What to Know Before Rhinoplasty: Pre-Op Tips & Expectations

In this episode of We Nose Noses, Dr. Undavia walks you through everything you need to know before your rhinoplasty surgery. From pre-op preparation to what to expect on the day of your procedure, this comprehensive guide will help you feel informed and confident as you take the next step in your journey.

What you’ll learn:

• The essential steps to prepare for your rhinoplasty surgery
• What happens before, during, and immediately after the procedure
• Tips for a smooth recovery and managing post-op expectations

Audio Transcript:

Dr. Undavia:

Hi guys, it’s Dr. Samir Undavia from NJENT and Facial Plastic Surgery. And today I want to talk to you about having your rhinoplasty and what to expect before surgery.

So the first thing is you’ve decided to have your nose fixed and we’ve already had our consultation. We’ve figured out what you want for your nose. And this is really a preparatory procedure visit to just go over the whole surgery, go over what happens before, during, afterwards, and then answer any questions that you might have. So the first thing I like to talk about is the before part. So before surgery, um we typically meet about a week or two before. And for our traveling patients, we can do that ah through virtual visits so long as we already have our photos.

When we meet, we want to send your prescriptions. We want to just go over what’s going to happen at the hospital, which facility you’re having your surgery at. First thing I tell patients is that the hospital is actually going to call you ah a couple of days before just to find out your past medical history. If you take any medications, any allergies, anything that they have to prep for in the OR.

They’re also going to call you a day before and tell you what time to show up and they’ll tell you you know what interest to enter into the hospital, um who you’re going to meet first. um Up till the day before surgery, you can eat up to midnight, but on the day of surgery, nothing to eat. You can brush your teeth and shower. If you need to take any medications, we’ll go over them at your pre-op visit, but we’ll have you take them with the tiniest sip of water.

The morning of surgery, brush your teeth, shower, you can get to the hospital. um You’re gonna meet the nursing staff that checks you in. You’re gonna meet the anesthesiologist. You’re gonna see me. We’re all gonna do some consents. We do something called a triple check, which is essentially checking that you are the person that we’re supposed to be treating. And we have a surgical plan that matches your consent.

So once we do that and we’ve got all the consents, you actually get a small little cocktail on the way into the OR. um It’s done through your IV and it’s meant to relax you because sometimes seeing all the lights and the equipment in the operating room can be a little bit scary.

So once you get into the operating room, everybody that’s in the operating just has a job that they’re doing on you. And it feels a little bit like ah like chaos, but it is actually controlled chaos. And everybody just wants to accomplish their job. so the first person’s putting on calf compressors on your legs and it just prevents blood clots.

The second pressure person’s putting on a blood pressure cuff in your arm it just checks your blood pressure throughout your surgery. Third person’s putting EKG electrodes on your chest to check your heart rhythm during your surgery. And the fourth person person, which is the anesthesiologist, gives you an oxygen mask and as soon as you get the oxygen mask, you know it’s about 20 or 30 seconds and you’re going to sleep. So ah once you go to sleep, you are going to have a breathing to place and you never feel it going in. You won’t feel it coming out.

So at the end of surgery, before you wake up, we put it, we take it out. So you never feel it going or out, but you end up with a sore throat for about 48 hours. And you can eat anything that you want. Sometimes our patients say these first four teeth on the top in the middle are a little sensitive or numb. Even a little bit of their palate might be sensitive or numb. And again, it doesn’t really stop you from eating. You’re more aware of it than anything else. um But as soon as you are you your airway is controlled, we then prep and drape and we do the surgery that we had planned.

For most patients, there is an incision right here. It looks like a little line with an EKG blip or a notch. um And there are incisions along the roof of your nose on the inside. If there are additional incisions, we’ll talk about that at your pre-op, just and that’s more of on a case-to-case basis. But we do all the things that we then plan to do based off of the imaging that we did in the office. um we We really do try and keep to that image um because that’s the thing that I obsess about towards the end of the case and make sure that we get as close to that as possible. And if there’s ah reason that we can’t, it’s gotta be a really good reason because we really we do this so much that what we draw is what we get. Now, once we were done with your surgery, and and by the way, that includes functional stuff too. So if we’re taking care of your septum, your turbinates, your nasal valve, any sinuses, if we need to, if we’re doing additional surgeries, we’ll take care of all of that before you wake up once Once we’re done with these surgeries, we have to put sutures or stitches in to close the incisions. So we do that. Typically, if they’re on the outside of the nose, they’re blue and stitches that we have to remove.

