Life After Facelift: What to Expect

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri.

Dr. Chao (00:08):
I'm Dr. Janet Chao. I'm a facial plastic surgeon here at Restore SD Plastic Surgery, and I work closely with Dr. Kat Gallus. You are listening to All the B's, an unfiltered plastic surgery podcast with our scrub tech Bri. Hi Bri.

Bri (00:20):
Good afternoon. I was going to say good morning, but today Dr. G gets a little break of me, although I don't know why she would want that. So we are going to put Dr. Chao in the hot sea and talk about all things facial plastic surgery. So welcome to Dr. Chao's Corner.

Dr. Chao (00:38):
Today we're talking about facelift recovery.

Bri (00:41):
Yeah. I get a lot of questions on the recovery, what it's like, how long do I need to be down for? So give us a little insight to recovering from a facelift.

Dr. Chao (00:51):
Yeah. So everyone needs to go home with a responsible adult who will stay with them overnight.

Bri (00:57):
Keyword responsible.

Dr. Chao (00:59):
Yes. Keyword. So for a lot of my patients, that's a supportive family member or a close friend and others prefer to just bring a private nurse or recovery specialist professional in which we have plenty of recommendations for, if that's the case. That same person usually accompanies you to your first post-op visit, which is the next morning after surgery. We'll teach them how to help with things like changing your dressings and gentle cleaning around the incisions. And that's it, just for the first night. But having someone with you for that first 24 to 48 hours just makes recovery a lot safer and smoother so that you can focus on resting and let them kind of handle the little things.

Bri (01:40):
Yeah. Let your husband and wife tell them you need three weeks off. Tell them they have to do three weeks of kids, grandkids, dishes, housework, they're going to have to cook for you. That's what I tell everyone.

Dr. Chao (01:53):
I'm just the baby for the week.

Bri (01:55):
Yeah, just the baby. Make sure they put on your movies, make sure they get your favorite stuff. You be catered. That 48 hours should turn into three weeks of being catered to.

Dr. Chao (02:05):
Alright, you guys got it from Brri.

Bri (02:06):
Really milk it. My professional medical advice.

Dr. Chao (02:10):
Yes. Perfect.

Bri (02:11):
So what would I expect to look like after a facelift?

Dr. Chao (02:16):
So right after surgery, you can expect to be swollen, a little bruised, maybe some puffiness or unevenness, which is totally normal. Most people don't feel socially normal for two to three weeks, but the recovery does improve day by day. That said, everyone heals a little differently. I've had some patients bounce back surprisingly fast. I had one woman who put on a full face of makeup, styled her hair and went to dinner, out to dinner with her husband seven days after. I had just taken her sutures out and she was like, I'm going to go out to dinner now.

Bri (02:50):
Wow.

Dr. Chao (02:51):
So in general, I think recovery does tend to be a little bit quicker with the deep plane technique that I do. There does tend to be less tension on the skin. I also like to use IV sedation in a lot of my cases, which makes the recovery from anesthesia a little smoother and easier. But if people have major life events coming up, like your child's wedding, a big photo shoot, a TV appearance, you want to give yourself a six month buffer. I'd say that just gives time for full healing, swelling issues to resolve, scars to mature. So you can look your absolute best without any stress.

Bri (03:25):
I just want to side note that if you do IV sedation, you really just get to stare into my eyes for five straight hours.

Dr. Chao (03:33):
Oh my gosh.

Bri (03:33):
We had one patient and she was so hilarious. She was so comfortable, but she was chit-chatting every time she opened her eyes. My eyes were right here and I was like, you're welcome. She even offered, she said, do you want me to help you? I was like, she was so funny.

Dr. Chao (03:47):
I remember that. She learned all the instrument names. She was like,

Bri (03:51):
She did.

Dr. Chao (03:51):
Oh, do you need the bishops now? Yeah. Do you need the iris? She was on it. It is so funny.

Bri (03:57):
Yeah. So just expect, if it's IV sedation, you just get to be two inches from my face for God knows how long.

Dr. Chao (04:04):
They love it. They love it and they're napping. They're in and out and everybody's comfortable. No one feels pain. But yeah.

Bri (04:10):
No, people do so well.

Dr. Chao (04:13):
I think you're more freaked out about that IV sedation than they are. You're like, why are you looking at me?

Bri (04:18):
Yeah. First surgeon, she's like, oh, I do everything under IV sedation. And I was like, excuse me, what? And we have done a whole bunch and there is not one person that has been uncomfortable. I'm like, damn, that's crazy.

Dr. Chao (04:31):
And it's freat for them too because I think it's less time under anesthesia in general. You can kind of lighten things up earlier on while I'm just putting in light stitches at the end and they can move their face during it and I can test facial movements. So lots of different reasons. No breathing tube.

Bri (04:49):
Which is a good thing to touch on. And maybe we can, I know we didn't reiterate this in our facelift, but tell me some of the complications from knowing where your nerves are. I know a really big part of my job intraoperatively is I stare at the face like it was what I was born to do and we're looking for twitching when she uses any kind of cautery. Tell me about the nerves a little bit and why that's important.

