Rhinoplasty


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.

 

rhinoplasty recovery tips

 

  • Manage your stress

 

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.

 

  • Watch out for bumps

 

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.

 

  • What you eat matters

 

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

 

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.

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The success of revision rhinoplasty surgery preparation will not just rely on the surgeon’s skills. Patient cooperation will also play a critical role on the final results and ultimately the satisfaction rate, according to the California Surgical Institute website.

 

The list below explains the “basics” of revision rhinoplasty surgery preparation. It is important to note that some patients may need to follow a set of highly specific instructions due to their unique anatomy or individual problem. For this reason, the safest route is to stick to the recommendations of one’s surgeon.

 

rhinoplasty surgery preparation

  • Wait

 

Minor contour irregularities and persistent fullness or swelling of the supratip (right above the tip) are best addressed after the skin has redraped completely to the new contour, which happens after 9-12 months. This “guideline” applies specifically to patients with markedly thick nasal skin, which is susceptible to prolonged swelling.

 

Waiting also allows the patients to be more objective on the results of their surgery and to ponder deeper on their cosmetic goals.

 

The idea is to have the most accurate assessment of the nose to achieve the most satisfying results possible. Nonetheless, certain deformities are best treated as soon as possible because of the zero possibility of improvement even after the passage of time.

 

 

  • Achieve optimal health

 

Any medical condition that can interfere with healing must be controlled well in advance of the surgery. Healthy lifestyle and/or medications can help patients achieve their optimal health so they can handle the surgery.

 

  • Avoid risk factors linked to increased bleeding, infection, and poor healing

 

Aspirin and other drugs and supplements with blood thinning properties must be discontinued 2-3 weeks before surgery and at least week afterward.

 

Tobacco and smoking cessation products (gum and patch) are also best avoided several weeks or even months ahead of the surgery because they are known to significantly increase the risk of skin necrosis and poor healing.

 

Doctors generally have preoperative information packet that explains what medications, supplements, drinks, and foods to avoid or at least limit their consumption. Furthermore, prudent patients should never hide or omit information regarding their drug use (including recreational drugs) to prevent complications and less than optimal results.

 

  • Lab screening

 

In the ideal scenario, lab screening, which is primarily blood work, is performed not later than 10 days prior to surgery to ensure that the patient is healthy enough for rhinoplasty and the ensuing recovery.

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The rhinoplasty preparation tips aim to help patients achieve their optimal health and ultimately the best results possible from the surgery. It is important to note that aside from the surgeon’s skills and experience, healing can also influence the long-term outcome.

 

Experts at the California Surgical Institute explain the “basics” of rhinoplasty preparation tips.

 

rhinoplasty preparation tips

  • Good diet

 

A balanced diet mainly consists of lean protein (about 15-25 percent of the total calorie intake), fresh fruits and vegetables, and “healthy” carbs. Meanwhile, avoid or at least limit the amounts of processed carbs (white pasta and bread), foods and beverages laden with too much sugar, and salty foods.

 

  • Supplements

 

Some doctors recommend multivitamins a few weeks or months leading up to the surgery. However, a prudent patient should not take any supplement without their surgeons’ approval because a gamut of remedies are known to interact with anesthesia and painkillers or may increase the risk of bleeding and poor healing.

 

Supplements known to increase bleeding and other complications (e.g., ginseng, fish oil, green tea, ginkgo biloba, kava kava, and garlic) are best avoided 2-3 weeks before and after surgery.

 

  • Discontinue all tobacco and smoking cessation products

 

While the general rule of thumb is to avoid these products for a minimum of three weeks, some doctors require a longer cessation period to ensure the patient’s full commitment. It is important to note that one stick is enough to compromise healing and even the long-term results of the surgery.

 

  • Make advance planning

 

Most patients will need at least a week of “social recovery” (before they look presentable in public), although it still makes sense to plan for at least a two-week off just to err on the safe side. Furthermore, in the first ten days postop their focus should be on their recovery alone; hence, it s highly ideal that they assign house/pet/child care to someone else.

 

  • Make the house “recovery-proof”

 

All surgeons will provide their patients a list of things they must purchase, prepare, or arrange weeks or days ahead of their surgery. Typically they include painkillers, button-down shirts, large pillows or recliner (it is ideal to keep one’s head elevated to keep swelling to a minimum), soft foods, and sources for entertainment (magazines, books, movies, etc.).

 

  • Camouflage makeup

 

For some patients the residual bruising especially around the eyes might take longer to dissipate. Camouflage makeup can help conceal these bruises.

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Rhinoplasty dissatisfaction usually stems from poor aesthetic results, breathing problems, unexpected changes during the initial healing stage, and unrealistic expectations of the patient that even a seemingly successful result (from the cosmetic point of view) fails to make him happy.

 

Rhinoplasty, or more commonly referred to as nose job, is a surgery by millimeters as it entails high levels of precision. According to medical literature, its revision rate is 5-15 percent, which is higher compared to other plastic surgery procedures.

 

rhinoplasty dissatisfaction

 

Nonetheless, there are several ways to avoid or at least minimize the chances of being dissatisfied with the results. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says it all starts with careful patient selection and thus lengthy consultation and good rapport are always a prerequisite.

