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RHINOPLASTY RECOVERY

By Rhinoplasty Surgeon & Sir Harold Delf Gillies Award Winning Author of the Circles of Prominence: A New Theory on Facial Beauty Dr. Philip Young M.D.

Award Winning and Rhinoplasty | Rhinoplasty Revision Expert Dr. Philip Young Discusses the Rhinoplasty Recovery Process for you to learn more about the post procedure period and what it entails through the video below. Dr. Young has over 12 years of experience in this area of expertise and is a published author on this subject and other areas of Facial Plastic and Reconstructive Surgery. Click here to see his chapter on the Management of the Crooked Nose Deformity. In this video of Dr. Young talking, he covers topics from: sleeping upright; cleaning your incisions; how to ice; using Afrin sprays / nasal irrigations; when to exercise; how long it takes to heal; etc. We will first go through the Day to Day expectations after Rhinoplasty. Then a Frequently Asked Question section will be below. Lastly our Detailed Instructions after Rhinoplasty is included. To find out more about why People from around the world are coming to see Dr. Young by clicking here: Top Ten Reasons to Choose Dr. Philip Young.


Here is one of our Main Introductory Videos on Rhinoplasty by Seattle's Dr. Philip Young.

Note: Individual results will vary. Images do not constitute a promise or representation of any particular outcome or experience.


To learn more about Dr. Young’s Rhinoplasty Procedure you can follow the links below:

Right after your Rhinoplasty Surgery:

During the recovery period, you are going to be pretty groggy and sedated. You might also have some bleeding from your nose. You will have a mustache dressing that we will show you how to take care of. This should be changed as needed based on how much bleeding you get. Also we would like you to start using the Afrin sprayssoon after you get home this will help slow down bleeding and keep your nose more open. We highly suggest using this for only 4-5 days and no more after your rhinoplasty. If you continue to use the Afrin sprays you can get a condition called Rhinitis Medicamentosa where your nose gets stuffy all the time. We also suggest you irrigating your nose soon after your surgery. You can use the Neil Med kit or other nasal irrigation kits that you can get at the drugstore, or you can use the recipe that we suggest. You can make your own nasal irrigation with 1 quart of distilled water, 1-3 teaspoons of salt (the less preservatives the better, some suggest pickling salt), and 1 teaspoon of baking soda. You can then use the blue bulbs that you can purchase at the drugstore to help you irrigate your nose.

In terms of Pain medication, we want you to start taking 1/2-3 tablets of the pain medication every 4 hours (Percocet is what we usually prescribe). But this depends on the medication that we prescribe and we would have you review your medication directions on the bottle and read it carefully. At first, the pain medication will not be as effective the first 3-6 hours as it builds up a level in your bloodstream. The pain medications will kick in though. We want you to keep your pain level in the 3-4 out of 10 range, where 10 is the worst pain of your life. You don’t want to be in the 0-1 level, this is too comfortable and could be dangerous as you will be too sedated from the pain medication. So keep your pain level in the 3-4 range.

Antibiotics: We also want you to start taking your antibiotics and start a new routine. Usually the antibiotics will be taken every 6 hours. Once you start it, you should keep taking it every 6 hours. Sometimes the antibiotics and pain medication can give your nausea. We suggest that you consider taking the nausea medications 1/2 hour before each pain and antibiotic dose you take. Ondansetron is what we usually prescribe. But you should always read the instructions on your medication bottle | label. We would like you to keep track of your medications with this log: Medication Recording Log.

Try to sleep with your head elevated to keep the bleeding to a minimum. It is best to do this mostly the first 48 hours but if you can do this for the first 2 weeks you will probably heal better. It is probably not necessary to do it beyond 2 weeks.

Icing should be done for 15 minutes every hour. It will be hard to ice with the splint there but we suggest you doing this mostly the first 48 hours although doing it the first week won’t hurt either.

Cleaning: Below you will read that you should clean your incisions 2-4 times a day for the first week or so. This is perhaps more important the first few days. We usually recommend constantly cleaning your incisions with the 1 part vinegar and 2-3 parts distilled water. You might find that you get the best results cleaning it every hour for the first few days. Importantly, it is not the forceful rubbing of the nostrils and incisions that will clean it but the frequency. The use of the mixture of vinegar and water will moisten the crusting to allow subsequent cleaning to remove the crusting. The liquid of the mixture will break down the crusting more gently than forceful rubbing. We recommend cleaning the incision at the bottom of the nose and inside the nostrils about 1/2 inch inside the nostril. The Afrin followed 1/2 hour later by the nasal rinses will help the cleaning of the nose as well. Crusting is our enemy because the crusting will promote bacterial growth as well as cause the incision to break down and promote infection. So get the crusting off.

