Post-Operative Instructions for Facelift Surgery

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.

Facelift surgery is one of the most dramatic procedures for looking younger.  Nothing can improve the jowl and neck more than the facelift.  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.  In order to take advantage of all the positive changes associated with the facelift the patient must pay close attention to the recovery process.

Immediately Following Surgery:

  • An adult should stay with you for at least the first 24 hours after surgery.  Rest is absolutely necessary.
  • You will be wrapped in dressings that will not be removed until your 24 hour follow up appointment.
  • You should rest with your head elevated in a recliner or with at least 2 pillows for at least the first week after surgery.  Try not to sleep on the side of your face but rather sleep with the back of your head on the pillow for about two weeks.  Some patients prefer an airline type pillow for comfort.  Also popular is the common pillow called a “husband.”  This is the large pillow that has extensions that go under the arms and supports the patient.
  • 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 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.

Bleeding

Mild bleeding from the surgical site is not unusual.  If bleeding does occur, go to bed, elevate your head, and apply an ice compress with mild pressure about the face and neck.  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 for 10 days after your surgery.  We require our facelift surgery patients to keep their activity to a minimum.  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 and can cause bleeding.  Some homeopathic herbs may also elevate bleeding times and should not be used before or immediately after facelift surgery.  Ginko, Garlic, and Ginseng, as well as high doses of vitamin E can increase bleeding.  If you experience severe pain and or swelling of one or both sides of the face, or if bleeding is heavy or prolonged call Dr. Hammond immediately.

Swelling

Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount varies from person to person, but it always seems more in the face since there is looseness of the tissues and because even a small amount makes the features appear distorted.  Do not be alarmed if one side of your face is slightly more swollen than the other.  This is common and usually disappears within a few weeks.

The swelling that is normally expected is usually proportional to the surgery involved.  Swelling around the eyes, cheeks, face, and down into the neck and chest 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.  The swelling will rapidly decrease after the 3rd day. The skin of the face may feel tight for a while due to the swelling.  You may feel that it interferes with your smile; this will disappear within a few weeks.
 
The swelling may became more pronounced along the jaw line and is generally worse when you first arise in the morning. The swelling itself is not serious and is not an indication that something is going wrong with your operation. As previously explained, your face and neck will remain swollen with varying amounts of discoloration for several days. The main thing to remember is that such swelling eventually subsides; you can help in several ways:

  1. KEEP ICE ON YOUR FACE AND NECK.  Crush up ice and place it in a zip lock bags.  Place a thin towel around the ice bag and place this over the surgical sites.  Do this as much as possible for the first 3 days after surgery.  After the 72 hours, either ice or heat is permitted. 
  2. AVOID BENDING OVER OR LIFTING heavy things for one week. Besides aggravating swelling, this may raise the blood pressure and start hemorrhage.
  3. AVOID HITTING OR BUMPING YOUR FACE, HEAD AND NECK. It is wise not to pick up small children and you should sleep alone for one week after your operation.
  4. SLEEP WITH THE HEAD OF THE BED ELEVATED for 1-2 weeks after your operation. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of it. Try not to roll on your face; this tends to tear down the supporting stitches used under the skin of your face; therefore, it is necessary to sleep on your back for 2 weeks. Some patients find a reclining chair placed at 45 degree angle to be more comfortable.
  5. SUPPORT THE SWOLLEN TISSUES with an elastic wrap applied according to the directions we will give you.
  6. Wear it constantly until one week has elapsed from the date of your operation; then it should be worn during sleep until 2 weeks has elapsed from the day of your surgery. It is beneficial to wear the sling during the day when you are alone during the first 30 day period.
  7. AVOID EXCESSIVE SUNNING of the face for one month; ordinary exposure is not harmful.
  8. IF YOU HAVE HAD LASER RESURFACING OR A CHEMICAL PEEL at the same time, it is important to place a thin coat of Vaseline over the treated skin for the first 5-6 days.

Pain

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.  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.

Diet

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.  Avoid straining when going to the restroom.  Getting a laxative or a stool softener may be beneficial.

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.  You may use Johnson’s Baby Shampoo and very gently wash your hair. Be gentle when washing and drying the face not to disrupt the lasered area or sutures.  Sutures have been placed 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.

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 10 days after surgery.  Incisions should not be exposed to direct sunlight for 6 months after surgery.  Sunscreen is mandatory over all incisions.

Discoloration

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, neck and even the upper part of the chest.  Bruising of this degree can take approximately two weeks to resolve. As the healing progresses, bruising can go from blue to purple to yellow.

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.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid 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 back up 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.

Additional Information:

  • 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 their 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.
  • 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.
  • It is not uncommon to have some mild post-operative depression.  Most patients are shocked when they see their face swollen and, perhaps, discolored. Be realistic and realize that this is a very temporary condition which will subside shortly. The best “treatment” consists of busying one’s self with the details of post-operative care and trying to divert one’s attention to other thoughts.  Just relax and rest and let your face heal.
  • An appointment will be made at the front desk for 24 hours after the surgery 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.  We will then see you at 1 week.
  • Do not smoke for at least 2 weeks post operatively as smoking significantly delays healing and increases the risk of complications.
  • 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.