport injuries. So that night that you go home, it's really important to rest. You can eat or drink whatever you want. It's really important to drink, drink, drink. I tell people, take a cup of something, put a straw on it and keep sipping. Your throat will be a little bit irritated from the tube, from the anesthesia. You can take a sipical lozenge if you want. But drinking is important. To keep hydrated your nose, even though I don't pack it, you will have a little drip pad. It's basically a piece of God that sits right under your nose. And, and I'll show you, it's a small piece of gauze and essentially kind of, it's called a mustache dressing. Sits right here. It allows you to not have to keep dabbing. Since there is no packing, there will be a little bit of bloody drainage the first night or two. It's totally normal. Every 15, 20 minutes you just take this off, put a new one. They'll give you a stack of them from the hospital or the surgery center to go home with. But again, every 15, 20 minutes, this will get bloody colored from bloody colored drainage. And you just swap it out, put a new one, and after about a day or two, the drainage slows down significantly. You don't even need it anymore. You can get rid of it now. What if you have drainage afterwards? Day three, day four, you can put it back on if you want, or just dab your lip. I don't want you to keep dabbing your nose. This is something I do not want you to be doing. If you keep dabbing your nose, it actually can cause movement of Grafts and sutures and things like that. So just let the drainage come to your lip and wipe your lip. You really want to have a stiff face. You don't want to have too much movement, not a lot of facial expression or movement. If you have to sneeze, open your mouth, let it decompress. Don't try to hold it back because the blood pressure goes up and you can bleed. But more importantly, avoid people that make you laugh or smile. This is important. The tip of the nose will be a little bit higher initially. It's going to drop down over a few weeks. It's important for not to drop down too much too quickly. It's hard to predict, it's really hard to control exactly how much it's going to drop down. But you don't want to create more trauma to the area as it's healing. So if somebody makes you laugh or you feel an urge to smile, grab your cheeks so it doesn't spread. It's really important to make sure it doesn't spread. Keep remembering that. Now you gotta again ice your eyes, ice your cheeks. Drink if you want to eat. You can eat whatever you want. Probably more bland foods are important the first night or two. Avoid spicy, fatty food, but you can eat or drink whatever you want. Use a small spoon, use a small fork, use a small toothbrush to brush your teeth. Again, you don't want to have too much facial movement. I don't want you really spreading your face and moving things around. Take your antibiotics. It's very important. Everybody's going to be on antibiotics. You want to make sure you don't get an infection. If you have pain, take the pain medicine I gave you. Definitely no NSAIDs, no aspirin, no Motrin, no ibuprofen, no Aleve, nothing that makes you bleed more. Only Tylenol or the pain medicine that I give you. You can't combine those two things, but you can alternate them if you want to. We do have a nausea medication for you as well if you're nauseous. Some people, they go home, they can vomit. Someone, they swallow blood during surgery and then they feel a lot better. It's not common, but if it does happen, don't be worried. Those are essentially kind of the main points. Now it's really important to cleaning that I'm going to show you. We have a video, separate video that shows how to clean the nostrils, how to clean the nose. I want you to keep the cast dry for the first five days, the last two days before you come in on Days six and seven. Basically, for most people, the last two days before you come in for splint removal, you're gonna get in the shower and get your face soaking wet. I mean, I want you to stand there, let the shower head hit your forehead, drip, drip, drip all over your face for a good 20 minutes. Lukewarm water, not really hot. So the splint and the tape gets soft enough for it to come off. Especially if you've got dry skin, do three showers. If you got oily skin, two is enough. But I don't want that tape to be stuck on so much for it to be difficult to remove. Many come in on days 5, 6, 7, or 8 or 9, whatever that day is. For most people, it's about a week out. So two days before coming in, start getting into the shower and start getting your face wet. But for the first several days after surgery, you're not going to get your face wet. You're going to use a little wash rag to wash your face. You can take a shower neck down. Don't get your face wet. Don't trim any of the tape. I've seen some patients trim the bottom of the tape. It gets bloody. Sometimes after surgery, they'll take a scissor and trim it. Don't do it. Leave the sutures alone. All the sutures, all the stitches are absorbable. They go away. But I don't want you pulling or trimming them. Leave them alone. Now, the cleaning video. Again, most people, I'll tell you, 90% of people, don't put enough ointment. So they come in, they're crusted, they're scabbed. The whole point of the ointment is just so things stay nice and moist so there's no scabbing or crusting. Because that bleeding that occurs the first night or two, that drainage, you want it to stay nice and moist. The sutures dissolve better when it's nice and moist. So put a lot of ointment. And whenever I tell people, do three times more ointment than you think you need to do, they still don't do enough. So let me show you. Essentially, the clean that you're doing is with peroxide. And again, I have a video of this. You dip this in the peroxide, and all you're doing is you're just dabbing this. You're not really scrubbing with this. Don't be going inside with a Q tip. If you see the head of the Q tip disappear in your nostrils, you've gone way too far. I've Seen people bang in there and give themselves a nosebleed, pop. Sutures and stitches don't do that. You just basically are using this as like paintbrush and painting that peroxide inside your nostrils. It fizzes the bubbles, it starts melting some of the blood. But the ointment is really important, and