Post Operative Swelling: When does it go away?

I was on Real Self answering more patient questions today and I am amazed by the number of questions that come in about swelling. Many of these patients have had surgery in the last week or two and are concerned because there is still swelling.

Any time you have surgery, particularly surgery on soft tissues (breasts, tummies, fat) , swelling is an expected normal reaction. There isn’t an operation in plastic surgery where you will see your final results in the first week or two. It just doesn’t work that way. It will usually take at least 4 to 6 weeks for most of the swelling to go away but it can also take between 3 to 6 months depending on what was done. Liposuction for instance will leave you swollen for 3 to 6 months. Now Smart Lipo laser lipo may leave you less swollen than traditional lipo, and you may swell less than your cousin, but everyone swells no matter the technique or the person. That’s just the way the human body heals.

So, if you are reading this and you are swollen post op you are probably healing completely normally. But, and this is the other thing I don’t get, if you are worried, call your doctor! Why turn to the internet for answers? You’ve researched and interviewed your surgeon and ultimately trusted them enough to let them operate on you. Listen to what they have to say.

3 to 6 months. That is normal.

Lee E. Corbett, MD

Board Certified Plastic Surgeon

What do you do when your results aren’t what you thought they would be?

I have recently begun answering questions on the Real Self website for prospective plastic surgery patients and patients who have already had surgery. A fair percentage of the patients who post are doing so because they do not like their results, are unsure of how things are going to turn out, or have had a complication. I am surprised that there are so many patients who are 4 or 5 days out from surgery and already are doubting their surgeons advice. So, I thought I would offer my recommendations on how to handle things if you find yourself in this situation.

First, understand that your surgeon wants you to have a ‘perfect’ result just as much as you do. Personally, my goal is perfection every time I step up to that operating table. Surgeons are an unusual breed. We are super Type A, detail oriented people. My point is your doctor wants great results just like you do. So trust him or her when they tell you things will improve/change. I realize it may seem like they are dismissing your concerns but they aren’t. They’ve just seen this scenario play out literally thousands of times and they are confident this, whatever ‘this’ is, will indeed get better.

Fact: There is no plastic surgery operation in existence where you will see your final result in less than 2-3 months. Soft tissue swells as it heals and so you will not see your final result until that swelling is gone and the tissues normalize.

If you see something you don’t think looks right, ASK YOUR SURGEON! Stay off of the dang internet, don’t call your niece who is a nurse, or the neighbor who knows someone in “whereever-ville”, ask your doctor. He or she knows your particular circumstance better than anyone else.

Now sometimes things don’t turn out as you or your surgeon expected. This can be due to unrealistic expectations on the patients behalf, miscommunication on what you expected from your procedure, or it can be due to the fact that what your surgeon saw in the operating room changed as you healed. In other words, sometimes revisions are necessary. No one likes revisions because they mean more surgery and recovery and costs. But sometimes it becomes the reality and if you are considering surgery you need to be willing to accept this reality. Revision rates are usually quite low with the things we do but they do occur. Your surgeon will be able to tell you early on if this is a possibility.

Complications. There is an old saying in surgery. “The only surgeon who doesn’t experience a complication is the surgeon who doesn’t operate”. This is true. It could be a bleed, or an infection, or a thick scar etc…In these cases trust your surgeon and communicate with them. We train 7 or 8 years to be Plastic Surgeons. I could teach just about anyone how to technically do any operation I do in a week or two. So why do we train for 8 years? Because we have to know how to handle every complication that can possibly occur from an operation. The Chairman of my General Surgery residency had this philosophy: “As a surgeon, you are not qualified to perform an operation until you are expert at every aspect of the pre and post operative care for that particular operation, including any complications.” My point in telling you all of this is if you do have a problem, your surgeon is well trained to help you and get you to where you want to be.

So when in doubt, go see your doctor. I guarantee you your doc would much rather see you lots than have you home worrying, stressed out that things might not be ok.

Lee E. Corbett, MD

Board Certified Plastic Surgeon.

How many cosmetic procedures can I have done at one time?

