Facelift Post-Op Week 1 & 2: Twenty things I Wish I Had Known Before Surgery
Six Months Before Procedure.
******* WARNING - CONTAINS GRAPHIC SURGICAL IMAGES. ***** WARNING - CONTAINS GRAPHIC SURGICAL IMAGES ***** WARNING **********
RELATED LINKS: WEEKS 1 AND 2, WEEK 3, WEEK 4, ONE MONTH FOLLOW UP, WEEK 7, WEEK 8 , 2 MONTHS, WEEKS 10-11, WEEK 12, 3 MONTHS, WEEK 14, 2 Year Anniversary
A facelift was never on my “to do” list. I had always been fit and healthy, and planned to “age gracefully”. But years of sun-worshipping in my teens and twenties (and beyond) were catching up with me. As age 60 approached, wrinkles and sagging jowls became more evident in my cooking demos and selfies. I was starting to look much older than I felt. I asked my dermatologist if it were possible to just pull some skin back and “y’know, just kind of get rid of it”, and learned the pull-the-skin-back-and-go lift of our grandmother’s day was over. He referred me to a plastic surgeon well known for her aesthetic work. From her, I learned about what is know as a “deep plane” lift, in which the surgeon elevates the skin above and around the ears and tightens the supporting muscles before trimming and re-attaching the skin. This technique is designed to help prevent that high-brow, windblown look of the earlier operations. The best part? For good candidates, results can last around ten years. I was in.
Home following surgery and pit stop at McDonalds. The purple lines were drawn by the surgeon for the fat transfer procedure and faded in about a week.
Steps Before the Surgery
During the weeks prior to the surgery, I spent time reading about the procedure and psyched myself up for the ordeal. To make the procedure fit my budget, I had elected to have the procedure performed directly in the surgeon’s office as an outpatient, under heavy sedation (a mix of prescription pain relievers and opioid-based pills). Ask if your surgeon offers this option if you would prefer not to be “put under” or need an anesthesiologist. My main concern was that these five little pills might not keep me asleep during the five-hour procedure. I also wondered if the surgeon’s office be as sterile as a hospital. My surgeon assured me that she would be using local anesthetic in concert with the medication so even if I woke up a bit, I would not feel anything. Her office was cool, clean and comfortable. The total fee was about $6700, and included $850 for a “meso - mix”, which included some Botox to smooth wrinkles around my mouth. She would also use liposuction to remove some fat from my stomach for use around my mouth and cheekbones. Part of the fee was for a sterile surgical tray.
I took the prescribed meds an hour prior to the surgery as directed, and was awake for the first few injections. Because I was also having meso-mix and abdominal fat transferred to my lip and cheek area, she also “numbed up” my upper and lower gums inside my mouth near the front teeth — while I was groggy but still awake. I typically hate shots right in my mouth, but remember thinking my surgeon did them better than any dentist. I remember telling her this, and heard her laugh and say “everyone says that” and then I was gone. I vaguely remember waking up and taking one more pill at some point. I remember hands on my head, and my face being turned to the other side a couple of times. I did hear one “snip” of scissors, but it didn’t stop me from passing back out immediately. I also heard liquid in one ear (more on that later). The procedure lasted for the full five hours. I was told upon waking that everything went perfectly. I was relieved to have the surgery over, and also hungry (!) so asked my husband if we could stop for my favorite personal reward — a McDonald’s Filet-O-Fish — on the way home. My head was wrapped like a mummy, so we used the drive-through. I relaxed, and looked forward to getting home to get some rest.
Unfortunately, rest didn’t happen much those first few days. I’d spent weeks preparing for the procedure, but had failed to prepare for the marathon that would follow. I realized I had only skimmed over the recovery sections of everything I read, thinking the worst would be over with the surgery behind me. I knew I must sleep sitting nearly upright, wearing an elastic bandage around my face, for at least a week. I did not know how difficult this would be. Do try sleeping this way prior to the procedure, to find a comfortable position using the correct number of pillows. You may wish to rent a medical chair (I actually had one in storage, and was glad I did). I also never imagined I would not be able to tolerate my pain meds. Be sure to talk to your doctor about what you should do if this happens. I simply went without, and it was no picnic.
Next, the procedure requires several return trips to the surgeon’s office. The first takes place the following day. Trust me, the last thing I wanted to do the day following a night of restless sleep, nausea and pain was to get out of bed, get dressed, and get in a car to drive one hour to my surgeon’s office. The next visits follow (typically) at five days, eight to ten days, three weeks, and three months (more on these visits below).
