AFTERCARE

Secret: Complications can occur after “the last stitch.” To

reduce that chance know your doctor’s philosophy

on aftercare.

As important as what to do, say the surgeons, are the things that one

should be meticulous about avoiding. “It all boils down to wound

healing,” says Manhattan plastic surgeon Z. Paul Lorence. The highly

competitive plastic-surgery community might bicker over techniques

and bragging rights, but when it comes to stating the worst offenses

that can be committed against a healing face, it is unanimous: smoking

and exposure to the sun. “We would never recommend that a facelift

patient go to St. Bart’s,” Lorence says. “If you do so, you’re likely to

return with a raised and glistening scar.”

As for smoking, some doctors, including Beverly Hills plastic surgeon

Robert Kotler, are now refusing to operate on patients who won’t give

up nicotine. “I just can’t do it,” he says. “There is no question that the

smoker has done irreparable damage to the skin and the blood vessels;

the complication rate is too high.” Kotler warns that a patient who

resumes her nicotine habit shortly after surgery is also doing herself a

great disservice. “Because smoking worsens the blood supply,” he says,

“the skin can break down and form another scar.”

-from “Well Healed”

by Patricia Reynoso

in W, November 2001

Since hospitalization is rare in cosmetic surgery, you must

anticipate where you will recuperate, who will take care of you and

what to expect. The superior practice provides excellent care before,

during and after your surgery. Also, knowing your options and being

familiar with common post surgical experiences should alleviate

anxiety.

Where Do You Stay?

Some patients will be most comfortable convalescing at home.

This can be appropriate after nearly all cosmetic procedures if there is

either a responsible adult available and willing or, better yet, a trained

medical professional present. Professionals who do “home care” are

available anywhere. They may be registered nurses, practical nurses

or medical assistants. Since there is no major

nursing duty involved in routine cosmetic

postoperative care, their title and credentials are

less important than their cosmetic surgery

experience level. The professional in attendance

should be familiar with the procedure’s routine

postoperative course and be capable of recognizing

problems and complications requiring the

surgeon’s attention.

Be sure to ask about the nurse’s experience

with your procedure(s).

For those patients desirous of complete care

outside the home, there is the “hideaway”

alternative. Most large cities have specialized

postoperative facilities that care for patients after

cosmetic surgery. Hideaways are professionally staffed, hotel-like

facilities offering appropriate meals plus transportation to the

doctor’s office for postoperative visits. Not to be confused with a

nursing or convalescent home, the distinct purpose of a hideaway is to

cater to patients recovering from cosmetic surgery. Frequently,

patients who have their procedures out-of-town will opt for the

hideaway, in lieu of staying in a hotel or motel. The seclusion and

freedom from all responsibility, coupled with professional care and

(as desired) the camaraderie of others undergoing similar procedures

is, for some, an important and valued aspect of the total experience.

190 Secrets of a Beverly Hills Cosmetic Surgeon

Being catered to in one of

these posh post-op retreats

can make you feel like a kid

again—sort of like ice cream

we all got as a reward when

we had our tonsils taken out.

Of course, feeling like a kid

again, and especially looking

like a kid (or at least like the

youngest possible version of

the present you), is what

cosmetic surgery is all about.

-Kathy Keeton, author

Longevity: The Science of

Staying Young

Typical Recovery Times

Recovery after cosmetic surgery is usually prompt and uncomplicated,

since only superficial tissues are involved. This is in contrast

to medically indicated surgery where involvement of major body

cavities requires prolonged healing time. Below is a list of commonly

performed cosmetic procedures and the anticipated time of recovery

associated with each. Recovery time is defined as the period during

which one refrains from routine social and work activities.

Aftercare 191

Nasal surgery 5 to 10 days

Ear surgery 5 to 10 days

Chin Augmentation with or without neck sculpturing 5 to 7 days

Breast Augmentation 7 to 14 days

Breast Reduction 10 to 14 days

Liposuction 5 to 14 days

Eyelid surgery 5 to 10 days

Forehead/eyebrow lift 5 to 10 days

Face and neck lift 10 to 14 days

Chemical or laser skin peel 7 to 14 days

Tummy Tuck 10 to 14 days

A hideaway retreat offers privacy and comfort with round-the-clock professional

care and transportation to your doctor’s office.

WHAT THE TOP COSMETIC SURGEONS DO TO

HASTEN YOUR RECOVERY

AND “GET YOU BACK OUT THERE”

Few people have the luxury of taking many weeks or months

away from work or normal duties to recover from elective surgery.

While once it was a matter of weeks and months before one could

return to the office or feel comfortable socially, today’s specialists

speak of days, not weeks, and “ten to fourteen days maximum,” not

six to eight weeks.

