BLEPHAROPLASTY | FACELIFT AND NECKLIFT | MACS LIFT | NASAL SURGERY
DR. RAVAL’S POST-OPERATIVE INSTRUCTIONS FOR BLEPHAROPLASTY
The following instructions are designed to answer any questions that may arise regarding postoperative care and tell you what you can do and what you should not do during your convalescence.
You and your family should read them several times to become thoroughly familiar with them.
Then, attempt to follow them faithfully – those who do so generally have the smoothest postoperative course.
Whatever question arises in your mind, refer back to this booklet; chances are you will find the answer; if not, then telephone us.
Swelling and Discoloration
As you were told before surgery, a varying amount of temporary swelling and discoloration follows every one of these operations, so try not to become anxious or depressed about it–it will pass.
We have tried to keep this at a minimum by prescribing certain medications to be taken after your surgery and by using meticulous surgical techniques.
- Sleep with head of bed elevated for one to two weeks, by elevating the head with two or three pillows.
- Apply ice compresses made of small Ziploc bags, containing frozen corn, peas, or blueberries, to your eyes as much as possible during the first three days after surgery, we highly recommend the Aqua Cool. This machine helps immensely and is very convenient.
- Avoid bending over or lifting heavy things (nothing over 25 pounds) for two weeks. Besides aggravating swelling, this may raise the blood pressure and start hemorrhaging.
- Avoid straining at the stool, which also raises the blood pressure. If you feel that you need a laxative, get Correctol or Colace from your pharmacy. No prescription is required.
- Avoid hitting and bumping your face and eyes. It is wise not to pick up small children.
- Avoid excessive sunning of the face for prolonged periods during the first 30 days following the operation; ordinary exposure is not harmful.
- You may take a shower or bath, including hair washing, the day after surgery. The face should be gently cleansed with cotton pledgets or tips of your fingers. When you shower the day after your surgery, be careful to keep the force of the shower from beating directly on the suture lines. It is ok for the sutures to get wet but not drenched.
- Take only prescribed medication or Tylenol, never aspirin or other medications that are over-the-counter, as it promotes bleeding. Do not take Tylenol with your prescribed pain medication.
- Apply a small amount of Bacitracin or Neosporin to the sutures 5 to 6 times per day. Be very careful not to use too much as it may cause eye irritation.
Generally, the body temperature does not rise much above 100° F following eyelid surgery, and this rises due to dehydration caused by insufficient intake of fluids. People often think they have an increased temperature because they feel warm, when in reality they do not. To be sure, measure your temperature with a thermometer.
Report any persistent temperature over 100° F, however.
Resuming Normal Activities
- You may wear a wig or hairpiece as soon as you desire.
- You may begin wearing eyeglasses or sunglasses the day following surgery. Do not go swimming, diving, water-skiing or participate in strenuous athletic activities for at least two weeks following surgery.
- Eye shadow, false eyelashes, or contact lenses should not be applied until 10 days after surgery.
- You should probably not plan to return to work until four to five days have elapsed following the surgery, perhaps even one week. Even then, it might be wise to procure sunshades with large frames, unless you don’t mind becoming the center of attention. You will have to play this one by ear.
- Alcoholic beverages are discouraged during the first two weeks after surgery. A social drink would be acceptable, but enough alcohol to make one feel “relaxed” also lowers one’s sense of awareness, which is needed to avoid disturbing the area of surgery. Do not take with pain medications or sleeping pills.
Your First Postoperative Office Visit
A Frost stitch (lower eyelids only) is placed to hold the lower eyelids up, preventing retraction. These will be removed after 3 to 7 days, depending on the amount of swelling present.
Do not build up a feeling of fear and anxiety about what is going to be done to you on your first postoperative visit to the office. A few of the skin sutures may be removed with special delicate instruments to minimize the discomfort. The incisions will be gently cleansed and you will probably feel much better.
About Some Potentially Upsetting, but Relatively Unimportant, Things That Might Occur During the Healing Period
- Swelling may persist somewhat longer than usual. However, we have never yet encountered a case where it did not ultimately subside. The same is true of discoloration.
