| Dr.
Daniel's Answers to the Top Ten Most Frequently Asked Questions
Following Nasal (Rhinoplasty) Surgery
- Why do I have drainage down the back of my
throat?
- Why do I have more drainage from my nostrils
one
day after surgery? Can I take an antihistamine/allergy medicine
to stop it?
- If Dr. Daniel didn’t pack my
nose, why am I stuffed up?
- I have a headache and trouble sleeping. Is
this normal? Can I take anything for it?
- It has been two days since my surgery. Why
is my swelling and bruising worse?
- Regarding donor sites for ear cartilage grafts
or facial grafts from the scalp... A. Why is there bleeding
and oozing?...
B. How do I clean the area?... C. When can I wash my hair?
- Can I clean inside my nose? Why just the
edges?
- When can I resume... A. Exercise...
B. Taking my vitamins and/or regular medications... C. Wearing
my glasses...
D. Going out in the sun
- Why do I occasionally have a funny smell
in my nose?
- It has been six weeks since my surgery.
Why does my nose swell periodically?
If you are considering Rhinoplasty,
click here to read these important instructions
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1. Why do I
have drainage down the back of my throat?
In a normal day, the nose secretes about a cup (8 oz.) of
mucus that goes down the back of your throat without your
being aware of it. However, once you have surgery and the
nose is stuffed up, you become very aware of this normal secretion.
It is nothing to worry about.
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2. Why do I
have more drainage from my nostrils one day after surgery?
Can I take an antihistamine/allergy medicine to stop it?
The combination of “normal mucus drainage” and
“intranasal swelling” can cause the mucus drainage
to come out the nostrils rather than go down the back of the
throat. Yes, you can take an over-the-counter antihistamine
by mouth or any other medicine that you normally take to dry
up a cold.
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3. If Dr. Daniel
didn’t pack my nose, why am I stuffed up?
It is very common to be “stuffed up” after surgery.
The reason is that there is as much swelling inside the nose
as outside of it. This swelling will peak on the second day,
and then go down slowly thereafter.
4. I have a headache and trouble sleeping.
Is this normal? Can I take anything for it?
Unfortunately, headaches are common following general anesthesia
and surgery. It is often a good idea to try something like
extra-strength Tylenol for your headache and save your Vicodin
or Darvocet for pain. After the night of surgery, you may
take a light sleeping aid (e.g., Tylenol PM) if you need it.
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5. It has been two
days since my surgery. Why is my swelling and bruising worse?
Typically, swelling and bruising peak on the second post-operative
day. For this reason, it is best if you can ice your eyes
and nasal region for the first day and a half post-operatively
and sleep with the head of your bed elevated. Also, try to
avoid salty foods. The good news is that the swelling decreases
rapidly thereafter and the bruising is usually gone by the
seventh post-operative day in about 95 percent of patients.
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6. Regarding donor
sites for ear cartilage grafts or facial grafts from the scalp:
- Why is there bleeding and oozing?
These areas are highly vascularized, and once the epinephrine
wears off from the local anesthesia, you may have “reflex
bleeding or oozing.” It is essentially normal and
nothing to worry about.
- How do I clean the area?
You can wash your hair and get the area of the scalp wet
where the facial graft was harvested. However, do not get
the yellow ear donor site or the nose cast wet.
- When can I wash my hair?
It is usually best to wait until the second or third day
after surgery to wash your hair, and it is often advantageous
to have someone wash your hair for you beauty-salon style.
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7. Can I clean inside
my nose? Why just the edges?
It is important that twice a day you clean all visible suture
lines that have black sutures, using hydrogen peroxide and
then apply a bacterial ointment (Neosporin, Polysporin). These
are permanent sutures and need to be cleaned. In contrast,
the clear sutures dissolve, and it is not beneficial to clean
them.
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8. When can I resume:
- Exercise
You can begin doing long walks relatively soon – by
three to four days post-operatively. You can go to the gym
and do a treadmill or stationary bike (no spin class) by
the second week. You can begin to do light weights and non-head-down
exercises by the third week. (Avoid heavy weights that would
raise your blood pressure.) By the fourth week you can try
any exercise, but stop if you have pain or discomfort.
- Taking my vitamins and/or regular medications
You can resume all your medications and vitamins as soon
as the cast is removed.
