What to Expect Immediately After Surgery
Patients awaken in the recovery room wearing a splint over the nose with a small gauze dressing taped under the nostrils called a "moustache dressing." The back of the bed is elevated to reduce swelling. Any discomfort is treated with painkillers. Depending on the amount of swelling and bruising, which are variable, patients usually look worse than they feel.
To Reduce Swelling:
- At home, pillows or a recliner may be used to provide head elevation.
- Ice packs may be used during the first 24 hours for comfort, and to reduce swelling. It is important to avoid sneezing or blowing the nose for about ten days. Patients need to be careful around children and elbows so as not to bump the nose. The nasal splint needs to be kept dry.
The Nasal Splint
A nasal splint is used after surgery on the dorsum and occasionally after surgery on the tip. In fact, some surgeons have given up using a splint at all. The splint is really an extra precaution to help remind the patient to protect the nose, but it is debatable as to whether it is really necessary. I still use it most of the time, but may choose not to use it if I'm also doing laser resurfacing on the skin.
Bleeding after Surgery
The nose has an excellent blood supply and there is bound to be some bloody drainage after surgery and after removal of packing (when packing is used). Usually there is minimal, if any, oozing after 24 hours.
Packing is something of a ritual for many surgeons, and more and more surgeons, like myself, are now avoiding it whenever possible. It is miserable having the nose packed because it forces the patient to mouth-breathe and this can be the worst part about recovering from a rhinoplasty. I have personally experienced nasal packing and will not forget it- that is why I avoid it! If packing is absolutely necessary, it invariably comes out the morning after surgery.
Patients are usually seen the day after surgery in my office. If nasal packing has been used, which is infrequent, it is removed. Bathing and showering can be resumed the day after surgery, with care to keep the splint dry. The splint stays on for four to five days before it is removed in the office. If it comes off on its own earlier, that's okay, it can be left off. Any sutures inside the nose dissolve and if external sutures have been used around the nostrils, or across the columella (the vertical part dividing the nostrils), these are removed about one week after surgery.
The nasal tissues heal rapidly. The nasal bones are quite firmly healed two weeks after surgery and unlikely to move. Exercise can be resumed at that time. Bruising is variable from patient to patient, and can take longer than a week to go away, but may be camouflaged with makeup. Most patients return to work in one week, or two weeks for a job requiring heavy physical activity.
Swelling of the dorsum of the nose gradually goes down over about a month. Swelling of the tip of the nose is notorious for taking a long time to go down, even up to a year. Accordingly, patients will not be able to appreciate the full benefit of the surgery for several months; this is how long it takes the swelling to go away and the skin to contract down. Of course patients have lived with their old nose for years. They just need to be informed about this so they don't expect the final result right away. In fact, for some, it may be an advantage in that the change in appearance will be more gradual and not so obvious at first to friends and coworkers. Nasal congestion is to be expected after surgery and gradually improves as the swelling goes down on the inside
Many patients are worried about how other family members will react. As long as the dreaded over-reduction is avoided, the reaction of others is almost always positive. There is no shame in wanting to look your best and a good result draws compliments and praise from others. Patients may be surprised that not everyone knows, even though the difference is obvious in before and after photographs. As long as the result looks natural, with no obvious scars or other signs of surgery, acquaintances may be none the wiser.
It is important to remember that perfection is the ideal that surgeons pursue, but is rarely if ever achieved. We work to achieve the best possible results for our patients while balancing innumerable individual variables that make up the unique physiology of each patient. Fortunately, patient satisfaction remains very high if patients are properly counseled and have reasonable expectations.