The following instructions are based on experience with many custom facelift operations. They will answer practically every question that may arise regarding what you should and should not do after surgery. You and your family should read them several times so that you may become thoroughly familiar with them. Please attempt to follow these instructions faithfully to ensure the smoothest post-operative course.
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. Often the swelling becomes a little greater the second day after your custom facelift. It may become more pronounced along the side of the neck and is generally worse when you first arise in the morning (proof that it is better to stay elevated as much as possible). The swelling itself is not serious and is not an indication that something is going wrong with your operation. It may even be uneven on one side compared to the other, but this is normal.
Elevate Head of Bed
To help minimize swelling, the head of the bed should be elevated 30 degrees when you go home. As an alternative, you may sleep in a recliner or use two pillows to elevate your head above your heart.
Turning the Head
AVOID turning your head or bending your neck. When you must turn, move the shoulders and head as one unit or as if you have a stiff neck. This will allow the under skin tightening to last longer. Neck mobility will return completely too normal.
There is usually little actual pain following a facelift, but you may experience a deep bruised sensation as a result of the swelling, and the face may seem heavy. The bandage you will wear the first night can seem quite snug under your chin. Rather than make you feel restricted, we hope it makes you feel secure. It will not restrict your breathing, but help to minimize bruising and swelling. It will be removed by Dr. Funcik or the nurse the first morning after surgery.
Unfortunately, all strong painkillers can cause sensations of lightheadedness, particularly in the immediate post-operative period and, consequently, seem to make recovery more tedious. Therefore, we generally recommend Extra Strength Tylenol – you may take 2 pills every 4-6 hours and we recommended that you take it as directed to keep it in your system to maximize the pain control. If the pain is severe, use the stronger medication that has been prescribed for you. Please eat something first. Narcotics may cause nausea, vomiting, extra bruising and discomfort. They may also cause depression, allergic reactions and constipation. Do not take aspirin or any ibuprofen-type medicines until instructed to by Dr. Funcik. Many over-the-counter pain relievers contain combinations of these products.
If significant bleeding does occur, go to bed, elevate the head, and please call us immediately. Slight oozing from the incisions, as when you nick yourself shaving, may occur. This stops with time and light finger pressure.
Getting Out of Bed
We usually recommend that you remain in bed during the first 12 hours following surgery, after which you may sit in a chair, walk to the bathroom or around your room. You should be as quiet as possible during this time. We discourage a great deal of talking and having too many visitors. The second day after surgery, you should be getting up and around more.
AVOID STRAINING AT THE STOOL. If you need a laxative, we recommend Correctol or Miralax (your pharmacist will give it to you without a prescription).
If you live in another city, you must stay in town. You may stay at a hotel, or with a friend nearby. You should plan to stay in town for at least seven days after surgery.
Removal of Dressings
In the operating room, a pressure dressing will be applied and two drains will be placed in the neck area to help decrease swelling. They will be removed the next morning by either Dr. Funcik or the nurse.
- Apply a liberal amount of Vaseline or Aquaphor to the suture lines around the front and back of the ears. Be sure to have a new, clean supply of the ointment. Do not put in the suture lines in the hair – this is too messy.
- Beginning the second day after surgery, start showering twice a day for the first week. Let warm water run throughout hair and face while showering. You may use Johnson’s Baby Shampoo or a suitable pH balanced shampoo that will not sting. Twice daily clean the staple and suture lines with the soap by using your fingertips and rinse well. After the sutures are removed in 7 days, you can use gauze or a clean washcloth. If you have eyelid surgery, do not be afraid to get the sutures around your eyes wet when showering.
- Report any signs of infection such as excessive swelling, redness, drainage or new unusual pain near the ears.
As previously explained, your face and neck will remain swollen with varying amounts of discoloration for several days. After most of the swelling has subsided in two weeks, there will be days over the next 3-4 weeks when you may have some recurrence of the swelling. Do not be alarmed. This will subside within hours of getting up in the morning. These fluctuations of swelling are expected and are temporary. The main thing to remember is that such swelling eventually subsides. You can help in several ways, as follows:
- STAY UP (sitting standing, walking around) as much as possible on your second post-operative day. Of course, you should rest when you tire.
