Manuals+

Your Guide to Surgery

Important Pre-Operative Information

For out-of-town patients, ensure your primary care physician, dermatologist, or local ENT specialist is readily accessible following surgery for any discomfort or issues. This is helpful for managing pain, sleeping difficulties, and ear pressure/cleaning.

Preparing for Surgery: Items to Purchase/Pack

  1. Aquaphor
  2. Hibiclens and Dial Soap
  3. Hydrogen Peroxide
  4. Q-tips & Gauze (size 4 x 4)
  5. Baby Shampoo (Johnson's, Aveeno, Dove)
  6. Arnica and Bromelain Vitamins (link to purchase on last page)
  7. Optional: Dr. Karam's Enrich Breathable Barrier Balm: Safe to use on face after surgery. (Alternative option is Aquaphor only.)

8 Weeks before Surgery: Discontinue Smoking & Vaping

Two Weeks before Surgery

You will need to sleep on your back after your procedure and sleep at 45 degrees upright with your head above your heart (e.g., use 2 pillows). Please start SLEEP TRAINING as soon as possible if you are a side sleeper or stomach sleeper.

One Week before Surgery

Day before your Surgery

Day of Surgery

DAY OF SURGERY: No vitamins. DO NOT TAKE MORNING DOSE OF ANTIBIOTIC - this will be taken after your procedure and should be taken WITH FOOD.

Day After Surgery: Continue your Arnica and Bromelain until your bottles run out.

MEDICATION

Antibiotic: Typically Keflex (Cephalexin)

Pain Medication: Typically Norco (Hydrocodone/Acetaminophen 5mg/325 mg)

Anti-Anxiety: Typically Ativan (Lorazepam)

Anti-Nausea: Typically Zofran (Ondansetron)

Anti-Nausea: Typically Promethazine (Phenergan)

Anti-Viral: Typically Valtrex

Vitamins: Arnica and Bromelain

ALWAYS REFER TO YOUR MEDICATION LABELS FOR INSTRUCTIONS FOR USE

Day After Surgery: BED REST!

Avoid bending over, looking down, exercise or lifting as you need to avoid movement that causes excess swelling or pressure to your face. By 4 weeks, you can return to full exercise.

Our postoperative team will see you the DAY after your surgery to check your surgical incisions and to ensure that everything is starting to heal properly. During this visit, we will remove your surgical dressings and thoroughly clean the incisions. Your temple compression sutures may or may not be removed at this appointment as well, as suture removal depends on the degree of swelling seen.

Post-Surgery: What to Expect Week 1

BED REST!

Incision Care and Post-Op Instructions

Drain Care:

JP drains / Active bulb drains are used in some patients that are having Vertical Restore/Prevent. These drains will remain in for 4 - 5 days after surgery. These drains are a closed-suction medical device that will continuously pull fluid from the face and neck, helping speed up the healing process. As the drains fill up with fluid, the bulb will expand. Once the bulb is about half-way full you will pull the drain stopper and empty the fluid into a toilet. After discarding the fluid, squeeze the bulb tight and reinsert the stopper so it creates a vacuum. The drains will be sutured in along the hairline behind each ear. To help prevent discomfort, keep the drains safety-pinned high on the shirt or connected to the lanyard. This will help to create slack on the tube and keep tension off the sutures holding it in place.

PAIN MANAGEMENT:

Sunscreen and Make-up

When can you apply Sunscreen and Make-up? Patients are safe to wear mineral makeup 9-10 days after surgery. Laser patients should consult with Dr. Karam's team to advise on when this is safe.

Shower: 48 hours after your procedure, except for patients having a laser as laser patients must wait 72 hours. Wait 48 hours after drain removal to shower. Please feel free to wash your hair, keeping any shampoo/conditioner away from incision lines. Use Baby Shampoo only postop week 1.

Hibiclens Link: Hibiclens

Arnica link: Arnica

Bromelain link: Bromelain

Enrich Breathable Barrier Balm:

Discharge Tips

Once you get home from the office have patient lay down at a 45 degree angle

Medications

Please give patient some apple sauce or soft foods with medication so it does not upset their stomach.

Patient can take prescribed pain medication or Tylenol every 4-6 hours:

Patient can take pain pill at

Patient can take prescribed anti-anxiety medication Ativan might say lorazepam on bottle) every 8 hours (unless patient has allergy to this medication)

Please resume antibiotics (at least 1 pill) with dinner/food

If patient is experiencing nausea:

This will dissolve under the patient's tongue and should help with nausea.

