ENDOSCOPIC MIDFACE / BROWLIFT / LOWER EYELID PREOPERATIVE INSTRUCTIONS
PREPARING FOR THE PROCEDURE:
Two to three weeks off of work is recommended to recover from surgery.
On the business day prior to the operation we ask you to call to confirm your arrival time for surgery.
Do not bring valuables (cash, credit cards, watches, jewelry, etc.) on the day of surgery. Remove all makeup and nail polish before arriving for your procedure.
It is essential that someone be available to drive you home, and that person is able to spend the evening of surgery with you. It is California law that every patient be monitored for a period of twenty-four hours following surgery. This person does not have to have any nursing experience, just an interest in your welfare. While you spend the day at rest, your helper will fix soft food for your lunch and dinner, assist in applying the cold compresses to your eyes, walk you to the bathroom and just be near if you should require anything.
You may not eat or drink after midnight the evening before the browlift procedure unless instructed otherwise. This includes all food, liquids, water, candy, mints or gum.
Clothing- A scarf can be worn to camouflage a soft bandage that surrounds the cheeks, ears and upper face. Wear a loose dress, or slacks and a blouse. You must not wear anything that pulls over the head or face.
It is imperative to refrain from tobacco products for one week prior and three weeks following surgery. If smoking is continued during these periods there is a significant risk of skin necrosis and sloughing.
It is recommended that you purchase thick cover-up make-up prior to your procedure. In some instances this may be useful to camouflage bruising or redness after surgery.
At your preoperative appointment you will provided with all of the instructions for you to follow before and after surgery. During this appointment you will also be given all of the prescriptions necessary for the recovery period. You should fill these prescriptions prior to the date of surgery. We will also ask you to obtain an antibiotic ointment and saline water for use following surgery.
Please avoid any aspirin, aspirin-containing products, or ibuprofen (Advil, Aleve, etc.) for one week prior to and two weeks following your surgery. See our “Medication List” for products to avoid prior to and immediately following surgery. If you are on any medications that affect bleeding (such as coumadin or warfarin) please notify the office immediately.
Please avoid herbal supplements for 10 days prior to surgery, including and especially fish oil, ginseng and garlic.
We ask that you remain on your daily medications unless instructed otherwise. At the preoperative appointment, you will be told which daily medications to take with just a sip of water on the morning of surgery.
Post operative midface lift medication checklist
1. Antibiotic (Keflex, Clindamycin) : prescription
2. Pain reliever (vicodin, percocet) : prescription
3. Medrol Dose Pack: prescription
4. Saline water: purchased over the counter
5. Erythromycin ophthalmic ointment: prescription
6. Artificial / Rewetting tears: purchased over the counter
7. Antibiotic ointment: purchased over the counter
8. Arnica (a natural herb that significantly decreases bruising): purchased over the counter
AFTER MIDFACE LIFT / BROWLIFT / LOWER EYELID SURGERY
Immediately after the procedure
When you wake up from surgery you will notice a soft, bulky head wrap dressing. Attached to your head dressing are two small drains. These drains collect excess fluids and help prevent infection.
Saline eye pads are placed over your eyes. These help to minimize swelling and bruising. Your vision will be blurry due to the eye ointment that was placed in your eyes after eyelid lift surgery. You may also notice that tears run down your cheeks, which is due to swelling and will subside during the first week following surgery.
Following your procedure, the nurses will ask you to meet the discharge criteria: to drink liquids, walk with a steady gait, void, manage your discomfort, and monitor and empty the drains.
You will be asked to come to our office the following day after surgery for a dressing change and drain removal. Sutures are removed from the eyelids 3-4 days after surgery; the remainder of the sutures are removed 7-8 days after surgery. You may then begin wearing make-up to camouflage any residual bruising or redness.
POST OPERATIVE MIDFACE LIFT / BROWLIFT / LOWER EYELID INSTRUCTIONS
The First 24 Hours:
Keep dressing dry and intact the evening after surgery. Notify your doctor if the dressings become loose or fall off. It is easy to monitor the drainage. A nurse will show you how at the time of discharge.
Following dressing removal the morning after surgery, an elastic (ace) wrap will be applied. The bandage removal is not painful nor is the application of the elastic (ace) wrap. We will again instruct you on suture care.
Brow / Midface Wound Care
Cleaning the sutures with a Q-tip dipped in saline water and then applying the antibiotic ointment (polysporin/bacitracin) twice a day is an essential part of the healing process. Sutures that have been kept lubricated with ointment are less painful to remove. Keep elastic wrap in place at all times other than suture care. (see video)
Eyelid Wound Care
Cleaning the suture with a Q-tip dipped in saline water and then applying the prescription antibiotic ointment (Erythromycin opthalmic) twice a day is an essential part of the healing process. Sutures that have been kept lubricated with ointment are easier to remove (see video).
The day after surgery you should begin using the artificial tears hourly. These rewetting drops help moisturize your eyes and keep them comfortable.
It is recommended to apply the ointment inside the lower eyelid at bedtime. Ointment inside the lower eyelid will make vision blurry, so do this immediately prior to retiring for the evening.
Sleep with head of the bed elevated or use two to three pillows. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.
Shower / Bathing
Bathing is ok as long as you don’t get your incisions/hair wet for a minimum of four days after surgery. You are encouraged to shower and wash your hair twice: the evening before and morning of suture removal (usually post-op day seven or eight). Slowly and carefully clean your hair by rolling it between your finger. Baby shampoo acts as a good softener. Four days of bandage enclosure and the anesthetic solution have left your hair stiff and dry. This is normal and quickly goes away.
Advance diet from liquids to soft food to your regular diet as tolerated.
