Rhinoplasty Aftercare

This guide covers what you need to know during the first 7+ days of your Rhinoplasty surgery recovery, to ensure you are recovering as safely as possible and are fully aware of how to perform your normal daily routines.

The most important aspect of Post-Rhinoplasty surgery is never to assess your results in the first 7-14 days after surgery. You may naturally see angular changes to your profile and a size reduction instantly, but there will always be internal nasal bruising and swelling to your nasal tip and upper bridge in the first several weeks that needs to reduce. Though you may return to full energy within 1-2 days of rest, your nose begins the process of swelling reduction once the nasal splint has been removed.

PLEASE NOTE THAT THIS SECTION IS AN OBSERVATION OF WHAT TO EXPECT AS A GUIDELINE. 

Date of Surgery

1. You may feel tired and/or nauseous in the first 24 hours after surgery. This is entirely normal and may lead to vomiting. This is commonly caused by the numerous medications and fluids that were administered that your body wishes to dispel. This is reported in 5% of post-Rhinoplasty patients. 
2. Your bruising around your eyes will be visible.
3. Your nose may likely appear upturned / over-rotated. As the swelling starts after surgery, your swelling may cause an upturn of your nasal tip and expose more of your nostrils. This is nothing to be concerned about and is not permanent. As the swelling reduces over the next several weeks, the nasal tip will return to its normal position. 

Day: 1

1. Your bruising will have increased from the previous day, and the swelling will likely have increased around your upper eyelids. This is normal, and we expect this in all patients. It is also normal to have swelling to the cheeks and jawline.
2. You may still be bleeding from the nose, which should be continued to be managed by using the disposable drip pads and tape we provided you to collect any discharge.  This should be used until you have observed the bleeding stop.
3. If you bought any herbal products like Arnica, you can resume these from today. 
4. Your nose will be almost blocked completely, and you may have to resort to occasional breathing through your mouth, especially at night. You are able to use any decongestant nasal sprays or saltwater sprays we previously advised from 24-hours after surgery.

Day: 2

1. Your bruising will further increase and be visibly more apparent around the eyes and cheeks. This is normal, and we expect this to look more intense than the previous day.
2. You may still be bleeding but at a very slow rate. 40% of patients on day 2 will still have discharge/bleeding to manage. 
3. Your breathing will still be constricted, and this is normal.

Day: 3

1. Your bruising and swelling will now be reaching a peak and will look slightly more than the swelling from day 2. Either or both of your eyes may be swollen, causing a limitation in opening your eyes fully. This is normal, and you have now likely reached the peak of swelling. 20% of patients may have slightly swollen cheeks and soreness further down towards the jawline. This is not uncommon and is nothing to be concerned about.
2. Any bleeding should have stopped entirely for 95% of patients. 5% of patients may still have a continuation of slight discharge. If this is the case, lay back in an upright position and place an ice pack on your forehead (not on your nose) and leave for 10 minutes. After 10 minutes, remove the ice pack and rest for 10 minutes before re-applying the ice pack for another 10 minutes. Please continue to do this for 60 minutes and let the remaining discharge slowly stop itself. 
3. If you assess the inside of your nose, expect swelling, blood clots and inflamed tissue. do not be concerned about this; this is temporary and should not be touched. This will be for every Rhinoplasty patient. 

Day: 4

1. Your bleeding will have stopped by this day, but if it has not, please get in touch with us, and we will observe and advise, but again it is nothing to worry about.
2. Finally, your bruising, purple skin areas and swelling will begin reduction on this day. You may see yellow pigmented skin around the lining of your bruising, and this is a sign of recovery.
3. Please expect your nostrils to look slightly asymmetrical. Almost 70% of patients will see asymmetry around their noses, which is nothing to worry about. It is worth reminding you that assuming this will be a prevailing result will lead to unnecessary concern.  You are on day 4 of a 12-month recovery, and making observations at this stage is not advisable. 

Day: 5

1. You will see a much-improved decrease in swelling and bruising compared to Day 3. You may see more areas of yellow pigment around the skin as the swelling increases in the recovery speed. 
2. Your nasal splint may look slightly off-centre due to the swelling, and in 15% of patients, it may have become loose. This is normal. If your splint is no longer secure, it has served its purpose. There is no need to re-secure the splint; let it fall out naturally. For most patients, the splint will be securely attached. 
3. Should you still find it difficult to breathe, this is normal. However, you can discontinue the Paracetamol if you are not in any pain.

Day: 6

1. A further reduction to bruising and discolouration and your facial movements may feel more flexible. 
2. Please ensure you follow the advice provided as you may have been advised to soak the splint the day before your next appointment with our clinical team. 
3. Your post-operative might be booked on this day if this was arranged accordingly by our team. 

Day: 7

1. This is commonly your post-operative date when you will back to see us for the removal of sutures and splint (if app). 
2. Again there will be further reduction where virtually all bruising would have subsided with trace amounts remaining. 

