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A Surgical Case Study View Photos

A thorough preparation to your surgery is of extreme importance. Reading ALL material before your surgery day is an obligatory step toward a better understanding of what will happen in the days and weeks following your surgical procedure(s).

REAL PLASTIC SURGERYâ€"A Case Study of Pre-Op and Post-Op care.                                                                 “Jeanne”

Facelift and Blepharoplasty (Upper and Lower Eyelid Surgery)

By Henri P. Gaboriau, MD

As a surgeon, quite often, I am not in the same room and at home with my patients to see exactly what they experience immediately following the surgery.  Recently, I had the wonderful experience of caring for the wife of a good friend of mine.  Jeanne and Jacques flew to Seattle from France.  I have known Jacques since we met back in France 30 years ago.  Now he had entrusted his wife’s care to me.  Jeanne had a full facelift and upper and lower eyelid surgery.  After Jeanne’s surgery, both she and Jacques stayed with me in my home in Kirkland.  Now that I have experienced post-surgical recovery up close and first-hand, my experience of pre and post operative care has allowed me to be much more personal in my perception of what happens to my patients.

We always give our patients a checklist of do’s and don’ts before surgery, but there are also many little things that one needs to think about such as food, beverages, companionship, entertainment and comfort.  You will need to do some planning and shopping to prepare for the big day! You must take care that all of these elements are in place before the day of the surgery, which we call Day 0.

Food. The last thing you want to do is to forage for food and medications while you are wearing bandages. You will not be able to eat much of anything for the first 36 hours and yet your body does require nourishment.  The key is not to eat too much and the food you choose to eat must be very light and packed with nutrition, and still be comforting.  I recommend soups, particularly chicken soup and minestrone, homemade of course!

Beverages. Staying hydrated plays a vital role in your recovery. You must of course have plenty of water available, but you also need to drink beverages that contain electrolytes such as Gatorade or POWERade.

Companionship and Care. This means much more than who will drive you home after you have had surgery.  You must have a trusted companion or caregiver with you by your side for 72 hours.  It is not enough to simply have someone drive you home and look in on you every now and then.  Your caregiver must be in the same room with you or very close by during these first three critical days of recovery.  The best companions are those who have had some kind of surgery, since they will know exactly what you are going through.

Entertainment.  Think of how you will spend your time for the first three days.  For the most part, you will need to be reclining in a 45 degree angle.  You will not be able to do much of anything. Since your eyesight may be limited, it is a time to think, meditate, or rely on your other senses such as hearing. This would be a good time to listen to music, or audio books, or even brush up on your language skills.  And, of course, if you have close companions nearby, it can be a great time for conversation or having your companion read aloud to you.

Comfort.  You will need to think about pain relief and methods to reduce swelling.  We do not recommend ice or cold compresses per se.  We do recommend plenty of frozen peas.  Several days before your surgery, take ten zip-lock sandwich sized bags and fill each with a single layer of frozen peas.  Any brand of frozen peas will do! Ten bags should take you through your recovery.  Also, you should have extra strength Tylenol to supplement other forms of pain medication.  You must avoid taking any medications that have aspirin or ibuprofen, since they are blood thinners and can cause bleeding.

Day 0. The Day of the Surgery.

 No Jewelry. No jewelry of any kind should be worn and that includes no watches, necklaces, earrings, or body piercings of any kind. In some instances, those kinds of items have been found in the patients’ bedding because they forgot to tell us that they had not removed these articles.

No makeup.  Absolutely no make-up should be worn, no lipstick, mascara, or any facial cream. On the morning of the surgery, the face should be washed with plain water. No sunscreen should be used or any kind of facial moisturizer.  Some creams are difficult to remove and interfere with our surgical marking pen.

Loose fitting clothing should be worn.  No T-shirts. No sweat-shirts.  No pullovers. Do not wear anything that needs to be pulled on over your head.  Wear sweat pants and zippered tops.  No tennis shoes, because they are difficult to pull on and tie on after surgery. Wear open shoes like sandals or slip-ons.  

The Drive Home. Your companion needs to be aware that immediately after surgery you will need to sit in the front seat of the car and that the seat must be reclined about 45 degrees.  There also needs to be awareness that it will be difficult to climb stairs.  At least one person must help you when it comes to navigating steps, but it is best to have two people to help you with stairs.  Jeanne was so fortunate because she had both Jacques and me at her side to help her up the stairs and into my home.

