Post-Operative Instructions for Eyelid Surgery and Forehead Lift
Post-operative care is very important. Unnecessary pain and the complications of infection and swelling may be minimized if the instructions are followed carefully. Sometimes the after effects of surgery are quite minimal, so not all these instructions may apply. Common sense will often dictate what you should do. However, when in doubt, follow these guidelines or call our office any time for clarification.
Eyelid and forehead surgery can be one of the most rejuvenating facial cosmetic procedures. The success of the surgery lies in the hands of the patient as well as the surgeon. The best surgeon on earth will not obtain satisfactory results if the patients do not properly care for themselves after surgery.
Immediately Following Surgery:
- An adult should stay with you for at least the first 24 hours after surgery.
- You should rest with your head elevated in a recliner or with at least 2 pillows for the first 48 hours after surgery.
- Take the prescribed pain medications before you begin to feel discomfort. It is easier to prevent pain than control it.
- Restrict your activities the day of surgery and several days afterwards. It is not unusual to require 7 to 10 days before you are feeling back to normal, and before you can resume strenuous physical activity.
- Place ice packs over the surgical site. Refer to the section on swelling for further explanation.
- Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing. Stand up slowly to provide time to steady yourself. If you feel dizzy when you sit or stand, you should lie back down immediately to minimize the possibility of fainting.
Mild bleeding from the surgical site is not unusual. Mild pressure will control the bleeding. The main reason bleeding occurs is from patients elevating their blood pressure by bending, lifting, straining, coughing, sneezing, straining on the toilet and other strenuous activities.
To avoid complications from bleeding you must absolutely refrain from activities that may increase blood pressure or bleeding for 10 days after your surgery. Failure to do so may affect your vision! We require our eyelid surgery patients to be “couch potatoes” for the first 48 hours after surgery. We ask you to elevate your head for the first week and simply relax. Take advantage of this vacation and turn your family into servants!
You must also refrain from taking any drugs that may prolong bleeding. Remember even 1 aspirin per day is very dangerous for bleeding around the eye. Some homeopathic herbs may also elevate bleeding times and should not be used before or immediately after eyelid surgery. Ginko, Garlic, and Ginseng, as well as high doses of vitamin E can increase bleeding. If you experience severe stabbing pain behind the eye or if bleeding is heavy or prolonged call Dr. Hammond immediately.
After your surgery, we will recover you in our office for approximately 30 minutes. During this time we will place cold compresses on your eyes. This will make you feel comfortable as well as lessen swelling and bleeding. The best thing to do is to continue this for 48 hours at home.
Your forehead will be wrapped for 24 hours. Place ice packs directly over the wrap.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the eyes and down into the cheeks and face is not uncommon. This is the body’s normal reaction to surgery and eventual repair.
The swelling will start the day of surgery and will not reach its maximum until 2-3 days post-operatively.
Occasionally, the eyelids will swell completely shut. The swelling will rapidly decrease after the 3rd day.
The swelling may be minimized by the immediate use of ice packs. Simply take a large bowl and wash it and fill it with ice cubes and water and place several wash cloths in the bowl. Place one wash cloth over the eyes and forehead and when it becomes warm replace it with another wash cloth. This is beneficial and should be continued for 48 to 72 hours. If you have had laser resurfacing or a chemical peel of the face or eyelid skin at the same time, it is important to place a coat of Vaseline to protect the treated skin and reapply it frequently. The lasered or chemically treated skin should always have a fine coat of Vaseline for the first 5-6 days.
Ice water soaks are kept on the eyes for the first 48-72 hours.
After the 72 hours, either ice or heat is permitted. Please note that it is important to keep your head elevated for 4-5 days following surgery to minimize swelling. A reclining chair or several extra pillows behind the head works well to keep your head elevated.
For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen is generally not recommended for the first several days after surgery. This is because ibuprofen can cause increased bleeding and/or bruising.
For severe pain, take the narcotic pain medication as directed. This prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery until you are no longer taking any narcotic pain medications and your vision is clear. Avoid alcoholic beverages as they will enhance the effect of the narcotic.This is a dangerous combination. Pain or discomfort following surgery should begin to subside after the first two to three days. If pain persists, it may require attention and you should call the office. Do not routinely take Tylenol with prescription pain medications. Many prescription pain medications already contain Tylenol.
After general anesthesia or I.V. sedation, clear liquids should be initially taken. Over the next several days a high calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Keeping well hydrated also prevents nausea and vomiting. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.
Decreased activity may promote constipation so you may want to add more raw fruit to your diet and be sure to increase your fluid intake.
Care for the incision site
The skin incisions should be washed with soap and water three times per day starting the day after surgery. This should be done very gently and pat dry (do not wipe). After drying, the incisions should be cleaned with a 50% solution of 3% Hydrogen Peroxide and a Q-tip. Mix the Hydrogen Peroxide with and equal amount of warm tap water. The incisions should then be constantly covered with the antibiotic ointment dispensed to you. If you do not have antibiotic ointment, a thin coat of Vaseline works well. Incisions should not be allowed to become dry or crust over.
