PS recovery

What to Expect During Your Plastic Surgery Recovery

May 25, 2016

Deciding to undergo reconstructive plastic surgery after massive weight loss can be daunting and scary. However, most patients feel that this type of plastic surgery is an essential component of their weight loss journey.  In many patients' quests to be smaller, they view their weight loss surgery as "Part One of Two" and plastic surgery as "Part Two of Two".

Recovery after reconstructive plastic surgery falls into three phases. The three phases of recovery are the initial, intermediate, and final recovery phase. Each stage is distinctly different; however, the borders of each phase are often not clearly defined.

Phase 1: Initial Plastic Surgery Recovery

This phase begins at the end of surgery. You will wake up from anesthesia like a new bird emerging from an egg, ready to bravely take on a new world.  As you awaken from anesthesia, you will probably have some pain. Your pain will be treated with medication given through your veins.

You might experience some shivering. Your post-operative shivering is usually the result of the anesthetics and will wear off quickly in the recovery room.  You may be cold but this will be easily fixed with a warming blanket.

You will be observed in the recovery room by a nurse and overseen by an anesthesiologist.  Also, several different machines in the recovery room will monitor you. Once your vital signs are stable, and your pain is satisfactorily controlled, depending on the circumstances, you will be transferred to the hospital floor, recovery center, or discharged home. Due to the anesthesia and other medications, you may not remember any of your initial recovery. Amnesia is normal.

During the first couple of hours and for a few days, you will be exhausted.  Tiredness is normal. Your body is devoting a lot of energy to healing your wounds.

Issues To Be Aware Of After Plastic Surgery

There are several things to watch for during this initial phase. In general, most plastic surgery procedures go well without complications. However, below are some conditions to be aware of.

Every plastic surgeon is different. Every plastic surgeon will give you a list of items about which to call or contact the office. Please follow your individual plastic surgeon's routine.

Fever: In the first one or two days after surgery, your temperature will increase. A low-grade fever is common, if not expected. This fever is due to tiny parts collapsing at the edge of the lungs; these parts are called alveoli. Alveolar collapse is called Atelectasis and is completely normal after general anesthesia. To minimize atelectasis and the accompanying fever, it is vital to take big deep breaths to pop open these tiny alveoli. I would suggest taking ten deep breaths every hour while you are awake.  If you were given an incentive spirometer, make sure to use it. This device will help to further open your lungs and decrease your initial "fever".  Most plastic surgeons consider a real surgical fever to be a temperature over 101.5. If you have a fever over 101.5, you should contact your plastic surgeon.

Chills: Uncontrollable chills may also be an indicator of infection. If you are experiencing uncontrollable chills, you should contact your plastic surgeon.

Nausea and vomiting: If you are experiencing significant nausea and vomiting, this may indicate a problem. It may be due to gastric irritation from medication, constipation, or a more serious problem.

Increased drainage from the drains: This condition is rare, but may be a sign of internal bleeding. Before your surgery, your plastic surgeon will tell you how much blood and fluid is to be expected from the drains. If the drainage increases, notify your plastic surgeon immediately. A sudden or significant increase in drain output may be critical and require urgent attention.

Redness on the incision, significant blood on the dressings, or wound breakdown: At first, the incision may look scary. If you are concerned about any redness, swelling, or wound breakdown, contact your plastic surgeon.

Numbness or tingling: This is rare. Numbness can be due to internal or external compression on the nerve. If you experience any numbness or tingling in your hands or feet, you should contact your plastic surgeon.

Pain: If you have pain that is not managed by your prescribed medication, this may indicate a real problem. It may also suggest that certain pain medications may not work for you. If your pain medication is not working, call your plastic surgeon.

Rash: Rashes after surgery are common and should not be ignored. Antibiotics, pain medications, surgical dressings, or tape can cause rashes. The surgical prep used during surgery can cause a rash as well. If you experience a rash, contact your plastic surgeon.

Constipation: Unfortunately, all pain medications cause constipation. Constipation is made worse by bed rest, dehydration, a high protein diet, and compression of the abdomen from the garment and muscle tightness. Usually, you will be prescribed medication to minimize constipation. If the constipation is severe, you should call your plastic surgeon for additional medications.

Extreme anxiety: Be aware if you experience shortness of breath, anxiety, and chest pain. These may be signs of a blood clot or pulmonary embolus. This complication is rare but does occur.  Your plastic surgeon should provide you with post-operative injections to minimize this risk. However, if you experience severe anxiety or shortness of breath, call your plastic surgeon.

