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Microsoft word - travis t tollefson md mph.doc

TRAVIS T TOLLEFSON MD MPH
FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY

Preparing for the Procedure: Rhinoplasty

One week off of work is recommended to recover from rhinoplasty surgery.
It is recommended that you purchase thick cover-up make-up prior to your procedure. In some
instances this may be useful to camouflage bruising or redness after surgery.
On the business day prior to the operation we ask you to call to confirm your arrival time for
surgery.
Do not bring valuables (cash, credit cards, watches, jewelry, etc.) on the day of rhinoplasty
surgery. Remove all makeup and nail polish before arriving for your procedure.
It is essential that someone be available to drive you home, and that person is able to spend the
evening of surgery with you. It is California law that every patient be monitored for a period of
twenty-four hours following surgery. This person does not have to have any nursing experience,
just an interest in your welfare. While you spend the day at rest, your helper will fix soft food for
your lunch and dinner, assist in applying the cold compresses to your eyes, walk you to the
bathroom and just be near if you should require anything.
You may not eat or drink after midnight the evening before the rhinoplasty procedure unless
instructed otherwise. This includes all food, liquids, water, candy, mints or gum.
Medications
At your preoperative appointment you will provided with all of the instructions for you to follow
before and after rhinoplasty surgery. During this appointment you will also be given all of the
prescriptions necessary for the recovery period. It is recommended that you fill these
prescriptions prior to the date of surgery. We will also ask you to obtain an antibiotic ointment
and saline spray for use following rhinoplasty surgery.
Please avoid any aspirin, aspirin-containing products, or ibuprofen (Advil, Aleve, etc.) for one
week prior to and two weeks following your rhinoplasty surgery. See our "Medication List" for
products to avoid prior to and immediately following rhinoplasty surgery. If you are on any
medications that affect bleeding (such as coumadin or warfarin) please notify the office
immediately.
Please avoid herbal supplements for 10 days prior to surgery, including and especially fish oil,
ginseng and garlic.
We ask that you remain on your daily medications unless instructed otherwise. At the
preoperative rhinoplasty appointment, you will be told which daily medications to take with just
a sip of water on the morning of surgery.
Postoperative rhinoplasty medication checklist
4. Nasal saline spray: purchased over the counter 5. Antibiotic ointment: purchased over the counter 6. Hydrogen peroxide: purchased over the counter
AFTER RHINOPLASTY SURGERY
After rhinoplasty surgery your nose will be packed with soft nasal packing. The packing will be
removed the morning after surgery.
The nasal packing will prevent breathing through your nose so you will have to breathe through
your mouth. Your mouth will become very dry. Please drink as much fluid as you can which will
help you from becoming dehydrated. Drinks at the bedside along with a humidifier (cool or
warm) may help.
You will have a gauze drip pad placed beneath your nose. Change this as needed for the first 24
hours following rhinoplasty surgery. It is not uncommon to change this every 15 minutes for the
first several hours following rhinoplasty. If you completely saturate the pad with bright red blood
every five minutes, please call your surgeon at the numbers provided.
The cast must remain on your nose for one week after rhinoplasty surgery. It must be kept dry or
it could become loose. Notify Dr. Tollefson immediately if the cast falls off.
Activity Sleep with head of the bed elevated or use two to three pillows. Sneeze with your mouth
open and do not blow your nose of sniff for seven days after your rhinoplasty procedure.
Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on
the floor and let them climb on to your lap. Ensure that care is taken to keep the cast dry while
bathing is important.
Diet Advance diet from liquids to soft food to your regular diet as tolerated. In the immediate
rhinoplasty postoperative period, avoid extremely hot liquids or foods if you experience
temporary numbness on the roof of the mouth.

Ice
During the day and evening of surgery, cold moist compresses are used continuously over the
eyes to minimize swelling and control bruising. Puffiness and bruising can occur but if present
usually regresses quickly over the next few days. There are several techniques for icing which
are effective. The glove with ice and cool compresses are the preferred methods. Icing for 24-48
hours is recommended, icing after this period can be used for comfort. See video on right.

