While every patient knows and anticipates that they will have some bruising and swelling after any plastic surgery operation, most do appreciate the sequence of the process or its time of resolution. This gives rise to many patient phone calls and much anxiety which is perfectly understandable.

The first concept for patients to grasp is that it is impossible to avoid these bodily responses to any form of invasive surgery. Blood vessels are broken and the tissues leak fluid from the injury, all of which is a natural and needed reaction in the first step of healing. While the use of steroids, oral arnica and external cooling are very helpful aids in limiting how severe bruising and swelling can become, they are control agents and not methods of prevention.

This first phase of bruising and swelling is an evolving one that really takes several days to become fully manifest. In my Indianapolis plastic surgery practice, I always tell patients it takes two days to see maximal swelling and a few days beyond that to see how much bruising will really develop. This really fools patients as they may continue to get increasingly swollen for the first few days. This gets them concerned that something may be wrong like and infection and can occasionally generate a phone call. Because most patient’s perceptions of swelling and bruising is usually less than reality, this can be quite scary for them, particularly when it is on one’s face.

While the origin of bruising usually subsides within hours after surgery, its appearance on the skin can take days to fully see. And because of gravity, it can appear in areas outside of the surgical site. This is most manifest in the face where lower neck and upper sternal bruising may be seen after a facelift for example…or bruising that appears over the ribs after a breast augmentation….or the most striking and shocking example for patients when the genital region becomes signficantly bruised after abdominal liposuction. (this always generates the most calls even though I caution patients in advance!)

The clearing of bruising is another interesting process. Most everyone knows that for bruising to resolve, the released blood cells must be broken down and removed. This gives the classic color phase of a healing bruise as it goes from black and blue…to yellow…to green as the pigments of the hemoglobin become visible as it breaks down. This process definitely takes weeks but is much faster on the face and neck due to its superior blood flow per skin area.

While the resolution of swelling varies by the type of plastic surgery procedure, a good rule of thumb is that if you still see some bruising, you still have some swelling. Once the last vestiges of bruising are gone, then you know that most of the swelling is gone also.

This entire visible recovery process will take about three weeks for most procedures. The return of normal skin color and softer more supple skin around the surgery site that feels more natural are its hallmarks. This external recovery does not imply that the internal surgery sites are completely healed and really quite far from it. That process is just getting ramped up inside and much work needs to be done in that regard before one is fully healed. It is important not to confuse the processes of recovery (how one looks and feels)and healed. (tissues have returned to normal)

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Enhancing one’s chin with an implant is a common plastic surgery procedure. The simple placement of a synthetic implant on the front of the chin (mandibular symphysis) bone can make a dramatic difference in how the lower jaw looks and in the appearance of the lower face and neck. While chin augmentation  is a very straightforward operation, there are some common side effects that will occur after surgery which will go away with time.

Despite the fact that a chin implant and the incision through which it is placed is small, it will definitely make the chin sore after surgery.  This is because it is necessary to lift the chin muscle (mentalis) off of the bone to position the implant in place. The soreness will go away in a week or so as the muscle pain settles down but the chin will feel stiff for awhile.  One may also notice some unusual muscle movements or ‘spasms’  as the chin muscle heals over the implant. This is the result of the muscle adapting to being stretched over the size of the implant.

Some moderate swelling of the chin is to be expected for a few weeks but bruising is rarely seen. If bruising occurs, it is mild and usually appears below the chin in the neck.

There almost always is some numbness after the chin implant procedure. The skin over the chin, and sometimes part of the lower lip, may feel numb for awhile after surgery. This occurs because the small branches of the mental nerve, which supplies feeling to the lower lip, front teeth, and chin, are stretched from the surgery. In some cases, the big end of this nerve where it comes out of the bone may be affected from placing the side wings of the chin implant. In either case, the feeling will return within a month after surgery.

Between the numbness and the muscle stretching in the chin, some patients will notice that their lower lip may appear or move a little differently after surgery. This effect can be disturbing but it is only temporary.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Tummy tuck or abdominoplasty surgery is a dramatic operation that offers an unparalleled change in your waistline shape and contour. It can be so significant that I frequently refer to it as the ‘facelift’ of the body. Like all dramatic surgical changes, there will be some equally dramatic immediate after effects that all patients should be aware of with the understanding that these are normal but temporary inconveniences.

Most importantly, most tummy tucks are significant surgery. You should plan an adequate time for recovery with particular emphasis on how long it will take to return to the type of work you do. Don’t short change yourself. I can make one assumption for most patients…..they don’t have a good idea (why would they?) as to what a tummy tuck operation is like after. Most of us are not as tough as we think. Plan accordingly!

