Post-operative

Procedures  | Post-operative

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Click on your procedure for a brief description.

• Breast Augmentation

Rest and leave the dressings in place for first 24 hours after the operation. After the first 24 hours, you may remove the support bra (provided to you at the end of the operation) and dressings.You may shower if you wish but try to keep the steri-strips covering the wound dry. Place small pads over the incisions and allow the support bra to hold these dressings in place. (The incisions should not be immersed in water while sutures are in place.)

Allow the steri-strips to remain in place until they begin to come detached by themselves. Many times they will remain adherent until the first post-op visit. At other times, they may detach themselves. If this happens, you may remove them. New steri-strips need not be applied.

A small amount of drainage is expected for several days after the operation. Large amounts of drainage that soak the dressing should be reported to Dr. Zubowicz.

Other than when showering, the support bra should be worn at all times, including sleeping. After one week, you may use a sports bra or another bra that is supportive, but no underwire bras for 6 weeks.


Shampoo your hair only with assistance for several days. The patient should not lift their arms over the head until the pain has subsided. Furthermore, lathering in hard to reach areas should be done by an assistant.

After the first 24 hours, light activity is permitted if it is comfortable. This would include walking, riding in a car, or any activity that is not strenuous and does not involve use of the arms. Driving may commence when the pain has gone. (Light exercise may begin in one week after procedure if the pain has subsided and the arms will not be used.) Tennis, swimming, running and golf are not permitted. Furthermore, any exercise that involves excess movement of the breasts is to be avoided. Walking is a superb exercise, as is riding an exercise bicycle.

Four weeks after the operation, most patients can resume their normal lifestyle and exercise habits. You will be seen in the office at this time and receive a medical clearance. It is advisable to work into your exercise routine over several days.

Work may resume if it does not involve strenuous physical activity or use of the arms and there is no pain. Most patients can return to desk-type jobs in 4-5 days. If the pain increases or excess fatigue occurs upon work, go home and rest.

Sleep on your back as much as possible. Sleeping on the stomach will put pressure on the chest, while sleeping on the side requires extension of the arms. You may put pillows at your sides for comfort.

**Remember: any activity that increases pain should be stopped.**

Complications

Complications are very uncommon after breast augmentation. When they do occur, they are treatable best if they are recognized and addressed immediately. The complications that may occur after the operation and before the first office visit are infection, wound separation, or hematoma (this is an abnormal collection of blood in the implant pocket). The following observations require an immediate call to the office:


• Excessive drainage, especially if it is foul smelling.
• Fever and chills.
• An excessively swollen or tight breast especially when compared with the opposite side.
• Severe pain not responding to the prescribed pain medication. Obviously some pain is to be expected. It should get better, not worse, with each day.

Other observations may be made that are not listed here. This does not mean that they are not important. If anything causes concern, please do not hesitate to contact the office.
• Breast Reduction

POST-OPERATIVE INSTRUCTIONS BREAST REDUCTION OR MASTOPEXY 1. Remove dressings the first day after surgery. Shower with mild soap and water. If cotton balls are present over the nipples, take a bath making sure not to get the cotton wet. Blot incisions dry and put postop bra back on. You may have some oozing or perhaps slight bleeding. Place a 4 x 4 gauze pad against the incisions and let the bra support the pad. Wash your incisions twice a day and dry well. You may use a little Neosporin or Polysporin ointment until the stitches come out. You will continue to wear the surgical bra day and night, other than when showering, for at least the first two weeks post-op. You may then switch to a good support sports-type bra that closes up the front. You should not wear underwire bras during the healing period because the wires may irritate the suture lines.

2. Light activity only the first two days after surgery, then gradually begin to increase from day to day. By the third or fourth day postop you should be able to go about your basic daily activities. Soreness will persist for at least several more days. Most patients can return to desk-type work when they feel comfortable (about one week). Remember, absolutely no heavy lifting, pushing or pulling until released by Dr. Zubowicz.

3. Have your prescriptions filled prior to surgery and take all medications as prescribed by Dr. Zubowicz. If you do not use the Phenergan suppositories, you may store them in the refrigerator where they will keep for up to a year.