If patient is experiencing extreme nausea utilize Phenergan suppository (unless patient has allergy to this medication)

Icing and Cold Compress

You can use ice for 20 minutes on and 20 minutes off with a barrier between the ice and skin.

Please stop icing 48 hours from your surgery date

A barrier is a clean piece of gauze or a clean towel

A cold compress is taking clean gauze and dipping into a bowl of ice water and laying it across patients face or eyes.

Please practice good hand hygiene!

Activity

Patient should be in bed resting in bed at a 45 degree angle

Incision Care

Please wash hands and wear gloves if possible before cleaning

All incisions need to be cleaned with hydrogen peroxide 2x a day (morning and evening) using clean gauze or q tips.

Apply Aquaphor over all incisions after cleaning with hydrogen peroxide except for upper and lower blepharoplasty incisions.

For upper and lower blepharoplasty incisions please apply stye ointment to keep eye incisions moist

Step 1: Use gauze or q tip and gently wipe with hydrogen peroxide.

Step 2: Apply Aquaphor using tongue depressor or q tip to entire incision and apply stye ointment for eye incisions only.

Showering: Clean ears 3x/day. Use a Hydrogen Peroxide soaked Q-Tip to place a few drops into your ear canal. Allow the solution to sit in your ear for about 1 minute. Gently clean outer ear canal. You can shower 48 hours after surgery if you did a Contour TRL Laser.

When washing hair:

What is an emergency and who do I contact?

Do not scrub incisions

Serious complications are very rare; however it is important that each patient understands the signs and symptoms of possible complications and how to detect them early on.

*IF YOU EXPERIENCE ANY OF THE SYMPTOMS LISTED IN THIS SECTION, IT IS IMPERATIVE THAT YOU CONTACT OUR OFFICE (858-259-3223) DURING OFFICE HOURS OR DR. KARAM IMMEDIATELY AFTER HOURS OR WEEKENDS. SO THAT WE CAN SEE YOU AS SOON AS POSSIBLE FOR INTERVENTION. DRAINS ARE REMOVED!

Hematoma:

A very rare but possible complication involved with all major incisional surgeries includes a hematoma, or an accumulation of blood under the surface of the skin. In the case of a hematoma, the accumulation of blood is usually accompanied by severe pain/discomfort and swelling, generally on one side of the face. Small collections of blood will usually absorb on its own, but for more severe cases, this will require drainage or even possible surgical intervention. This is why Dr. Karam uses compression sutures.

Infection:

Signs of infection may include chills, fever, excessive swelling or redness with a sudden onset, purulent drainage and/or excessive pain/discomfort.

If you had a Lower Blepharoplasty:

Severe swelling, pain, or loss of vision could indicate a hematoma and is a true emergency. If these symptoms are noticed, contact the office during business hours or Dr. Karam immediately after hours or weekends. On the off chance you are unable to get a hold of Dr. Karam or the staff, go to an emergency room immediately for prompt medical attention.

9AM-5PM CALL OUR OFFICE (858) 259-3223

5PM-9AM CALL DR. KARAM EMERGENCY LINE FOR ANY SIGNS OF HEMATOMA OR LOSS OF VISION (858)720-7137

Day 1 Post Op Appointment

Your Post op Team members:

DAILY CLEANINGS:

Twice / day. Very important to clean all incisions with Hydrogen Peroxide and then cover the incisions with a thin layer of Aquaphor at least two times per day, morning and evening. (Okay to use Dr. Karam's Enrich Balm during this week)

Note: Do not apply Aquaphor along eye incisions, please use your provided Stye Ointment.

Fat Transfer Harvest site (outer thighs or abdomen) Keep clean, moist, and covered with a band aid

Clean inside ears 3x/day. (example: Soak Q-Tip in Hydrogen Peroxide, let sit in ear, then clean)

You can shower tomorrow with Hibiclense/Dial Soap or Baby Shampoo. Water temperature should not be too warm. You can wash your hair but avoid scrubbing directly on incisions. It's perfectly okay for the soapy water to run along your incisions. Showers are encouraged.

Discontinue icing of the face tomorrow. You may place cold, wet gauze over eyes if they are irritated and use the eye drops that were given.

This week is BED REST. No lifting or bending over. No leisure walks or outings. WASH YOUR HANDS.

Photos will be taken at every appointment.

Temple compression suture removal:

Next Post-Op Appointment:

Next Post-Op Appointment:

Last Post-Op Appointment:

Please refer your Post-Op Guide Booklet for all information.

Further questions: Call (858) 259-3223 during office hours.

