Get To Know About Rhinoplasty Patient Management & Follow Up

1. The first follow-up visit will be one week postoperative for cast removal. When removing the cast consider the following:
   1. Reassure the patient that there is no pain.
   2. Remove both sides of the tape at the same time and the cast from the middle. Do not remove side by side, the cast will cause pressure and bump the nose. Clean the nose with soapy wet tissue (Chubs wet pack).
   3. Remove blood clots from the nares. Trim long sutures but do not remove as the sutures will be absorbed.
   4. If pimples developed, they should be scraped and the nose cleaned with wet soap and hydrogen peroxide.
   5. Patient is allowed to use mirror to see the reshaped nose.
   6. Vasovagal attack may occur at this stage in some emotional patients, in particular when a big difference has been achieved as in preoperative crooked nose or patients with hump and long noses. Patient should lie flat with legs and feet elevated. The vagovasal attack will disappear in two minutes time.
   7. Nasal massage instructions:
      We instruct the patient to use two types of massages:
      1. Bidigital massage:
      2. By using the two index fingers to achieve gentle pressure on the sides of the dorsum of the nose to keep the nose straight and to reduce oedema. The gentle pressure is applied for ten minutes three times a day. (Fig. 2 – 6)
      3. Index-thumb massage:
         By using the thumb and index fingers of one hand for massaging the base of the bony pyramid of the nose in order to avoid nasal bone displacement and reduce oedema. The massage from down-up is repeated twenty strokes three times a day. (Fig. 2 – 7)

Fig. 2 – 6. Bidigital massage: By using the two index fingers to achieve gentle pressure on the sides of the dorsum of the nose to keep the nose straight and to reduce oedema. The gentle pressure is applied for ten minutes three times a day.

Fig. 2 – 7. Index-thumb massage: By using the thumb and index fingers of one hand for massaging the base of the bony pyramid of the nose in order to avoid nasal bone displacement and reduce oedema. The massage from down-up is repeated twenty strokes three times a day.

2. Further follow-up

1. The next visit after cast removal will be after three weeks in order to watch for any mild deviation or any infection or intranasal adhesions or to remove obvious sutures. If mild deviation is noticed at this stage, the patient is instructed to perform unilateral index finger massage by placing the index finger along the deviated side and pushing gently to the opposite side for ten minutes / four times a day.
2. Next follow-up will be in two months time to watch for any mild deviation, notching, pinching or any nasal asymmetry. If any of the other mentioned problems are obvious and concerning the patient, correct without any delay.
3. The next visits will be in six months, then, one year. If any problems arise, correct without any delay and don’t leave your patient waiting even with a minor problem.

Refrences
Patient Management

1. Anderson J, Johnson C: A self-administered history questionnaire for cosmetic facial surgery candidates. Arch Otolaryngol 104:89-99, 1978. 2. Bittle R: Psychiatric evaluation of patients seeking rhinoplasty. Otolaryngol Clin North Am 8:689-704, 1975. 3. Butler J: Graphics and microcomputers, present and future. Paper presented at symposium, June 26, 1987. 4. Donald P: Postoperative care of the rhinoplasty patient. Otolaryngol Clin North Am 8:797-806, 1975. 5. Echavez M, Mangat D: Effects of steroids on mood, edema, and ecchymosis in facial plastic surgery. Submitted 1993. 6. Hayden R: Postoperative care. In Krause C, Mangat D, Pastorek N (eds): Aesthetic Facial Surgery. Philadelphia, JB Lippincott, 1991, pp 113-212. 7. Huffman D: Preoperative management of the rhinoplasty patient. Otolaryngol Clin North Am 8:679-684, 1982. 8. Gorney, M: Psychiatric and medical-legal implications of rhinoplasty, mentoplasty, and otoplasty. Symposium of Aesthetic Surgery of the Nose, Ears, and Chin. Vol. 6, St. Louis: Mosby, 1973. 9. Jacobson, W.E., et al. Psychiatric evaluation of male patients seeking cosmetic surgery. Plast. Reconstr. Surg. 26:356, 1960. 10. MacGregor, F.C., and Shaffner, B. Screening patients for nasal plastic operations. Psychosom. Med. 12:277, 1950. 11. Meyer, E., et al. Motivational patterns in patients seeking elective plastic surgery (women who seek rhinoplasty). Psychosom. Med. 22:193, 1960.

12. Palmer, A., and Blanton, S. Mental factors in relation to reconstructive surgery of nose and ears. Arch. Otolaryngol. Head Neck Surg. 56:148, 1952. 13. Peterson R: Preoperative evaluation for rhinoplasty. In Millard DR (ed): Symposium on Corrective Rhinoplasty. St. Louis, MO, CV Mosby, 1976, pp 56-63. 14. Reiter D, Alford E, Jabourian Z: Alternatives to packing in septorhinoplasty. Arch Otolaryngol Head Neck Surg 115:1203-1989. 15. Shoenrock L: Five year facial plastic experience with computer imaging. Facial Plast Surg 7:18-25, 1990. 16. Shoenrock LD: Computer graphics-a new form of aesthetic editing. Paper presented to Nippon Aesthetic Surgery Society, Japan, October 26, 1986. 17. Shoenrock LD: Computer graphics _a new form of aesthetic editing, Update I. Otolaryngol Head Neck Surgery, 56-61. 18. Schwartz M, Tardy ME: Standardized photodocumentation in facial plasty surgery. Facial Plast Surg 7:1-12, 1990. 19. Stern, K., Fournier, G., and LaRiviere, A. Psychiatric aspects of cosmetic surgery of the nose. Can. Med. Assoc. J. 76: 469, 1957. 20. Thomas S, Baird I, Frazier R: Toxic shock syndrome following submucous resection and rhinoplasty. JAMA 247:2402-2403, 1982. 21. Zimmerman G: Imaging Systems. Patient’s video guide. May, 1987.

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