And if they’re on the inside of your nose, they’re yellow or clear, and they’re ones that we don’t have to remove because they dissolve. Now, once we’re done with the surgery, we’ve put the stitches in, we do put a cast over your nose and the cast has a little bit of glue, ah some tape and a little plastic shield. And it’s just meant to kind of prevent swelling from getting out of hand and also protect your nose in case there are little lumps and bumps because you are feeling a little lightheaded, you’re tired, you’re groggy, you might not see the door or wall coming at you. And this helps to prevent any big accidents.

So we put the cast over your nose, anesthesiologist wakes you up, takes the breathing tube out before waking up, and then you get to the recovery room. You stay there for about an hour, maybe an hour and a half. I will talk to whoever you have requested that I talk to. Usually that’s a family member or friend. And if you give me permission, I can show them pictures. Every one of my patients gets my cell phone afterwards. So if they, if you guys have have any questions or worries, just call or text me.

I also like to send pictures over so that patients can get an idea or get excited about their nose because afterwards there’s a lot of swelling and you don’t necessarily always see the result right away. So you go to recovery room for about an hour and then you go home. Most of our patients will be on something to keep their nose moist on the inside and that’s because the nose reacts to surgery as though it has a cold. So You’re going to be producing a lot of mucus in your nose. You’re going to have some scabs, some old blood, and we don’t want you blow your nose because the main risk of this surgery is a nosebleed. um It’s anywhere between one to 3% roughly, and that risk goes up if you blow your nose.

So instead, what we have you do is we rinse your nose with a saline mixture ah that you can make at home or you can buy them pre-made over the counter. But essentially, you are irrigating your nose and washing out all this stuff. And it helps you keep ah breathing a little bit, and it helps prevent nosebleeds, keeps your nose wet on the inside. The outside, we want you to keep dry. So we want you to keep this cast dry. Keep some antibiotic ointment here and then use the saline on the inside of your nose. And that’s the first week.

It typically is not a painful surgery. What you do feel like is a bad cold. You’re stuffy. There’s no packing inside your nose, but you’re still stuffy because of the scabs and the swelling and the mucus and some old blood, which you’re washing out, but it’s still there. Your eyes get really puffy. Typically, most patients have their peak and eye swelling around day three. So if you had surgery on a Monday on Thursday is when your eyes are the most swollen and then it comes down pretty quickly because I see our patients around one week and I like to vacuum out their nose, but by the time I see them in one week, most of their bruising has gone. a little hint of something right here underneath their eyes, um sometimes a little green or purple or yellow, um but it’s minimal.

What they do have though is swelling on the cheeks and the nose. um so The first thing we do when we see patients back in the office And by the way, we make this appointment at your pre-op visit. So you’re all taken care of and you’ve already picked up your medicines because you’ve before the surgery, because we sent them before surgery. But when we see you in the office for that first week visit, what we typically do is put on a little bit of, it’s like nail polish remover, but it’s basically something to get rid of the stickiness on the on the tape on your nose. Then i vacuum out your nose. That part is a little uncomfortable. It’s about 10 to 15 seconds though. It’s really fast and you really appreciate it because you’ve had a very stuffy week.

And when I clean out your nose, you’re going to feel so much better. You can appreciate breathing through your nose again. And if you’ve had a deviated septum, you can really see the difference afterwards. Now that’s not the final result. It actually does get better, but it’s going to get a little worse before it gets better again, because your nose is going to still keep making some of that mucus.

I don’t want you to blow your nose for about three weeks. So, uh, you’re going to continue doing your sinus s rinses. Um, but again, it’s going to get better. It just takes a little time. Now, at that same first post-op appointment, I also take out these sutures and I take the cast off. And the first thing most most of our patients are going to notice is that from the side, your nose looks great. It’s from the front that it looks really wide. And if there was a lot of crookedness and we’re fixing that using grafting, sometimes the grafting can make it look crooked because it retains water in that spot. So we tell our patients not to panic. It’s very normal to be wide and sometimes be a little off kilter at that first visit. It’s just the significant water retention that your nose has during that time period of your healing process. So at that visit, I’m also inspecting things. Sometimes I put a little steroid in, sometimes I don’t. We’re just kind of making sure everything’s healing and in the direction that we want it to and healing at like an appropriate stage for that one week visit.

