Patient Care Instructions

Congratulations!  You have made it through surgery!  Now what?  Our office is here to walk you through the entire recovery process.   Yes, the first few days can be difficult but with a little preparation you will do just fine.    Here is what to expect.

After Surgery Instructions

Immediately following surgery you will wake up in the recovery room and will be quite groggy, this is very normal. If you are staying in the hospital you will be brought to your room after resting in the post-anesthesia area and your vital signs are stable. Most patients feel well enough to leave the hospital between 3-5pm the following day. Patients staying in the hospital are brought to 8East in the Newton Pavilion. The nurse’s station telephone is 617-638-2800. Loved ones can use this number to confirm when a patient is settled into their room and ready for visitors and/or to check on a patient. If you are being discharged on the same day as your surgery (ambulatory surgery) then you will be brought to the short-stay recovery room to relax until you are feeling well enough to leave with your escort. During your recovery if you feel ill or nauseous alert a nurse who can make you feel better with some medication or special care. You will be given some medication for pain and an antibiotic before you leave to ensure you are comfortable for your journey home. Prescriptions for some pain medication and antibiotics will be given to you or your escort prior to being discharged from the hospital. Remember, you will not be discharged from the hospital without an escort home. A taxi driver or hired driver is not acceptable.

At home

The first days following surgery you are newly swollen, bruised, and sore – this to be expected. During the first 24 hours after surgery ice your face and treated area[s] as much as possible with ice-water soaked gauze pads or small amounts of frozen peas or blueberries in zip-locked bags. This will help reduce some of the swelling. If you have a splint on your nose, cover the splint with some gauze prior to icing your face to keep the splint from getting damp.

An ace bandage will be placed around your face following surgery and should be kept on as tightly as possible for one week or until instructed otherwise by Dr. Spiegel. If this becomes irritating to the skin place a soft piece of cloth (i.e. a handkerchief) between your skin and the wrap to create a comfortable buffer.

Some incisions will be jagged and irregular. This is done purposely so the incision will mimic natural lines of the face and become less noticeable over time. Straight lines on the face are more easily noticed and look unusual. Tightness and lumpiness around the face, jaw, and neck is common and simply takes time to settle. After one week gentle massaging can be applied to any lumpy areas to help address this problem. Do not pick or remove any scabs or crusting.

Bruising and swelling peek 2-3 days following surgery and will subside about 7-10 days later. Some swelling may be evident for several weeks after surgery; especially following augmentation or bone reconstruction surgery. However, any residual swelling lasting after 3 weeks will be quite small and not noticeable to others. If liposuction of the neck was done there may be some additional swelling and bruising to the neck and upper chin area-this is expected and can be treated with ice for the first few days.

Lack of feeling or partial feeling near the treated area[s] is normal and will gradually improve with time. This may take up to one year although it usually takes about 6-8 months for full sensation to return.

You may experience light bleeding in or around the incision areas. This is normal and not worrisome. However, it you find any hard, large collections of blood or excessive bleeding please alert our office as soon as possible. You can page the on-call doctor by calling 617-638-8000 and ask to page 4433—they will be able to reach Drs. Hwang and Spiegel immediately. If you have any new areas of fluid collections contact Dr. Spiegel as soon as possible. You will likely be sent to our office (not the ER) for examination.

Follow your medication instructions carefully and consult your PCP regarding resuming any discontinued medications before doing so. Be sure to use your pain medication as instructed and substitute Extra-Strength Tylenol for your prescription pain medication as soon as you are comfortable doing so. Pain medication is generally not needed after one week. Communicate with our office regarding any questions or a problem you may experience with your pain medication – our goal is for you to be comfortable.

Button-down shirts or zip sweaters/sweatshirts are ideal following surgery to avoid pulling on the incisions.

Keeping It Clean

Once a day remove the ace wrap around your head and clean the incisions carefully using a gentle cleanser, such as Cetaphil. Simply dampen a cotton-swab and apply a tiny amount of cleanser to the face. Use the cotton-swab to dab at the incisions and wash away any areas of blood or dirt. Rinse your face as you normally would. After cleaning the areas, apply Neosporin to keep the area clean and moist—this will encourage the incisions to heal and the stitches to dissolve faster. Remember, never to pull away from the incisions. Stubborn areas to clean can be remedied with a mixture of water with a small amount of hydrogen peroxide or a diluted hydrogen peroxide pad. Please, be gentle! After cleaning, cover the incisions with gauze and rewrap the ace wrap as tight as comfortably possible. Keeping the incision areas as clean as possible will not only help you feel and look better faster, it will also help us remove your sutures more easily.

