Rhinoplasty (nose reshaping), nasal cosmetic surgery, is
performed to improve the nose aesthetically - making it
harmonize better with the other facial features - while
maintaining or improving function. Because it is the
most defining feature of the face, the size and shape of
the nose has a significant impact on a person's
appearance. Dr. Lopez’s goal in rhinoplasty is to
minimize the attention that is given to the nose in
order to accentuate the beauty of the eyes.
Some patients want their
nose to be straight, others want the nostrils narrowed,
and others say their nose sticks out too far from their
face. Because the nasal tip loses support as we age,
some patients are surprised to realize how significantly
rhinoplasty contributes to a more youthful appearance.
Dr. Lopez shapes the nose to blend into the face, so
that the eyes become more of the focus of attention.
rejuvenation procedures the best place to start is by
before and after photos to see just what can be
accomplished. As you will see in the photos, patients
often ask to combine a rhinoplasty with other cosmetic
surgery. Eyelid lift, chin implants,
otoplasty (ear surgery) and lip surgery can also be
performed in conjunction with a rhinoplasty.
When patients come to see
Dr. Lopez seeking facial plastic surgery, it's not
uncommon for them to focus on a single aspect of their
appearance rather than the overall picture. One of the
most common concerns we hear from patients seeking
rhinoplasty is that they do not want a “Michael Jackson”
nose. Fortunately reduction rhinoplasty is becoming
less common. Fewer surgeons are stripping the nose of
vital cartilage that supports the function of the nose.
Dr. Lopez believes that form follows function, meaning
that a good looking nose is a nose that breathes well.
Dr. Lopez would never compromise nasal function for an
improved aesthetic result.
As Dr. Lopez is a board
certified facial plastic surgeon, trained to perform
plastic surgery exclusively on faces and necks, he knows
that his responsibility is to evaluate not only the
areas of concern but also the motivation behind the
requests. Some patients are not ready for cosmetic
surgery and are better served with conservative
measures, such as
for fine lines and wrinkles or fillers for deeper
wrinkles. Patients who educate themselves about facial
rejuvenation know when and if the time is right to
proceed. Your understanding of the procedures and
postoperative routines is essential to a successful
Although the preoperative
and postoperative instructions for
revision rhinoplasty are the same as for the primary
(first-time) rhinoplasty patient, revision rhinoplasty
has its own set of special considerations. If you are a
patient seeking revision rhinoplasty, please review
special considerations for revision rhinoplasty.
Facial plastic surgeons
(board certified reconstructive and cosmetic surgeons
that concentrate exclusively on the face and neck) are
specialty trained to perform rhinoplasty, the most
challenging of all cosmetic surgery. Not every cosmetic
surgeon is trained in rhinoplasty and not all surgeons
have the skill to perform rhinoplasty. More than any
other cosmetic surgery, Dr. Lopez highly recommends that
you do your homework in selecting a surgeon that
specializes in rhinoplasty.
At your preoperative
appointment Dr. Lopez will provide all the instructions
for you to follow before and after surgery. Rhinoplasty
takes about 1-3 hours depending on the structure and
amount of change you are seeking. Revision rhinoplasty
generally takes longer. Also, if you are having a
combination of procedures your surgery will take longer.
Recovery time from the anesthetic takes about an hour
and you will be discharged about four to five hours from
the time of admission.
Please avoid any
aspirin, aspirin-containing products, or
ibuprofen (Advil, Aleve, etc.) for two weeks
prior to and two weeks following your surgery.
See our "Medication
List" for products to avoid prior to
surgery. If you are on any medications that
affect bleeding (such as coumadin or warfarin)
please notify the office immediately.
