Post Operative Instructions | Facelift Surgery

Preoperative Preparation

See also preoperative preparation

Immediately after the procedure

1. A dressing is placed after the procedure around the head and neck. It is critical that the dressing is not removed until the next day by the doctor.  The dressing is designed to provide moderate compression so that the area can heal naturally.
2. Dr. Shah does not use surgical drains.

The First 24 Hours:

1. Activity.  Ambulatory patients, after a short period in the Recovery Room, will return home. It is a time for rest. A bed with two or three pillows, a large couch, or a lounge chair with the head elevated provides the appropriate positioning for the next 24 hours. Walking to the bathroom or moving about your room is permitted, however great care must be taken not to lift, pull, strain, bend or in any way challenge the healing wounds.
2. Facial movement. Jaw movement with eating, talking or laughing, should be minimized. A good amount of repositioning of facial tissues has occurred over the muscles responsible for jaw movement. Inactivity will facilitate healing. Try to keep your head forward. Turn your head with your shoulders. Talk only when necessary. Be stare your diet is soft or liquid and light.
3. Yawning, also places a stress on these fragile surfaces and should be avoided.
   
4. Cold compresses to the eyes and cheeks (30 minutes on, 15 minutes off) through the day and until the hour of sleep will help to reduce swelling in this area. There are several techniques to ice the area including cool compresses, frozen peas, or ice packs. The eye area incorporates some of the loosest and thinnest skin in the body. Even though no surgery is done on the eyelids they do tend to swell.
   
5. Pain of significant intensity is not usual following facelift.
   Discomfort and sensation of pressure, especially over and behind the ears, is quite usual. ‘This is readily controlled with the Tylenol with codeine (taken with milk). Severe pain should be reported.
6. The initial bandage is removed the day after surgery in our office.All incisions are inspected and any minor blood collections removed. No washing, scrubbing or manipulation is done at this time. The bandage removal is not painful nor is the replication of a smaller bandage.A small amount of staining on the bandage can be expected but any sudden painful swelling should be reported. Despite taking all precautions, medications, surgical meticulousness, proper bandaging and the patient’ s adherence to all directions, blood can accumulate under the elevated skin.A small collection is usual, a large collection is quite rare.
7. High Blood Pressure Patients. Patients with hypertension, also known as high blood pressure, should check their blood pressure at home either via home health care or with a machine twice per day.  If your blood pressure is elevated it may cause excessive swelling, prolonging your recovery.  It is best to manage your blood pressure during the postoperative period to ensure that it remains at acceptable levels during the recovery period.

The First Week:

1. During the second and third days following surgery, the smaller and softer bandage will loosen somewhat but still ants protectively to restrict head movement.  Once the first 24 hours have passed, any possibility of bleeding becomes remote. You may increase your ambulation but continue the soft diet.
   
   Swelling about the eyes is always worse 48 hours after surgery. The cold compresses are soothing and are still effective.
2. Suture removal begins on the  seventh day after surgery. Further bandaging is not necessary after the fourth post-up day. Fine stitches, just in front of the ear (and beneath the chin if this area has been re- sculpted), are removed on the seventh day. The remaining tiny suturess in the hair behind the ear will come out on the 10th to 14th post-up day.
3. A few hours after the fourth day-bandage removal, you may shower in tepid water even though the staples are present. Slowly and carefully clean your hair by rolling it between your finger. Four days of bandage enclosure and the anesthetic solution have left your hair stiff and dry.Baby shampoo acts as a good softener. The hair you’ll see in the shower drain belongs to the redundant scalp skin removed at surgery.You may gently groom the hair with a large-toothed comb. A hair dryer, if used at all, must be on a cool setting. The scalp cannot tolerate any heat at this time.
4. The face may be washed or cleansed with a gentle upward movement from the fourth day on.
5. Following all facelift operations, a small amount of “lumpiness” is always noticed just in front of the ears. This is temporary and related to the repositioning of the tissues beneath the skin. It may take a week or two to smooth over.In this same area, and also behind the ears and in the ear lobes, there is a mild numbness to the touch. This is always a part of the facelift procedure.This numbness begins to disappear in a week or two, moving from front to back. It may take three months for sensation to return to the ear area.In very rare instances some numbness may persist.
6. It is best that you stay out of the summer sun for about 60 days. A sunburn could quickly cause the swelling to return. The mild insensitivity of the skin could lead to a severe burn and, possibly, some pigment changes. If you are to be walking between sun and shade, wear a large hat and be sure to apply a sun block or lotion.
7. Any discoloration (black-and-blue) is almost entirely gone by the 10 th-14th day. You may notice that the discoloration has migrated from the sides of the neck to the space above the collar bone. This is normal.
8. You may notice some crusting in the hair along the suture lines.
   This may recur for a period of two to three weeks, but is not a cause for concern. It may be removed gently after wetting the hair in the shower.
9. Temporary hair loss along the incision lines above and behind the ear can occur a week or so following the lift. This is usually a very narrow path when it does occur and can always be covered by the hair in front or above it. Regrowth will usually resume after a few weeks.
10. The “lifting” in the facelift is designed to allow as little tension in front of the ear as possible and as much tension as possible above and behind the ear. This produces a fine line scar in front of the ear and heavier scars in the hair and behind the ear. These scars in the hair may persist for several months, but can usually be camouflaged very satisfactorily with the hair itself. This scar behind the ear is hidden but may remain thick for several weeks.
11. At the end of the first week and the beginning of the second week, you may feel a little blue or depressed. ‘This common reaction to facelift surgery is transient. In the next few days, as the bruising fades, the swelling subsides and you resume your normal life, a sense of elation replaces the down feeling. This “blue” feeling may occur even though you have read about it and tried to avoid it. Your swelling, bruising and new scars are expected. Only in the movies are the results immediate.
12. The facelift operation can turn back the clock, but it can’t stop time. The face can retain its pleasant firmness for five to seven years, and you will not experience any sudden fall or drop in the tissues at that time. Rather it is a gradual process of relaxation that occurs. However, the improvement from facelift surgery is always apparent. For example, if you had a twin who did not have the lift, you would always look better than your sibling.

Activities:

1. During the first week, walking about without staining, lifting, pulling or bending at the waist is the extent of permitted activity. It is most important that you not turn your head from side to side. It could weaken the undersign muscle and tissue reconstruction. Always move the head with the trunk. During the second week, you may increase your activities but still no heavy lifting. You can turn you head slightly. At the third week, you may begin exertional exercise, including mild weight- lifting.By the end of the future week, you can resume a fairly normal range of activities including golf, tennis and swimming.
2. Our goal in facelift surgery is improvement. Perfection, as in all plastic surgery, is neither possible nor even desirable. Removal of wrinkles and upward stretching of skin is always done within the limits and tolerances of the tissues. What you can anticipate is looking as fresh, alert and rested as is possible for your age.
3. The facelift operation does not affect the fine wrinkling around the mouth. Nor does it eliminate the very deep lines that run from the outside attachment of the nose to the corner of the mouth. It also does not eliminate the very deep scowl or frown lines between the eyebrows and on the forehead. These require a separate, but different, procedure.