You may shower 24 hours following surgery. Baths are acceptable; however, avoid soaking any of the treated areas in water. Your incisions can get wet but should not be soaked for long periods of time.   A mild shampoo like Johnson & Johnson’s baby shampoo is best. Do not bend over to wash your hair, instead, hold your head back in the shower. When washing your hair, always scrub towards your incisions – never away. Be gentle with your face and scalp—especially when toweling dry and do not massage the scalp. Do not use a hair dryer for 4 weeks and proceed with a cool setting until 8 weeks after surgery.

A first post-operative appointment is scheduled 5-7 days following surgery. At this time, Dr. Spiegel will review your progress, answer any questions and remove any sutures.

Do’s and Don’ts

During the first week after surgery you should rest at home/hotel as much as possible. You also should not be moving your head around or bending down at the waist for the first few days after surgery—this is to minimize rushing blood to the area. Instead, bend at the knees and/or turn your entire body if necessary. Keep your head elevated at all times. When sleeping, use two pillows to prop up your head and support your neck. It is not necessary to sleep at a 90° angle but keeping your head above your heart is best. Do not sleep on your side for one week and if necessary, place pillows on the side your face to prohibit yourself from turning your face while sleeping.

Many patients are anxious to get back to work or communicate from their laptop. While we understand the demands of work and life, we stronger suggest rest and relaxation for two weeks following surgery – especially the first week following surgery. Providing your body ample time to recover will help you heal faster in the long run – that means physical, emotion, and mental relaxation!

Short walks a few days following surgery are encouraged but please have an escort with you the first couple of trips. However, any physical activity that raises your blood pressure or causes sweating is prohibited for two weeks and should be resumed with caution.

Avoid excessive chewing by consuming soft foods like fruit shakes, yogurt, soup, eggs, and pudding following surgery. Minimize your facial movements (i.e. talking, turning your head) as much as possible to allow the skin and tissue to heal properly.

Do not use hot hair rollers or get your hair cut or colored for six weeks.

Avoid sun exposure to the surgical area for six weeks and use sunscreen on incisions for at least one year. This will help improve the quality of the scar and help it fade over time.

Traveling is permitted after one week. However, it is important to receive help carrying any heavy luggage.

After two weeks most patients feel they look presentable and return back to work around this time. Please do not wear any earrings for three weeks to avoid any pulling in the ear area.

After two weeks you may resume: driving, sedentary work, and light exercise like slow walking or using an exercise bike. Intense exercise (running, pilates, elliptical) can be resumed 4 weeks following surgery. Yoga, especially upside-down poses, should be avoided for 8-10 weeks.

Most importantly, DO stay positive during your recovery. Recovery following surgery is a difficult time – physically and mentally – but keep your spirits up and the rest will come with some time. You will do great!

Contact our office prior to scheduling any dental work following surgery.

Skin Care

Before Surgery

Arnica Montana, an herbal supplement, is recommended before and after surgery to help reduce excess bruising. DermaCirculation Formula from Neova treats post-operative skin by helping reduce bruising and calms inflamed skin. The formula stimulates nutrient flow and Nitric Oxide production in the body to improve microcirculation in skin, quickly calming the irritation cycle and minimizing the appearance of bruising and inflammation. It can be applied directly on the bruised areas and comes in a silky smooth lotion.

After Surgery

You may wash your face gently following surgery however; moisturizing or makeup application is strongly discouraged. After one week, you may apply makeup to camouflage any bruising if necessary. Full Cover by Make Up For Ever (available at Sephora) is an excellent full coverage concealer. Do not apply makeup to incision areas for 10 days. If you’d like, you can apply ointment, like Neosporin, to the incision areas.

If you are going outside, you should use a sunscreen with an SPF of 15 or higher. A higher SPF should be used on your scars to help reduce their visibility as much as possible. Electrolysis, laser treatments, facials or any other skin treatments should be avoided for two months. Products containing Retin-A, Renova, Vitamin E, glycolic or alpha-hydroxy acid should be avoided for three months.

Our office carries a number of Neova products like gentle cleansers, moisturizers, and sunscreens ideal for post-operative care.

Clean

  • Herbal Wash
  • Radiant Skin Wash
  • Deep Therapy Wash
  • Balancing Toner
  • Microderm Scrub
  • Smoothing Gel

 

Treat

  • DermaCirculation
  • Prevage MD by Allergan
  • Antioxidant Serum

Protect

  • Ti-Silc SPF 45
  • Z-Silc SPF 30

Improve

  • Acne Cream
  • InviCible Scar Cream
  • Essential Lash
  • Ponaris Nasal Ointment

Moisturize

  • Day Therapy
  • Eye Therapy
  • Night Therapy C
  • ream de la Copper
  • Body Therapy

Special Instructions by Procedure:

 

Cheek Augmentation

Medications

Be sure to take your antibiotics until they run out. This is especially important with the placement of implants.