Please refrain from
tobacco products for six weeks and alcohol for
one week prior and three weeks following
surgery. Along with delayed wound healing,
persistent skin redness and other complications
may persist when tobacco and alcohol are not
Please notify us of
all routine medications and significant health
history. We ask that you remain on your daily
medications unless instructed otherwise. At the
preoperative appointment you will be told which
daily medications to take with just a sip of
water on the morning of surgery.
preoperative appointment you will be given
prescriptions for use following surgery
including an oral antibiotic, anti-swelling
medication, antibiotic ointment and pain
medications. Please obtain these prescription
medications before your surgery so you will have
them ready for use when you return home after
We will ask you to
take Arnica, a natural herb that significantly
decreases bruising, before and after surgery. We
will also ask you to take Vitamin C (ascorbic
acid), which helps promote healing, before and
You may not eat or
drink after midnight the evening before the
procedure unless instructed otherwise. You may
brush your teeth. Your procedure will be
cancelled if you do not follow these
Remove all make-up
and nail polish before arriving for your
Someone will need
to drive you home after your surgery and stay
with you that evening.
After surgery your nose
will be packed with soft nasal packing. A nasal cast
will be on your nose and you will have gauze taped under
your nose. There will be silastic splints along each
side of your septum (divider of the inside of the nose).
Splints reinforce the newly shaped cartilage. You may
notice that tears run down your cheeks. This is due to
swelling and will subside during the first week
The nasal packing will
prevent breathing through your nose so you will have to
breathe through your mouth. Your mouth will become very
dry. Please drink as much fluid as you can which will
help you from becoming dehydrated. Drinks at the bedside
along with a humidifier (cool or warm) may help.
Following nasal surgery,
mucous membranes can produce extra mucous. Draining of
red-tinged mucous through your packs onto your drip pad
is normal. You can change your drip pad as often as
Following your procedure
the nurses will ask you to meet the discharge criteria:
to drink liquids, walk with a steady gait, void, manage
your discomfort, and to have your nasal drainage under
control. The nurses will teach you how to change the
drip pad under your nose, which you will need for about
You will be asked to see
Dr. Lopez 1-2 days after surgery for packing removal.
Although removal of nasal packing has been described by
most patients as discomfort rather than pain, you are
encouraged to take your pain medication about an hour
prior to packing removal. Packing removal will help
relieve some of the pressure. However, due to swelling,
you will not be able to breathe well through your nose
for two weeks. You will return to see Dr. Lopez 6-8
days after surgery for cast and suture removal. Two
weeks after surgery Dr. Lopez will remove the silastic
POSTOPERATIVE RHINOPLASTY INSTRUCTIONS
Sleep with head of the bed
elevated or use two to three pillows. Sneeze with your
mouth open and do not blow your nose or sniff for seven
days. Absolutely no bending, lifting or straining. If
you have little children, bend at the knees or sit on
the floor and let them climb on to your lap. One week
off work is recommended following rhinoplasty. Avoid
long steamy showers for one week postoperatively or the
cast may become loose. Ensure that care is taken to keep
the cast dry while bathing.
Advance diet from liquids
to soft food to your regular diet as tolerated. In the
immediate postoperative period, avoid extremely hot
liquids or foods if you experience temporary numbness on
the roof of your mouth.
Keep cold packs on
eyes until bedtime, changing pads every 20-30
minutes. It is the weight of the cold pack as
well as the temperature that helps minimize
bruising. A small bag of frozen peas or corn may
also be used. Make sure the bag is not placed
directly on the skin. Use a washcloth or towel
between the bag and your skin.
You will have a
gauze drip pad placed beneath your nose. Change
this as needed for the first 24 hours following
surgery. It is not uncommon to change this every
15 minutes for the first several hours following
rhinoplasty. Ice packs to the forehead and/or
back of the neck may help decrease bleeding. Do
not place ice packs directly on your skin. Do
not swallow any drainage from your nose as it
may make you nauseated. Cough it up and spit it
of the packing, the drainage will eventually
subside and the drip pad will no longer be
required. Do not use saline nasal spray until
the night following packing removal.
The cast must
remain on your nose for one week. It must be
kept dry or it could become loose.
complain of pressure from swelling and
congestion more than pain. Use pain medication
(most commonly Vicodin) as directed/as needed.
Vicodin contains Tylenol. Do not take additional
Tylenol or acetaminophen while taking Vicodin.
Do not drive or drink alcohol while taking pain
medication. Side effects of pain medications can
include nausea and constipation. Taking pain
medication with food can minimize nausea.
