BEFORE AND AFTER YOUR FACIAL SURGERY FACELIFT Our intention is to help you have the best and safest experience possible. This letter contains important instructions, and we ask that you carefully read this in its entirety. . Feel free to call us at 410-978-3962 if you have any questions. Prior to surgery: In order to minimize the risks of surgery, it is mandatory that you follow these instructions: -Do Not Ingest Any of the Following For a Minimum of 14 Days Prior to Surgery: Aspirin or aspirin containing products Ibuprofen or similar medications (Motrin, Advil, etc) Gingko Biloba, Ginseng, Vitamin E supplements If you are taking other medications, ask if it is ok to continue them or not prior to your surgery. -You Cannot Have Anything to Eat or Drink – Not Even Small Amounts After Midnight the Night Before your Operation An exception may be made for some prescription medications – please consult with your primary care physician about this. - You Must Have a Friend or Family Member Drive You to the Surgical Center, as well as Drive You Home Afterward You are expected to have made these arrangements in advance. This is mandatory. You are not allowed to travel alone, nor in a cab, after your operation. - You Must Make Arrangements to Have Someone With You the First 48 Hours After the Operation We will provide you with the option of contracting private duty nursing for this. We find that many of our patients value this greatly. However, it is fine to simply have a family member with you. We also can help you arrange a stay in a beautiful bed and breakfast nearby, with round the clock nursing. You are likely to require assistance with simple activities, incision care, eye care and the like. In addition, while facial cosmetic surgery is generally very safe, it is important to have someone with you just in case you have any issues you need help with. The day of surgery: You should wear loose and comfortable clothing that is easy to get in and out of. You will meet the anesthesiologist and nursing staff and any of his additional team members (such as the fellow) in the morning. You should leave the recovery room with: A supportive elastic dressing for later use. You will want to have this with you at home, and bring it to your clinic visit the next morning. MEDICATIONS See the attached list for the medications and what they are for. You can obtain your prescriptions from your doctor in the office prior to the procedure, or on the day of the procedure. After the operation FACELIFT Your face and neck will be wrapped in a large compressive dressing. This stays on overnight. There may be drains placed in your neck. If so, these are removed the day after the operation. Sleep with your head elevated for the first three nights. The day after the operation, you will come to clinic – either at Greenspring Station, or at the Johns Hopkins Outpatient Center downtown. This should be confirmed prior to your surgery date. The dressings will be removed, and if there are drains, they also will be removed. Your face and incisions will be examined, and instructions given to you on incision care and the use of supportive dressings/garments. It is possible that your doctor will not see you during that visit – if he is unavailable, then either the nurse or surgical fellow will care for you. It is important to begin taking a daily shower with shampoo either one or two days after surgery. If you do contract with a private duty nurse, she may assist you with the initial dressing removal and shampooing on the morning after the operation, prior to coming in to see us in clinic. During the first seven days after the operation, you should shower and shampoo once daily. The soapy water can run over all the eyelid, scalp, and facial incisions. You must also clean the facial and neck incisions with diluted hydrogen peroxide (mix 50:50 with water) and apply bacitracin antibiotic ointment twice daily. This is for any incisions around the ear area, as well as under the chin. The idea is to keep dried blood and crust out of the incisions, and to keep them moist with ointment. No dressings specifically covering the incisions are necessary. After each shower, and incision cleaning/ointment application, you are to re apply the elastic supportive dressing. We prefer you wear this most of the day, and at night. This helps to support the swollen soft tissues of the face and neck the first seven postoperative days. Your sutures will be removed 5-7 days after the operation. This requires an appointment, and should be scheduled prior to your procedure. The sutures may be removed by your doctor or one of our experienced nurses, depending on the days schedule. After the operation: What can I expect? The first week: You are likely to have some pain, swelling, and bruising after the procedure. The pain is usually quite mild, and easily controlled by the prescription pain medication. You may feel very fatigued. Some patients experience nausea, even vomiting, during the first 24 hours, although this is not common. A sensation of tightness – around the eyes, the face, the neck – is relatively common. A sore throat can occur from the use of an endotracheal tube during the procedure to assist with ventilation. This is common, and may last for a few days. Please call us for any questions about this. Don’t engage in very vigorous activity the first week, nor bend over. Gradually increase your activity. You should be up and about the first day after the procedure, however. Do not stay in bed. The first month: The more dramatic swelling of the first 48 hours will resolve fairly quickly. The bruising is typically gone by 2-3 weeks after the procedure. Very few patients have any significant pain after the first night or two. . During the first month you may notice a number of surgical and healing response related findings. These may include asymmetric swelling, some irregularities to the skin and underlying soft tissue (“lumpiness”), a sensation of tightness, numbness in certain areas, tingling, palpable sutures, mild blurry vision, changes in the ear or brow position on one or both sides, and the like. These are normal, routine feelings. Some describe the feeling that they no longer look like themselves the first week or two. This is common, but does not last. The first year: Most patients return to full social and work activities within 2-4 weeks after the procedures. From that point on, continued, slow healing occurs for at least one year. These procedures are popular because of the noticeable benefit that most patients receive. No result is perfect, however, and up to 10% of patients will want something more or different done because they are not satisfied with their result. You may develop some noticeable scarring or tissue irregularities, or asymmetries in the scarring, the soft tissue, or the facial, eyelid or brow position. Some patients have skin and soft tissue which loosens and relaxes after the surgery. There is no way to predict for this, and these patients may have a result that they are frustrated by. Further surgery may be unable to correct this. Thankfully, approximately 90% are pleased by the change in their appearance, and their resolution of the various surgical and healing response related issues. Summary card Preop Medical clearance Nothing to eat or drink after midnight. Have someone drive you. Postop day #1 Come in to clinic for dressing change, drain removal if you have one. Postop days 1-7 Take pain medications if you feel pain. Sleep with head elevated. Shower every day, let soapy water run over incisions. Gently clean facial incisions twice daily with diluted hydrogen peroxide. Gently clean eyelid incisions twice daily with saline or soapy water. Apply antibiotic ointment to incisions 2-3 times daily. (Bacitracin to face or neck incisions, and lacrilube to eyelid incisions) Wear Velcro compressive dressing. Postop day 5-7 Sutures removed Appointments you need to make: The day after surgery 5-7 days after surgery you make one appointment for suture removal Two to three weeks after surgery. Two to three months after surgery Six months after surgery.