As part of your surgery, you were administered General Anaesthesia. It is not uncommon for anaesthesia to cause nausea or sickness whilst at the hospital. We will provide you with Anti-sickness mediation during your stay to manage this. It is likely that the feeling of nausea is still present after leaving our hospital. If you are sick when returning home, this is normal and may cause your nose to bleed, but it is nothing to be concerned about. Should you be sick, it is important to replenish any lost body salts and to keep hydrated with fluids. 

There is no restrictions to movements or any day-to-day house chores however, try to ensure you do not bend your head down for too long a period or lift any heavy objects E.g suitcases, heavy grocery bag etc. This is to avoid a rush of blood to the head and risk of a nasal bleed.

WHAT TO EAT/DRINK
There are no restrictions to eating/drinking. For the first few days after surgery, try to avoid spicy food and overly hot drinks. I.e let coffee/tea etc cool slightly before consuming.

It is essential to take all medications that we have given you. In most cases, you would have been given the following:

• IBUPROFEN
Take 400mg every 6 hours with food. This is to help with any swelling and inflammation.

• PARACETAMOL
Take 2 tablets every 4 hours. This is to control any moderate pain/discomfort.

PLEASE DO NOT TAKE MORE THAN 8 TABLETS IN 24 HOURS.

Most patients feel no pain but do not be concerned if there is slight pain. You can avoid any onset of pain if you continue to take both the above tablets on time as soon as you leave the hospital.

If you are on any other prescription medications, please continue to take them as normal after surgery, unless you have been told otherwise.

For all herbal supplements, dietary products, vitamins, etc. you can restart these 24 hours after your surgery.

• ARNICA

Arnica is a holistic product you may have been previously advised to purchase. You can resume taking these from when you return home after surgery, from the first evening onwards. 

• DECONGESTANT SPRAYS / SALT SPRAYS

You are permitted to use these sprays from 24 hours after surgery. 

Bruising is as common as bleeding, and a Rhinoplasty is performed in an area where soft skin tissue is present near your eyes and cheeks, which is susceptible to swelling and bruising.

Bruising Locations always vary. You can have bruising in the lower eye bag area or in some cases, in the upper eyelid. In common circumstances, your cheeks may be slightly swollen down to your jawline. As mentioned above, this is the softest tissue closest to the nose that responds to trauma. Bruising around these areas will continue to increase for up to 72 hours after your surgery and then begin to reduce and disappear over 7-10 days.

Bruising and swelling can’t be predicted perfectly. Every patient’s defence against trauma is different, and for this reason, you may recover faster or slower than a person who you know has had this surgery before.

What is important to remember is that swelling and bruising is not permanent, your skin will heal quickly and bruising and discoloration disappear completely once you have recovered. 

TIPS AND TRICKS TO BRUISING/SWELLING

• We may have discussed with you that Arnica tablets are an alternative supplement used to help treat bruising. This is taken as tablets before and after the surgery.

• Using Ice Packs (Homemade or Disposable) are great to apply when you come home after surgery. They will help “freeze” the increased swelling of the nasal/eye area. It is important never to apply ice packs on the nose itself (the nasal bridge). Always apply ice packs to the forehead or around the eyes.

• You must continue taking Ibuprofen after surgery to keep the swelling down as best as possible. 

NASAL PACKING

The nasal packing will likely have been removed at the hospital.

NASAL PADDING

The nasal padding covering your nostrils is to collect the remaining bleeding discharge. Generally, these can be removed after 24-48 hours when the bleeding has stopped. Commonly, some patients need to wait a few days before the bleeding has completely stopped before they can stop applying the padding completely.

NASAL SPLINT

Your splint must not be removed. This will be removed at your 7-day post-operative review by our nursing team.

Your nasal splint is solely to protect your nose from trauma. If you notice your nasal splint is slightly bent and not sitting on your nose completely straight, this is fine and is not leaning/bending your nose during your recovery. Nasal splints will often move to one side as the swelling on one side pushes it away.

Usually, 1 in 5 patients may experience loosening of the nasal splint. This can be caused by the nose swelling reduction pulling away from the splint or even oily skin dislodging the splint. The splint may inevitably fall off after 3-6 days. Again this is fine but try not to assess your nose as the width of the nose will appear wider and swollen.

IT IS ABSOLUTELY CRUCIAL THAT YOU NASAL SPLINT STAYS DRY DURING THE FIRST 7-DAYS OF RECOVERY. DO NOT LET WATER ENTER UNDER OR AROUND THE SPLINT. IF YOU FEEL THE SPLINT MAY HAVE BECOME WET, PLEASE CONTACT THE CLINIC.

BATHING/SHOWERING

You can shower anytime after your Rhinoplasty with the help of a few tips:

• Never let your splint get wet until the night before your appointment for splint removal.
• Try to use a hand shower and wash your whole body as normal, but be careful about bending your head downwards.
• Keep the temperature of the water lukewarm.

