Healing and Factors Common To All Surgeries
Doctor, will I have scars?

I usually heal really fast.

These two statements are the most often heard in a plastic surgeon's office. They are also the two most commonly misunderstood concepts by patients.

All invasive procedures will cause swelling. Swelling in cosmetic procedures can be great. So great, that some patients may be alarmed by the magnitude and length of time involved in swelling. Surgery also causes scars. Our aim is to make the scars inconspicuous. By definition, all surgical procedures are invasive. This sets off an automatic sequence of events in the body aimed at healing itself. The speed of these events cannot be hurried. All healthy people heal by the same course with little variation.

This timeline of healing shows how each step of the healing process affects four common types of elective surgery. It is not an absolute schedule and some variation is not uncommon. However, all surgical areas, regardless of the type of surgery performed, will undergo the following steps of healing.
POST 
PROCEDURE 
POINTERS

Days 1-5 (Inflammation)

Facelift and Eye Tuck

Liposuction /

Tummy tuck

Breast Augmentation/Lift

Rhinoplasty
  • The body swells in response to the "injury" produced by surgery
  • Swelling is maximal at 3-5 days
  • Bruising may be visible
  • You will fatigue easily as your body uses all its resources to heal the "injury"
The eyes, cheeks & neck will swell and bruise The treated areas may appear bigger than pre-op Swelling of the entire chest and upper abdomen with scattered numbness The nose, cheeks, and eyes are swollen and bruised

Days 7-21 (Repair)
        
  • The ground work for healing is delivered by the body into the surgical sites
  • The operative swelling from the first week has decreased
  • A stiffer feel or "thickening" still remains in the operated areas
  • Wounds begin to appear pink and thicker
  • The size of the operated site begins to decrease
  • Your tire less often, but your stamina is still low
Opening eyes and moving the neck is easier, although the eyelid margins are still thick Some areas treated may feel "fuzzy" or numb. Surgical sites begin to reshape and contract. Less tension on the skin and easier movement of the breast tissue or implant with less pain. Some areas may have lingering scattered numbness Bruising and swelling around the eyes and cheeks decreases. Internal nasal swelling improves but the nasal tip stays swollen and tipped upward

 Weeks 3-6 (Remodeling)
        
  • The body increases the rate of softening of the surgical sites and scars
  • Intermittent episodes of swelling in operated areas are not uncommon especially after exercise or other activities
  • Rule of thumb: the texture and color of your external scars reflect the process in the deeper layers
 The eyes appear "brighter" and the scars are less pink. Cheek swelling decreases but settles more under the chin  The areas treated are showing more rapid contraction and decreasing pain. The lower abdomen just above the tummy tuck scar may remain swollen. Softening of the lower part of the breast and early transformation to the "pear shape" Tenderness is less near the upper bones and the hump area begins to soften. The nasal tip, although improved, remains swollen

 Weeks 7-12
        
  • Continuous subtle further remodeling
  • Skin and scars are now more supple and can easily be squeezed or rolled between two fingers without pain
Scars begin to fade and soften. Cheek and neck areas remain stiff but minimally swollen Continued remodeling and shrinkage of skin. Swelling just above the tummy tuck scar decreasing. Relaxation of the tissues allowing a more natural appearance Better definition of the upper nose and tip, but the lower tip area may remain thick and stiff

 Months 4-12
        
  • More extensive procedures, nasal surgery, or surgery in previously scarred areas may continue with pink scars and vague stiffness of the area
Gradual subtle changes can continue for up to one year or more in any operated site
How much time until you can be "in public"?

Eyes/Face 14-21days
Breast 3-7 days
Liposuction 5-10 days
Tummy tuck 10-14 days
Rhinoplasty 7-10 days

If multiple procedures are performed, assume the longest time period for recover and public appearances.


