Before your rhinoplasty
My nurse and office manager will make all arragements regarding scheduling of your surgery and will give you specific instructions as well as reconfirm these with you by telephone and/or letter. Since my schedule and your desires must be coordinated with hospital and anesthesia schedules, please allow my personnel a reasonable amount of time to make these arrangements. They will make every attempt to accommodate your requests.
Avoid aspirin of any type two weeks
No aspirin or medications containing aspirin should be taken for at least two weeks prior to your surgery , since they interfere with normal blood clotting. Tylenol may be substitmed instead. Common medications containing aspirin which should be avoided include Alka Seltzer, Anacin, Ascriptin, BC, Bufferin , Coricidin, Darvon Compound, Fiorinal, Dristan, Excedrin, Midol, Sine Aid , Sine Off, Percodan, Triaminicin , Vanquish, etc. If in doubt, check the label carefully, or check with us. Nicotine causes constriction of blood vessels and can impair circulation to tissues following your procedure. Smoking should be discontinued prior to the procedure and for a minimum of two weeks following the procedure. Arrange for someone to drive you home at the appropriate time following your procedure and arrange for someone to stay with you the night of surgery if you are not in the hospital.
Do not eat or drink anything for eight hours before surgery
Do not or drink anything for 8 hours before surgery. Safety in the administration of anesthesia requires that your stomach be absolutely empty for this interval of time before surgery. Notify us any other medications which you are taking prior to your operation. Wear comfortable, loose fitting clothes that do not have to be put over your head.
In 98% of case , I do not pack your nose so that you are unable to breathe through it
At the completion of the procedure, my goal is to place no packing or splints inside your nose. In 2% of cases (2 out of 100). Internal splints or packs may be necessary , but in 98 of 100 cases, no packs or internal splints are used. Due to drainage of material and fluid following surgery, some degree of blockage of the nasal airways is normal, but you will be able to partially breathe through the nose. A thin external splint of aluminum will be applied to the outside of your nose if we have repositioned the nasal bones. The external splint is fixed in place by tape and usually remains in place 5 – 7 days. You will then be transferred to our recovery area for an appropriate period of time.
Important Medication Information
About Aspirin Intake Before Surgery For the two weeks prior to the scheduled date of your surgery, please do not take any medication which contains aspirin as an ingredient. Aspirun has an effect on your blood's ability to clot and could increase your tendency to bleed at the time of surgery and during the postoperative period. Please check the labels of medications that you take (even those available without a prescription ) to see that you do not take aspirin.
After Your Nasal Surgery
Instruction and Information for you from Dr. Tebbetts
How you will feel
You will be drowsy following surgery – we have given you medication to help make you more comfortable. Expect to wake and doze on and off during the evening, and simply make yourself comfortable when you get home. The drowsiness will disappear in the evening or overnight. The day following surgery you may still feel a bit tired. But go aheah and begin to resume your normal activity immediately. Your energy will return more rapidly if you begin to resume normal activity the day following surgery. You may be a bit stiff when you first awake in the morning following surgery. Go ahead and move about without fear of disrupting anything. I have carefully reinforced all of your incision areas so that anything short of drastic athletic activity will not affect them. It's not unusual to have some nausea following surgrey parictlarly if you begin to get up and move about too soon. All nausea will be gone 6 – 8 hours following surgery. Although we've given you nausea medications prior to, during , and possibly after surgery, these medications are only about 80% effective and you may still experience a bit of nausea. If so simply relax and don't try to eat any heavy foods – just try some clear liquids. Please call my office within 24 hours after you return home. We want to know how you are progressing and will make your follow – up appointment.
Medication for pain
You'll be given a prescription for pain medication. Take a paia pill before retiring the evening of surgery (preferably after you have kept something in your stomach to avoid stomach irritation). It's a good idea to take another pain pill the morning following surgery, since you may feel a bit stiff and uncomfortable when you begin to move about. If the pain pills disagree with you in any way, simply try extra – strength Tylenol – most patients find that by the first to second day following surgery Tylenol is quite adequate. Rarely will pain medication be necessary more then 3 – 4 days following surgery.
Antibiotics
You received antibiotics in your IV prior to surgery, so no further antibiotics are necessary following surgery except in specially not apparent for several days following surgery. If you notice significantly increased redness or swelling accompanied by tenderness or fever at any time, call so that we may examine you. It's normal to experience temperature elevations to 101 F following sugery for many patients. If your temperature reaches 102 F , notify our office. If you are given additional anibiotics or any other type of medication , be sure to take the medication exactly as directed on the label.
You will be more swollen after lying in bed overnight
Expect to have more swelling when you awaken the morning following surgery. If you can comfortably sleep on two pillows, do so as this may reduce your swelling slightly. However it's more important that you sleep well, even if on one pillow, since the swelling will subside anyway over the next 48 – 72 hours.
