Preventing or at least minimizing the risk of rhinoplasty infection should be one of the most important goals of any prudent surgeon performing nose-reshaping surgery, according to California Surgical Institute website.
The list below shows the basic guidelines on how to minimize risk of rhinoplasty infection.
Anyone with uncontrolled medical condition linked to higher risk of infection and poor healing is discouraged to undergo any elective plastic surgery.
Prior to rhinoplasty, judicious surgeons require all their patients to pass lab screening to ensure that they can handle the surgery and the ensuing recovery.
- Achieve one’s optimal health
Achieving one’s optimal health generally includes eating healthy, avoiding smoking and too much alcohol and caffeine, and discontinuing aspirin and aspirin-like products for at least 2-3 weeks.
- Accredited surgical facility or hospital
This is the safest surgical venue. Being accredited means the surgical facility adheres to the highest patient safety standard.
Moreover, an accredited surgical facility has the necessary equipment, building design that promotes sterilized environment, and highly trained staff to reduce risk of infection and contamination.
Many surgeons today recommend prophylactic (preventive) antibiotics to help ward off infection, which must be taken on time and their full course completed.
The patient must be informed of the telltale signs of infection such as elevated temperature, unusual skin changes, and poor healing.
If the patient notices anything unusual, he must notify his surgeon right away than wait for his next scheduled appointment. Some individuals might be apprehensive contacting their surgeon thinking that they might bother them over some trivial thing.
Furthermore, the patient must understand that his full commitment is necessary to minimize risk of complications. For instance, smoking even just a single stick a few weeks leading up to the surgery or during the initial healing stage is enough to drastically increase one’s risk of poor healing, infection, and less than optimal results.
It is important to leave the nose alone to heal. No picking at the incisions, blowing hard, wearing eyeglasses, or anything that might compromise healing.
Rhinoplasty bleeding is often minimal provided that the surgeon uses meticulous techniques, which can also lead to shorter social recovery (no outward signs of the surgery), and natural results that can last a lifetime, according to California Surgical Institute website.
Rhinoplasty, or nose job in layman’s term, typically results in 1-2 weeks social downtime, which is closely linked to the amount of postop bruising and swelling.
The list below shows the “core principles” in minimizing the amount of rhinoplasty bleeding.
- The patients should be in their optimal health.
Hypertension, blood disorder, and other chronic medical conditions can lead to increased bleeding. Hence, rhinoplasty or any other elective plastic surgeries require all patients to pass a rigorous lab screening.
While some of these conditions can be controlled through medications or healthier lifestyle, it is important to note that some factors are not within the patient or surgeon’s control. For instance, older individuals often have more fragile blood vessels than younger ones and so they may experience more bleeding and postop bruising.
All drugs and supplements with blood thinning properties are discontinued for at least 2-3 weeks before surgery and about a week afterwards to prevent bleeding and excessive postop bruising. The same rule may also apply to smoking and alcohol.
However, some doctors recommend Arnica montana (homeopathic remedy) and some “special” diet known to promote healing.
- Use of drugs known to constrict the blood vessels
The use of local anesthesia combined with epinephrine—a drug that results in the constriction of blood vessels and thus reduces the amount of bleeding—is known to promote healing.
Decongestants like Afrin may also minimize the amount of bleeding by constricting the blood vessels.
- Keep blood pressure low at the time of surgery
Board-certified plastic surgeons only work with board-certified anesthesiologists to ensure patient safety.
Qualified anesthesiologists know that keeping the patient’s blood pressure low during surgery under general anesthesia can reduce bleeding. Also, one of their tasks is to monitor the patient’s vital signs to prevent serious complications.
- Avoid certain activities during the initial healing stage
Sneezing and blowing one’s nose should be avoided for 2-4 weeks because doing so can trigger bleeding.
It is important to note that despite best efforts, some patients remain susceptible to bleeding and thus they are required to use nasal packing while they recover.
