When ENT surgeon Dr Gillian Dunlop told her father she wanted to be an artist on finishing high school, he said get a ‘proper job’. As much as it distressed her at the time, she’s grateful now; she insists it’s important for women to achieve financial independence. It’s a topic Dr Dunlop will cover at this year’s RACS NSW Surgeon’s month at the Art Gallery of NSW. Her medical career never stopped her from pursuing a passion for art. Dr Dunlop is also a well known portrait artist, and has painted many prominent Australians, including Dame Quentin Bryce and Dame Marie Bashir.
This is a really important question for anyone approaching rhinoplasty to ask. Yet probably even more important is “What medicines CAN’T I take before a rhinoplasty?”.
Medicines rhinoplasty patients might be taking fall into 3 categories:-
• Prescription medicines.
• Over the counter preparations.
• Vitamins and herbal extracts.
For a rhinoplasty patient, each group potentially is dangerous before your nose surgery.
Any drugs that thin the blood, such as anti-inflammatory medicines, could mean significant bleeding with nose surgery, both during and after the rhinoplasty. Avoid Cartia (aspirin), Celebrex, Mobic and Voltaren for at least two weeks before and after your rhinoplasty.
Over the counter medicines are especially dangerous as they could promote nose bleeding. Avoid Nurofen, Naprogesic, Ibuprofen and cold remedies such as Codral and Sudafed, for two weeks before and after rhinoplasty.
Vitamins and herbal extracts
Many rhinoplasty patients are unaware of the adverse effects of these agents on nose surgery. Fish Oil and Vitamin E can promote nose bleeding, so avoid these for one week before and after rhinoplasty. Echinacea, Gingko, garlic or ginger tablets are also a problem.
Nose puffers can also promote nose bleeding. Sinex, Drixine and Otrivine are dangerous but Nasonex, Avamys and Rhinocort are fine. Asthma puffers are also OK.
Cigarettes and Alcohol
Cigarette smoking is a risk for nose surgery. Smoking interferes with the blood flow so healing is poorer and infection more likely. This can lead to nose scarring and the need for revision rhinoplasty. The oral contraceptive pill is not a problem itself, but if combined with smoking, a rhinoplasty patient could develop leg clots and possibly even death as the clot passes to the lungs. Smoking also causes coughing on waking up after rhinoplasty surgery. Coughing can lead to bleeding which may mean the nose must be packed with ribbon gauze to stem the nasal bleeding. This could distort the rhinoplasty result.
Alcohol within 48 hours of an anaesthetic could alter the amount of drug the anaesthetist needs to give. Best avoided!
In a special group are Roaccutane and steroids such as Prednisone. Both of these medicines will delay healing to the point where nose surgery is not advisable. Make sure you have been off Roaccutane for six months prior to any nose surgery. Ask your doctor about Prednisone as this varies with the dose.
Remember, rhinoplasty surgery is elective surgery. You want the very best result so you will need the very best conditions. For a full list of medications to be avoided before and after rhinoplasty, go to our tool bar, click “Rhinoplasty”, and then click “General Instructions”. If there is any doubt, simply contact us.
No one can undergo a rhinoplasty without some swelling afterwards. The bulk of the swelling and bruising will be gone 2 weeks after rhinoplasty surgery but it takes 18 months for all the swelling to truly settle. On a positive note, this means your rhinoplasty will look better and better.
Certain factors affect the amount of swelling you will experience after rhinoplasty.
1. If you don’t need much done e.g. a small bump, your rhinoplasty will not involve much disturbance to the body, so post op rhinoplasty swelling is small. Conversely if you have a nose which has been traumatised by sporting injuries it may need major rhinoplasty reconstruction. Here obvious post op rhinoplasty swelling may last several weeks, even months.
2. Allow time for your post op rhinoplasty to settle. It is fine to plan to return to work 2 weeks after rhinoplasty surgery but less than this amount of time may mean that your swelling is noticeable.
3. As we age, the collagen and elastic fibres in our skin are less likely to take up the new shape of the nose quickly. This means that after rhinoplasty the skin gradually moulds and the swelling takes longer to subside.
