Rhinoplasty and Cosmetic Surgery

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Secret: Complications can occur after “the last stitch.” To reduce that chance know your doctor’s philosophy on aftercare.

As important as what we 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”

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.

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

How Cosmetic Surgeons can get you back in Action in Days, not Weeks

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 and 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

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.  Contain  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 medicine that was making them nauseous. As  we mentioned above, today’s pain medicines are effective 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 for 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 bruising has 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.

More Information on Specific Surgeries and Procedures