Home Care Do’s. If you live in a split-level home or a home with more than one story, it will be necessary to stay on the ground floor for at least 72 hours.  It is best to be situated close to a bathroom. The first 48 hours you will only be allowed to sit up to go to the bathroom.  Most of the time, you will have to be on a recliner or a nice comfortable armchair.  Immediately post-surgery, and upon your arrival home, the most comfortable position will be lying down at a 45 degree angle.  No lying or sleeping on your stomach or side for 72 hours.  It is a great idea to have a small cooler close to you, full of your Zip Lock bags of peas!! Now is the time to begin applying your frozen pea packs to help to reduce swelling and to lessen any pain.  You do not need to place a protective layer between the frozen pea pack and your skin since there is not enough ice to cause a burn.  You will need to drink fluids, both water and a Gatorade type of drink.   It is okay to eat something very light such as chicken soup with crackers.  To avoid nausea, you must always eat and wait a half hour before taking any medication.

Home Care Don’ts. For the first 72 hours, coffee, tea, any drink with caffeine is forbidden.  No alcohol. Any beverage aside from a POWERade type drink and water can cause nausea and vomiting.  You cannot be left alone.  Your caregiver should be in the same room or closeby.  You must not go to the bathroom alone because you will be unsteady on your feet.  Your caregiver must always accompany you to the bathroom.  Don’t take pain medication or antibiotics on an empty stomach.  It is easy to eat soup and wait a half hour before taking any medication.

Day 1. The day after the surgery. 

Begin light exercise. Your caretaker should walk you around the house just to get some exercise. The most comfortable position is still lying down on your back at a 45 degree angle.  No bending or lifting.  Keep applying your frozen pea packs as needed to help to reduce swelling and to lessen any pain.   Continue to drink fluids, both water and POWERade drinks.   Continue to eat light, such as chicken soup or minestrone.  You may not need to take any pain medication if you experience relief by simply taking extra-strength Tylenol.  As far as pain medication goes, do not wait until the pain becomes unbearable. Take it a little sooner and you can alternate with Tylenol extra strength. For the first 72 hours, there is a chance you will not need the pain medication. Remember to always eat and wait a half hour before taking any medication.

Home Care Don’ts. Caffeine and alcohol drinks are still forbidden.  You still cannot be left alone.  Your companion or caregiver should be in the same room or close by.  You still must not go to the bathroom alone.  Your caregiver must still accompany you to the bathroom.  Don’t take pain medication or antibiotics on an empty stomach.  It is advisable to eat soup and wait a half hour before taking any medication.

Day 2. The second day after the surgery. 

Day 2 can be the most dangerous day of all! Don’t overdo it! This is because you are beginning to feel good and you may want to do things around the house.   Jeanne she wanted to throw on a big hat, oversized sunglasses and a long scarf to take a walk around the neighborhood.  We had to persuade her to that a walk to the yard was as far as she could go! Always remember that even if you do feel good that your body did go through a surgery.  Your head should always be held above your heart.  No bending or lifting.  Continue icing.

Day 3 or Day 4.

You may feel very tired.  The burst from the day before suddenly vanishes.  You will feel fatigue.  How much fatigue depends on each individual and it is quite expected after anesthesia.  Don’t fight it.  Some patients even feel sad or tearful and do not know why.  This weepiness happens among 30% of our patients and it is totally normal.  Jeanne did not shed a tear but I have heard from other patients that they felt sad and did not know why they cried.

Wear a hat and large sunglasses. Now if you feel more energetic, you can leave the house and take a short walk but take care to protect yourself from the sun.  You can now resume eating normally.  Even if you now feel good, it will take your body 7-to-10 days to completely recover from the surgery.  You need to keep in mind that you are not yet able to endure a full day of activity.  If you do too much, there will be swelling.

The first 3 - 5 days. 

Please refrain from overdoing any activity and stay off your feet.  As the swelling goes down, you will experience an increased need to go to the bathroom. The fluid needs to be eliminated.  Most of our patients do feel good within 72 hours and want to do things and this can be a problem--when we can see an increase in swelling, bruising and even bleeding.  If you do not refrain from over-exertion and start doing too much too soon, two things may happen: First, you can delay the healing and jeopardize the final result.  Second, you may need a return to the operating room and have to use anesthesia again and incur more discomfort.  Continue taking all medications as prescribed.  Use gels, creams, and lotions as instructed. Do not use nasal sprays. Do not do anything that we have not cleared you to do. We do not want to see you back for a repeat surgery so soon!

Postscript:  Jeanne and Jacques stayed with me for another two weeks after Jeanne’s surgery.  Her surgery was very successful and they loved my home style cooking!  Jeanne had a chance to visit the Pike Place Market and fell in love with Etta’s Seafood and Maximilien-in-the-Market.  They are scheduled to return again late next summer and plan to stay for Bumbershoot.  (Please see some of the photos that were taken of Jeanne before and after the surgery in our "Photo Gallery.")  Jeanne is very pleased and proud enough to share the results! 

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