- Swelling and discoloration become more pronounced after some patients leave the office, this is why you should follow the instructions given above to minimize swelling, and not take any medications containing aspirin. Furthermore, if you should have nasal allergy or sinus trouble, you should take antihistamines to decongest your nose, as this may be a contributing factor.
- Rarely, the whites of one or both eyes may become partially discolored. This is painless, will not harm vision, and absorbs eventually.
- Occasionally, the swelling will cause the lower lid to be separated from the eyeball. This condition will resolve as the swelling subsides, but can be prolonged if face powder granules, etc., become deposited in the area when cosmetics are being applied.
- Because a person is so “keyed up” before the operation, there is usually a mental and physical letdown afterward. It is not unusual for the patient to feel depressed and tired following surgery. If this happens, it is not abnormal.
- Occasionally, small cysts, which resemble ordinary whiteheads, will appear beside the upper lid incision; like whiteheads, they will disappear after their contents are expressed in the office. They may also occur in the lower lids, but less frequently than in the upper lids.
- Patients also experience some blurring of vision for two or three days after the operation. This is generally due to swelling and/or ointment that has been used during the operation and will clear spontaneously.
Jeffrey R. Raval, MD, FACS
DR. RAVAL’S POST-OPERATIVE FACELIFT AND NECKLIFT INSTRUCTIONS
The following instructions are based on experience with many facelift operations. They will answer practically any question that may arise regarding the “do’s” and “don’ts” after surgery. You and your family should read them several times so that you may become thoroughly familiar with them. Attempt to follow them faithfully – those who do so generally have the smoothest post-operative course; this, of course, favors proper healing.
WHAT TO DO BEFORE AND AFTER SURGERY TO IMPROVE OUTCOME AND RECOVERY
There have been many studies trying to improve the outcome of surgery. Oftentimes, we are asked what can be done before surgery to improve the outcome. The only preoperative regimen that has been shown to convincingly improve outcome is that of aerobic exercise. Therefore, we recommend 30 minutes of cardiac exercise every day for at least two weeks prior to the surgery. If you have not been on a regular exercise regimen in the past, please consult your primary care physician for recommendations.
Postoperatively, hyperbaric oxygen treatments have been shown to also improve recovery and swelling. We do not provide this in our office, but we do have resources available in Denver, which have hyperbaric oxygen treatments available for you. The cost for five treatments is approximately $800. Please contact our office for more information.
Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount varies from person to person, but it always seems more in the face since there is looseness of the tissues and because even a small amount makes the features appear distorted. Sometimes the swelling becomes a little greater the third or fourth day after your operation. It may become more pronounce along the jaw line, and is generally worse when you first arise in the morning. The swelling itself is not serious and is not an indication that something is going wrong with your operation.
It is not unusual to have varying amounts of discoloration about the face. Like the swelling, it may become more pronounced, especially in the neck, after the first several days or so, but remember this is temporary.
There is usually little actual pain following a facelift, but you may experience a deep bruised sensation as a result of the swelling, and the face may seem heavy. As is usually the case with such things, this seems worse at night and when one becomes nervous.
Unfortunately, the usually prescribed painkillers often cause sensations of light-headedness, particularly in the immediate post-operative period and, consequently, seem to make recovery more tedious. Therefore, it is better to try the application of cold compresses before resorting to drugs. If this is not effective, we will generally prescribe Percocet, Vicodin or Extra Strength Tylenol if there is no history of sensitivity to these products. If the pain is severe, notify the doctor or nurse and stronger medications can be ordered for you. Under no circumstances should ASPIRIN or medications containing aspirin or salicylates be taken without first consulting us. If you are unsure of an effect of a medication, ask us. Be sure to check the labels of any previously purchased medication before you take it.
The incision does extend into the hairline behind the ear for both the necklift and the facelift. This area can cause itchiness as it is healing. This usually resolves with Benadryl and time.
Wash towels (not ice bags) soaked in ice chips and applied across the jaws and neck every twenty minutes for the first 72 hours will help to reduce the swelling, discomfort, and discoloration. They may be placed in a plastic baggie to avoid wetting your dressing and your clothing.