The following list is not meant to be a substitute for medical advice provided by your doctor. It is based solely on my experience, and different surgeons may have different methods than mine. These pointers are meant to be somewhat entertaining, as well as hopefully stimulate conversation about your after-care expectations between you, your surgeon and your personal support team.
1. Realize it is your job to plan for and be be prepared for your own recovery. Get ALL the opinions. Your doctor will have some instructions on their website, but research, research, research! It seems every surgical center in the world has a page on recovery. Take notes and don’t be afraid to ask questions! If you see information that conflicts with your doctor’s advice, bring it up with your doctor or her/his staff. For instance, my surgery center’s website directs facial surgery patients to “lift nothing heavier than a newspaper” for the first two weeks. Another surgery center’s site suggested patients "may be able to do light housework” after the first two days. That’s a pretty huge difference in expectations.
DAY FIFTEEN - HEALING NICELY! NOTE THE CONTINUED BRUISING.
2. Many informational sites sponsored by actual surgeons (and their lawyers, certainly) include a blurb about using an American Society of Plastic Surgeons (ASPS) Board Certified plastic surgeon. I was glad to learn about the rigorous standards for this and other similar professional designations. Check your surgeon’s credentials. Take time to learn about the different types of designations. This is your face. Don’t take chances.
3. Listen to your doctor, but also listen to your body. I learned to respect my body’s experience and reaction to surgery and understand it is different from anyone else’s. It was easy to become disheartened when my recovery veered from “textbook”. If I got tired, I sat down. If I needed help, I asked for it. I had to make it “OK” to slow myself and let my body do the hard work of healing itself. What you want to hear (i.e., you can go back to the gym in three weeks!) isn’t necessarily going to be your reality. Plan ahead. Don’t rush yourself. Give yourself the gift of at least two weeks time. If you heal faster, that’s fantastic! Enjoy your time off like a mini-vacation.
4. Have an honest discussion about expectations with your caregiver(s). You will need a driver for the surgery day, of course, but will you feel alright driving yourself to the 24-hour follow-up visit? You may still be taking heavy pain medication. You may also need personal assistance — some of it intimate — for far longer than the suggested first 24 hours. You may get sick from your pain medications (I did, and was unable to take any pain medication for the duration). You may not be able to ice your own sutures or even find them (they are buried in your hairline and around your ears). In rare cases, you may spike a temperature and end up needing emergency care. Hire a nurse if you think you should. This is surgery and should be taken seriously! You will have drains coming from behind your ears that need to be monitored. One surgeon’s office expects patients to check ad empty facial drains every 6-8 hours and record each drain’s output — in millimeters. My surgeon just told me to check it regularly, and make sure to keep light suction in the drains. Be prepared for this as it MUST be done. I was so nauseous that first day I could not have done this if I wanted to. My husband emptied my drains for me and measured the output, and watched a YouTube video to learn how to re-attach and keep the correct suction in the drains. I don’t even remember him doing it. In the end, I needed help with almost everything for the first three full days and nights, including timing my medication.
5. You will be told you can shower after 48 hours. You will probably not want to. Your head will feel like you are washing Baby Yoda. You may lose plugs of hair where the sutures displaced your skin. Use the recommended baby/gentle shampoo where you dare. Be gentle, using a baby washcloth. You will not be able to feel much of your head — remember, many nerves may have been cut! For me, the area around both ears, temples and much of the area under my jaw were numb for more than two weeks. I mostly let lukewarm water gently float away the hair, sweat, etc. Some people include a brow lift with their facelift, which would require even more specialized care. It may be best to have a friend in the bathroom with you in case you feel dizzy.
6. Do not plan to go back to work, parenting or the gym for about 10 days, and do not plan to work very long days or lift much for about three weeks when you must go back. Your energy level will lag even longer if you were sick at first, and unable to eat the recommended ‘high protein’ diet. Don’t even try to lean forward to clean a litter box. Your face will throb. Get a pedicure before your procedure, as it’s won’t be easy lean forward to reach your own toes for a while.
7. Your sutures will seem gigantic and you will feel like a zombie or Frankenstein’s monster for about ten days. Pulling your hair back into a ponytail will frighten small children. After the stitches are removed the scabs will start peeling away around your ear, upper hairline and about 3” into each side of your lower hairlines. Do not plan to go out unless you plan to wear a floppy hat and hair pulled waaaaay over the top of your ears. Wearing glasses was difficult, too, and the masks for Covid-19, still required for many establishments, were impossible. Remember, you just had stitches and staples all around your ears. The skin may be tender for several weeks, even after the stitches are removed. Don’t plan a big “coming out” party two weeks after surgery only to be disappointed by remaining bruising and swelling. Review the section of your recovery expectations that states how long it can take for all (or at least most) of your bruising and swelling to resolve. Most sites note it can take from three months up to a year. Mentally prepare yourself for this.