Protect the tape on your nose
Try to keep the tape which I have placed on your nose as dry as possible. We will remove it for you in the office in 5 – 7 days.
Drainage from your nose is normal
It's normal to have drainage from your nose which will be tinged with blood for the first 48 – 72 hours. Usually the drainage decreases markedly after 24 – 36 hours and becomes clear. Remember that your nose will feel stuffy for a week or two because of the lining of the nose.
Cleaning your nose
Keep your nostrils clean and free of drainage using Q – tips dipped in Hydrogen Peroxide. You may need to clean frequently the first 2 – 3 days and then less frequently. Reach inside the nose only as far as the length of the cotton on the Q – tip.
Blowing your nose can cause bleeding
Do not blow you’re your nose for the first 5 days following surgery or for me first 10 days following surgery if we have operated on your septum. Blowing your nose risks significant bleeding. Similarly, do not lift heavy objects for the fist 10 days since straining can cause bleeding also.
Wearing eye – glasses safely after rhinoplasty
If you ever glasses , you may tape them to year forchead with a small loop of tape passed over the hose piece. Do not allow them to rest on the nose for the first 10 days following surgery. Remember that your glasses may require nosepiece adjustments for proper fit since we may have changed the shape of your nasal bones. When you first begin to wear your glasses , you'll notice indentations where the glasses touch the nose. These indentations are not harmful – as the swelling in the skin of your nose decreases. The indentations will be less noticeable.
How long does it take for swelling and bruising to resolve?
You'll notice more bruising the morning following surgery than the day of surgery. This bruising will begin to disappear in about three days when the swelling also begins to decrease significantly. Swelling resolves at different rates in different people. Shortly after we remove the tape from your nose in five to seven days, the swelling will have sufficiently decreased that you'll appear fine in public. Almost all of the more marked swelling will be gone between two to three weeks, but the thicker skin areas such as the nasal tip will begin to improve in definition and appearance for several months. After the first three weeks. The changes are very slight and very slow, and you may not notice them.
Swelling is always different on the two sides
Remember that the degree of swelling will be different on the two side – even if we have performed exactly the same procedure. Don't worry about any differences in swelling or bruising which you see for the first three weeks following surgery.
Numbness in the tip of your nose
The tip area of your nose will be quite numb for the first several weeks following surgery. This is normal, and skin nerves regrow following surgery , your sensation will return. Totally normal sensory return in the tip may require several months.
A void any aerobic exercise for 3 weeks
Avoid any type of aerobic exercise (any exercise which elevates your pulse above 90) for a minimum of three weeks following surgery. When your pulse rises, the accompany rise in blood pressure can cause bleeding. Graually resume exercise beginning two to three weeks following surgery. Avoid any type of contact sports for a minimum of 4 – 6 weeks following surger During this time , any strong blows to the nose could disrupt the recontoured nasal bone areas. Moderate bumps and blows to the nose usually will not cause disruption.
Airflow through your nose increases as swelling subsides
As we change the external shape and appearance of your nose, we also change the pattern of air flowing through your nose , even when these changes are to relieve airway obstruction and increase air flow through the nose you may notice a difference in the feel of the air flowing through your nose. Due to swelling, the best improvement in air flow will not be noticeable until swelling decreases two to three weeks following surgery. Don't worry that your breathing feels different through the nose you will adapt to the new pattern of air flow very naturally over a period of weeks.
A void nasal sprays or antihistamines
While your nose is swollen and stuffy. Try to avoid using nasal sprays such as Afrin or other types of anitihistamines, even if your nose seems to be draining a lot . If you dry these secretions inside your nose with antihistamines or sprays they will clog your nose and be very difficult to remove.
When you touch and feel your nose
Your nose will feel very strange to touch after we remove your tape. The skin will be somewhat numb, and you may be able to feel small bumps, firmness, or ridges if we have altered the nasal bones. As the bony areas heal over a period of weeks, you'll be able to feel these much less. You may always be able to feel some changes which are not visible on the outside of your nose in order for us to achieve the desired result. If your nose begins to bleed at any time, try to relax (this is imperative to avoid your getting overly excited and raise your blood pressure) and lie down with your head lightly elevated. Use a moist washcloth and apply gentle pressure to your nostril area. By relaxing and holding this pressure for 15 – 20 minutes , virtually any bleeding will stop. Should relaxation and pressure not control more excessive bleeding, call the office immediately.
If you have any Questions or problems
We have spent considerable time and effort to make your surgical experience as efficient and pleasant as possible. I would personally appreciate your suggestions and comments regarding any area of your care which you think could be improved or changed to make your experience more pleasant. If you have any additional questions or should any problems arise, please contact my office immediately by telephone. The number is (214) 220 - 2712