Removal of Dressings
A pressure dressing will be applied before you leave the operating room; it is to remain in place until the following morning. You should be as quiet as possible during this time; therefore, a great deal of talking and having too many visitors are discouraged. If your dressing begins to feel excessively tight or uncomfortable, ask your family member to report it to us.
A drain will also be placed under your neck after your facelift and necklift surgery. This is usually removed the following day. However, if there is a large amount of drainage, the drain may stay in place up to 48 hours.
Elevate the Head of the Bed
To help minimize swelling, the head of the bed should be elevated above the level of your heart. This usually means using 2-3 pillows to sleep with for the first week.
You were given medication before your operation in an attempt to keep swelling, pain and risk of infection at a minimum. Please follow the directions for these medications, as they will provide you with greater comfort during the recovery period.
Getting Out of Bed
We usually recommend you remain in bed during the first 12 hours following surgery. However, we encourage that you get up to use the restroom and take occasional walks as needed. After the first 12 hours, we encourage you to walk 4-5 times per day to stimulate the circulation in your lower extremities.
Avoid STRAINING at the stool. Tell the nurse or the doctor if you need a stool softener or a laxative and we will prescribe one for you. Colace is a stool softener sold over the counter and will help with constipation post operatively.
As previously explained, your face and neck will remain swollen with varying amounts of discoloration for several days. The main thing to remember is that such swelling eventually subsides and that you can help in several ways:
- Avoid bending over or lifting heavy objects for two weeks. Besides aggravating swelling, this may cause an increase in the blood pressure and lead to hemorrhage.
- Sleep with the head of the bed elevated for two weeks following surgery. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of it. Try not to roll onto your face; this tends to tear down the supporting stitches used under the skin of your face. Therefore, it is necessary to sleep on your back for two (2) weeks.
- Avoid straining at your stool.
Sometimes the discoloration may become more obvious after several days. It usually lasts not more than two weeks, all the while decreasing in intensity. The measures previously described to help the swelling will also help the discoloration subside. However, there is no medication, which will cause it to disappear rapidly, only “tincture of time.”
If bleeding does occur, go to bed, elevate the head, apply ice compresses about the face and neck and report it by telephone. If the bleeding has not subsided within 20 minutes of holding pressure, call us immediately. You will probably be told to return to the office.
Generally, the body temperature does not rise much above 100 degrees following a facelift. This rise is due to the healing process. Patients will often think they have an increased temperature because they feel warm, but, in reality, they do not. To be sure, you should measure your temperature by mouth. Report any persistent temperature above 100 degrees.
It is not unusual after a person has an anesthetic or any type of operation for them to feel weak, have palpitations, break out in cold sweats, or get dizzy. This gradually clears up in a few days without medication.
When there is too much difficulty in sleeping, we can prescribe a sedative. It should be remembered that such drugs also tend to make some people feel light headed and weak and should only be taken if needed. In addition, this medication is not to be taken in conjunction with your narcotic pain medication.
Because a person is so “keyed up” before the operation, there is usually a mental and physical let down afterward. It is not unusual for the patient to feel depressed and tired following the surgery. If this happens it is not abnormal. It is not unusual for an individual to go through a period of mild depression after cosmetic surgery, because no matter how much they wanted the operation beforehand and how much they were told about what to expect post-operatively, they are always shocked when they see their face swollen and discolored. Be realistic and realize that this is a very temporary condition, which will subside shortly.
Diet and Alcoholic Beverages
Immediately following surgery, you are encouraged to take a moderate amount of liquids to avoid dehydration. Following face-lift surgery it is best to avoid foods that require vigorous chewing for one week. As always though, a well-balanced diet in moderation is recommended for those interested in maintaining their best physical condition. One or two alcoholic beverages are acceptable two to three days following surgery. However, alcoholic beverages are not to be taken while you are taking your narcotic pain medications or your prescription sedatives
Parts of the face, neck and ears sometimes feel weak or numb after the operation, but this usually temporary. The skin of the face may become tight for a while and you may feel that it interferes with your smile. This will disappear after a few weeks.
