Rhinoplasty, Septorhinoplasty
&
Repair Of Nasal Fractures
What is rhinoplasty?
Rhinoplasty
is a facial cosmetic procedure, usually performed to enhance the appearance of
the nose. During rhinoplasty, the nasal cartilages and bones are modified, or
tissue is added, to improve the
visual appeal of the nose. Rhinoplasty is also frequently performed
to repair nasal fractures. When rhinoplasty is used to repair nasal
fractures, the goal is to restore pre-injury appearance of the nose.
Septorhinoplasty is a related
procedure performed for patients who also have nasal obstruction.
Septorhinoplasty not only improves the appearance of the nose, but it removes
any internal obstructions that may be blocking nasal breathing.
What does the surgery involve?
Initial Evaluation
Cosmetic
concerns and expectations should be fully discussed prior to surgery. The
surgeon's recommendations and any particular limitations set forth by the
structure of your nose, face, and skin
are important to understand and have explained. Photographs are
usually obtained before surgery to help with preoperative planning
and after surgery to document postoperative results.
Before Surgery
In most
situations, the surgery is performed as an outpatient at either the hospital or
the surgicenter. In both facilities, quality
care can be provided without the expense and inconvenience of an
overnight stay. An anesthesiologist is present for
monitoring vital functions throughout the procedure. Usually, the
anesthesiologist will call the night before surgery to review the medical
history. Preoperative laboratory studies will need to be done several days in
advance. Transportation after the procedure will need to be arranged
and someone should stay with the patient during the first night.
Aspirin, or
any product containing aspirin, should not be taken within 10 days of the date
of surgery. Non-steroidal anti- inflammatory medications (such as Advil, Motrin,
Naprosyn) should not be taken within 7 days of the date of surgery. Many
over-the-counter products contain aspirin or Advil type drugs so it is important
to check all medications carefully. If there is any question, please call the
office or consult a pharmacist. Tylenol is an acceptable pain reliever. Prescriptions for pain medications are usually written
prior to the date of surgery and should be filled in advance.
No food or
liquids should be consumed within 6 hours prior to the time of surgery. This
includes even water, candy, or chewing gum. Anything in the stomach increases the chances of an anesthetic complication. Smokers
should make every effort to stop smoking, or at
least reduce the number of cigarettes. This will help to reduce
postoperative coughing and bleeding.
Any illness prior to the day of surgery should be reported to the
surgeons office as soon as possible. If illness occurs the day of
surgery it is best to proceed to the surgical facility as planned and
be evaluated to decide if surgery is safe.
The Day of Surgery
It is important to check in with the surgical facility on time.
Bring all papers and forms including any preoperative orders and
history sheets. Wear comfortable loose fitting clothes that do not
have to be pulled over the head. Leave all jewelry and valuables at
home. Remove all make-up with a cleansing cream. Thoroughly wash the
face with soap and water and do not apply make-up or creams.
Do not take
any medication unless instructed to do so. Usually a nurse will start an
intravenous infusion line (IV) in the pre-operative holding room and a medication may be given for relaxation.
During Surgery
In the
operating room, the anesthesiologist will usually use a mixture of a gas and an
intravenous medication. Continuous monitoring during the procedure usually
includes a pulse oximeter (oxygen saturation) and EKG (cardiac rhythm). The
surgical team is prepared for any emergency. In addition to the surgeon and the
anesthesiologist, there will be a nurse and a surgical technician in the room.
Depending on what is required and what additional procedures are performed, the
surgery may take one to several hours. The surgeon normally talks with any
family or friends once the
patient is safely in the recovery room.
After Surgery
Patients are monitored after surgery in the recovery room by a
nurse. A patient is able to go home the same day as the surgery once
fully recovered from the anesthetic. This usually takes several
hours. Transportation home will need to be arranged. A responsible
adult should be in the same residence overnight for help on short
notice.
At home the patient should have bed rest with the head elevated on
2-3 pillows. Edema and swelling are minimized by
keeping the head elevated above the heart. An assistant should be available for
out of bed excursions to the bathroom. Straining should be avoided. If
constipated, take a stool softener or a gentle laxative.
Swelling
and bruising of the nose, upper lip, cheeks, or around
the eyes for several days after surgery is a normal occurrence. This
will gradually go away over the next 7 to 10 days. Ice on the face,
bridge of the nose, and eyes as much as tolerated will help to
minimize these problems. This will also help with postoperative edema
and pain. Some patients have found frozen vegetables in packages (for
example bags of frozen peas) to be a convenient ice pack which
conforms to the face.
