Surgical Instructions




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FACIAL COSMETIC SURGERY

GENERAL AFTER CARE INSTRUCTIONS

Please read these instructions several times and make sure all of your questions are answered prior to surgery. We will give you specific instructions if we make any changes in these directions.

DAILY ACTIVITIES

Since you have just undergone a major surgical operation, use good common sense in the first 7 days after surgery in restricting your normal activities, exercise regimens, and any activity requiring heavy lifting or straining for at least one week or longer. It is acceptable to do some light walking on the third day after surgery. Jogging and light non-contact exercise should not be resumed for six weeks. You can resume more strenuous activities as your condition improves.

You may be up and around on the day following surgery but some natural fatigue may persist for two to three days due to the normal effects of the anesthesia and surgical procedure.

Use your best judgment and do not ignore signs from your body of overdoing. When you move, stand or change positions, do it deliberately and carefully for the first seven days. In turning your head, move your head and shoulders deliberately as a single unit. Don't twist your neck.

ICE PACKS

Do not use the ice packs continuously. Use them for thirty minutes, then leave them off for thirty minutes. Do not use ice after 48 hours unless you are told to do so by the Doctor

HEAD ELEVATION

Sit up or rest with your head and back elevated with three pillows. It may help to sleep in this position for two to three days to prevent bruising and swelling.

DIET AND FLUIDS

Soft foods will generally be easier to chew for the first few days. Protein in your diet is very important to help you heal and to prevent swelling. Be sure to eat 60 grams or more of protein per day. Protein supplement drinks like Ensure, Boost and Carnation Instant Breakfast, dairy products, meats and fish are excellent sources of protein.

You must drink at least 2 quarts (64 ounces) of fluids each day to prevent dehydration. Start drinking as soon as you get home after surgery and keep a written record of your intake to be sure you are getting enough fluid. If you feel nauseated, it usually means that you are dehydrated. Drinking more fluid will help to eliminate the nausea. In moderation, talking and smiling are perfectly acceptable, however excessive smiling and talking may increase your swelling.

MEDICATIONS

Take pain medication with food or liquid as prescribed. You may take any of your regular medications after surgery as usual unless instructed not to take them. Avoid aspirin and other anti-inflammatory drugs (Advil, Motrin, ibuprofen, Aleve, etc.) for five days after surgery, these medications can increase bleeding and bruising. Other routinely taken medications may be taken as necessary.

SKIN CARE

Care of your skin before any procedure is important, especially if undergoing a chemical peel or laser procedure. Prior to any chemical peel or laser procedure, apply a medical grade sunblock and hydroquinone (Obaji Clear) for a minimum of 4 weeks before, and Retin-A for a minimum of 2 weeks before. Discontinue these two days before the procedure.

Vitamin C Serum may be recommended to aid the skin in healing with any facial procedure.
Botox or Dysport may be recommended one week prior to any procedure to minimize muscle movement during healing

GENERAL CARE AND EXPECTATIONS

Your head should be elevated on two pillows during sleep for the first 2 days. This keeps your head higher than your heart and helps facilitate the resolution of swelling. Do not sleep face down. Sleep on your back or side.

Facial and neck swelling and bruising are normally present after facelifts , jaw, chin or neck procedures but the degree of each varies widely from patient to patient. The worst swelling usually occurs on the third day after surgery. Do not be concerned if you have more or less swelling than others who have undergone the "same" operation. Generally, most patients appear quite socially acceptable within 10 to 14 days following surgery.

WOUND CARE

Apply Bacitracin or Polysporin (not Neosporin-as this causes prolonged redness) antibiotic ointment to sutures after cleaning several times daily in order to avoid crusting of the incisions and to accelerate the reduction of incision redness. Do not apply any other ointment or medication unless we prescribe it.

You may gently shampoo your hair 48 hours after surgery. Avoid any strong rubbing or combing trauma to the incisions in the hair and around the ear. Blow dry only on "cold" or "warm" setting for five days and postpone any permanent waves or hair coloring for three weeks following surgery.

Do not apply any make-up (mascara, eyeliner, or eye shadow) for the first 10 days following surgery. When you resume wearing eye make-up, use a soft make-up brush to apply shadow verses a sponge tip applicator or your finger.

You should avoid all sun exposure during the first three weeks because excessive exposure to sun (including sun tanning parlors) after surgery may result in prolonged facial swelling and injury to the skin. Therefore, you should always protect your skin with an SPF 25 or stronger sun-block in order to decrease the irritating effects of the sun on your skin.

