Establishing Objectives and Surgical Candidacy
Clear goals and a frank look at your anatomy, risks, and expectations set the tone for success.
Functional versus aesthetic indications
Functional versus aesthetic indications
- Functional: Nasal obstruction (e.g., septal deviation, turbinate hypertrophy, nasal valve collapse), trauma sequelae, chronic sinus disease, congenital anomalies.
- Aesthetic: Dorsal hump reduction, tip refinement/rotation, base narrowing, asymmetry correction.
- Combined functional–aesthetic rhinoplasty is common—fixing airway issues often requires structural moves that also influence shape.
- Talk through what’s actually achievable based on your anatomy, skin thickness, and healing patterns.
- Many surgeons use brief BDD screeners; if concerns pop up, a mental health referral is wise. Digital imaging helps align expectations, but it’s not a promise.
- Expect a full exam: external analysis, internal inspection, and often nasal endoscopy to assess the septum, turbinates, and internal/external valves.
- Imaging: CT scans are reserved for trauma, chronic sinus disease, suspected polyps, or complex revisions. Routine CT isn’t needed for straightforward aesthetic cases.
- Standard high-res photos (frontal, obliques, lateral, base view) guide planning and track outcomes.
- 2D/3D morphing clarifies priorities and expectations—keeping in mind swelling and tissue dynamics mean final results will vary.
- Choose a board-certified surgeon (ABOto/ABOHNS—facial plastic surgery; ABPS—plastic surgery) with deep rhinoplasty experience and a robust before/after portfolio.
- Facility accreditation matters: AAAASF, AAAHC, or The Joint Commission.
- Anesthesia plan: Most procedures use general anesthesia with endotracheal intubation for airway protection and bleeding control. Some minor tip work can be done with sedation plus local—ask about pros and cons.
Medication and Supplement Management
Medications and supplements can sway bleeding, bruising, and anesthesia interactions—plan changes with your prescribers.
Anticoagulants, antiplatelets, and NSAIDs
- Aspirin (primary prevention): Often stopped 7 days pre-op; continue if secondary prevention is critical (loop in cardiology).
- Clopidogrel/prasugrel/ticagrelor: Typically hold 5–7 days; coordinate with cardiology if you have stents or recent ACS.
- Warfarin: Usually stop 5 days pre-op; consider LMWH bridging only for high thromboembolic risk (e.g., mechanical mitral valve, VTE <3 months, AF with very high CHA2DS2-VASc).
- DOACs (apixaban, rivaroxaban, dabigatran): Hold 2–3 days; longer if renal impairment or higher bleeding risk; no bridging in most cases.
- NSAIDs (ibuprofen, naproxen, diclofenac): Stop 5–7 days pre-op. Use acetaminophen instead.
- Post-op resumption: Resume these meds post-op as your surgeon advises (often after bleeding risk eases).
Herbal supplements and vitamins with bleeding risk
- Stop 1–2 weeks pre-op: ginkgo, garlic, ginseng, St. John’s wort, high-dose vitamin E, fish oil/omega-3, turmeric, saw palmetto. Standard multivitamins are usually fine—confirm.
Steroids, retinoids, and acne treatments
- Chronic systemic steroids: You may need peri-op “stress-dose” steroids if you’ve taken ≥5 mg prednisone daily for >3 weeks in the past 3–12 months—coordinate with anesthesia.
- Topical retinoids/strong exfoliants: Many surgeons pause them on nasal skin 1–2 weeks prior to minimize irritation.
- Isotretinoin: See timing above. Don’t restart until you’re cleared.
Allergy verification and perioperative medication plan
- Confirm true allergies versus side effects: (nausea isn’t anaphylaxis). This steers antibiotic choice: cefazolin is common unless there’s true beta-lactam anaphylaxis (then clindamycin may be used).
- PONV prophylaxis: If you’re prone to severe nausea, ask about a multimodal plan (ondansetron, dexamethasone, scopolamine patch).
- Pre-fill prescriptions for pain control, antibiotics (if prescribed), antiemetics, and nasal sprays so everything’s ready when you get home.
Practical Logistics and Day-of-Surgery Checklist
Small prep steps make a big difference when you’re home—especially with splints in place and airflow feeling different.
Home setup for recovery
- Sleep with your head elevated 30–45 degrees (wedge pillow or extra pillows) for 1–2 weeks to curb swelling.
- Cold compresses on the cheeks and around the eyes (not directly on the nose) for 10–15 minutes at a time during the first 48 hours.
- Use a humidifier and saline nasal spray (as directed) to ease dryness and crusting.
- Supplies: Sterile gauze for drip pad changes, lip balm, gentle cleanser, petrolatum for incision care if instructed, paper tape if taping is part of your plan, a thermometer, and a small bin nearby.
- Medications: Acetaminophen, prescribed pain meds, an antiemetic, stool softener, saline spray, antibiotic ointment (if instructed). Avoid NSAIDs until cleared.
Transportation, caregiver, and documentation
- Arrange a licensed adult to drive you home and stay the first night. Rideshares without an escort are usually not allowed after anesthesia.
- Have consent forms, pre-op photo review, and financial details squared away in advance.
Pre-op instructions (follow your facility’s specifics)
- Fasting (NPO): No solids for at least 6–8 hours pre-anesthesia. Clear liquids (water, electrolyte drinks, pulp-free juice) are often allowed up to 2 hours—confirm locally. Skip milk/cream.
- Antiseptic shower the night before and the morning of surgery with chlorhexidine or as directed; don’t apply it inside the nose. Avoid lotions, perfumes, and makeup on surgery day.
- Attire: Wear a clean, front-fastening shirt so you’re not pulling anything over your face. Remove all jewelry, piercings (including nose rings), and nail polish/acrylics where the pulse ox goes. No contact lenses.
- Medications: Take only what’s approved with a small sip of water. Bring inhalers (if asthmatic), CPAP (if OSA), and an up-to-date med list.
What to bring and what to expect
- Bring a government ID, insurance card (if applicable), payment method, and pre-filled prescriptions if allowed.
- Expect pre-op marking, a final plan review, and a brief team “time-out” for safety.
- Early recovery milestones:
- First 24–48 hours: Swelling and bruising peak; mild bloody oozing is normal. Keep the drip pad clean and change as directed.
- Days 3–5: Discomfort improves—keep elevating and using cold compresses.
- Day 5–7: External splint and sutures often come off; breathing starts to feel better as swelling eases (internal swelling lasts longer).
- 2–6 weeks: Most visible bruising clears. Avoid glasses on the bridge unless your surgeon gives you a taping or splint workaround.
- Red flags—call your surgeon immediately if you have:
- Rapid bleeding soaking a drip pad every 10–15 minutes for over an hour
- Fever >38.6°C (101.5°F) after day two, escalating pain, or foul drainage
- Visual changes, severe headache, or neck stiffness
- Persistent vomiting with inability to keep fluids down
- Worsening shortness of breath or chest pain
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