4. Schedule a follow-up appointment with Dr. Zubowicz for one week after surgery. Your stitches will probably be ready to come out the following week. The stitches around the nipple stay in place and will dissolve over time.

5. Do not be alarmed if your breasts are not completely round or symmetrical immediately after removing the dressings. Swelling will create temporary distortion and this will correct itself in several weeks. Any large differences in size should be reported to Dr. Zubowicz. In rare cases a hematoma (collection of blood under the skin) may cause one breast to be much larger and/or more painful than the other. In this case, Dr. Zubowicz would need to see you immediately.
• Breast Reconstruction

POST-OPERATIVE INSTRUCTIONS - BREAST RECONSTRUCTION 1. Activity: When released form the hospital, REST! Absolutely NO strenuous pushing, pulling, lifting or exercises. Put pillows behind your back and under your legs to keep your waist flexed. Avoid any repetitive movements with your arms as this may increase swelling. Walking is an excellent form of exercise. You may find that you may not be able to stand up straight for several days after the operation.

2. Drains: There will be two drains in the lower abdomen and possibly one in the axilla. These drains help remove fluid that can prevent proper healing and cause minor discomfort. These drains are sutured in to prevent accidental removal. If this happens, notify Dr. Zubowicz. You may sponge bathe or get in the shower (with assistance), however, do not immerse yourself in the bathtub. There will be some drainage from the drain sites. This is expected and is not cause for alarm. Keep a clean gauze pad against the drain site. If your drains were removed, you can expect the holes to close in a few days.

3. Cleansing: Gently cleanse the abdomen and your new breast(s) with hydrogen peroxide or mild soap and water. Be sure to cleanse the umbilicus (belly button) by pouring peroxide into it, letting it bubble for a moment, and then gently use a clean cotton swab to dab out any dried blood or drainage. Apply an antibiotic ointment to your incisions. Neosporin, Polysporin or Bacitracin Ointments are all acceptable and may be purchased over the counter at your local drugstore.

4. Dressings: Apply clean gauze pads over the incisions and put your surgical bra and/or abdominal binder on, letting them support the pads (tape is not necessary). Change the pads after bathing and when soiled with drainage - at least once a day. Keep the abdominal binder around your waist. Do not let it ride up around the new breast.

5. Medications: Take your pain medication as directed. Narcotic medication can cause constipation and/or nausea. Use Tylenol for mild pain relief. If antibiotics are prescribed, be sure to finish all of them.

6. Follow-up Appointment: Call the office and make an appointment to be seen by Dr. Zubowicz 3-5 days after you are released form the hospital. At that time your drains will be removed. Your sutures will be removed one week after that.
• Facelift

Activity: For the first 24 hours, rest is absolutely necessary. Elevate the head and talk as little as possible. Sleep in a recliner if possible or with your head on several pillows.

Dressings: A large bulky dressing is placed immediately after the facelift. This to catch any drainage, to provide gentle pressure to diminish swelling, and to force the skin to re-adhere itself to deeper tissues, thus preventing fluid build up between the tissues. This dressing should be left undisturbed until it is removed by the doctor or his assistant, usually on the first post-operative day. A smaller, lighter dressing replaces the bulky postoperative dressing. This should be left in place for one day, then removed. You may then shower, gently washing the hair with a mild shampoo. If there is no further drainage, another bandage will not be applied. Elastic compressive straps are generally prescribed for several weeks after the operation. These are easily removed for bathing. Please wear these as much as possible and especially at night.

Drains: Drains are usually placed under the skin to evacuate collections of serous (yellow) or blood-tinged fluid. These drains are connected to a plastic bulb which generates suction. If used, the drains will be removed the first postoperative day by Dr. Zubowicz or one of his nurses. If you do go home with a drain, we will instruct you in its management at that time.

Showering: You may remove your bandages and shower the first day after your operation. You may need some assistance in the shower. Use a mild shampoo (like baby shampoo) to shampoo your hair, and to cleanse the suture lines. Use a good conditioner to rid the hair of tangles The hair is likely to be more tangled than usual due to bits of blood clinging to the hair.

