Surgery Recovery Questions

ABDOMINAL SURGERY

1. When will my drains come out after a tummy tuck?
   Dr. Brenner will place surgical drains during your abdominoplasty (tummy tuck) procedure. Surgical drains for tummy tucks will remain in place for about one to two weeks. Dr. Brenner most commonly will remove one drain on the fifth post-operative day. The second drain will usually be removed a few days later but may remain in longer depending on the amount of fluid that is collecting within them.
2. How long do I have to wear an abdominal binder after a tummy tuck?
   Patients are generally asked to wear an abdominal binder for several weeks following a tummy tuck. This is to ensure a proper healing process and can actually contribute to a comfortable recovery.
3. Will adding liposuction to my tummy tuck surgery prolong my recovery?
   Undergoing liposuction as a standalone procedure, or in addition to a tummy tuck, may increase the amount of early post-operative swelling in the surgical area. However, doing so should not prolong your tummy tuck recovery period.
4. What can I do to make my scars heal better?
   All abdominal surgery requires some type of incision, and all incisions turn into scars. It is important to realize that scars take about one full year to completely heal, flatten and fade. Scars will appear to be their thickest and reddest at about two or three weeks after surgery. This is normal. From that point on, scars will continue to remodel and refine for one full year. As the scar tissue heals, so too will its appearance. However, there are a few options for helping out the process. Topical silicone gel (Biocorneum) is available in Dr. Brenner’s office and can usually be applied starting two weeks after surgery. Silicone gel sheeting may also be ordered, especially for patients with longer incisions. Further, laser treatments are available through The Spa to help reduce thickening and color change that may occur in some scars.
5. Will I have numbness after my tummy tuck?
   Numbness of the abdominal skin can occur immediately following a tummy tuck. The abdominoplasty operation, by definition, will disrupt some of the sensory nerve fibers that serve the abdominal skin. Much of the numbness is temporary, however, permanent numbness of some of the skin may occur.
6. Is it normal to feel tightness in the area of my tummy tuck when doing abdominal exercises?
   A sensation of “tightness” is normal when the abdominal wall muscles have been sewn together (plicated). This sensation is most pronounced in the first few weeks after surgery and usually improves gradually. Some patients may experience this sensation long after surgery when performing exercises that use their “core” muscles.

BREAST SURGERY

1. Will I have drains placed after breast augmentation, revision breast surgery, or breast reduction?
   Occasionally Dr. Brenner will place surgical drains during breast reduction, breast revision, capsulectomy surgery or breast reconstruction. Drains are rarely placed during primary breast augmentation. Surgical drains in breast surgery can stay in for one day or for several weeks. For instance, most breast reduction drains will be removed one to two days after surgery. However, revision or reconstruction cases, especially those that require acellular dermal matrix replacement, may require that drains stay in for a few weeks. You will be instructed on proper drain care by Dr. Brenner and his staff.
2. How long before I can lift heavy things or exercise after breast surgery?
   It is important to remember that during your breast surgery recovery, lifting and reaching with your arms needs to be limited. In general, Dr. Brenner restricts his patients from any heaving lifting for four to six weeks after breast implant surgery. This allows time for the breast tissues to heal around the implant and reduces any potential complications.
3. How long will it take for my breast implants to settle after breast augmentation?
   After breast augmentation, particularly after sub-muscular placement, breast implants will tend to “ride high.” This is normal. Your breast implants will “drop into position” over about a four to five week period. Occasionally Dr. Brenner will place you into a breast band to help facilitate implant settling. Further, breast massage will further help encourage implant settling.
4. What type of bra will I need to wear after breast augmentation?
   At the conclusion of your breast operation, Dr. Brenner will place a comfortable dressing of gauze and surgical bias wrap. This will stay on overnight and be removed on your first post-operative office visit. You will then be placed into either a surgical bra (fit to size) or a sports bra. We recommend that you shop for sports bras prior to your operation. You should plan to purchase bras that clip or zip in the front to facilitate putting on the bras without raising your arms. Further, you should get two bras in two different sizes; the first bra size should be big enough to account for the postoperative swelling that occurs over the first two weeks. The second bra should be one size smaller, so that it will fit comfortably once the immediate swelling goes down. Dr. Brenner recommends wearing either a surgical bra or sports bra (both without an underwire) for the first four to six weeks after surgery.
5. How much will my breasts swell after breast augmentation?
   After your breast operation, you can expect to have post-operative swelling within the breast tissues. Swelling can be unpredictable and certainly varies from patient to patient. Post-operative swelling is more prominent during the first 24 to 48 hours after your operation. Swelling tends to subside gradually, and can take several weeks to go away completely.
6. When do I start breast massage after implant surgery?
   After your breast augmentation, you will be instructed on breast massage by Dr. Brenner and his staff. Breast massage is usually started one to two weeks after breast augmentation surgery. This time frame may be different for patients who undergo breast lifting or breast reconstruction with implants, so make sure you ask Dr. Brenner prior to starting.

