Plastic Surgery Post-Op Instructions
Pain and Medications
Pain and discomfort should be expected with any surgery. Dr. Hsu will try to minimize pain and discomfort by providing more local anesthesia injections and nerve blocks than other surgeons, especially for surgeries such as breast augmentation and tummy tucks. Pain medication should be used on an “as needed” basis but if the pain is hard to control, it can be used on a scheduled basis for the first 24 hours. That means giving yourself pain medication every four hours scheduled. This allows the medication to build up in the system so you don’t fall behind. Our doctors usually recommend going to “as needed” on the second day and thereafter. Nausea medication is only indicated if there is nausea. Frequently, patients will develop nausea as a result from anesthesia or most commonly, the pain medication itself. The faster you can get off pain medication, the more likely you will resolve your nausea and constipation. Dr. Hsu allows his patients to transition to Advil or ibuprofen immediately after surgery. Advil and ibuprofen can be effective pain relievers and are superior to Tylenol, which is better for fevers.
Start your antibiotics when you get home and you should finish all of them. The usual course for preventative antibiotic therapy is about 5-7 days depending on the procedure. Antibiotics can be a common cause of nausea and vomiting so take the nausea medication as prescribed “as needed”. Both pain medication and antibiotics should not be taken on an empty stomach. You can lessen the amount of nausea if you just have a little food in your stomach.
What to look out for
Although complications are rare, they can happen. Whether you are having a breast augmentation, liposuction or tummy tuck, complications that are caught early can improve your overall outcome. The two most common complications that you may develop before you see Dr. Hsu at the first follow-up is a hematoma or an infection. A hematoma occurs when you have bleeding in the areas of surgery. This bleeding fills the area that was operated on and is contained since all the incisions are closed. This will usually produce pain, discomfort and a lot of pressure at the site of surgery. Although these symptoms are usual with any surgery, a hematoma will usually present with a lot of abnormal swelling as well, especially if only one side is affected such as in a breast augmentation, face lift or tummy tuck. If you feel like you have a hematoma, you should contact our office immediately so it can be evaluated.
Infections are very uncommon however they can occur, especially if a foreign body (something that doesn’t belong in your body) is placed such as a breast implant. If an infection does occur, it will usually be around 4-7 days after surgery. It will usually manifest as increasing amount of pain, pressure and swelling at the surgical site. This is especially true if things have been improving and then all of the sudden start to hurt more. You may also experience low-grade fevers, however, fevers that are less than 101 degrees Fahrenheit are normal after surgery. You should only be alarmed if it is higher than 101. The last clinical sign to look for involves increased amount of redness and warmth in the area that was operated on. This redness will usually be a bright red that blanches if you press on the skin. Small amount of redness after surgery is very common. The area may feel warmer or hotter to touch.
All of the clinical signs that have been described are common after any surgical procedure. However, it is unusual for someone to have all of the signs. This is why Dr. Hsu follow-up his patients very closely and is available to answer any questions. Should you have a concern, it is best to call the office and speak with one of the nurses that work exclusively with Dr. Hsu. He is always available to his patients by way of the office and will tend to any questions that patients may have postoperatively.
After any surgical procedure, whether tummy tuck, breast augmentation or liposuction, the patient can shower 36 hours after the completion of their surgery. All the areas of the body can get wet, even the incision site. Stay away from soaps that contain too many perfumes or scents. A simple antibacterial soap such as Dial is most appropriate. Be sure to not scrub the incisional area and leave steri-strips (butterfly tape that may be covering your incision) on. Afterwards, pat yourself dry and then allow everything to air dry for about 2 minutes. Avoid using any lotion around the incision areas for about two weeks. Other areas such as your hands and feet can be moisturized as usual as long as there’s no incision there. Dr. Hsu will remove your steri-strips at around two weeks.
If you have drains, they have been placed because they are very important and our surgeons feel that they are needed for a speedier recovery. Drains are commonly used throughout all areas of surgery to help evacuate fluid. Surgery causes damages to tissues and as a result, the tissues will leak. Having a drain in place will evacuate this fluid as you heal. Fluid that accumulates at the surgical site that is not properly evacuated is called a seroma. Drains help prevent hematomas (blood collection) and seromas. Although they are a nuisance, drains are very necessary.
Strip and record your drain output 3-4 times per day. It’s easiest to do it with every meal and before you go to bed. Make sure you record the output as measured when the drain bulb is deflated. Total up your daily output for each drain so it is easier for Dr. Hsu to see if they are ready to come out. The output needs to be less than 30 ml or cc ‘s per 24 hour period per drain before that drain can be removed. It should be less than 30 cc’s per day for two consecutive days.
Make sure you clean your drain where it enters your skin with a Q-tip and some alcohol twice a day. Then cover the drain entry site with a small gauze and tape to keep clean and prevent infection.
With any surgery anywhere on your body, it is important to not do any heavy lifting early in the postoperative period. Any strenuous activity can result in unnecessary elevation in blood pressure, which can result in bleeding. Heavy lifting can also tear recently repaired tissues and pop sutures. This could all lead to unnecessary pain or bleeding. In general, limit your activity and lifting to under 5 pounds before you see Dr. Hsu. Each specific surgery will have a specific set of instructions on how to return back to your daily activities.
You should not drive at all before you see Dr. Hsu for your first postoperative visit.
Dr. Hsu will clear you to drive after your first postoperative visit provided that you are off all pain medications. Most patients will be recommended to start taking Advil or ibuprofen as a substitute for their pain relief. Try to drive vehicles with good power steering especially after surgeries such as breast augmentation and tummy tucks. Make sure you have someone with you on your first trip so that if you don’t feel comfortable enough you can pull over and stop.
Returning back to work is very dependent from patient to patient and surgical procedure to surgical procedure. Patients all have different pain thresholds and motivations. In general, breast augmentation and liposuction procedures can return back within one week, tummy tucks 2 weeks. Be sure to ask Dr. Hsu and the Memorial Plastic Surgery staff how long recovery would be for you on your specific surgery.
Scars and Scar Therapy
Scar quality is for the most part genetically determined. We look to other scars on your body to see how you naturally heal. Be patient while you are healing and rest assured that time is the most important factor in scar healing. It takes at least a full year for your scars to be fully “mature”. “Immature” scars are pink or red, raised, and occasionally can be itchy or tender. In contrast, mature scars are flat, soft and supple to the touch and faded, without any symptoms such as itching or discomfort. Typically, all scars look better with time.
As mentioned earlier, any incision on the body will result in a scar. Dr. Hsu will do all he can to minimize scarring by suturing meticulously followed with aggressive post-operative scar therapy. Scar therapy usually starts between two – three weeks with some form of silicone sheets, silicone band-aids or silicone gel. Silicone based adhesives are one of the few products on the market that have been proven over and over to help with scars. Although some patients will swear by cocoa butter, vitamin E, and Mederma, little improvement if any have been shown with these products.
Avoidance of Sun
After all types of Plastic Surgery but particularly in the face, strict sun avoidance is imperative after surgery to avoid “hyperpigmentation” (darkening of the skin and the incisions) and sunburn. Wearing a hypoallergenic sunblock of at least SPF 50 is vital and should be done for a year regardless of your surgical procedure. Cover your incisions with sunblock since many clothing are not UV protective and rays can inadvertently penetrate your garments.