A nasal
splint or cast will cover the outside of the nose, and
will usually be removed one week following surgery. As swelling
subsides, the splint tends to fit less tightly. If the cast gets wet
it may come off prematurely; this is usually not a problem and does
not affect the outcome of the procedure.
Moderate bleeding from the nose is normal, and will gradually
decrease. The gauze dressing ("mustache dressing") will collect blood
and should be changed only when saturated. It is not unusual to
change these dressing every hour during the first 24 hours after
surgery. This dressing will usually not be needed after a few days.
Do not take aspirin, aspirin-containing medications, or non-steroidal
anti-inflammatory medications (such as Advil) for 3 weeks following
surgery.
It is best
to eat a light, soft, and cool diet as tolerated after recovery from the
anesthetic. Avoid hot liquids for several days. It is best to go slowly with
food immediately after the procedure to prevent postoperative nausea and
vomiting. Patients occasionally vomit one or two times immediately after surgery; if it persists,
medication to settle the stomach may be prescribed. It is important
to remember that a good overall diet with ample rest promotes
healing.
Antibiotics
are prescribed after surgery. It is important to finish all the pills that have
been ordered. Some form of a narcotic will also be prescribed (usually vicodin)
which is to be taken as needed. If narcotics are taken, it is important not to
drive or engage in activities where impaired judgment could cause injury. In
some situations steroids may be prescribed to be taken either preoperatively
and/or postoperatively. It is very important to take this medication as
prescribed, and not discontinue it prematurely. An anti-emesis medication such
as phenergan may be prescribed for nausea or vomiting postoperatively. Possible
drug reactions to any of these medications, such as a rash, should be reported
to the doctor as soon
as noticed. No other medications, either prescribed or over-the-
counter, should be taken without the knowledge of your doctor.
What Occurs After Surgery?
In most
situations, packs will have been placed in the nose to control postoperative
bleeding. The packing material will be removed at a scheduled postoperative
visit. Arrangements should be made for someone else to drive to and from the
office for this first visit. Eat a light meal before this visit and avoid taking
excessive pain medications. Immediately after the nasal packs are removed, a
saline
nasal spray such as "Ocean Spray" is used several times per day to
prevent crusts from forming in the nose. Several subsequent office
visits are necessary to asses healing, remove crusts, and insure a
speedy recovery. The nose is usually tender after surgery, so a spray
of special numbing medication is used before removing crusts.
After the packing has been removed, breathing through the nose is
acceptable, but do not blow or sneeze through it for 7-10 days. Any
sneezes should be channeled through the open mouth. Expect some light
blood-tinged drainage from the nose for several days. If bleeding
becomes excessive, apply ice and rest quietly with head elevated
while holding the nose. If bleeding continues, call the doctor.
Rest for
the first week following surgery. Avoid excessive talking, smiling, hard
chewing, strenuous activities, lifting heavy objects, bumping the nose, and
bending over. Try not to rest glasses on the bridge of the nose until soreness
and swelling subsides. Contact lenses can be worn once eye swelling and any
irritation has resolved. Alcohol and tobacco should be avoided because they may
prolong swelling and healing. Smoke, dust, and fumes may irritate the nose and
cause an infection. Facial tanning is discouraged for 6
months after surgery. Number 15 or greater sun block is recommended
during any sun exposure. Make-up may be worn anytime after surgery.
Lubricate
the nostrils, as instructed, with a Q-tip and Vaseline to soften harden crusts.
Peroxide helps to loosen crusts. After several days a few of the absorbable
sutures may become noticeable. Be gentle while brushing the upper teeth. They
will often be tender for several weeks, and there may some numbness of the teeth
and palate for several months.
Exercise and swimming may be resumed after 3 weeks if there are no
bleeding problems. Diving should be postponed for two months. It is
advisable not to schedule travel for three weeks following surgery to
allow for proper postoperative.
Notify Your Doctor If You Have:
- A sudden increase in the amount of bleeding from the nose
unrelieved by pressure, ice, and head elevation.
- A fever
greater than 101.5 degrees F which persists despite
increasing the amount of fluid intake and Tylenol. A person with a
fever should try to drink approximately one cup of fluid each waking
hour.
- Persistent sharp pains or headache that is not relieved by the
prescribed pain medication.
- Increased swelling or redness of the nose or eyes.
Next: What are the risks and complications? »
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From the Doctors at MedicineNet.com  |
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Last Editorial Review: 4/24/2002
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