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These instructions should be carefully read and followed. They are designed to answer the most commonly asked questions regarding post-operative care.
Supplies for Postoperative Care of Nasal Surgery
- Q-tips
- Hydrogen peroxide
- Antibiotic Ointment (Polysporin or Neosporin)
- Arnica (herb)
- 2 x 2 gauze pads
- 2 bottles of saline spray
- Afrin nasal spray
- "Wedge" pillow or 2-3 pillows to elevate head
- Humidifier if available
Activity – The First Week
Limit your activity sharply over the first week following surgery. You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects. If you overexert yourself, bleeding may result. When you rest or sleep, keep your head elevated on 2-3 pillows and try to avoid turning on your side. Keep your emotions under control. It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better. Anger or crying will only add to swelling or initiate bleeding. Restrict your diet to plenty of fluids and easily chewable foods. Hard to chew foods like steak should be avoided for a week.
You may carefully clean about the nostrils with a Q-tip and peroxide 3 times per day. Immediately afterwards place a bit of antibiotic ointment in the nostrils to keep them from drying out. Your nasal passages will be obstructed by swelling for at least two weeks. A humidifier may help you sleep by allowing you to breathe through your mouth more comfortably.
When packing is taken out, use saline nasal spray every 15 minutes while awake. This helps stop crusting and makes you feel more comfortable. Do not blow your nose or sniff excessively for 3 weeks as this will only irritate the healing tissues. If you must sneeze, open your mouth. Also, avoid picking up babies or small children; a flailing little arm may strike your nose. You probably will hit your nose once or more during the first week. This will hurt but cause no problem unless the force is excessive.
With assistance, you may bathe in a tub; avoid showering, as it is best to keep the nasal cast dry. It is alright to wash your face with a mild soap and clean washcloth or cotton balls.
Avoid cigarette smoking or even being in an area of excessive smoke as this irritates the nasal tissues and impedes healing.
Activity – After the First Week
It takes six weeks for the nasal bones to fully heal. Slowly resume your activity. After the first week, let your body tell how much to do. Strenuous exercise may be resumed in 5-6 weeks. Build up to this level slowly. Semi-contact sports are to be avoided for four to six months. Full swimming is allowed after six weeks.
Do not let your nose become sunburned for six months. This may result in prolonged swelling and erythema (redness).
Pain, Swelling, Bruising
Most patients complain more from discomfort from nasal and sinus congestion than from pain. Any pain should be controlled via the prescribed medication. After the first day the pain may subside enough so that Tylenol may be sufficient. If not, give us a call. Swelling and bruising about the eyes and cheeks is variable. Swelling maximizes at about two days then subsides over the next 5-6 days. A small amount of swelling will be present for up to 6-8 months, becoming more noticeable to you with increased activity. This does resolve and is generally not apparent to anyone but you. Do not worry if you have excess swelling about the eyes and cheeks. This will clear completely and not adversely affect the final result. Bruising (discoloration) may persist a few days longer. You will be instructed on the use of Arnica, a herb with known side effects, to minimize bruising. Remember, all these effects subside in time with no bearing on the final result.
Bleeding
It is normal to have some nasal bleeding over the first twelve hours after surgery. It may be necessary to change the gauze drip-pad a dozen or so times over that period. It is normal to have a pinkish-reddish discharge from your nose and your throat for the first three to four days. This will gradually subside. If you have any profuse nasal bleeding after this time, immediately lie down with your head elevated on three to four pillows. Iced wash cloths on the back of the neck and over the eyes may help. Give us a call if these measures do not suffice. If the cast has been removed, forego the fingers-on-nose “exercises” until you check with us.
Medications
Avoid medications that contain aspirin or ibuprofen for 2-3 weeks before surgery. Pain medication is prescribed. Take it as directed. After the first 24 hours, Extra-Strength Tylenol may be sufficient. Remember pain medications may impair your reactions, so avoid driving or other hazardous activities while on them. If the prescribed medications do not control your symptoms, please call us. Take food 20 minutes before your medications to decrease the chance of nausea. Nausea may occasionally be related to the above medications. Small amounts of clear liquids at frequent intervals may help nausea. If this is not effective, call us. Itching under the cast may occur and generally is treated with distraction. Narcotic pain medication and anesthesia may cause constipation. Increasing fiber in your diet, Metamucil powder or capsules, docusate sodium (stool softeners), prunes, or prune juice all help with constipation.
Infection
Infection is unusual after nasal surgery, but occasionally occurs. Fever (over 100 degrees), excessive pain, and swelling with redness may signify a developing nasal infection and should be reported to us. Infections generally clear up quickly with appropriate antibiotic treatment.
Post-Op Visits
Any sutures are removed and the nose is cleansed five to seven days after surgery. These appointments will be made at the time of your pre-op visit. If you do not have them by that time, you should call our office and make these appointments. At seven or eight days after surgery the cast is removed. When the cast is removed the nose will be quite swollen and the nasal tip will be turned up. This will settle down over the next 3-4 days, then more gradually thereafter. Nasal “exercises” are then demonstrated. These are done to keep the sides of the nose narrow and in proper alignment. They should be done in front of a mirror 15-20 times a day and held for 30 seconds. They are to be continued for six weeks. Remember that the nose does not assume its final shape until many months after surgery. Your nose will probably look better than prior to the operation within two to three weeks, but the final results take longer; be patient. Occasionally an injection is necessary to reduce swelling in an area. This is relatively painless and is done in the weeks following surgery to give you the best possible result.
Any touch-up surgery that may be necessary is not done for at least six months. This is usually a small office procedure and no physician’s fee will be charged. There is a charge for the facility/supplies and anesthesia if sedation is indicated.
We hope the above information will help you in the post-operative period. Remember to call us if you have any questions. Our goal is to give you the best possible care.
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Dr. Neal Goldman is a skilled, experienced, facial plastic surgeon who is specialized in cosmetic and reconstructive surgery of the face and neck. He is board certified by the American Academy of Facial Plastic and Reconstructive Surgery and the American Board of Otolarnygology-Head and Neck Surgery.
Dr. Neal Goldman is a skilled, experienced, facial plastic surgeon who is specialized in cosmetic and reconstructive surgery of the face and neck. He is board certified by the American Academy of Facial Plastic and Reconstructive Surgery and the American Board of Otolarnygology-Head and Neck Surgery.
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