Postoperative instructions

Stitches and staples

• Absorbable — Only the blue or black sutures need to be removed (after Adam’s apple reduction, blepharoplasty or lip lift). All white sutures will dissolve on their own within about two weeks and do not need to be removed. If staples were used, they should be removed 8 days after surgery.

To move

• Move as fast as possible — It is important to try to move your limbs as soon as possible after surgery to prevent blood clots. Do not stay in bed for long periods during the day.

Medicines

• Pain medication
  • Dafalgan-Codeine — Every 4 hours, maximum 6 per day.
  • Diclophenac — Every 6 hours, maximum 4 per day.
• Mouthwash — We will provide you with an antiseptic mouthwash to care for the intra-oral incisions. You can find specific instructions per procedure below.

Swelling and bruising

• Voltage: — As a result of the swelling, the skin may feel very tense and warm. This is normal and will subside over time.
• Ice packs — Icepacks can be found in the refrigerator in the hallway of the guesthouse. In our guesthouse there is also a cooling system especially for the eyes(see video). Use the machine and icepacks as much as possible. It can be very effective.
• Moisture loss — In case you had a large hematoma (cheeks, or neck after an Adam's apple reduction) it can become 'liquid' again after a few days. This can cause some old blood to leak from the wound. This is not fresh bleeding but a way for your body to get rid of the hematoma.
• Evolution — Swelling is maximum 2-3 days after surgery. Swelling and bruising may be present for 2-4 weeks. It may take up to 3-6 months to get a sense of the final result. Patience is required.
• Location and size of the swelling — Immediately after surgery, swelling will occur primarily in areas with loose connective tissue (cheeks, lips, around the eyes). During the first few days, the swelling will move downwards towards the lower jaw and neck due to gravity. The degree of swelling and bruising varies greatly from person to person and can occur anywhere.
• Height: — Try to sleep elevated (ask for extra pillows). This will help drainage and relieve swelling.

Incisions

• Cleaning — The incision areas should be cleaned thoroughly in the shower every day by washing the area, removing the scabs and then carefully patting the skin dry. If the scabs are not removed, an ugly scar can form. It is therefore important that you remove them. After about 2 weeks, the wounds will have healed sufficiently and you may apply a special ointment to help the scars heal nicely (cicaplast).
• Make-up — For 7-10 days after surgery, you may wear light makeup to camouflage the incisions and bruising if desired.
• Sunbathing — A 'young' scar is very sensitive to the sun's rays, because it contains very few melanocytes. Therefore, we advise you to protect the scar with sunscreen or to stay out of the sun for the first 6 months after the operation. The first week after the operation, it is better to stay out of the sun completely, because the risk of infection can be greater if your face and body get too warm.
• Washing the hair — The first 2 weeks after forehead surgery you should wash your hair every day. For good wound healing it is important to remove all blood clots and scabs, using shampoo helps with this. Do not be alarmed if the wound bleeds a little while washing your hair. If you also have an aluminum splint on your nose (rhinoplasty) it should remain dry.
• Scar tissue — After the wounds have healed (after two weeks), you can start a gentle massage of the incision sites with the scar ointment (Cicaplast). This gel is very easy to apply and should be applied at least twice a day. The recommended minimum duration of treatment is two months.

After forehead recontouring

• Double vision — It is possible that double vision develops in the first two weeks due to swelling around the eyes (5 percent of patients). This is annoying and worrisome in the evening, but always disappears. We have never had a patient with permanent double vision.

After mid-facelift, canthoplasty and eyelid correction

• Upward massage of the eyelid — To prevent ectropion, you should massage the eyelid several times a day for 3 to 5 minutes with an upward movement starting two weeks after the operation. This will improve the color of the eyelid and its position. Often, when performing the transcutaneous eyelid correction, the orbicularis muscle is denervated and the eye tension is reduced. When the muscle tone returns, the position of the eyelid should also recover. With a correction of the lower eyelids, it takes a year before the result is fully visible.