- Wearing my glasses
This is a difficult question to answer, as it depends on
the type of surgery done – especially the osteotomies
and the grafts. As a rule of thumb, you can resume wearing
your glasses one month after surgery.
- Going out in the sun
The problem with sun exposure is that your nose will be
numb for three to six months, and you can easily burn your
skin without being aware of it. Therefore, you should make
sure your moisturizer has a sunscreen with an SPF 10-15
(a good idea for everyone) and use it daily on the nose.
If you are going to be out in the sun, then wear a hat for
the first three months and use a sunscreen on the nose (SPF
15-30). If you are going to the beach or on a boat, wear
a hat and frequently apply a 45 SPF sunscreen specifically
formulated for water sports (Bullfrog, etc.).
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9. Why do I occasionally
have a funny smell in my nose?
At several weeks post-operatively, you may notice an unusual
or bad smell in your nose. It is caused by the accumulation
of mucus in the nose due to a reduced mobility of the “mucus
blanket” within the nose. As you recall, the nose secretes
a cup of mucus a day that is propelled into the back of the
throat by the nasal lining cells. After surgery, the physiology
of the nose takes four to six weeks to come back to normal,
but in the interim you can clear the mucosal blanket with
intranasal saline sprays (e.g., Ocean Spray).
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10. It has been six
weeks since my surgery. Why does my nose swell periodically?
Swelling in the nose decreases in two stages. Stage one is
a true fluid type swelling which is generalized and comes
down in the first two to three weeks. Stage two is truly scar
remodeling that goes on between the skin and the underlying
structures. It comes down sequentially from the top of the
nose to the tip in a three-to-six-month to nine-to-12-month
progression. In the first three months, the nose swells generally
from time to time, especially on frontal view – what
you see in the mirror. It will diminish with time, and you
do not have to worry about it.
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If You are Considering
Rhinoplasty
DO NOT take any HERBAL
REMEDIES/ MEDICATIONS (St. John's Wort, ginko biloba,
ginseng, echinacea, Herbalife, etc.), or any DIET
MEDICATIONS (phen-fen, redux, ephedrine, etc.).
Also, DO NOT use any of the
following products for TWO WEEKS PRIOR TO SURGERY:
- ASPIRIN or any products
containing aspirin. This includes Motrin, Advil, Alleve,
Ibuprofen, Midol, and many other medications. Please check
with your pharmacist.
- MULTIVITAMINS, VITAMIN E
- ALCOHOL
- RECREATIONAL DRUGS (cocaine,
marijuana etc.)
These all tend to interfere with the blood
clotting process. Please do not take any medication other
than TYLENOL without checking with your physician.
Surgery is a great time to quit smoking! Smokers
must stop smoking two weeks prior to surgery. DO NOT use Aspergum,
Nicorette gum or Nicotine patches. Please contact our office
immediately if you develop a cold or other illness prior to
surgery.
TWO WEEKS PRIOR TO SURGERY, begin using a
germ-inhibiting soap (examples include: Dial, Safeguard, or
Irish Spring) once a day all over your entire body. Then the
night before or the morning after
of surgery you will need to wash your hair, face
and body with the liquid anti-bacterial soap.
Do not use any shampoo, conditioner, cream rinse or any hair
products in your hair.
Do not wear make-up, lotion, deodorant, jewelry,
contact lenses, wigs, or hairpins on the day of surgery. Remove
all fingernail and toenail polish as this interferes with
monitors that are placed over your fingertips. In the case
that you have acrylic nails, you do not have to remove them
just remove the polish.
On the day of the surgery, you will need to
come to the surgery location wearing comfortable, warm, loose
fitting clothing, nothing that pulls over your head. It must
zip or button up the front. Do not wear jeans or tennis shoes.
This will make it easier to get dressed following your surgery.
You are having GENERAL/ LOCAL WITH
IV SEDATION anesthesia, DO NOT EAT OR DRINK
ANYTHING AFTER MIDNIGHT THE NIGHT BEFORE SURGERY, INCLUDING
WATER.
Following surgery, you will not be allowed
to drive yourself home. Have someone drive you to the surgery
location, and make certain that a responsible adult will be
avail able to take you home and stay with you for 24 HOURS
following your surgery. It is also a good idea to bring a
pillow for a comfortable ride home.
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