This article was written for Body Language France issue n°9. It has been translated from the original French. We thank Dr Drossard and Body Language for sharing it with the international community.

Any surgical procedure requires management of the operative phase by the surgeon, but also and most importantly by the patient, who is considered as being the principal actor in successful recovery and healing. Dr Guillaume DROSSARD looks over the essential aspects to respect in order to optimize the results of aesthetic surgery.

A common reaction after an aesthetic procedure often looks like this: ‘Finally, I have been operated on! Phew, it’s over, I made it!’ However, it is not as simple as it seems.

The postoperative step is crucial, even one of the most important in the process. It must be prepared for very carefully during the pre-operative and operative steps, in order to avoid any disappointing results even if the surgeon has done their job well.

A good postoperative phase is therefore prepared before the operation takes place. Control meetings will be planned. The patient should not be caught off guard, because once operated on, they should rest. This postoperative period needs to be straightforward, simple and organized.

The patient must have trust in and listen carefully to their surgeon. The surgeon will adapt treatment to the patient and the procedure; treatment can differ from one patient to another, even for an identical operation. Identical surgeries performed on a 45-year-old woman without any particular background and on a 70-year-old patient who is diabetic and a smoker will not require the same postoperative treatment.

That is why patients must be wary of different opinions found on the Internet. Those “amateur” opinions are not necessarily adapted to their own case. Thus, the postoperative instructions given must be simple and effective in order to be fully respected.

Preparing for the operation

- Pre-operative hypnotherapy can help prepare the patient to handle the stress of operation, to approach it with more serenity, and to rest well.

- The patient needs to quit tobacco three weeks before the operation and continue to not use it for three weeks after. It is crucial to stop smoking because in general, complications such as infections, bruises or healing problems are more frequent in smokers. An addiction specialist can help the patient stop smoking. Nicotine patches are a good alternative. They allow nicotine to be delivered in a continuous manner, which avoids the harmful effects of nicotine peaks. Nicotine peaks induce significant vasoconstriction of the vessels and thus decrease oxygen supply. Consequently, healing is less efficient. Nicotine peaks are observed when a patient inhales the smoke from a traditional or electronic cigarette. Electronic cigarettes are therefore less recommended, unless the nicotine charge is weak to null.

- Considering micronutrient levels will get the patient into a good shape for the operation, and will help prepare for the healing process. The body will not have any protein or amino acid deficiencies, or any hydro-electrolyte disorders, which are all essential elements for tissue repair.

- The patient must work on their sleep quality (hypnosis, medication, relaxation therapy) .

- The patient is advised to workout during the week before the operation.

During the operation

Local or loco-regional anesthesia complements the general anesthesia. Indeed, the value of per-operative local anesthesia it is that it makes it possible to reduce the dose of analgesics needed after the operation, which consequently allows for an earlier release from the clinic.

The control consultations

Eighty per cent of my activity is outpatient, which means that the patients go home the same day; hence it is important that the paramedical team do a follow up by telephone. Maintaining contact with the patient after the operation is essential. It reassures and helps prevent errors, because despite the numerous documents given, in the end patients only read a few pieces of post operative advice…

In this way, a phone call from my team allows us to monitor adherence to the advice and to check that that the treatment is running smoothly.

Consultations at doctor’s office will have been scheduled before the operation and for patients who live far away, FaceTime or Skype sessions will be organized, in order to reduce the number of unnecessary round trips.

The dressings

The dressings must be simple and efficient, this is the key.

It is often advised to shower the day after the operation, which goes against an old urban legend, which says not to get the wounds wet. The patient should use superfatty soap, followed by a disinfectant.

A healing cream, often Aquaphor (Eucerin) or Cicalfate (Avène), needs to be applied. Finally, gauze pads should be applied with the help of tubifast. Any sticky bandages use (silicon or not) must be limited; those bandages are considered a source of blisters and reactions.

From the third week after the operation, a cream or silicone based bandages should be used (Dermatix, BepanthenCica, Eurogel or other). The role of these silicon-based bandages is to slow down the healing process, which can sometimes cause inflammation, and avoid scars that are too red, too hypertrophic and pruriginous.

The medication

- The pain: paracetamol is sufficient most of the time. To complement this, mostly on demand, I use Acupan in capsule form, broken under the tongue.

- An antibioprophylaxy: it is sometimes useful, but not systematically, and will depend on the operating zone and the operation type.

- Corticosteroids: I frequently use them for a period of two to three days after the operation on the concerned area. They help with the disappearance of edema and ecchymosis.

- The antithrombotic prophylactic treatment: this is indicated for some procedures. Subcutaneous injections of Fraxiparin should be carried out once a day for approximately 10 days.