DAY FIFTEEN - NOT HEALING SO NICELY…BUT TOLD IT WILL BE OK. EXTREME BRUISING HERE.
8. Tubes and stitches and staples — oh my! BE PREPARED for your first return visits. The day after surgery you will return to your surgeon’s office to have your mummy bandage removed and drainage tubes, which feel like foot-long silly straws, pulled out from under your skin behind each ear. It was mildly alarming when one nurse stood on each side to pull them simultaneously, but for me it did not hurt. Expect it to feel like the strangest millisecond tickle you’ll never forget. When I asked why they pull them at the same time, I was told some people freak out a little. Next, you will be fitted with an elastic facial support garment. This garment will be your best friend for at least the next couple of weeks.
A little more about your drains. The clear, hollow fluid-receiving ends are about the size of a computer mouse, and catch fluid build-up from under your skin. The draining tubes and ends together look like Jar Jar Binks’ ears. As I noted above, you are expected to monitor and manage these devices. My husband reports he removed and drained them for me (I was reeling with nausea). The first night one had 20 mg of fluid, and the next morning the second had 25 mg. I didn’t ask what he did with that nasty, pinkish fluid, but I expect he flushed it down the loo.
9. Next up: Stitches and staples. The stitches and staples were removed in the following two visits. Be prepared for snipping sounds, some tugging, and possibly a sensation of needle pricks as the sutures are snaked from your skin. The “front” (ear) stitches typically come out first. As the assistant clipped what felt (and looked) like scabby and seeping fishing lines I felt very little (remember, many nerves were cut…thankfully). The back stitches and staples — think the kind that holds a sheaf of paper together — were removed at the next visit three days later. They were not uncomfortable to remove, as long as the area being pulled was still numb from severed nerves. The few areas that retained nerve endings nearly sent me to the ceiling, but I breathed through it. On a of 1 - 10 pain scale it was about a 2, but on the “ick” scale it was a 7.
10. Keeping your facelift a secret will not be easy. The first week will be spent wearing a facial sling for support. This sling is your best friend. The second week the sling is often worn only at night. Some websites suggest wearing the sling during the day (at least) when you’re alone for the first 30 days. And don’t forget about the yellow and purple bruises, and large train tracks of stitches around the ear lobe. They’ll tell you everyone’s different, but I’m sorry. You just had major surgery on your face. Plan on looking like it for a while.
11. You will get food cravings. Maybe it’s a return to childhood comfort foods, but when I finally stopped vomiting I wanted a McDonald’s Filet-O-Fish so bad, I could have eaten three of them. It could have been that my post-op sickness disrupted electrolytes with the vomiting, and I was craving the salt and fat. Talk to your doctor about the possibility that you may not tolerate your prescribed pain meds. My husband drove to town for me to pick up my craved food (it was day three post-op and I felt comfortable being alone for short periods) and I wanted to cry with joy as I ate that McDonald’s Filet-O-Fish. Sadly, now I don’t want another one and expect I may not for a long, long time.
12. Speaking of food, you’re supposed to eat a high protein diet post-op, to help your body mend. That’s not easy if you can’t really open your mouth, especially the first few days. If you get fat transfer done, you will, like me, probably have a lovely Pinocchio stitch on both sides of your mouth. Try to keep the tape over these stitches. Plan on eating flat foods and pulling down on your chin to insert any bite larger than 1/4”. I had OK luck on day three post-op with a toasted cheese sandwich that I tore apart and ate like a two-year old. Applesauce and yogurt were also life savers, as was Panera mac & cheese. Have a large variety of small frozen meals prepared - at least a dozen lunches and dinners. Think high protein.
13. A flexible drinking straw will be a good friend for the first few days. Along with the lockjaw sensation, it may not be easy to drink from a cup. Even with a straw I had to pinch my lips around it so liquid wouldn’t pour out.
14. You may temporarily lose some hearing out of one or both ears for the first two weeks following surgery. I remember the last thing I heard as I passed out was my ear filling with liquid that I still hope wasn’t blood. Ick. The first thing I remember waking up was someone’s cotton tipped finger jammed in my ear. For the first few days it sounded like I was hearing through cotton balls in my left ear, and I was worried I’d had a nerve cut and lost my hearing. I talked to my regular doctor about it two weeks following the surgery (I had a regular checkup planned). She took a look and agreed it was dried blood. She said it would probably come out by itself eventually, offered to rinse it out with hydrogen peroxide mixed with warm water once the ear wasn’t so tender. The next morning I tried a little hydrogen peroxide on a Q-tip (I know, bad, bad, wrong) and let some drip in. The hearing did improve a little, so I may not have to deal with a peroxide power wash.