Brushing and blow drying the hair is allowed if performed carefully. The blow dryer should be set on low heat. Remember that the scalp may be numb in certain areas and in this unprotected state could be inadvertently burned. Hair coloring and permanents should be avoided until three weeks from the time the sutures are removed.

Postoperative Office Visits: Schedule your first postoperative visit for five days after your operation. At this time the stitches in front of your ear will be removed. Your next visit will be a week later, when the rest of your stitches will be taken out. Dr. Zubowicz will then want to see you again two to three weeks later, then as needed.

Driving: This should not be resumed until it is comfortable to move the head about without any restrictions from pain or swelling. This is usually around two weeks postop.

Exercise: During the first postoperative week, activity should be kept to a minimum - only what is necessary to take care of oneself. Over the following two weeks exercise may be gradually increased. There should be, however, no strenuous activity as this may increase facial swelling and compromise the final result. Walking is a superb way of getting exercise and not jeopardizing the operation. After about three weeks, exercise may be increased incrementally until the normal routine is recognized at six weeks. Judgment, however, must be used. Not all patients heal alike.
• Browlift

1. After the operation there will be an elastic compressive strap holding your dressings on and applying gentle pressure to the brow. Leave this dressing on for 24 hours. You may reinforce it if necessary.

2. Elevate your head on several pillows or sleep in a recliner. Elevation helps diminish the swelling. Ice compresses should be used for at least 24 hours, or longer if desired.

3. You may remove your compressive strap and dressings after 24 hour and gently wash your hair with a mild shampoo such as baby shampoo. Use a good conditioner to help remove tangles from the hair. Avoid pulling on the sutures when brushing the hair. You may experience some numbness of your scalp, so be sure to use the low heat setting if you blow dry your hair. There is no dressing needed after a browlift.

4. Some bruising and swelling is expected with this procedure and should resolve within ten days or so. You may experience blurred vision due to ointment used in the eyes during this surgery. This should resolve in 24 hours or so. Headaches are to be expected and should resolve within the first three to five days. You may have numbness or decreased function of your forehead. This may last a few days to a few months. This is generally due to injections of a local anesthetic and/or swelling around nerves. The scalp behind your incision may remain numb and/or itchy for several weeks to months.

5. Every patient heals differently. Your final result will not be achieved for several weeks to months.

6. Take all medications as directed. If you have any questions, please feel free to contact the office.

7. Avoid foods which contain salt, particularly canned foods such as soup, as this can aggravate swelling.

8. You may drive a car when you can comfortably move your head and have no blurring of vision. No bending over, heavy lifting or strenuous exercise should be done for the first four to six weeks. You may walk to keep in shape as this will not compromise your healing or final result. Dr. Zubowicz will advise you on increasing your activity at your office visits.

9. Please schedule a follow-up appointment in 7 to 10 days to have your sutures removed.
• Laser

Dr. Zubowicz will follow you closely after your laser treatment. This may necessitate several office visits the first few weeks as your skin resurfaces. This is determined on an individual basis and will not be the same for any two patients. Flexan topical wound dressing in some cases will be placed on the affected area after your treatment. This will be changed in our office as needed over the first few days.

Antibiotic: You may be prescribed an antibiotic. Be sure to take all of it, beginning in the evening after your surgery until all the medication is gone, usually five days.

Continue to take the Valtrex 500mg two times a day for seven days after laser surgery.

In the afternoon following your procedure you will begin this regimen (if you have flexan over the affected area, wait until the flexan is removed):

1. Gently wash the affected area with Technicare wash and facial sponge three to four times a day. Rinse off completely when finished.

2. Follow the above with dilute vinegar soaks (one tsp. Vinegar in pint of water). This will aid in the removal of tissue or eschar. Soak a clean washcloth in the water or vinegar solution and hold against the affected area(s) rinsing often. Do this ten to fifteen minutes - three to four times everyday. It is very important that you clean as much of the yellow eschar tissue off the lasered area as possible. If you do not clean the eschar tissue off properly it can become dry and crusty - resulting in scarring.