How Today’s Pros Do It

Strict avoidance of aspirin, aspirin-containing compounds

(you will be amazed how many products—prescription and

nonprescription—have aspirin as an ingredient). See our

attached list.

Avoidance of certain homeopathic or herbal supplements

that can affect blood clotting. Example: Beware the “4 Gs.”*

1. Garlic

2. Gingko

3. Ginseng

4. Ginger

Please see Appendix D’s list of nonprescription, herbal and

homeopathic drugs to be avoided.

Use of specific medications including homeopathic

medicines:

1. Arnica. A homeopathic drug. Doctors prescribe

it—prior to surgery and during the recovery period

to reduce bruising.

2. Fresh Papaya and Fresh Pineapple. Contains

the enzyme papase. Helps reduce both bruising

and swelling. Get to your grocery store

and stock up!

192 Secrets of a Beverly Hills Cosmetic Surgeon

* Edward Pribitkin, MD in Cosmetic Surgery Times, September 2000.

3. Low doses of cortisone. Safe when taken as

directed for a short period of time. Extremely

effective in reducing early swelling.

Postoperative Suction-Vacuum Systems

A high-tech, self-contained means to continually remove

blood and tissue fluid—from under the skin—that can

cause “black and blue” discoloration and tissue swelling.

Typically used for one to two days after face and neck

lifting, neck sculpture, forehead/eyebrow lifts, breast

surgery and tummy tucks. Painless removal if done under

local anesthesia.

Better Pain Control, Without The Unpleasant Side Effects

Newer medicines that stop pain in its tracks without nausea,

vomiting, and that “woozy” feeling. Anesthesiologists introduce

the medicines while you are asleep so that when you

awaken after surgery, you are comfortable and do not require

Morphine, Demerol, and other heavy narcotics.

Encourage Early Mild Exercise

Cosmetic surgeons—like their surgical brethren—found

out that being bed bound for days was detrimental to a

prompt recovery. Slow walking and stretching can be safely

begun the day after surgery. The longer you stay in bed, the

more lethargic you become and the cycle worsens: less

exercise equals more weakness, and laziness generates more

bed rest. Do not plan on running a 10K the day after your

nose job, but put on your jogging shoes and at least tour the

neighborhood (at sunrise or under the cover of darkness if

you prefer).

Ensure Adequate Sleep

To recover quickly, you need your sleep. Often, patients

sleep poorly if they have discomfort or if they are anxious,

so today’s cosmetic surgeons make sure their patients have

the right sleep cycle by providing proper pain medicine and

by insisting that they not sleep during the day. (Best way to

stay awake is to get some light exercise, as mentioned

above.) If you need a short-acting sleeping pill for just a

Aftercare 193

night or two, that is fine. “Be awake during the day, but

sleep at night.”

Proper Diet

To heal, you need protein. And your body needs

carbohydrates and fluids to function normally. Any kind of

fluids, whatever you like. When patients come in one to two

days after surgery and state that they “feel weak,” the first

question is: “Are you eating?” Long ago, we learned that

patients might not be eating because they were taking too

much pain medicines that were making them nauseous. As

we mentioned above, today’s pain medicines are effective,

and without that unpleasant side effect.

What to Expect

The timing of your first postoperative visit to the surgeon will be

dependent upon the procedure(s). Face and neck lifts, tummy tucks

and some breast surgery patients may be seen daily in the first few

days. Less involved operations—such as nasal and eyelid

procedures—typically, do not require the first visit for four to six

days.

It is generally advisable to refrain from strenuous activities such

as running, tennis and contact sports for seven to ten days beyond the

basic recovery periods listed above.

Healing rates vary. But typically you can expect to be presentable

within one to two weeks after any of these procedures. Most swelling

and any bruising have usually disappeared by the seventh to tenth

day. Cosmetics used for camouflage can be applied as early as three to

five days following surgery. The longest period that any stitches

remain in place is 14 days.

Recovery times vary: they are a function of surgical technique,

type of procedure, and patient resilience. However, here are generally

accepted guidelines for recovery/convalescence by procedure:

Breast Augmentation

Convalescence: Home care is appropriate. No hospitalization

required.

194 Secrets of a Beverly Hills Cosmetic Surgeon

Stitch Removal: Internal absorbable stitches dissolve. If any

external stitches have been placed, they are removed within

seven to ten days.

Return to work: Depending on the technique used, one may

return to work as soon as one week after surgery—or as long

as two weeks. If the breast implants are placed deep to the

chest muscle, expect the longer time frame. Heavy

lifting—at work or at home—is not recommended for the

first three to four weeks.

The first week: The dressings are removed on the first or

second day after surgery. The breasts are sore; mild to

moderate pain medication may be temporarily required.

