RHINOPLASTY

INSTRUCTIONS FOLLOWING SURGERY

IMMEDIATELY AFTER SURGERY

SLEEPING - First night

1a. Stay in the company of a responsible adult. Rest quietly in bed after surgery, with the head straight and elevated on two pillows.

SWELLING AND BRUISING

b. Gauze squares soaked in a bowl of ice water makes good ice compresses as it is not heavy on the eyes.

c. Continuous compresses are to be continued for 48 hours without fail and are one of the most important aspects of your immediate post-operative nursing care.

d. Then ice is to be used intermittently for 1 week.

e. It is not uncommon for the eyelids to swell shut or be black and blue. This will usually resolve in 1 - 2 weeks.

f. Try not to lean the head forward for two weeks. (If you have to pick up something, bend from the knees with the head erect). Bending forward could start a nose bleed or increase swelling.

DURING THE FIRST WEEK OF SURGERY:

f. Restrict talking and laughing.

g. Avoid lots of visitors. Rest quietly, working at a minimum.

h. Do not strain or do anything which requires significant effort.

i. Avoid making a lot of head movements.

NASAL CARE - After removal of the packs:

INITIAL WOUND CARE

2a. Your nose will feel stuffy when you wake up as you may have nasal packing or a nasal splint. This will resolve when removed in a few days.

b. Folded gauze secured with tape will be placed under the nose to catch drops of blood in the first 24 hours. Change as required.

c. You will have a nasal splint or tape on your nose. DO NOT DISTURB THIS UNTIL REVIEWED BY YOUR NURSE.

d. Do not put anything up your nose, not even cotton buds.

WOUND CARE AFTER DAY 3 -4: Once the nurse has reviewed your nose and removed your packs:

3. a. Clean the edge of the nostrils or stitches with ¼ strength hydrogen peroxide and ¾ strength normal saline using cotton buds.

b. Apply antibiotic ointment to the edge of nostrils and any stitches that you may have.

c. Your external splint will remain on for 1 week. Note: If you had a graft, it may stay on for 10 - 14 days.

d. After the splint has been removed, the nose is to be taped daily with Micropore for 1 week. The tape is to remain on overnight along with the splint. Note: It can take a good six weeks for the bones to set.

e. Following this, tape the nose for 4 weeks at night only and wear your splint over the top to protect the nose while sleeping.

HYGIENE

4. a. BATHING - You may bathe 24 hours after surgery. Do not get the bandages or nose wet. Shower with your head back.

b. Brush your teeth very gently for the first 2 weeks and use mouth wash.

c. Hair may be washed after 24 hours, providing you have someone to help.Do not bend your head forward. Tilt your head backwards.

SLEEPING

d. Sleep on your back with your head elevated on two pillows for six weeks. (Sleeping on one side can cause the nose to bend to one side).

e. Place 2 pillows either side of your waist to rest your arms, to avoid turning to your side.

PAIN & MEDICATIONS

4a. For pain relief, take Panadeine Forte 1 or 2 tablets every 3 - 4 hours, no more than 8 tablets per day.

b. No drinking of alcohol for 1 week after surgery and keep this to a minimum as it tends to increase swelling.

c. Do not make any legal decisions after the anaesthetic or under the influence of medications.

d. Do not take Aspirin or any medication containing Aspirin or Vitamin E for at least two weeks after surgery.

DIET

5. a. A light diet is best as the anaesthetic can make you nauseous. Vomiting may cause bleeding and increase swelling and stuffiness of the nose.

b. Avoid foods that are chewy for the first 2 weeks

c. Failure to do so may cause excessive bleeding/swelling, haematoma, and/or displacement of the nasal bones in the early post-operative stage.

d. Sometimes there is a loss in the sense of taste or smell. Do not worry this will usually return in 3 months.

EYEGLASSES

6. a. Do not wear eyeglasses or sunglasses whose frames rest on the nasal bones for at least 6 weeks. Gauze may be folded and placed on the bridge of the nose, so that glasses do not directly rest on the nose and cause any indentations. Nose pads can be purchased from an optometrist to alleviate this.

DO NOT:

b. Do not strain while having a bowel movement.

c. Do not smoke for a week after surgery because it irritates the lining of the nose and causes coughing, both of which could bring on a late nose bleed.

d. Do not expose yourself to the sun for 2 months as this will increase swelling. Use a sunscreen as the nose may be sensitive after 6 weeks of taping.

e. Do not cough and sneeze - do so with an open mouth if necessary.

f. Do not blow your nose for 3-4 weeks. You may gently ‘pat’ under your nose with a tissue.

ACTIVITY LEVEL

7. a. During the first 5 days after surgery, it is important not to engage in any activity which will elevate the blood pressure and possibly produce bruising under the skin.

b. During the first 48 hours, I recommend bed rest as this is the most convenient position to do your ice compresses.

c. During the next 3 or 5 days, you should restrict your normal activities.

d. Persons who feel well enough can cook and care for their personal needs. e. Flying is permitted one week after surgery as this increases swelling.

e. Do not exercise or engage in strenuous physical activity until cleared with the physician - generally six weeks.

f. DO NOT PARTICIPATE IN ANY CONTACT SPORTS FOR 6 WEEKS.

g. DO NOT SWIM FOR 6 WEEKS.

h. DO NOT DIVE FOR 6 WEEKS.

i. Avoid exercise for 6 weeks as it increases swelling and could alter the result. Light walking or use of an exercise bike and light leg weights are permitted.

YOU CAN EXPECT:

• Initial nose bleed for about 4-5 hours. Change ‘drip pad’ gauzes under your nose as needed.
• Moderate discomfort, use pain killers as prescribed.
• Swelling and black and blue around your eyes sometimes more on the second or third day after surgery than the first.
• Blood-shot “whites” of your eyes. Eye-drops can be prescribed if this persists or is irritating.

CALL IF YOU HAVE:

1. Severe pain not responding to medication.

2. Prolonged profuse bleeding (sometimes more than 5 drip pads per hour, after 4 hours).

3. If any other questions or problems arise. Some oozing is normal, but if bleeding continues and is bright red, call the office on 3287044.

IN CASES OF HEAVY BLEEDING:

Put your head back, apply ice packs, hold gauze under the nostril, lie still for 40 minutes and call the office if it doesn’t settle.

PLEASE NOTE

About two weeks after the operation, some swelling will have subsided, usually enough to return to work or visit friends. The majority of swelling should subside in 6 - 8 weeks.

The healing process can take up to 12 months, and during this time you will see progressive improvement in the fine details of your nose. Normal breathing at times may take up to three months to recover completely.

To purchase prior to surgery for dressings:

• Normal Saline - 0.9% - 100 ml.
• Cotton buds.
• ½ inch Micropore tape - preferably flesh -coloured.

Please call the office for routine questions and to schedule follow-up visits.

For Emergencies ONLY call 016 288 699

20 Manning Road, Double Bay N.S.W. Sydney, Australia Tel: Intl. + (61 2)93287044 Fax: Intl. + (61 2)93286036