Yoo and colleagues performed a retrospective medical record review of 363 consecutive adult patients who underwent preoperative nasal swab testing and rhinoplasty or septorhinoplasty in a single private practice. Directed nasal swab cultures were taken by the surgeon from the nasal vestibule 4 to 14 days prior to surgery using a culture swab. Of 363 patients, 284 (78.2%) showed normal nasal flora on preoperative cultures. Thirty-nine patients (10.7%) had Staphylococcus aureus, and only 1 (0.28%) had methicillin-resistant S aureus (MRSA). There were 27 patients (7.4%) whose cultures grew out of one of the fecal coliform species. Age, sex, smoking, the use of oral contraceptives, or the presence of seasonal allergies did not significantly change the nasal flora or the postoperative infection rate. The overall infection rate was 3.0%, with 4.0% seen in primary septorhinoplasties and 2.1% seen in revision cases. Coliforms accounted for 5 cases (45.5%) of postoperative infections, while S aureus was responsible for 4 cases (36.4%), including 1 case of MRSA. The results of this study suggest that risk factors alone may not reliably predict the subset of patients for whom antibiotic prophylaxis is indicated.