There may be bruising. You will require a support bra.

After the first week: You should feel well enough to return

to work and social activities within the second week after

surgery. The swelling and soreness abates quickly. The

breasts will feel firmer. The support bra may be necessary

for an additional two or three weeks. If there has been any

numbness, it typically disappears within a month or so.

Exercise will be tolerable at two to three weeks.

Breast Lift

Convalescence: Recovery at home. Mild to moderate pain is

controlled with pain medicines.

Stitch removal: Internal absorbable stitches dissolve. If any

external stitches have been placed, they are removed within

seven to ten days.

Return to work: Most commonly, one week, but may be

longer.

The first week: Dressings may be in place for up to one

week; there may be several changes to observe the healing

process. Swelling and bruising begins to lessen at the end of

the first week. A support bra is helpful.

After the first week: Scars mature but may take up to six or

even twelve months before becoming minimally visible.

The complete tissue healing to yield the final result may also

take many months. Smokers can expect more prolonged

healing.Asupport bra may be necessary for several weeks.

Aftercare 195

Breast Reduction

Convalescence: At home. Mild to moderate pain medication

may be required.

Stitch removal: Many stitches are placed—some internally—

which dissolve. External stitches may be left in place up

to fourteen days, depending on individual healing rates.

Return to work: Two weeks is reasonable. Some patients

require less while others take three weeks before returning

to routine work duties. Healing and recovery time are a

function of many factors including smoking, exercise, and

lifestyle habits, as well as certain inherited features.

The first week: Swelling, soreness, and bruising are

expected. There may be some drainage from the incisions.

The suction drains were inserted to reduce swelling and

hasten healing. They will be removed in one to two days. A

support bra is mandatory.

After the first week: Scars and symmetry are the major

concerns and it may be months before some temporary

asymmetry settles down and the scars begin to fade.

Complete scar maturation following breast reduction may

take up to one year or even longer. The surgeon may

recommend various medications and wound care treatments

to hasten healing and minimize the visibility of the

final scars. A support bra may be necessary for several

weeks.

Tummy Tuck

Convalescence: At home. Mild to moderate pain

medication required. Because the abdominal muscles may

be quite stiff and sore, you may need a bit of help getting in

and out of bed for the first couple of days.

Stitch Removal: External stitches are in place from five to ten

or even fourteen days. Removal may be done serially—not all

at once, depending on the speed of wound healing.

Return to work: One to two weeks. Longer if lifting or

stooping are job features.

The first week: If a suction drain is used, it may be in place

two days or longer. The purpose is to remove fluid that

196 Secrets of a Beverly Hills Cosmetic Surgeon

accumulates under the skin which, if not evacuated, can

compromise healing and prolong swelling. Abdominal

muscles are stiff and sore. You will find it difficult to flex

and extend the abdomen. Bruising may be present. A

corset-binder is helpful.

After the first week: You may continue to use the

corset-binder for several more weeks. Swelling abates and

soreness disappears. If there is any bruising, it also fades

rapidly. The scars will be obvious for many months and

they take a year or longer to be fully mature and minimally

visible. Sun protection, of course, minimizes the possibility

of increased scar pigmentation during the first year or so.

Liposuction

Convalescence: Hospital stay only if large volume of fat is

removed. Otherwise at home. Mild to moderate pain

medication indicated.

Stitch removal: Stitch removal in five to ten days,

depending on the location.

Return to work: Average is one week. May be up to two

weeks if large volume or multiple areas were addressed.

The first week: Muscle stiffness and soreness and bruising.

A compression garment is warn. Skin numbness or tingling

is not uncommon.

Aftercare 197

Which is the Stronger Sex?

The days and weeks immediately following surgery are crucial to

good results. Taking time off from work, wearing bandages, resting,

avoiding the sun and strenuous activities, and saying no to alcohol and

cigarettes are all important for plastic surgery patients. But these

things can sometimes be difficult for men, who have been programmed

by society to be stoic. Studies have shown that men often deny their

pain and feel foolish about asking for help after surgery, so it is

important that they have a support person available for at least a week

following their operation.

– Allison Hatfield, author

“He’s So Vain,”

Fort Worth, July 2001

After the first week: The compression garment may be

advisable for several more weeks. Bruising disappears.

Sensation returns to normal. Some lumpiness is expected

but typically disappears after several months. A routine

exercise program can be resumed in two to three weeks.

Nasal Surgery

Convalescence: Home care by any responsible

adult is generally adequate. You may choose to

spend your first night at a hideaway retreat or

hospital, but this is not necessary.

