Facelift / Necklift

Items To Purchase Before Surgery

•  Hydrogen Peroxide or Witch Hazel (Peroxide for lighter color hair, witch hazel for brunette or darker color hair. 

•  Cotton tipped applicators.

•  Antibiotic ointment. 

•  Non-Stick Pads or abdominal pads: These will help to absorb any fluid that may be seeping from the incisions. Please keep in mind that drainage from surgical sites is typical for the first 72 hours following surgery.

•  Neck pillow: Neck pillows (the round ones that most travelers use on flights) will help secure the neck and face while the patient is in a seated position. The pillow will allow the patient to rest their head comfortably while also discouraging abrupt movements of the neck.

•  Stool softener (Ducolax, Miralax, Metamucil, or Peri-Colace)—Pain medication can constipate you. Peri-Colac or docusate sodium is my favorite as it helps soften the feces (“the mush”) and also helps stimulate the bowels (“the push”). These should be started the day after surgery. Often patients needs to double up on the dose or take 2 tablets twice a day. 

•  Dial ® or other antibacterial bar soap: You will use this bar soap the morning of surgery to wash the surgical areas. You do not need to use this soap in the postoperative period as it will dry out your skin. You may resume your normal soap postoperatively.

•  Johnson’s or generic baby shampoo. 

•  Arnica and Bromelin: These are herbal supplements that aid in bruising and swelling. These can be found on Amazon (Arnica Montana 30 x) or in most health food stores. It is best to start the Arnica prior to surgery if possible (a few days prior if able)

General Instructions

• After surgery, have an adult available to stay with you for the first 24 – 48 hours, as you will be weak and drowsy. 

• It is also important for you to keep your head elevated the evening after surgery as well as for the first two weeks following surgery. This can be done by either sleeping in a recliner tilted at 45 degrees or sleeping with two pillows underneath the head. Avoid rolling onto your face. Sleeping on your back for the first two weeks after surgery helps to ensure this.

• Go over suture lines four times daily with hydrogen peroxide on a Q-tip both in front of your ear as well as behind it. After this again with a Q-tip apply a liberal amount of Bacitracin (other antibiotic ointments such as Neosporin are acceptable) ointment.

• Avoid straining of any kind for the first 5 days. Avoid turning your head to either side as this will pull on the stitch lines. To turn, move your head and shoulders as a unit. 

• Facial movements (smiling, talking, chewing, yawning, etc.) should be kept to a minimum for the first week. Movements can disrupt suture lines or resulting in internal bleeding. 

• You may apply covered frozen vegetables or cool compresses (keep them cold or in ice) to the exposed areas of your face for the first 24 – 48 hours to reduce swelling post-operatively. Do not remove head dressing at this time. You will have your head dressing removed the next day after your surgery. 

• You can expect some swelling of the face and eyes after surgery. If you develop acute onset of swelling on one side of your face or neck, which is definitely more pronounced than on the other side, and if you are having EXCRUCIATING pain, go to the emergency room.

• You may shower (with shampoo only) 2 days after surgery. This is to keep suture lines clean. Lather your hair gently using the palms of your hands and rinse thoroughly until the soap is out. It may take several washings before all the crust and ointment is out of your hair and incision lines. Use your finger tips to gently rub small circles around your incision sites to encourage dry blood to fall off. Be sure to use a gentle shampoo such as Johnson’s Baby Shampoo.

• After the shower, your hair may be dried with a blow dryer on a cool, not a hot, setting. 

• Do not use hairspray, conditioner, gels, etc. while the stitches are in place. You may start washing your face gently and use a moisturizer on your face, being careful to keep it away from the stitch lines.

What To Expect

Swelling: Swelling will vary both patient-to-patient as well as side-to-side. Swelling may actually increase the first three to four days before subsiding. Most of your swelling should resolve over the first two to three weeks. Do expect, however, to have minor fluctuations in the remaining swelling over the course of the next two to three months.  Your face will feel tight due to swelling. Things to do to minimize this swelling include keeping your head elevated as much as possible over the first two to three weeks; avoid bending over or heavy lifting for the first three weeks, and avoiding prolonged sun exposure for the first two to three months.

Discoloration: Bruising will vary like swelling from person to person as well as side-to-side. Most bruising and discoloration should resolve over the first two weeks. Make up can be applied ten days to two weeks after surgery if permitted by Dr. Allen. 