Without question, pain is a common immediate feeling after a tummy tuck. Whether the pain is significant or surprisingly moderate is determined by whether your abdominal fascia (covering of the rectus abdominal muscles) has been tightened down the middle. This is what gives tummy tucks their pain afterwards. Not all tummy tucks are done with muscle tightening. Some can be simple skin and fat cutouts (simple abdominoplasty or panniculectomy) which do not have much discomfort at all. If your plastic surgeon is going to tighten the muscles (which you should know and discuss beforehand), then ask if there will be some type of pain relief offered after surgery such as a 24 or 48 hour pain pump. Pain does get better within a few days but the first week can be a rough one for some patients.

Tummy tucks do not usually have a much swelling and rarely any bruising. If you have a lot of bruising across the abdomen after surgery, call your plastic surgeon. This might be the development of a hematoma. (bleeding) This is of particular concern in the first day or two after surgery. Small insignificant amounts of bruising may appear later but these are not of any concern.

The skin over the stomach area will feel very numb. This numbness will persist for many months and the feeling may take up to a year to come back, particularly down close to the incision area. This occurs as the tiny skin nerves that give feeling to the skin are cut (they can’t be seen) as the upper abdominal skin is raised and stretched down to meet the lower incision. The numbness gradually gets smaller as the feeling comes in from the side, closer to the center and down near the incision. Some patients may have a small area in the center of the incision just above it which may always be numb.

Difficulty standing straight after a tummy tuck is common…if the muscles have been tightened. In those abdominal procedures where muscles are not tightened, then standing straight is not a problem. If the muscles have been tightened and you can stand straight right away…that is a good sign. That will get better by the end of the first week after surgery. This means they have been tightened enough to make a real difference.

Almost all tummy tucks require a drain after surgery. Some plastic surgeons use one drain, others use two. Either way, they will need to stay in place for 7 to 10 days until their fluid output drops considerably. They help immensely in decreasing the risk of a fluid-build-up after surgery under the skin. They are necessary evils of the procedure.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana]

Clarian West Medical Center, Avon, Indiana

Indianapolis

Return to Normal Quickly after Breast Augmentation – Dr Eppley’s Approach in Indianapolis

Breast augmentation is both a popular and highly successful procedure that is done over 300,000 times per year in the United States alone. Some women, however, fear the procedure due to the belief that there is a lot of pain after surgery and that their return to work or normal activities may take several weeks. Breast augmentation surgery today, however, can put the patient back to a near normal schedule within days.

Breast augmentation, from a simplistic standpoint, is really a big ‘pulled muscle’. In this
case, the pectoralis muscle on the chest is ‘pulled’. Breast augmentation, in most cases, is the lifting up of this muscle and placing an implant partially underneath it. No breast implant is completely under the muscle or it would be positioned too high and the nipple would be pointing downward. As the pocket into which a breast implant is placed controls the final shape of the breast, recovery after breast augmentation is really muscular. From a physical therapy standpoint, how do you recover from a pulled muscle? Do you not move it…or bind it up and keep it from moving? The answer is…..use it! Early moving and stretching of an injured muscle is the key to a faster recovery after breast augmentation. You can’t hurt the breast implant by using your arm and chest muscles and early movement will not be responsible for an implant ‘getting out of position’.

In Indianapolis, the approach to a no recovery breast augmentation program begins in the operating room. A dose of steroids is given at the start of surgery and a bioelectric device, known as Actipatch, is placed over each breast before the patient leaves the operating room. This device, which is worn for 48 hours after surgery, helps control pain and swelling. I then start my breast augmentation patients on range of motion arm exercises beginning the night of surgery as well as 800mg of Ibuprofen also. The goal is to get patients off narcotic pain medication in 24 hours, if possible, and be able to get out of the house for dinner or shopping the next day. While not every patient achieves this exact timeline for a ‘no recovery’, this approach helps make a breast augmentation easier to go through than ever before.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Steps to Having a Successful Recovery after Plastic Surgery

While the plastic surgeon is responsible for performing a good operation, the patient must also participate in their surgery. And laying on the operating table asleep does not constitute what I mean by participation! Here are some essential things that a patient must do to have a comfortable and rapid recovery after their plastic surgery procedure.

PreSurgical Education

Studies have shown that informed patients feel less anxiety before and after surgery. Take the time to research the procedure you are having via books or the internet. Make sure you understand the procedure you are having and don’t be afraid to ask questions prior to surgery such as: What type of anesthesia will be used ? How long with the
procedure take? What medications will I take? When can I start doing normal activities? When can I shower and apply makeup?

Medications, Smoking and Supplements

Discontinue use of any nicotine products at least 2 weeks prior to surgery. This includes cigarettes, cigars, nicotine gum, and patches. Nicotine reduces the blood flow to the skin and may impair healing; and quitting smoking drastically improves the body’s response to surgery.