Dr. Chao (05:19):
Yeah, so I just want to say in general, I think our OR is super fun. Bri's a great surgical assist. We listen to music. We're usually chatting having a great time, but when it's time to go into the deep plane and it is, things get a little bit more like, okay, turn the music down, look at the face. We are watching that facial nerve. So I'd say that's the number one thing people worry about. And rightfully so. We are operating very close to that nerve, so we're watching it the whole time. Or Bri is, thank you, Bri.

Bri (05:55):
Keep going. Keep going.

Dr. Chao (05:55):
Yeah. But mean having a small amount of asymmetry here and there after the surgery is somewhat normal just from some stretching and swelling and things like that. But yeah, I mean we watch that nerve like crazy to make sure that we don't cut it obviously, but that's a risk. The biggest risk in the first few days is a blood clot. So the best candidates have really well controlled blood pressure. They're not on any blood thinners. Women have a little lower risk of hematoma than men do, but bleeding is another risk. And then just little bits of asymmetry, scar issues, stuff like that. But I'd say hematoma and facial nerve injury are the two big ones to worry about.

Bri (06:45):
And if you're worried about hematoma, can these patients expect to have drains after?

Dr. Chao (06:52):
Good question. So I don't always use drains. I kind of make that decision intra-op, depending on how the patient's doing. If it's pretty bloodless, we'll just leave it without drains, put a little pressure dressing on and that's that. If I do use drains, I'll use it small penrose drain that comes out behind the ear. It's like a little rubber band essentially that just sticks out right behind the ear and it's underneath all of your dressings. You don't even know that it's there. I don't use the big bulb drains. So there's nothing to manage and it usually comes out the next day.

Bri (07:28):
Awesome. And then what, right after surgery, I like to call 'em cute little Q-tips because everyone looks like a little Q-tip. We wrap you up. But what can patients expect to wear as far as garments after the surgery and how long would you like them in them?

Dr. Chao (07:43):
I like your little Q-tip description. I tell people they're going to look like the Michelin man or a marshmallow.

Bri (07:51):
It's a mix between a Q-tip and a Michelin man. Oh, you also go through really quickly Bri's Beauty salon. I get you all lathered up. We clean your hair, we make you beautiful. We shampoo, we condition.

Dr. Chao (08:04):
If you have long hair, she'll do a nice little braid for you. That's always good.

Bri (08:07):
Yes, A little brush, all the good stuff.

Dr. Chao (08:10):
Yeah. And I'd say after the surgery you asked what can you expect for garments and dressings, right? So after the surgery, we'll wrap you up in that little light pressure dressing and you'll come back in the next day and we'll take it down and look at everything, take out in the drains, and then we'll just dress you right back up in that same pressure dressing. After three or four days, I switch you out to a little elastic band that's a little more comfortable and a little easier to manage. And you wear that for a week. For the second week, I let you take it down if you want to go to the grocery store and leave the house. But whenever you're at home, I want you wearing it. And then for about a month, you're wearing it at least at nighttime. So after two or three weeks, you wear it at night, but you can kind of go about your day normally.

Bri (08:59):
And make sure when you're going about your day, you're wearing a hat. You keep your face covered from the sun.

Dr. Chao (09:06):
Yes. Speaking of, I had this great hat that a patient wore at her post-op visit one time, and I was like, I love that hat. That is the perfect post facelift recovery hat. Where did you get that? And she was so nice. She was like, I'm going to order you a bunch. And she did. She ordered a dozen and I have them sitting in my office and I've been giving them to my patients.

Bri (09:30):
Wait, can we throw one on really quickly?

Dr. Chao (09:32):
Oh yeah, please hold. I'll go grab one.

Bri (09:34):
Please hold. You need to see this. This is super important. Keeping your incisions out of the sun. Just like any scar, we want those incisions to look good. Look at her. She's so cute.

Dr. Chao (09:45):
This is the hat. This is the hat. It comes in multiple colors. It's got this little face dressing. I love it. This is a podcast. I don't know if they're going to be able to see this on video.

Bri (09:55):
They can always, always look at little snippets or shorts.

Dr. Chao (09:57):
But anyway, I didn't know this. You can unzip this part and it becomes a visor. My patient came in the other day with the visor on, and then there's this front part that you can use.

Bri (10:10):
Amazing.

Dr. Chao (10:11):
I can't do it with my headphones on. Please hold.

Bri (10:15):
If you want to look at this hat, go ahead and check out. We'll put a little clip it on our Instagram. It is great. I need that for my daily walks. Yes. Fabulous. Man you guys are missing out if you're just listening.

Dr. Chao (10:36):
Alright, so that's it. I only have a few left, so hurry up and book if you want one of those.

Bri (10:41):
Yeah, come get your facelift, cuz you get a hat with it? Definitely going to have to order more of those.

Dr. Chao (10:47):
That's like, I saw this Instagram post, I think of a surgeon being like, come to Chicago and get your surgery and we'll pay for your flight. And I was like, oh, okay. Well, I don't know about paying for $25,000 surgery to get a flight, but Sure. But anyway, so you get a free hat.