Key Facts:

• Only start the below process of cleaning your nose once your bleeding has completely stoppped and you have removed the nasal padding (drip pad).
•  You should clean the inner nostril area no more than 3-times in the first 7-days. Please only clean the inside of the nostril area to remove anny dried blood or mucus.

Be patient when cleaning your nose after rhinoplasty surgery.

STEP 1:
Dip a cotton bud in hot water and gently massage it around the inner nostril. This will slowly dissolve and dislodge the crusty discharge. It may take up to 5 cotton buds per nostril to completely clean. It can take up to 30 minutes to clean. 

STEP 2:
Dip a fresh cotton bud in some Vaseline and lightly coat your inner nostrils.

Generally, this only needs to be performed on one occasion to remove all dried residue within the nose.

BLOWING YOUR NOSE
Try not to blow your nose, but if you have a lot of loose mucus, then do so extremely slowly and softly. Blowing your nose on multiple occasions or aggressively will likely encourage bleeding.

Try to use a saltwater spray to help clean the inside of your nose. 

Bacterial Infections after Rhinoplasty are quite rare. There are two signs to look out for when checking for infection:

1.  Your bleeding has stopped completely but after several days/weeks you have a sudden bout of profuse bleeding. This may likely be due to a wound breakdown and antibiotics may be prescribed. In extremely rare cases (less than 1%), you may need to have the nasal packing re-inserted to absorb and stop the bleeding.
2. Extreme swelling to the width of your nose specifically between your eyes and swelling/redness in the corner of your eye(s). This is likely an infection and requires antibiotics to treat.

WHAT IS NOT AN INFECTION

Patients often observe an off smell in their noses or a bitter taste in their mouths a week or so after surgery. This is caused by regaining improved senses of taste and smell after nose surgery but also as the sinus ducts are likely swollen causing the mucus productions to contain an off smell/bitter taste. In this case, try to use a saltwater spray to irrigate your nasal channels up to 5 times daily and include a decongestant spray at night for 3-4 nights. 

A bacterial infection is nothing to be concerned about as long as it’s treated within a reasonable time.

• The first 7 days after surgery, try to rest and relax at home and don’t begin strenuous exercises.
• Returning to work can take 7-14 days from your Rhinoplasty procedure.
• Returning to the gym can be after 7 days after the surgery for light cardio exercise, running and cycling.
• Returning to heavy weight lifting can be from 6 weeks after surgery only. Any lifting before may cause nasal bleeding.
• Returning to swimming/sauna/spa only after 6 weeks. This ensures all incisions are fully healed and not open to a possible infection.
• Returning to facials, facial peeling, or any cosmetic treatments to the face should only be considered 8-12 weeks after your surgery.
• You can use all your everyday skincare products after 7 days post-rhinoplasty. 

• Short-haul flights of 2 hours or less can be taken 24 hours after your surgery. You will have special guidance provided about this.
• Mid-haul flights of 2-4 hours can be taken after 5 days
• Long haul flights of 4-12 hours can be taken after 7 days from your Rhinoplasty surgery

I’m finding it impossible to breathe through my nose. Can anything be done?

During the first 28 days, you may find it difficult to breathe through your nose and may resort to having to breathe through your mouth. Unfortunately, this is considered the most discomforting aspect of initial recovery. Some patients find relief in taking a nasal decongestant spray, Menthol Crystals can sometimes help with initial relief.

My nasal splint looks lopsided. Is this ok?

Your splint is to protect against any knocks to the nose accidentally. Your splint may be pushed to one side from swelling, forcing the splint to look bent. This does not mean the nose is recovering to one side. In all instances, ensure your splint does not come into contact with water until the night before you are booked in for your splint removal appointment.

I’ve looked up my nose, and it looks infected. Do I need antibiotics?

Your nose has the following:

1. Swelling from the walls on the nose
2. Inflamed balls of tissue
3. Dried Blood/Mucus.
4. Internal stitches (dissolvable) that look like white thread.

When added all together, your nose inside may appear of concern. However, all aspects above are a part of the healing process and should be left to heal, dry and shed naturally. This can take several weeks.

My nasal splint is peeling off. Is this ok?

Swelling and oily skin can contribute to the splint peeling away. If this happens, do not attempt to remove the splint and let it naturally peel off if it’s becoming too loose.

My nostrils look asymmetrical; is this a final result?

Not at all. You should not be assessing your nose at this point. Swelling will always cause some or all of the following appearances, and none of these should be of concern:

1. Your nasal tip appears too high – this is due to the swelling of the nose raising the tip upwards, and it will settle down back to normal as your swelling reduces.
2. Your nasal tip appears bulbous – in some instances, it may become more bulbous than before surgery. Again swelling has filled the nasal tip and requires time to reduce and reduce in size.
3. Your nostrils are different shapes/sizes – this is very common. Swelling on either side of your nose may pull, stretch or weigh down on one/both nostrils and this is temporary while the swelling is applying weight on the tip.