Dr. Dirk Lazarus
Plastic Surgeon

Tel: 021 424 1112
Fax: 021 424 1118

86 New Church St
Tamboerskloof
Cape Town, 8001
South Africa

Surgery can be demanding on your body. Try to allow yourself the time and space to recover. Attempt to keep an empty diary for 2 or 3 weeks following surgery. Have a positive mental attitude - this will not only make you feel better, but actually enhances healing. If you experience any problems at any time, please contact me.

Before Surgery:

1. To reduce bleeding and minimise bruising the following agents should NOT be taken for 2-4 weeks prior to or after surgery:

a. Aspirin or aspirin-containing medication
b. Vitamin E or vitamin E-containing products
c. Evening primrose oil
d. Any other agent that affects blood clotting

2. To enhance healing, you may take the following agents pre-operatively:

a. Vitamin C 1000 mg daily
b. Zinc

3. Do not take Arnica pre-operatively - it can cause bleeding. Arnica may be started on the 2nd post-operative day.

4. Smoking diminishes blood flow and therefore the delivery of essential nutrients and oxygen to the tissues. Smoking is associated with a 12 times greater risk of complications and especially skin loss. If you are a smoker, you should cease smoking 2 weeks before surgery and not resume until a week after surgery.

5. Wash your hair with your normal shampoo the night or morning before surgery.

6. If you develop any skin infections, pustules, boils, or similar problems prior to surgery, please notify my office.

7. Wear comfortable loose clothes that you do not have to pull over your head.

8. Do not wear any make-up to surgery: this includes mascara and nail polish. If you tint, dye or bleach your hair this should be done about a week prior to surgery.

9. Avoid wearing jewellery or bringing valuables to theatre.

10. Bring a pair of sunglasses and a scarf to wear after surgery.

11. Try to ensure that you are well prepared: you will need a lift home; ensure that you have clean bed linen and meals available. Plan ahead.

12. You must have nothing to eat or drink on the morning of surgery. You must be nil by mouth.

After Surgery:

1. If you experience any problems, please contact me. If the problem is minor then I may be able to simply reassure you over the telephone. If the problem is not minor, then I prefer to know about it sooner rather than later.

2. Possible problems and what to look out for:

a. Bleeding under the skin - a so-called haematoma - usually manifests as:

i. swelling, often just on the one side,
ii. oozing of blood from the wound, often just on one side,
iii. excess pain and discomfort, often just on the one side.

Most often, this occurs within the first 24 hours of surgery, although small haematomas can occur later. Significant haematoma requiring a return to theatre to correct it is rare and most of the measures outlined below are aimed at reducing the risk of haematoma. If haematoma does occur the treatment is to return to theatre to remove the blood collection and to stop the bleeding.

b. Infection following face surgery is rare, but is more common in smokers. Infection can lead to poor healing and skin loss. Infection occurs later, usually from day 3 onwards. The signs are:

i. Increasing pain,
ii. Fever, temperature, warmth
iii. Not feeling good
If these symptoms occur, then antibiotics should be started.

c. Other complications include: nerve damage (sensory causing numbness or motor causing weakness), abnormal scarring, dimpling from sutures, prolonged bruising and swelling, etc.

3. What to do to prevent problems:

a. Rest. You will have had a long operation which has been delicately sutured. Do not laugh, cough, strain, bend, pick up objects, talk or plan to be too active for the first 2 weeks after surgery and especially for the first few days post op. Failure to take things easy can lead to complications which may compromise the long term result.

b. Avoid moving your head too much and turning your head from side to side. Try to move your body as a unit. Keep your chin up and your head above shoulder level at all times. When sleeping try to use 2-4 pillows so that you sleep in a semi-sitting position for the first few nights. Place a towel on top to avoid blood staining the pillow.

c. Do not bend over for 2 weeks after surgery. If you need to pick something up, bend at the knees.

d. If eyelid surgery has been performed concurrently with facelift, use cold eye packs as frequently as possible during the first 48 hours.

e. For the first few days after surgery, try to eat soft food that does not require too much chewing. Drink plenty of fluids: aim for 8 glasses of water a day. Ensure that you are passing good quantities of pale yellow urine.

f. There may be some blood staining of the bandages or tapes used to dress and support your face. This is normal. You may remove the facial band and bandages on the day after surgery. You may gently shampoo your hair in the shower on the first day and allow the water to run over your face. Do not change or remove support plasters or micropore. Dry carefully: dab the skin and be gentle with your hair. Be aware that your skin may be numb so that you should only use your hair dryer on the cool setting. Do not sit under a hot dryer or use curling irons or similar. Replace the elasticised facial band afterwards. You should try to wear this band for a week or two after surgery.

g. Do not use hot pads, hot water bottles or any other heating devices on the face after surgery as some areas may have diminished sensation.

h. Light exercise such as short walks can be performed from the day after surgery, but bear in mind the instructions in points a, b and c.

i. Stretching and gentle exercises can be started after 2 weeks. Gym and sports may be re-started after 3 weeks.

j. Do not drive for 5-7 days after surgery. Avoid excessive turning of the neck.

k. Do not smoke for at least a week after surgery.

4. What to expect after surgery:

a. You will experience some mild pain and discomfort. This can usually be controlled with the medication prescribed. Take the tablets with a light meal. For the first 48 hours, rather take the medication regularly to keep the pain away.

b. You will experience some tightness in the face and neck for the first few days, even weeks after surgery. This feeling will ease in time.

c. You may experience some minor bleeding or blood-staining of the dressings. If this is minor and associated with only minor swelling and pain, then it is normal and not a cause for concern.

d. Expect swelling and bruising for up to 4 weeks post-operatively. This may be asymmetrical. There may be lumpiness and irregularity which will disappear, but which may last up to 6-8 weeks.

e. Expect mood changes after surgery. It is not unusual to feel euphoria initially followed by a period of depression which usually resolves as the swelling and bruising subside.

5. Once again, if there are any problems, call me.