Preparing for surgery

Prepare for the surgery as you have been told. Also:

• Tell your healthcare provider about all medicines you take. This includes herbs and other supplements. It also includes any blood thinners, such as warfarin, certain anti-inflammatory medicines, clopidogrel, and daily aspirin. You may need to stop taking some or all of them before surgery.

• Don't smoke or use nicotine from any source. These can affect healing after the surgery. For better results, discuss the effects of smoking and nicotine with your surgeon or healthcare provider in the weeks before and after your surgery.

• Follow any directions you are given for not eating or drinking before surgery. (If you have been told to take medicines, take them with a small sip of water.)

• Tell your surgeon or healthcare provider if you are ill or pregnant. They may choose to delay the operation if you are sick. 

The day of surgery

The surgery takes about 2 to 6 hours. You may go home the same day. Or you may stay overnight in a hospital or outpatient surgical center.

Before surgery begins

• An IV (intravenous) line is put into a vein in your arm or hand. This line supplies fluids and medicines.

• You’ll be given medicine to keep you free of pain during the surgery. You may have general anesthesia. This puts you into a state like deep sleep during the surgery. (A tube may be inserted into your throat to help you breathe.) Or you may have sedation. This makes you relaxed and sleepy. With sedation, local anesthesia will be injected to numb the areas being worked on. The anesthesia provider will discuss your choices with you.

During the surgery

• The surgeon makes a cut (incision) on one side of the face. In most cases, this starts near the hairline at the temple. It travels along the front of the ear, and then behind it. It ends in the scalp. The same incision is made on the other side of the face. And often under your chin.

• The surgeon may also use shorter incisions, or incisions in different places.

• The surgeon lifts the skin to reach the fat and muscle layers beneath.

• The surgeon may remove excess fat or use it in another place for smoother contouring. The deeper muscle and tissue layers may be tightened and lifted with stitches.

• The surgeon pulls the skin back down. Any extra skin is then removed.

• The incisions are closed with stitches, staples, or surgical glue.

• A small tube (drain) may be placed near the incision. This removes fluid that can build up after the surgery.

• Other procedures may be done at the same time for fat filling, recontouring, or soft tissue augmentation, if you choose.

After the surgery

You’re taken to a recovery room to wake up from the anesthesia. You may feel sleepy and nauseated. Your throat may be sore at first if a breathing tube was used during surgery. You’ll be given pain medicine to relieve any discomfort if needed. Your face may be bandaged. And you may need to wear a compression garment around your head. An ice pack or cold compress may also be applied to your face. These steps help reduce bruising and swelling. You may go home the same day. Or you may be moved to a room to stay overnight. Have an adult family member or friend ready to drive you when it's time to go home.

Recovering at home

For the next few weeks, expect to have some pain, bruising, and swelling. Your surgeon will tell you when you can return to your normal routine. Once at home, follow all the directions you’ve been given. Be sure to:

• Take all prescribed medicines exactly as directed.

• Put an ice pack or cold compress wrapped in a thin towel on your face as directed. Never put ice or a cold compress directly on the skin.

• Care for your incisions as directions. This includes keeping your bandages and incisions dry when bathing or showering.

• Wear your compression garment as directed.

• Keep your head higher than your heart for 10 days after surgery. Or as directed by your surgeon. For example, don’t stoop down to tie your shoes.

• Walk at least a few times a day, but don’t push yourself too hard.

• Don't lift anything heavy or do strenuous activities as directed by the surgeon.

• Don't drive until your surgeon says it’s OK. Don't drive while taking medicines that make you drowsy or sleepy.

• Continue not to smoke or use nicotine from any source.

When to call your healthcare provider

Call your healthcare provider right away if any of the following occur:

• Chest pain or trouble breathing (call 911)

• Fever of 100.4° F ( 38°C ) or higher, or as directed by your healthcare provider

• Symptoms of infection at an incision site, such as increased redness or swelling, warmth, pain that gets worse, or foul-smelling drainage

• Increased pain or rapid swelling on one side of the face

• Rapid, pounding, or irregular heartbeat

• Pain, swelling, redness, or warmth in your leg, calf, or thigh

Follow-up

You’ll have follow-up visits with your surgeon or healthcare provider. These are needed to check how well you’re healing. These also allow your healthcare provider to keep track of the results of your procedure. If you have a drain, it may be removed about 2 days after surgery or as directed by your surgeon. If your stitches need to be removed, this is done about 5 to 7 days after surgery. Staples at the hairline are often removed 7 to 10 days after surgery.

Risks and possible complications

Risks and possible complications include:

• Bleeding

• Infection

• Facial nerve injury, causing partial paralysis of the face (usually temporary)

• Injury to underlying structures, such as your muscles or parotid gland

• Blood clots

• Poor incision healing

• Hair loss near the incision sites

• Changes in sensation, such as numbness or pain

• Skin discoloration

• Death of skin tissue, or of fatty tissue in the skin

• Abnormal collection of fluid under the skin

• Not happy with cosmetic results

• Risks of anesthesia. The anesthesia provider will discuss these with you.