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About Face

Chapter Eight The Nose The Psychology of Rhinoplasty Patients Expectations Initial Surgery Making the Nose Smaller Saddle Nose Columella Deformity Revisional Treatment Recovery

Recovery

After rhinoplasty, a patient can expect to suffer swelling and discoloration around the nose and eyes, but very little pain. In a survey of my own patients, I found that twenty-five percent took no pain medication at all. Any pain can usually be handled with Tylenol 3, available by prescription.

Surgeons will place a small cast on the nose after rhinoplasty. The purpose of the cast is not to hold the nasal bones in position, but rather to reduce swelling around the surgical field. the cast is usually removed during the first postoperative visit.

Bruising around the eyes is often worse the second day after the operation. Most of it is gone within two weeks, but in the meantime, sleeping with your head propped up will help to minimize the discomfort: swelling is affected by gravity, so the more time you spend upright, especially at night, the faster it will clear. Avoid lifting, bending or any activity that would increase body temperature or blood pressure. As the swelling subsides, the discoloration will become more noticeable; first dark, then a yellowish hue, before it fades away. This is perfectly normal, and those who are comfortable with cosmetics can conceal discoloration reasonable well. A trip to an aesthetician specializing in cosmetic camouflage techniques can be helpful for this sort of bruising.

There is as much swelling inside your nose as there is outside, and this will result in nasal blockage. You’ll have to breathe through your mouth until it subsides, so make sure you’ve got a ready supply of fluids, hard candies and mouthwash at hand. The dry mouth will go away after about two weeks, when the swelling is gone.

As long as you’ve avoided strenuous activity, there shouldn’t be any fresh bleeding from the nose, but you can expect a blood-tinged discharge for the first week. It’s important to wear a “mustache” dressing to catch these secretions, because any dabbing or wiping might affect the cosmetic and/or functional outcome of the operation. Don’t be tempted to use over-the-counter vaso-constrictuve sprays like Otrivin or Neo-Synephrine to help clear the nose. If the discharge is particularly thick and bothersome, mix 5 mL (one teaspoon) of salt into 500 mL (two cups) of water to make a solution, then squeeze a few drops at a time into the nostrils, using an eyedropper. This will help to liquefy the secretions and break up any crust that might form after the first week.

Once the discharge has stopped, crusting will naturally occur. Do not, under any circumstances, pick inside your nose to remove crusts. Picking might lead to further bleeding and abnormal healing. Instead, use Q-tips dipped in a small amount of Polysporin ointment, to soften the crusting so that the scabs will fall away. If a crust is very adherent and won’t come away, leave it alone for another day or two, but don’t pick.

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