How is bleeding controlled during rhinoplasty?

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.  

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.

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

Good question which patients rarely ask. The nose is very vascular, which means there are many blood vessels. Therefore it is important to control this blood flow prior to any surgery so the surgeon can see what he/she is doing. The first thing we do is decongestant the nasal membranes, which shrinks the blood vessels in the mucosa and decreases blood flow. Then we inject the nose with local anesthesia which contains  epinephrine, which contracts all the blood vessels and reduces bleeding to a minimum. Once this takes effect we can make incisions and perform the alterations needed to change the shape of the nose. Bleeding is therefore minimal, and rarely an issue. After surgery the medications wear off, and a slow oozing for the first 1-2 days is normal.

Most of the control of bleeding occurs before the surgery even starts. It involves placing a decongestant throughout the nose to shrink the blood vessels and decrease any inflammation in the nose. Once this is done, I then inject Lidocaine with epinephrine which provides anesthesia to the area in addition to further decreasing the size of the blood vessels.  Doing this in a very systematic manner will decrease the overall bleeding during the surgery. Additionally, meticulously dissecting the tissues also greatly minimizes bleeding.