4. If you are not active and simply take to bed following your rhinoplasty, the swelling will be prolonged. Vigorous exertion may create bleeding but walking at least once a day win the first 2 weeks following rhinoplasty surgery is a good way to encourage the rhinoplasty swelling to drop with gravity. Lying horizontal tends to allow it to puff up again.
5. Lastly, if you have a very big nose, or a very big bump, your new rhinoplasty nose may be much smaller. You need to allow time for the rhinoplasty to heal as the skin envelope of the old nose moulds to the new rhinoplasty nose.
Like everything, there is no one special time. For rhinoplasty it will be affected by several factors. Firstly, you need to make the decision that this is right for you. You have chosen a rhinoplasty surgeon you can trust and that you understand what rhinoplasty involves. Allow some room for doubt and anxiety especially just before your rhinoplasty surgery. This is normal and reflects that you are not undertaking your rhinoplasty lightly.
The timing of rhinoplasty will also be affected by your work and social commitments. Post-op rhinoplasty bruising lasts at least 2 weeks and swelling to a much lesser extent takes weeks to months to finally settle. Therefore we suggest you avoid commitments in the first 2 weeks following rhinoplasty surgery and major events such as weddings for at least 6 weeks.
For sporting activities similar advice is given following rhinoplasty. Gentle activity such as walking is encouraged as it helps resolve post op rhinoplasty swelling but vigorous activity such as running could promote bleeding in the first 2 weeks following rhinoplasty. After the 2 week mark it is fine. Contact sports such as football, soccer and netball are dangerous in the first 6 weeks following rhinoplasty as any trauma to a post op rhinoplasty nose could permanently alter the shape. Goggles for swimming laps are also discouraged for 6 weeks following rhinoplasty. In summary, plan your rhinoplasty for the end of the sport season, or alter your exercise pattern for those early post op rhinoplasty weeks. For major contact sports like football, it is best to have your rhinoplasty at the end of your football career.
With so many rhinoplasty websites available on the net it is difficult to choose a rhinoplasty surgeon. Obviously you would choose a rhinoplasty surgeon with FRACS after their name as this ensures specialty training but even then it is difficult to know how often they perform rhinoplasty.
The very best way to choose a rhinoplasty surgeon is to ask someone who knows. The very best reference comes from operating theatre staff and local doctors.
Last year Dr. Dunlop performed over 50 rhinoplasties of which 10% were on staff, staff’s relatives or relatives of local doctors. People endorse people they trust.
Next best, I would trust someone who has already had a great rhinoplasty and ask them about their rhinoplasty surgeon. They have only had one rhinoplasty experience but this is a good guide.
If your only resource for choosing a rhinoplasty surgeon is the internet make sure the rhinoplasty website you choose has the following:
Choosing a great rhinoplasty website is not the way to choose a great rhinoplasty surgeon. You need someone well experienced in rhinoplasty, well regarded and naturally, someone you feel you can get along with. Rhinoplasty patients see their rhinoplasty surgeon for at least 18 months. It takes this long for a rhinoplasty to fully heal.
Rhinoplasty surgery takes 2-3 hours which is followed by an hour in recovery so tell friends and relatives to allow plenty of time before expecting to see you awake. With modern rhinoplasty anaesthetic techniques bruising is minimal but it may increase and move down over the cheeks over the first few post op rhinoplasty days.
Most people stay one night in hospital following rhinoplasty though some people are discharged that day. For the first night only you will need to sleep up on 3 pillows. Nurses or your relatives change the small rhinoplasty bandage under the nose. The nasal dressing in only required for the first night. This is not difficult for your family but it does mean getting up in the middle of the night.
Before discharge after rhinoplasty your doctor and nurses will show you how to douche the nose with saline. This will need to be done 6 times a day for 6 weeks to prevent crusting and infection in the rhinoplasty wound. Antibiotics will also be given to you, for one week.
After 5 to 7 days you will see your rhinoplasty surgeon for removal of the rhinoplasty splits both inside and outside the nose. Many people fear this visit but it is usually a great relief to have the plaster off and to breathe freely (and probably better than ever). Having sutures out is fiddly but not a huge discomfort.
After 5 days you will no longer be so tired in the afternoons so we encourage you to take up gentle exercise such as walking. By now your rhinoplasty plaster is off and you can wear makeup.