FACTORS COMMON TO ALL SURGICAL PROCEDURES

PREOPERATIVE CONSIDERATIONS

All patients are strongly encouraged to stop smoking. Smoking is not only a recognized health hazard in its own right but is responsible for a number of post operative problems and complications in patients who have a general anaesthetic. Heavy smokers are more likely to develop a chest infection postoperatively, particularly after major procedures. They are also more liable to suffer the consequences of impaired circulation. This can lead to flap necrosis (loss of the skin resulting in bad scars) following a facelift or abdominoplasty. Alcohol and aspirin should be avoided for two weeks before and after any significant operation. Both impair clotting and hence the patient is more likely to bleed during and after the operation. Abstinence from food and drink from early morning or the previous midnight is essential depending on the time of the operation and the orders of the anesthetist.

All surgery and anaesthesia are associated with a small risk. Complications that can be extremely serious, even fatal, can arise in any operation. Elective cosmetic surgery however on healthy patients is not considered to be a high risk.


POSTOPERATIVE EVENTS THAT CAN OCCUR AFTER ANY SURGICAL OPERATION.

PAIN AND DISCOMFORT

Surgical procedures result in discomfort for the patient. The degree and duration of this will depend on the nature of the operation and the patient's pain threshold. Tablets or injections are usually given in the immediate postoperative period. Patients are discharged when they are comfortable.


SCARS

All surgical incisions heal with a scar. The surgeon tries to place incisions where they are not easily seen, such as in natural skin folds or behind the hairline. It is wrong to think that scars will be invisible or that they will fade to nothing in time. Wound healing is a complex process and scarring can be very variable. Most scars will look worse (red and raised) for some time after the operation before they mature and become pale. In general scars take 6-18 months to mature and there will always be a permanent mark, no matter how inconspicuous, where an incision has been made. Scars can occasionally be bad for no apparent reason and may require further treatment at a later stage. Complications such as infection or stretching of the wound can lead to bad scars. Some areas of the body and some skin types are notorious for producing worse scars than others.


BRUISING AND SWELLING

This is the body's natural response to injury. Every surgical procedure is followed by a period of bruising and swelling, depending on the nature and extent of the surgery.


BLEEDING AND HEMATOMA

Sometimes bleeding can continue after the end of the operation or restart after an interval. It can either track to the surface, or more commonly, collect beneath the skin. Such a collection of blood is called a haematoma and if it becomes large enough it may require treatment.


INFECTION

A wound can become infected for a variety of reasons. Prompt and effective treatment is necessary to prevent further complications. Infections can also occur as a result of surgery in areas quite distant from the operation such as in the chest or urinary system.


DEEP VEIN THROMBOSIS (DVT)

This is the situation in which blood has clotted in the deep veins of the calf. It is rare in patients undergoing elective cosmetic surgery. If the clot becomes dislodged and travels to the lungs it can have very serious, possibly fatal, consequences. Patients with a previous history of postoperative deep vein thrombosis should warn the surgeon and the anesthetist before the operation. Oral contraceptives increase the risk of deep vein thrombosis and there is some controversy about the benefit of stopping such treatment before surgery. It is thought wise to stop oral contraceptives prior to certain operations.


ALLERGIC REACTIONS TO DRUGS AND DRESSINGS

Various drugs are administered during the course of an operation particularly if there is a general anaesthetic. It is important to avoid giving any drug to a patient who might be allergic to it. Any known allergy must be reported to the surgeon and the anesthetist before the operation. Severe allergic responses have to be dealt with promptly and effectively to avoid serious consequences.


BLOOD TRANSFUSION

This is seldom required in cosmetic surgery. All blood is carefully screened by the blood transfusion service for any infectious agent before it is released for use. It is quite common for patients to be given some fluid with a drip during and after operations.

DRAINS

Sometimes small flexible tubes are used to let out collections of blood or other fluids from a wound. Often used for Abdominoplasty operation, in which case they are removed 7-10 days after operation.

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AUSTIN PLASTIC SURGERY CENTER ~ S.P. MAGGI, MD
3410 Far West Boulevard, Ste 110 ~ Austin, Texas 78731
Phone: 512.345.3223 ~ Fax: 512.345.3228
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