Splint/protector and packing removal: Since

most nasal surgery is performed “internally”

dissolving stitches are used. These generally do

not need to be removed. The splint/protector is

painlessly removed on the 4th, 5th or 6th day

after surgery. Nasal packing, typically a

tampon-like pad, is in place for one to five days,

198 Secrets of a Beverly Hills Cosmetic Surgeon

Happy — next day after

surgery

BIZARRO © 2001 by Dan Piraro. Reprinted with permission of UNIVERSAL PRESS

SYNDICATE. All rights reserved.

depening on whether or not functional surgery was also

performed.

Return to work: The nose will be swollen and bruised at

first, but presentable by the end of the first week. You may

then return to work and normal activities providing they are

not strenuous.

The first week: Contact lenses can be worn one to two days

after surgery. Four to six days after surgery you will be

scheduled for an office visit where the outside protective

shield and any remaining interior packing will be removed.

If there is any bruising at this time, it should disappear

within the next two to three days and can be easily

concealed with makeup.

After the first week: Any residual swelling will rapidly

diminish. The nasal airway improves daily. Optimal

breathing is generally achieved within one month.

Aftercare 199

INSIDER’S INSIGHT

Aftercare - Including Nasal Pack or Stitch Removal

Need Not Be Painful

After nasal surgery, the best practices make nasal pack removal swift and

painless by using old-fashioned decongestant nose drops with an added liquid

anesthetic. Nothing exotic. The medicine is dribbled into the nostrils and absorbed

into the nasal passages. This “shrink and numb” solution then allows the nasal pads to

glide out painlessly. No torture session here. Likewise, we apply a specially

compounded anesthetic ointment to eyelid and facelift incisions prior to stitch

removal. Why should you have any pain at all — even during stitch removal?

For chemical or laser wrinkle removal, there are highly sophisticated and

specialized anesthesia formulas available. Pain-killers are started before the patient

even goes under general anesthesia, so when they wake up in the recovery room, the

pain medicine is already working —keeping them comfortable. As appropriate, some

patient’s home care kits contain Valium. This tranquilizer, in addition to providing a

relaxed, peaceful attitude the first day after surgery, also causes amnesia. As one

patient remarked, “I can’t remember any pain, so I guess it never happened.”

Modern medicine has the answers to keep you comfortable and free from pain

for the big things and even the little things. Anesthetic creams, sedatives,

tranquilizers, sleeping pills, pain-killers. Superspecialists utilize all of these because

they compulsively focus on every detail — before, during and after your procedure.

They are driven to bring you the best total experience. The less specialized cannot do

it because they are too busy pursuing a wider field of interest. Another good reason to

insist on the best practices run by superspecialist surgeons.

-RK

You will probably be seen by the doctor two to three times in the

first month after surgery to check healing and answer any questions.

Thereafter, visits are infrequent. Postoperative photos are taken no

sooner than three months after surgery.

200 Secrets of a Beverly Hills Cosmetic Surgeon

INSIDER’S INSIGHT

In Our Practice, Tuesday Is Fun-Day

Thursday is the most popular day of the week for nasal surgery. Patients select

Thursday most often because they use the weekend for recovery and can be back at

work the following Wednesday or Thursday. Only four to five days off work.

A Thursday nose surgery means that the following Tuesday is the

much-anticipated unveiling! Because nasal surgery requires the application of a

lightweight plastic protector to avoid accidental injury, it also requires that the

patient wait several days to see the result. In contrast, with breast augmentation,

eyelid or facelifting, chin augmentation and other procedures, the dressings are

removed within 24 hours and the result is then visible.

My staff and I share the patient’s delight and wide-eyed amazement when— as

the protector is quickly peeled away—the patient’s new nose is revealed. Sure, it is

a bit swollen and sensitive, and there is usually some mild, residual bruising.

However in just five short days, the profile is straight, the bump gone. The nose is

narrower; the tip more refined. The nose is already a better nose than it was less than

a week earlier.

When parents, siblings, other relatives or friends are present, they share in the

happiness as we hand the patient two mirrors —to see the new front view as well as

their profile. We then watch that big smile evolve and the look of happy

astonishment emerge.

The patient is reminded that “it only gets better” and we reinforce that by

saying, “you are already looking better than you did only 120 hours (five days) ago.”

Copies of their “before” photos are presented as a not-too-subtle reminder of their

progress.

The treatment room is a happy place; the scene of one of life’s positive

experiences. A smile—and occasionally even a joyful little tear. We have unwrapped

a gift of lifelong satisfaction that will not wear out, needs no maintenance (except

sunscreen the first three months!), and will never go out of style.

To be the creator and then the presenter of this unique gift is a very special role.

In that treatment room, at that time, is where my job satisfaction is defined. This is

the essence of being a physician: service to fellow man that brings happiness and

comfort. My gratification compensates for the decades of late-night study, thirty-six

hour training “days,” and having to pass the innumerable exams necessary to be

qualified and capable of delivering this most special gift.