Avoid rejuvenating (such as glycolics) skin care products for one week.

After Suture removal, Vitamin E cream may be applied twice daily and continued for four to six weeks.. After five weeks Mederma may be applied to the incision sites.

It is very important that you follow all instructions given to you by our office and that we check your progress regularly following surgery.

PLEASE REPORT ANY OF THE FOLLOWING TO OUR OFFICE:

  • Excessive bleeding or drainage.
  • Itching, redness or rash.
  • Temperature above 101 degrees.
  • Excessive, sudden swelling or discoloration.
  • Excessive fatigue.
  • Severe eye pain or vision changes
  • Any other unexpected symptoms or problems

Please call our office 817 552-3223 if you have any questions or problems.

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FACIAL COSMETIC GENERAL INSTRUCTIONS

  • Apply ice to the surgical site for 48 hours. Keep your head elevated for 36 hours.
  • Incisions may be gently cleansed after 24 hours with a warm moist facial towel and an antibacterial mild soap. After the fifth day, any scab may be gently soaked with one-half strength hydrogen peroxide and Q-tips. Apply Bacitracin or Polysporin (not Neosporin-as this causes prolonged redness) antibiotic ointment to sutures after cleaning.
  • If a dressing is applied, it is to be worn for 3 to 5 days depending upon the procedure.
  • Avoid rejuvenating skin care products for one week.
  • Do not shower the surgical sites for one week. You may bathe and gently wash your hair the following day after surgery.
  • After anesthesia, drowsiness may persist up to 24-36 hours. If this occurs do not drive or remain without supervision.
  • After the bruising has diminished and sutures removed, Vitamin E cream may be applied. After five (5) weeks apply Mederma or ScarFade to the incision site, keeping away from eyes.
  • Avoid smoking for 2 weeks.
  • Avoid sun exposure to facial incisions for 6 months with sunglasses, hat, and/or Sunblock (SPF 25 or greater).
  • Your surgery will benefit by increasing blood flow; therefore, daily walks after initial recovery are recommended, but avoid strenuous exercise for 2 weeks.
  • If you wear contact lenses, do not wear them for one week.
  • While wearing eyeglasses or sunglasses make sure they do not pull on the incision. Apply sterile saline eye drops (contact lens eye drops) to your eyes if they feel dry or irritated.
  • Do not apply any make-up (mascara, eyeliner, or eye shadow) for the first 10 days following surgery. When you resume wearing eye make-up, use a soft make-up brush to apply shadow verses a sponge tip applicator or your finger.
  • Do not pluck your eyebrows or have them waxed for at least 2 weeks after surgery.
  • Report any severe or sudden eye pain or change in vision to the office staff immediately.
  • Healing is gradual so you will not notice final results for up to 3 to6 months. Improvement varies, depending on your initial condition. In most cases, a single procedure achieves the desired results.

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AFTER FACELIFT

IMMEDIATELY UPON ARRIVING HOME:

  • HEAD ELEVATION: Lie down with your head and back elevated with two pillows. You must sleep in this position for one week
  • DRESSINGS: Do not remove bandages. These will be removed at the office on your first or second post surgery visit.
  • ICE PACKS: Place ice packs (ice in Ziploc baggies or packages of frozen peas) over cheek areas for 24 hours. DO NOT put ice on after 24 hours unless you are told to do so.
  • SWELLING/BRUISING: Ice packs will keep swelling and bruising to a minimum. Bruising often last 7-14 days.
  • MEDICATION: Take pain medication ONLY IF NEEDED and with food or crackers.
  • DIET: Upon arriving home from surgery, begin with clear liquids until fully awake then begin regular food intake with soft foods.
  • SUTURE CARE: Keep all sutures clean with peroxide/water solution equal parts (50/50). Keep sutures lightly covered with antibiotic ointment Bacitracin or Polysporin (not Neosporin-as this causes prolonged redness)at all times. Clean 3-5 times per day.