FACIAL SURGERY

1. Will I have bruising and swelling after my facelift?
   A little bruising and swelling is normal following a facelift procedure. The bulk of the swelling usually subsides between one to two weeks following the procedure. However, patients may have a small amount of swelling that persists beyond that.
2. Will I need to wear a facial garment after my facelift?
   In general, most facelift patients will be placed into a head wrap for the first night after surgery. This is removed in the office on the first day after surgery. For patients who undergo extensive liposuction of the area under the chin or along the jawline, they will be placed into a compression garment for several weeks after surgery.
3. When will my sutures be removed after my facelift?
   The types of sutures that will be placed during surgery will ultimately depend on the type of facelift or neck lift that you receive. Most patients will have small sutures placed around the edges of the ear, and/or underneath the chin. These sutures are usually removed between four and seven days after surgery. For patients who undergo a brow lift procedure, they may have staples in the hair-bearing scalp that will be removed about seven to ten days following surgery.
4. When can I start wearing make-up after my facelift?
   For patients who wear make-up, they may resume using it once all sutures have been removed and the incisions are healing normally.

LIPOSUCTION

What can I expect during my recovery from liposuction?

• Compression Garments – Each patient will be fitted with a compression support garment to wear after surgery. There are usually two stages to the post-operative compression garment. The stage one garment is usually a bit larger in order to accommodate the foam padding that is placed over the liposuction area immediately after surgery. Most patients will have a fair amount of swelling after surgery. Once the swelling begins to go down in the first few weeks after surgery, patients are ready to wear the stage two garment. This garment is frequently smaller and tighter, and usually slips on without zippers. These garments help reduce inflammation, swelling and bruising. They should be worn anywhere from several weeks to several months. It is important to follow Dr. Brenner’s advice on garment use in order to maximize your results.
• Antibiotics – Most patients will be given antibiotics to start taking immediately after the operation for five to seven days.
• Pain killers – Dr. Brenner will most likely prescribe or recommend analgesics (pain killers) to relieve pain and inflammation. These will usually be acetaminophen-based narcotic, or non-narcotic medications. No anti-inflammatory medications that contain Ibuprofen, Aspirin or similar compounds should be taken as they all can increase the risk of post-operative bleeding and bruising.
• Stitches – Each patient will be given a follow-up appointment to have the stitches removed within one week of the operation.
• Bruising – There may be significant bruising in the targeted area. The amount of bruising is usually proportional to the amount of liposuction performed. The bruising may go on for several weeks and in rare cases for months. Post-operative bruising can be minimized by taking Arnica Montana before and after surgery.
• Numbness – Some patients will experience numbness in the area where fat was removed. This should improve within six to eight weeks. Permanent loss of sensation following liposuction is rare.
• Results – Patients will not be able to fully appreciate the results of liposuction until the inflammation and swelling has subsided, which may take several months in some cases. Typically, most of the swelling will have settled after about four weeks and the area where fat was removed should appear less bulky.
• Positioning - Patients who undergo fat grafting procedures at the same time as their liposuction procedures should avoid direct pressure or compression of the areas that were grafted. More precisely, direct pressure for more than twenty at a time (i.e. sitting, laying down) on these areas needs to be restricted for about four weeks after surgery.

Patients who maintain their weight can usually expect permanent results. Those who gain weight after the procedure may find that their fat distribution alters. Those who previously had fat accumulating in their hips might find that their buttocks become the new problem area. With a carefully designed operation that is followed by an uneventful post-operative course, most patients are pleased with their results.