Rhinoplasty nostril flare is a type of nose-reshaping surgery in which the wide nostrils are reduced. While it can serve as a stand-alone procedure, a good number of patients also require a simultaneous “standard” rhinoplasty (i.e., involving all the aspects of the nose) to achieve natural, proportionate results.
Some patients think that correcting their nostril flare is enough to solve their “cosmetic” concern not realizing that without addressing the nasal tip as well, it may create an illusion of a bulbous tip. For this reason, computer imaging prior to surgery can help them settle realistic expectations and improve their communications with their surgeons.
Before and After Photos of a Patient with Impressive Results from Rhinoplasty
Rhinoplasty nostril flare technique is typically done with the use of incisions on the “outside” of the nostril base (where it meets the cheek). The scar must lie precisely at the natural skin crease for optimal scar concealment, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley who has performed more than 2,000 nose surgeries to date.
Aside from the risk of visible scarring (if the surgeon fails to use meticulous scar placement technique), another concern is nostril asymmetries. It is important to note that there is always some preexisting asymmetry and so all efforts are made to ensure that this is not exacerbated by the surgery.
Further complicating the situation is the fact that some patients have a significant upward notching of their nostril rim. Hence, removing an ellipse-shaped tissue from the sill of the nostril may not be enough, as this technique alone does not address the aforementioned problem.
To improve the appearance of nostril rim that notches upward, cartilage graft (which can be harvested from the nose itself or bowl of the ear) is used to bring it down a bit. Achieving a good level of symmetry between the two nostrils can be a challenging feat and so the right surgeon for the job should have extensive experience.
Experience allows the surgeon to hone his skills and “predict accurately” how much skin can redrape to the new contour. Moreover, it is important to reinforce the new structure and allow the skin to shrink-wrap around it.
Thick skin has a rather limited plasticity compared to thin skin; hence, over-resection of the tissue often leads to bulbous tip particularly in patients whose nasal skin is markedly thick.
With meticulous dissection and deep understanding of the nasal anatomy, rhinoplasty nostril flare and its ancillary procedures can provide permanent results that look natural and proportionate.
Rhinoplasty reduction could mean a lot of things depending on the patient’s cosmetic goals. For instance, some want to remove the prominent bump or fullness along the bridge of their nose, while others like to slightly reduce the overall projection of their nose, according to leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Patients with a large hump that gives an illusion of a larger nose despite that it is actually of normal size can expect dramatic result after rhinoplasty reduction. Interestingly, this type of aesthetic problem is generally much easier to address compared to patients who like the overall shape of their nose but feels it is too big relative to their face.
When the goal is to reduce the size of the nose without altering its “inherent” shape, Dr. Smiley highlights the importance of reducing the tip, middle third, and bridge equally to achieve smooth and natural-looking results. Furthermore, the thickness of the overlying skin must always be taken into consideration to avoid a gamut of complications.
The celebrity plastic surgeon says most rhinoplasties just alter the bony and cartilaginous framework of the nose; hence, the overlying skin must be able to redrape to the new contour.
However, Dr. Smiley warns that thick skin, which is commonly found in ethnic patients (Asian and African background), does not redrape as good as thin skin (Caucasian patients). For this reason, over-resection or over-reduction of the cartilaginous framework involving ethnic rhinoplasty almost always results in disaster, he says.
Aside from predicting the amount of skin shrinkage, Dr. Smiley says good surgeon-patient communication is also critical to achieve results that will satisfy both parties. As a result, prudent rhinoplasty surgeons should explain the benefits and limitations of surgery—i.e., there is a limit on how much the surgeon can reduce the size of the nose without resulting in amorphous or bulbous tip.
Moreover, over-resection can result in breathing or function-related problems, which can be avoided by reinforcing the cartilaginous framework that is occasionally done by using grafts or “living tissue,” explains Dr. Smiley.
Dr. Smiley says he typically collects grafts from the septum, or wall between the two nostrils, because of their stability and predictability, allowing him to deliver results that can last a lifetime.
Other possible donor sites include the bowl of the ear and ribs, he adds.
