Postoperative instructions Dr Bart van de Ven

Postoperative instructions Dr Bart van de Ven

Click here to view video testimonials from the recovery process of facial feminization surgery during the first week

Sutures and staples

  • Reabsorbable—Just the blue or black sutures need to be removed (after Adam’s Apple reduction, blepharoplasty or lip lift). All white skin sutures are reabsorbable within about 2 weeks, so don’t need to be removed. In the case staples have been used they need to  be removed 8 days after the surgery.

Moving

  • Move as soon 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.

Medication

  • Pain medication:
    • Dafalgan-Codeine: Every 4 hours, max 6 a day
    • Tramadol: Every 4 hours, max 6 a day
    • Diclofenac: Every 4 hours, max 3 a day
  • Antibiotics­ provided if necessary— One pill a day for three days, starting the day after surgery (after breakfast)
  • Mouth rinse — We will provide you with a post-surgical antiseptic mouthwash to take care of the intra-oral incisions. You should rinse after every meal. However, you should clean with a toothbrush, toothpaste and dental floss as soon as possible. Except for the incision on the lower front teeth in case you had chin surgery. The intra-oral incisions are absorbable and should not be removed. They will dissolve in about two weeks. When the bottle is finished you can stop the usage.

Swelling and bruising

  • Tightness ­— Feelings of tightness and warmth, due to swelling, are normal and will subside over time.
  • Icepacks—We will give you icepacks during your preop consultation. In the guesthouse we also have icepacks especially for the eyes (see movie for instructions on use) at your disposal. Use them as much as possible. It really helps.
  • Leakage—In case you had a big hematoma (cheek, neck after Adam’s Apple reduction) it might become fluid again after a few days. This could cause some old blood leaking from the wound. This is not a fresh bleeding but a way for your body to get rid of the hematoma.
  • Evolution­— Swelling is on its maximum 2 to 3 days after surgery. Swelling and bruising may be present for up to 2-4 weeks. It may take up to 3-6 months to see the final results. Patience is required.
  • Place and extensiveness­— Immediately after surgery the swelling will be mostly in areas of loose connective tissue (cheeks, lips, around eyes). During the first few days, the swelling will move downwards towards the lower jaw and neck due to gravity.  Swelling and bruising differ strongly from one person to another and can be anywhere. Bruising may not appear immediately and will gradually fade over the course of several weeks.
  • Elevation—Try to sleep with head elevated (ask for extra pillows). This helps the drainage and will alleviate swelling.

Incisions

  • Cleaning­— The incision area’s should be cleaned carefully on a daily basis by bathing the area, removing the crusts and patting it dry carefully. After about 2 weeks the wounds will be healed enough to potentially begin applying a special ointment to improve the scars (cicaplast).
  • Make up — You may wear light make-up 7-10 days after surgery to help camouflage the incisions and bruising.
  • Sunbathing— The young scar is very sensitive to the sun´s rays as it contains very few melanocytes. Therefore during the first 6 months after surgery we recommend protecting the scar with a sunblock or to stay out of the sun. During the first week after surgery it’s better to stay out of the sun completely as the risk for infection might be higher if your face and body get too warm.
  • Washing the hair­— If you had forehead surgery the first 2 weeks after surgery you should wash your hair every day. For good wound healing it’s important to remove all blood clots and crusts, even better when you use shampoo. Don’t be alarmed if the wound bleeds a little bit while washing your hair. If you also have a plaster cast on your nose (rhinoplasty) the plaster should stay dry.
  • Scar ointment—After the wounds have closed (after two weeks), you may begin gentle massage of the incision sites with the scar ointment gel (Cicaplast). The scar ointment gel is very simple to apply and should be used at least twice a day. The recommended minimum duration of treatment is two months.

After forehead recontouring

  • Double vision—It is possible the first two weeks because of the swelling around the eyes double vision occurs (5 procent of patients). This is annoying and evening worrying but ALWAYS resolves. We never had a patient with permanent double vision.