- AVOID BENDING OVER OR LIFTING heavy things for two weeks. Besides aggravating swelling, this may raise the blood pressure and start hemorrhage.
- SLEEP WITH THE HEAD OF THE BED ELEVATED for 2-4 weeks after your operation. To accomplish this, place two pillows under the head of the mattress or one or two on top of it. Try not to roll on your face; therefore, it is necessary to sleep on your back for one month, if possible. Some patients find a reclining chair placed at a 30-45° angle to be more comfortable.
- SUPPORT THE SWOLLEN TISSUES with a chin sling applied according to the directions we will give you. Wear it constantly until one week has elapsed from the date of your operation. Then it should be worn during sleep for the second week.
- AVOID EXCESSIVE TANNING of the face for 2-3 months. Ordinary exposure is not harmful, but please use an SPF 20 or greater sunscreen and wear a hat, if possible. Splotchy brown coloration may occur with sun exposure.
It is normal to have varying amounts of facial bruising or discoloration. Like the swelling, it may become more pronounced, especially in the neck and jowl corner of the mouth area after the first day or so, but remember this is temporary. Sometimes the discoloration may become more pronounced after you have been discharged. It usually lasts less than two weeks, but occasionally longer, all the while decreasing in intensity. The measures previously described that help the swelling to subside will also help the discoloration. However, there is no medication which will cause it to disappear rapidly, only time. You may camouflage the discoloration to some extent by using a thick makeup. A water-based makeup, BALANCED by Clinique, may be applied with fingertips. After it dries, a second layer may be applied. It can be removed with a water-based cleanser. Estee Lauder Concealer may be used over hard-to-cover areas. Do not apply makeup over the incisions themselves until two days after the sutures have been removed; however, you may bring it up to the line of the incisions.
The body temperature may rise to nearly 100° following the facelift. This rise is due to the healing process. Patients will often think they have an increased temperature because they feel warm, but in reality do not. To be sure, you should measure your temperature by mouth. Report any persistent temperature above 100°.
It is normal after a person has an anesthetic, or any type of operation, to feel weak, have palpitations, break out in cold sweats or get dizzy. This gradually clears up in a few days without medication.
It is common that patients have some difficulty sleeping in the post-operative period, please let us know if you would like us to prescribe a sleeping pill for you. It should be remembered that such drugs also tend to make some people feel lightheaded and weak and should be taken only if needed.
It is normal for an individual to go through a period of mild depression after cosmetic surgery because no matter how much they wanted the operation beforehand and how much they were told about what to expect post-operatively, they 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.
Parts of the face, neck and ears sometimes feel weak or numb after the facelift operation. This is perfectly normal and will generally subside with time. Sometimes unusual sensations may occur when the feeling nerves are returning. This can range from hypersensitivity to actual pain at times. This will subside and normal feeling will return. This occurs for several weeks to a few months following surgery. Avoid curling irons or use them only with care during this period.
Tightness of the Face
The skin of the face may feel tight for awhile and you may feel that it interferes with your smile. This will disappear within a few weeks.
Thinning of the Hair
There may be transient thinning of the hair in areas adjacent to the suture lines in the temple, top of the head or behind the ears. If this occurs, it is a temporary shock phase to the hair follicle. The new hair shaft will not be visible for 4-6 months, however.
If You Injure Your Face
Many individuals sustain accidental bumps to the face during the early post-operative period. Usually, one need not be too concerned unless the blow is hard, or if hemorrhage or considerable swelling ensures. Please inform us of any injury.
The Arnica Montana (for bruising and swelling, 3 pills 3 times a day) can be taken the day of surgery and continued up to 2 weeks if needed. Keflex can be restarted the day after surgery and until finished. After your surgery, you may resume your regular medications that day, unless otherwise instructed by Dr. Funcik. You can restart vitamins and minerals after two weeks. No blood thinners until cleared by Dr. Funcik.
- WEARING GLASSES AND CONTACT LENSES: Eyeglasses may be worn as soon as the bandages are removed. Contact lenses may be inserted the day after surgery. If you had eyelid surgery, wait at least ten days after surgery and ask Dr. Funcik when it would be safe for you to try them. Be careful not to let your glasses dig or rub behind your ears.
