Before Rhinoplasty Surgery

Aesthetic surgery is elective. This means that it is not done as an emergency but should be done at a time of choosing when both your own health and life are at an optimum.

The reason for this is that it helps with the recovery and will also reduce the chance of any complications. For many of our patients undergoing elective surgery, we will carry out tests before the operation to ensure that your health is maximised. This may include blood tests, X-rays and heart tracings. We work at major private hospitals in London and they carry out a pre-assessment as part of your admission for surgery. This can help identify underlying medical conditions which have not been identified to date and can be optimised prior to going forward for your elective surgery.

In terms of physical health one of the most important things is to stop smoking and vaping if this is a regular habit. Smoking has been shown to reduce wound healing as it reduces the blood supply to the skin and tissues by narrowing the blood vessels. It is the nicotine within smoke that does this, and on this basis nicotine replacement products should not be used either. A reduction in the blood supply to the tissues can reduce healing, result in blistering and tissue loss and also increase the chance of infection.

One of the most important aspects of undergoing aesthetic surgery is to be in a good state of mind. It is well documented that patients having personal problems or conflict in their lives at the time of surgery potentially have a poorer outcome than those that are at peace. It is therefore not a good idea to have any form of aesthetic surgery if you are in the midst of relationship difficulties, bereavement, divorce, financial difficulty or conflicts at work. It is imperative that any mental health conditions such as body dysmorphia are actively managed by a specialised psychologist.

We would generally recommend a reduction or stopping alcohol prior to surgery for at least a week and ideally a reduction in the consumption of red wine as this can thin the blood. The aim of this is to reduce the dehydrating effect that alcohol can have on the body. A well balanced diet is important in the approach to surgery with plenty of fruit and vegetables, which would ensure your vitamin levels are optimised. Many patients follow anti-inflammatory diets before, during and after the surgery. Vitamin supplements are not usually necessary and it is important to let your surgeon know if you are taking any other supplements such as garlic, ginkgo, glucosamine or fish oils as these can thin the blood and therefore increase the chance of bleeding at the time of surgery. For young women, a pre-operative blood test will check the red blood cell level and rule out anaemia relatively common due to menstrual bleeding and may occasionally need iron supplementation or an increase in iron containing foods such as kale and spinach in the diet.

Physical fitness is also important in the run up to surgery and it is important to be mobile and active. This should be combined with keeping well hydrated by drinking plenty of clear fluids and hopefully this will help reduce the chance of a deep vein thrombosis.

Clinical photos are an essential part of your consultation. These are used as part of your medical records and used for simulations of desired outcomes. Photoshop simulations are a good tool for communication and not a guarantee of results.

In complex cases with previous trauma or previous surgery we would arrange for a Cone Beam CTscan. If you are fit and well no further tests are required.

It is very normal to feel apprehensive at the thought of being put to sleep. We have worked with the same anaesthetic team for twenty years and we can guarantee that safety is their priority. We trust them even with our own children when they need surgery. For most people, general anaesthesia is a very pleasant experience, and the modern drugs have fewer side effects.

No surgery is without risks. First, get ready emotionally as this isn’t just a physical but also an emotional journey that many patients can underestimate. Manage your expectations as surgery aims to improve your appearance, not at perfection. It is important that you take time to think about which style of nose you wish and to be open and honest with us during the consultation.

The risk of infection is low under 1% and you will have prophylactic antibiotics. Bleeding occurs for the first few days, numbness, nasal congestion, altered sense of smell, persistent swelling and change over time, residual deviations/asymmetries, scar, pigment, redness, irregularities and sometimes the need for non-surgical treatment in the post-surgery phase.

The risk of needing a secondary procedure is between 4-8% depending on the complexity of the original surgery. It is important that you understand the risks as sometimes undesirable healing can lead to an unsatisfactory outcome.

Skin conditioning to manage oiliness, inflammation, rosacea, etc. We can recommend topical and systemic skin management.

If you suffer with any nasal allergies, it is worthwhile keeping them under control before, during and after surgery. Antihistaminic tablets a week before and a week after surgery are useful.

Aim for a low salt diet with plenty of antioxidants and proteins.

Stop any aspirin, nonsteroidal anti-inflammatory drugs (ibuprofen, etc.), supplements, vitamins, fish oils, garlic and arnica at least one week prior to surgery.

Discontinue all herbal supplements and herbal teas, such as ginseng and echinacea, one week before surgery. Discontinue omega-3 fish oils and ginger one week before surgery.

Plan and arrange for help at home during your recovery time.

Inform work you will be off for two weeks.

Do not proceed with surgery unless you are certain you understand all the risks and benefits.

Discontinue all medications which may affect clotting such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, neurofen…)

Discontinue all herbal supplements and herbal teas such as ginseng, echinacea and other herbal supplements. Avoid high doses of Vitamin E and avoid omega 3 fish oils, garlic and ginger.

Avoid all forms of nicotine/ alcohol consumption and sun exposure.

The hospital pre-assessment team will get in touch.

In preparation for the after surgery, you may want to buy the following:

1. Cooling Pads – prior to cast removal to be placed in the fridge (not freezer) and used daily during your recovery time to reduce puffiness and reduce discomfort. Click link cooling pads
2. Gel face mask – for use after cast removal for the purpose of aiding with lymphatic drainage. Click link gel face mask
3. Clinisept plus – procedure aftercare to facilitate the cleaning of the nostrils as required. Click link antiseptic spray
4. Gelositin spray – to moisten the inside of the nose to prevent crustiness and dryness.   Click link Sesame seed oil spray
5. Octenisan face wash. Click link Octenisan

One week before surgery, you should discontinue all herbal supplements and herbal teas such as ginseng, echinacea, and other herbal supplements. Avoid high doses of Vitamin E and avoid omega 3 fish oils, garlic, and ginger. Avoid arnica.

Use Octenisan antiseptic wash for pre-surgery face cleaning.

No make-up and wash your nose and face thoroughly. Remove any nail varnish.