Follow up care after plastic surgery differs from patient to patient. Nonetheless, most surgeons prefer to see their patients the morning after their surgery and a week afterward for monitoring the healing process.
The succeeding follow up visits become less frequent or will have longer intervals (e.g., one month, three months, and six months) provided that the patient heals nicely and does not encounter worrying symptoms such as persistent swelling and bruising, increasing pain, excessive bleeding, and fever.
Dr. Smiley requires regular follow up visits to ensure that his patients are healing nicely.
Should any of the aforementioned symptoms arise during recovery, patients should see their plastic surgeon ahead of the scheduled follow up to prevent more serious complications. Take note that fever is usually a sign of infection, while increasing pain and bleeding signal that the body is not coping well.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who regularly performs body contouring surgeries like liposuction and Brazilian buttock lift, may require follow up visits at six months to one year, although it will depend on patient’s availability.
There are specific protocols used by each surgeon during a follow up consultation. Oftentimes, he simply checks if the wound is healing well and asks the patients for symptoms that are bothering or worrying them. In some cases, he removes the sutures and/or dressing, or assess if the patient’s compression garment (commonly used after liposuction and body lift) fits snugly but is not causing skin changes or interfering with circulation.
Furthermore, during a follow up consultation doctors ask their patients about the progress of their healing and their level of pain. If needed, he may adjust the medications to help them cope with any discomfort.
Meanwhile, long-term follow up visits tend to be more important after a facial plastic surgery—e.g., facelift, neck lift, cheek lift, and fat transfer. This is particularly true for patients who want to maintain their more rejuvenated appearance for as long as possible. For instance, people who have had facelift may need minor tweaks in the form of dermal fillers or mini facelift to preserve their youthful look.
Nonetheless, the details of follow up care after plastic surgery depend on many variables such as the patient’s age, type of surgery she had, her expectations and level of commitment, and lifestyle.
Liposuction scar generally fades into negligible “marks” after 6-12 months, although patient commitment to recovery remains critical to achieve the best results possible. For instance, sun exposure must be avoided for at least six months since UV rays can cause hyperpigmentation in which the scars turn dark.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley shares his scar management tips that will further ensure that your liposuction scar will blend well into the background.
The after photo on the right shows no visible scar, which contributes to high patient satisfaction.
* Minimize tension on the skin. When there is no or very minimal tension on the scar, it tends to heal nicely. Hence, the use of surgical tape and/or Steri-strips can be helpful as they eliminate the stress and “pulling” that can delay healing or cause the scar to widen.
* Achieve your optimal health well in advance of the surgery. When you’re healthy, there is less risk of infection, which can affect the appearance of your scars. Simply put, liposuction or any other body contouring surgeries will require commitment to superb diet and healthy lifestyle.
* Eliminate risk factors of infection. Each doctor has his own specific wound care instructions, although there are generally agreed upon guidelines such as never submerging your incision in water for at least three weeks; not using any topical product unless with the approval of your surgeon; and avoiding smoking.
* Treat infection immediately. In the hands of a board-certified plastic surgeon, infection is extremely rare because of the use of tumescent fluids injected into the fatty area prior to extraction. But should it occur, it must be treated immediately to prevent complications and poor scarring. Common signs of infection include asymmetric swelling, fever, chills, and drainage of pus.
* Use of topical treatments containing silicone. Once the incisions are completely sealed, which happens around three weeks postop, patients may choose to apply topical products such as silicone sheets and creams known for their hydrating effects. Scars that heal in a moist environment usually heal better and fade quicker.
* Use sun protection for one year. While staying out of the sun is the best way to reduce risk of hyperpigmentation, this is generally difficult or even impossible to accomplish. Hence, the use of sunscreen, protective clothing, and makeup products that offer SPF protection remains valuable.
Reducing the amount of rhinoplasty bleeding is one way to promote shorter social recovery. Hence, plastic surgeons who use precise and gentle dissection during surgery have patients “socially” and “professionally” ready at 1-2 weeks.