 

According to a study published by Plastic and Reconstructive Surgery journal, about a third of patients seeking rhinoplasty had symptoms of body dysmorphic disorder (BDD) that impede with their daily functions or make it difficult to maintain social relationships due to their minor or imaginary flaws.

 

The study involved 266 patients seeking rhinoplasty, with about 80 percent of them had not had a previous nose surgery.

 

Dr. Smiley says that BDD patients are less likely to be happy with the results of rhinoplasty despite acceptable levels of improvements, and should they be happy with the outcome, there is an increased chance that they will move on to another minor or imaginary flaw.

 

For this reason, the celebrity plastic surgeon only reserves the procedure in patients who have realistic goals and expectations and do no exhibit any psychological or behavioral issue.

 

To further minimize risk of rhinoplasty dissatisfaction, the patient should reach his optimal health prior to surgery. It is important to note that healing will play a critical part in the final appearance; hence, it is important to avoid smoking, herbal supplements whose effects are still widely unknown, and aspirin and other products with blood thinning properties well in advance of the surgery.

 

Medical condition that interferes with healing must also be controlled through lifestyle change and/or medications.

 

Good patient-doctor communication is also a key to achieve satisfying results from rhinoplasty. The patient must be able to explain in details his cosmetic goals, which the surgery can realistically accomplish. Simply put, both parties should be on the same page.

 

Despite factors influencing the success rate of rhinoplasty, studies have suggested that the surgeon’s skills and experience will have the most effect. For this reason, a prudent patient should only consult with a board-certified plastic surgeon who performs nose surgeries (cosmetic and reconstructive in nature) on a regular basis.

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Rhinoplasty swelling is a common part of recovery, although by 2-3 weeks it is barely perceptible that most patients can return to work or attend social events. However, the final results could take up to one year or even longer since the skin needs time to redrape to the new cartilaginous framework, according to the California Surgical Institute website.

 

While the social recovery from rhinoplasty in general takes 2-3 weeks, some patients may experience a period where the swelling fluctuates (i.e., slight swelling only during the morning) as they move forward to their recovery.

 

rhinoplasty swelling

However, swelling that remains obvious or persistent after several months or about a year postop might be caused by aggressive scar formation.

 

The presence of scar tissue in the internal nasal cavity and subcutaneous tissue is normal and for the vast majority of patients it will resolve with time and possibly with a use of some conservative management such as massage. A good rule of thumb is to wait at least a year before resorting to a more aggressive method such as steroid injection and revision surgery.

 

Steroid injection (Kenalog) is particularly helpful in rhinoplasty swelling in the supratip, which lies just above the tip. This treatment can reduce the amount of scar tissue by breaking up the bonds between the collagen bundles; however, it involves judicious injection to prevent skin depression or thinning, hypopigmentation (the skin turning lighter), and other untoward side effects.

 

If the supratip develops excess scar tissue, the area becomes swollen to the point that the nose appears like a parrot’s beak; hence, it is also referred to as polly beak deformity.

 

To avoid skin changes, a highly diluted form of Kenalog is injected deep enough so as to prevent the dermis of the skin from shrinking. To further reduce the risk of complications, there should be a 6-8 weeks interval for each treatment.

 

While Kenalog may start working as soon as 1-2 days after injection, most patients can expect its full effects in two weeks.

 

To further control the amount of rhinoplasty swelling in the supratip, it may be necessary to tape the area for about a week after injection.

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Revision rhinoplasty, also referred to as corrective or secondary nose job, deals with deformity of varying degree. In general, mild asymmetries such as small residual hump along the profile are best addressed after 6-18 months postop; the idea is to wait for all the residual swelling to subside.

 

Waiting is also ideal for patients with a markedly thick skin that makes them susceptible to protracted postop swelling in order to achieve a more favorable outcome, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

revision rhinoplasty

 

Postponing revision rhinoplasty also ensures that the skin has fully shrink-wrapped to the new contour, and the patient becomes more “objective” in assessing the surgery’s results. Simply put, waiting prevents anyone from making hasty decision that could lead to more problems and frustrations.

 

However, there is no reason to wait when the issue involves gross deformities and abnormalities, especially when there is very little chance that they will improve even after all the swelling has dissipated. This is particularly true for twisted nose, collapsed appearance, and polly beak (the nose resembles a parrot’s beak due to its excessive convexity).

 

Function-related problems are also best addressed sooner than later to prevent further suffering.

 

In addition, patients with significant swelling caused by aggressive scar tissue inside the nose are best treated with steroid (Kenalog) injection as soon as possible, provided that the nasal framework is sturdy.

 

Steroid injection is commonly used in the supratip (right above the tip) to reduce persistent swelling, which is not uncommon in patients with thick nasal skin. However, the treatment should be used sparingly (i.e., highly diluted form and at intervals of 4-6 weeks) to minimize risk of skin depression, skin discoloration, and abnormal blood vessel formation.

 

In summary, the right or ideal timing for revision rhinoplasty will depend on many factors such as skin thickness, degree and type of abnormality or deformity, amount of postop swelling, stability of the framework, and presence of function-related problems. Simply put, the “usual” guideline of waiting 6-18 months is not always justified.

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