After facelift, jaw angle reduction and chin correction

• Face mask — The face mask that we give you is intended to support the soft tissue of your face after the operation. It keeps everything in the desired position, prevents 'dead spaces' and the formation of scar tissue therein, and reduces postoperative swelling. The face mask must be worn 24 hours a day for the first three days. This is really important. This allows the chin muscle to reattach itself to the bone. It can only be removed for a short time while eating and showering. Dr. van Nimmen will tell you during the preoperative consultation whether or not the face mask should be worn afterwards. The mask can be washed at 60°C.
• Soft food— If a sliding genioplasty was performed (= the chin is sawn loose from the lower jaw, moved and screwed back together), you may not put any force on your lower jaw for the first 4 weeks after the operation, because it could break in the chin area. During these 4 weeks you may not eat raw meat or bite into apples etc. Eat pasta or rice, well-cooked vegetables and soft meat. These should not cause any problems.
• If you did not have a sliding genioplasty, you may still choose to eat soft foods for the first few days because of the sores and swelling inside your mouth, but you can basically eat whatever you want.
• You notice that you cannot open your mouth enough after jaw surgery — Muscles can cramp after surgery. If this happens, it is important to practice opening your mouth with wooden sticks for 5 minutes every hour.
• Mouthwash— We will provide you with an antiseptic mouthwash to care for the intra-oral incisions. You should rinse after every meal. However, you should also brush your teeth with a toothbrush and toothpaste as soon as possible after the jaw surgery, and then floss.
  • Please note! The exception to this is chin surgery as an incision is made under the front teeth. Do not brush your lower front teeth for the first week after chin surgery. You may damage the sutures that are close to the teeth. After the first week, brush your teeth twice a day with a very soft toothbrush.
  • The intraoral incisions are dissolvable and should not be removed. They will dissolve after about two weeks. When the bottle of mouthwash is empty, you may stop rinsing.

After a nose job

• Aluminum nose splint — An aluminum splint is placed on your nose and secured with tape. This should remain on the nose for a week.
• Vaseline — No crust should form in the nose as this is not good for healing. The crust should be removed. Applying Vaseline three times a day helps to soften the crusts so that you can gently remove them.
• Breathing — Most people find it very difficult that they cannot breathe through their nose after their nose job. We will give you nose drops during the preoperative consultation with which the nose can be opened.
• Stitches — The stitches under the nose are removed by Dr. Bart van Nimmen 7 days after the operation.
• Bleeding — Sporadic bleeding can be expected during the first few weeks. This is normal and is not a cause for concern. 
• Bruising — Most people will have bruising around the eyes and cheeks. The bruising under the eyes will get worse for two or three days before it starts to disappear. After 15 days, only you and your surgeon will be able to see the marks from the surgery.
• Appearance — Your nose will quickly return to its normal appearance, but the final results of the rhinoplasty cannot be fully determined for up to six months. The tip of the nose is the area that takes the longest to achieve its new, final shape.

After a hairline lowering

• Stitches — After 2-3 weeks, the dissolvable stitches around the hairline will fall out.
• To prevent infection, we recommend taking azithromycin once a day after meals for the first 3 days after surgery.
• In case of infection (e.g. S. Aureus) — As with any surgery, infection can occur (see photo below). With a hairline lowering procedure, it can be extra difficult to keep the surgical area clean and sterile during aftercare. Small hairs can grow in or under the skin that can cause irritation or infection. Usually, these small hairs can be removed with sterile tweezers. In case of infection, we advise you to:
  • Floxapen 500mg (flucloxacillin) to be used 4 times a day for 14 days;
  • Fucidin ointment to be used for 14 days;
  • clean the wound twice a day with chlorhexidine in water;
  • Apply Flaminal or Flammazine ointment to the wound twice a day;
  • to send an evaluation of this treatment to Dr. van Nimmen after 10 days using photographs.
• Scar — The scar will remain red and swollen for 2-6 months. After about 6 weeks, small hairs will begin to grow through the scar, making it less visible.
• Numbness — All patients experience numbness in the front of the skull. Sensation will return within 3-12 months. Sometimes there is itching during the recovery period.
• Temporary Hair Loss — After 2-4 weeks post-op, there may be some shedding of the fine hairs at the front of the scalp. This is called “effluvium.” Hair normally grows back after 3 months. We sometimes recommend using 5% Minoxidil in this area after surgery. This can reduce the chance of potential hair loss and promote hair growth where there is hair loss, as well as where the incision was made.
• Full recovery — Full recovery is expected after 12-18 months, when the scar has fully matured. The scar will be visible, but after a year it will usually have faded to the point of being barely noticeable.