Instructions for Plastic Surgery Post-Op

Different plastic surgeries have different recovery paths. The recovery from an arm lift is quite distinct from the recovery after an abdominoplasty.  Below are general guidelines.

Below are general guidelines for plastic surgery post-operative patients:

Go home, go to bed, and keep your feet elevated: After most surgeries, you will have some degree of  your feet swelling. To minimize swelling or edema, keep your feet elevated above your heart. Foot elevation is important because gravity will force the fluid that is causing the swelling to return to your normal circulation. Recovering in a recliner can elevate your feet and minimize edema.  Alternatively, if you are recovering in bed, you can place several pillows under your feet to elevate your feet above your heart. Contrary to popular belief, exercise and walking during this phase make swelling worse, not better.

Take your medication as prescribed: It is critical to take your antibiotics, stool softeners, and blood thinner injections. You will also be dispensed medication to take on an "as needed" basis.  These medications are usually to minimize pain, nausea, and anxiety.  Take these medications on an "only as needed" basis. Do not take pain medication if you do not need to. With respect to these "only as needed" medications, less medication is best. Pain is very subjective; that means everyone experiences pain differently. For the same procedure, some patients experience significant pain and require a lot of pain medication, whereas, other patients do not have as much pain. In general, all pain decreases with time. Only take pain medication if you have pain. Keep in mind that pain medications cause constipation. Taking unnecessary pain medications may cause more constipation.  Some patients have more pain with constipation than the incisional pain.

Empty your drains frequently: At the hospital or recovery center, your nurse will provide you with instructions on how to take care of the drains. It is very important to routinely empty your drains every six to eight hours.  Your drain should always be on suction.  If your drain is not on suction, you should contact your plastic surgeon. Additionally, your nurse will show you how to measure and record your drain output.  These drain records will be necessary for drain removal.   Depending on your drain output, your drains may be removed during the initial or intermediate phase. Drain removal is performed in your surgeon's office. If your drains are scheduled to be removed, you may want to take some pain medication to minimize the pain.

Wear your garment: To reduce swelling, you should wear your compression garment. The compression garment should be tight, but not so tight that you cannot breathe. Additionally, if your hands or feet are numb, the garment may be too tight.   There should be no wrinkles in the garment as wrinkles in the garment can leave permanent skin creases. The garment should not cross the incision line. If the seam of the garment crosses the incision line, the incision may break down.

Minimal activity: Unless specifically instructed by your plastic surgeon, you should minimize your activity. This means going to bed and letting your body heal. Your body devotes a significant amount of calories, energy, vitamins, and oxygen to the healing of your wounds.  Even minor activity like walking or bending can tear open a fresh, healing incision. You may need to have others take care or your pets, perform grocery shopping and other types of tasks.

Eat about 100 grams of protein: In weight loss surgery patients, for optimal wound healing, there are many medical studies that show the importance of eating or drinking about 100 grams of protein a day for two weeks. Pre-operative food preparation will help. Have your favorite high protein drinks and foods on hand.  During the initial phase of recovery, patients usually tolerate protein drinks better than food.

Perform dressing changes: During the initial phase, your plastic surgeon may or may not have you perform dressing changes. If you are to perform dressing changes, please follow your plastic surgeon's instructions.

Go to all your scheduled office visits:  You may have to rely on others to get you to and from your plastic surgeon's office. It is extremely important for your plastic surgeon to examine your progress and make sure there are no issues.  It is very important to bring your drain records to your appointments. If you are digitally inclined, I would suggest you place the drain log on your smartphone. Additionally, I suggest you write your questions on your smartphone to ask during your follow-up visit.

During the initial recovery phase, below is a list of things NOT TO DO.

  • Do not engage in excessive walking or physical exercise. Unnecessary exercise can tear the incision and leave a chronic open wound, which can take months to heal.
  • Do not do any extraneous activities.
  • Do not resume your regular exercise routine
  • Do not skip meals because you are not hungry, in pain, and do not want to gain any weight.
  • Do not take pain medications to help you sleep.
  • Do not take pain medications for anxiety.
  • Do not take any new medications prior to contacting your plastic surgeon.
  • Do not take sleeping medications unless cleared by your plastic surgeon.
  • Do not apply tape to your skin. The tape will cause blisters and skin breakdown.

These are just general guidelines. If you have any questions or concerns, it is best to contact your plastic surgeon.

This initial phase concludes when your wound(s) has somewhat healed, you have more energy and are more active. Plastic surgeries vary, but in general, the initial phase ends two to three weeks after your surgery.

Phase 2: Intermediate Recovery

During this phase, you will be more active, but still not 100%.  Some days you will be doing well and able to do most things.  However, the next day, you may be completely exhausted due to being more active from the day before.