There may be transient thinning of the hair in areas adjacent to the suture lines in the temple and behind the ear.
If You Injure Your Face
Many individuals sustain accidental hits on the face during the early postoperative period. Usually, one need not be too concerned, unless the blow is hard or if hemorrhage or considerable swelling ensues. Report the incident at the next office visit or by telephone if you are significantly concerned.
- Wearing glasses and contact lenses. Eyeglasses may be worn as soon as the bandages are removed. Contact lenses may be inserted the day after surgery.
- Hair and Body Care. You may wash your hair out with lukewarm water in the shower and comb it out with a large-toothed comb on the second or third day after surgery.
– You may have your hair washed at a salon one week after your surgery, but do not use the usual-type heating hair dryer, use a hand blow dryer on a low setting. Be careful not to rest your neck on the rim of the washbowl in the area of the incisions. Hair coloring should also be delayed for two weeks after your surgery. The same goes for permanents and other types of relaxers.
- Use cotton balls or gauze to wash the face gently with mild soap, such as Ivory or Neutrogena twice daily after the first week and then use a gentle upward motion.
– You make take a shower by the second or third postoperative day, but NEVER on a day when you have had sutures removed. You can take a bath avoiding the head area the days after surgery.
– Do not tweeze the eyebrows for one week.
– You may wear a wig regularly if you wish after surgery, as long as it does not fit directly over the stitches.
- Pullover Clothing It may be best to wear pull over clothing that fastens either in front or back, rather than attempting to pull over your head for one week.
- Athletics. No swimming, strenuous activity or exercises that involve turning the head for two weeks.
- Returning to work and resuming social activities. When you should return to work depends on the amount of physical activity and public contact your job involves, and also the amount of swelling and discoloration that you develop. The average patient may return to work or go out socially two to three weeks after surgery.
- We recommend that you not drive for at least 10 days. The reason for this is that given the stiffness and soreness of your neck, it may be difficult to make abrupt turns of the head during emergency situations while driving. It usually takes approximately 10 days for this soreness to improve significantly.
After all stitches have been removed, the scars will appear a deep pink color. There will be varying amounts of swelling in and around the scars themselves. With the passage of time, the pink will become white, the firmness of the scar will soften, and will become less noticeable. Each individual varies with respect to healing, but it takes approximately one year for these changes to occur in the scars.
Excessive redness can be treated with laser treatment 1-2 weeks following the removal of your sutures.
- Go over your suture lines two to three times daily with water on a Q-tip around the front and back of your ear. Apply a small amount of antibiotic ointment to the suture lines in front of the ear and behind the ear. The goal is to keep the sutures covered with antibiotic ointment at all times.
- Apply peroxide to staples also, but never use Vaseline on the staples, only peroxide. Do not use cotton balls soaked in peroxide–they will dye your hair. Use only Q-tips soaked in the peroxide. Use the Vaseline, Neosporin or Bacitracin only on the suture lines around your ears, but never in your hair.
- The second or third day after surgery, you may shower with warm water. If you had eyelid surgery, do not be afraid to get the sutures around your eyes wet when showering. Just do not let the shower directly hit your eyes.
- Report any excessive bleeding that persists after pressure if held for 20 minutes.
- Report any signs of infection, such as excessive swelling, redness or drainage.
- Avoid taking medications on an empty stomach. If you experience nausea it is usually due to the pain medication. Try taking half a pill every hour instead of 1-2 every 4-6 hours.
- Never wash your hair the day of staple removal, wash it the following day using baby shampoo only. You may not use cream rinse until we tell you to.
- After your dressing has been removed, we encourage gentle massage of the neck and face area 10 times per day for 10 minutes.
Your First Office Visit
Do not build up a feeling of fear and anxiety what is going to be done to you on the occasion of your first postoperative visit to the office. You will have a large wrap around your face and neck, which will be removed. If a drain was placed, it will likely be removed on the first visit. On occasion, the drainage may be too great and the drain is left in place for a second day. Once your drain is removed, a second wrap will be placed and will you follow up on the following day for another visit. At that time, the dressing will be removed and a removable dressing will be applied. The removable dressing will need to be worn for at least 8 hours a day. While the dressing is off, you will begin your neck massages.