After midfacelift, canthopexia and blepharoplasty

  • Upward massage of the lid—To prevent ectropion (lid margin evertion) two weeks after surgery you should start regular upward massage of the lid several times daily for 3 to 5 minutes. This will improve lid tone and the lid position. Frequently when performing the transcutaneous blepharoplasty the orbicularis muscle is denervated and lid tone is diminished.  As the tone of the muscle returns the lid position should as well.  Lower blepharoplasty takes one year to fully mature into post operative results.

After facelift and jaw reduction and chin recontouring

  • Facemask—The facemask provided is meant to give support to the soft tissues of your face after surgery. It keeps them in their desired position, prevents dead spaces and the creation of scar tissue in them and reduces postoperative swelling. The facemask should be worn 24 hours a day during the first week. That is really important for the proper re-attachment of the chin muscle to the bone. Only during eating and showering it can be removed for a short while.
    Dr van de Ven will tell you during the preoperative consultation whether the facemask should be worn afterwards or not. It can be washed at 60°C.
    _DSC2384
  • Soft food—If you had a chin height reduction you should not put force on your lower jaw during the first 4 weeks postoperative as it could break in the chin area. During these 4 weeks you shouldn’t eat raw meat or bite apples etc. But pasta, rice, well cooked vegetables and soft meat shouldn’t pose any problems.
  • If you didn’t have a chin height reduction you might choose to eat soft food during the first few days because of the wounds on the inside of your mouth but you can basically eat whatever you like.
  • If you notice you can not open your mouth enough after jaw surgery—Muscles may have a cramped reaction after surgery. If this happens it is important to exercise the opening of the mouth every hour for 5 minutes with wooden sticks. Click here to watch a video with instructions of how to do this.
  • Mouth rinse—We will provide you with a post-surgical antiseptic mouthwash to take care of the intra-oral incisions. You should rinse after every meal. However, you should clean with a toothbrush, toothpaste and dental floss as soon as possible. Except for the incision on the lower front teeth in case you had chin surgery. The intra-oral incisions are absorbable and should not be removed. They will dissolve in about two weeks. When the bottle is finished you can stop the usage.

After rhinoplasty

  • Nose cast—A nose cast is placed on your nose and fixed with tape. It should stay on the nose for one week.
  • Vaseline—No crust may be formed in the nose as this is not good for healing. The crust have to be removed. Vaseline 3 times a day helps to soften the crusts so you can remove them gently (see video below).
  • Breathing— Most people find it very difficult not being able to breathe through their noses after the rhinoplasty. We will give you some nose drops to open up the nose during your preoperative consultation.
  • Stiches—The stitches underneath the nose will be removed by Dr Bart van de Ven 7 days after the surgery.
  • Bleeding—Some sporadic bleeding could be expected during the first couple of weeks, which is normal and should not be a cause of concern.
  • Bruising— Most people get bruising around the eyes and cheeks. The bruises under the eyes will intensify during two or three days before they begin to vanish. 15 days later, only you and your surgeon will be able to notice any traces of the surgery.
  • Appearance—Your nose will regain its normal appearance very soon, but the definitive results of the rhinoplasty will be fully appreciated after six months. The tip is the area that takes the longest to acquire its new shape.

FAQ about the recovery process

General

What happens with the sutures? How long until they dissolve?

How long does it take for the skin sutures to dissolve?

White skin sutures are dissolvable, blue or black ones have to be removed after about 6 – 8 days. The white skin sutures dissolve in 1 or 2 weeks. If they would still be in the skin after 2 weeks they will easily break when you pull with your fingers.

How long does it take for the sutures in the mouth to dissolve?

That normally takes 5 – 7 weeks. If they would still be in your mouth after 7 weeks you can easily remove them just by pulling as they will immediately break.

Is it safe to perform an MRI after FFS?

Yes, we use very small titanium screws and plates which are never a problem for an MRI. Also the bonecement does not contain metal.

When can I have sauna again after my FFS?