-RK

Ear Surgery

Convalescence: Home care is adequate. As with all

procedures, a precise instruction/direction sheet and a “care

package” of medications and supplies are provided.

Stitch removal: Incisions are generally entirely behind the

ear and are closed with dissolving stitches. Some stitches

may take up to six weeks to dissolve.

Return to work: You can return to work, school, and other

normal activities three to five days after surgery. Expect the

ears to be temporarily bruised, slightly swollen and sore to

the touch.

The first week: A helmet-type dressing is placed over the

ears at surgery. It is removed the next day during a brief

office visit. Small rubber drains, placed to reduce swelling

and bruising, are removed from the wounds at this time.

The ears are lightly redressed. Dressing can be removed at

home the following day. Two days after surgery you can

shower and shampoo.

After the first week: It is advisable to limit strenuous

exercise for three weeks, and contact sports for six weeks

after surgery. To protect the newly repositioned ears, it is

recommended you wear an elastic skier’s headband at night

for the first six weeks.

Over the first few months the ears will have diminished

sensation and perhaps minimal residual swelling. By three

months the incisions have softened and become nearly

invisible, and the ears feel “natural.”

Chin Augmentation

Convalescence: Convalescence at home is appropriate

unless this procedure is done in conjunction with a full face

and neck lift.

Stitch removal: The location of your incision will be

determined during consultation. It is dependent upon

individual anatomy and surgeon preference. Hidden,

horizontal, under-the-chin incision stitches are removed

anywhere from the fourth to the sixth day after surgery.

Implants can also be placed through an incision hidden

Aftercare 201

inside the mouth between the lower gum and lip: stitches

dissolve if the external incision is used, “steri-strips” or a

“butterfly” dressing may be applied for an additional

several days following stitch removal.

Return to work: After one to two days it is safe to resume

normal activities. If there is bruising, it can be concealed

with make-up.

The first week: There may be some “numbness” or slight

decreased sensation about the lower lip and chin area. This

will improve gradually and continue to disappear within

the first several weeks. The lower lip may be stiff and

swollen for a week or so.

After the first week: Minimal residual swelling that will

disappear completely within one month of surgery.

Neck Sculpture

Convalescence: The first night can be spent either in a

hideaway retreat or at home. Some surgeons place a small

plastic suction tube under the skin through a tiny nick in the

lower neck skin. This reduces swelling and bruising. Excess

fluid collected by this drain automatically flows into a

reservoir that can be managed by any responsible adult. A

brief office visit is made the day after surgery. The tube is

removed that day or the next.

Stitch removal: Stitches are removed for the hidden,

under-the-chin incision beginning on the fourth, fifth or

sixth day after surgery.

Return to work: You can expect to return to work and

normal activities in five to seven days. Bruising can be

concealed with make-up.

The first week: Your neck will feel “tight” and there is slight

limitation of movement for the first few days. You may

experience numbness. Automobile driving is permitted

after five days; this prohibition is a safety—not

medical—issue since limitation of neck motion

compromises your driving faculties.

202 Secrets of a Beverly Hills Cosmetic Surgeon

After the first week: Numbness about the chin and upper

neck usually begins to subside. The incision may still feel

lumpy, which is normal and temporary. If a chin implant

has been inserted, the lower lip stiffness that may have been

present initially, after surgery, begins to abate. Strenuous

exercise and activities can be resumed three weeks after

surgery.

Over the next several months the upper neck may feel

“lumpy” to the touch but is usually not visible. This

condition will generally disappear in eight to twelve weeks.

Within three months, the incision under the chin has

matured to become fine, soft and nearly invisible. For the

first six months the use of sunscreen is strongly encouraged

to protect the incision and neck skin.

INSIDER’S INSIGHT

Why I Like House Calls

Occasionally, there is a good medical reason for a house call

Before I tell you about cosmetic surgery house calls, I will remind you that doctors

who treat illness—family practitioners, pediatricians—did not stop visiting patients in

their homes because they were lazy. They realized that apart from being able to

perform a very superficial—and hence, inadequate—examination, they had little of

modern science to help them diagnose and treat their patient. No lab, no x-ray.

In the heyday of house calls, there was not much technological help to be had

outside the doctor’s black bag. The house call was ceremonial and social, which was

fine for that era of the horse and buggy.

Today, we want the best medicine rather than a dose of nostalgia and a social

visit. The house is not where crucial technology lies.

Cosmetic surgery is different.We do not need CT scans, MRIs, or fancy equipment

to check our patient’s progress after surgery. We need what still remains the best pieces

of equipment: our eyes, ears, and hands.

