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
Indianapolis, Indiana