Over-the-counter laxatives are indicated if
removal has been described as pressure rather
than pain, we recommend taking pain medication
about one hour before coming to the office for
antibiotic (Keflex) when you arrive home
following the procedure. During your surgery you
received antibiotics through your IV. Take
antibiotics as directed until gone. It is not
uncommon to have a low-grade fever for 24 hours
prescription for swelling medication (most
commonly Medrol Dosepak) when you arrive home
following surgery. At your preoperative
appointment, our nurse will provide specific
directions for use of this medication following
following packing removal, start using the
antibiotic ointment (most commonly bacitracin)
three times a day inside the base of each
nostril and on the incision. Insert only the
cotton part of the Q-tip into your nose.
packing removal, start your saltwater rinses in
the evening. Salt water rinsing is very
important for your postoperative healing. The
salt water moisturizes, cleanses and facilitates
You can make your
own salt water by mixing one tablespoon of sea
salt (not table salt) and 12-16 oz. lukewarm
water in a small plant mister bottle. Place the
tip of the mister gently near the opening of the
nose and spray your nose. If you prefer you can
purchase saline spray in your drugstore without
a prescription. Please rinse your nose with salt
water five to six times per day until your
splints are removed. You may then decrease your
rinsing to three times per day.
Nasal congestion, facial
fullness, headache and disrupted sleep are very normal
postoperative symptoms and will decrease as the healing
process occurs. It is not uncommon to have numbness on
the roof of the mouth (palate) behind the front teeth.
Therefore avoid extremely hot liquids or food in the
immediate postoperative period.
Following a rhinoplasty, it
takes time for the swelling to subside and for the skin
to heal. Most patients return to work one to two weeks
following surgery, depending on the degree of privacy
one is trying to maintain. At three weeks
postoperatively, swelling and bruising may be apparent
to you but not to many of your coworkers and closest
Final results following a
rhinoplasty are not apparent for one full year following
surgery. Dr. Lopez will want to see you 3, 6 and 12
months after the surgery to ensure that you are healing
Revision rhinoplasty is
more challenging than primary rhinoplasty for several
reasons. First is the altered "geography" of the nose.
At the time of the primary rhinoplasty, distorted
cartilage was removed to make the nose straight and
restore function. Therefore, in revision rhinoplasty,
the cartilage needed for reconstruction is no longer
available. Depending on the amount of cartilage that
remains, the need to borrow cartilage from behind one
ear (an auricular graft) or even from a rib (costal
cartilage graft) to restore nasal form and function is
not uncommon. Although the ear incision is camouflaged
well and does not change the shape, size, form or
function of the donor ear, and the incision for the rib
is hidden under a bra/bikini, the need to borrow
neighboring cartilage means an extra incision. Dr. Lopez
will determine if cartilage is necessary to restore your
nose to a more natural form as well as where the
cartilage should come from. Dr. Lopez does not use
synthetic implants when performing rhinoplasty. There
are situations where Dr. Lopez will use irradiated rib
cartilage, for instance in older patients where ear
cartilage will not provide sufficient support.
Nasal lining that has
undergone surgery is also subject to scar tissue, which
increases the complexity of revision surgery. Therefore,
the amount of surgical time required to perform revision
rhinoplasty typically is longer than primary rhinoplasty.
Revision rhinoplasty may
have its own set of special considerations but it also
can be the most rewarding. If you are considering
revision rhinoplasty (regardless of where you elect to
have the surgery performed) it is essential that you
consider a board certified facial plastic surgeon. Why?
Because facial plastic surgeons have unique board
certifications in both head and neck surgery and
cosmetic and reconstructive surgery. Dr. Lopez has an
extensive experience in revision rhinoplasty. He has
patients that travel from all over the country to seek
out his expertise.
1) I want my nose to look
like Brad Pitt's?
Your nose is very specific to your face. Dr. Lopez’s
goal with rhinoplasty is to create a nose that blends
into your face and does not take attention away from the
beauty of your eyes. Therefore, Brad Pitt’s nose may
not look right on your face. Dr. Lopez will thoroughly
evaluate your nose and discuss with you the your optimal
2) I have a large hump on
my nose, can that be fixed?