Breathing:
Invariably, there is some nasal stuffiness during the week after surgery. The external edema
(swelling) is reflected internally, but the mild blockage will improve steadily. it is imperative to
avoid extensive manipulation inside of the nose. DO NOT BLOW THE NOSE. DO NOT USE
NOSE DECONGESTANT DROPS (AFFRIN).
Pain:
Discomfort following rhinoplasty is usually limited to the two or three hours just after the
procedure. It may best be described as a headache. The prescription for pain tablets that you have
received is more precautionary that necessary, but please have it filled and available at your
home bedside. Take pain medicine with milk to avoid any stomach upset. Most patients switch to
extra strength Tylenol on the first day of recovery.
Medications
Most patients complain of pressure from swelling and congestion more than pain. Use pain
medication (most commonly Vicodin/hydrocodone) as directed/as needed. Vicodin contains
Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin.
Do not drive or drink alcohol while taking pain medication.
Side effects of pain medications can include nausea and constipation. Taking pain medication
with food can minimize nausea. Over-the-counter laxatives are indicated if constipation persists.
Start your antibiotic (Keflex/Cephalexin) when you arrive home following the rhinoplasty
procedure. During your rhinoplasty surgery you received antibiotics through your IV. Take
antibiotics as directed until gone.
Start the prescription for swelling medication (most commonly Medrol Dosepak/methyl
prednisolone) when you arrive home following rhinoplasty surgery.
The evening following packing removal, start using the ointment (most commonly
polysporin/bacitracin) two times a day (morning and evening) inside the base of each nostril.
Insert only the cotton part of the Q-tip into your nose. Ointment is applied after the morning and
evening saline rinses.
Please Remember! Nasal congestion, facial fullness, headache and disrupted sleep are very
normal postoperative symptoms for rhinoplasty and will decrease as the healing process occurs.
It is not uncommon to have numbness on the roof of the mouth (palate) behind the front teeth.
Therefore avoid extremely hot liquids or food in the immediate rhinoplasty postoperative period.
After the First Week:
Nasal Appearance:
At the time of nasal splint removal, you will have your chance to see the new nose. It will appear
quite swollen but, in most cases, even in this swollen condition, the improvement can be
appreciated. It takes time for the skin and soft tissue to adhere to the new framework. During
your postoperative visits Dr. Tollefson may use medicines to help contour the shape of your
nose.
Final results following rhinoplasty are not apparent for one full year following surgery. After
three months, the changes are ever so subtle, although still important. Being perfectionists about
our work, you may tell us you are pleased long before the one year anniversary. However, we
request that you follow-up with us at that time for postoperative rhinoplasty photographs and so
that we can enjoy your final result.
Nasal Exercises:
In most cases you will be requested to begin nasal exercises after the rhinoplasty cast is removed.
These exercises help reduce the swelling in your nose and should be continued for three weeks
after surgery. You will be instructed on how to perform these during your visit. Nasal exercises
should be performed two to three times daily for two minutes at a time. Please remember to
alternate using your right and left hands.
Activity
Sleep with head of the bed elevated or use two to three pillows for three weeks after
surgery. Three weeks after surgery you may resume full activity without medical restrictions. It
is advised that you resume your work-out regimen slowly, as your body may fatigue a little
easier than usual.
Wearing Glasses:
You should not wear glasses for at least one month. If glasses must be worn, taping the central
bridge of the glasses to the forehead will allow as little pressure as possible on the nasal bones.
Sun Exposure:
Your skin should be protected from sun exposure for at least six months after surgery. A sunburn
will cause the nose to swell dramatically and delay the final result. Sun avoidance or protection
with a hat is preferred. You may begin wearing sun block three weeks after surgery. Factor 25
sun block with both UVA and UVB protection.
PreOp / PostOp Checklist
BEFORE SURGERY CHECKLIST

Preparing for the Procedure:
1. Call to confirm your arrival time for surgery. 2. Do not bring valuables on the day of surgery. 3. Arrange a friend / family member to observe you for 24 hours after surgery. 4. You may not eat or drink after midnight the evening before the procedure. 5. No smoking for 1 week before and 3 weeks after surgery. 6. Purchase thick cover-up make-up prior to your procedure. 7. Medications: avoid (Aspirin, Motrin, Ibuprofen, Alieve) unless advised to continue by your doctor. Inform office if you are on coumadin / warfarin, plavix, or other blood thinner. 8. Medications: confirm which of your daily medications to continue the morning of 9. Medications: fill your prescriptions before the day of surgery. Typical medications are 10. Over the counter items: arnica, hydrogen peroxide, saline nasal spray, Qtips, ice packs.
General Postoperative Medication Checklist
4. Nasal saline spray: purchased over the counter 5. Antibiotic ointment: purchased over the counter 6. Hydrogen peroxide: purchased over the counter AFTER SURGERY CHECKLIST
Immediately after the procedure
You must meet nursing criteria for discharge home; walking, voiding, talking.
Your nose may have small packings inside the nostrils. These control any bleeding after surgery
but may partially obstruct your nasal breathing.
The First 24 Hours
1. Wound care: cleaning the sutures with a Q-tip dipped in saline water and then apply the antibiotic ointment (polysporin/bacitracin) twice a day. 2. Activity: sleep with head of the bed elevated or use two to three pillows. No strenuous activity / aerobics / yoga / heavy lifting for 3 weeks after surgery. 3. Bathing is ok as long as you don't get your incisions wet for a minimum of four days after 4. Advance diet from liquids to soft food to your regular diet as tolerated. 5. Cold compresses are used continuously over the forehead to minimize swelling and control bruising (30 minutes on, 15 minutes off) for the first 48 hours after surgery. 6. Medications: use pain medication as necessary. You can have a maximum of 8 tablets of vicodin + Tylenol in a 24 hour period (6 vicodin + 2 Tylenol = 8, ect). 7. Medications: Start antibiotic (Keflex/Cephalexin) when you arrive home and feeling ok 8. Medications: Start Medrol Dosepak/methyl prednisolone when you arrive home and 9. Medications: Start the nasal saline spray 1 day after surgery.
One Week After Surgery
1. Make-up can be started 1 week after surgery to camouflage any bruising or redness. 2. Nasal exercises can be started when instructed and should be performed for three weeks 3. Avoid sun exposure for three weeks after surgery, then use sun block. 4. The tip of the nose and sometimes the front teeth will be numb to touch following surgery. This will improve in the first few weeks to months after surgery. 5. Swelling, bruising and disrupted sleep are very normal postoperative symptoms and will 6. Differential swelling may asymmetries of the right and left sides of your nose. As the swelling goes away, so will these asymmetries. Please be patient.

Source: http://www.drtravistollefson.com/procedure/Rhinoplasty.pdf

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