- HAIR AND BODY CARE: You may wash your hair with lukewarm water and baby shampoo in the shower and comb it out with a large-toothed comb two days after surgery. You may have your hair washed at a salon three weeks after your surgery, but do not use the usual type of heat hair dryer. Use a hand blow dryer on low setting. You may use conditioner on your hair after one week. Be careful not to rest your neck on the rim of the washbowl in the area of the incisions. Generally hair coloring can resume at 4 weeks once the incisions are well healed. Please get Dr. Funcik’s approval. Use your fingertips to wash the face gently with a mild soap (Ivory or Neutrogena) using a gentle upward motion. Do not tweeze the eyebrows for two weeks. You may wear a wig as long as it does not directly fit over the stitches or staples.
- HOUSEHOLD ACTIVITIES: You may be up and around the house, but no housecleaning.
- PULLOVER CLOTHING: For two weeks, you should wear clothing that fastens either in the front or the back rather than the type that must be pulled over the head. Removing pullover garments may loosen the sutures near your earlobes.
- ATHLETICS: No swimming, strenuous athletic activity or exercises that involve turning the head are permissible for four weeks. You may begin light aerobics after two weeks, but no head or neck turning exercises for four weeks. You may begin walking one week after surgery. Do not weightlift for at least 2-3 weeks. Start with the lower body first.
- KEEPING A STIFF FACE AND NECK: You should not move the face and neck excessively until the skin heals to the underlying tissues.
- Avoid excessive grinning and smiling.
- Do not bend the head forward or extend the neck backward.
- Do not turn the head without turning the neck and shoulders as one unit. When you must turn, do so as if you had a crick in the neck for two weeks.
- Avoid gum or foods that are hard to chew. Soups, mashed potatoes, stewed chicken, hamburger steak, or any easily-chewable food is permissible. Steaks, French bread, etc. should not be eaten for at least two weeks.
- Avoid yawning with the mouth opened widely for two weeks.
- RETURNING TO WORK AND RESUMING SOCIAL ACTIVITIES: When you should return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling and discoloration you develop. The average patient may return to work or go out socially 1-2 weeks after surgery when these factors are minimal. You will have to play this by ear. Do not drive preferably until the end of the second week.
We are all fond of our pets here at Coastal Facial Plastic Surgery. However, over the years we have noticed that a few patients who tend to sleep with their pets in close proximity will sometimes have some extra inflammation or perhaps even early infection. We recommend that if your pet sleeps on your bed, you take appropriate precautions until a few days after all your sutures are removed. Pets must sleep on the floor or, if necessary, in a separate room. Make sure all of your bed sheets, pillow cases, etc., are freshly laundered.
After all the 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 fade to pale, 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 completely occur in most scars.
Your First Week Post-Operative Office Visit
Do not build up a feeling of fear and anxiety about what is going to be done to you on the occasion of your first week post-operative visit to the office. Most of the skin sutures will be removed and the progress of your healing will be checked. Removing sutures is quick and uncomplicated because it is done with small delicate instruments to minimize discomfort. There is a special instrument designed to remove the small staples. This can be minimally uncomfortable because of swelling. Some patients prefer to take a pain pill before arriving at the office. You will probably feel much better after the first office visit. Ordinarily, all staples are removed within two weeks from the day of your surgery.
Remember the things you were told before your operation; namely:
- When the bandages are first removed, the face will appear swollen and lumpy, and there will be varying amounts of discoloration. This swelling will subside to a very large extent within two weeks. However, it will take a minimum of 6-8 weeks for all the swelling to disappear and for your face to reach its final contour.
- The discoloration will gradually disappear over a period of 10-24 days in most cases. We have yet to encounter a case where it persisted permanently.
- Temperature elevation above 100°.
- Sudden swelling or discoloration.
- Discharge from wound or other evidence of infection.
- Development of any drug reaction.
Most of all, BE PATIENT during the healing process. If you have further questions, you are urged to call us. While it is better to call during office hours, we are available 24 hours each day. We are here when you need us.