You will have to wait for 4 weeks, then you are free to have a sauna!

In general, how long after FFS can I sport again?

If osteotomies (rhinoplasty, sliding genioplasty, forehead recontouring type 3) have been performed your should wait around 6 weeks before you do sports where someone could accidentally hit you in the face. Other than that it is up to you to FEEL when your body is ready for sports again.
As rule of thumb we would say that it takes 3 – 8 weeks before you can start sporting after FFS. This depends on the extend of the surgery, your age and your physical condition before the surgery.

How long after the operation should I wait to apply make-up and other creams?

You can start to use make-up and perform your daily cleaning rituals almost immediately on all areas without wounds. For the incision areas you should wait about two weeks.

What happens if I need to see a doctor when I return to my home country?

We would advise you to see your GP or the doctor that is on call. We would then discuss the problem with this doctor once you’ve been seen, and recommend the appropriate treatment. In extremely rare cases it might be necessary for you to come to Antwerp.

How do I clean the extra-oral incision areas? What should I do and for how long?

If there are steri-strips covering the wound or you have a bandage you should not touch it and keep it dry. If there are no strips or bandages, extra-oral incision area’s should be cleaned carefully on a daily basis by bathing the area as advised and patting it dry carefully. After about 2 weeks the wounds will be healed enough to begin applying a special ointment to improve the scars. For this we recommend Dermatix gel, which you can buy at any pharmacy. Use this ointment with gentle massage for about 3 months until the scar has matured.

Where will the swelling be?

Immediately after surgery the swelling will be mostly in areas of loose connective tissue (cheeks, lips, around eyes). During the first few days, the swelling will move downwards towards the lower jaw and neck due to gravity. Swelling and bruising differ strongly from one person to another and can be anywhere. Preferential places are around the eyes and in the lips, but can also involve the lower jaw and neck. Bruising may not appear immediately and will gradually fade over the course of several weeks.

How long will I have swelling?

About 80% of swelling will have disappeared after 2 to 3 weeks. For a final result you’ll have to wait up to 1 year.

Can I stay in the sun?

The young scar is very sensitive to the sun´s rays as it contains very few melanocytes. Therefore during the first 6 months after surgery we recommend protecting the scar with a sunblock or to stay out of the sun. During the first week after surgery it’s better to keep out of the sun completely as the risk for infection might be higher if your face and body get too warm.

How long after the operation I should wait until starting facial hair removal procedures again?

After bone surgery the area that was worked on is can be very sensitive to pressure. If this is the case we advice 3-6 weeks to heal from surgery. Some patients on the contrary experience temporary numbness after the surgery and reported us that with electrolysis that was handy, as it didn’t hurt that much.The reason some say to stay away from electrolysis or laser post FFS is to avoid infection. With electrolysis and laser bacteria can get in the bloodstream. And from there to the fresh wounds in your face. But, as the wounds are already exposed to all kind of bacterias in the mouth and on the skin, this argument is not valid in the case of facial feminisation surgery.

Of course the scar itself shouldn’t be lasered or electrolysed. Scars need to heal before they are hit by the laser. This takes until 6 months after the op. You can just get the laser technician to avoid the area.

Forehead recontouring and hairline lowering

When can I start using Minoxidil on my hair after forehead reduction or hairline lowering?

You can start Minoxidil after proper healing of the incision wounds, three to four weeks after surgery.

When can I start dying my hair again?

Before you can start stain your hair again after a forehead recontouring the incision should have healed 100%. If the incision was made a few cm inside the hair (no hairline lowering) this will take about 6 weeks. In case you had a hairline lowering this might take longer (up to 4 months).

I had a hairline lowering. I experience hair loss just behind the incision line. What is the cause and will it grow back?

The hair loss just behind the hairline is caused by reduced blood supply. The reduced blood supply is caused by the incision itself which cuts off the blood supply from the front and by the tension caused by the hairline lowering. The hair loss is at its maximum after about 1 month. Sprouting of blood vessels across the scar will create a new blood supply from the front and as tissues relax the tension will go down. This will ultimately result in a regrowth of the hair. To what extent and how long it will take varies per patient but in general most of the lost hair will be back after 6 months. If you want to do something about it you could use some Monoxidil lotion.