I have made house calls—usually on a weekend—when I was concerned about

the patient’s postoperative progress and if it was impractical to see them in the office.

Patients appreciate house calls; some are bewildered and amazed when I say: “I’ll be

right over.”

Now that you have revived yourself from passing out after learning that a cosmetic

surgeon makes house calls, let me expand on that a bit. From my own experience,

house calls have been some of the more interesting and richest aspects of my practice,

and greatly appreciated by the patients. I have had a chance to visit some patients in

their homes where they have shared with me personal aspects of their lives, particularly

their travel experiences, or perhaps their collectibles or artwork. Such a visit is no

burden—it is a learning opportunity. I have even taken one or both my daughters with

me because it is a valuable life experience for them, to meet and visit interesting people

in their unique habitats.

Aftercare 203

I particularly recall a house call we made one Saturday to a patient who lived in

Pasadena. She was having a minor problem and it was not easy for her to get to the

office that day. It is only a 25-minute drive and I promised my daughter I would take

her to lunch at her favorite restaurant in Pasadena afterwards. When we came to the

house, we realized we had come upon a special home with a unique, personal art

collection. The woman had traveled extensively and, particularly, in Italy; she had

some unusual religious artifacts. The conversation quickly turned to St. Francis of Assisi

since my daughter was then doing a paper on him. Well, Lindsey never needed to

open her textbook again because my patient spoon-fed her some key information and

directed her to the most productive resources for research. That was over ten years ago

and my daughter, when studying art history recently, happily and clearly recalled that

special visit. I share this with you to remind you that medicine can be —and should

be—a very personal interaction between doctor and patient. When present, that

personal attachment makes medicine a very special profession.

-RK

Eyelid and Forehead/Eyebrow Lift

Convalescence: The first night can be spent at a hideaway

retreat or with professional home attendant. If you prefer to

be at home, a precise instruction/direction sheet and “care

package” of medications and supplies allows for home care

by any responsible adult.

Stitch removal: Upper eyelid stitches are removed between

the fourth and sixth postoperative days. Lower eyelid

stitches dissolve and generally do not need removal.

Hidden forehead stitches may remain in place for up to ten

days.

Return to work: Most patients are capable of reading,

writing and light activity within forty-eight hours of

surgery. Normal activities can resume in five to seven days.

No strenuous exercise for ten days.

The first week: Any significant swelling and bruising

during the first week can be concealed by wearing

sunglasses. Eye make-up can be applied after stitches are

removed. Eyes or brows may feel “tight”

After the first week: Incisions are concealed in normal skin

creases, but are slightly visible in the first four weeks following

surgery. Each week their visibility is reduced until they

are nearly imperceptible—about six weeks. Nightly

application of a multiple vitamin ointment silicon gel is

advised to promote rapid healing.

204 Secrets of a Beverly Hills Cosmetic Surgeon

For the first several months sunscreen is strongly advised to

reduce the chance of increased redness or pigmentation of the

incisions as they heal.

Face and Neck Lift

Convalescence: A one or two-night stay at a hideaway

retreat or a professional home attendant is recommended.

The complexity of a face and neck lift requires professional

post-surgical observation and care. Small suction drains

may be placed through tiny incisions to minimize swelling

and bruising, and to speed recovery. These are best

monitored and maintained by an experienced professional.

Discomfort is typically minimal throughout the immediate

postoperative period, but pain pills are provided if

necessary. Precise instruction/direction sheets will guide

you in proper care of incisions, etc.

Two week recovery schedule: Because of the complex

nature of a full face and neck lift, recovery times are

different from other procedures previously discussed.

Day 1- Surgery

Aftercare 205

It is mid-afternoon. Our face-lift patient is about to be tranported to a recovery

hideaway. Holding a hand mirror, she is already a bit curious

about how she looks.

Day 2 - Brief office visit and dressing change. You will

already appreciate a difference in your appearance.

Day 3- Office visit. Dressing is changed, suction drains

are removed and you return home.

Day 4- At home. You may remove the dressings and

shower and shampoo.

Day 5, 6 or 7- An office visit to remove stitches about

the ears and chin. Swelling and bruising should be

minimal at this stage and you are able to be more active.

Make-up can be applied. Driving privileges are restored.

Walking is an excellent form of exercise at this point;

however, no strenuous activities such as tennis or

swimming are permitted.

Day 8, 9 or 10- A third office visit for further stitch

removal from the “hidden areas” (within the hairline).

All bruising has typically cleared by now. You should

feel quite good. You may be ready to return to work.

Day 14- Brief office visit. You can fully appreciate the

changes in your appearance and are ready to resume

your normal activities.

206 Secrets of a Beverly Hills Cosmetic Surgeon

The morning after face and neck lift. Dressings have just been removed. Note

minimal swelling. Arrows show location of suction tubes under the skin, which

minimize swelling and bruising. The tubes are painlessly removed

the following day.

