Pre & Post Operative Instructions (Shervin Naderi, MD, FACS)

• Make sure all of your questions & concerns are answered by Dr. Naderi or members of our staff prior to the actual surgery.
• Arrange your post-operative appointment time before your surgery. All Rhinoplasty patients will need to be seen in our office for follow-up the next day after surgery.
• Fill all your prescriptions prior to surgery and bring them with you on the day of your surgery. Start taking your antibiotics 24 hours before your surgery if your surgery will be under local anesthesia. For other types of anesthesia, you will start your antibiotics immediately after your surgery.
• You may take your blood pressure & heart medication with a small sip of water the morning of your surgery. Diabetic patients should always coordinate with their primary care doctors.
• Stop taking Aspirin 2 weeks prior to your Rhinoplasty. Ibuprofen, Motrin, Alleve, Advil and all NSAIDs can make you bleed excessively as well. Only take Tylenol or Celebrex for aches & pains within 2 weeks of your surgery if OK’ed by your family doctor.
• High dose Vitamin E, Fish oil, Herbal supplements and health food store products often make you bleed excessively during nasal reshaping operations as well. Avoid these 2 weeks prior to surgery. If in doubt, check with your doctor.
• If you Take Coumadin or Plavix or Aspirin, check with your family doctor to make sure these are OK to be stopped with enough time prior to surgery. (2 weeks to 5 days depending on medication type)
• Drink plenty of fluids the afternoon prior to surgery as well as after your surgery to avoid dehydration and fainting spells.
• Make sure you are well nourished. You need energy and protein to heal properly after a Rhinoplasty. This is no time to diet! A simple Multi-vitamin is a good supplement.
• Make sure you do not eat or drink past midnight the night before surgery IF YOU ARE being sedated or being put to sleep for surgery.
• Take a shower the morning of your Rhinoplasty surgery and wash your face and hair with a mild soap & shampoo. DO NOT USE ANY MAKE-UP or products on your face after your shower or after your surgery until cleared by Dr Naderi. Typically you can wear makeup as soon as a week out from your Rhinoplasty once the small nasal cast is removed.
• Wear loose fitting & comfortable clothes with a shirt that buttons down the front. (No tight or crew – neck collared shirts that can snag on your nose!)
• Make sure you have someone drive you to your Rhinoplasty surgery and pick you up afterwards. Make sure you have a friend or relative stay with you for at least 24 hours after your nasal surgery. (You cannot drive or stay alone)
• Use Hydrogen Peroxide diluted with water in a 1:1 ratio on a Q-tip to clean all your nasal incisions (inside and out) and suture lines then cover the area with a thick layer of antibiotic ointment. Do this at least 4 times a day for 10 days on all areas that are NOT covered by brown tape or dressing, or if the tape should fall off before your follow-up appointment. Dr. Naderi will demonstrate this technique to all his patients on their post-operative day follow-up appointment.
• Use Cool Compresses to decrease swelling: Purchase new baby washcloths (or gel Swiss-therapy eye masks.) Make an ice-water bath in a clean bowl. Soak the washcloths, then drench them out so they are cold but not wet and use these on your eyes and forehead as “cool compresses.” 10 minutes on and 5 minutes off. DO NOT place actual ice packs or frozen pees on your face as these are heavy and will wet your nasal splint. Do not get your nose splint or tape wet until the morning of your one-week appointment.
• On the morning of your post-op-week-one appointment, get in the shower and thoroughly wet your face and nasal splint before coming to the office to see Dr. Naderi. This will make removal of your cast easier.
• No lifting over 10 lbs and avoid bending over for 10 days. You may NOT exercise for 2 weeks. Refrain from sexual activity for up to a week if possible. No contact sports for 3 months. You may wear contact lenses at any point but no eyeglasses or sunglasses on your nose for at least 1-3 months.
• Sleep with your head up on 2-3 pillows or on a recliner for at least 1 week after surgery to reduce swelling. This really helps! Also try to sleep by yourself for the first few nights so your partner does not inadvertently hit your face while asleep.
• When in doubt - call! Call with any questions or any rare signs of allergic reaction (redness, induration, itching) or infection (redness, swelling, pain, pus, discharge, blisters, or fever) or excess bleeding or broken sutures. These issues are very rare after Rhinoplasty but they can occur.