3. After soaks - cleansing regimen, apply Aqua Phor as a protective and hydrating crème. Apply this ointment liberally. It is important to keep the area moist. Do not let the lasered area become dry.

4. Follow this regimen until wound is completely covered with the new, pink skin.
• Liposuction

Activity: Rest for 24 hour after the operation. It is permissible to walk around enough to take care of your basic needs but nothing more. After 24 hours you may walk or ride in a car but no strenuous activity. When the pain has subsided, it is permissible to drive a car and return to work providing that your job does not involve strenuous activity. The duration of discomfort will depend upon the size of the treatment area and your individual tolerance to pain.

Bathing: Only sponge baths are permitted during the first 48 hours.  After that, when dressings and garments are removed, you may shower. Do not immerse the sutures in water (i.e. no baths, no swimming). The sutures will be removed one week after your operation, providing that your wounds are healed.

Dressings: The area to be suctioned will be covered with an adhesive compressive tape under a compressive garment. These insure that the area suctioned has gentle pressure applied. This helps the skin re-adhere to the underlying tissues, avoiding any space for fluid to accumulate. The tape and the garment must be left in place for 48 hours. After this you may remove the support garment and set it aside. The tape may be very adherent to the skin and difficult to remove. Get into the shower and let water or baby oil help remove it. Afterwards, cleanse the area under the tape gently with soap and water.

A support garment will be provided and should be worn at all times. It is permissible to remove it to bathe and for short periods of time to allow your skin to breathe. The garment is fully washable but should not be put into the dryer as it may shrink. The longer it is off the more difficult it may be to put it back on because of swelling. Other types of compressive garments are perfectly acceptable to wear providing that they are compressive and snug. These garments should not be too tight, however. Places to buy these types of garments include J.C. Penny's, Sears or sports stores.

Drainage: A modest amount of drainage from the incisions will be present for several days and is to be expected. The volume of drainage is variable. It should not be copious, nor have a foul smelling odor. It should decrease in amount over a few days. If this is not the case, please call the office.

Daily activities and work: You may return to work and your daily activities when the pain has subsided. This does not include strenuous activity such as aerobics, tennis, swimming, etc. which can increase swelling. Convalescence is quite variable depending on the size of the area treated, the amount of fat removed and the individual tolerance to pain. If activity generates pain or fatigue, rest is required.

Complications: Complications are extremely uncommon with liposuction. All patients have some bruising and swelling. These are not complications. Do not become alarmed if the bruising appears excessive. This will go away. Furthermore, swelling post-operatively may hide the final aesthetic product. It may take several months to see the final result.

Some discomfort is to be expected, and a prescription will be provided for this at your preoperative workup. Take this medication as directed. The pain should diminish in intensity from day to day. Some redness and warmth over the treated area is to be expected.

Abnormal collections of fluid and infections under the treated area do occur, although rarely. The following signs should prompt a call to Dr. Zubowicz: 1. Drainage that is excessive or foul smelling. 2. Fever and/or chills. 3. Excessive warmth and tenderness of treated area. 4. Severe pain not responding to pain medication.

Other observations may be made that are not listed here. This does not mean that they are not important.
• Abdominoplasty

Activity: When released from the hospital, REST! Absolutely NO strenuous pushing, pulling, lifting or exercises. Put pillows behind your back and under your legs to keep your waist flexed. Walking is an excellent form of exercise. You may find that you may not be able to stand up straight for several days after the operation.

Drains: There will be two drains in the lower abdomen. These drains help remove fluid that can prevent proper healing and cause minor discomfort. These drains are sutured in to prevent accidental removal. If this happens, notify Dr. Zubowicz. 24 hours after the surgery you may sponge bathe or get in the shower with assistance. DO NOT immerse yourself in the bathtub until the drains have been removed.