Remember the things you were told before your operation, namely:
- When the bandages are first removed, the face will appear swollen and there will be varying amounts of discoloration. This swelling will subside to a very large extent within two weeks; however, it will take six to eight weeks for all the swelling to disappear and for your face to reach its final contour.
- The discoloration will gradually disappear over a period of 10 to 14 days in most cases. We have yet to encounter a case where this persisted permanently.
a. temperature elevations.
b. sudden swelling or discoloration.
d. discharge from wound or other evidence of infection.
e. development of any drug reactions.
Most of all, BE PATIENT, during the healing process. If you have further questions, you are urged to call me.
Jeffrey R. Raval, MD, FACS
DR. RAVAL’S MACS LIFT POST-OPERATIVE CARE
Following your MACS-Lift procedure you will remain in the recovery room until you have received food and drink, and are ready to go home. The person you have arranged to drive you home will collect you from this area. Someone must be with you for your first 24 hours at home. Please follow the below post care instructions.
- No bending over or heavy lifting for 72 hours
- Elevate the head when lying down and use cold compresses for 24 hours after if desired to keep swelling to a minimum.
- Sleep in upright position; use extra pillows for 72 hours.
- Keep dressings dry 24 hours
- The first 24 hours may be uncomfortable, for pain relief please take regular analgesia as directed by the nurse or physician. DO NOT TAKE Aspirin based or anti-inflammatory medications, unless otherwise indicated and clarified with your Surgeon.
- Please keep garment in place until your day seven appointment, or otherwise advised. You may remove to shower after 48 hours, please be careful when washing your hair as your stitches will still be in.
- For the next two weeks please wear your support garment for 12 hours a day.
- You will return to the clinic on day 1 for a wound check and day 7 to have most of your stitches removed. If you have clips they will be removed on Day 10. Rigorous activity is to be avoided for approx 4 weeks. But moderate exercise can be resumed within a two week period.
- Daily activities can be resumed after one week or as you feel able.
- Any excessive swelling, formation of a painful lump: and or bleeding through the dressing please apply pressure to the area with a clean towel for 15mins. If bleeding persists contact the clinic (303)381- 3223.
- Complete ALL your prescribed antibiotics to prevent potential infections.
- On Day Two start applying the Bacitracin or Neosporin Antibiotic Ointment onto your suture lines 2-3 times per day, for 7 days, or until sutures are removed.
If you have any concerns please contact the clinic on (303)381-3223
In an EMERGENCY contact Dr. Jeffrey Raval on (720)201-1451
DR. RAVAL’S POST-OPERATIVE NASAL SURGERY INSTRUCTIONS
The following instructions are based on experience with thousands of nasal plastic operations. They are designed to answer practically every question that may arise regarding the “dos” and “don’ts” after surgery. You and your family should read these several times so that you may become thoroughly familiar with them. Attempt to follow them faithfully – those who do so generally have the smoothest post-operative course. This, of course, favors proper healing.
Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount of swelling varies from person to person, but it is seen more in the face because there is looseness of the tissues, and because it makes the features appear distorted. It is usually greater when both the inside and outside of the nose have been operated upon than when surgery is done on the outside only. You are given medicine before the operation to attempt to keep swelling at a minimum. You will receive another type when you leave the hospital to speed up absorption of that which has formed.
Sometimes, the swelling will become a little greater on the first, or second, day after you leave the hospital or office. It may also become more pronounced along the jawline and is generally worse when you first arise in the morning. This is proof that it is better to stay up as much as possible during the day! This is not serious and is not an indication that something is going wrong.
The main thing to remember is: such swelling always eventually subsides and your face will return to normal.
You can help the swelling and your recovery to subside in several ways:
- Preoperative exercise: Studies have shown that one of the most effective ways to improve your recovery is by vigorous aerobic exercise. I, therefore, recommend vigorous aerobic exercise for at least 30 minutes per day for at least two weeks prior to your surgery. This will lead to improvement and recovery of any type of surgery. The bottom line is, the better shape that you are in at the time of surgery, the better you will do.