It is fine to shower the day after your surgery. Be gentle when washing and drying the face not to disrupt the lasered area or sutures. If you have had brow lift or facelift you will have sutures in the hairline incisions. Be careful not to snag them with a comb.
Hair dryers can be used on a low cool setting to help dry the hair. The hot setting is not to be used for several weeks following surgery. Coloring of the hair is not to be done for 6 weeks following surgery. There may be transient thinning of the hair in areas adjacent to the suture lines in the temple and behind the ear.
After all stitches have been removed, the scars will appear a deep pink color. There will be varying amounts of swelling in and around the scars themselves. With the passage of time, the pink will become white, the firmness of the scar will soften, and they will become less noticeable. Each individual varies with respect to healing, but it takes approximately one year for these changes to occur in most scars.
Some patients will experience dry eyes. You can purchase non-prescription eye drops at your local pharmacy. We recommend Refresh Eye Drops for daytime and Refresh Plus eye drops for nighttime.
Placing a drop in each eye every several hours will hydrate and refresh your eyes.
Beginning 6 weeks after the surgery, application and gentle massage with vitamin E, cocoa butter, or Mederma may promote softer, less conspicuous scar. Incisions normally will be red for several months but will gradually fade. Incisions can be covered with makeup 2 days AFTER SUTURE REMOVAL. Incisions should not be exposed to direct sunlight for 6 months after surgery. Sunscreen is mandatory over all incisions.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. In most patients, this is a normal occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
In younger patients, bruising is rare and sometimes is represented as a slight yellow discoloration. In older patients, especially the elderly, bruising can be quite significant and is represented as black and blue discoloration. This can cover a larger area sometimes even involving the eyelids, face and cheeks, and even the upper part of the neck. Bruising of this degree can take approximately two weeks to resolve.
As the healing progresses, bruising can go from blue to purple to yellow. Some patients will have the “white of the eye” turn red or pink and this is not a problem. Some patients may also experience what looks like a blistering of the eyeball. This is from swelling and is rarely a problem.
You can camouflage the discoloration to some extent by using a thick make-up, PANCAKE, by Max Factor (two shades darker than your skin color), may be applied with a moist sponge; after it dries, a second layer may be applied. It can be removed with water. Revlon-Erase (two shades darker than your skin color) may be used over “hard to cover” areas. Do not apply make-up over the incisions themselves for several days after the sutures have been removed; however, you can bring it up to the line of the incisions.
Please take the antibiotics as directed. Make sure you finish the antibiotic even if you feel like you are completely better and do not need it. Discontinue antibiotic use in the event of a rash or other unfavorable reaction, and notify the office of the reaction. Sometimes taking antibiotics with yogurt can help prevent diarrhea. If you take birth control pills, the birth control may become ineffective; use backup form of birth control.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on flat coke, tea, or ginger ale. You can also purchase coke syrup over the counter which can have a soothing effect on the stomach. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Please call if the nausea does not subside within 3 hours. There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.
- Numbness of the skin surrounding the surgical site is normal and there is no cause for alarm. As stated before surgery, this is usually temporary in nature although in some instances, it can be permanent. This will usually take several months for complete feeling to return.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol should be taken to reduce the fever.
- Your case is individual as no two people are alike. Do not accept well intended advice from friends. Discuss your questions and concerns with either Dr. Hammond or a member of our staff.
- If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may be much more difficult. We recommend that you take at least 14 days off from any vigorous physical activity. When you do resume your exercise regimen, start with a light to moderate workout and gradually increase your regimen over several sessions. Stop exercising if you get light headed.
- Eyelid and forehead incisions heal in a very cosmetic manner, but usually look very “raggedy” and irregular for the first several weeks. They may look uneven or bumpy, but generally heal better than any scar on the body. Don’t be concerned about the scar for the first several weeks. Sometimes the eyelids do not close all the way immediately after surgery. This is not unusual and will improve rapidly.
- You should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head for one week.
- Most people pay little attention to their eyelids until they have an operation. Don’t be too picky for the first several weeks or worry unnecessarily. Relax and let the healing take place. Remember, you will look worse before you look better. 99.9% of patients heal with excellent results. Minor nips or tucks are required to fine tune a result in some patients but again, this is rare.
- No heavy lifting for 3 weeks
- If you need to color your hair, do so 2 weeks prior to surgery OR not for 6 weeks after surgery.
- An appointment will be made at the front desk for 1 week to check the surgical sites. If you did not receive an appointment please don’t hesitate to call our office so we can see you.
- Do not smoke for at least 2 weeks post operatively as smoking significantly delays healing and increases the risk of complications.
- Wait at least 2 weeks before wearing contact lenses.
- You will have sensitivity to light and wind, tearing, and possibly double or blurred vision for several days and sometimes weeks. Wear sunglasses as this will help with the sensitivity.
- If you have any questions regarding your condition, it is best to call the office during our regular office hours. A follow-up visit is provided as a courtesy at no charge. If you have a true emergency, Dr. Hammond or his assistant can be reached 24 hours a day 7 days a week. During the day call the office number. At night, call Dr. Hammond on his cell phone. If there is no answer, leave a message and Dr. Hammond will call you back as soon as possible.