Bri (11:07):
You must have a little connection with the airline or something. Yeah, you don't get a flight, but you can get a really cool hat. So let's talk about sutures. Are there any sutures that need to come out? When do they come out? Do some absorb?

Dr. Chao (11:22):
So obviously there are the deep sutures that are absorbable that anchor the SMAS platysma. So those are absorbable and they stay in. And then there are the skin sutures. So the sutures around the ear come out at about a week. The one under the chin will come out somewhere between five and seven days. And then the ones in the hairline, if they're in the scalp, I usually wait until about 10 to 14 days to pull those.

Bri (11:51):
Quite nice. And then after that, do you have any kind of scar regimen that you put them on? Do you use creams, lasers, what you do?

Dr. Chao (12:00):
Yeah, no lasers. I mean these sutures really, the suture sites usually heal up really well, the incisions. I do have them start using bio cornium about two or three weeks post op, which we provide to you in a little pre-op goodie bag. And that's a silicone scar cream that also has an SPF in it. And I think that that's all you really need.

Bri (12:24):
And how do patients manage their post-op pain? I know from my experience, I see the patients stroll it in looking like they just went to lunch and I'm like, well, aren't you on day one? But what are your thoughts on post-op pain?

Dr. Chao (12:39):
I feel like the patients like to show off when they come in, they're like, look, I'm not wearing my head dressing. I'm like, why aren't you wearing your pressure dressing? What are you doing walking in that? I'm like, chill out, chill out. But no, it's great. Our patients are so fun. But yeah, no, surprisingly facelift recovery is not that painful. I'd say people describe it more as like a tightness or pressure, maybe some soreness around the neck, but people usually switch to just Tylenol by day two or three. It's a pretty short-lived pain experience.

Bri (13:10):
Yeah, it's crazy. Simmer down now ya'll. So when people are recovering from a facelift, I know there's a lot of physical and emotional changes stages. What are your thoughts on that? How do they kind of go through these stages of facelift recovery?

Dr. Chao (13:34):
That's a great question because I do think a facelift recovery is just as much emotional as it is physical. So people kind of go through a healing roller coaster. The first week is the worst. You're swollen, you're tired. Maybe wondering, what did I do to my face? I tell everyone, don't look in the mirror at all that first week and just know that everyone looks a little bit puffy, a little bit bruised, nobody looks good the first week and just relax.

Bri (14:01):
I know you say that when I've seen your patients. And I'm like, damn. I was like, I need a facelift. She had one stroll in post-op day seven, and I'm pretty sure her partner booked a facelift on the spot. I was like, you look so good.

Dr. Chao (14:17):
That's funny. But yeah, I feel like there are some patients particularly recently who've done really well exceptionally fast. But in general, I try not to make that the expectation. And even them, the first three or four days, they didn't look like themselves. Your puffy, your bruised, your swollen, that can go away pretty quickly. By week two especially, the bruising improves a lot, but you still might feel a little off, maybe a little puckering around the outside of the face, maybe feeling a little bit stiff in the neck. And then week three or four is when people start looking a little more like themselves and feeling ready to be social again. And then by month two or three, that's when confidence usually comes back and people are like, wow, you look great. I can't really tell what you did though. So yeah,

Bri (15:12):
We love that.

Dr. Chao (15:13):
That's the timeline.

Bri (15:15):
So any other tips and tricks for facelift recovery that you want to give?

Dr. Chao (15:22):
I would say just whoever you're going to be spending a lot of time with, make sure that they're supportive of the process because they're going to be looking at those incisions. And if not, obviously we have some great recovery nurses. Get some good shows on TV and just relax. If you have a good music station you want to listen to, if you have a good book you want to read, just have some stuff to do that's not super high activity. And find a way to pass the time for a week. Just know that the recovery gets better, gets better after that first week especially.

Bri (16:04):
It's a process.

Dr. Chao (16:05):
Yep.

Bri (16:05):
And is there any pre-op things that you would suggest? I know we've done a lot of post-op recovery, but is there anything that you would suggest people to do before getting facelift?

Dr. Chao (16:19):
So eat nutritiously, stay super hydrated. Exercise, just get your body into tip top shape. If you think about it, facelift is putting your body through a lot of stress, right? You're kind of pushing yourself to the limits. So you want to help your body recover as fast as possible by being as healthy as possible. I think eating a lot of good protein, getting the nutrients you need. Yeah, I think that'll just help you both for longevity and just wellness in life. But for a facelift recovery too.

Bri (16:58):
Right. Be healthy, get a facelift.

Dr. Chao (17:01):
Be healthy, be beautiful.

Bri (17:04):
Come to Restore. Yeah, come to Restore, get a facelift to get a free hat.

Dr. Chao (17:09):
Yes, for a limited time only. Hats are running out, all the good colors are taken. Although I like this pink one.

Bri (17:18):
I love the pink one too. We can match it with anything.

Dr. Chao (17:21):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check the show notes for links. Scrubbing in.

Bri (17:32):
And scrubbing out.

Dr. G (17:34):
If you're listening today and have questions, need info about scheduling, financing, reviews or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us go to restoresdplasticsurgery.com. Follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, apple Podcasts, Spotify, or wherever you like to listen to podcasts.