Chapter 4

Preparing for Your Rhinoplasty Surgery

When to Schedule

You should find out from your surgeon how far in advance you need to book your surgery. You should pick a time that is convenient for you, when you will be able to take the time to recuperate, and you will have the help you need while you are recuperating. The most popular time for surgery seems to be the summer, especially August, and also the winter, especially December.

Meet with the Surgeon

Review the Plan , Sign Consent, and review Logistical Details

Dr. Becker will meet you again in the office prior to surgery to re-examine you, and to review the surgical plan, the computer imaging, and answer any additional questions. Written permission ("surgical consent form") is reviewed and signed. (A copy of Dr. Becker's consent form is provided here.) Any outstanding logistical details are addressed.

What Will you Tell People

Based on the experience of our patients, most are able to go back to work, or out in the public eye, after a week without people really noticing that they had surgery. We are conservative in the advice we give, so to our patients who want to be most sure of being "clandestine," we advise that they should wait 10 days from the day of surgery.

Believe it or not, most people's visual memory is such that they generally will not notice the difference - they will notice that you look better, but generally will not be able to pinpoint the difference.

But, in case someone notices the swelling, or a scar or some bruising in the early healing phase, or some other clue of nasal surgery, it can be helpful to decide what you will tell people. Our patients' tell us that, if they don't want to say that they had cosmetic surgery, the easiest thing to say is that you had to have some surgery to fix a breathing problem.

Schedule Medical Tests

Based on your age and medical history, your surgeon will advise medical tests, including possible blood work, electrocardiogram, chest X-ray or other. The purpose is to assess your health to be sure that you are healthy enough to have a 2 hour operation under anesthesia.

Fill Prescriptions

We will give you prescriptions for after surgery - a pain medicine, an antibiotic, and an anti-nausea medicine to use if needed immediately after surgery. Also, we sometimes give patients medication to help them sleep prior to surgery. You should fill all these medications before the day of surgery, so you will not have to do this after.

Buy OTC Items

Some useful items are Q-tips, gauze, hydrogen peroxide, and 4 bags of frozen peas!

Caregiver

It is nice to be pampered a little. You should make arrangements to have some down time. Someone must be with you for a period of time after surgery.

Plan for your Recovery

Do's and Don'ts
Please read & familiarize yourself with these instructions both BEFORE & AFTER surgery. By following them carefully you will assist in obtaining the best possible result from your surgery. If questions arise, do not hesitate to communicate with me and discuss your questions at any time.

BEFORE SURGERY INSTRUCTIONS:

*You are having surgery at the Kennedy Surgical Center, 540 Egg Harbor Rd., located directly in front of our office.

* Call the Kennedy Surgical Center at 856-218-4900 on __________________________, between 1-3 pm to find out what time you must report for surgery. Please call us if you experience any difficulty.

* You are required to have someone drive you to and from the Surgical Center. If you are an out-of-town patient or if you are having trouble arranging a ride, we will be happy to help arrange transportation to and from the Surgical Center, as well as to and from our office.

* You must stop using any aspirin or aspirin related    medication 2 weeks prior to surgery, as well as, 1 week post op. This includes Ibuprofen, Advil, Aleve, Motrin, Bayer etc., in any form (Cold & Sinus, Tension Relief, Migraine etc).

* You have been provided with prescriptions for after surgery. You should have these filled prior to surgery so that they will be ready for you at home after surgery.

* You will be scheduled for a morning surgery; therefore, you are to have nothing to eat or drink after midnight the night before your surgery.

* We have contacted your family doctor in order to let them know you will be having a surgical procedure, and to request medical clearance. CALL YOUR DOCTOR to arrange a pre-surgical appointment with them to facilitate medical clearance.

* Your first post operative visit is on _______________________ at ___________. Someone should drive you to this visit.

* Regarding any insurance-related surgery, we will call your insurance to verify your benefits and coverage. We will find out if any co-pay, deductible or referral is necessary. Your primary doctor will be notified if a referral is required. We will also contact you if there is anything you need to do or pay in advance of your surgery. Should you have any questions regarding your benefits and coverage, feel free to contact Donna at our office.

AFTER SURGERY INSTRUCTIONS:
Take this list to the hospital with you and begin observing these directions on the day of surgery.

