Postoperative Instructions after Rhinoplasty
First 12 hrs after Surgery
once fully awaken in the theatre, you will be shifted to the ward. You can expect to have cool compresses on your eyes and cheeks to reduce any swelling or bruising that may occur following surgery. Your 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, you must remember to breathe through your mouth.
The nurses will be checking your vital signs frequently- Pulse, BP Temperature etc.
Nasal Packing
There will be a nasal pack to prevent any bleeding after surgery. We use Merocel pack with or without an airway.
If the nasal septum is straightened (Septoplasty), 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.
Columellar incision
Inverted V shaped incision on the columella should be taken care of.Keep moist with applying Neosporin ointment, avoid rubbing.
Avoid sneezing
Take antihistamine(loratidine) as prescribed by the surgeon.
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. We suggest that you keep your head elevated as much as possible.
Your 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.
Remember
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 yur 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. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of the mattress. It is recommended that you sleep on your back for 30 nights. Some patients find a reclining chair placed at a 45-degree angle to be more comfortable than a bed.
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.
It is not unusual to have varying amounts of discoloration in the nose and eye area. Like the swelling, it may become more pronounced, especially in the eye area, after the first day or so. Remember this is normal and temporary. It usually lasts no more than two weeks, all the while decreasing in intensity. The measures previously described that help the swelling to subside will also help diminish discoloration; however, there is no medication that will cause it to disappear rapidly – only the natural course of time.
If you have external incisions, do no apply make-up over the incisions themselves until one day after the sutures have been removed; however, you may bring make-up to the line of the incisions.
Nasal Drainage or Bleeding
You should expect some blood-tinged drainage from your nose following any nasal surgery. The hospital nurses will place a nasal pad under your nose when you are discharged from the hospital. This pad should be changed whenever it becomes soiled. If you develop active bleeding from the nose, spray each nostril 4 to 6 times with a decongestant nose spray such as Otrivine and ice pack over the Nose .You may repeat this maneuver every 10 minutes for up to 30 minutes. If bleeding continues despite these steps, call the doctor.
Cold compress
This provide the simplest and most effective cold compresses to reduce swelling, bruising, and discomfort following surgery. During your waking hours, apply the packs to the cheek and eye area around your nose for 20-30 minutes each hour for at least 48-hours following surgery.
Pain killers
Even though you may not feel much initial discomfort following your surgery, pain medication should be taken as prescribed, every 4-8 hours for the first 24 to 36 hours after surgery. We find that many patients initially feel very well following surgery and are reluctant to take any medication for symptoms of pain. Unfortunately, the patients who “tough it out” often develop discomfort 18 to 24 hours after the procedure, which may then last for 3 to 4 days. Those patients who take their medicines faithfully, as instructed, have very little, if any, discomfort. Beginning 36 to 48 hours after surgery, Diclofenac and Paracetamol is usually adequate for any discomfort you may still experience.
Antibiotics
You will take an oral antibiotic for 7 to 10 days following your surgery. All antibiotics should be taken with food or liquids to prevent nausea and promote proper absorption of the medication (do not consume milk or dairy products when taking your antibiotic as they can inactivate many medicines). Take your antibiotic as instructed by your physician until medication is completely gone. Do not forget to take your antibiotic and do no stop taking it because you feel better.
Gastric acidity
Gastric acidity develops following many types of surgery and is not uncommon after nasal surgery. You may be given a prescription medication, Rabeperazole and Domperidone capsule to be taken once daily.
Fever
Generally, the body temperature does not rise much above 100 degrees following nasal surgery. If any high fever, call the doctor.
Feeling dizzy
It is not unusual for a patient to feel weak, have palpitations, break out in “cold sweats,” or get dizzy following any type of surgical procedure especially when anesthesia has been administered. Within a few days these feelings will generally disappear without medication. Returning to a normal diet and light activity will shorten the duration of these feelings.
Not able to sleep
If you experience excessive difficulty in sleeping during the postoperative period, take mild sedative and pain killer at night. It should be remembered that such drugs also tend to make some people feel light-headed and weak and should be taken only if absolutely needed.
Resuming Activities
1. DO NOT SMOKE & AVOID ALCOHOL CONSUMPTION for 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.
7. DO NOT DRIVE A CAR for one week. Also, do not drive while taking any sedative or prescription pain medications.
Follow up Appointments
Your first postoperative appointment will occur 5-7 days after your surgery .Your second postoperative visit will be 2-3 weeks after your surgery
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