DAY AFTER SURGERY

  • MOIST HEAT: Ice packs are discontinued 24 hours after surgery. WAIT 12 HOURS – then you may BEGIN MOIST HEAT. Use a moist wash cloth between an electric moist heating pad and your face. Do not use heat continuously e.g. on for 30 min. – off for 3 mins. DO NOT set heating pad higher than MEDIUM at any time regardless of how cool it feels to you.
  • ACTIVITY: Stay upright as much as possible. Avoid bending over or lifting heavy objects for one week. Strenuous activities should be limited for 2-3 weeks.
  • WORK: Most people plan to return to work in ten days to 2 weeks. This depends upon how you feel about being seen with bruising or swelling. Most of the bruising can be masked with make-up in you prefer to return earlier.
  • MAKE-UP: Cosmetics may be applied on the 6th day. Ask us about special cover up products for bruising. Mint green cover stick followed by flesh tone foundation will cover most bruises.
  • BATHING: You may bathe or shower but keep bandages dry. When bandages are removed, gently wash facial area.
  • HAIR CARE: You may wash your hair on the 3rd day after surgery. DO NOT BEND OVER to wash hair. This may cause bleeding or swelling to occur. Use medium heat on your hairdryer. High heat or hot rollers should not be used for 7-10 days. You may use color on your hair in 3 weeks.
  • DIET: Eat regular but soft meals. You will need your vitamins and minerals to help with healing. We will be glad to give you vitamin and mineral information.
  • SUN: Protect your facial skin from excessive sun exposure for one month after surgery.

PLEASE REPORT ANY OF THE FOLLOWING TO OUR OFFICE:

  • Excessive pain or bleeding
  • Itching, or rash around the stitches
  • Temperature above 100 degrees orally.
  • Excessive: Swelling/bruising, Fatigue/depression

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AFTER BROWLIFT

  • The head dressing, if used, will be removed at the first postoperative visit.
  • The small surgical clips used to close the incision will be removed in the office 7 to 10 days after surgery.
  • Clean suture lines with hydrogen peroxide and water (1/2 to _ mixture) using a Q-Tip 4 times daily. Apply Bacitracin or Polysporin (not Neosporin-as this causes prolonged redness) antibiotic ointment ONLY to the sutures following cleaning for the first 3 days. Do not apply an antibiotic ointment to any other areas unless instructed by the doctor.
  • After sutures or staples are removed, fine paper tape may be used on the incision. Please be sure to keep these dry.
  • Forehead swelling may prevent the upper eyelids from closing completely for several days. Lubricating eye ointment such as Duratears or Lacri-lube may be used before going to sleep to prevent dryness. Eyedrops such as Liquifilm Forte or Refresh can be used during the day if your eyes feel dry.
  • Numbness and tingling sensations in the forehead may last for several weeks. You may also experience some tenderness in this region.
  • As the small nerves grow back, bizarre symptoms of itching are often experienced; these will eventually disappear.
  • Makeup can be used within several days. Although your appearance will be presentable within several weeks, final healing may require several months.

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AFTER BLEPHAROPLASTY

  • No dressings are applied to the eyes following surgery. It is important to be sure to keep moist cool compresses on your eyes. There is no need to put antibiotic ointment on the incision lines.
  • When you arrive home, get a small basin with ice cubes and water and apply cold, moist compresses to your eyes. A bag of frozen peas with a damp washcloth works the best. This is to keep the swelling down and to keep the wounds clean of all crusting. Continue cold compresses over the eyelids for 3 days, then switch to warm moist heat.
  • Sleep with your head elevated for one week.
  • Continue to take prescribed medications and antibiotics as directed.
  • Apply sterile saline eye drops to your eyes if they feel dry or irritated. If an upper lid procedure was performed, you may want to use Duratears ointment at bedtime and artificial tears several times a day.
  • Occasionally, a small area of swelling or reddish bumps is seen on or around incision lines; these disappear as healing progresses.
  • Swelling, bruising, and redness of the eyelids of varying degrees may occur. It last for approximately 2 weeks.
  • Wash hair following surgery, if desired.
  • Avoid bending over or lifting heavy objects for one week. No strenuous exercise for at least 6 weeks.
  • Do not apply any makeup for the first 10 days following surgery.
  • Do not wear contact lenses for 10 days. Wear glasses, if necessary, being sure they do not pull on the incision line.
  • Do not pluck eyebrows for 2 weeks following surgery.
  • Report any severe or sudden eye pain or change in your vision to the office immediately.

