• Dr. Waterman

How do I prepare for Rhinoplasty? What to do the day of your procedure

Day 0.

The hardest part is already over.

You've done it! If you've read the guide and followed this advice, there is very little you will need to do on the day of your procedure, other than fasting in the morning and gently relaxing when you get home. Knowing what to expect will help you be sure that you have everything you need to get through the first day with no hiccups or unexpected twists.


Arriving home and getting comfortable after your nose job.

So you've just had your nose job, and you're on the recovery road. If you're on the way home and reading this for the first time, it might be hard to follow because of the anesthesia medications, so I recommend reviewing this article in advance.

"What should I do?" "Is this feeling normal?" "Am I too swollen or bruised?"

There can be a flurry of questions that come up during the first day of recovery. In addition to guiding you through my advice for recovery day 1, I will try to address these common questions and concerns.


Icing helps reduce swelling and discomfort after surgery. Frosting helps reduce stress and sorrow, and keeps cupcakes moist. Understanding the difference is important but I don't see why anyone wouldn't do both. Just to be safe?

Simply having a plan can help you avoid the stress and anxiety of uncertainty.


What to Do: Day of Surgery

There is not much to do on the first day of recovery after rhinoplasty. In fact, much of my advice here is to limit your activity, only doing what you must during your first day of rest.


If you've followed my advice about preparing during the week leading up to your procedure, you should already have your recovery nest built, stocked, and ready to rock. If you didn't get around to preparing a recovery space with all of your favorite relaxation needs, that's OK too.


In short, wherever you end up during day 1, you will want these bare-bones essentials:

  1. A cozy spot with ample pillows and blankets to keep your head elevated

  2. Water, plenty of it

  3. Ice packs (10 minutes on, at least 20-minutes off when Icing)

  4. Medication (Tylenol & Ibuprofen, and Rx)

  5. Entertainment

  6. Food

Having someone to be by your side and support you during day 1 can be a total game-changer. The anesthesia medication from surgery and the painkillers afterward can make you nauseous, woozy, delirious, and lethargic, so having someone to help prepare a light meal, help you get water, and anything you need to stay comfortable -- it's all very worthwhile.


Expect to be bruised and swollen, and expect it to get worse before it gets better. This deserves its own post, which I will hopefully get around to writing.


Do not touch the cast you will be wearing for the next week or so, do not touch it and especially leave along the bandages holding it in place. Adjusting to wearing the cast isn't immediate, some people find it to be uncomfortable.


Never remove your own cast. Never have someone who isn't your surgeon remove your cast.


What to know about Pain Management:

Before we get into the topic, it's important to recognize a few facts about surgery, recovery, and pain and discomfort.

  1. The first is that you will certainly experience pain and discomfort during your recovery, but it doesn't last long and most people are able to manage the discomfort even at its greatest.

  2. Second, the goal of pain-management is not to eliminate the sensation of pain, but to bring your discomfort to a manageable level during the time immediately after your surgery.

  3. Lastly, the pain and discomfort people experience after surgery is made worse by swelling and inflammation, so addressing these sources of pain with medication or icing is generally more effective than just dulling the sensation of pain with narcotics.


Different surgeons have different approaches to pain-management after rhinoplasty surgery. I prescribe a minimal quantity of narcotic pain killers because in general, patients report avoiding their use altogether or using them only during the first day, and switching to Tylenol and ibuprofen after that. Considering the risks and consequences of extended opioid medication use and the potential for addiction, I recommend people try to avoid using them at all, or to limit their use to a day or two days maximum.


Once you arrive home, you can begin taking Tylenol and Ibuprofen. I recommend taking Tylenol every 4-6 hours. Refer to the table below as a good general guideline for timing your medication. Adults of average build should avoid taking more than 4000mg of Tylenol per day, especially for extended periods of time. Taking too much Tylenol can damage the liver and even lead to death.


Timing your Tylenol doses will help level out your discomfort. Adding Ibuprofen will be even more helpful when staggered with Tylenol, such that you alternately take one, then the other every 2-3 hours depending on your needs. Ibuprofen helps reduce inflammation, and that means less swelling and discomfort while you heal.

Source: Harvard Men's Health Watch, "Acetaminophen safety: Be cautious but not afraid" [https://www.health.harvard.edu/pain/acetaminophen-safety-be-cautious-but-not-afraid] 11/22/2019

There are risks associated with taking NSAID medications like Ibuprofen after surgery. The greatest risk is bleeding, since NSAID medication can be somewhat blood-thinning. In most instances, Ibuprofen is tolerated without incident, but when bleeding is profuse to the point of being alarming or problematic, it generally isn't because of medications at all. Complications with Ibuprofen are exceedingly rare, and the benefits of anti-inflammatory medication greatly outweigh the risks in my opinion.


To-Do List:

  1. Comfort & Relaxation: Find a spot. Sit/lay there with your head elevated.

  2. Food & Water (Especially Water): Don't forget to eat! Be wary of overeating after anesthesia, some people get pretty nauseous.

  3. Stay on-top of your Pain management (Medication, Icing).

  4. Sleep, relax, knit, text, do crossword puzzles or watch a movie. Just nothing active.


What not to do:

The obstacle of the first days of recovery is not so much tackling what you should do, but confronting what you should avoid doing. In today's age, it can be difficult, jarring even, to retreat from daily responsibilities and grant yourself the necessary space and time for relaxation and a proper recovery. This is why you must continually hold yourself to a new standard of laziness. Be strict.


As a rule of thumb, I like to advise folks to avoid tasks that a frail, very old person should avoid.

  • Don't lift anything heavier than a gallon of milk.

  • Don't stay standing for long periods of time.

  • Don't exert yourself.

It isn't fool-proof, and you may have to make exceptions, but it's a good benchmark for understanding whether you should do something, or for how long, if you must. You're fragile when you're recovering from plastic surgery, and that can be unfamiliar for many patients. It's important to respect your body's needs, and let yourself laze out for a while.



The Takeaway:


Do: Very little to nothing.



Don't: Be a hero.



Rest, relax, and repeat. If you feel like doing something, wait until you don't want to do it anymore and then don't do it. Just be lazy, lazy as can be. Stay hydrated & medicated, but pretty much that's it for day 0.


Chapters:

  1. Introduction: How should I prepare for a Nose Job?

  2. 1 Week Before Surgery: Building your nest.

  3. What to do the day of your procedure: Arriving home and getting comfortable. (Coming SOON)

  4. Week 1: What to know about the longest week ever.

  5. Month 1: Getting back on your feet.

  6. Up to 3-months: The waiting game.

  7. After 3 months: Preparing for long-term care.


Updated February 5, 2020.

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