How is bleeding controlled during rhinoplasty?

Question

During a rhinoplasty procedure, how is bleeding controlled?  Is suction used? Is gauze placed in the nose? Or does the patient end up swallowing most of the blood?  I wonder if aspiration is any sort of risk during the procedure.

Shervin Naderi, MD, FACS · Answer

Hi

	First off I agree with Dr. Papel that the bleeding is usually minimal but only in good surgical hands with good meticulous technique.  Sloppy surgical technique creates significant bleeding.  Use of local anesthetic with epinephrine as well as decongestants like Afrin or Cocaine create constriction of the blood vessels which minimize bleeding.  The patient's blood pressure is also usually kept low during General Anesthesia if safe with a systolic pressure of about 90 which also minimizes bleeding.  Ultimately good surgical dissection in the proper area of the nose minimizes bleeding.  This is something that good surgeons will know how to do well and poor ones will not.  Use of cautery is kept as a last resort to minimize scar tissue formation.  With all this, some patients will and do bleed more than others.  We also check labs before hand to make sure the patient does not have a bleeding disorder.

William Portuese, MD · Answer

In our surgery center, rhinoplasty is performed under general anesthesia with total protection of the airway so that patients do not have aspiration of blood into their lungs.  Once the patients are placed under general anesthesia, an injection of Lidocaine with epinephrine is placed inside the nose, numbing both the nasal bones, the septum, and the turbinates.  In addition to that, Afrin is given to the patients to help shrink the membranes and decrease the bleeding.  Both of these drugs decrease bleeding in the nose during the procedure.

Sacha Obaid, MD · Answer

The answer to this question really depends on what type of anesthesia that is used to perform your rhinoplasty.  I typically use general anesthesia and we place a packing in your mouth and throat to prevent you from swallowing any blood.   We also pass a tube into your stomach while your asleep to remove any additional blood.  If you are not having general anesthesia, the packing is not used although the tube in the stomach may be passed depending upon your surgeon and anesthesiologist.
	
	Other than that bleeding is controlled as it would be in any other surgery through cauterization and use of medicines that cause the blood vessels to clamp down preventing blood from leaking. 

	
	Best of luck with your surgery.

Stephen Weber MD, FACS · Answer

Aspiration is typically not a risk because it is something that a rhinoplasty surgeon carefully controls. The first step is to prevent bleeding from occurring. This is achieved by proper injection of local anesthetic containing epinephrine which minimizes bleeding. The second step is to operate in the proper tissue planes which are typically bloodless. The final step is to use careful cautery to stop any bleeding that does occur. We also typically place small cotton pads in the nose to soak up any bleeding before it reaches your airway. Rhinoplasty is very safe in experienced hands.Stephen Weber MD, FACS

Jonathan Kulbersh, MD · Answer

Bleeding the enemy of the surgeon during a rhinoplasty.  I take steps before going to surgery to prevent bleeding.  I have a list of medications and foods I have all of my patients stop taking 2 weeks before surgery.  Before going back to surgery, I have patients ice their nose to slow the blood flow to the nose.  

	 

	In surgery, the throat is packed with gauze to prevent blood from running down into the stomach or in the trachea.  At the end of the case, the stomach and throat is suctioned cleaned to remove any blood that may be in that location.

	 

	During surgery, the nose is injected with medication to prevent bleeding and I keep the blood pressure low during the surgery.  With these maneuvers  I typically have very little bleeding during a rhinoplasty in my office in Charlotte.

How is bleeding controlled during rhinoplasty?

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How is bleeding controlled during rhinoplasty?

Answers (10)

Answer: Bleeding varies but it must be controlled during a Rhinoplasty

Answer: Bleeding varies but it must be controlled during a Rhinoplasty

Answer: How nasal bleeding is controlled during rhinoplasty

Answer: How nasal bleeding is controlled during rhinoplasty

Answer: Controlling bleeding during rhinoplasty.

Answer: Controlling bleeding during rhinoplasty.

Recommended reading

Everything you need to know about Rhinoplasty

Answer: How is bleeding controlled during rhinoplasty?

Answer: How is bleeding controlled during rhinoplasty?

Answer: I Use Multiple Ways To Control Bleeding

Answer: I Use Multiple Ways To Control Bleeding

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