NASAL SURGERY

1. How long will I be swollen and bruised after rhinoplasty?
   Whether undergoing “closed rhinoplasty” or “open rhinoplasty”, swelling after rhinoplasty is normal. The reason that the nose swells after rhinoplasty has everything to do with the surgical dissection that occurs, resulting in local inflammation. If the nasal bones need to be surgically fractured during the surgery, you may expect slightly more swelling particularly on the cheeks and around the eyes. This is normal. As a rule of thumb, you can expect the swelling in your nose to persist for 3-6 months in the upper third of the nose, 6-9 months for the middle third of the nose, and 9-12 months for the lower third of the nose. After a rhinoplasty surgery, it may take as long as one full year for the swelling to do down completely at the tip.
2. How long will I have tape and splints on my nose after rhinoplasty?
   At the conclusion of the rhinoplasty, a dorsal splint will be placed across the nasal bridge. This typically stays on for one week and will help to minimize swelling. Additionally, just prior to the application of the dorsal splint, Dr. Brenner will place surgical tapes across the nasal bridge and nasal tip. This tape will be taken off and replaced one week after your operation when your sutures are removed. After about two weeks of continuous nasal taping, you will be given instructions about how to “self-tape” and started on a regimen of nighttime taping.
3. Will I need to have splints inside my nose after rhinoplasty?
   Swelling after rhinoplasty not only occurs under the skin but also occurs inside the nasal airway. Dr. Brenner will place Doyle Intranasal Splints into the nasal airway at the completion of your rhinoplasty. This will serve to both stent open the airway and also reduce intranasal swelling.
4. Can I use cold compresses after rhinoplasty?
   Cold compresses do help reduce swelling during the initial 24 hours after your operation. However, cold compresses should only be placed on the cheeks and NEVER be applied directly onto your nose. If you place a compress onto your nose, you could potentially move the small cartilage grafts or bone segments.
5. Are there any medications I can take to help minimize bruising and swelling?
   
   • Bromelain is an over the counter medication that is a derivative of a pineapple fruit extract. It has been shown to reduce surgical swelling and should be started the day prior to surgery.
   • Arnica Montana may be used to handle bruising that follows rhinoplasty. This bruising particularly occurs when the nasal bones are infractured in order to narrow the nasal width.
6. Can I wear glasses or sunglasses after rhinoplasty?
   Wearing glasses and sunglasses should be avoided for the first six weeks after rhinoplasty. Placement of anything on the bridge during the post-operative period can lead to bone or graft malallignment and can negatively impact your result.
7. What if I have to sneeze or blow my nose after rhinoplasty?
   As awkward as it sounds, if you need to sneeze for the first few weeks after rhinoplasty, you should try to sneeze through your mouth. Further, you should not blow your nose until instructed to do so by Dr. Brenner.
8. Can I clean the inside of my nose after rhinoplasty?
   You will be supplied with a saline mist spray after your rhinoplasty. You may gently use this to irrigate out your Doyle splints. You should NOT place this inside your nose. Further, you should not place fingers, Q-tips or any other devices inside your nose until instructed to do so by Dr. Brenner.

SKIN CANCER SURGERY

1. When will my sutures be removed after my Moh’s reconstruction?
   Usually, sutures on the face will be removed between 5 and 7 days after surgery.
2. What do I do if my surgical dressing becomes wet or dirty after my skin cancer repair?
   Soiling of the dressings is commonplace in the first day or two after Moh’s reconstruction. You may need to return to Dr. Brenner’s office for dressing changes during this period.
3. Do I need to clean my sutures with anything?
   Cleaning of facial sutures is fine after 24 hours if the sutures are exposed. A Q-tip with warm water or saline is the best way to gently clean suture lines. Do not use hydrogen peroxide as it may impair healing.
4. Can I wear makeup after surgery?
   You will be instructed by Dr. Brenner about when you may resume using make up or concealer after surgery. As a rule of thumb, this is usually allowed once the incisions are healing and all sutures are out, which is usually two weeks after surgery but may vary.

PAIN MANAGEMENT

EXPAREL

Surgical procedures require some kind of anesthetic to decrease sensation in the area. The anesthetic used can be local or general depending on the nature and extent of the procedure and other factors.

One of the anesthetics commonly used locally is Marcaine (bupivacaine hydrochloride). Marcaine is a local numbing agent used for spinal block. The analgesic (pain relief) effects of Marcaine last for 7 to 9 hours after which additional narcotics may usually be needed to manage and control pain.

HOW EFFECTIVE IS EXPAREL?

Exparel is the latest local anesthetic that has been FDA approved and is given in the form of an injection near the area where the surgical incision will be made. Exparel has long-lasting effects with 72 hours of pain relief after surgery.

Although it is an expensive anesthetic, Dr. Brenner who has used this extensively in his clinic has found excellent long-lasting results with Exparel. He offers it as an adjunct to many procedures including tummy tucks, breast augmentations, breast reductions, and so on.

The best results are in the form of reduced immediate post-operative pain along with the minimal need for narcotic pain medications post-surgery, according to Dr. Brenner. Fewer narcotics after surgery mean less unpleasant side effects of nausea, vomiting, constipation and so on from the narcotics and faster recovery.