HEALING VERY WELL - DAY FIFTEEN. RIGHT EAR.
15. The days following surgery you may not want to talk or see people, and may get cranky or disheartened if your recovery isn’t “textbook”. Yes, it’s true that everyone is different and heals differently. But if, like me, you followed every directive and still feel you’re lagging behind the “typical” schedule for healing, there will be some moments you may question why you did this to yourself. Be patient. (Note: You will want to throw things at anyone who reminds you to ‘be patient’ during this time).
16. Every day does get a little better. Sometimes in very, very small increments. Again. Be patient.
17. Be aware you will be dealing with a variety of physical issues in recovery. The top two for me were the temples-to-ear-to-jaw/neck numbness and heat, and tightness. Sometimes I felt like my neck could act as a sinewy stand-in for the Incredible Hulk. Even going into week three of recovery I’d wake up with so much “firmness” in my neck muscles that I would put my facial sling back on for an hour or two to help with the swelling. I’m not saying this happens to everyone, but it’s best to be prepared for the strange sensations that can accompany the healing process. And did I mention not really being able to turn my head? Driving is difficult if you can’t turn your head without feeling like you’re going to pull something or snap a stitch. I didn’t drive for 15 days following the surgery.
18. Be selective about who you DO tell. Once friends, co-workers and family members know you’ve had a face lift, you can become one of three things: A pity case, a gossip topic, or a science experiment. One of my friends was truly against the procedure, insisting I “age gracefully”. She made me look at online images of women who’d had “too much” work done and ended up looking like a cat. And that was only when I mentioned I might have the fat-transfer procedure, not a full lift! I ended up lying to her and telling her I combined the fat transfer with a procedure to repair a problem with an infection that resulted from a botched root canal (I did, but my procedure focused on aesthetics, not dental work). She’s pretty smart, but the drains and stitches looked like a pretty convincing as a legit medical surgery.
19. Good news…maybe: You may look better before you feel better. The days after I “graduated” from wearing the facial support at night, I woke up to see a face that looked…gorgeous. Though I still couldn’t feel my left earlobe, and my temples were a little lumpy and the areas around my ears were still tinged with pale yellow and purple, I was seeing results. And I really liked what I saw. I went around the house praising my surgeon as “an artist with a medical degree”.
20. The day you do feel better, it will be like a switch has been flipped from “ugh” to “awesome!”. Though you may only have energy for a few hours, you will feel more like yourself during that time. And even though you still may not be able to feel much of the sides of your face, you’re going to look in the mirror and be excited happy with what you see. The best moment for me was day 15 following surgery, when my desktop camera turned on and I swear I saw my 30 year old self looking back. Though it was still difficult to do a full smile (remember, 3 months to get 90% of the swelling down on average), It made the entire first two weeks of recovery worthwhile. Many people return to a mostly normal activities at this time. Talk to your doctor if you’d rather wait for the scar lines to calm down from angry, flaky red to pink before you take your new look out of the house. They should be able to assess your progress and give you a reasonable timeline.
I’m writing this in the middle of week two post-op and improvement seems to have stalled with the nerve reconstruction. There is still a lot of heat and tingling in the area around my face where a full-face scuba mask would sit. I can now open my mouth about 90% of the way, but turning my head to the left and right is still limited. Tilting my head up no longer feels as tight in the neck (except in the morning). Sleeping positions are still limited. It’s uncomfortable to lie on my left (favorite) side, which puts too much pressure on my left ear, which is healing more slowly, and is still quite numb. Lying flat at night still causes me to wake up feeling like my head and neck is Humpty Dumpty’s for the first half hour or so. I am so sick of sleeping half sitting up on a stack of pillows.
I’m now past the two-week recovery mark and am physically much better. I still experience energy lags, but realize my body is still healing and I need to be patient (grrrr!). Then I look in the mirror and am so happy. I remind myself it can take up to a year (a Y E A R!!!!) for numbness and tightness to completely go away, and some people find they may need adjustments. I do not expect to need adjustments. The fat transfer areas look great, and I can’t wait to be able to do a real, total smile. At this point the tingling I feel in that “full face snorkel mask” area when I smile is really distracting.
I will continue to update this every week as progress continues.
RELATED LINKS: WEEKS 1 AND 2, WEEK 3, WEEK 4, ONE MONTH FOLLOW UP, WEEK 7, WEEK 8 , 2 MONTHS, WEEKS 10-11, WEEK 12, 3 MONTHS, WEEK 14