What Can I Expect After Surgery?
There will be a mild to moderate amount of pain and discomfort associated with the surgery. For most patients, this should be easily controlled with over-the-counter oral medications. Acetaminophen and ibuprofen are excellent pain relievers, especially if they are started before the injected anesthetic wears off. In general, it is easier to get ahead of pain and prevent it than it is to calm it down once it starts. For this reason, it is recommended that you take pre-emptive pain medication every 4-6 hours for the first 48 hours after surgery. Thereafter, you can wait and see if any additional medication is needed.
The discomfort and pain should begin to decrease within 48-72 hours after surgery. A significant increase in pain after this period should prompt you to call the office.
All incisions that are made in the skin will heal by forming a scar. Dr. Basak will always make your incision as hidden as possible. Secondary procedures on scars (Kenalog injection, dermabrasion, or scar revision with additional surgery) may be suggested by your surgeon to further camouflage it.
Right after surgery, incisions will often appear raised and red with rippled or bumpy skin.
Don’t worry, they will eventually flatten and the redness will generally fade! However, this takes time and your incision will not be completely healed for about 1 year after surgery (or even a few years on the leg or foot). However, incisions are usually looking significantly improved by 6 weeks post-operatively.
If you use CPAP, surgeries on or near the central face/nose may prevent you from being able to use your machine for the first few days post-operatively due to bulky bandaging. As a short-term solution, a nasal dilator can help with breathing during this time (e.g. Turbine Nasal Dilator, available on Amazon.com).
You can restart aspirin and other supplements 3 days after surgery.
Call the Office Promptly if You Notice Any of the Following:
- Significant increase in pain after the first 48 hours following surgery
- Development of a temperature exceeding 100.0 degrees.
- The incision has purulent drainage (pus), is very warm to touch, and/or develops redness that spreads and increases with time. Some redness at the incision edges is normal, but it should be stable in its width after the first 48 hours.
- Bleeding that cannot be controlled with pressure or is extensive
If any of the above should occur, call the office. After hours, there is an option to connect with the on-call doctor. Dr. Basak’s post-operative handout also has her cell phone number on it. If you notice one of the above changes and cannot reach us for evaluation, go to the emergency room.
Office Phone: 720-778-3376
How Do I Care for My Incision After Surgery?
Be sure to fill any antibiotic or pain prescriptions given post-operatively. Take antibiotics and pain medication only as prescribed by the office.
If you notice some bleeding from the incision, simply apply firm pressure to the area for 30 solid minutes. If the bleeding persists contact the office or Dr. Basak.
If external stitches were used during the surgery to close your incision, follow the written wound care instructions provided at your appointment. In general, most linear and flap closures need to stay dry with a pressure dressing in place for approximately 30-48 hours. After that, the initial dressing can be removed. You can get the wound wet at that point, but avoid soaking it for long periods of time or exposing it to strong water pressure. Clean the area with antibacterial soap (e.g. Hibiclens) or 3% hydrogen peroxide by rolling a Q-tip moistened with the cleaning agent over the incision and gently rinsing with water. Then use a clean Q-tip to apply a generous amount of Vaseline or Aquaphor ointment over the incision. In some cases, Dr. Basak will prescribe an antibiotic ointment (such as mupirocin) to use either in place of or in combination with the Vaseline/Aquaphor ointment. Then cover the incision with either a sufficiently large Band-Aid or a non-stick pad held in place with tape (essentially creating your own bandaid). For smaller incisions, an appropriately sized Band-Aid is fine to use and can be trimmed to fit the area. For larger or awkwardly shaped incisions, non-stick pads (eg telfa) can be cut to fit and then secured with tape. Retention tape such as Hypafix is recommended because it breaths, is hypoallergenic, and conforms well, but any sensitive skin tape will work.
There are two variations to the wound care depending on surgery location. For surgery on an extremity, the non-stick pad can be held in place with Coband or an ACE bandage rather than tape, which is less aggravating to the surrounding skin. On the scalp, the bandage can be taped down as much as hair will allow, and then a tightfitting wig or ski cap can be placed over it to help hold it in place, especially at night.
Do not allow drying of the incision or crust formation. Keeping the site moist with the above procedures will hasten healing and provide you with the nicest scar possible.
Do not wear make-up over the incisions until the sutures are removed (or have dissolved), and a thin layer of new skin covers the area. This usually takes 14 days. After 1 week, placing bandages on the incisions is generally optional. You may choose to continue bandaging your wound if it will be exposed to a dirty environment or intense sunlight. Dr. Basak may ask you to place small surgical paper tapes across the incision (called Steri-Strips). These tapes are useful to take tension off of some incisions, resulting in a thinner scar in the end.
Sleeping with your head elevated for the first 48 hours helps decrease swelling that may be noted with the surgery. Sometimes swelling can be quite intense, and for surgery near the eyes or on the forehead, the eyelids may swell shut or become very bruised. This will resolve within the first few weeks after surgery.