By 10 to 14 days post rhinoplasty, you will feel well enough to go to work.
Most rhinoplasty patients comment at this stage that there is very little pain following rhinoplasty surgery. They mainly notice post op fatigue and 5 days of nasal blockage.
Contact sports or wearing swimming goggles are avoided for 6 weeks following rhinoplasty. Sun or reading glasses also weigh down on the rhinoplasty wound and are best avoided for 3 weeks, more if they are particularly heavy.
Your post op rhinoplasty appointments will be made for 1 week, 2 week, 6 week, 3, 12 then 18 months. You will be surprised and pleased to see increasing definition in your post op rhinoplasty nose as healing occurs over this 18 month period. Remember as well the older we are, the longer it takes to heal.
The best way to prepare for rhinoplasty surgery is to ensure all your questions are answered. If you understand what rhinoplasty involves, your apprehension particularly on the day before rhinoplasty surgery will be less. Often this means arranging another appointment to see your rhinoplasty surgeon to discuss any specific issues about the aims to be achieved for your personal rhinoplasty, or issues regarding medications, sport, work or travel.
Please refer to our rhinoplasty website page for general instructions. This lists the 60 medications which will promote excessive bleeding and increase the risk of revision rhinoplasty. These medications e.g. Nurofen, Aspirin, Codral and Fish Oil should be avoided for two weeks prior to your rhinoplasty.
Sport or going to the gym within two weeks after rhinoplasty can cause bleeding. Exercise such as walking in the first two weeks following rhinoplasty is encouraged as it helps reduce swelling for you to be moving around. Contact sports such as soccer or netball are avoided for six weeks after rhinoplasty, to allow for firm bone healing.
Travel plans for the period following surgery should be discussed with your rhinoplasty surgeon as you will need regular post op consultations to check on the rhinoplasty wound healing … frequently, for the first six weeks then occasionally for a total of 18 months.
As you will be having a general anaesthetic, avoid alcohol for 24 hours prior to your rhinoplasty. Cease smoking as early as possible prior to surgery as your rhinoplasty wound healing will be compromised.
Lastly, another tip is to wash your hair the morning of the procedure as hair washing is tricky following surgery as you must keep your rhinoplasty plaster dry.
Grommets are tubes to equalise the pressure between the middle ear and the outside world. They can become blocked from infection e.g. swimming without ear plugs or sinusitis.
A blocked grommet makes the ear feel dull and the hearing poor. If you fly with a blocked grommet it can be painful on aircraft descent.
A blocked grommet needs to be seen by a doctor as it may be blocked because it is extruding and needs replacement. There are many types of grommets but common varieties last either A: 6-12 months or B: 2-3 years.
Once a doctor has established your grommet is blocked he or she will write a script for Sofradex drops. You need to flood the ear canal twice a day, pumping the drops through the grommet using the skin tag (tragus) in front of the ear. This takes 1-2 mins per application. If you can taste the drops down the back of your throat you have succeeded in unblocking the grommet. This can take up to 3 weeks of therapy.
Grommets allow air to lift up the eardrum so it can vibrate. This allows for better hearing. For a child learning to speak good hearing can be crucial. Without good hearing speech development can be slow.
Grommets allow air into the middle ear but if wet e.g. by swimming, they can allow water with bacteria in as well. The best way to avoid problems is to avoid diving and to wear earplugs. Grommets connected to the middle ear will fill with water if submerged, just like a bottle fills with water if submerged.
Care is taken with the choice of plugs. Never use commercially available plugs which dry and crumble, leaving particles in the ear canal. Dr Dunlop’s staff will make custom-made plugs for you ($45 pair) or you can purchase Ear Putty ($5 pair) which is softer than Bluetack.
Remember, you can swim freestyle but do not jump in the pool or duck dive. Infection is manifest as sticky pus oozing from the ear canal without pain. Treat this quickly with Ciprofloxacin drops. The longer the infection is present, the longer it takes to clear. It will also clear faster if you contact Dr Dunlop for professional ear cleaning. Never syringe the infected ear with a grommet. Antibiotic tablets or syrup are rarely adequate treatment.