What is the Benefit of Using a 4% Chlorhexidine Based Antibacterial Cleanser the Night Before and the Morning of Rhinoplasty?

I am having open rhinoplasty next week and my generic pre-op instructions state to use a 4% chlorhexidine based cleanser all over my face the night before and the morning of surgery. Most websites I read say to use Dial or some other antibacterial cleanser. I am worried about the harshness of this type of cleanser and damage to my skin. I asked the nurse if I could use another type of cleanser and she said no. Why use such a high strength cleanser all over my face?

Doctor Answers 7

Chlorhexidine Cleanser Before Rhinoplasty

Serious infections following rhinoplasty are rare.  However, antibiotic resistant organisms are now commonly found in the community and minor infections of the skin and suture lines are more difficult to treat with routine antibiotics.  Many surgeons are now using chlorhexidine prior to surgery to reduce the bacterial population on the skin and lessen the risk of infection. Used as suggested, Chlorhexidine cleanser should not have any long term effects on your skin. It is important to keep the product out of your eyes.

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 112 reviews

Use of anti-bacterial soap prior to surgery

It is generally not recommended to use this type of soap near the eyes otherwise you should be fine.  The use of a surgical soap helps to decrease the bacterial count of the skin prior to surgery.   This has been shown to decrease infection rates especially on surgery of the breast and body.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

What is the Benefit of Using a 4% Chlorhexidine

Just your surgeon's preference. In over 30 years of doing that surgery we have not had such a requirement and have never had an infection. But each surgeon will have his preferences and if you want that surgeon you should follow his advice.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Antibiotics before a rhinoplasty

Dear RamonaQ,

  1. It is common practice before a rhinoplasty to reduce the bacterial load with chlorhexidine 4%
  2. It may dry out the skin, and it will improve after surgery, so it is just temporary
  3. You can use a moisturizer at night (but not in the morning) to reduce dryness

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Goal of chlorhexidine is to reduce bacteria on your skin

The chlorhexidine scrub is meant to reduce the number and type of bacteria on your skin. The treatment is safe and will not damage your skin. In fact, the same prep agent might be used in the operating room to cleanse your face. It is very important to follow the recommendations of your rhinoplasty surgeon including the skin prep that they've outlined. The worst case would be to avoid the skin prep and develop an infection following surgery. I hope this information is helpful.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Chlorhexidine will not "damage" your skin

The use of Chlorhexidine or Hibiclens is a common recommendation for many practices. It helps to reduce bacterial counts on your skin prior to surgery, therefore reducing the risk of postoperative infection. Even though the chance of a postoperative infection occurring after a rhinoplasty is relatively low because of the robust blood supply to the face, wouldn't you want to do everything possible to have the best outcome after surgery? The two time use of Hibiclens on your face is not frequent or harsh enough to damage your skin. Thank you for sharing your question. Best of luck with your surgery.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 164 reviews

Antibacterial prep before rhinoplasty

While your surgeon is probably recommending this out of an abundance of caution, it's probably overkill for a rhinoplasty. These sorts of scrubs do help reduce surgical site infections for other surgeries on the body, but the face is much more resistant to infection, thankfully. Perhaps if you were a MRSA carrier, this might make some sense, but I do not routinely have patients do any special antibacterial prep before rhinoplasty. And (knock on wood), I haven't had a rhinoplasty infection in any of my 13 years of practice and hundreds of rhinoplasties.

Good luck with your surgery,


Pearson Facial Plastic Surgery®

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.