Pre-Op Timeline and Instructions

Post-Op Timeline and Instructions

Post-Op Instructions and Guide

Antibiotics
Start antibiotics on the night of your surgery and continue until completely finished.

Pain Management
Some discomfort and pressure or throbbing is to be expected. You will be prescribed pain medication for post-operative pain control. If your discomfort is not strong, take Tylenol in place of the prescribed medication. Do NOT take Tylenol with the pain medication, as the prescribed medication will most likely contain Tylenol. Do NOT exceed 4000mg of Tylenol in any 24 hour time period. Take the medication with food to minimize the risk of nausea. Narcotic medication refills are seldom given and cannot be called in.

Nausea
If you are experiencing nausea (which is not rare after general anesthesia, as well as a known side effect of some stronger pain medications), take your nausea medication which will be included in your prescriptions.

Constipation
You may experience constipation if taking narcotic pain medication. MIralax or other over the counter laxatives are recommended. Do not wait until you are constipated – begin taking the laxative with the first narcotic pain medication.

Prescription Medication
Make sure you understand how and when to take all medications. We suggest keeping a notepad to keep track of the medications you have taken. Do NOT lose your scripts, as duplicate pain medication scripts cannot be given.

Medications to Avoid
Take only those medications approved or prescribed. Avoid medications containing NSAIDS like aspirin or ibuprofen (Advil, Motrin, Naproxen, others) for two weeks prior and following surgery. These medications will increase bleeding. Avoid blood thinners.

Substances to Avoid
Avoid alcohol, nicotine and caffeine as these will dramatically slow the healing process.

Nutrition
Eat as tolerated and take small bites. Soft foods are easier to swallow since you will not be able to breathe through your nose and chewing may be uncomfortable. Dark green leafy vegetables and pineapple juice can help reduce bruising and swelling. Eat lots of pineapples. Continue to follow your dietary and supplement restriction prior to surgery for three weeks following surgery.

Stay hydrated by drinking eight (8) to ten (10) glasses of water each day. Use straws when drinking fluids.

Sneezing / Blowing Your Nose
Sneeze with your mouth open. NO nose blowing or wiping for one (1) month, as this may result in a nosebleed or dislodge grafts.

Showering
Lukewarm showers from the neck down are permitted. Do NOT get your face wet. NO hot showers or baths, as this may cause a nose bleed or dizziness. The nose cast must be kept dry until the night before the cast removal appointment.
Hot baths or jacuzzi are NOT permitted until your incisions have healed and approved by Dr Shuaib. This is usually around six (6) weeks following your surgery. Do NOT submerge your head under the pool, lake or ocean for two (2) to three (3) months following your surgery.

Driving
Do NOT operate a vehicle until you have discontinued narcotic pain medications for at least 24 hours. Additionally, do not make any important decisions until you have discontinued narcotic pain medications for at least 24 hours. Use good judgement.

Physical Activity
Refrain from any activity that requires physical exertion. Do NOT bend over, strain or lift more than twenty (20) lbs for the first week following surgery. Do NOT raise your blood pressure or heart rate. Any activity that raises your heart rate increases swelling which causes more scar tissue.

NO exercising or straining for at least three (3) weeks until you are examined by Dr. Shuaib. Leisurely slow walking is acceptable and can help reduce swelling, but do NOT be tempted to power-walk/speed-walk.

Return to Work
Most patients return to work after the cast is removed at the one (1) week post-op appointment. This however depends on each individual’s job responsibilities and amount of face-to-face interaction required.

Recovery Care Instructions

Drip Pad
Use the drip pad (folded gauze taped to cheeks for bleeding) for at least 48 hours following your surgery. (You may discontinue after 48 hours or continue using the drip pad for one (1) week.) Change the drip pad gauze every 10 to 20 minutes initially, as needed. Apply a thick layer of Vaseline on each new gauze before placing under the nose to keep the nostrils lubricated. Over the next day, the drainage should slow but continue to change the gauze at least every two (2) hours.

Cipro Soak (For Revisions Only)
Begin Cipro Soaks the day following your surgery and continue for two (2) to three (3) months. Crush 1000mg of Cipro tablet and mix with one (1) cup of Neilmed solution. This solution should be refrigerated. Roll gauze (it may help to cut the gauze in half), soak the gauze in Cipro solution and carefully insert into each nostril for 20 minutes. (See Figure 1.) This is critical to prevent infection.

Congestion
Ok to use Afrin up to two (2) times a day to relieve congestion.

Saline Rinse
Use Neilmed Sinus Rinse or generic equivalent up to five (5) times a day to help with crusting and breathing.

Cleaning of the Nose
Gently clean around your nostrils four (4) to six (6) times a day starting two (2) days following your surgery with Q-tips soaked in Hydrogen Peroxide. Apply a thick layer of Vaseline after each cleaning to keep the nostrils lubricated. Keep the nostrils clean and scab-free, but do NOT go deep into the nose. You do not want the blood and mucus hardening and scabbing. You must do your own cleaning (i.e., parents or anyone else cannot do the cleaning). Do NOT explore or look inside your nostrils.

Stitches
Do NOT cut, pick or try to remove the stitches. The stitches are dissolvable, and Dr Shuaib will trim any irritating stitches at your post-op appointment.