The hump (convexity) on your nose is usually made of
bone and cartilage. Dr. Lopez is able to lower both the
cartilage and bone if necessary. Again, your nose must
be in harmony with your face as well as the rest of your
body. Tall individuals look better with a small
convexity or straight profile rather than a scooped out
appearance. Shorter individuals can look better with a
bit of scoop to the nose. Men in general also look
better with a bit of a convexity, i.e. the “Grecian
3) If my nose is made
smaller, where does the extra skin go?
Over time the skin will contract and take the shape of
the underlying bony/cartilaginous structure.
4) My nose is crooked, can
that be fixed?
A crooked nose can be because the bone has been broken
and is no longer in the midline, or because the
cartilage in the middle of the nose (middle vault) has a
concavity or both are off. To fix crooked nasal bones,
Dr. Lopez makes cuts in the bones to reset the bones in
the midline. In order to straighten out the middle part
of the nose, Dr. Lopez may need to use cartilage to fix
5) My nose ticks out too
far and I have a weak chin, will fixing my nose make my
chin look stronger?
In general no. A weak chin that does not project out
enough usually can be made to look much better with a
chin implant. This will also improve the rhinoplasty
result as the face will be in better harmony.
6) Will I still look like
"me" after surgery?
Many of my patients report that when they return to
their normal life, their friends comment, “You look
great. Are you getting more sleep?" or "You look less
stressed and tired”. Dr. Lopez will not drastically
change the way you look, just enhance it.
7) Where are the incisions
for a rhinoplasty?
In an open rhinoplasty Dr. Lopez makes a very small
incision in the skin at the base of the nose in the
midline. This incision heals extremely well and is
nearly imperceptible once healed. The remainder of the
incisions are within the nose.
8) What is an open
An open (external) rhinoplasty involves making a small
inverted V-shaped skin incision in order to raise the
nasal tip skin up and be able to visualize the tip
cartilages. The advantage of the open approach is the
increased exposure that Dr. Lopez is able to get in
order to produce your optimal result. The disadvantage
is that the nose will be swollen longer when compared to
the closed (endonasal) approach.
9) What is a closed (endonasal)
In a closed (external) rhinoplasty there are no external
skin incisions. Dr. Lopez will use this technique when a
lot of work does not need to be done to the tip or
middle vault. The advantage of the closed approach is
that the swelling subsides quicker. The disadvantage is
the decreased exposure the surgeon attains when trying
to manipulate the middle vault or tip.
10) How much pain will I
Most patients who have a rhinoplasty say how surprised
they are that the pain is less than they anticipated.
Understandably, after any surgical procedure, some
discomfort can be expected. All patients are provided
with prescriptions for pain medication. Patients
sometimes use the prescription medication two to three
days after surgery and then switch to Extra Strength
11) Will I be awake during
Patients are asleep during the surgery with general
anesthesia. Patients do not hear or feel anything and
are comfortable during the operation. Patients wake up
very soon after the surgery is completed. All patients
must have a responsible adult to stay with them through
the night following surgery. Patients may not drive for
following their procedure if they are taking pain
medicine or their vision is impaired.
12) Do I go home after
Most rhinoplasties are done on an outpatient basis.
Because you will go home after receiving sedation, you
will need to make arrangements for a responsible adult
to drive you home, to stay with you overnight and to
drive you to our office for your first postoperative
appointment. Patients having surgery must stay in the
immediate San Antonio area overnight.
13) Will I bruise and swell
afterwards and how long will it last last?
Unfortunately it is impossible to do surgery without
causing swelling. Dr. Lopez does everything possible to
minimize the amount of swelling that occurs. Generally,
postoperative swelling begins to resolve at the end of
the first week. Bruising is extremely variable.
Patients that have a tendency to bruise will generally
bruise for about 10 days. Patients that don’t tend to
bruise may have minimal if any bruising. Complete
resolution of bruising and swelling may take two to
three weeks. However, bruises may be camouflaged fairly
easily at seven to ten days with a concealer stick.
14) How long should I stay
in San Antonio following surgery?