Aside from meticulous dissection during rhinoplasty, or in layman’s term “nose job,” leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that bleeding can also be minimized with careful patient selection. The idea is to reserve this cosmetic surgery to people with no chronic medical condition such as bleeding disorder, heart problem, etc.
Because the patient’s health status is closely tied to the success of rhinoplasty, Dr. Smiley highlights the importance of lab screening whose “details” will depend on the information gathered during the initial consultation. For this reason, he says that patients must fully disclose their medical history and drug use to prevent complications.
Once they pass lab screening, Dr. Smiley says “preparation” is the next step to further reduce bleeding and risk of complications. There are generally agreed upon guidelines such as complete cessation of smoking (minimum of three weeks); discontinuation of drugs and supplements with blood thinning properties (at least two weeks); and controlling medical condition, if there is any, through lifestyle changes and/or medications.
After surgery, a very small amount of bleeding can be expected (and is normal) in the first few days. Severe bleeding in which blood is pouring out or down one’s throat, meanwhile, is extremely rare and requires immediate treatments, says Dr. Smiley.
To prevent bleeding and healing problems, Dr. Smiley says he requires all his patients to avoid nose-blowing, rigorous activities, blood-thinners such as aspirin and ibuprofen, and alcohol for a certain period of time (usually 2-3 weeks, although the specific instructions may differ from patient to patient).
To further promote healing, keeping the amount of bruising and swelling to a minimum can also be a huge help, says. Dr. Smiley who advocates head elevation and cold compress (around the cheeks and eyes for the bruises).
The degree of arm lift pain after surgery greatly varies from patient to patient due to individual pain threshold, physical fitness, and extent of surgery (short vs. long incision technique).
Dr. Tarick Smiley, a prominent Orange County plastic surgery expert, says it is expected to experience temporary pain, numbness, tingling sensation, skin sensitivity, and tightness following an arm lift surgery, or medically referred to as brachioplasty.
During an arm lift, Dr. Smiley says the excess skin is removed with incisions made within the armpit fold; however, patients who require extensive correction will need their scar extended into their elbow to achieve the most natural, smoothest results possible.
(Note: Aside from skin excision, the operation also involves reshaping and tightening the fascia, which connects the skin to the muscle. This additional step also contributes to the amount of arm lift pain after surgery.)
The perpendicular scar from “full” or standard arm lift is generally positioned on the inner aspect of the arm so it remains hidden most of the time.
In the first few days, most patients will need narcotics painkillers to help them cope with the discomfort. However, these can be minimized with the use of Exparel injection, which can numb the surgical site for up to four days.
Dr. Smiley, who regularly posts educational videos on Snapchat, often uses Exparel in body contouring surgeries. This medication is injected directly into the muscle before closing the incisions with sutures and has eliminated the need for pain pump, a balloon-like device that slowly releases numbing drugs for several days.
Most patients are “back on their feet” about a week postop and may choose to return to work provided it is only a desk job. Meanwhile, it remains prudent to avoid heavy lifting, rigorous exercise, and stretching the arms for at least six weeks.
Dr. Smiley says that most bruising and swelling will resolve 2-3 weeks. At this period, the use of compression garments might help with their resolution and to some extent even control the pain.
While bruising and swelling tend to resolve easily with time, this may not always be the case with the “lingering” pain or discomfort, which could emanate from sensory nerves starting to “wake up”.
It is important to note that during surgery, some small nerves are injured and can take months to recover fully. While the pinprick sensation or shooting pain is rather inconvenient, this is actually a good sign that the nerves are gradually repairing themselves.
Should the discomfort remain persistent, some patients may take Tylenol and anti-inflammatory drugs, or massage the affected area, provided their surgeons give them permission.
Several studies have been conducted to evaluate long-term liposuction results. In this procedure, the unwanted fats—specifically the subcutaneous fat found beneath the skin—are suctioned out with the use of a flexible tube called cannula.
Some studies have suggested grim findings: After about a year all the benefits of liposuction were gone.