We will add more of the day to day instructions…

Frequently Asked Rhinoplasty Recovery Questions:

1. When can I exercise after Rhinoplasty?: Most Facial Rhinoplasty Surgeons say that you can start slowly at 2 weeks. We go on further to clarify that you should do about 20% of the normal effort you would exert at 2 weeks, 60% at 6 weeks, and 80% at 6 months. With weightlifting you should lift 20% of your normal weight you use at 2 weeks, 60% at 6 weeks, etc. The same goes for running, yoga, basketball, and all forms of activity based on the 20,60, 80 rules.

2. How long does it take to recover from Rhinoplasty?: The hardest part of the recover is the first 2 weeks. But just like the 20,60,80 rule above, the length of recover is also about the same. You can judge for yourself by seeing this Photo Healing Diary of Rhinoplasty

3. What are some helpful hints for recovery after Rhinoplasty?:  Alot of the helpful things to do occur before the procedure. Staying healthy will mean a healthy recovery. Stopping smoking 2 weeks before the surgery and 2 weeks after will help tremendously. The same goes for drinking and drugs. Avoiding blood thinners is very important. Bleeding is probably the thing that can impact your procedure the most. More bleeding and the complications can go up after your rhinoplasty. Icing 15 minutes every hour for the first week can help the swelling. Cleaning your incisions effectively leaving no crusts will prevent infections from taking hold and for your incisions to heal well. Avoiding trauma to your nose is important to avoid more inflammation to your nose after the procedure. Sleeping elevated can decrease the swelling.

Here is more of the instructions:

POST PROCEDURE INSTRUCTIONS

FOR YOUR RHINOPLASTY AND WOUND CARE

Congratulations on completing your Rhinoplasty procedure! Below is a list of instructions designed to help you through the recovery process. After you have read these instructions and you still have questions (especially if you think there is an emergency) please call the office at 425-990-3223.
Please make sure to come in to see us the day after surgery for your post-op appointment. For your privacy we have a back entrance to be used for follow up appointments, there is a doorbell at this entrance. Please ring the bell upon your arrival and we will greet you at the door. We ask that you use this entrance for all follow up appointments for the first month after your procedure.
Things You Will Need:

  • Distilled Water
  • White Vinegar
  • Q-tips
  • Gauze
  • Tape
  • Nasal Saline Rinses
  • Afrin Nasal Spray
  • Blue Bulb for Nasal Rinses
  • Silicone Scar Healing Gel
  • Ice packs: you can purchase facial ice packs at www.ice-packs-store.com to help with icing.

If you can’t afford these you can always use an ace bandage to wrap the areas and frozen peas for icing.

Nasal Care:
1. You can start rinsing your nose with cool saline rinses once the packing in your nose is removed, if you have packing. The mixture is a quart of distilled water with 2-3 teaspoons of salt, and 1 teaspoon of baking soda.
2. You can use a blue bulb that is found in drug stores, in the baby care section to help you with this nasal irrigation.
3. When you rinse the nose you should feel the salt water go all the way into your nose and come out the other nostril. This helps to cleanse your nasal passages and can be done 2-3 times a day.
4. Cool compresses (ice pack or bag of frozen peas) are essential for the first 7 days (or longer if needed) 15-20 minutes each hour. Popsicles, and cool foods and liquids can also keep things cool in the nasal area as well.
5. You should go to the pharmacy and consider purchasing some gauze and tape so that you can change the moustache dressing as needed for any oozing.
6. Afrin nasal spray can be used starting right after your procedure and should only be used for a total of 3-5 days. This could help clear your nasal passages and prevent bleeding.

Cleaning Your Incisions:
1. You should clean your incision 2-4 times a day for the first two weeks with 1 part vinegar and 3-4 parts distilled water mixture. This will help to avoid scabbing/crusting around the wound.
2. You can read our web page on wound healing for more information at http://www.drphilipyoung.com/Wound Care and Scar Prevention.php.
3. You should keep Vaseline on the incision at all times for the first 10-14 days or until further notified. This will allow your incision to heal faster.
4. After two weeks you can consider Kelocote or other products containing silicone gel (ingredients like Polydimethylsiloxane, siloxane) on the healed incisions. Apply the silicone gel for 12 hours a day on and 12 hours a day off for the next 3-6 months. The silicone gel only applies if you have an external incision. The other 12 hours that the silicone gel is off, you should apply spf 45 or greater sunscreen on your incisions (during the day).

Food and Liquids:
1. You should avoid hot (temperature) and spicy liquids and foods for the first 2 weeks. Drink plenty of fluids to make sure that your urine is not too dark. It should be a light yellow to clear in color. Eating helps you to absorb your medication and also prevent nausea with your pain medication. However, early on after surgery too much food can cause nausea.