I want to show you how much ointment you're going to put. It's quite a bit. And when you do that, I don't know if you can tell. Let me show you how much ointment you're putting. But basically, most people, when I show them how much ointment they're going to be putting inside each nostril, they get a little surprise. This is how much ointment I want you to put inside each nostril. And again, you're just going to push, pushing in around the nostrils. You're not really going deep. You just want to get it around the nostrils a little bit just so it stays nice and moist. That's really why you're doing that. Those are essentially the main points. I'm going to go over this real quick just to make sure I didn't miss anything. The swelling and bruising is completely normal. Remember, when the cast comes off, you are going to have swelling. Even though we've gone over this many times, the fact that I tell my patients it really takes three years or more for most of the swelling to go down. There's obviously they're going to be swelling and scar tissue right after surgery. But on the vast majority of cases, right after surgery, splint comes up. It's still so much nicer. It's a much better nose than the starting point. And you have to understand that it's going to fluctuate. It's going to vary. The two sides will vary every day, morning and night, it's going to vary. It's going to go up and down, but it takes it months and months and years and years for really all the swelling to settle down. The swelling is scar tissue. That's what it is. Everybody gets it. And the scar tissue is what heals. It develops because there's a space between the skin and the cartilage and bone. And over many years, it kind of goes down and settles down after surgery, about a week or so afterwards, if you have a lot of crusting and things on the inside. We do ask patients to spray some saline inside their nose. It's just salt water. You not putting the nozzle deep inside the nostrils that can bang around in there. Just hold it Right at the edge. Squirt it. Most of it probably will just spill back down, so do it over a sink. But that saline will start softening up the inside of your nose. I don't want you exercising for about a month. Nothing significant, nothing strenuous for about a month. I don't want you blowing your nose for about a month. Gentle sniffing. Gentle sniffing is okay. Nothing too aggressive, because aggressive sniffing can again cause nosebleeds as well. No glasses on the nose for about a month. You have to wear contact lenses for about a month. After that, it's okay. After the splint comes off, your nose will be oily, the skin will be oily. The way I have patients clean their nose is take a large cotton ball. Use an astringent like a Neutrogena product or Johnson and Johnson product. Astringents are at every grocery store or pharmacy. And. And you just get the cotton ball soaking wet and you just gently paint it on again on the nose so that there's not a lot of movement. I don't want a lot of pressure on movement. You don't want to put friction and trauma on the nose. Afterwards, as it's healing, there will be swelling. I gotta say this over and over again. Stop staring at the nose. I don't want you to go home. And I keep staring at the nose from every single angle. It's impossible for the nose to be 100% symmetric from side to side, side. It's impossible for it to feel as smooth as a piece of marble or granite. You're getting a much nicer nose, but you got to be realistic. And as soon as the cast comes off, nose looks better, face will look prettier. Put some makeup if you can enjoy it, and then let things take place. Let the time take care of the swelling and the scar tissue. Sometimes I may have to do a little cortisone injection to the tip of the nose to bring down scar tissue faster for people with thicker skin. But just enjoy it and we'll see each other frequently. As time goes by over the next several months and several years, people ask, when is the final result? There is never a final result. If you read online, I talk to other plastic surgeons. They say one year is a final result. That's just absolutely not true. Between one and three years, major reduction in swelling and scar tissue occurs, especially at the tip. There is never a final result. 3, 5, 10, 15, 20 years later, continuously change, your whole face changes. But from the first week to maximum, the first month, it's A much nicer nose. Now, some people do hold a lot of swelling and scar tissue. Some people do have to be much more patient. But for the majority of people, you're ready to go after about a week to a month. That's kind of your downtime. Avoid significant contact sports. I mean, if you're a martial artist or if you work for the law enforcement, you may want to be aware of trauma for about three months or so. You also want to make sure that my patient coordinator just pointed out to me one thing I forgot. Sun exposure. You want them to stay out of the sun, you want to stay out of the heat. You want to avoid flying for as much as possible. Now, like I said, I have a lot of patients that fly internationally, come in here for rhinoplasty. 5, 9, 10 days out from surgery, they gotta fly back. What happens with flight? You do get more swelling. It is what it is. And then once you land, it kind of starts going down again. But if you can avoid flying, it's best to do so. The worst thing you can do is fly to a warm climate, going down to Miami, getting on the beach, getting into the sun, exercising. That will create a whole lot of swelling. So if you can avoid heat and sun and too much activity and flying after surgery, it's really best. Now, again, you have to live your life, but at the same point, you want to get the best possible results. This essentially covers the main points. I'm sure there's stuff that I probably missed, but we have such a thorough list of things on the website, and my staff go over it with you. But please, please just watch this video several times. Watch it beforehand, watch it afterwards. It's really important. And you're gonna have a nice nose. Enjoy it. Don't be too nervous. You've come to the right place. Like I said, this is the only surgery I do. I don't do anything else. I can't create magic or perfection. But I can give you a nicer nose. And I appreciate you being here. Have a good one.