After a hairline lowering and browlift I now have bumps along my hairline which are irritating, do these settle down?

Those bumps are the Endotines that have been placed just inside the hair to prevent the hairline from pulling back. They will resorb in about a year, sometimes even a bit more.

How long does it take for the endotines to disappear?

According to the manufacturer it takes about 3-6 months for the endotines to absorb. According to our experience it takes about 6-18 months before the endotines dissolve completely.

When can I wash my hair?

Almost immediately. Don’t be alarmed if the wound bleeds a little bit while washing your hair. For wound healing it’s very good to remove all excessive blood cloths and crusts, even better when you use shampoo. Just remember to blow-dry thoroughly and dab with a drying antiseptic, like alchohol, afterwards to eliminate any remaining moisture.

Is it safe to perform an MRI after FFS?

Yes, we use very small titanium screws and plates which are never a problem for an MRI. Also the bonecement does not contain metal.

I feel air under my forehead skin after the operation, is this normal?

After a forehead recontouring there is often a connection between the frontal sinus and the space under the forehead skin. If you blow your nose, air can be pushed into that space. If you push the skin with your fingers you can hear a typical crackling sound. This is absolutely harmless.

This air escape will disappear in time when the skin is reattached to the bone. To help this process you will be provided with a forehead mask, which you should wear for two weeks. This mask will push the skin against the bone. Also care should be taken not to blow your nose too hard. After two weeks you can take the mask off and carefully try to blow your nose. If still air escapes to the space under the skin, the forehead mask must be used longer.

Will type 1 forehead recontouring give me the best possible results?

In about 1 out of 3 patients that need forehead recontouring Dr van de Ven will use only shaving (type 1). In all other patients he does the type 3 forehead recontouring meaning the anterior wall of the frontal sinus needs to be set back. If Dr van de Ven proposes a type 1 forehead recontouring he does this because he really thinks he can have the best possible result with it and can save the patient some costs (type one is cheaper because it’s less work). If during the surgery he will come to the conclusion it would be better for the patient to perform a type 3 recontouring he will without charging extra costs.

I’m having double vision in the first week after forehead recontouring, is this normal?

It is possible the first two weeks because of the swelling around the eyes double vision occurs (5 procent of patients). This is annoying and evening frightening but ALWAYS resolves. We never had a patient with permanent double vision.

How long does it take for the final result to be visible and the blue stains to disappear completely?

After the forehead recontouring procedure patients heal relatively quickly. However, healing is different for every patient. Mostly for this procedure a final result can already be visible after one to two weeks. But if the blue stains are severe (10% of patients, and there is no way to predict to whom this will happen), it can take up to 4 weeks for the blue stains to completely disappear.

Hairline lowering with expander

Jaw and chin recontouring

Is it safe to perform an MRI after FFS?

Yes, we use very small titanium screws and plates which are never a problem for an MRI. Also the bonecement does not contain metal.

Will I be able to eat?

If you haven’t had any treatment involving your teeth a sliding genioplasty or orthognathic surgery, you’ll be able to eat normally quite soon. Due to the effects of general anesthesia, you should only feel nausea for the first few hours. You may prefer to eat softer or pureed foods initially if you have intra-oral sutures. Patients should prepare accordingly in advance and purchase juices, yoghurt and soups to have during for the first few days after surgery.
After a sliding genioplasty you should be very careful not to put too much force on the lower jaw e.g. by eating raw meat (steak) or biting an apple. The jaw is really weak in the chin area and it will take about 6 weeks until it has regained it’s original strength.

What happens with the stitches in my mouth?

They dissolve in 5 – 7 weeks. They don’t have to be removed. If they would still be in your mouth after 7 weeks you can easily remove them just by pulling as they will immediately break.