Chemical or Laser Skin Peel

Convalescence: During the first five to seven days, your

face is covered with a coating of medication. No later than

the seventh day, the coating will have been washed off,

revealing fresh, reddish-pink skin (akin to sunburn). By the

eighth or ninth day, make-up can be applied. Appropriate

skin care products, such as cleansing lotion, softening oils

and sunscreens are provided by the doctor’s office.

Make-up techniques are also discussed.

Aftercare 207

Elegant attire the morning

after our lady’s face and

neck lift.

Bobbi’s face and neck lift

the prior day precluded her

usual morning coffee.

Today she is back on track.

The first several months: The reddish-pink color fades

naturally, and the lightening process is accelerated by

medications provided. This pink color is usually gone

within six to eight weeks. Any ruddy color can be concealed

with cosmetics. Some people experience excessive skin

dryness due to inactive oil glands, but this is easily corrected

by the use of skin products provided by the doctor.

Going back into the sun? Once the pink color has faded, the

new skin may be slightly lighter than it was prior to the

procedure and less apt to tan. Sunning is one of the most

common factors of skin aging, so you will want to be

vigilant about future tanning and burning. Proper

sunscreens recommended by your doctor will reduce your

exposure and keep your skin protected.

208 Secrets of a Beverly Hills Cosmetic Surgeon

Post-operative medication and supplies should be provided

by your surgeon.

PATIENT COMMENTARY

I wanted to take a few moments to thank you for making my

surgery as pleasing an experience as possible. From the

moment I walked into your beautiful office, I knew I was in

the right place. Your WONDERFUL staff took the time to

walk me through all the steps of my surgery and answer

every question I had. I was able to see pictures of your prior

work and my projected results. I felt totally at ease with

you. You made it easy to discuss exactly what I wanted and

any fears I had. You explained how these changes are made

and let me know exactly what my surgery would entail. As

my surgery date approached, I received many calls from your

office to make sure I had no further questions or concerns.

The support I received from them was incredible. Your

anesthesiologist even called the night before! I’ve never

really had a major surgery, but I doubt that most patients

receive this kind of thoughtful care. Everybody in the

Surgicenter made sure my spirits were up and I was ready to

go the morning of my surgery. I felt totally and completely

unafraid. After I was home that night, I received calls from

both you and your office (even the people at the surgicenter

made sure I was okay). What I can tell you is that it has now

been about two months since my surgery and I’m more

pleased than I thought possible. I didn’t want to look like

another person, just improved on the old one. But the results

have far exceeded anything I could have imagined.

–Melissa M, actress

California

Aftercare 209

Sometimes – Even In The Most Expert Hands –

Surgery Does Not Go Perfectly.

What You Need To Know. And, What To Do.

Sometimes, for reasons identifiable (or unidentifiable), complications

or unsatisfactory results occur. Be mindful of the following:

Acomplication should not be confused with an

imperfect outcome. Before surgery, when you

officially consent—in writing—to having the

procedure(s) performed is when you accept

possible complications; i.e., known, inherent

risks such as, infection, scarring or poor

healing. Not that these or other possible

difficulties are likely; they are not. But in some

small percentage of cases, complications or

unexpected conditions do occur. Usually, they are not the

fault of the surgeon, per se. Please do not blame the surgeon;

he shares the anguish. Neither of you asked for this.

Fortunately, most complications, unsatisfactory results, and

disappointments can be improved upon.

The competent, concerned surgeon knows what to do and

will stick with you until the problem is rectified. “With you

all the way.” He wants you satisfied. You are his walking

advertisement.

210 Secrets of a Beverly Hills Cosmetic Surgeon

The only surgeon

who has no complications

is the one who

never operates.

– Aphorism

well-known to all

surgeons

This young man had two prior nasal cosmetic and functional surgeries

elsewhere. A challenging case because of the technical difficulties of operating

upon twice-visited tissue.

Some imperfections or complications improve spontaneously,

so the savvy doctor knows to allow nature some

time. This is one more way where experience counts. The

more specialized, seasoned veterans, having seen it all, have

a larger fund of experience to draw from. This helps them

better predict the course of events. These pros also tend to be

less anxious about the ultimate outcome because they know

that either nature, they themselves, or a colleague will help

correct the situation. The novice, the inexperienced

practitioner, often becomes anxious, nervous and uneasy.

This visible lack of confidence can spread to you. Your

anxiety and worry need not be compounded by your doctor.

Your doctor should explain the problem to you, outline the

possible solutions, and suggest the best course of action.

Often, only a minor office treatment or series of treatments

may be the solution to correct the problem.