Nevertheless, several studies have also shown that good old-fashioned exercise can preserve liposuction results and prevent patients from regaining fats elsewhere in their body (i.e., areas not treated by the surgery). Of course, physical activities must always be complemented by superb diet, which is an equally critical aspect of long-term weight management.
To shed light on the long-term results of liposuction, a team of Brazilian researchers conducted a study in which 36 healthy but inactive women aged between 20 and 35 had undergone the surgery.
These non-obese participants had 2.5-3 lbs. of abdominal fat removed through liposuction. Afterwards, they were divided into two groups: half were asked to stick to their old habits, while the other half were required to follow a moderate exercise routine.
By six months after liposuction, the first group had regained all the fats previously removed by surgery. And not only that, they developed additional visceral fat—or fat deposition in organs such as the liver and intestines—and thus predisposed them to increased risk of insulin resistance (diabetes), inflammation, and a wide range of health problems.
The uptick in the percentage of visceral fat was notable—about 10 percent more compared to their pre-surgery level.
However, the participants who were asked to perform moderate exercise for four months did not regain fat and even achieve additional health benefits. (Note: The exercise regimen was “doable”—an hour of cardio and weight lifting three times a week.)
Furthermore, the women included in the “exercise group” have improved insulin sensitivity and physical fitness.
The researchers have concluded that exercise can prevent the body from [over] compensating for the abrupt change in the fat composition and distribution caused by liposuction. It is believed that the body has a strong predisposition to defend its fat stores, and a sedentary lifestyle can aggravate this propensity.
Meanwhile, separate studies have suggested that a sedentary/poor lifestyle after liposuction may cause the patients to regain fats in other parts of their body not treated by liposuction, which of course could lead to a disproportionate appearance.
The liposuctioned areas, meanwhile, were less likely to regain fat unless in the event of significant weight gain (i.e., more than 20 lbs.)
With these findings, Dr. Tarick Smiley, a board-certified plastic surgeon who has performed over 9,000 liposuctions, says the long-term success of surgery will always boil down to patient’s commitment to healthy lifestyle.
In the first few weeks of recovery, the use of post facelift makeup can help conceal the bruising and swelling. However, cosmetics are best avoided for at least a week to prevent irritation, infection, and permanent tattooing, which may happen if the cosmetics get into the incision site.
Moreover, post facelift makeup can help some patients show up for work sooner (without drawing some unwanted attention); however, others forego the use of camouflage cosmetics and just patiently wait for their social recovery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that most patients look socially presentable at two weeks postop, although it all depends on the type of skin, extent of surgery, individual healing, and propensity to bruise (some are less likely to bruise than others).
Mineral- and water-based cosmetics with hues slightly lighter than the patient’s skin are the best way to conceal discoloration. It is highly ideal to use brand new makeup, sponges, brushes, and applicators to minimize risk of irritation and infection.
On the other hand, oil-based cosmetics are best avoided while the skin is still sensitive because they may cause irritation; they also require a special remover and are harder to take off than mineral and water-based makeup.
However, camouflage cosmetics are not the only thing that can hide postop symptoms. Large sunglasses, turtle neck tops, and scarves can also come in handy, and of course less “troublesome” than applying makeup to conceal skin discoloration.
Once the postop symptoms are gone, makeup application becomes a breeze. In fact, most facelift patients have mentioned that the reduction in their wrinkles makes it easier for them to apply creams and foundation.
The problem with deep lines—e.g., nasolabial folds, or more commonly referred to as laugh lines, and marionette lines, or creases that run straight downwards from the mouth’s corners—is they can trap powder, foundation, or cream, further accentuating their appearance.
To correct facial lines and wrinkles, Dr. Smiley highlights the importance of lifting the SMAS layer (and not just the skin alone). By going deeper into the facial layer, he can deliver more natural results that can persist long term.
To further smooth out the lines, some of his patients require simultaneous fat injection, which can also be used to create a smoother lid-cheek transition, and to plump up the gaunt cheeks.
And with less facial lines and sagging appearance, and “softer” cheeks, most patients find makeup application more pleasant after surgery.