Ice after Midface / Brow / Lower Eyelid Surgery
During the day and evening of surgery, cold moist compresses are used continuously over the forehead, eyelids and cheeks to minimize swelling and control bruising (30 minutes on, 15 minutes off).
Puffiness and bruising around the eyes can occur but if present usually regresses quickly over the next few days. There are several techniques for icing which are effective. The glove with ice and cool compresses are the preferred methods. Icing for 24-48 hours is recommended, icing after this period can be used for comfort. See videos on right.
Discomfort following surgery is usually limited to the two or three hours just after the procedure. The prescription for pain tablets that you have received is more precautionary that necessary, but please have it filled and available at your home bedside. Take pain medicine with milk to avoid any stomach upset. Most patients switch to extra strength Tylenol on the first day of recovery.
Most patients complain of pressure from swelling more than pain. Use pain medication (most commonly Vicodin/hydrocodone) as directed/as needed. Vicodin contains Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin.
Do not drive or drink alcohol while taking pain medication.
Side effects of pain medications can include nausea and constipation. Taking pain medication with food can minimize nausea. Over-the-counter laxatives are indicated if constipation persists.
Start your antibiotic (Keflex/Cephalexin) when you arrive home following the procedure. During your surgery you received antibiotics through your IV. Take antibiotics as directed until gone.
Start the prescription for swelling medication (most commonly Medrol Dosepak/methyl prednisolone) when you arrive home following surgery.
One Week After Surgery
Bruising can be camouflaged at one week postoperatively with make-up. It is recommended that you purchase thick cover-up make-up prior to your procedure. In some instances this may be useful to camouflage bruising or redness after surgery. A scarf can be worn around the head to hide the incisions.
Dr. Kolstad will instruct you on when (usually two weeks after surgery) and the type of eyelid exercises that are appropriate for your surgery. Depending on the procedures, there are three different types of exercises (see video upper lid, lower lid, and midface lid exercises).
What to Expect During Healing
Above the eyebrows, the forehead and part of the scalp there is a moderate numbness to the touch. This is always a part of the browlift procedure.
This numbness begins to disappear in a couple weeks, moving from front to back. It may take three months for sensation to return to this area.
In very rare instances some numbness may persist.
Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. Following surgery, our staff will tell you when it is ok to apply sunscreen, cosmetics or facial creams. Avoid unprotected prolonged sun exposure for three months following surgery to prevent pigmentation of incision lines.
Swelling, bruising and disrupted sleep are very normal postoperative browlift symptoms and will decrease as the healing process occurs. Assistance with daily activities the first two to three days after surgery is strongly recommended.
PREOP / POSTOP CHECKLIST
BEFORE SURGERY CHECKLIST
Preparing for the Procedure:
1. Call to confirm your arrival time for surgery.
2. Do not bring valuables on the day of surgery.
3. Arrange a friend / family member to observe you for 24 hours after surgery.
4. You may not eat or drink after midnight the evening before the procedure.
5. No smoking for 1 week before and 3 weeks after surgery.
6. Purchase thick cover-up make-up prior to your procedure.
7. Medications: avoid (aspirin, Motrin, ibuprofen, Alieve) unless advised to continue by your doctor. Inform office if you are on coumadin / warfarin, plavix, or other blood thinner.
8. Medications: confirm which of your daily medications to continue the morning of surgery.
9. Medications: fill your prescriptions before the day of surgery. Typical medications are found below.
10. Over the counter items: arnica, saline water, Qtips, ice packs.
General Postoperative Medication Checklist
1. Antibiotic (Keflex, Clindamycin): prescription
2. Pain reliever (vicodin, percocet): prescription
3. Medrol Dose Pack: prescription
4. Saline water: purchased over the counter
5. Antibiotic ointment: purchased over the counter
6. Arnica (a natural herb that significantly decreases bruising): purchased over the counter
AFTER SURGERY CHECKLIST
Immediately after the procedure
1. You must meet nursing criteria for discharge home; walking, voiding, talking.
2. Receive instructions dressing and drain management.
3. Confirm your appointment with the office, always on the morning after surgery.
The First 24 Hours
1. Wound care: cleaning the sutures with a Q-tip dipped in saline water and then apply the antibiotic ointment (polysporin/bacitracin) twice a day.
2. Wear the ace bandage 24 hours a day until instructed to wear it only at night
3. Activity: sleep with head of the bed elevated or use two to three pillows. No strenuous activity / aerobics / yoga / heavy lifting for 3 weeks after surgery.
4. Bathing is ok as long as you don’t get your incisions/hair wet for a minimum of four days after surgery.
5. Advance diet from liquids to soft food to your regular diet as tolerated.
6. Cold compresses are used continuously over the forehead to minimize swelling and control bruising (30 minutes on, 15 minutes off) for the first 48 hours after surgery.
7. Medications: use pain medication as necessary. You can have a maximum of 8 tablets of vicodin + Tylenol in a 24 hour period (6 vicodin + 2 Tylenol = 8, ect).
8. Medications: Start antibiotic (Keflex/Cephalexin) when you arrive home and feeling ok to take medicine.
9. Medications: Start Medrol Dosepak/methyl prednisolone when you arrive home and feeling ok to take medicine.
One Week After Surgery
1. Make-up can be started 1 week after surgery to camouflage any bruising or redness.
2. Avoid sun exposure for three weeks after surgery, then use sun block.
3. The brow and scalp will be always be numb to touch following surgery. This will improve in the first few weeks to months after surgery.
4. Swelling, bruising and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs.
5. Differential swelling may asymmetries of the right and left sides of your face. As the swelling goes away, so will these asymmetries. Please be patient.
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