Your doctor may suggest a consultation with another

specialist. It may be appropriate that some or all of the

touch-up work–if necessary–be done by a specialist who has

specific knowledge and skills that should be utilized.

There could be additional cost, particularly if another MDis

recruited. Sometimes, your health insurance is applicable.

But all financial matters should be discussed before

additional procedures are planned.

If at any point, early or late, after a problem occurs and you

have any uneasiness, lack of confidence, or uncertainty, get

a second or even a third opinion. Your surgeon should be

willing to provide the names of specific specialists who have

the appropriate expertise. You are also free to select your

own consultant.

Consultations are valuable, if for no other reason than you may

hear from another specialist that what your surgeon is doing—or

proposes to do—makes sense. And incidentally, when you go to

another surgeon for consultation, be sure to bring copies of all your

records, including before-and-after photos. Having the complete case

history facilitates giving you an immediate, well-founded recommendation

at the first visit.

Aftercare 211

The Patient is Not Responsible for an Imperfect Result

The surgeon should not make you feel responsible or ashamed for

the unsatisfactory outcome or complication.

I have heard from dissatisfied patients, consulting with me, that

their surgeon blamed them for the problem. One patient was told that

the reason her nose was “still too wide” after rhinoplasty was that she

“failed to massage it as told.” How silly!

Having performed over 3000 cosmetic nasal

surgeries, I feel comfortable sharing this

with you: In cases where the nose was not

acceptably narrow in the eyes of my patient,

and after the necessary time passed for

swelling to reduce naturally, it was obvious

to me that I had not narrowed the nasal

bones and/or cartilage enough. A misjudgment

on my part; not a failure of the patient.

And while massage can be helpful for the minority of cases where

there is an inherent tendency for the tissues to post-operatively retain

fluid, this phenomenon eventually passes. What the patient wears

and bears is the sole result of the surgeon’s concept, intention and

execution. It is not the patient’s responsibility to produce the end

result. That is what you hire a cosmetic surgeon to do for you.

Such blame shifting to the innocent and now bewildered patient

is not proper and suggests, to me, an immature professional. A

stand-up doctor accepts responsibility for his work. When the patient

is satisfied, will he not gladly accept the orchids? But, when the

patient is not satisfied, he must accept the onions. He should

understand that his patient is not criticizing him, only the product; he

must distance himself personally from the work issue at hand.

The honorable response is to say to the patient that he does

deserve an improvement from the current status and that it will be

provided. No excuses, no criticism, no fiction creation, no transfer of

responsibility back to the patient. The surgeon should fix it, should do

the right thing.

When that proper discussion takes place—without rancor,

hostility or anger—both patient and surgeon should again be relieved

and comfortable with each other. A solution to a problem has been

proposed and accepted. There is a plan in place. After all, the patient

212 Secrets of a Beverly Hills Cosmetic Surgeon

If there is a problem, ask the

patient or family for permission to

get a second opinion before they

request it.

– advice from Joseph Mallach, MD,

one of my teachers at

Northwestern Medical School,

December 1966

merely wants to know that something will be done; no one likes to be

“left hanging.” Particularly when the predicament was not of their

creation. The top professional understands that his role does not

automatically end when the last stitch of the operation is placed; it

ends at the discretion of the patient—the customer, if you will—who

needs to feel that everything possible has been faithfully rendered in

service to him.

Do not confuse a surgeon’s inappropriate criticism of patient

conduct (having no bearing on the result), with a patient’s willful

action that compromises the outcome. The patient who smokes

immediately before and after a facelift is increasing the risk of poor

healing and scarring. Likewise, the nasal surgery patient who returns

prematurely to contact sports and injures a fragile nose shouldn’t be

blaming the surgeon. You, too, have duties and the first is to heed the

doctor’s advice.

PATIENT COMMENTARY

Following previous unsuccessful surgery with another

doctor, you reconstructed my nose on July 20, 2000. I just

want to thank you so very much for my wonderful nose. I

came across my before photos the other day and forgot how

different I looked. You did a marvelous job!Mynose looks so

natural that nobody believes me that I had a nose job. But

when they see my before photos, they are amazed at what a

great and subtle job you did! Once again, thank you for my

cute nose that is now two years and seven months old!

– e-mail received from Melissa S. on March 20, 2002

California

Aftercare 213

“Oh, doctor,” said the young lady, “will the scar show?”

“That, madam,” said the doctor, “is entirely up to you.”

-Jacob M. Braude

Braude’s Treasury of Wit and Humor

214 Secrets of a Beverly Hills Cosmetic Surgeon

Thirty-one percent of women would consider plastic surgery

either now or in the future.

– American Society for Aesthetic Plastic Surgery as quoted in

Allure Magazine

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