Keeping It Clean All oral incisions will require a mouthwash to be used regularly following surgery to keep the mouth as clean as possible. You’ll simply need to “swish” once or twice a day. You are free to brush your teeth as soon as you are feeling up to it – usually 48-72 hours after surgery.

Chin Augmentation and Recontouring

Medications

Be sure to take your antibiotics until they run out. This is especially important with the placement of implants.

Keeping It Clean All oral incisions will require a mouthwash to be used regularly following surgery to keep the mouth as clean as possible. You’ll simply need to “swish” once or twice a day. You are free to brush your teeth as soon as you are feeling up to it – usually 48-72 hours after surgery.

Forehead Surgery

At the Hospital

It is common and expected for your eyes to swell shut following the forehead surgery. While this is uncomfortable and off-putting resist the temptation to panic. This swelling it is completely normal and will resolve after the first 24-36 hours. Time and some ice are the best things for it.

You will be given some medication for pain and an antibiotic before you leave to ensure you are comfortable for your journey home. Prescriptions for some pain medication and antibiotics will be given to you or your escort prior to being discharged from the hospital.

At Home

Bruising and swelling usually peek 2-3 days following surgery and will subside about 7-10 days later. Most patients experience the majority of their bruising in the corners of their eyes and brow area. Some swelling and tightness will be evident for several weeks after surgery; however this amount will be quite small and not noticeable to others. Generally patients feel comfortable returning to work after 2-3 weeks.

Lack of feeling or partial feeling in the scalp and face is normal and will gradually improve with time, generally 6-12 months after surgery.

DO NOT blow your nose for at least two weeks after surgery. Try to keep sneezing to a minimum and sneeze as “gently” as possible.

Medications

Hormones may be resumed when you are able to move around regularly and comfortably—usually 5-6 days after surgery.

Lip Lift Surgery

At Home

It is very common for patients to experience significant swelling in their lips following a lift and/or augmentation. This swelling WILL go away.

Mandible Surgery

At Home

Lack of feeling or partial feeling in the face, chin, neck and jaw is normal and will gradually improve with time.

Lumpiness and swelling can linger for many months following this surgery. Massage will help alleviate some swelling and time will take care of the rest.

Medications

Be sure to take your antibiotics until they run out. This is especially important with the placement of implants.

Keeping It Clean All oral incisions will require a mouthwash to be used regularly following surgery to keep the mouth as clean as possible. You’ll simply need to “swish” once or twice a day. You are free to brush your teeth as soon as you are feeling up to it – usually 48-72 hours after surgery.

Otoplasty Surgery

At Home

An ace bandage or headband should be worn 24 hours a day until your first post-operative visit with Dr. Spiegel or for 2 weeks – whatever comes first.

Septoplasty and Rhinoplasty Surgery

At Home

It is common to experience some draining of mucus or blood in your throat after surgery—this is from the incisions in your nose. DO NOT blow your nose during the first week post-op. Instead, use the nasal saline spray to gently irrigate (clean out) the nose a few times a day. Your nose will be cleaned out at your first post-operative appointment. Do not pick at or remove any scabs or crusting.

Following surgery patients experience difficulty breathing through their nose due to its stuffiness and post-operative pressure. You will need to resort to breathing through your mouth for one week. Using Chapstick and drinking plenty of water will help you avoid chapped lips and keep your mouth comfortable during this time. You can gently clean the area with nasal spray and Q-Tips but again, do not blow your nose to clear this—that may result in disrupting the stitches and incision area.

Skin Resurfacing

At Home

The first days following surgery your skin will be very red and tender-it is to be expected. Keep the resurfaced areas clean using a gentle cleanser, such as Cetaphil, and apply a thin layer of Vaseline or Aquaphor over the area to keep it moist at all times. The skin may crack and you may experience light bleeding or tightness in or around the treated areas. This is normal and not worrisome. Do not pick at or remove any scabs or crusting.

Please contact our office for a prescription for an anti-viral medication prior to surgery.

Trachea Shave

At Home

It is common for the trachea incision to appear low following surgery. This is due to the swelling and the incision area will rise up once the swelling has dissipated.

Some patients have experienced a sore or scratchy throat following surgery and this resolves itself in 3-4 days.