Facial Reconstruction Post-Operative Guidelines

Instructions

• Have someone drive you home after surgery and help you at home for 1-2 days.
• If you have received Medication for pain or sedation while under our care, you should not drive, operate machinery, drink alcohol, or sign any legal document for 24 hours.
• Get plenty of rest.
• Follow a balanced diet.
• Take pain medication as prescribed.
• Take any antibiotics as instructed. It helps to eat cultured yogurt or over the counter Acidophilus tablets while on antibiotics to minimize intestinal side effects.
• Dr. Khosh may instruct you to take the herbal supplement Arnica-Montana. This is intended to minimize bruising.
• You may be prescribed steroid tablets to minimize post op swelling. If so, take them as instructed on the packet. Note that steroids can make you feel anxious; this is a common side effect.
• Do not take aspirin (or products that contain aspirin) for 3 days.
• Do not drink alcohol while taking pain medication.
• DO NOT SMOKE. Smoking decreases blood flow to the skin, and particularly to the area of the operation. It can delay wound healing or cause tissue loss.

What to Expect

• Maximum discomfort should occur in the first few days, improving each day thereafter.
• Expect bruising, swelling, numbness, tightness and tenderness of the skin for 10 – 14 days.
• Sensation around the area of the operation may be decreased. This may or may not fully return.

Activities

• Start walking as soon as possible, this helps to reduce swelling and lowers the chance of blood clots.
• Do not drive while you are taking pain medication (narcotics).
• You may tire easily. Plan on taking it easy for the first week.
• No strenuous activity, including sex and heavy housework for 2 weeks post op.
• Sleep with your head elevated at a 45 degree angle (half way between lying down and sitting up) for 3 days and 3 nights. You can use 2 couch pillows to do this or sleep in a recliner.

Incision Care

• Apply cold compresses to the surgical area. Frozen peas in a Ziplock bag work well for this purpose.
• You may shower the morning after surgery.
• If there is a steri-strip on the incision, leave it on for at least several days, if possible.
• If there is no steri-strip on, you can wash area with soap and water and apply an over the counter antibiotic ointment such as Bacitracin 3 times/day.
• Avoid excessive sun exposure and tanning beds until the scar is no longer pink (6-12 months). Casual and intermittent sun exposure is fine.
• Always use a strong sun block (SPF 30 or greater), particularly on the scar, if prolonged sun exposure is unavoidable.
• Skin Graft/Bolster Dressing (sewn or clipped on over the graft)
  • Do not remove this dressing. It will remain in place until your first post op appointment.
  • You may shower the morning after surgery – avoid having the water hit the dressing directly. It is ok if the dressing gets a bit wet.
  • The graft may be mottled or purplish when the bolster is removed. This is normal.
  • Call if you experience increase swelling. There may be fluid accumulating under the graft.
  • Mild oozing is expected and not uncommon.
• Donor Site – where the skin or cartilage graft was harvested
  • The usual places for donor sites of the face are the skin in front of your ear, your lower neck or collarbone areas, or the firm part of your ear (if cartilage was needed).
  • These donor sites are generally closed with sutures (stitches).
  • If the donor site has a steri strip on it, leave it on until the first post op day.
  • If the donor site does not have a steri strip on it, you can wash it after 24 hours with soap and water and then apply antibiotic ointment daily.
• Nasolabial or Forehead Flap
  • There will be a small bridge of skin leading to the flap on the nose. This will lead to increased drainage, particularly for the first few days.
  • Use a Q tip with peroxide and water (1/2 and 1/2) to gently clean around and underneath the bridge.
  • The stitches will be removed at the first post op visit.
  • No dressing is necessary.
  • Apply antibiotic ointment three times a day to all incision lines and on the exposed tissue of the bridge.
  • This bridge will stay in place for 3-4 weeks. Another surgery will be scheduled at that time.

When To Call

• If you have increased swelling or bruising.
• If you have increased redness along the incision.
• If you have increased pain that is not relieved by your pain medication.
• If you have any side effect from your medication; rash, nausea, vomiting, diarrhea, etc.
• If you have a temperature greater than 101.0F
• If you have yellow or green drainage from the incisions or notice a foul odor.
• If you have bleeding from the incisions that is difficult to control with light pressure.
• If you have any questions or concerns you may reach Dr. Khosh at 212-339-9988.