Cleansing: Gently cleanse the abdomen with hydrogen peroxide or mild soap and water. Be sure to cleanse the umbilicus (belly button) by pouring peroxide into it, letting it bubble for a moment, then, gently use a clean cotton swab to dab out any dried blood or drainage. Apply antibiotic ointment to your incisions. Neosporin, Polysporin or Bacitracin Ointments are all acceptable and may be purchased over the counter at your local drugstore.

Dressings: Apply clean gauze pads over the incisions and then put your abdominal binder on, letting it support the pads (tape is not necessary). Change the pads after bathing or when soiled with drainage, at least once a day. Keep the abdominal binder around your waist other than when showering. You will probably want to replace it with a foundation garment one to two weeks after surgery.

Medication: Take your pain medication as directed. Narcotic medication can cause constipation and/or nausea. Use Tylenol for mild pain relief. If antibiotics are prescribed, be sure to finish all of them.

Follow-up Appointment: Call the office and make an appointment to be seen by Dr. Zubowicz 3 - 5 days after you are released from the hospital. At that time your drains will be removed. Your sutures will be removed one week after that.
• Rhinoplasty

1. Do not remove any nasal splint, nasal packing or steri-strip tape on your nose unless instructed to do so by Dr. Zubowicz. Do not insert any Q-tips, Kleenex or any other object into your nose in an attempt to clean it out. If it is necessary, you will be instructed on what to do on your first postoperative visit. Apply ice wrapped in a cloth on your forehead and/or cheeks after the operation for 6-8 hours but do not place it directly on your nose.

2. Sleep in a recliner or with your head elevated on several pillows to help decrease swelling. Avoid bending your head forward as much as possible. (Someone should assist you in washing your hair so that you do not need to bend forward). You may bathe 24 hours after the operation but do not get the nasal dressing wet.

3. Expect to have swelling and bruising around the nose and eyes after the operation. The amount of swelling usually depends on the extent of the operation. The bruising will last around 10-14 days and will change color as you heal. The swelling usually lasts several weeks. Swelling in the tip may last several months. Be patient!

4. Do not blow your nose. If you have drainage, blot it away gently with gauze or tissues. You can expect to have some drainage for several days. Be very gentle when blotting your nose. Do not pinch or push your nose in an attempt to decrease drainage. If drainage becomes profuse or has a foul odor, please call the office.

5. Avoid aspirin and anti-inflammatory containing products for two weeks after your operation.

6. Diet: Easily digested foods such as ginger ale, jello, etc. for 24 hours. Take your pain medication with crackers to avoid nausea. Avoid salt in your diet absolutely as much as possible as it will increase swelling. Do not eat any canned soup or food because they contain an unusually high content of sodium.

7. Avoid heavy lifting and strenuous activity which can increase drainage, bleeding and swelling. You will be instructed when you may return to athletic activities by Dr. Zubowicz after he sees you for follow-up visit in the office. Make-up may be applied several days after your operation, as long as it does not interfere with the nasal splint, packing or steri-strip tape. Do not wear any glasses that lie directly on the bridge of the nose.
• Cheek or Chin Implants

1. Elevate the head for the first 48 hours after your operation.

2. Incisions made inside the mouth are closed with an absorbable suture, which will dissolve in approximately 7-14 days. These stitches do not need to be removed.

3. Brush your teeth very carefully. Avoid trauma to the incision. Rinse your mouth four times a day with a dilute solution of hydrogen peroxide and water.

4. Eat a liquid diet for the first few days after your procedure. You may then start a soft diet taking care to avoid vigorous chewing.

5. Some swelling and bruising are expected. This should subside in 10-14 days.

6. Take all medications as directed by Dr. Zubowicz. Finish all antibiotics.
• Minor Surgical Procedure

After a minor procedure, there will be dressings and sutures to be cared for. Depending on the circumstances, slightly different wound care will be prescribed. Listed below are the instructions for most of the incisions and their dressings. Most incisions will be covered with a small dressing secured by tape. The tape and the absorbent pad should be removed the day after the procedure.

Underneath the pad, one of two situations will generally be observed: A. The sutures and wound will be exposed, OR B. The wound will be covered with steri-strips (reinforced tape directly over the sutures).