How can I expect the feeling in my chin and lower lip to be after a chinplasty?

After a chinplasty the feeling in the lower lip and chin is always disturbed. If the mental nerve (that comes out of the jawbone just behind the chin and then runs into the lower lip and skin of the chin) has not been ruptured during the surgery, for sure sensitivity will come back. It is not possible however to predict when and to which extent. Mostly the recovery will take between several weeks and several months but it can take up to even 2 years. It is normal that sensitivity of lower lip and chin doesn’t recover completely.

If the mental nerve has been ruptured (in the hands of Dr Bart van de Ven around 1%) it can be sutured. Of course the prognosis will then be worse. Damage to the mental nerve will however not be visible to the outside world as it is a 100% sensory nerve. It doesn’t contain motor branches so function of any muscle is not involved.

Is it safe to perform an MRI after FFS?

Yes, we use very small titanium screws and plates which are never a problem for an MRI. Also the bonecement does not contain metal.

Rhinoplasty

How long should I wear the nose moulder?

You should try to wear the nose moulder as much as possible during the first 3 weeks after surgery. Please make sure the nose moulder is placed in the middle. If it hurts you should make the elastic band wider and/or leave the nose moulder completely off for a while.
After the first 3 weeks we advise to wear the nose moulder every night until the check-up 4 months after the surgery.

How long should I wait to see the final result of a rhinoplasty?

After a rhinoplasty you have to be really patient. During the first 3 months it can be very swollen. Especially if you have a thick type of skin it can take more than a year for all the swelling to disappear. The nose can continue to change until 1 – 2 years after surgery.

Would it help my nose swelling if I put some tape across it?

The tape helps partly to avoid the swelling from forming. Once the swelling is there, the tape will not let is disappear. Only waiting….Also the nose moulder is not useful for the swelling, this is only to keep the nosebones in place.

Croton oil peel

A few weeks ago I had a croton oil peel. Now I have some dark spots in my face. What should I do?

These darks spots are signs of postinflammatory hyperpigmentation (PIH). This This is a frequent and transient (so temporary) complication of croton oil peeling. Permanent problems have not been seen. Best is to continue the daily application of tretinoïn- and hydroquinone-ointment that you have received from us before the peeling for 3 to 6 weeks. It will help to remove the hyperpigmentation. Also it is very important for you to stay out of the sun until 6 months after the peeling and use the sunblocker that we gave you.

After a chemical peel how long should I wait for laser hair removal?

You should wait two weeks to have your laser hair removal treatment done provided all signs of inflammation have resolved and there are no signs of increased pigmentation.

How long do I have to wait before I can shave again?

You should wait until the skin has completely healed, which takes about 10-14 days.

Other procedures

We are now two weeks after the operation with an incision under the lower eyelids and the lower eyelids are a little bit pulled down. What should I do?

Frequently when performing the transcutaneous blepharoplasty the orbicularis muscle is denervated and lid tone is diminished.  As the tone of the muscle returns the lid position should as well.  To prevent ectropion (lid margin evertion) two weeks after surgery you should start regular upward massage of the lid several times daily for 3 to 5 minutes (at least 3 times a day). This will improve lid tone and the lid position. Lower blepharoplasty takes one year to fully mature into post operative results.

We are now two weeks after the operation with an incision under the lower eyelids and the lower eyelids are a little bit pulled down. What should I do?

Frequently when performing the transcutaneous blepharoplasty the orbicularis muscle is denervated and lid tone is diminished.  As the tone of the muscle returns the lid position should as well.  To prevent ectropion (lid margin evertion) two weeks after surgery you should start regular upward massage of the lid several times daily for 3 to 5 minutes (at least 3 times a day). This will improve lid tone and the lid position. Lower blepharoplasty takes one year to fully mature into post operative results.

What happens with the stitches in my mouth?

They dissolve in 5 – 7 weeks. They don’t have to be removed. If they would still be in your mouth after 7 weeks you can easily remove them just by pulling as they will immediately break.

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