Patients undergoing a face lift are counseled preoperatively about the amount of time required for recovery. Lumpiness, discoloration, and edema can prolong the recovery phase in patients undergoing an anterior neck procedure at the same time as the face lift.
At the end of a face lift procedure, a moist gauze is placed along the mandibular line and pressure is applied in the upper neck and in the retroau-ricular area. An Ace® wrap is applied in the operating room, and if retrotragal incisions have been made, two small cotton earplugs are used to prevent the oozing and drainage from creating a long-term postoperative ear cleansing problem.. The formation of large hematomas is a rare but unsolvable problem. The best preventive strategy is the “second look” technique, which involves raising the entire face lift flap on the second side before hemostasis and closure on the first side. Even with use of this strategy, I still encounter small hematomas; however, major hematomas have been almost eliminated in my practice. Administration of sublingual nifedipine in the operating room and careful monitoring of blood pressure for the first 12 hours after completion of face lift procedures have been useful in maintaining blood pressure stability.
The recovery period following face lift surgery is somewhat like that of childbirth in that patients receive notoriously inaccurate information from other patients who have undergone the procedure. It is easy to forget how long the recovery actually took when viewed in retrospect. In my practice, patients who have undergone a face lift are admitted to the recovery room and then to the plastic surgery floor overnight; they are discharged after drains are removed the following morning. At the time of drain removal, pressure is placed on the drain tracks for 3 minutes to prevent a drain track hematoma from forming. Before the patient is discharged a new supportive soft dressing is placed on the face to support the skin closure and to prevent the patient from becoming distressed at his or her initial appearance. If a small hematoma is found at the time of the first dressing change in the hospital, it is evacuated at the bedside by removing one or two retroauricular sutures and using suction catheter drainage. Small nodules and areas of isolated minimal hematoma are amenable to direct pressure and massage, which allows the patient to be involved in his or her recovery and speeds the resolution of visible or palpable lumpiness. Any skin loss is treated conservatively.
The patient returns to the office 3 to 5 days after the face lift for removal of the appropriate preauricular, infra-mental, and retroauricular sutures. During this visit the patient is allowed to shampoo his or her hair and apply some camouflage makeup. Most patients don’t feel ready to appear socially for 2 weeks but may be comfortable being seen if they are wearing a turtleneck jersey and dark glasses. Most patients are “presentable” 1 month after surgery; occasionally, a patient will need a 6-week recovery period.
To ensure patient confidence, the plastic surgeon’s staff should be available at any time postoperatively. This is particularly important during the early postoperative period when patients may be emotionally vulnerable. After 3 weeks, patients are instructed to begin massaging any lumps with vitamin E oil. They are instructed not to massage suture lines for 1 month to 6 weeks. Although massaging suture lines appears to help convert a red raised condition to a more flat, white scar, perhaps its biggest advantage is that it promotes the patient’s involvement in his or her recovery and the touching of numb areas that could become hypersensitive.
Consultations regarding the use of facial cosmetics are provided by my nursing staff, who are knowledgeable about postoperative camouflage techniques. Patients are instructed not to resume use of Retin-A® (which is often recommended preoperatively) until 6 to 8 weeks after the face lift surgery. Glycolic acid and trichloroacetic acid peels should not be used on undermined skin for 4 to 6 months.
Attention to detail and personal management of the patient’s emotional and clinical state is recommended. Ironically, patients who seem to struggle the most in the early postoperative period are most likely to refer other patients for aesthetic treatment. I believe this occurs because these patients appreciate the close contact and direct care provided by the surgeon and thus are happy to refer their friends for surgery.
Patients who have had a face lift are seen 6 weeks following surgery, at which time postoperative photographs are taken. They are seen again 6 months and 1 year after the procedure, and then at yearly intervals thereafter.
The points I have highlighted in this article are intended to be neither exhaustive nor inclusive; rather, they are the key elements of my surgical philosophy and the preoperative and postoperative care I provide for my patients undergoing blepharoplasty and face lift surgery.