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It is becoming increasingly important that patients having cosmetic surgery are able to return to work and social activities as soon as possible. Also they want to have a discreet reintroduction to their colleagues and friends. Cosmetic surgery of the head and neck always results in some degree of temporary swelling and/or bruising. We employ a number of steps to minimize this. Among the instructions are: avoiding certain medications, such as aspirin, that thin the blood; avoiding elevations in blood pressure caused by pain or a full bladder; and limiting bending and lifting activities. The use of adrenal corticosteroids (cortisone) helps greatly. We also recommend the use of Arnica. The roles of precise surgical maneuvers and the meticulous control of bleeding are not to be underestimated.
In regards to head positioning after surgery, I and most of my colleagues have recommended that patients having cosmetic facial and scalp surgery sleep with their head elevated on three pillows for the first few nights after surgery. The theory behind the more upright position is so the tissue fluids present underneath the skin more rapidly migrate downward into the neck and chest. Indeed, this does occur. And as these fluids migrate downward, we would almost always see some swelling and bruising of the eyelids, lower cheeks, neck, and chest. These are often areas that were not directly traumatized by the surgical manipulations. In spite of following all instructions, some patients experience excessive swelling and bruising. It finally made sense to me that if patients slept on their back, which is much more natural and comfortable, swelling from surgery of the scalp, forehead, eyelids, face, and neck would go towards the most dependent areas; the back of the head and neck where little shows. In the last year, I have advised this positioning for many patients and have noticed a marked decrease in facial bruising and swelling and a more rapid resolution of the sequelae of surgery. Also, the patients have a more comfortable and restful sleep.
When doing hair transplants, I remove thin strips of the scalp from the sides and the back of the head. This creates a defect that is precisely closed either by stitches or staples. Both give a similarly undetectable scar, but the stitches are more comfortable, especially when the head is on a pillow. I often will use staples on the sides of the head, which makes the patients sleep on their back. They subconsciously seek the more comfortable face-up position when they turn to the side. We have almost no incidence of forehead swelling after hair transplants when patients follow this regimen. I am applying this principle of having the patient sleep on his/her back in almost all facial surgery patients as well.
Therefore, I am recommending (until experience proves otherwise) that patients follow a most simple and comfortable instruction for their time at home after surgery; that is, to sleep on their back on one pillow. If they are the type who like to turn and sleep on their face, they could use a foam pillow that has a head rest cut out so they will tend to stay on their back or use airplane inflatable headrests that keep the head in the midline.
This very simple and more comfortable way of sleeping after cosmetic facial surgery has the benefit of more rapid resolution of swelling and bruising. |