Medications:
1. We recommend that you start taking your nausea and pain medications as soon as possible. Start with the nausea medication as soon as you can after surgery followed by the pain medication (1/2 tablet to one tablet) ½ hour later. You should only have a maximum of 12 tablets of Percocet (5/325) over 24 hours and no more. The pain medication takes an hour or so to take effect and during the start up time you will have pain. The nausea medication also takes about an hour to take effect. But depending on what pain medications you have, you need to follow the directions on the bottle that contains the specific medication.
2. Always try to remember not to take too much pain medication. Pain medications can slow your breathing, which can be dangerous. Also you can only have 4 grams of Tylenol in 24 hours; over this amount can lead to irreversible liver damage. So never combine regular Tylenol with your Pain medication.
3. Do not use high dose vitamin E, herbal medications or supplements, aspirin, Aleve, Ibuprofen or other anti-inflammatories for two weeks before and after your surgery. These medications and agents all cause bleeding. Here is a link to all the medications to avoid http://www.drphilipyoung.com/pdf/Medications to Avoid.pdf.
4. You should start your antibiotics and Clonidine (if you have this medication) as soon as possible after your surgery as well. The antibiotics and Clonidine are to be taken regularly and finished completely. The nausea and pain medications are taken on an as needed basis.

Stitches:
1. Some of your stitches will need to be removed 6-7 days following your surgery; others may be removed a month later.
2. Sometimes stitches can break because we use very delicate stitches to get a good result. If this happens schedule an appointment as soon as possible for us to re-stitch the area.

Bleeding:
1. You will have some mild bleeding from your incisions. This is normal when the local anesthesia wears off. The first 24 hours is the most common time period for severe bleeding. The other time point is at 7 days when the clots get dissolved. Hence the first two weeks are crucial and you should be careful.

Swelling:
1. We usually see you the next day after your procedure. This is when we determine if you have swelling that we should worry about.
2. Your swelling may increase over the next 3-4 days. Sometimes swelling lasts well over a week in a small population of patients. It all is dependent on the amount of surgery that you have.
3. Try to avoid sleeping on the sides of your face. This can lead to asymmetry and lead to a distorted look. Give yourself some time for the swelling to go down. All lumps and bumps eventually resolve.
4. Sleeping at a 30-45 degree angle, on your back can help the swelling for the first week.
5. Cool compresses (ice pack or bag of frozen peas) are essential for the first 7 days (or longer if needed) 15-20 minutes each hour. No warm compresses are recommended nor Massage unless directed by the Doctor.
6. 15-20 minute walks twice a day will also resolve residual bruising and swelling (start these 3 days after your surgery if you would like).
7. If you notice redness spreading, skin hot to the touch, white/yellow discharge from the incisions, or increased pain to one particular area, please set up an appointment to be seen this could be an infection that is easily treatable if caught early.

Sun Avoidance:
1. Sun avoidance is crucial to avoid having your wound turn dark from hyperpigmentation.
2. You must stay out of the sun or minimize your exposure for the next 6 months. If you do go out in the sun you must wear sunscreen SPF 45 and reapply every 30 minutes to an hour. You should try to avoid putting on sunscreen for the first two weeks.

Activity:
1. No strenuous activity, straining, bending over, lifting greater than 5 pounds, drinking alcohol or hot oral fluids, eating spicy foods, strenous exercise, very hot showers and hot baths, aspirin, anti inflammatories, high dose vitamin E, herbal medications, smoking, for 2 weeks after surgery. It’s okay to take a light walk for about 15-20 minutes once or twice a day after the first three days and increase your activity slowly after two weeks.
2. Light walks also sometimes help with resolving residual bruising and swelling.
3. You can bathe/shower after the first 72 hours, just as long as you don’t use very warm water. The water should be lukewarm just warm enough not to cause discomfort from being too cold.
4. If you are straining going to the bathroom, in order to avoid pressure along your incision lines and to avoid bleeding, our Doctors usually suggest drinking a lot of
fluids to help your bowel movements (to the point where your urine is clear), Metamucil daily, and / or Colace 100mg orally twice a day. Our Doctors also suggest using over the counter suppositories or enema’s as needed.
5. Your healing, swelling and recovery will be 60% at 6 weeks and 80% at 6months. You should gauge your activity based on this. We generally advise starting regular activity slowly 2 weeks after your procedure.

Make Up:
1. Make up can usually be worn after 7 days depending on how your incisions heal. No makeup should be applied over raw areas.
2. Do not use age defying make-up around your incisions or on your eyes as it contains retinol and may cause an allergic reaction for up to one month after your procedure.

Follow Up:
i. We typically have most of our patients come back the next day.
ii. You will then return in another 6-7 days after your surgery for suture removal unless otherwise directed.
If there any questions that are not being cleared up please call the office or set up an appointment immediately if you have concerns.

If you are interested at anytime about scheduling an appointment you can email, call (425-990-3223) and even text message us at anytime. Click here if you would like to find out more about our consultation process. We can set up a phone consultation for you and show you how to take the 5 basic photos that you will need.