NECK LIFT: POSTOPERATIVE CARE
Performance of the procedure itself only fulfills part of our obligation to the patient and the care they receive postoperatively is arguably as important as the surgery itself. Diligent postoperative care will also ensure the best result and limit the likelihood that problems and complications will occur.
Patients are discharged with specific written instructions as to how they are to care for themselves, and the surgeon should always be available to answer questions and see any patient, if needed.
SLEEPING AND HEAD POSITION
Patients are instructed to sleep flat on their backs without a pillow. A small cylindrical neck roll is permitted if the patient requests or requires it. This posture assures an open cervicomental angle and averts dangerous folding of the neck skin flap and obstruction of regional cervical lymphatics that inevitably occurs if the patient is allowed to ‘elevate their head on pillows’as is commonly recommended after head and neck surgery. If patients are allowed to elevate their head on pillows, their neck will inevitably end up flexed and their skin bunched and folded. In addition, a flat-in-bed position encourages swelling to drain posteriorly to the back of the head instead of inferiorly to the anterior neck, where it is not harmful, less noticeable and more rapidly transmitted away from the head and neck area when the patient sits upright. This is particularly helpful if a facelift has been performed as party of the procedure.
Patients are shown an ‘elbows on knees’position that ensures an open cervicomental angle while sitting. This posture places the patient’s book, magazine, paperwork, notebook computer or meal in a position that allows reading, writing, eating or TV watching to be performed comfortably and safely with their chin up and their neck skin smoothly and uniformly distributed over their neck. If patients are allowed to sit upright during these activities their neck will inevitably end up flexed and their skin bunched and folded.
Patients are asked to rest quietly and apply cold compresses to their face and eyes for 15-20min of every hour they are awake for the first 3 days after surgery. For most patients, oedema peaks at about this time. It is not necessary or productive to apply ice compresses continually throughout the day or at night.
All patients are provided oral (usually non-narcotic) analgesics, sleeping pills, oral dissolving antiemetic tablets, preservative-free ointment and preservative-free ‘artificial tears’solution with instructions for their use. Patients are required to use ophthalmic ointment each night for the first three weeks after surgery or until all signs of eye irritation are gone. Artificial tears are used throughout the day on an as-needed basis.
Patients are allowed to take their usual diet as tolerated after surgery but are encouraged to avoid sweet, salty, sour, dry and difficult-to-chew foods for several weeks. It is particularly important to avoid these sorts of foods, which stimulate salivation, for 7-10 days if submandibular gland reduction has been performed. Patients are asked to abstain from the intake of alcohol for 2 weeks after surgery and until they are no longer taking pain killers or sleeping medication.
Patients are instructed to begin a daily routine of showering and shampooing no later than 3 days after surgery, even if their drains are still in place. This helps remove crusting about the suture lines, keeps incisions clean and usually improves the patient’s general outlook and wellbeing. Patients are also informed that they need not be as thorough as usual when washing their hair and assured that shower water, shampoo and conditioners are not harmful and will not interfere with healing or cause infection.
Patients are allowed to use their usual hair-care products but must be warned that their scalp may be partially numb after surgery and that they must be careful to ensure that shower water is not too hot and that hair dryers are not used on high heat settings. Patients are also instructed not to ‘perm’, tint, dye, highlight, colour or otherwise chemically treat their hair for 2 weeks after surgery to limit the chance of hair breakage or hair loss. ‘Hot curlers’and ‘curling irons’must be used with care for several months following forehead lift surgery as patients might unknowingly burn their foreheads and scalps when doing so. Patients are advised to apply hair gel, hair cream, hair spray and similar products sparsely, or preferably not at all, until all sutures have been removed.
At least one drain is usually left in the neck until the first suture removal visit. This is because drain output often quickly falls on the first or second day after surgery during the time the patient is mostly supine and resting, but then typically picks up again when the patient begins to spend more time upright and starts to move his or head about more. Leaving the neck drain in longer, for 4-5 days, will reduce the likelihood that small collections will form and it will speed the overall resolution of oedema, ecchymosis and the induration in the neck area.
When sutures are removed will vary depending on the type of procedure performed. If a short-scar neck lift has been performed, a submental incision only will be present and sutures are removed on the 4thor 5thday. If an extended neck lift or facelift and neck lift have been performed, 6-0 sutures are removed on the 4thor 5thday and half-buried vertical mattress sutures of 4-0 nylon with the knots tied on the scalp side are removed on the 7thand 9thday. If sutures are left in longer, tell-tale and objectionable ‘suture marks’are likely to occur.
RETURN TO WORK AFTER SURGERY
How long is it before patients can return to work and their social lives depends upon their tolerance for surgery, their capacity for healing, the type of work they do, the activities they enjoy and how they feel overall about their appearance. Patients are asked to set aside 7-10 days to recover, depending on the extent of their surgery, and additional time off is recommended if a facelift and related procedures are simultaneously performed. If the patient is doing well and not experiencing problems, she or he is allowed to return to light office work and casual social activities at that time. It is often wise to begin with a limited workday at first and to adjust schedules there-after. If a patient’s job entails more strenuous activity or physical labour, a longer period of convalescence may be required. Patients are advised not to drive for the first 10 days after surgery and until they are feeling well, their vision is clear and they are off pain medications.
AFTER SURGERY ACTIVITY
Patients are advised to avoid all strenuous activity during the first two weeks after surgery. Two weeks after surgery, patients are allowed to begin light exercise and gradually work up to their presurgical level of activity. Four to six weeks after surgery, they are allowed to engage in more vigorous activities, including most sports, as tolerated.
Diligent postoperative care will also ensure the best result and limit the likelihood that problems and complications will occur.