Preparing for rhinoplasty surgery

Before you are booked

Cosmetic surgery in Australia requires a referral, at least two pre-operative consultations, and a seven day cooling off period. The referral should come from your usual GP where possible, or from another GP or specialist who works independently of me. At least one of the two consultations must be in person with me, as the surgeon who will do the operation. The cooling off period runs from the point both consultations are done and consent is signed, and the surgery cannot be booked or a deposit taken until it has passed.

The first appointment is typically a full examination: I take your history and examine your nose inside and out, including your airway with a small camera (endoscopy). The second focuses on photo morphing of your own photographs, to show what a change might look like, and on answering your questions.

Bring your history. Previous nasal surgery, injuries, breathing problems, allergies, and every medication and supplement you take. Previous septoplasty or sinus surgery changes the plan considerably and is easy to forget about.

If you are pursuing aesthetic change you may bring photographs of noses you like. The aim is not to replicate someone else’s face. They help me understand what you are after, and I will tell you what is achievable within your own anatomy.

Further imaging, such as a CT scan, is arranged where it is needed to understand the internal structures.

The timeline

You will be given this in writing at your pre-operative appointment. It is here so you can plan around it before you book.

Six weeks before. Stop smoking. This matters more in nasal surgery than in most operations, because nicotine reduces blood supply to the skin of the nose and that skin has to re-drape over a changed structure. Arrange your time off work, which is ten to fourteen days for most people. Organise someone to drive you home.

Two weeks before. Stop alcohol. Stop aspirin, ibuprofen, fish oil and vitamin E unless I have told you otherwise, because all of them affect clotting and increase bruising. Do not stop prescribed medication without speaking to me or your GP first. Fill any prescriptions early rather than on the day.

The week before. Have the house ready. Wash the sheets and towels, vacuum, and clear a path to the bathroom you can walk at night without thinking about it. Set up the bed or a recliner so you can sleep with your head raised at about thirty to forty five degrees.

The day before. Shower and wash your face with a mild soap. No moisturiser, perfume, makeup or deodorant afterwards. Do not eat or drink after midnight unless you have been told otherwise. Pack a small bag: identification, glasses rather than contact lenses, your prescribed medication, lip balm and tissues.

The day itself. Loose clothing that does up at the front, because nothing should be pulled over your head. No jewellery, makeup, contact lenses or nail polish. Bring the responsible adult who will take you home and stay with you.

What to ask

Patients often arrive unsure what to ask. Worth considering:

• What approach would you recommend, and why
• Will you be addressing both the appearance and the breathing
• What is realistically achievable, and what is not
• How long will the result take to settle
• What happens if I am not happy with the result
• How many of these do you do

You should get direct answers to all of those. If you do not, that is information too.

Medications and supplements

At your pre-operative appointment you will be given a written preparation guide covering what to stop, what to start, and when.

Some things to know now. Medications affecting blood clotting need to be stopped before surgery, and that includes several common over-the-counter drugs and supplements. Aspirin, ibuprofen, fish oil and vitamin E are the usual ones people do not think of. Do not stop prescribed medication without discussing it with me or your GP first. Bring a complete list of everything you take, including anything you would not think of as medication.

If you smoke, stopping well before surgery matters more here than in most operations, because nicotine affects blood supply to the nasal skin.

What to have at home

Practical, and worth doing in the week before rather than on the day.

For comfort and recovery

• Cold compresses or gel ice packs
• A neck pillow, which makes sleeping propped up considerably easier
• Enough pillows to sleep with your head elevated

For nasal care

• Sterile gauze pads
• Micropore tape, tan, 1.2 cm wide
• Cotton buds
• Saline nasal wash

Also

• Dry shampoo or baby wipes, since washing your hair normally is awkward with a splint
• Mild, fragrance free facial wipes
• Soft unscented tissues and a lip balm
• Tops that button or zip at the front, because nothing should go over your head
• Soft food for the first few days, and something to drink that is not very hot
• A cool mist humidifier, which some people find helps a congested nose at night
• Nostril retainers, which are ordered online and brought to your first post-operative appointment

I will also give you a short list of over-the-counter items that can help with bruising and swelling, with when to start and stop each one. I have deliberately kept the specifics to that written guide rather than this page, because they are worth going through with me against your own history rather than reading off a website.

Practical arrangements

Time off. Most patients take 10 days to two weeks. The splint comes out at your review, between seven and ten days after surgery. Stitches are usually dissolvable; the only ones that need removing are after an alar base reduction (alarplasty). You then tape the nose at night for six to eight weeks, and most people are presentable rather than fully settled at two weeks.

Someone to drive you home, and a responsible adult to stay with you for the first 24 hours. This is not optional and surgery will be cancelled without it.

Glasses. They cannot rest on the bridge of the nose for the first six to eight weeks. If you wear them, arrange contact lenses or work out how you will tape them to your forehead.

If you are travelling from outside Brisbane, the trip needs planning around the cooling off period and the seven to ten day review. You cannot fly for two weeks after surgery, so do not book non-refundable return travel before then.

Costs

You will receive a written quote after your consultation setting out the surgeon’s, anaesthetist’s and hospital fees, together with any Medicare rebate and health fund benefit that applies.

Where the surgery includes a functional component, part of it may attract a Medicare item number and your health fund may cover the hospital fee. Eligibility depends on documented findings (a NOSE Scale score above 45, or a significant acquired, congenital or developmental deformity) and is assessed at consultation. Full detail is on the cost page.

Changing your mind

You can change your mind at any point before you sign consent, and signing consent is not a commitment to go ahead. Once you have paid the deposit, the deposit and cancellation terms in our terms and conditions apply.

Next steps

More about the operation itself is on the rhinoplasty page, and the risks are set out on my risks and side effects answers.