ARE THERE ANY SERIOUS SIDE EFFECTS?

You will be watched closely throughout the procedure after receiving Exparel to make sure it is being well tolerated and there is no adverse reaction. The initial consultation with Dr. Brenner is also the time to discuss the concerns regarding Exparel if any and let the surgeon know if you are pregnant or have a prior history of liver or heart diseases, history of seizures or allergies to any anesthetic. Dr. Brenner is the best person to guide you if Exparel is a suitable anesthetic for you.

FOLLOW-UP APPOINTMENTS AFTER SURGERY

1. When is my first follow-up appointment with Dr. Brenner during my surgery recovery?
   For most major surgical procedures, Dr. Brenner will see you back in the office the first post-operative day after surgery to make sure everything is fine. For many minor procedures, he may see you for the first time the week following the procedure.
2. How many follow-up appointments will I have with Dr. Brenner?
   The number of follow-up appointments after surgery will depend on the exact procedure as well as how well you are healing. Most patients will see Dr. Brenner on two to four visits during the first two post-operative weeks. There will also be later follow-up visits.
3. I have a follow-up appointment scheduled for next week, but I am having a problem that cannot wait until then. What should I do?
   If you need to speak with Dr. Brenner, call the office (or answering service after hours) and asked to speak with him. Occasionally urgent or emergent issues do arise, and should not wait for routine office visits.

FOOD & MEDICATION DOS AND DON'TS BEFORE & AFTER SURGERY

1. Are there any medications to avoid before and immediately after surgery?
   If you are taking any medications on this list, they should be discontinued 10-14 days prior to surgery and only Tylenol (and Tylenol-based products) should be taken for pain. All other medications that you are currently taking must be specifically cleared by Dr. Brenner and your primary care physician prior to surgery. Please be aware that this could include cold medications, eye drops, nasal sprays and over the counter medications. If you do not find your particular medication here and you are unsure of its effects, simply discuss it with Dr. Brenner.
2. I know that I cannot smoke prior to surgery, but can I smoke after surgery?
   No. Smoking (or use of any tobacco or tobacco replacement product) will delay wound healing and can lead to serious health problems after surgery.
3. Can I drink caffeine (coffee, tea and soda) after surgery?
   Please refrain from caffeine-containing drinks after surgery as they may elevate your blood pressure and can increase the risk of bleeding.
4. Can I drink wine, beer or alcohol after surgery?
   Please refrain from intaking alcoholic beverages after surgery as they may interact with the medications that you are taking and can have deleterious effects.
5. My pain medications are giving me constipation… what can I take to help relieve my constipation after surgery?
   Many narcotic pain medications can slow down your intestines. Taking stool softeners such as Colace, Dulcolax or even fiber supplements will help keep your bowel habits regular and help you to avoid straining. Straining to go to the bathroom will elevate your blood pressure and can lead to bleeding during the post-operative period.
6. Can I eat a normal diet after surgery?
   You may eat a normal diet after surgery..but you will need to build up to it slowly. Eating normal food in the immediate postoperative period may lead to nausea after anesthesia.

HYGIENE AFTER SURGERY

1. When can I take a shower after surgery?
   Most surgical patients will be restricted from showering for the first 5-7 days after surgery. Of course, the length of time that you will need to keep your dressings dry will depend on the exact procedure. As a rule of thumb, once the sutures (and drains, for those patients requiring them) have been removed, you will be able to get your incisions wet. To be on the safe side, make sure to ask Dr. Brenner prior to showering or bathing.
2. Do I need to change my dressings after surgery?
   Do not remove your dressings after surgery. If you find that your dressings are soiled, please call and come into the office so that Dr. Brenner and his staff can safely change your dressings and surgical tapes. For patients who have undergone nasal procedures, a “mustache gauze dressing” is given, and can be changed as needed during the first 1-2 days after surgery. A small amount of nasal drainage is normal in this manner. You will be provided tape and gauze immediately following your procedure.
3. My dressings came off… what do I do?
   First of all, do not worry if your dressings come off. If you have any concerns about the integrity of your dressing, please call the office and notify Dr. Brenner. He will then instruct you on the best course of action.
4. Can I clean my incisions after surgery?
   Sutures that are left open to the air, may be cleaned periodically with room temperature saline solution. Do not use sodium peroxide, as it may impair wound healing.