Numbness: Most of your face will be numb following surgery. This is normal and will subside over the coming weeks to months. Unusual sensations, pins and needles, and occasionally mild discomfort may occur as these nerves regenerate over time. Sensation may take 9 months or longer to return completely. 

Asymmetry: Occasionally nerves are affected by swelling and patient’s can experience or notice slightly more asymmetry in the face following surgery. This usually resolves with time. 

OTHER THINGS:

 • Expect a bruised and puffy face for 7 – 14 days, although some patients do not bruise at all.

• It is normal to feel a firmness/hardness around the chin area and on the cheeks. This will start to subside by week 6.

• By the third week, you will look and feel much better.

• It is normal for pleats to develop along the cheek area; these will improve with time.

• It takes 6 MONTHS FOR FINAL RESULTS to appear. In the interim, you may notice:

Scar Therapy

• Silagen® Scar Refinement System (http://www.silagen.com) is available at the office to purchase should you choose to do so. Silagen® silicone gels are made with the highest quality medical grade silicones that create a protective barrier over scars which increase hydration and help stop excessive collagen buildup. This will help flatten and soften scars and reduce redness, itching, and pain.

•  You may begin using Silagen® as soon as the skin is fully closed, after all sutures

are removed and after all scabs have fallen off. This usually occurs anywhere between 3 – 6 weeks from surgery.

• Other over the counter scar creams can be used but be sure they contain silicone for best healing outcomes. 

•  It is recommended you use at least 2 months of Silagen® gel which is massaged on to the incision twice daily for 2 – 4 months.

Compression Stockings And / Or Dvt Prevention Device

If it is determined that you are a high-risk patient for developing a blood clot, (a DVT), you will be provided with a DVT prevention device to be used on your legs in the initial postoperative period.

Emotional Exepectations Following Surgery

It is not unusual for patients to undergo significant emotional “ups and downs” after any type of surgery. Factors such as underlying stress, medications, and/or psychological tendencies can result in patients experiencing a “post operative depression” that generally resolves after a few weeks. Having a partner, family member, or friend who is supportive can help with this process. Understanding the stages of emotional “ups and downs” can help patients stay calm and recover from this emotional process faster: 

Phase 1: Being Out of It

Swelling and discomfort is most severe over the first few days after surgery. Pain medications also can make you disoriented and emotional. 

Phase 2: Mood Swings

 Having just had surgery, patients are adjusting to a sudden change in their appearance with much anticipation. The presence of bruising, swelling, and asymmetries will distort a patient’s results thereby concealing the final outcome. Mood swings (especially sadness), worry and depression are common emotions as a result. Patients may even ask, “What have I done?” or think that “I never should have done it.” 

Phase 3: Being over critical 

During the second week, patients will probably be feeling a lot better. The swelling and muscle cramping/spasms will be decreasing and sutures will be out. Because of anticipation, it is natural for patients to look critically at their new body worrying about symmetry, scars, and so on. At this point, it’s normal to wonder if they have achieved their goal and what they paid for. This is too soon to tell and most concerns are resolved with time. 

Phase 4: Happy at last 

Finally, about 3 – 6 months out of surgery, patients will probably start liking how they look and are feeling much better. They may be in the mood to check out some bathing suits, clothing, or outfits to show off their new self.  

PLEASE CALL THE OFFICE AT 919 676 5052 IF:

• You have redness, increased pain at surgical incision sites, sudden increase in swelling to face or neck, warmth, drainage (pus), or oral temperature greater than 101.5°F

• You have nausea and vomiting despite anti-nausea medication use, rash, shortness of breath, leg pain with swelling, or diarrhea after taking your medication.

PLEASE VISIT AN EMERGENCY ROOM OR CALL 911 IF:

• At any point you experience shortness of breath or leg pain with swelling as this could indicate a pulmonary embolism (blood clot in lung) or dvt (blood clot in legs) and could be deadly if untreated. Also visit an ER if you have an increase in swelling to neck or face.

PLEASE VISIT AN URGENT CARE ON THE WEEKENDS OR WHEN THE OFFICE IS CLOSED IF:

• You have redness, sudden increase in swelling, warmth, drainage (pus), or oral temperature greater than 101.5°F