Please email photos of areas of concern to POSTOP@drkaram.com

Day 6/7 Post-Op FAQ

Today:

Post-Op Day 8:

Post Op Day 10:

Post Op Day 14:

Day 6/7 Post-Op FAQ Continued

4 Weeks (30 days) Post Op: Back to your normal routine!

Swelling/Bruising

"Trust the Process"

Moderate swelling and bruising is normal after any surgery. It is also important to understand that swelling and/or bruising may be ASSYMETRICAL in the initial healing period post operatively. Asymmetry is quite normal and is not indicative of your final surgical results. Compliance with the recommended supplements (Arnica and Bromelain) might help decrease the severity of these symptoms but time and patience is what will ultimately resolve swelling.

Sleeping:

Try to sleep upright for the first 2 weeks. Try to sleep on your back for the first month (avoid side sleeping position)

Ice roller: Can be beneficial for reducing swelling and promoting the healing process.

Foods to Eat for Optimal Healing

Fruits and vegetables

Eat a variety of colorful fruits and vegetables, especially berries, carrots, broccoli, and sweet potatoes. These foods are rich in vitamins and antioxidants, which can help reduce inflammation and the risk of infection.

Lean proteins

Eat lean proteins like chicken, fish, turkey, and eggs. These foods are high in immunity boosters and easy for the body to digest.

Fiber-rich foods

Eat foods rich in fiber, like apples, lentils, and whole grains, to help with digestion and regularity.

Anti-inflammatory foods

Eat foods that reduce inflammation, like pineapple, blueberries, and almonds.

Iron-rich foods

Eat foods rich in iron, like spinach, almonds, shellfish, eggs, brussels sprouts, and chickpeas.

Day 6/7 Post-Op FAQ Continued

Numbness:

Temporary numbness in areas of surgical manipulation is normal and will return within a few months following surgery.

Red/Itchy Incisions:

All new scars go through a healing process which can present as various colors such as red, pink, and finally white. Keep your incisions lubricated with the Silagen and Sunscreen. Placing cold, damp gauze on the incision can help soothe the area if it's itchy. This is normal and will pass in time.

Incision Healing:

Incisions heal at different rates. They typically look the worst between 2 – 6 weeks. Rippling/bumps caused by swelling along the incision lines take a few weeks to a few months to smooth out. They will continue to improve up to one year following the procedure. It is important to be patient during this healing process.

Dissolvable Sutures:

The sutures will dissolve in 4 – 6 months. You have dissolvable sutures underneath the skin. If you experience a stitch poking out along the incision line this is harmless and any of our staff members can easily clip the suture to provide some relief. There is no increased risk of infection occurring from this.

Asymmetry:

In addition to natural asymmetry, during the first 3 – 4 months after your procedure, the swelling doesn't resolve the same way. The unevenness will improve back to baseline.

Fat Transfer:

Fat is living tissue. Your fat transfer will continue to improve years down the line.

Fat Transfer Harvest Site:

This site may be tender to touch for weeks following your procedure. You may have a bump at the site, which can take up to one year to soften and flatten.

Treatment Timeline:

Day 6/7 Post-Op FAQ Continued

Hair Drying/Dying:

30 days after your procedure. If earlier, there is potential risk of infection. Blow-drying can open the follicles which can release bacteria with heat and moisture. There is potential risk of burning your scars.

Botox:

Wait 4 – 6 weeks after your procedure.

Facials:

Wait 6 – 8 weeks after your procedure. No manipulation/massage to face or neck prior to this.

Micro needling:

Dr. Karam recommends quarterly Micro needling for maintenance of your skin/collagen. This can be done 3 – 6 months after your procedure depending on the depth of the needle.

Massage:

Must wait until 5 weeks after your procedure to get a massage, or being face down.

Lymphatic Massage:

Wait at least 2 weeks after your procedure, and must be done in an upright position.

Hyperbaric Chamber:

Recommended to wait at least 1 week after your procedure but it is up to you if you'd like to start sooner.

Sauna/Steam room:

Wait until 6-8 weeks after procedure.

Red Light Therapy:

Wait 2 weeks post procedure

Pets:

No sleeping with pets for 1 month. Wash all bedding if they are in the bedroom.

No headphones/earbuds/airpods until day 14. DISINFECT them before and after use.

Glasses:

Okay to wear glasses after day 14. Clean them before and after use. If you need to wear them beforehand, disinfect glasses, and protect arms with gauze as they will rest along incisions.

Contacts:

Okay to use at day 14. This decreases risk of infection.

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The Complete Anti-Aging Routine

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