- Iron treatment: the treatment should ideally start 15 days before the surgery and continue for at least one month. It is prescribed for potentially hemorrhagic procedures as iron helps in the production of hemoglobin.

- Edema and the ecchymosis: a proteochoc is systematically prescribed, possibly a homeopathic type, such as Arnica.

- Muscle relaxants: Decontractyl or Miorel are especially recommended for submuscular breast implants, or any other surgery affecting muscles.

- All aspirin should be avoided: a platelet antiaggregant can cause hemorrhagic problems, therefore the aspirin should be avoided for 10 days before the intervention and up to 15 days after. Moreover, attention should be paid to medicines containing aspirin, such as Alka-Selzer. However, depending on the procedure, other treatments may be prescribed.

Nutrition

A micro-nutritionist doctor is systematically suggested to the patient. Indeed, when care is taken with nutrition, the patient benefits from better healing and physical recovery. Bruises will be less severe and the weight of the patient will be stable, which is crucial for most surgeries.

LEDs and lasers

These are systematically used. They help to avoid the sometimes inflammatory phase of healing. This preventive treatment therefore prevents the appearance of red, sensitive and sometimes pruriginous scars between the second and sixth months following the procedure. The frequency of sessions must be adapted to each case; it is necessary to respect the protocol proposed by the practitioner. LED session should start immediately after surgery. It is recommended to combine these treatments with silicon bandages and compression garments.

Compression

Compression is very important after many aesthetic and plastic surgery produces. It is necessary to apply it immediately after procedures to the body and breast. It has an undeniable analgesic role; it allows the skin to recover in a homogeneous way and to avoid the tearing of tissue, a source of effusions. How long compression should be applied is indicated by the surgeon and will depend on the procedure and the patient. Class 2 to 3 compression stockings (not socks), depending on the zone and procedure, can also reduce the problems of deep vein thrombosis.

Several leading manufacturers propose support clothes and lingerie, such as Medical Z or Cereplas, but a new French brand, Embody Paris, recently made its appearance. It offers some real technical novelties in the materials, sewing and fasteners, and is equipped with patented, particularly practical, magnetized closures. The Embody Paris range also has the merit to consider the expectations of the patients in terms of comfort and elegance, with its French lace and its smart style. We noticed that compliance was better with this range. Indeed, it is often advisable to wear a compression bra for two to three months, but for discomfort or aesthetics reasons, the patients do not always respect this period. The brand’s proposal in terms of elegance and technical contributions in the comfort, results in better adherence to this recommendation and therefore an optimal final aesthetic result.

At the first month mark, patients often tend to avoid compressing the scars for fear of damaging or irritating them. This is a mistake. It is recommended to compress the scars for two months, using, for example, briefs with wide elastic for compressing abdominalplasty scars, or a bra for compressing a scar below the breast.

Hypnotherapy and surgery

My patients meet with the hypnotherapist that I work with. He prepares them for their surgery, teaches them how to handle stress, and allows them to arrive to the procedure relaxed.

The hypnotherapist can also assist the patient during surgery when it is performed under local anesthetic, and help them during the postoperative step. Pain levels will be better controlled and the post-stress syndrome or postoperative depression will be either absent or mild. Since the blood pressure will be better controled, the operation will be easier. The ecchymosis and edema period will also be reduced, which is very important for facial surgeries as it allows the patient to get back to work quicker.

Physical and professional activities

It is very important to respect the instruction to rest but it is also necessary to be mobile from the day after the surgery; it is discouraged to stay in bed all day.

Exercising should be avoided, on average, for one to three months, and can be gradually started again according to the instructions given by the surgeon.

Patients will be required to stay off work for between three to 15 days, depending on the procedure and the patient’s profession.

Finally, it is advised to not travel too far or take a plane trip within one month of the surgery, as air travel can stimulate the appearance of phlebitis. To combine two thromboembolic risks is dangerous and increases the risks to the patient considerably. Therefore I do not know what to advise for cosmetic surgery procedures that are performed abroad.

Beauty gestures

Shaving or waxing the affected zones is forbidden for the five days before the operation, because it promotes skin irritations, which can lead to small, localized infections that are detrimental to the procedure. The patient can start shaving again three weeks after the procedure, and this also applies to laser hair removal. Regarding hair dye, the patient is advised to wait three weeks after a scalp procedure to dye their hair.

Conclusion

The management of the postoperative process must never be underestimated by the patient; it is an integral part of the whole surgical process. It needs to be carefully prepared and organized. In this way, the healing process will go smoothly and the aesthetic results will surely meet the expectations of the patient.