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AFTER RHINOPLASTY

  • Swelling: Swelling is the body’s normal response to surgery and the beginning of the healing process. Swelling and discoloration will vary among individuals and according to different procedures. Swelling will increase over the first 48 hours, and subside over the next 5 to 7 days, although swelling in the tip of the nose can persist for several months. Apply cold packs (15 minutes on, 15 minutes off) for the first 36 hours while awake. Keep the head elevated for the first 72 hours using pillows under the back and head while sleeping.
  • Bleeding: Minor bleeding or blood-tinged mucous may occur for the first 24 to 48 hours. Do not blow your nose for at least one week after surgery. A “mustache” drip pad of gauze may be used and changed as often as needed. If bleeding persist over 2 days or is heavier than normal, call the office.
  • Pain: Medication has been prescribed according to your anticipated level of discomfort. Take pain medication before numbness from the local anesthesia is gone. Repeat every 4 to 6 hours as needed unless otherwise instructed by your doctor. Take the medication with a milk shake or other food or beverage to avoid nausea. Do not drive, operate hazardous machinery or drink alcohol while taking pain medications.
  • Packing: At the doctor’s discretion, you may have packing placed in your nose at the time of surgery. This is done to minimize swelling inside your nose and to improve breathing. These soft plastic packs are sutured into place and will be removed by the doctor about one week after the surgery. There removal by the doctor is not painful.
  • Splint: The nasal splint with tape will remain in place for five to seven days. Avoid getting it wet. Wash your hair in a beauty salon fashion. After the splint is removed, do not allow glasses or mask to rest on the bridge of your nose for 6 weeks. Glasses should be taped to the forehead if needed
  • Wound Care: You can use Afrin nasal spray for the first 2 days following surgery, provided splints are not inside your nostrils, but you cannot use it longer than this or it will actually cause nasal congestion and impair healing. You can, however, use over-the-counter salt water nasal sprays such as Ocean spray or Fresh Ayre, warmed gently in the microwave, as often as desired. This will help clean the nose and decrease intranasal swelling. You may clean the edges of your nostrils with a Q-tip dipped in hydrogen peroxide to remove crust. However, do not advance the Q-Tip into the nose at all.
  • Diet: If your surgery is to be performed under an IV sedation or general anesthesia, you should not eat or drink anything for at least 6 hours prior to the procedure. After your surgery, start with a soft or liquid diet, and advance slowly to a normal diet to avoid post-operative nausea.
  • Sutures: The sutures placed inside the nose will dissolve by themselves. Sutures holding in the nasal packing and on the outside of the nose will be removed by your doctor about one week after your surgery.
  • Medications: In addition to medication for pain, you have also been given a prescription for an antibiotic and or a decongestant.
  • Activity: Do not engage in any strenuous activity (bending, heavy lifting, etc.) for at least 2 weeks following surgery. Protect your nose from excessive sun exposure for 8 weeks after surgery.
  • Be assured that our interest in you well being does not end with your surgery. If you have any questions or problems, please call the office number. Help will always be available. A post-operative appointment has been scheduled, but we would be happy to see you sooner should the need arise.
  • Report any excessive pain, nasal drainage, rise in temperature above 100.5, or injury to the nose.

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AFTER LASER RESURFACING AND CHEMICAL PEELS

  • Apply ice packs to treated areas for the first few days to decrease swelling.
  • DO NOT PICK OR RUB TO REMOVE DEAD SKIN OR SCABS, as this may increase the risk of scarring. Any scabs should be gently soaked off, if possible. Use the prescribed Avene Thermal Spring Water (- or one tablespoon of white vinegar to one cup of water on a soft cloth) to soak the regions six to eight times daily. You may trim the ends of any flaking skin with clean scissors.
  • Apply a moisturizer, the prescribed Avene Cicalfate (or Aquaphor or Catrix), three to four times daily, or whenever the skin feels dry.
  • Apply the prescribed Hydroquinone (Obaji Clear) when the skin has stopped oozing and flaking and started healing, generally day 5 to 10.
  • Do not apply any skin rejuvenating products such as glycolics or Retin-A for six weeks after your procedure, or as instructed.
  • Sleep on your back with your head elevated on a few pillows for 3 - 4 days. You may experience increased swelling each morning upon awakening.
  • If the skin around the mouth is swollen or tight, drink using a straw.
  • Avoid strenuous exercise for 2 weeks to avoid irritating the skin.
  • Avoid drafts, fans, or air conditioners, etc., as air blowing on treated areas may cause stinging and will also dry out the skin.
  • Do not expose the skin to ANY sun for 2 weeks. It is very important to keep the area protected from the sun for the next several months to avoid changes in skin pigmentation and to minimize redness. For 2 - 8 weeks after surgery, a Titanium Dioxide containing sunscreen should be applied daily along with the use of hats, sunshades, sunglasses.
  • Most laser/chemical peels are supplemented by the use of rejuvenating creams. These may be started after 4-6 weeks.
  • The physician will instruct you when it is okay to start wearing make-up. This is usually day 7-10. A green or yellow undercover make-up applied under your foundation will help hide redness. We strongly recommend a consultation with our aesthetician prior to and one week after surgery for skin care and make-up directions and tips.

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