How am I supposed to clean alar base reduction? Am I supposed to keep it moist, if so what do I use? (photos)

Question

Unfortunately my surgeon decided to do an alar reduction without my knowledge during my Rhinoplasty surgery. Now I have so many concerns about scarring and post care and he is so unhelpful. I am so scared of scarring but I'm not sure how to clean, care for the wound. Please help! I am 10 days post op and have been using mupirocin ointment because they start to hurt and feel dry. Would it be safe to moisturize with something else? I want to prevent scarring and just care for it properly.

Tanveer Janjua, MD · Answer

I have attached a video with details on how to perform local wound care after an alarplasty. You have to clean the incision lines with cotton applicators dipped in hydrogen peroxide and remove any scabs, then dry them and apply mupirocin. Do it 5 times a day for 2 weeks. After 2 weeks start applying sunscreen every morning to the incisions, at the end of the day massage the scars gently with cotton applicator and cocoa butter. At bed time apply liquid silicon gel (Scaraway) Do this routine for one to three months to get the best healing.RegardsDr. Janjua

Adam Bryce Weinfeld, MD · Answer

Each surgeon has his or her own preferred wound care after surgery.  It is best is you contact your surgeons office to discuss specific wound care.  Since you are 10 days  out, it is possible you don't need any wound care at all and may be able to begin scar management soon.

Justin C. Cohen, MD, FACS · Answer

Typically, a small layer of mupirocin is all you need. At this point you could also switch to using something like Aquaphor ointment. When done well these incisions usually heal beautifully. Best of luck.

Andre Panossian, MD · Answer

Every surgeon will have their preferred way of cleaning any fresh incision. The process may also be different from Day 1 to Day 10. For instance, after the dorsal cast is off, I routinely tell patients to shower normally with soap and water and allow everything to wash over the area. If there is still some crusting of blood, then you can use a bit of hydrogen peroxide on a cotton swab to gently clean the area. I use Mupirocin only during the first week. As always, make sure to run this by your surgeon. What makes a bad scar are sutures that are left in too long. With that said, if the sutures are fine enough, then I tend to leave them in for 10 days before removing them.

Greg Bran, MD, PhD · Answer

Thank you for your question. It is advisable to have the sutures removed at this stage. You can clean the healing scars twice per day with Hydrogen Peroxide and use Aquaphor in between. The ointment will reduce the surface tension of the healing scar which will not only accelerate healing but also lead to a better scar. Be alar of sun protection (SPF50!). Avoid direct sunlight or tanning beds for at least 4-6 Weeks.
Good luck
Greg Bran MD PhD
Double board-certified Facial Plastic Surgeon 
Member of the American Academy of Facial Plastic Surgery
Member of the European Academy of Facial Plastic Surgery

Paul N. Afrooz, MD · Answer

Your surgeon or representative from the office should be available to answer your questions.  Sometimes alar base reduction sutures are left in longer than other sutures because this area is a very dynamic with facial movements, and these incisions have a tendency to open of the sutures are taken out too early.  Your surgeon would know best based on the design of the alar base reduction, so it is important to have this question answered.  Your surgeon may also have a specific regimen for cleaning.  I advise patients to gently clean this area with dilute hydrogen peroxide and a Q-tip very gently in order to remove dried blood and crusting.  Your surgeon may have a different regimen.

Aaron Stone, MD · Answer

At 10 days your sutures should be out. I am sorry to hear of your difficulties with your surgeon but you should try to mend that breach. Mupirocin is a topical antibiotic used for MRSA. You should not use it as a moisturizer as you will end up being colonized with even more resistant bacteria. Numerous moisturizers are available and you should consult your doctor or his/her nurse, patient coordinator... to find which one they approve.

Ashok Govila, FRCS, MCh, MS - Account Suspended · Answer

Hello,
Thanks
for the question and pictures.
I don't see any stitches
at the alar base from outside which means your surgeon did it from inside.In this case, not much care is needed for my patients.
I
suggest them to use some skin antibiotic ointment form inside.
I
am sure you can find ways to reach your surgeon who's staff will guide you.He
seems to have done a good job.

Michael Elam, MD (retired) · Answer

Dear taniazednanreh, If you feel that the surgeon is not being helpful I would try and contact the patient coordinator who scheduled your surgery or helped with your pre-operative appointment. You should have a liaison in the office that you can contact at anytime to help walk you through the recovery phase. Personally, I give every surgery patient my cell number so that they are free to contact me with any questions.With that said, it sounds like the post operative care you are using is fine.  Aquaphor ointment would also help with the dryness. It is important that you use what your surgeon prescribes and follow their post operative protocol. When alarplasty is performed properly you should have no visible scars. Best regards, Michael V. Elam, M.D.

How am I supposed to clean alar base reduction? Am I supposed to keep it moist, if so what do I use? (photos)

Answers (9)

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