- Avoid bending over or lifting heavy things for one week. Besides aggravating swelling, this may raise the blood pressure and start hemorrhage.
- Sleep with the head of the bed elevated until all of the dressings have been removed from the nose. To accomplish this, place 2 to 3 pillows under the head of the mattress and 1 or 2 on top of it. Try not to roll onto your nose.
- Ice compresses over the eyes for the next three to four days are helpful. Try not to make the icepack too heavy, such that the weight is uncomfortable. Sometimes, frozen peas or frozen corn have been shown to work a little bit better since they conform to the shape of the eyes more readily.
- When bathing, avoid getting the nasal dressing wet. If it becomes loose, let us know. Do not pull the dressing off.
- Avoid constantly rubbing the nostrils and base of the nose with Kleenex or a handkerchief. Use a mustache type of dressing instead if the discharge is excessive. Report any excessive bleeding that persists after applying pressure and lying down for 15 minutes.
- Arnica Montana: There have been a lot of published reports on Arnica Montana and its ability to help with swelling. Most of the reports are inconclusive, but there are some that show that it may help. My basic feeling is that Arnica Montana probably will not hurt, but it is questionable as to whether or not it provides any relief. I do not discourage trying it to see if it provides any benefit. It is available in most health food stores.
It is not unusual to have varying amounts of discoloration about the face. Like swelling, the discoloration may become more pronounced after you have been discharged; it usually lasts not more than a week, all the while decreasing in intensity.
The measures that help the swelling to subside will also help the discoloration.
You can camouflage the discoloration to some extent by using makeup. Discolored areas usually require a makeup with a heavy base. A water-based makeup may then be applied with a sponge. This may make your skin dry. If so, a good moisturizing cream should be applied when it is removed.
Whenever the nasal passages are blocked, such as when you have a cold or allergies, the nasal glands produce more mucus than normal. Your nose is blocked from the swelling resulting from the operation, so you can expect more mucous drainage for several days. It will be blood tinged and should cause you no concern unless the drainage becomes frankly bloody and flows profusely, as when one cuts a finger. If hemorrhage does occur, go to bed, apply ice compresses about the neck and face, and report to us by telephone. You will probably be told to return to the office. Avoid: bending over and lifting heavy objects, hitting your nose, removing blood clots, etc., from within the nostrils and picking at the nose.
There is usually minimal pain following rhinoplasty. Most patients complain of congestion with the nasal stents in place. You will receive medications for pain control, if you experience any. Intranasal stents are usually removed at the time of your first postoperative visit, which generally occurs 3-5 days following your surgery.
When there is too much difficulty in sleeping in the period before the dressings are removed, we will prescribe a sedative. It should be remembered that such drugs often tend to make one feel lightheaded and weak and tends to slow recovery.
Because a person is so “keyed up” before the operation, there is usually a mental and physical letdown afterward. It is not unusual for the patient to feel depressed and tired following surgery. If this happens, it is not abnormal.
It is not unusual for an individual to go through a period of mild depression for a period of 24 to 72 hours after surgery, because no matter how much they wanted the operation beforehand, and how much they were told about what to expect postoperatively, they are shocked when they see their face swollen and perhaps discolored.
Be realistic and realize that this is a very temporary condition, which will subside shortly. The best “treatment” consists of busying one’s self with the details of postoperative care and trying to divert one’s mind.
Alcoholic beverages are acceptable 24 hours following your surgery. However, alcoholic beverages are not to be taken with narcotic pain medication.
Nasal Blockage and Nose Drops
Nasal blockage is to be expected after rhinoplasty and will gradually subside over a period of time. The patient must reconcile himself or herself to this. The blockage is greatly improved following your first postoperative visit after the intranasal stents are removed. However, you may experience continued blockage from swelling for as long as 6-8 weeks following surgery. We do not recommend the use of Afrin or other decongestant nasal sprays that can be purchased over the counter, as this may inhibit or damage the healing process occurring inside your nose.
You may sleep without the head of the bed elevated after two weeks.
