After Facial Flap Surgery
WHAT CAN I EXPECT AFTER SURGERY?
There will be a mild to moderate amount of pain and discomfort associated with the surgery. This should be easily controlled with oral medications.
The discomfort and pain should begin to decrease within 48 hours after surgery. A significant increase in pain after this period should prompt you to call the office.
All incisions that are made in the skin will heal by forming a scar. Dr. Ducic will always make your incision as hidden as possible. Secondary procedures such as laser resurfacing, or dermabrasion will usually be required to give you the best aesthetic result. These secondary procedures will usually be performed at about 6 weeks after the initial surgery. Uncommonly, more than one session of dermabrasion or laser resurfacing may be needed.
Initially after surgery, incisions will often appear to be raised and more red than is desirable. Don’t worry, they will eventually flatten and the redness will generally fade. However, your flap will not be completely healed for about 1 year after surgery.
It is of utmost importance to tell Dr. Ducic ahead of time if you have ever been on Accutane, received radiation therapy to the head or neck, taken steroids or immunosuppressive agents.
Immunosuppressed patients (HIV positive, chemotherapy, AIDS etc.) and patients with certain autoimmune disorders may not be good candidates for this procedure as the risks of poor healing and infection leading to permanent scarring and poor aesthetic results may be much higher. It is mandatory that you inform Dr. Ducic if you have any of these conditions before surgery.
CALL THE OFFICE PROMPTLY IF YOU NOTICE ANY OF THE FOLLOWING:
- significant increase in pain after the first 48 hours following surgery
- development of a temperature exceeding 100.0 degrees.
- the area of the incision becomes red, has purulent drainage, or is very warm to touch.
If any of the above should occur after regular office hours, do not hesitate to reach us through the answering service. For whatever reason, if you notice one of the above changes and cannot reach us at our office or through the answering service, present yourself to the emergency department for evaluation.
HOW DO I CARE FOR MYSELF AFTER SURGERY?
Be sure to fill your prescriptions before your surgery since it means one less thing for you to worry about afterwards.
Take the antibiotics and pain medication only as prescribed by the office.
Do not take any aspirin or any anti-inflammatory compounds for 2 weeks before and 2 weeks after your surgery unless you first discuss it with your surgeon. This may not be a necessary requirement for small procedures. If you are not sure, ask Dr. Ducic.
If you notice some bleeding from the incision, simply apply firm pressure to the area for 15 to 20 minutes. If the bleeding persists, contact the office or answering service.
If external stitches were used during the surgery to close your incisions, do not get the area wet for 1 week after surgery. Instead, you should clean the area by rolling a Q-tip moistened (not soaked) with hydrogen peroxide over the incisions, and then gently applying a small amount of antibiotic ointment on them. This procedure should be repeated about 4 times per day. You may purchase the ointment in any drug store without a prescription (polytopic, polysporin, or bacitracin). After 1 week, you should generally use a small amount of vaseline on the incisions (after cleaning with hydrogen peroxide) instead of the antibiotic ointment because some people will develop a slight local skin reaction (redness) if antibiotic ointments are used for longer periods. Occasionally, Dr. Ducic will ask you to use antibiotic ointments for longer than 1 week.
Do not allow drying of the incisions or crust formation. Keeping the site moist with the above procedures will hasten healing and provide you with the nicest scar possible.
Do not wear make up over the incisions or flap until the sutures are removed (or have dissolved), and a thin layer of new skin covers the area. This usually takes 7 to 10 days. You should not wear make up directly over the incision until you are told it is all right to do so by the office.
Placing bandages or gauze dressings on the incisions is generally optional after the first full day beyond surgery. Dr. Ducic may ask you to place small surgical paper tapes across the incision (steri-strips). These tapes are useful to take tension off of some incisions, giving a thinner scar in the end.
Sleeping with your head elevated for the first 48 hours may help decrease any swelling that may be noted with the surgery.
External sutures should be kept clean and dry. Dissolvable sutures will disappear on their own within 5 to 7 days. Non dissolvable sutures should generally be removed (unless you are told otherwise) between 7 to 10 days after the surgery. If surgical staples have been used in closing an incision in the scalp, they are often removed between 10 to 14 days after surgery. Sometimes, they will be gradually removed over a couple of visits to the office.
You can expect to experience some numbness in the area of the flap for several weeks after the surgery. Occasionally, this numbness may persist indefinitely.
Avoid exposing new surgical incisions to the sun as this may result in long-term darkening of the scar. You should apply sunscreen to the incision (SPF 15 or greater) for at least 6 months after surgery whenever you are exposed to strong sunlight.
You should generally avoid vigorous exercise or strenuous exertion such as lifting or straining for a minimum of 3 weeks following surgery. Sometimes, you may begin light exercise after 10 to 14 days if approved by Dr. Ducic. In such a circumstance, small surgical paper tapes across the incisions may be very useful.
It is not unusual during the healing phase to note some irregularities under the skin. These small distortions will gradually subside and eventually resolve. Small bumps under the skin may be present if deep sutures were used during the surgery. These bumps will almost always flatten out as the deep sutures are dissolved by your body.
Do not massage, rub or place any tension on any of the incisions for a minimum of 4 weeks after your surgery.
If a skin graft has been used, do not disturb the dressing until you have been seen at the office.
Approximate healing of small facial flaps is as follows:
DAY 1 Return home, leave any surgical dressing undisturbed for first day after surgery.
DAY 2 Aching, throbbing. Start cleaning wound with hydrogen peroxide followed by application of antibiotic ointment. Repeat 4 times per day.
DAYS 7-10 Stitches removed or dissolving.
DAYS 7-14 Clean wound with hydrogen peroxide followed by application of vaseline (unless told otherwise by Dr. Ducic). Repeat 2 times per day. May use cover makeup.
6 WEEKS Usually require either laser resurfacing or dermabrasion to give nicest result. Both procedures will flatten the edges of the flap and provide a smoother, less noticeable transition between the flap and the surrounding skin.
6-12 MONTHS Red color of flap edges is going away.
1 YEAR Final result.
REMEMBER: If you have any concerns or questions, please contact our office any time. Our office should be a source of information and reassurance throughout this entire experience, from the time of your first consultation and continuing after your surgery.