After Surgery

You should sleep with the head up at 45 degrees for the first 72 hours. Many patients find using a travel pillow helpful for stability.

The day after surgery is often comfortable, but things will get worse before they get better. Days two and three post-surgery are the worse in terms of tiredness, nasal congestion, swelling or bruising.

You will experience some ooze of blood-stained secretions in the first 3-4 days, and you will feel tired to a variable degree after the anaesthesia. You need to rest and not overexert yourself. You should use the cooling pads at fridge temperature on your cheeks

You may sniff to clear secretions and blow your nose gently after three days.

If you feel the need to sneeze, let it happen with your mouth open.

The throat may be uncomfortable.

You will see swelling and bruising under your eyes (use a cooling pad at fridge temperature)

You must keep the plaster cast dry. You may shower if the cast stays dry.

You will see a difference in your nostril shape from day to day due to internal swelling.

Use the antiseptic spray, clinisept to clean your upper lip and the base of your nose gently.

Use the ointments and drops which were dispensed to you.

You should make the most of the first week after surgery to rest and convalesce. Patients who rest, recover, and heal much quicker.

When we book your surgery day, we also book your appointment for cast removal which is 6 to 8 days after your operation. You will have two further follow up appointments, one at around three months and the other at a year.

The chloramphenicol eye ointment is to use inside of the nostrils and along the stitch line if you have had an open approach. You should use it a minimum of three times a day. It should be used after the decongestant spray. The ointment keeps the nostrils moist, and it is a topical antibiotic.

The decongestant nasal spray should be used three times a day and it helps with a sense of relief in the first two weeks. Do not use after two weeks.

Avoid putting fingers, tissues, and buds inside of your nostrils.

You will be very congested.

We do not use nasal packs or tampons inside of the nose. You will be able to breathe through your nose but within the first week you will get a lot of nasal congestion. It feels as if you have a heavy cold with the congestion only starting to ease after the cast if removed and the nostrils cleaned. The nasal decongestant spray will give you some relief.

You may sniff to clear secretions and gently blow your nose from day three after surgery. Once your cast is removed you will be able to inhale steam and the moisture will help cleaning the secretions and blowing will be easier.

You may use an antiseptic spray and with a clean tissue or bud clean the base of the nose but avoid using fingers, tissues, or buds inside the nostrils at this stage. Using the ointment on a regular basis will keep the nostril crusts and dissolvable stitches softened. Once the cast is removed, we will clean inside the nostrils.

You will be quite comfortable as the anaesthetic drugs are still in your system. Some patients find it difficult to sleep. You should sleep with the head raised at 45 degrees. Three pillows. It makes the face a little less puffy. It is also helpful to use a travelling neck ring for comfort. Make sure you take all the medication given even if you are not in discomfort.

The nose bleeds and you just need to dab any secretions that come onto your upper lip. Do not blow, or push tissues inside.

Today and tomorrow will be your worse days. You are going to feel tired and with general body ache. The throat will be dry and the puffiness in your cheeks will be worse. It is the worse day for swelling if piezo technology is used. The piezo uses irrigation-water during surgery and it makes the tissues oedematous. The fluid and puffiness will go down quickly over the next few days.

Just as you thought you would be feeling better, you are feeling worse. The bruising is at its worst and the secretions from the nose still have a string of blood. You are very congested, and it is very important you use the ointment and the spray as indicated. Continue to use the medication regularly.

Stay strong, after today, you will turn the corner, and matters improve quite quickly.

You will be feeling a lot better, and the blue bruising will start to turn yellow. Some of the swelling under the eyes will now travel to your jawline. The nasal secretions will be dryer and congealed in the nostrils. Do not attempt to remove the crusts as it will be uncomfortable but please continue to use the ointment generously.

You will start to be impatient about having the cast removed. The cast will feel a bit looser, and it can feel itchy. You are now probably a bit bored and feel a combination of anxious excitement about your appointment for cast removal. Its fine to go for a walk-no other exercise.

We will see you back in the office at 5-8 days when the clinical nurse specialist or one of the consultants will remove the plaster and clean the nose. If there are any splints inside the nostrils, those are removed at the same time.

Having the cast removed is slightly uncomfortable so you might benefit from taking paracetamol a couple of hours before coming to the office. Make sure you have something to eat. It can be helpful to have your support person with you at this emotional time. You may have different emotions – be very happy or feel shocked, tearful, and very emotional, all reactions are very normal at this stage.

It may take some time to become acquainted with your new nose so please don’t worry. Your face is still a bit puffy, and it can take a bit of time to feel comfortable seeing yourself with new appearance. Remember you are at the very early stages of healing. The best thing will be to get back home and have a long steamy shower, the moisture will help the skin to breathe again, and it will help with the dryness of the nostrils. Use an exfoliation product to clean the skin dead cells and start doing lymphatic drainage massage. Using the gel face mask will be helpful to reduce the swelling.

