POST SURGERY

POST-SURGICAL INSTRUCTIONS

POST RHINOPLASTY
Patients can have an uncomfortable recovery after Rhinoplasty. My recommendations are as follows: Sleep with your head elevated on two pillows. Avoid eating or drinking quickly which could cause you to cough. Arnica gel and oral granules help to diminish bruising. Apply ice compresses to your eyes for several day after surgery especially in the morning. Remove your packing with a tweezer by grabbing the packing and pulling straight forward (when instructed by your physician). Have paper towels prepared to squeeze your nose for 20 minutes between fingers to stop excessive bleeding. Do not remove the tapes applying pressure to the nasal tip or the plastic splint on the nasal bridge. If the splint becomes dislodged you may clean it, place it in water in the microwave for 60 seconds then carefully reapply with pressure to your nose. After removing the packing clean your nose by carefully inserting with a twisting motion a q-tip applicator straight towards the back of your head. In a few days the nasal drainage will decrease; at this point use peroxide on the applicator. Finish with a small amount of saline gel or antibiotic ointment. When the bleeding ceases you can gently blow your nose. Do not bend forward to tie your shoes or lift heavy items. Avoid dusty areas to prevent sneezing. When your nose stops bleeding you can gently blow your nose. If bleeding is excessive call your physician; if not available proceed to your nearest emergency room.

POST BREAST AUGMENTATION/LIFT/REDUCTION
The first day after breast augmentation you will typically begin to have moderate pain especially when moving your arms. I prefer Vicodin 1/2 pill every two hours or 1 pill every four hours for more severe pain. Dressings can be left in place until you wish to shower usually on the second post operative day. At this time you can remove the gauze pads and the tapes holding them in place. Shower with soap and water, pat the wounds dry. Do not remove the steri-strips or paper tapes on the skin, they are holding the wounds closed. You may clean the strips and any exposed incisions with peroxide or alcohol. Some patients choose to apply antibiotic ointment over the strips. Reapply gauze pads held only with your bra until there is no drainage, typically lasting up to one week. Do not allow moist tapes or dressings to sit on wounds as this can cause infection. It will be difficult to get out of bed the first day after surgery so sleep with your back propped up on two pillows and roll out of bed. Valium taken two to three times daily is helpful to reduce muscle spasm and helps you to fall asleep. A milder form of muscle relaxant Carisprodol is less sedating. The more active that you are and the less time that you remain in bed the faster you will be back in action. Antibiotics need to be taken for one week usually twice daily. By the second day you should be out of the house, the third day back to work and the seventh day to the gym.

POST LIPOSUCTION
Activity as soon as possible after liposuction is recommended; not only does it improve circulation but it raises the spirit. Moderate exercise and work can be commenced two days after the procedure.  A moderate amount light red watery drainage is typical and beneficial for one to two days.  This represents the toumescent solution and inflammatory fluids. Suture sites should be cleansed twice daily with peroxide followed by application of antibiotic ointment. Absorbing pads kept over the incision sites will keep your garments dry. A compression garment should be worn most of the time for one month after liposuction. Wrinkling of the garment is to be avoided as this may lead to irregular fat contour.  Pain is typically mild to moderate; adequate medication will be prescribed and taken every four to six hours if needed.  Sutures are removed after one week. Massage is beneficial to improve circulation and soften occasionally encountered firm areas.  It is always recommended to call the office for advice.

POST ABDOMINOPLASTY
Abdominoplasty is one of the most involved and complicated aesthetic procedures.  A compression binder is applied immediately after surgery.  This is to be worn continuously for the week after surgery.  It maintains pressure on the operative site thereby decreasing bleeding and bruising.  Absorbent pads are to be changed starting the second day after surgery.  You may shower at this time.  Incisions and drain site if present should be cleaned of all material with alcohol or peroxide.  Antibiotic ointment and clean gauze are then replaced twice daily or more often if needed.  If a drain is placed the reservoir should be emptied, recorded and replaced on vacuum at least twice daily.  You should move your legs and stay out of bed as much as possible. Patients at higher risk of leg vein clots will be instructed on the use of daily blood thinner.  Avoid excessive movements of the midsection. A snug girdle should be worn for one month.  If a drain is utilized antibiotics should be taken twice daily after meals.  At the seventh day follow up visit dressings will be changed and steri-strips applied.  Excessive swelling, bleeding, fever or pain should be reported to your surgeon.  If not available report to the best staffed emergency room in your area.  Fatigue, mild dizziness, swelling and pain are to be expected. As with all surgical procedures please refrain from and avoid second hand smoke for one month.

POST LASER PEEL/LASER, INFLAMMATION AND PIGMENTATION
The majority of lasers and chemical peels work by transmitting heat to the superficial and deeper layers of the skin.  Surgical scars heal by a modification of the inflammatory process.  There are several options to decrease this inflammation and post treatment redness. Standard pharmaceutical options include Motrin, Advil, Diclofenac pills and cream.  These medications taken after bleeding is not a concern diminish pain and swelling and inflammation.  Steroid creams applied for limited periods are also effective.  Oral antibiotics like Doxycycline will also decrease inflammation as well as diminishing the risk of infection.Herbal and natural supplements also are effective.   B Propolis a natural antibiotic may be taken by mouth or applied as a topical cream.  Arnica Montana pellets (3-5) in addition to pure Arnica extract gel 3-4 times daily aid in decreasing bruising and swelling.  Aloe gel preferably from the leaf has been proven to hasten the healing of open wounds and burns. Calendula gel or ointment, Boswellia and Curcumin 200 mg decrease inflammation. Pineapple containing Bromelaine and asparagus, a good source of Vitamin K decrease bruising and bleeding.  Fresh Ginger grated into salads and juices or boiled in tea is a proven anti-inflammatory.  Multivitamins in the post operative period help to replenish what is used by the body in healing the wounds and stress of surgery.  Zinc, Beta Carotene, Vitamin A, Vitamin C powder and Selenium are important.  Vitamin E 200-400 IU daily by mouth and the oil applied to healing scars decrease production of scar collagen.  Our experience with lightening of brown pigmented scars with the Intense Pulsed Light Laser and TCA peels has been positive.  Several conservative treatments two to four weeks apart in addition to skin bleaching creams have resulted in postitive results. Application of pressure as well as injection of Fluoruracil and Kenalog help to lighten and flatten thick scars.

Please consult with your surgeon at to the timing of taking any medication or supplement. If there is any question about wound care call or text your doctor prior to making a false move.