Depending on where our patients live and depending on the needs for the inside of the nose, I sometimes see the patients soon after in a week or two. Sometimes I see them at eight weeks. We’ll make that decision together. But over the first eight weeks, that’s when most of the, well, I’ll correct that. Over the first two weeks, maybe three weeks, that’s when you feel more like the cold and you’re stuffy inside your nose. But after that, number one, you can breath you can blow your nose after three weeks. But also a lot of the mucus and the scabbing and the crusting slows down. So you still have it on some level for six to eight weeks, but the vast majority of it is not really being produced after three weeks.

So I want our patients to do the sinus rinses for at least three to four weeks, but to feel really good, you probably need to do it for six to eight weeks. um We have our patients not blow their nose for the first three weeks to prevent the nosebleed.

We actually also have our patients not lift weights for three weeks. um From ah like a impact or cardio exercise perspective, I have patients, you can walk right away, but I don’t want you to run or do impactful exercises for four weeks. And I don’t want you wear glasses for four weeks. And there are things, there are fixes for that. If you need to wear glasses, we can talk about that. There’s something called the rhino shield or I have you tape your nose. um ah Also brings up another good point. I love taping the nose afterwards, especially at night.

I think it makes a huge difference and it has people healing much faster than I would expect. So we teach you how to tape your nose at night and we give you a little care package or a little gift set for your post-op visit, for your post-op recovery period. It’s a little bag. It has some arnica and bromelain to help you with bruising and swelling. It has some hydration packets to keep you hydrated. It has some lip balm because your nose is stuffy you keep your mouth open all the time. And it has some gauze and some tape. And so we give you the tape that you need to tape your nose at night and some gauze just to help for the first 72 hours or so as your nose drains. um But once we don’t need to clean out your nose, we see you every few months. And we usually make that decision around eight weeks.

So around eight weeks, I see you. We check to make sure that the inside is fully healed or at least doesn’t need any more cleaning. And then we see you every couple of months. And usually the things that we need to see you for are to use steroids or a medication to get some of the swelling down in specific spots of your nose. The most troublesome areas for most of our patients are right here in the super tip. And that’s an area that used to have the hump if you did have a hump and the skin has it’s kind of taking its time to shrink wrap down onto the internal structures. So we use steroids, we tape your nose, and it speeds up the process. um Having super tip fullness is one of the most common things that we see almost every patient.

It’s not the same as a polybeak deformity, it’s just fullness of where the skin used to be. And you could tell because when you push on it, it’s got this sponginess to it there. um The other things that we deal with for our patients most commonly are in the radix, which is up here. You can get a little bony callus where we did osteotomies or bone cuts and you’re your nose is reacting to that bone cut by producing more bone temporarily. So it’s just got to have some time to resolve itself. And it usually does that over a couple of months. It’s a tiny little bump. Sometimes it’s nothing. Sometimes it really does persist. And in that case, we can usually just kind of shave it down in the office in a two minute procedure um under local anesthesia with no cuts.

In any case, we see each other every few months or more sooner if we need to, but every few months until we don’t need to anymore. So sometimes that’s a year, sometimes that’s a little bit longer, but in general, and this is really a rough schedule, but in general, our swelling schedule is over the first two months. So if if this was how big your nose was gonna be when all the swelling is gone,

When we take your cast off, let’s just say it’s out to here. And over the first two months, it comes down about 50%. And the first two months are the most dynamic. So there’ll be days when it’s like looking a little bit like this and it’ll change for the afternoon or for the morning or for you know a day or two. It’s really a dynamic process. But after two months, it comes down about 60% in three months. 80% in six months and by a year, you’re 90%. And so obviously there’s outliers on both sides. Some patients heal really fast and some patients take a lot longer to heal.

All of it is normal and we’ll be with you throughout that whole process. um But yeah, if we need to see each other for 18 months, we see each other for 18 months. If we only need to see each other for six months, six months it is. I do like to keep the year mark just to make sure that everything is as that planned. But um I’ve had some patients where swelling was just a long, drawn out process and it took two to three years. so That’s fine. We just, we we take our time and we do this right because this is your forever nose, not your nose for two or three years. But once your healing is done or once we don’t have to worry about certain areas of the nose, we just see each other as needed. Some of our patients do telemed visits because they’re traveling far and that’s fine. And if we need to see each other, we can arrange that or I can have them see somebody locally over that. So i hope I hope you get a gist of what it’s like to have the surgery.

If you have any other questions, obviously you have my cell phone and yeah, we’ll see each other soon.

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