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Why do I need to ensure my procedure is performed by an experienced plastic surgeon?

The key to a beautiful and natural-looking nose job is careful analysis, communication, and attention to detail. It is important that you choose a plastic surgeon who has the technical expertise and experience to help you achieve your goals with nose surgery (rhinoplasty). At Hill Country Plastic Surgery, Dr. Farber will improve the appearance of your nose and correct any breathing issues, if present. Every nose is completely different, and every patient requires a customized approach to achieving their goals. Dr. Farber employs the most advanced techniques to ensure your new nose is stable, balanced, and suits your other features.

What can I expect during my consultation visit?

Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion. During your initial consultation with your surgeon at Hill Country Plastic Surgery:

  • We will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs.
  • Once we identify your concerns and surgical goals, we will discuss all treatment options that are available to you. 
  • Every patient is unique, and we will develop a tailored surgical plan that addresses your specific goals. 
  • In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details such as your family breast cancer history.
  • It is very important that we obtain accurate information in all areas, as it may impact the outcome of your surgery. 
  • If you have any prior breast imaging, please send it to the office prior to your appointment.
  • While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. 
  • Pre-operative (before surgery) photos will be taken either at your initial consultation or during your pre-operative visit.
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What should I expect after my consultation?

You will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you.

If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

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Your Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have and measure you for your post-operative compression garments. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

In the Weeks Before Surgery

  • Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. 
  • Please stay away from secondhand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and you will need to undergo a nicotine test prior to surgery to ensure that it is out of your system.
  • Please do not drink alcohol before or after your surgery (until cleared by your surgeon). 
  • In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life-threatening side effects.
  • Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.
  • Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.
  • You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc.) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.
  • The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.
  • Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.
  • Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.
  • Do not eat or drink anything after midnight the night before your surgery.
  • Please call our office if you have an infection of any kind prior to your surgery.

What will happen on the day of my surgery?

  • On the day of surgery do not take blood pressure medications with generic names that end in “-pril,” “-sartan” before your surgery. If you are on metformin, you will be asked to not take it on the day of surgery.
  • On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last-minute questions or concerns you may have. Your plastic surgeon may make some preoperative markings and will perform extensive checks with careful attention to detail, to ensure your safety and quality of care. 
  • You will then meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.
  • Throughout the procedure, your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for aftercare will be given to you in your preoperative paperwork.
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Aftercare Instructions

To make your recovery faster and more comfortable, we recommend that you prepare leading up to your surgery. Some actions you can take include:

  • Prepare a sleeping area that is easy to get to. For example, set up a downstairs bed instead of needing to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
  • You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
  • If you’re having an outpatient same-day procedure you will be released to go home that day and will need someone to drive you home afterwards.
  • Review your post-surgery instructions given to you at your pre-operative appointment
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Medications

  • After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.
  • You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for pain medication. If you are prescribed medications that contain acetaminophen (Tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (Tylenol) per day. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.
  • Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as MiraLAX or Colace once or twice daily.
  • You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.
  • If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.
  • Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.
  • We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Anesthesia

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery. When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Pain Medications

After surgery you will have a certain amount of discomfort. The goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

Resuming Your Regular Activities

You may resume your regularly prescribed medications after surgery apart from blood thinners as this will be determined by your surgeon. We will give you a prescription for pain medication. If you are prescribed medications that contain acetaminophen (Tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (Tylenol) per day.

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Important Information on Narcotic Medication

  • You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.
  • Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over-the-counter stool softener such as MiraLAX or Colace once or twice daily.
  • Do not drive, operate heavy machinery or make any important decisions while taking narcotic pain medications.
  • We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.
  • Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

Surgical Site Care

You may shower 48 hours after your surgery. Do not scrub the incisions. Let the water run over them and gently dab them dry afterwards. Apply gauze over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery.

Drain Care

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full, or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

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Please Call Us Immediately If:

  • Temperature greater than 100.5 F
  • Increasing pain that is not controlled on oral pain medications
  • Increasing redness or size at the surgical site
  • Your drain is not holding suction
  • Bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
  • If your wounds come apart
  • Any other concerns
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For Non-Emergency Questions:

  • During business hours (8 AM – 4:30 PM): call (210) 658-3555.
  • After hours and on weekends/holidays: call (210) 658-3555. You will be forwarded to the on-call surgeon.
  • If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity Restrictions

You will be asked not to engage in the following vigorous activity until your follow up appointment: pushing, pulling, bouncing, housecleaning, yoga, running, and heavy lifting. Avoid activities that raise your blood pressure and heart rate. You are encouraged to walk around, and you may climb stairs after surgery. You should try not to remain sedentary for extremely long periods. 

Your Follow-Up Appointment

Your follow up appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555. The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Limitations, Risks, and Complications

Risks of the procedure include risks of anesthesia, bleeding, infection, fluid collections, opening of the incision, widened scarring, numbness on the abdominal wall, skin discoloration, recurrent looseness of skin, deep fat may die (fat necrosis), deep vein thrombosis, cardiac and pulmonary complications, asymmetry, need for revisions, persistent pain.

Begin your journey.

Your journey to a happier, more confident life starts with a private, in-depth consultation with your surgeon, where we learn about you and your vision and goals. Discover San Antonio’s premier clinic for plastic surgery.

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