Nose reshaping recovery may differ from patient to patient, although most can go out in public after 8-14 days without having to worry about the “outward signs” of surgery such as bruising and swelling.
Many patients are surprised that the recovery following a nose reshaping surgery (which is medically referred to as rhinoplasty, or in layman’s term nose job) is not as painful as they have been expecting it to be. Nonetheless, most describe the experience as rather “uncomfortable” since they have to breathe through their mouth due to temporary nasal congestion.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley has provided a list of activities to avoid or at least limit during the nose reshaping recovery.
* Running, jogging, dancing, and other similar aerobics exercises are best postponed for two weeks, or sometimes even longer depending on the individual healing. It is important to note that the pressure and nasal congestion also makes it difficult to perform rigorous workouts.
* Contact sports are best avoided for a minimum of 2-3 months to give the underlying framework of the nose the opportunity to heal completely.
* Avoid wearing eyeglasses. How long should one wait depend on many things, although patients who have had osteotomies (breaking of the nasal bone) are typically instructed to avoid wearing eyeglasses for a minimum of six weeks.
* Making extreme facial expressions. Anything that causes discomfort or results in excessive manipulation of the upper lid (which affects the nose itself) is best avoided in the meantime.
* Avoid showers to prevent bandages and splint from getting wet. Typically, they are removed about a week postop.
* Avoid blowing one’s nose. By two weeks postop, most patients can blow their nose as long as they do this with care. However, others are required to wait up to three months particularly if they have had septal perforation repair or other similar types of complex or reconstructive surgery.
* Avoid hard-bristle toothbrush in the first few weeks following a nose reshaping surgery. The goal is to prevent excessive manipulation of the upper lip to keep the nose at rest and prevent inadvertent injury or disturbance.
* Avoid accidental bumps with proper attire. Button down shirts and wrap-around dresses are particularly ideal in the first few weeks of recovery.
Each doctor has a specific set of rhinoplasty recovery tips. Nonetheless, they all boil down to controlling the amount of swelling and bruising, and preventing injuries during the healing phase to achieve optimal results from the surgery.
Most patients already know the basics of rhinoplasty recovery tips—the drugs and supplements to avoid a few weeks before and after surgery, the foods and drinks to limit, and the activities that could jeopardize their results. Hence, the list below explains the not-so-popular guidelines that can promote healing.
Chronic stress can put a toll on your immunity. For this reason, a longer time off from work might be more ideal than returning to office just 10-14 days after surgery, or once the outward signs (bruising and swelling) are gone.
If a longer leave of absence is not possible, you may ask to work part-time until you regain your pre-surgery energy level, which often takes 4-6 weeks after surgery. The goal is to control your stress level, according to experts at the California Surgical Institute.
Of course, managing stress also boils down to adapting a positive attitude in life.
- Use of bed wedge pillow or recliner bed
Head elevation all day long and during the night can keep swelling to a minimum and can also promote healing. Many patients have noted the convenience of using a bed wedge pillow or a recliner bed, as opposed to the soft standard pillows.
You may want to sleep alone in your bed and avoid pets and small children for the time being because even the slightest bump may cause bleeding or interfere with healing.
Other things to avoid while not yet fully healed include wearing eyeglasses, blowing your nose, making excessive facial expressions, and applying too much pressure when brushing your teeth. Moreover, it makes sense to wear button down shirts or wrap-around dresses during the initial healing stage to avoid accidental bumps on the nose.
Aside from consuming more fiber-rich foods and lean protein, it is important to follow a low-sodium diet. It is important to note that too much salt causes water retention, which can aggravate the amount of postop swelling.
Empty calorie foods laden with sugar and fats can also suppress your immunity and aggravate constipation, which is not uncommon after any type of surgery due to narcotic painkiller use.
Sun protection is one of the most critical rhinoplasty recovery tips. It is important to note that after surgery the nose is extra sensitive to UV rays and thus the risk of discoloration or hyperpigmentation is perceived to be higher.
If you cannot stay away from the sun, try to slather on sunscreen with at least SPF 30 or use a wide-brimmed hat.