• Always check with your family physician, heart and diabetes doctors as well as eye doctor if it’s OK for you to have surgery and anesthesia! We require a clearance letter from them most of the time prior to scheduling surgery.
• You may have bruising. It may take up to 2-3 weeks for complete resolution but after 7 days you can cover the areas with water-based make-up. YOU WILL HAVE SWELLING. THIS IS A NORMAL PART OF THE HEALING PROCESS. 70% of the swelling will be gone by one month and 90% will be gone by 3 months. The "final outcome" takes a year or more to become apparent. However, after 10 days most of your casual friends and relatives will not be able to tell that you have had a "nose job" and you can start to enjoy the initial results of your Rhinoplasty from this early period!
• BE PATIENT and feel free to ask questions. You may have slight asymmetries or numbness of the nasal tip or tightness of your upper lip smile. This is all normal and should even out with time as the swelling resolves. IT IS ALSO NORMAL to get depressed or anxious before and especially after your surgery. Understanding this will help you get through it. Sometimes an anti-depressant or Valium prescribed by your family physician can help you get through this period. Do not feel ashamed or frustrated. Everyone goes through this to different degrees. The end result is what counts!
• Your skin may become oily under the tape during the first week. Our licensed Aestheticians will pamper you with a complimentary facial peel to unclog your pores and improve your skin after your one-month follow up appointment.
• You will be seen 2 to 3 times during the first week after your Rhinoplasty or Revision Rhinoplasty and then at 1 month, 3 months, 6 months and a year for follow up with Dr. Naderi. For local patients, Dr. Naderi prefers to see you yearly after that as well. For long distant or international patients, we can work around your schedule to decrease the need for frequent follow-up trips.
• Do not get your splint wet until the 7th day! The splint must stay on for one full week.
• You may have some bloody discharge from your nose for several days. This is normal. Do not wipe your nose. Change the small gauze dressing under your nose as needed or let the drainage come to your upper lip and wipe your lip.
• DO NOT BLOW your nose or SNIFF forcefully for 2 weeks. (You will have swelling inside your nose as well as outside, which can make breathing out of your nose more difficult at times).
• Clean the inside of your nostrils with hydrogen peroxide soaked Q-tips then apply antibiotic ointment. Do this at least 4 times a day. (Place the entire cotton tip gently inside your nose but no deeper! This correlates to about 1/4 inch inside the nose). You can use straight peroxide or 1:1 diluted with tap water.
• Purchase a non-medicated “Nasal Saline Spray” and starting on the 5th day after your surgery gently spray 2 “puffs” on each side followed by GENTLE sniffing every 2-3 hours to soften up the dry blood and crusts inside your nose.
• Keep a stiff upper lip. Avoid excess smiling for one week. Brush your teeth with a baby toothbrush.
• Take frequent sips of water or fluids through a straw to avoid your throat drying out due to the potential mouth-breathing. Use Vaseline on your lips to avoid chapping
• If you have to sneeze, do it with your mouth and nose open.
• If your Rhinoplasty surgery was done “open” you will usually be seen 3-5 days after your surgery to get sutures removed from the columella. If the Rhinoplasty surgery was “closed” then the small nose cast will be removed a week after surgery since there are no outside sutures to be removed. You will always be seen the day following your surgery as well. Routine follow-ups are at 1, 3, 6 and 12 months after surgery.
• Do not wear glasses on your nose for at least 4-12 weeks.
• Although very rare, if you develop a brisk nose bleed, sit in a recliner....take your pain pill....put cool compress cloths across your face and eyes and hold pressure on each side of the base of your nostrils for 10 minutes. You may use 2-3 sprays of Afrin or Neosynephrine medicated nasal spray in your nose and repeat in 10 minutes if necessary. Call 911 if the bleeding is excessive or concerning. Go to the nearest E.R. when in doubt.
• Call 703-406-2444 with questions or comments.
• Call 911 to be taken to the nearest Emergency Room if you have an emergency or cannot reach your doctor.
• Visit our website www.VirginiaRhinoplasty.com for additional information.