1. Do not blow nose until instructed. Wipe or dab nose gently with Kleenex if necessary.
2. Change dressing under nose (if present) until drainage stops.
3. The nasal cast will remain in place for approximately one week and will be removed in the office. Do not disturb it; keep it dry.
4. Avoid foods that require prolonged chewing. Otherwise, your diet has no restrictions.
5. Avoid extreme physical activity. Obtain more rest than you usually get and avoid exertion, including athletic activities & intercourse.
6. Brush teeth gently with a soft toothbrush only. Avoid manipulation of upper lip to keep nose at rest.
7. Avoid excess or prolonged telephone conversations and social activities for at least 10-14 days.
8. You may wash your face - carefully avoid the dressing. Take tub baths until the dressings are removed.
9. Avoid smiling, grinning, and excess facial movements for one week.
10. Do not wash hair for one week unless you have someone do it for you. DO NOT GET NASAL DRESSINGS WET.
11. Wear clothing that fastens in front or back for 1 wk. Avoid slipover sweaters, T-shirts and turtlenecks.
12. Absolutely avoid sun or sun lamps for 6 weeks after surgery; heat may cause the nose to swell. Thereafter, use sunscreens.
13. Don't swim for one month, since injuries are common during swimming.
14. Following removal of the dressing, the nose, eyes, and upper lip generally show some swelling & discoloration - this usually clears up in 2-3 weeks. In certain patients it may require 12-18 months for all swelling to completely subside.
15. Take only medications prescribed by your doctor(s).
16. Do not wear regular glasses or sunglasses which rest on the bridge of the nose for at least 4 weeks. We will instruct you in the method of taping the glasses to your forehead to avoid pressure on the nose.
17. Contact lenses may be worn beginning 2-3 days after surgery.
18. After the doctor removes your nasal cast, the skin of the nose may be cleansed with a mild soap or Vaseline Intensive Care Lotion. BE GENTLE. Makeup may be used as soon as the bandages are removed. To cover discoloration, you may use "ERASE" by Max Factor, "COVER AWAY" by Adrien Arpel, "ON YOUR MARK" by Kenneth, or other makeup as directed by our office.
19. DON'T TAKE CHANCES! - If you are concerned about anything you consider significant, call me.
20. When we remove your splint, your nose will be swollen and will remain so for several weeks. In fact, it takes at least one year for all swelling to subside.

The Night Before, The Day Before

What to Wear to the Surgery Center, and after

Wear clothing that fastens in front or back for 1 wk. Avoid slipover sweaters, T-shirts and turtlenecks

Homeopathic medications

Many patients ask about the use of the supplements Arnica and Bromelain, for use after surgery to reduce the early swelling and bruising. I have never urged my patients to take these, because in my hands, the early swelling and bruising reliably goes down in 5-6 days, by the time the nasal bandage comes off. I attribute this to healthy patients and careful surgical technique.

There is more or less bruising depending on many factors, including the type and extent of procedure, the age and overall health of the patient, whether the patient is asmoker, whether the patient bruises easily, and many others. I do not object to the use of these treatments; I just have found that in healthy patients, and with good surgical technique, their effect appears minimal.

However, because it appears that there are few if any known side effects, some patients choose to use these products, on the chance that it may speed their recovery process.

Arnica

In herbal medicine, Arnica usually refers to Arnica montana, a mountain plant used for relief of bruises.

One Arnica product that is widely used is SinEcch. SinEcch is said to speed healing after a planned trauma like plastic surgery. SinEcch is a set of 12 capsules on a blister card with the information about when to take each dose printed right on the card. The dosage regimen is custom designed to match the level of bruising and swelling which most patients experience in the most common plastic surgery procedures, facelift, rhinoplasty (nose surgery), blepharoplasty (eyelid surgery), liposuction, etc.

Pineapple extract - Bromelain

Bromelain is an anti-inflammatory formula containing the proteolytic enzyme from the stems of pineapples. Proteolytic enzymes are capable of dissolving proteins. It is most often used after sports injuries, to relive edema and after surgical procedures to help with swelling. 

Arnika Forte is the only combination product of homeopathic Arnica Montana, Bromelain, grape seed extract, and Rutin in a capsule formulation. Grape seed extract and Rutin are products that are said to speed healing. You can find these products online; and we also do make this product available in our office.

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