Most patients stay in San Antonio about seven to ten
days following surgery. After that it's ok to fly or
travel long distances.
15) When can I return to
Most of Dr. Lopez’s patients take about two weeks off of
work. After two weeks, most of the residual bruising and
swelling can easily be camouflaged with make-up.
16) When can I exercise?
Dr. Lopez prefers that aerobic activities be avoided for
two weeks after surgery. In addition, heavy weight
lifting or more strenuous workouts should be avoided for
three weeks postoperatively. It is extremely important
to avoid bending, lifting or straining during the early
postoperative period as these activities can increase
swelling and delay healing.
17) At what age can I have
You should not have a rhinoplasty until your face and
nose have stopped growing. Usually the age is around 16
for a female and 17-18 for a male. Once your shoe size
has been stable for a year, that is a good indication
that you can have a rhinoplasty.
18) When can I have a
Dr. Lopez performs a lot or revision rhinoplasty
operations to correct or enhance the work of the
previous surgeon. In general the nose will continue to
change over the first year following a rhinoplasty, so
Dr. Lopez prefers that patients wait a year after their
original surgery to have a revision.
19) Is revision rhinoplasty
In general yes. Once the nose has been worked on scar
tissue distorts the normal tissue planes. In addition,
grafting material such as the nasal septum may have
already been used. Often times ear cartilage or even
rib cartilage is necessary to correct the deformity.
Make sure that the surgeon you choose has a lot of
experience with revision rhinoplasty.
20) What is the septum?
The nasal septum is a cartilaginous and bony structure
that divides the nose into two nasal cavities. Dr.
Lopez often uses the septal cartilage to strengthen the
nose and improve the appearance and function of the
21) If you take ear
cartilage will that change the shape of my ear?
Dr. Lopez uses ear cartilage often and it does not
change the shape of your ear or the function of your
ear. At 6 months from surgery even with your hair up
nobody will know that you had ear surgery.
RHINOPLASTY PREOPERATIVE INSTRUCTIONS
22) Should I do anything
before to prepare for surgery?
You will have a preoperative appointment with Dr. Lopez
and his staff to go over the preoperative instructions.
23) Why do I need a
This is an essential appointment to prepare you for your
upcoming surgery. Dr. Lopez will take preoperative
photographs at the visit as well as go over the
procedure again to ensure that everyone is on the same
page. All questions that you have will be answered on
that visit as well. You will often times be given your
prescriptions on the preoperative visit day.
24) What else can I do to
do to prepare for surgery?
Dr. Lopez likes to have patients that have well
controlled blood sugar to drink three eight ounce
glasses of pineapple juice for at least one week before
surgery. Pineapple juice can help minimize the
postoperative swelling. Patients that use tobacco will
be asked to stop for six weeks before and six weeks
following surgery. Tobacco has properties that impede
wounds from healing. Dr. Lopez will encourage tobacco
users to not resume smoking at all after surgery; in
fact many of his patients have used the surgery as their
impetus to quit smoking.
25) What about my daily
medications before surgery?
In general you will be allowed to take most of your
daily medications. Medications that thin the blood such
as ibuprofen, vitamin E, and herbal supplements need to
be stopped two weeks before surgery. You can continue
to take a multivitamin. Aspirin needs to be stopped
three weeks before surgery. Dr. Lopez will provide a
"Medication List" that reviews all medications and
supplements to avoid prior to surgery.
26) Do I need any special
prescriptions before surgery?
Dr. Lopez will generally give you a prescription for an
antibiotic, a pain medicine, antibiotic ointment, as
well as an anti-swelling medication.. Dr. Lopez does
prefer patients to start Arnica, a natural herbal
substance, the day before surgery in order to minimize
bruising. He also asks you to start Vitamin C before
27) What does it feel like
when I wake up from surgery?
When you wake up you will have a small cast on your nose
and small packs within your nose. The packs will not
allow you to breathe through your nose. We will make
sure you are not nauseated or queasy. Our nurses will be
right there with you as you wake up from surgery.
28) What medications do I
take following surgery?