Cast / Packing
Do NOT cut, pull or trim any part of the cast. If the cast starts to come off, email photos to Dr Shuaib. Your nose may be retaped. If the skin becomes red or bumpy or increases in itchiness, contact the office, as this may be an allergic reaction to the tape.

You may have a plastic splint on the side walls of the nose. Do NOT manipulate it. Cover the nostrils with a thick layer of Vaseline.

Taping
Begin taping your nose following cast/splint removal for one (1) month using 3m Micropore tape. See video of taping here:  articles/tape-nose-rhinoplasty

What to Expect During Healing Process

Breathing
Internal nose swelling from the surgery can restrict airflow through the nose. One side of the nose may be easier to breath than the other. While some patients may get improved nasal airflow after a few weeks, some take longer. Use Afrin up to two (2) times a day for congestion. After one (1) month following surgery, nasal steroid spray and anti-snoring stents may help.

Drainage
You will have bloody drainage following surgery. The drip pad is used to catch this drainage. You may also have thick mucus with bubbles.

Swelling
Swelling is to be expected for many months. Typically, 50% of swelling is gone after one (1) month, 60% after two (2) months and 70% after three (3) months. The nose will change hourly and daily for years to come. It takes up to a year for major reduction in swelling, and three (3) to five (5) years for full resolution of swelling. Enjoy your new nose, but recognize that changes will occur so avoid over analyzing. See Figure 2 for the swelling timeline.

Taping nightly following cast removal for the first month is highly recommended.

Bruising
Bruising around the eyes and nose can happen. Most bruising is gone after one (1) to two (2) weeks. The bruise will progress from a purplish color to a yellow/greenish shade as it starts to resolve.

Taking Arnica supplements and drinking Arnica tea may help reduce the bruising.

Stiffness
Your nose and smile may be stiffer during the healing process. This should improve over the next few years.

After Cast / Splint Removal
When the cast is removed, there will be swelling. The swelling will increase during the following week. Your face may look “odd” to you; however, keep in mind that this is normal.

Skin Changes and Cleansing
It is normal for the tip of the nose to be numb. This is temporary and will improve with time. Your skin may be drier or oilier, and your nose may be runnier or drier. Additionally, your skin may be redder and you may have pimples.

Gently clean the outside of the nose with cotton balls soaked in Astringent or 2% Salicylic Acid Anti-Acne Toner. Do NOT aggressively wipe your nose, and do NOT move the nose.

Asymmetries
There will be swelling 100% of the time, as well as minor asymmetries inside and outside the nose. This is normal. New slight irregularities may result along the bone and cartilage edges during the healing process. Most of these subtle irregularities or asymmetries are to be left alone and will improve with time.

What NOT to Do During the Healing Process

• Do NOT use Q-tips inside the nose for the first two (2) days. Be gentle with using Q-tips at all times following the two (2) days. Aggressive or deep cleaning can result in a nosebleed and may require a trip back to surgery with additional costs to you.
• Do NOT wear sunglasses or goggles for at least one (1) month.
• Do NOT get too close to dogs, kids or crowds. Avoid any contact to your nose.
• Do NOT put pressure on the nose.
• Do NOT sleep on your side.
• Do NOT take Aspirin, Ibuprofen, Naproxen or any other blood thinners until Dr Shuaib advises you it is safe.
• Do NOT use “Biore” or similar strips for at least three (3) months.
• Do NOT use medicated decongestant nasal sprays until Dr Shuaib advises you it is safe.

Emergency Situations – When to Contact Office or Go to the Hospital

• Signs of Infection
  • Spreading redness, worsening swelling, increased drainage or draining of pus, worsening pain and warmth at incision site
  • Temperature over 101 degrees Fahrenheit
• Excessive Bleeding
  • If the gauze pads are non-stop saturated with bright red blood or clots, and you are making very frequent dressing changes sooner than every five (5) minutes
  • Blood clots in your throat
• Other Emergency Situations
  • Shortness of breath or difficulty breathing, chest pain, lightheadedness that does not resolve quickly, severe vomiting or pain in your legs

Shopping List

• Prescription Medications
• Tylenol (Acetaminophen) – Alternative to narcotic pain medications for mild pain
• Afrin – Helps ease congestion
• Vaseline – To keep the nostrils lubricated
• Q-tips – For applying Vaseline and Hydrogen Peroxide
• Sterile Gauze – For Cipro-soaks
• ½ inch 3M Micropore Tape – For taping nose
• Pill Crusher – For crushing Ciprofloxacin to make Cipro-soak solution
• Hydrogen Peroxide – For gentle cleaning of dried blood around the nostrils
• Neilmed Sinus Rinse or Generic Equivalent – For cleansing and to keep the nose moist
• Arnica (Tablet and Tea) – Herbal supplement that can reduce swelling and bruising
• Throat Lozenges (without herbal ingredients) – Eases sore throat after surgery which can occur from mouth breathing and/or anesthesia tube
• Fresh Pineapples and/or Cold-Pressed Pineapple Juice – Helps reduce swelling
• Frozen Pea Packs – Place handful of frozen peas in sandwich bag and freeze. Packs need to be lightweight for placement on the eyes, forehead and cheeks (NOT on the nose)
• Distilled and/or Bottled Water – For mixing Neilmed Sinus Rinse
• Straws – Aids in ensuring hydration following surgery
• Small Container with Lid – For storing Cipro-soak solution in refrigerator
• Soft Foods