The following instructions are designed to answer your questions regarding post-operative care and to tell you what you can and should do during your recovery. You and your family should read them several times to become thoroughly familiar with them. Attempt to follow them faithfully. Those who do, generally have the smoothest post-operative course. Whenever a question arises in your mind, refer back to these instructions and chances are you will find the answer. If not, please telephone us without hesitation. We are here to help. Someone is available 24 hours per day. Dr. Funcik would rather have you call with questions than have you delay your recovery or worry unnecessarily. Please, before trying any original ideas or suggestions from well-intended friends (even those in the field of medicine); take just a moment to ask us before deviating in any way from the care advised in these instructions.
Swelling and Bruising
As you were told before surgery, a varying amount of temporary swelling and bruising is normal, so try not to become anxious or depressed about it. It always passes. We attempt to minimize it by using meticulous surgical technique and providing you with medication during surgery. However, each person is different, and swelling and bruising are variable but expected and temporary.
After Your Operation
- Continue to take your antibiotics until your supply is exhausted. The prescription need not be refilled.
- Sleep with your head elevated 30-40 degrees with an additional pillow or two, or in a recliner, until the swelling subsides. Sleeping flat will cause dramatic swelling.
- Apply ice compresses to your eyes as much as possible during the first 48 hours after surgery. Prepare as follows: Place 1- 1 1/2 cups frozen garden peas in a soft Ziploc baggie. This will serve as an ice pack. Moisten clean gauze pads with cold water and apply one to each eye before placing the baggie on your eyes. You may use an ace eye wrap to keep the baggies in place. We will provide the gauze and wrap and instruct you further before you leave the office the day of your surgery. After 48 hours, ice no longer reduces swelling, but it may be used if it feels soothing.
- STAY UP (sitting, standing, walking around) as much as possible after the second day. This will help the swelling resolve. Of course, you should rest when you tire.
- You may take a shower and shampoo the day after surgery. The face may be gently cleansed with a mild soap (such as Neutrogena, Ivory or Basis) and be sure to rinse well. Do not be afraid to get suture lines wet, but avoid strong water pressure. Use your fingertips with the soap to clean the suture lines. After the sutures are removed, your may use gauze or a clean washcloth.
- After surgery, use the Refresh pm eye ointment 5-6 times a day for the first 24-48 hours – this may cause blurry vision. After the first 24-48 hours, begin using the Refresh plus (no preservatives) eye drops 5-6 times a day and the pm ointment only at night. Begin to wean off the eye drops as tolerated, typically 1-2 weeks. If you have scabbing, you may go over your suture lines 3-4 times a day with Refresh PM ointment on a Q-Tip. Scabs will loosen on their own by 5-10 days. DO NOT pull scabs off yourself.
- Avoid bending over or lifting heavy things for one week. Besides aggravating swelling, this may raise the blood pressure and cause bleeding and bruising.
- Avoid straining while going to the bathroom which also raises the blood pressure. If you feel you need a laxative, take one.
- Avoid hitting and bumping your face and eyes. It is wise not to pick up small children or pets for 2 weeks after your surgery.
- Avoid the sun for 30 days following surgery. After two weeks, use SPF 25 or greater sunscreen until the incisions are completely healed and all redness has faded.
- Do not tweeze your eyebrows or pull up or down on the eyelid skin for two weeks, for this could cause your incisions to separate.
- Take only prescribed medication or Tylenol. DO NOT TAKE Aspirin, Motrin (ibuprofen) Advil, Nuprin or any other anti-inflammatory medications (e.g., Aleve) as they promote bleeding and bruising.
- If minor bleeding occurs, simply rest and apply a cool compress. This is normal and nothing to worry about, but call us if you are concerned or if it persists or increases.
- Report to us any excessive bleeding or extreme black and blue bulging bruises. These things are extremely rare and unlikely, but if they do occur, please notify Dr. Funcik promptly.
- Call the office if you notice any marked difference or discomfort in one eye versus the other. There will always be some noticeable difference in bruising and swelling, but call us if it is severe or worrisome.
- Certainly, if you experience any change in your vision other than mild blurriness due to ointments and tearing, please call us immediately.
You were given several prescriptions before your surgery. Please fill all of them. They have specific purposes. One prescription will be for pain. Take pain medications only if the cold compresses and Extra-Strength Tylenol do not suffice because pain relievers usually cause sensations of dizziness, nausea and drowsiness and make recovery more tedious.
If bleeding occurs, go to bed, elevate the head, apply cold compresses over the eyes and have someone report it to us by telephone. Please read the section on transconjunctival blepharoplasty.
Generally, the body temperature does not rise much above 100° following eyelid surgery. This rise is due to dehydration caused by insufficient intake of fluids. People often think they have an increased temperature because they feel warm. To be sure, measure your temperature with a thermometer. Report any persistent temperature above 100°.
Resuming Normal Activities
- You may begin wearing eyeglasses or sunglasses one day following surgery. Wait at least 10-14 days before wearing contact lenses.
- Avoid swimming for ten days and do not dive, lift weights, water ski or participate in strenuous athletic activity for at least three weeks after surgery. After two weeks, you may begin jogging, playing tennis and golf, and in general increasing your level of activity.
- You may begin using makeup around the eyes 2 days after the sutures are removed. You can camouflage the discoloration about the eyes with DERMABLEND (two shades darker than your skin color). The following technique of application seems best: first, smear a layer over the entire discolored area, then apply more with a patting motion; finally, blend the edges with the surrounding skin.
