The removal of the external cast exposes the delicate internal and external structures of the nose following rhinoplasty. Careful attention is required to ensure optimal healing. Proper post-cast cleaning is necessary for hygiene and for managing the internal congestion and external skin issues that arise after surgery. Approaching this process with gentleness will support the fragile tissues as they settle into their new shape.
Internal Nasal Hygiene: Clearing Crusting and Blockage
The primary focus of internal care is the safe removal of dried blood, mucus, and crusting that accumulate in the nasal passages during the initial healing period. These materials are a normal byproduct of healing, but if left in place, they can obstruct airflow and delay recovery. The most universally recommended method for internal cleaning is the use of a sterile, isotonic saline solution, which hydrates the nasal lining and loosens the crusts.
Use the saline spray or rinse gently two to five times a day to moisturize the nasal cavities without causing irritation. For a saline rinse, tilt your head slightly forward and allow the solution to flow into one nostril and drain out the other. Ensure your mouth is slightly open to prevent pressure buildup in the ears. After application, use a cotton swab moistened with sterile water or saline to carefully clean the very rim of the nostrils. Avoid inserting the swab deep into the nose, as this risks disturbing internal incisions and causing a nosebleed.
Following the gentle removal of visible debris, some surgeons may recommend applying a small amount of an antibiotic ointment, such as Bacitracin or Aquaphor, to the inside of the nostril rim. This step helps keep the area moist, preventing new crusts from forming and aiding in the healing of any sutures present. Maintaining a clean, moist environment inside the nose encourages healing and minimizes congestion.
Managing External Skin and Tape Residue
The skin on the outside of your nose, covered by the cast and tape for about a week, is likely to be oily, flaky, and coated with adhesive residue. You must treat this skin with caution to avoid putting pressure on the newly shaped cartilage and bone underneath. To remove the sticky tape residue, gently wipe the area with a cotton ball or gauze pad soaked in a mild substance. Examples include mineral oil, baby oil, or rubbing alcohol, if specifically approved by your surgeon.
For general facial cleansing, wash the skin around the nose with a very mild soap, such as Ivory or Neutrogena, using a soft cotton ball rather than harsh scrubbing. The obstruction of pores caused by the surgical tape often leads to a temporary breakout of blackheads and small pimples. Manage these with gentle cleansing only. Do not use aggressive exfoliating products, astringents, or pore strips, as these could place tension on the healing tissues and compromise your result.
Critical Safety Measures and Actions to Avoid
The post-cast period requires protecting the delicate structures that are still healing. Never blow your nose forcefully, as the pressure created can cause internal bleeding, displace healing tissues, or introduce bacteria into the surgical site. If you feel the urge to sneeze, open your mouth widely to redirect the pressure away from the nasal cavity.
Avoid any activity that significantly raises your blood pressure, such as heavy lifting, bending over, or strenuous exercise, for several weeks post-surgery. This minimizes the risk of sudden bleeding and increased swelling. Furthermore, do not insert fingers or any sharp objects deep into the nose, as this can easily cause trauma to the fragile lining. Protecting the nose from accidental bumps is also important, and you should avoid prolonged sun exposure, which can exacerbate swelling and lead to permanent skin discoloration.
When to Contact Your Surgeon
While some discomfort and drainage are expected, certain symptoms warrant immediate communication with your surgical team. Contact your surgeon if you experience excessive or persistent bright red bleeding from the nose that does not stop after remaining still for 10 minutes. Signs of a potential infection, such as an escalating fever above 101°F, increasing redness or warmth, or a thick, discolored discharge, also require urgent medical review.
Sudden, severe pain that is not relieved by prescribed pain medication should be reported immediately. Any sudden change in vision or sensation, though rare, must also be reported without delay. Your surgeon’s office is your primary resource during this recovery phase, so call them with any concerns about your healing progress.