Stop using medications containing aspirin and ibuprofen two weeks prior to surgery. Aspirin thins the blood and can produce excess bleeding and bruising. Be sure to read the labels of any over-the-counter remedies you regularly take as many common medications contain aspirin. For the same reason, also avoid: Vitamin E and herbal supplements, herbal teas, and red wine.

Begin using an ARNICA supplement 7 days prior to surgery and continue for one week after surgery. Arnica is a naturopathic remedy that helps prevent as well as clear bruising. You should also consider adding Vitamin K to your diet. This fat-soluble vitamin plays an important role in blood clotting and can be found in such foods as spinach, broccoli, and kiwi.

Plan for Success

During your recovery, you want to be as relaxed and comfortable as possible. By planning in advance, you can set yourself up for a worry-free time when your body can completely concentrate on recuperation.

· Plan your wardrobe for the day of surgery and the week following. Loose-fitting clothing that can be unbuttoned or unzipped down the front is best.
· Designate an area in your home for yourself – such as a quiet bedroom or sofa away from busy family activities
· Even if you are having a minor procedure, you will still need a minimum of 24 hours to recover from anesthesia, and will not be up to handling responsibilities by yourself. If you do not have a friend or family member to care for you the night of surgery, a private suite at Clarian or Meridian Surgery Center can be arranged for you at a modest charge,
· Get all your prescriptions filled prior to your surgery
· Plan your meals for the week after surgery and make the necessary trip to the grocery store
· Arrange for child care
· Rest and sleep, combined with small meals and plenty of fluids, are key to a quick and comfortable recovery.
· Avoid excessive sun exposure for at least two weeks after most surgeries.
· Be patient. Everything (swelling going done, bruising going away, etc.) takes longer than almost every patient expects or wants.

The number one cause of postoperative pain and complications is ‘overdoing’ it after surgery. With proper planning and arrangements, this can be avoided and a smoother recovery will occur.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Advanced Bio-Electric Healing Technology

What can I do, as a plastic surgeon, to help my patients recover faster? What can I do to help their swelling, bruising, and pain be less? We use all of the traditional therapies of cold compresses, arnica tablets and gel, elevation of the surgical area, and pain medications. But I have recently added a new option, offering advanced bio-electric therapy (ActiPatch) to help my patients heal better after surgery.

ActiPatch delivers the same pulsed electromagnetic therapy, used by physicians, therapists, and athletic trainers worldwide to reduce pain and swelling and accelerate healing. The traditional clinical treatments of bio-electrics is expensive and inconvenient for most patients. Now, through microchip technology, this home-based therapy is available in a convenient, easy to use, low-cost patch. Applied right after surgery, and used for the first week after surgery, ActiPatch works by driving out the swelling and negative by-products from the damaged tissues. With less swelling, a decrease in pain occurs.

ActiPatch is a wearable technology, is flexible, light weight, and easy to apply and use. Once activated, ActiPatch begins pulsing a continuous low level current to energize damaged cells in the surgical region, helping remove the effects of surgery so you can feel better and look better faster!

ActiPatch has been shown to be effective in reducing pain in breast augmentation, abdominoplasty, blepharoplasty (eyelid), nose and facelift surgeries. I consider it a very useful aid in my Indianapolis plastic surgery practice.

Dr Barry Eppley
www.eppleyplasticsurgery.coom
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Reduce Bruising after Surgery!

Used for centuries in Europe to treat swelling, soreness, and bruising, Arnica Montana (extract of the dried root and flower of the arnica plant and also known as leopard’s bane) can be used either by tablet or applied as a topical gel. I particularly like its oral form and have all of my Indianapolis plastic surgery patients take it sublingually (under the tongue) starting one week before and then one week after surgery as well. Patients should take 4 tablets under the tongue four times a day. The pills are very small and have no real taste to them so they are not unpleasant to take.

This homeopathic remedy is believed to have anti-inflammatory and antibacterial properties and stimulates white blood cells to aid healing by eliminating excess fluid from the surgical area. To me, the more impressive property is its effect on decreasing bruising. Having used it in patients for years, there is no question that it decreases the amount of bruising that occurs after surgery as well as helps clear bruising that does occur faster. My patients frequently comment on how effective it has been for them. I have no hard scientific evidence that quantifies exactly how much it prevents bruising or how much better it clears bruising but my feeling is about 25 – 33% prevention and about 50% prevention.

Arnica is of particular value in all facial plastic surgery such as rhinoplasty, blepharoplasty, and facelifts as well as liposuction body surgery. It is very inexpensive (less than $40 for 100 tablets) and has no real side effects so there is no reason not for the patient to take it. We keep a stock in the office so patients have easy access to it.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis