Jubilee Hospital,Trivandrum.
Post operative care and instructions
Cosmetic Surgery of Nose (Nose job) or Rhinoplasty is one of the most commonly performed cosmetic surgery procedure especially in the younger age group. Nose being the most projecting and prominent part of our body, it cannot go unnoticed. A pleasing nose in harmony with lips, chin and eyes is considered hallmark of one\’s beauty. An ideal nose is that which suits your face the best and is in harmony with other facial features.
Nose is divided into upper fixed root, middle dorsum or bridge and the lower moveable lobule or the tip region. All these regions of the nose are amiable to change. Thus a nose that is too big, very broad, with hump or prominent bridge, very long, drooping, broad, rounded or heavy tip, short, depressed or crooked, wide and flaring can be corrected and made more pleasing.
Septoplasty- Blocked nose with difficulty in breathing responds well to septum correction surgery called septoplasty which can be done along with Rhinoplasty.
Post operative care
First 12 hrs after Surgery
once fully awaken in the theatre, the patient will be shifted to the ward. One can expect to have cool compresses over the nose and cheeks to reduce any swelling or bruising that may occur following surgery. The nose will be blocked as a result of swelling from the surgery and from the thermoplast that are placed in your nose to assist in maintaining its new shape and function. For this reason, one should remember to breathe through the mouth.
The nurses in post operative ward will be checking the vital signs frequently- Pulse, BP Temperature etc.
Nasal Packing.
There will be a nasal pack to prevent any bleeding after surgery. I use Merocel pack with or without an airway.
If the nasal septum is straightened (Septoplasty), a thin silastic splint will be sewn inside the nose to assist in keeping the septum straight while it is healing. These silastic sheets are removed by in the OPD one week after surgery. Removal of the splints is usually painless.
All stitches, dressings and splints are off after 7 days and one can resume normal light activities. There are no visible scars or marks over the nose. Although the postoperative swelling may take several months to subside nose looks good after dressings are out and keeps improving thereafter.
Inverted V shaped incision on the columella should be taken care of. Keep moist with applying Neosporin ointment, avoid rubbing.
A short course of Antibiotic, antinflamatory and analgesics are given for 5-7 days.
Swelling and Discoloration
Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount varies from person to person, but it always seems more dramatic in the face. I suggest that one should keep the head elevated as much as possible.
The nose and eye area may remain swollen with varying amounts of discoloration for several days. The most important thing to remember is that these conditions always subside.
Some tips to shorten the duration of the swelling include:
1. Stay vertical. Sit, stand and walk around as much as is comfortable beginning on your second postoperative day. Of course, you should rest when you become tired but keep your upper body as upright as possible.
2. Apply ice packs frequently for a minimum of 24 hours after your return home from surgery.
3. Avoid bending and lifting heavy things for one week. In addition to aggravating swelling, bending and lifting may elevate blood pressure and start bleeding.
4. Avoid hitting or bumping your Nose. It is wise not to pick up small children and you should sleep alone for one week after your operation.
5. Sleep with head end up for 1-2 weeks following your surgery.
6. Avoid straining while in Toilet. If you need a laxative, take Dulcolax or Creamalax tablet one at night. Proper diet, plenty of water and walking are strongly recommended to avoid constipation.
7. Avoid direct sunlight on your face for one month.
8. Avoid heavy exercise for one week following surgery.
Things to remember
1. DO NOT SMOKE & AVOID ALCOHOL CONSUMPTION for 2-3 weeks. Both of these activities significantly slow the healing process.
2. WEARING GLASSES AND CONTACT LENSES. Eyeglasses should not be supported by the nose for at least one month after surgery. Eyeglasses may be taped to the forehead or a device called a “cheek rest” may be purchased to clip on to your glasses. (These steps are taken to avoid any external forces being applied to the nose which may result in a change in its new shape and function). Contact lenses may be inserted the day after surgery, if no eyelid surgery was performed.
3. HOUSEHOLD ACTIVITIES. On your second postoperative day, you are encouraged to be up and around the house with your usual activities; however, no bending, no heavy lifting, and no strenuous activity for 1 week.
4. PULLOVER CLOTHING. For 1 week following surgery, you should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head.
5. EXERCISE. No strenuous athletic activity or exercises that involve straining or heavy lifting for 1 week following surgery.
6. RETURNING TO WORK AND RESUMING SOCIAL ACTIVITIES. When you return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling and discoloration you develop; the average person is ready to return to work or go out socially 1 week after surgery.
Unrealistic Expectation
I discourage patients coming for Rhinoplasty operation with unrealistic expectation; some need psychological counseling prior to surgery. However what is desirable may not be attainable at times, especially if a person has unrealistic expectations and the surgeon is not trained enough to proceed. There are no fatal complications and sometimes-small touch up procedures may be required at a later date to improve the results.
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