Reach About Rhinoplasty Postoperative Instructions & Follow-up Management

1. The following postoperative instructions are given to the patient on discharge from the hospital. The first ten instructions are carefully read by our staff nurse:
   1. Take your antibiotics regularly as indicated.
   2. Do not expose yourself to any visitors with common colds or infections.
   3. Stay at home for five days to avoid dust and contamination of the nose by the outdoor atmosphere.
   4. Do not swim for six weeks.
   5. Remain upright and moving around at home as much as possible.
   6. Avoid bending over, lifting heavy things and climbing up stairs in a hurry.
   7. Do not play with young children in order to avoid bumping the nose.
   8. Sleep on your back with head elevated for the next two weeks.
   9. Report frank bleeding, headache or fever to our clinic or hospital.
   10. Avoid pushing hand tissue into the nostril or rubbing the nostril.
   11. If the nose continues to drain blood, use moustache dressing with light paper adhesive tape.
   12. Avoid excessive sneezing. If sneezing is troublesome it should come out through the mouth and use decongestant and antihistamine.
   13. Avoid the type of clothing that must be pulled over the head to avoid injury to the nose.
   14. Brush the lower teeth as usual and clean the upper teeth with toothpaste on a face cloth.
   15. Do not smile excessively or pull down the upper lip.
   16. Avoid exposure to sun for one month.
   17. Avoid getting the nasal cast and tapes wet.
   18. Avoid using glasses for one month. Use contact lenses. Glasses may cause depressions or dorsum deviation.
   19. Avoid jogging and tennis for six weeks.
   20. Avoid diving and skiing for two months and avoid contact sports for four months.
   21. Body bathing allowed and the hair washed in the sink as in the salon and avoid cast and bandage becoming wet.
   22. Avoid decongestant nasal sprays.
   23. Discolouration: usually bluish below the eyes. Alleviated by the use of Reparil or Herudoid gel and may be covered by make-up. Usually disappears in two weeks.
   24. Patient should keep busy by reading and doing other activities during first few days postoperative to avoid depression which may be due to swelling, discolouration and the hangover effects of anaesthesia, analgesics and antihistamine.
   25. Mild nose swelling and oedema may last for one year. 80% of the swelling will subside during the first six weeks and remaining 15% within the next six months and the last 5% up to twelve months. The swelling and oedema may last more (up to two years) in patients with thick skin and a wide nose. These patients should be well informed and reassured.
   26. During the first three weeks the tip may appear over-rotated and turned up too much. This is due to the swelling over the tip of the nose and in the upper lip. Our patients are usually concerned about this temporary over-rotation and overprojection but we reassure them that this will go away in three weeks.
   27. The upper lip may look longer and feel stiff and interfere with smiling. This always bothers the patient and he/she usually says, “My smile has changed”. This will disappear in two months .
   28. Numbness over the tip of the nose may bother the patient. This too will eventually disappear.
   29. The nose may be blocked for the first two weeks after the operation due to blood clots and swelling. Normal saline drops and gentle sniffing are encouraged to clear the nose.
   30. A mild degree of vasomotor rhinitis may occasionally last for a few months and eventually disappears.
   31. Patients with difficult noses, complications, severely crooked noses and revision cases should be advised to keep follow-up appointments at the clinic for at least twelve months postoperative because there is always the possibility of considering a secondary procedure.
   32. For the first two weeks eat easily chewed food such as soups, hamburger, potatoes, chicken and avoid steak and chewing gum.
   33. It is not unusual for the patient to feel dizzy or to get cold sweats for a few days postoperative.
   34. Return to work after seven to ten days according to the degree of swelling and discolouration.
   35. Avoid excessive sniffing which may cause some bleeding.
   36. Avoid sitting under the beauty salon’s hair dryer for two weeks. Use a hand held hair dryer.
   37. Swelling around eyes will reach its peak on the third day and then gradually subside.
   38. Patient should report by telephone any injury to the nose, and should see the doctor if haemorrhage and swelling occur.
   39. Remember that the nose is classified into five categories:
       Beautiful nose
       Normal nose
       Abnormal nose
       Ugly nose
       Ridiculous nose

Only one procedure will improve the nose for a stage down to a stage up. We can not achieve a beautiful nose from an ugly nose. Sometimes the surgeon may be able to achieve two or three stages in one procedure (but not usually). The patient should wait at least eight months before considering a second procedure.