During this phase, many patients become frustrated with their "slow progress".  Many patients have never had healing problems or difficulties with surgical procedures.  Patients must realize that after most weight loss surgeries, there are absorption and metabolic issues like low iron (anemia) and low vitamin levels (B12). Usually, these issues are not apparent during the initial weight loss surgery.  However, a year after weight loss surgery, these metabolic issues can dramatically impact healing from plastic surgery procedures.

Plastic surgery is unlike weight loss surgery.  In plastic surgery, the incisions are much longer, the incisions are under tension, you lose your appetite, and the surgery hurts more. All these factors contribute to slower healing with plastic surgery compared to weight loss surgery.

Contributing to your frustration, your energy level may be low.  You will be exhausted due to multiple issues.  These include blood loss from surgery, history of anemia causing a decreased oxygen carrying capacity, inadequate caloric intake, constipation, and having to wear a compression garment.  With time, these issues will resolve during this phase.

In addition, during this phase, many patients experience a "hormonal roller coaster ride".  One must realize that fat is like a sponge and absorbs many hormones like estrogen and testosterone.  Once the fat is removed during an abdominoplasty or body lift, the body goes into "hormone withdrawal".  Because of this, patients may experience unexplainable bouts of depression and tearfulness.  This can be followed by bouts of extreme joy. Usually after several weeks, these symptoms resolve.

During this phase, patients must wean off narcotics.  For some, this may be difficult and may require consultation with a pain management specialist.

During this phase, if you continue to have low energy levels, you may need further laboratory testing.  If your certain levels are low, you may require blood or iron transfusions.

During this phase, you will be allowed to resume sexual activities.

During this intermediate phase, patients will attempt to resume working.  Returning to work is different for each patient.  Returning to work depends on a patient's medical condition, healing capacity, and type of work (sitting or active, physical job). The following is a very broad outline as to when a patient can return to work after a procedure:

AbdominoplastyApproximately two weeks
360 Circumferential Lower Body LiftApproximately three weeks
Posterior Body Lift or Buttock Lift with Buttock Implants or Buttock Fat GraftingApproximately two weeks
Arm LiftApproximately two weeks
Breast Lift/Breast Augmentation Approximately one week
Upper Body Lift with Back LiftApproximately two weeks
Thigh LiftApproximately two weeks
Facelift and Neck LiftApproximately one week

Phase 3: Full Recovery

This is the final stage of recovery. During this phase, you will have an almost complete return of your energy level, have returned to work, and be off narcotics.

Activities: You will be able to exercises better without all those extra pounds of hanging skin and fat. You may be able to walk better, run better, and exercise better. Often your sense of balance will improve.  You may be able to do new activities which were never possible before weight loss surgery. Maybe you are able to ride that roller coaster you always wanted to ride. Perhaps, you can proudly return to your high school or college reunion.

Clothing: Clothing may fit better. It may be possible to purchase clothes off the rack. You may be able to buy that dress or outfit you have always been wanting.

Scar management: For optimal wound healing, you need to apply silicone to the scar. The magic ingredient to obtain the optimal scar is silicone. Patients should apply a silicone based ointment and/or silicone strips to the scar. These should be implemented for a minimum of six months. If your surgical scars are not healing satisfactorily, you may need to have laser treatment or steroid injections.

Garment: You will also be allowed to start wearing your binder less than you have been. For most patients, this is a liberating feeling. To minimize swelling, wearing the garment is advised during exercise. To increase physical and emotional comfort levels, many patients continue to wear compression garments for months after the procedure.

Social situations: After you've had plastic surgery after massive weight loss, you may experience some anxiety with friends and family. Some people may be jealous while others may be envious. Total strangers may look at you in a different way. At first, this may seem awkward. Still others may seek your attention. This is all part of the weight loss process.

Initially, the thought of further surgery and especially plastic surgery may be scary. However, the rewards can be tremendous. Make sure to do your research and find a qualified, board-certified plastic surgeon. Your chosen plastic surgeon should be experienced in reconstructive plastic surgery after massive weight loss. Be proud of your body. Have plastic surgery and show the world all you have accomplished with your weight loss journey!

timothy katzen

ABOUT THE AUTHOR

Dr. J. Timothy Katzen is certified by the American Board of Plastic Surgery. Dr. Katzen specializes in reconstructive plastic surgery after massive weight loss. He has written many articles and given lectures around the world about how to perform plastic surgery on patients who have undergone massive weight loss. Dr. Katzen has offices in Beverly Hills and Las Vegas.


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