Dr. Lopez will ask you to take the following medications
starting the day of surgery:
1- An antibiotic- generally Keflex for one week
2- Pain medicince- vicodin or percocet to take as
3- Antibiotic ointment- to place on the incision sites
at least three times a day.
4- Antiswelling medication- for patients that are not
diabetic a medrol dosepak will be given.
5- Vitamin C 1 gram for 1 week before and two weeks
following surgery to promote healing.
6- Arnica- place under the tongue three tabs three
times a day before meals for two weeks.
29) When do I begin taking
Patients take their pain medication as needed. Begin
taking vitamin C one week before surgery. You can begin
taking Arnica the day before surgery. The antibiotic
and swelling medications begin when you arrive home
following surgery. Unless you are notified otherwise,
resume all daily medications when you arrive home from
30) Are there any foods to
avoid following surgery?
No. Dr. Lopez encourages you to eat a well-balanced
diet. You may notice that saltier foods can cause you
to swell for a longer period of time.
31) When can I shower?
You can shower once the second dressing is removed.
Make sure that you pat dry the incisions well after the
shower and apply the antibiotic ointment.
32) When is my first
You will be asked to see Dr. Lopez on the second day
following your rhinoplasty. At that appointment Dr.
Lopez will remove the nasal packing. Some patients
describe the packing removal as a mild discomfort, but
Dr. Lopez still recommends taking a pain pill 1 hour
before your appointment. You will need someone to drive
you to this appointment.
33) What happens after the
first postoperative visit?
After your first visit, take your medications as
directed and keep your incision clean and moist. We
will ask you to use a Q-tip to cleanse them with
peroxide once a day and apply an antibiotic ointment
three times a day to keep the sutures soft. Dr. Lopez
will want to see you 6-8 days after the surgery for
removal of the cast and suture removal. Suture removal
may be uncomfortable, so Dr. Lopez recommends taking a
pain pill 1 hour before your appointment. You will need
someone to drive you to this appointment if you are
taking pain medication.
34) Are there any
instructions about regular daily activities?
Sleep with head of the bed elevated or use two to three
pillows for one week. Facial fullness, headache and
disrupted sleep are very normal postoperative symptoms
and will decrease as the healing process occurs.
Absolutely no bending, lifting or straining. If you have
little children, bend at the knees or sit on the floor
and let them climb on to your lap.
35) When can I blow my
You are not allowed to blow your nose for one week.
Avoiding nose blowing minimizes bleeding and swelling
36) Can I wear my glasses
or contacts after rhinoplasty?
It's best to allow a day or so before using your contact
lenses following rhinoplasty. It's not uncommon for
patients to tell us that giving their eyes a temporary
rest from the contact lenses feels good for the first
two to three days following rhinoplasty. It's OK to rest
your glasses on the nasal cast. However, one week
following rhinoplasty the cast is removed. At that time
we will show you how to use the Frame-Ups® to prevent
your eyewear from resting directly on your nose. We
strongly recommend that you use the frame-ups for
postoperative week #2 - which is the week following cast
37) How long does the
Healing and evaluation of the final result takes one
full year. However, after three months, most patients
have about 90% of their final result.
38) How can I minimize the
swelling and bruising?
Most of Dr. Lopez’s patients will have a little
bruising. He minimizes bruising by having patients stop
all blood thinners well ahead of surgery as well as
using Arnica before and after the procedure. The cold
packs around the eyes should be used every 20 minutes
while awake after surgery to help prevent swelling and
bruising. The cold packs should be used for the first
72 hours. You do not need to wake up to use the cold
packs. A good night’s sleep is vital to healthy
healing. Patients are also asked to sleep with their
head at least at 45 degrees to minimize the swelling.
39) When will I look
You will be presentable at two to three weeks. You will
look great at six weeks and even better at six months as
things settle and expressions become more natural. At
three weeks you know you are well on the way to recovery
and most patients resume routine activities around two
to three weeks following surgery. Final results are
evaluated at one year.
40) How often do I need to
return for postoperative visits?
Dr. Lopez likes to see his patients 3, 6, and 12 months
after the procedure to ensure that the healing is going