- You should probably not plan to return to work until a couple of days after the sutures are removed. This depends on you, your job and on your recovery. Even then, it might be wise to obtain a pair of sunglasses with large frames. To a certain degree, some bruising under the eye is to be expected after eyelid surgery.
Your First Post-Operative Office Visit
Your first post-op visit will be in 5- 7 days to have the sutures removed. Do not build up a feeling of fear and anxiety about what is going to be done to you during this visit. A few skin sutures will be removed with special delicate instruments which minimizes discomfort.
Transconjunctival or Inside Approach to Lower Eyelid Surgery
If you have had incisions inside your lower eyelids, you may experience some minor bloody oozing from your eyes. This may even occur several days after surgery when a soft scab may come loose from the hidden incision. This is of no great consequence and needs to be brought to our attention only if it persists or is excessive. If you are concerned, please call. With this particular technique, we commonly make small incisions on the outside of your lower eyelids along the eyelashes which are closed with fine sutures. These incisions are maintenance-free; simply cleanse them in the shower.
About Some Potentially Upsetting, But Relatively Harmless, Things that Might Occur During the Healing Period
- Swelling may persist somewhat longer than usual. However, we have never seen a case in which it did not ultimately subside. The same is true of discoloration.
- Swelling and discoloration become more pronounced after you leave the office and usually peak at about 48-72 hours. This is why you should follow the instructions given about minimizing swelling and not take any medication containing aspirin.
- Rarely, the whites of one or both eyes may become partially discolored. Despite being very dramatic in appearance, it is painless, will not harm vision and means nothing of significance or that anything went wrong with the surgery.
- Rarely, the swelling will cause the lower lid to pull away slightly from the eyeball. This condition will be reversed as the swelling subsides, but can be prolonged if face powder granules, etc. become deposited in the area when cosmetics are being applied. The swelling may also interfere with normal tear drainage and make it seem as if your eyes are watering.
- Dry Eye Syndrome – This is a bothersome and confusing problem for a few patients. For those patients who normally have a low tear film production, having cosmetic eyelid surgery can precipitate a situation that can be very annoying and sometimes uncomfortable until it subsides. The whites of the eyes become bloodshot and the eyes feel like there is sand under the lid or possibly a stitch in the eye. What is really happening is that the tear film is either inadequate or the swelling is interfering with this normal lubricating function of the lid. Following surgery, the eyelids may partially stay open due to swelling and tightness, thus further aggravating the dryness of the cornea. Paradoxically, your eyes will tear excessively because the tear gland is trying to overcompensate for the inadequate tear films. The solution to the problem is to add more tears and lubrication, especially at night. We suggest that you purchase some artificial tears in a dropper bottle such as Refresh, Aquafresh, Hypotears or Celuvisc. Use two drops in each eye every two hours during the day. At night, put a small amount of eye lubricant, such as Refresh Lacrilube, Duratears or one suggested by your pharmacist. During the day, these will add to the blurriness. The problem will correct itself when healing is complete. Call us if this problem affects you. Do not use Visine or other redness relieving drops.
- During the first several days following surgery, the scars will be inconspicuous. Then they go through a period of slight swelling and reddening, especially at the outer corners. This subsides and they become virtually inconspicuous again. This is the way normal scars mature. Thus, any unevenness of the edges of the incisions or lumpiness of the scars is usually temporary and will subside with the passage of time.
- Patients often experience some blurring of vision for 2-3 days after the operation. This is generally due to swelling and/or ointments that have been used and will clear spontaneously.
- Occasionally, one may actually experience a change in vision as evidenced by trouble reading even with previously-used corrective lenses. Do not worry. THIS IS TEMPORARY. It will resolve with time and is due to subtle swelling around the eye itself which minimally changes the refraction. Unfortunately, in very rare cases, this can persist for more than two weeks.
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.
Summary of Post-Op Care
- Rest, Hydrate, and Elevate: keep head elevated 30-40 degrees for several days until swelling subsides.
- Apply ice cold compresses to eyes as much as possible the first 48 hours: see packet for details (4 layers: Refresh PM ophthalmic ointment, 1 moisten clean gauze with ice water, then small frozen bag of peas, then loose ace wrap to keep secure)
- Use the Refresh PM ointment 5-6 times a day the first 24 hours (this may cause blurred vision). After the first 24-48 hours, switch to the eye drops 5-6 times a day and use the pm ointment at night until instructed to discontinue or until your tear supply seems adequate and normal.
- Pain medication – use extra-strength Tylenol and cold compresses to the eyes to help with discomfort. Tylenol can be taken – 1-2 pills every 4-6 hours, try to keep it in your system for the first few days. If needed, you may take the prescribed medication; we recommend not taking it on an empty stomach. Remember not to take any medication that thins the blood for several weeks – (Aspirin, Advil, Motrin etc.).
- Continue the Arnica Montana the day of surgery (3 times a day and may continue up to 2 weeks depending on the bruising and swelling). Restart the Keflex the day after surgery and continue until completed.
- Keep diet light – beginning with clear liquids then small portions of soft food and advance as tolerated.
- You may shower the day after surgery. The face may be gently cleaned with a mild soap such as Neutrogena or ivory. Suture lines may get wet, but avoid strong water pressure. Use fingertips with soap and water to clean suture lines until the sutures are removed.
We hope this helps you and reassures you during your recovery. Please call us promptly if you are concerned or bothered by something.