On the face, dissolvable sutures will disappear on their own within 5 to 7 days. Non-dissolvable sutures should generally be removed within 1 week of surgery, unless you are instructed otherwise. On the scalp, trunk, arms, and legs, non-dissolving sutures are usually left in place for 2 weeks before removal.
You can expect to experience some numbness in the area of the incision for several weeks-to-months after the surgery. Occasionally this numbness may persist to indefinitely.
Avoid exposing new surgical incisions to the sun as this may result in long-term darkening of the scar. You should apply sunscreen to the incision (Broad spectrum SPF 30 or greater) for at least 12 months after surgery. In the more immediate post-operative period, it may be easier to simply cover the area with a bandage whenever you are exposed to strong sunlight.
You should generally avoid vigorous exercise or strenuous exertion such as lifting or straining for a minimum of 3 weeks following surgery. Sometimes, you may begin light exercise after 10 to 14 days, if approved by Dr. Basak. In such a circumstance, small surgical paper tapes (e.g Steri-strips) across the incision may be very useful.
It is not unusual during the healing phase to note some irregularities under the skin. These small distortions will gradually subside and eventually resolve. Small bumps under the skin may be present due to deep sutures used during the surgery. These bumps will almost always flatten out as the deep sutures are dissolved by your body.
Do not massage, rub, or place any tension on the incision for a minimum of 6 weeks after your surgery.
What Kind of Scar Care Should I Do?
- Silicone Scar Sheets and Silicone Gel
You can start applying silicone-based scar products to the wound one week after suture removal. Silicone is the most effective scar product and comes as a gel or a sheet. The sheets provide more rapid improvement than the gel but donot stick well in areas with oily skin, thicker hair, or active movement; the gel works better in these locations. Silicone products can be purchased at the pharmacy or online. A reliable, easy-to-find brand online (e.g. Amazon) or at most pharmacies is ScarAway. To use the sheets, place the sticky-side down over the incision so that it completely covers the scar and overlaps onto normal skin, and try to wear for at least 12 continuous hours. The more you wear it, the more it softens the scar, fades redness, and promotes faster healing. The gel can be rubbed gently into the scar twice daily. Use the silicone product for 2-4 months, or until scar has softened and redness has faded. - OK to start using make-up 1 week after sutures are gone
- Sunscreen
Start covering the scar with broad spectrum sunscreen SPF≥30 1 week after suture removal in order to prevent darkening (if scar is covered by an opaque silicone sheet or bandage, then sunscreen is not necessary). Scars, especially new scars, tan much more easily than surrounding skin. After a year, they become less sensitive to sunlight but they will always be slightly more prone to pigmenting. - Scar Massage
Start scar massage six weeks after surgery. Use silicone gel or lotion as a lubricant. Applying direct downward pressure to the scar, start at one end of the scar and rotate your finger in a circular motion, pushing as hard as you can without hurting yourself. Then move your finger to the next adjacent area of the scar and repeat. Do this until the entire scar and repair area (for flaps and grafts) has been massaged. Spend additional time on any areas of the scar that are particularly raised or bumpy. Massage 2-3 minutes three times daily for 8 weeks. This is the single most helpful thing you can do to help a scar fade and disappear. - Dermabrasion and/or Kenalog (steroid) injection
These are done in the office with Dr. Basak. If any part of the scar remains raised or bumpy 10-12 weeks after surgery despite silicone and scar massage, call the office and schedule a follow-up with her. She will assess the area and determine if dermabrasion or Kenalog injection are appropriate. Dermabrasion uses medical-grade sandpaper to literally smoothen and buff the edges of a scar and blend it into normal skin. The Kenalog steroid shot flattens elevated scars or any persistent tissue fullness. - Scar Revision
Although not common, an additional surgical procedure is sometimes required in order to achieve the best cosmetic or functional outcome. If you are concerned about your scar, schedule a follow up with Dr. Basak to discuss the options.
Recovery Timetable
Approximate healing of most incisions is as follows:
DAY 1 – Return home, leave surgical dressing undisturbed. Take pain medication q4-6 hours.
DAY 2 – Aching, throbbing – usually not present if have been taking pain medication. Leave dressing in place.
DAY 3 – Remove the dressing and start cleaning wound with 3% hydrogen peroxide or Hibiclens, followed by application of ointment. Cover with non-stick bandage.
DAYS 5-6 – Daily dressing change.
DAY 7 – Non-dissolving facial stitches removed.
DAY 14 – Non-dissolving trunk, extremities, scalp stitches removed. Can start using make-up and sunscreen on face. Can start silicone scar gel/strips.
WEEKS 3-5 – Protect incision with daily sunscreen of at least SPF 30. Avoid direct sunlight. Continue silicone scar gel/strips.
WEEK 6 – Begin scar massage. Continue silicone scar gel/strips. Consider dermabrasion.
WEEK 12 – Evaluate need for surgical revision, dermabrasion, and/or Kenalog injection. Can discontinue silicone scar gel/strips if scar flat and faded.
MONTHS 4-6 – Scar flattens and redness fades. Complete any surgical revisions necessary. Scar massage and silicone gel/strips as needed.
MONTHS 6-12 – Scar continues to fade.
1 YEAR – Final result.