How to Handle Common Postoperative Issues

How To Handle Common Postoperative Issues

Review and follow all your post-procedure instructions we provide for you. The details count. If you are bothered by something at any time during the postoperative process, tell us. Communication is key to preventing complications and improving outcome.

The Following Should Be Reported To Us Immediately:

  • Any sudden decrease in vision or sudden pain unrelieved by medicine
  • Any persistent vomiting unrelieved by medications
  • Sudden large swelling and/or bruising, especially if only on one side
  • Episodes of heavy bleeding from surgical sites
  • Any new “opening” of your incisions. This may manifest as a visible gap with new bleeding or crusting
  • Skin rashes, usually associated with intense itching
  • Any persistent temperature above 100 degrees
  • Any feelings of intense depression especially if associated with suicidal thoughts
  • Any injury to the surgical sites

Pain

Pain is a normal part of your procedure and usually is at its worst in the first 24 hours. Most describe this as an ache that improves considerably during the first days. It may seem worse at night, when under stress, or if the head is not adequately elevated. Please take the pain medicine as needed. Do not try to "tough it out" if you are uncomfortable as this may increase your blood pressure and cause bleeding. Reducing swelling and bruising will also help to reduce pain.

You should take the opiate pain medication which we have prescribed for you if you have pain. Usually you have the choice of Acetaminophen w/ Codiene (e.g. Tylenol #3) or Acetaminophen w/ Hydrocodone (e.g. Vicodin, Lortab, Norco). Some patients will already have an idea which one works best for them. Please let us know.
Unless we instruct you otherwise, do NOT use pain control products that contain Ibuprofen or Aspirin. These medications thin the blood and may cause excess bleeding and/or bruising. Be sure to check the labels of any pain medication you have, or that you purchase from the drug store.

Once you feel that you have less pain, it is best to transition to non-opiate pain medication (i.e. regular Tylenol). If you find you needed to take 2 prescribed pills for pain control, you may want to try substituting 1 with regular Tylenol. The side effects of prolonged opiate use include nausea and constipation.

Nausea/vomiting

We do all we can both before and during your procedure to minimize nausea, but unfortunately, you may experience nausea and vomiting after your procedure. For those who have a history of nausea and vomiting or are undergoing an especially long procedure, we offer a medication called Emend. One tablet is taken prior to your procedure and helps a great deal. After your procedure you may take the prescribed Odansetron ODT tablets. They dissolve in the mouth and work quickly. You may repeat every 6 hours. If you received a general anesthetic (i.e. you were asleep during your procedure), then nausea will generally improve as the general anesthetic works its way out of your system over the first few days. Prolonged nausea, vomiting, and/or constipation, on the other hand, is usually caused by continued opiate pain medication use. Please try to transition to non-opiate medications when discomfort is under control.

Bleeding

Bleeding from incisions sites may occur and usually is at its worst in the first 24 hours. Bleeding that is more like a slow “drip” is ok and may be relieved by 1) elevating the area, 2) applying cold compresses, and 3) holding light pressure for 10 minutes. Any bleeding that is heavy or persistent should be reported to us. Bleeding under the skin is normal to a limited extent and is what forms bruising. Bruising can the cause more swelling. See below how to minimize this cycle.

Swelling & Bruising

Swelling and bruising often go hand-in-hand and are a normal part of your procedure. The amount varies from person to person, but it always seems more prominent in the face. Swelling and bruising may be more noticeable in the mornings after you first wake up. This is normal and expected. It takes 6 weeks for 90% of swelling to subside. Bruising usually lasts no more than two weeks, and it changes color and decreases in intensity all the time. You may camouflage bruising with makeup or a concealer as long as it is not placed within a ¼ inch of an incision. Makeup may be applied over incisions only several days after sutures have been removed.

The main thing to remember is that swelling and bruising eventually subsides. You can help minimize it in the following ways:
  • For the first 72 hours, use cold compresses in the swollen areas for 20 minutes at a time every 1-2 hours while awake. Bags of frozen peas or crushed ice in a plastic bag wrapped in a wash cloth works well because its shape conforms to the area. Never place ice directly to the skin. Alternatively you may soak 4x4 gauze in an ice water bath, wring it out so it is not dripping wet, and then place over the swollen area.
  • Always maintain your head above your heart at all times. An upright position decreases blood pressure and swelling in the face. Sleep with the head of your bed elevated for a week.
  • Avoid pressure on any surgical sites as it may cause injury. Therefore, it is usually best to sleep on your back for 3-4 weeks. Some patients find a reclining chair placed at a 45 degree angle to be more comfortable.
  • Avoid straining, lifting, and exertion
    • Do not lift heavy objects. Even when lifting lights objects, bend at your knees.
    • Avoid activities that increase your blood pressure or heart rate, or cause you to perspire.
    • Be especially careful not to bump your surgical sites.
    • Avoid straining during bowel movements. If you need a laxative, your pharmacist can suggest an over the counter preparation.
  • Maintain adequate pain control and stress levels. If you are tense, your heart rate and blood pressure will elevate and cause more bleeding under the skin.

Fever

Generally, your temperature will not rise very much above 100 degrees after your procedure; this rise is due to the healing process. It is common to feel that your temperature is increased after your procedure, but this is usually not the case. If you feel feverish, you should measure your temperature by mouth. Report any persistent temperature above 100 degrees to the office.

Allergy

You may develop an allergy to ointment, tape, or one of your medications. Please report to us any wheezing, shortness of breath, severe abdominal pain, diarrhea, skin rashes, or severe itching.

Depression

It is not unusual for you to go through a period of mild depression after cosmetic procedures. No matter how much you wanted the operation, the postoperative swelling and bruising can be disappointing. Be patient. The bruising and swelling will subside quickly, and your surgical result will be evident.

Numbness

Areas surrounding the incisions will likely feel weak or numb for weeks to months. This is temporary, and will gradually go away. As the nerves heal, you may feel momentary sparks or twinges that are not painful.

Injuries to your face

You may have some kind of accidental blow to your surgical sites during the early postoperative phase. Be careful around pets and small children. This actually happens quite often. You don't need to be too concerned, unless the blow is hard, or if you have hemorrhaging or swelling afterwards. If you do have these symptoms, call the office. Otherwise, just mention it to us at your next visit.
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