After cast removal you may be tempted to look at your nose all the time, we would recommend you avoid mirrors and phones for the first few days as the nose will keep experiencing many changes. At this stage of healing, you may experience congestion, the dissolvable stitches can be visible and as they break down, they may drop out of the nose. When you touch the nose, you may feel irregularities and notice asymmetries. You will have a tingling, woody sensation with numbness on the nose which is often worse in the nasal tip. You will just be ‘very aware’ of your nose.  We will now book your next appointment in approximately three months’ time.

It is very normal to have redness inside the nostrils for a few weeks after surgery. The dissolvable stitches can cause a reaction on the skin, and they can get mixed with the nostril hair follicles. This localised infection, ‘like a spot’, gets better with a topical antibiotic ointment. The same chloramphenicol ointment we advised you on when you left the hospital.

If you have had an open approach and/or an alar base reduction, you will have scars at the base of the nose which will be pink for a few weeks. There are several silicone gels for scar improvement which can be useful. Dermatrix, silderm, Kelocote. You can apply those daily for six weeks.

With one index finger either side of the nose, use the length of the index finger and not just the tip, you should swipe from the nose to under the eyes to finish on the side of your face beneath your ears then sweep down you neck to the notch between your collar bones. 2 minutes every morning for the first two weeks.

1. You will be very aware of your nose and will continue to feel congested for several weeks. You may blow your nose gently. It is helpful to have moisture. Steam in the shower or use inhalations of steam up to three times a day. This will help with congestion (congestion can be a problem for up to 6 weeks). We normally recommend a sesame seed oil spray e.g., Gelositin/Nozoil. These are soothing and minimise crusting. 
2. Look after your skin– use a non-soap gentle cleanser and gentle exfoliation for the first two weeks. We will advise you on any additional products. Use a SPF 50 sunscreen all over the nose (including the base of nose) and face, for the first two months after surgery.
3. In the early weeks it is not unusual to detect an odour inside your nose, this is normally from the dissolvable stitches. Clean gently inside your nostrils with a moistened cotton bud. 

1. You will see some variable swelling in your nose usually related to your skin type. We will advise you if taping or massage is required. To massage, place your index finger on either side of the nose just below the bridge and sweep down the cheeks. Work your way down to the tip. Do this for 2-3 minutes as part of your skin care. We will instruct you about taping if necessary
2. You may wear makeup as soon as your plaster is removed.
3. Glasses are permissible. They sometimes, however, make an impression on your skin. You may consider contact lenses if your nose is still too tender.A strip of tape over the bridge on your skin will help with pressure from your glasses.

During the healing phase and as there is internal swelling, the nostrils are often a different size. You will probably notice this a lot more than anyone else.

Glasses are permissible but if the frame is heavy, it may leave indents on the skin. You may consider contact lenses for the first month or if the nose is still tender. A strip of tape on your bridge where your glasses rest mat help.

You may wear make-up as soon as your plaster is removed.

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Depending on your skin type, taping can be helpful. Use the 3-M micropore surgical tape 1.25cm width. Overlap the tapes avoiding any gaps. This will keep pressure on the skin for several hours a day. Most people choose to tape the nose when they go to bed. You can continue to tape every night for two weeks. nose taping video

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This can happen if the dissolvable stitches are still present, and some mucus gets trapped around the stitch. A moistened cotton bud and gently cleaning of the nostrils is helpful followed by an antibiotic ointment or cream. Chloramphenicol ointment or fusidic acid cream.

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You should allow two weeks before you return to normal activities, including socialising, partying, travelling, commuting to work.

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You should allow two weeks off.

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Ten days after surgery, you should be able to return to normal activities. If the surgery has been complex or the recovery slow, it would be better you wait for two weeks.

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You should not fly for the first 10 days following surgery.

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You may start toning and gentle exercise at two weeks. Avoid Undertaking strenuous ‘red faced’ exercise for 3-4 weeks to minimise swelling/throbbing in the skin. Refrain from any contact sports for 6 weeks, as your nose will still be very vulnerable.

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You should avoid alcohol for at least two weeks after surgery. Alcohol also causes facial puffiness so you may be better avoiding it for longer.

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Please follow the instructions given. There is a lot of information online, but we will prefer it if you trust us and follow our protocols.

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Do not take arnica before surgery as it can potentially cause more bleeding during the operation. After surgery you may use topical arnica cream under the eyes, but it has not been proven to be helpful. There is no need to take arnica tablets.

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Use should use a SPF 50 sunscreen all over the nose (including the base of nose) and face, for the first two months after surgery. After any intervention, the skin is at risk of hyperpigmentation.

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You may have facials or beauty treatments 6 weeks after your surgery.

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Yes, you can but it may be better to wait until most of the swelling has settled.

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The risk of needing a secondary procedure (revision surgery) is between 4-8% depending on the complexity of the original surgery. For patients who have had their first surgery elsewhere and we undertake the revision/reconstruction, the risk of needing a further procedure is higher at 12%. Further surgery incurs further charges.

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You will see the difference in appearance immediately after the cast is removed but of course this is the early stage, and the result doesn’t happen for several months and sometimes years. It depends on the skin re-draping over the new framework.

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