Light activity, such as walking on a treadmill, can be resumed after 10 days. Full activity can be resumed after two weeks.
No Advil, aspirin or other aspirin-containing products for four days following surgery. After four days, these may be used as a supplement to your narcotics to help control pain and discomfort.
Avoid sneezing until the bandage is removed; if you must, let it come out of the mouth–like a cough. If it becomes a real problem, we will prescribe medicine to alleviate the condition.
During the first week, you will have a nasal splint on the bridge of the nose. Eyeglasses or sunglasses may be worn over this. Once the nasal splint is removed, usually 7-8 days following surgery, a piece of tape should be applied over the bridge of the nose to act as a cushion from the weight of the glasses.
Contact lenses may be inserted the day after surgery.
Showering and hair washing can be resumed 48 hours following your surgery. However, caution should be used around the nasal splint. Try to keep the nasal splint as dry as possible.
Dryness of the Lips
If the lips become dry from the breathing through the mouth, coat them with oil, Vaseline or Chapstick.
Generally, the body temperature does not rise much above 100°F following rhinoplasty, and this rise is due to the fact that the patient becomes mildly dehydrated because he does not drink enough water. Patients will often think they have an increased temperature because they feel warm, but in reality do not. To be sure, you should measure your temperature either rectally or in the armpit; a rectal temperature is one degree above and the armpit temperature is one degree below that measured by the mouth.
Report any persistent temperature above 100° F, however.
When discharged from the hospital, you will be given the remainder of your medicine that you were taking prior to admission and in addition, medication prescribed for you while in the hospital. Take these as per directions given you until the supply is exhausted; these prescriptions need not be refilled.
You will also be given some prescriptions at the time of discharge. Your will receive a narcotic pain medication, as well as an antibiotic. Additionally, if there are no medical contraindications, you will receive a steroid, which will help to decrease swelling during your postoperative period.
It is not unusual after a person has had an anesthetic or any operation for them to feel weak, have palpitations, break out in “cold sweats”, or get dizzy. This gradually clears up in a few days without medication.
Your First Postoperative Office Visit
Soon after returning home, you should call the secretary in the office to schedule your first postoperative visit with me at three to five days following your surgery. During this visit, your intranasal splints will be removed. On postoperative day 7 or 8, your outer nasal splint will be removed. Once the outer nasal splint is removed, you will be given a nasal splint to be worn at night for the next two weeks. An analogy for this would be similar to the use of a retainer after braces have been removed. Wearing the nasal splint at night helps to maintain the straightness of your new nose, as well as decrease any swelling.
Do not build up a feeling of fear and anxiety about what is going to be done to you on your first postoperative visit to the office. The material inside your nose will be softened so that it comes out easily. You will feel much better after your first office visit.
Returning to Work or School
The average patient is able to return to school the day after the bandages are removed. That is usually eight days following surgery. Some hearty souls have done so earlier.
When you should return to work depends upon the amount of physical activity and public contact your job involves, in addition to the amount of swelling and discoloration you develop; the average patient may return to work in the eighth to tenth postoperative day, when these factors are minimal.
Injury to the Nose
Many individuals sustain accidental hits to the nose during the early postoperative period. One need not be too concerned, usually, unless the blow is hard or if hemorrhage, or considerable swelling ensues. Report the incident at the next office visit or by telephone if you are sufficiently concerned.
Remember the Things You Were Told Before Your Operation:
- When the bandage is first removed completely, the nose will appear fat and turned up too much; this is due to operative swelling over the nose and in the upper lip.
This swelling will subside to a large extent within a week; however, it will take up to 4-6 months for all the swelling to disappear and for your nose to reach its final contour.
- The discoloration will gradually disappear over a period of 7 to 14 days in most cases. We have yet to encounter a case where it persisted permanently.
- The thicker and oilier the skin is, the longer it takes for the swelling to subside.
- The upper lip may appear stiff for a while and you may feel that it interferes with your smile; this will disappear within a few weeks.
- The tip of the nose sometimes feels numb after rhinoplasty, but this will eventually disappear. If you have any further questions, you are urged to call me.
Jeffrey R. Raval, MD, FACS