A. If the wound and sutures are visible:

1. Clean wound gently with soap and water or peroxide twice a day. 2. Cover wound after cleansing with a thin layer of antibiotic ointment (Neosporin, Polysporin, or Bacitracin). 3. The wound may become wet during bathing or showering but should be carefully blotted dry afterwards. 4. You may replace gauze pad over the wound if you choose, but it is not necessary.

B. If steri-strips are covering the wound:

1. Keep the wound clean and dry as much as possible. 2. You may shower and if the steri-strips become wet during bathing, allow them to air dry. 3. If the steri-strips should begin to come loose, you may gently remove them and treat the wound as outlined above in this section, “If wound and sutures are visible.”
• MOHS Closure

1. In most cases, you will have a cotton ball tie-down dressing covering the area that Dr. Zubowicz operated on. This will stay in place until your first postop visit, usually three days after the operation, at which time it will be removed.

2. Once the tie-down is removed, you may wash the area with mild soap and water. Do this twice a day, being sure to carefully pat it dry each time, then apply an light coating of antibiotic ointment, such as Neosporin or Polysporin.

3. Make an appointment to see Dr. Zubowicz again around your seventh to tenth day postop. At this time your stitches will most be removed.

4. Continue to wash the area twice a day and apply ointment or your usual facial moisturizer with a sunscreen will be permissable until all the scabbing is gone and only new, pink tissue is in place. Once this is the case, you may begin to use makeup concealer if you wish until the pink coloration fades.
• Local

After a minor procedure, there will be dressings and sutures to be cared for. Depending on the circumstances, slightly different wound care will be prescribed. Listed below are the instructions for most of the incisions and their dressings.

Most incisions will be covered with a small dressing secured by tape. The tape and the absorbent pad should be removed the day after the procedure.

Underneath the pad, one of two situations will generally be observed: a. The sutures and wound will be exposed, OR b. The wound will be covered with steri-strips (reinforced tape directly over the sutures) If the wound and sutures are visible:

1. Clean wound gently with soap and water or peroxide twice a day. 2. Cover wound after cleansing with a thin layer of antibiotic ointment. (Neosporin, polysporin, bacitracin) 3. The wound may become wet during bathing or showering but should be carefully blotted dry afterwards. 4. You may replace gauze pad over the wound.

If the steri-strips are covering the wound:

1. Keep the wound clean and dry as much as possible. 2. You may shower and if the steri-strips become wet during bathing, allow them to air dry. 3. If the steri-strips should begin to come loose, you may gently remove them and treat the wound as outlined above in the section "If wound and sutures are visible".
• Otoplasty

1. For 24 hours after your operation you should rest with your head elevated on several pillows or in a recliner.

2. Leave the compressive dressing on your head for 48 hours. You may then gently remove the dressings, being careful to avoid pulling on the ears. If the dressing sticks to the ear, gently tease it away. If you are uncertain about the dressings, you may come to the office and we will gladly remove them for you.

3. After the dressings are removed, you may shampoo your hair gently cleansing the ears with lather from the shampoo. Baby or a gently shampoo is recommended. Blot the ears dry and put the compressive strap back on the head. This will prevent accidental injury to the healing ears.

4. The sutures dissolve in about 7-14 days and do not need to be removed. You should however, be certain to return to Dr. Zubowicz for regular follow up appointments as instructed.
• Post-operative Visit Schedule

Abdominoplasty: 3 to 5 days for drain removal, 10 to 14 days for suture removal

Breast Augmentation: One week

Breast Reduction/Mastopexy: One week; 10 to 14 days for suture removal

Browlift: 5 to 7 days for suture removal

Eyes: 5 days for suture removal

Facelift: Next day (In some cases the patient must stay overnight) day 5 for suture removal

Laser: Day 3 - 5, return for exam

Liposuction: 5 to 7 days for suture removal

MOHS Closure: 3 to 5 days for suture removal

Rhinoplasty: Day 1 for packing removal; Day 5 for splint removal.