RETURNING TO NORMAL ACTIVITIES

1. When can I get up and move around after my operation?
   For most operations, Dr. Brenner prefers that his patients initiate some activity (i.e. sitting up in a chair) on the first evening after surgery. Care must be taken not to overdo it. Excessive straining can elevate your blood pressure, and lead to unwanted bleeding. Most patients may require some assistance with ambulating for the first day or two after surgery.
2. When can I start exercising after surgery?
   For most operations, heavy exercise including fast walking, running, weight lifting and core strengthening maneuvers will be restricted for about 4 to 6 weeks after surgery. This will likely be sooner for more minor procedures.
3. Can I go swimming or sit in a hot tub after my operation?
   Please avoid swimming or sitting in a hot tub after surgery. Chlorinated water can impair wound healing. Further, some spas may contain bacteria that can cause post-operative infections.
4. When will I be able to return to work after surgery?
   The time interval for returning to work following surgery will ultimately depend on three things:
   1. What procedure you had done.
   2. What types of activity you do in your job.
   3. Your level of comfort returning to work with surgical dressings still in place. This should be discussed with Dr. Brenner.

SCAR MANAGEMENT

1. How long does it take for my surgical scars to heal?
   Scars take about one full calendar year to completely fade, soften and flatten.
2. Will laser treatments help the appearance of my scars?
   Yes. There are laser skin resurfacing treatments available for this purpose. The Harmony™ laser system and the CO2 Dot laser treatment are both designed to improve uneven textures on the skin, such as scars.
3. What is silicone gel and will it help my scars?
   Kelo-cote®/Biocorneum is an innovative topical silicone gel for the management of surgical scars and for the prevention of abnormal scars, such as hypertrophic scars and keloids. Kelo-cote® is indicated for scars resulting from trauma, surgery, burns or other events that result in broken skin. Please feel free to ask Dr. Brenner any further questions you have regarding silicone gel.
4. How important is it to use sunscreen on my scars?
   Post-operative surgical scars in sun exposed areas pose a great healing challenge. Scars take nearly a full calendar year to heal as they mature, soften, flatten and fade. During that time, new scars are highly susceptible to UV photo damage. For that reason, Dr. Brenner always advises his patients to keep their scars covered and avoid significant sun exposure during that year of healing. Should a scar become exposed to sunlight, it may develop color changes that can be permanent. While post-operative incisions are covered with surgical tapes for the first few weeks following a procedure, most patients find it difficult to keep them on for longer. Using Biocorneum, which is essentially Kelo-cote® with sunscreen mixed in, obviates that problem.
5. When might I need a steroid injection (Kenalog) for my scars?
   For scars that heal as either hypertrophic scars or as keloids, steroid injections may provide some benefit by helping to calm the inflammatory reaction.

SLEEP POSITIONING DURING PLASTIC SURGERY RECOVERY

1. What is the best sleeping position after breast augmentation?
   Sleeping supine (on your back) is the most comfortable sleeping position after breast augmentation. Once your breast have healed (about 6 weeks), you may gradually find that sleeping on your stomach is more comfortable.
2. Do I need to sleep with my head elevated after surgery?
   Sleeping with you head elevated after surgery is generally recommended for any patients who undergo head and neck procedures such as facelift and necklfit, rhinoplasty and facial skin cancer reconstruction procedures.
3. I cannot fall asleep because I am generally uncomfortable. What do you recommend?
   Dr. Brenner commonly prescribes sleep aids (i.e. Ambien or Valium) to help patients fall asleep after surgery. Check your list of prescriptions, and use as directed if need be.
4. Do I need to stay in bed, or can I get up and walk around?
   Walking around after most operations is a good thing. It helps to reduce the risk of developing blood clots in your legs. However, care needs to be taken following many procedures (i.e. tummy tuck) as ambulating may be difficult at first. Do not be shy to ask for help.

SUTURE MANAGEMENT AFTER SURGERY

1. What is the difference between dissolvable and non-dissolvable sutures?
   Dissolvable sutures will be absorbed by your body over a period of time. The exact time depends on the exact suture material. Non-dissolvable sutures will not be absorbed by your body and will need to be removed at some point.
2. Dr. Brenner placed non-dissolvable sutures in the skin during my operation; when will they be removed?
   Sutures on the face are usually removed between 5 and 7 days after the operation. Occasionally, they may be left in longer. Some sutures in other body locations may also be left in longer. Be sure to ask Dr. Brenner if you are unsure.
3. I have a suture poking through my skin; what should I do?
   Occasionally a buried absorbable suture will become exposed. When this occurs, they usually need to be removed. Do not become alarmed; call Dr. Brenner’s office to notify him.