There are several factors that you and your surgeon need to consider if your are thinking of having more than one procedure. Patient Safety is our primary concern. The primary issue is “How healthy are you?”. The reasons that people have serious complications around the time of surgery is because they have a bad heart and/or bad lungs. So if someone comes to me with emphysema from smoking their whole life I tell them no. If someone has active chest pain or a heart attack history I’m not operating on them either. People with a history of a blood clot that required blood thinners is also a “no go”. Now, if your lower back hurts everyday, and you had a hysterectomy, and you are hypothyroid, well none of that really factors in. None of those issue will affect how you do during anesthesia so they aren’t relevant. The summary statement is we need to look at your combination of medical problems and see if any of the constitutes a ‘red flag’. The second issue is time under anesthesia. Most plastic surgeons that I know will call it quits after about 6-7 hours for elective cosmetic procedures because after this point complications rates can go up. The third issue is “What are we combining?”. I’ve had patients request 5 or 6 things be done at once and we did them all because they were relatively small operations. Usually it is a breast & tummy combo, the Mommy Makeover, and I do those all the time. That being said I’ll never combine a thigh lift or a body lift with anything else because they are significant operations. So the answer is we have to look at the scope of procedures and base our answer off of that.

So, combining procedures is fine and we do it everyday in plastic surgery. We just need to make sure, as with any surgery, that you are a good candidate based on the factors described above.

Lee Corbett, MD

Medical Director, Corbett Cosmetic Aesthetic Surgery and MediSpa

Cosmetic Surgery and the Internet

My name is Dr. Lee Corbett, I am a Board Certified Plastic Surgeon in my 16th year of practice. I finished my plastic surgery residency in 1998 and so my career has spanned the huge explosion in information that is available on line. Be it via commercial websites, blogs, YouTube, etc…you can find information and/or videos of just about any and every cosmetic surgery that exists. A lot of the information is really good, accurate, factual stuff that is valuable for people who are considering surgery. BUT…there is also an enormous amount of the most ridiculous, outrageous, bunch of misinformation interspersed, making it impossible for someone who is not a Dr. or a nurse to sort it all out. For instance, two days ago I was meeting with a very intelligent, well informed patient who wanted breast implants. When we got into the silicone vs saline debate & she immediately opted for saline. Which is fine because I use both types, but when I asked her why she had eliminated silicone she told me that she had read on a blog that if the implant shell split the gel would leak out into her body, that it was poisonous and it would kill her! I couldn’t believe it. Unfortunately I’ve heard that before. That is absolutely, utterly false. First, the gel is a solid and doesn’t ooze out and secondly it most certainly is not poisonous in any way. That’s just absurd. The other common rumor I hear is that breast implants have to be replaced every 10 years. Again, that’s absolutely ridiculous and untrue. The failure rate on a gel implant at that point is very very low, way less than 5%. No surgeon is going to take out a perfectly good implant just because it is 10 years old. These are just two examples and there are dozens more related to just about any cosmetic operation. So, here’s my advice. Be very wary of what you read on blogs and non medical commercial websites. When you seek out information look at the blogs and websites of Plastic Surgeons. When you do you will notice a trend, and that is that we all say just about the same thing. Why, because our national society, the American Society of Plastic Surgeons, has very strict ethics by-laws prohibiting us from dispersing false or misleading information or claims. So, we tell it like it is, not only to keep out of hot water with our society but because we want our patients to have solid information upon which to base their decisions about surgery or medi-spa treatments. And not to blow our own horns too loudly, but as a group we are a bunch of highly trained and educated men and women. Plastic Surgeons go to 4 years of medical school and then complete 7 or 8 years of residency, where, in my era, 100 to 120 hour work weeks were the norm. We live and breathe this specialty and we know our stuff. I’m biased but that makes me feel like my colleagues and I are more qualified to disseminate information about our specialty than anyone else. Ok, I’ll hop off my soap box but it drives me nuts when my patients are scared/misinformed/misled by bogus information.

Lee E. Corbett, MD

Medical Director, Corbett Cosmetic Aesthetic Surgery and MediSpa