This page is designed specifically for patients who have plastic surgery (and cosmetic surgery) in Bangkok, Thailand by Dr. Nond Rojvachiranonda. Instructions are personal opinion and cannot always be applied to everyone. Application must be always confirmed by Dr. Nond Rojvachiranonda as each operation is different.
Swelling is a routine normal response of the human soft tissue after trauma. Surgery is considered a kind of trauma. Degree of swelling thus varies by the surgical invasiveness. It cannot be avoided, but controllable.
Swelling usually peaks on the second and third day after surgery. It often starts to get better on the fourth day. Proven measures to control postoperative swelling are: -
- Elevation of the operated area above the heart
- Cold pack
The above techniques are useful for the first 4-5 days only.
Swelling from most surgery is around 10-30% after one week, and about 5-10% after 2 weeks. Swelling lasts longer with more extensive surgery and surgery of the eyelids and lips.
Less swelling does not mean your surgeon has done a good job. On the other hand much swelling swelling does not mean your surgeon did bad job. Swelling is more related to other factors such as location of operation (eyelid is more sensitive than other parts), degree of dissection, etc.
Let's look at a few example for more understanding.
A lady had facelift and postoperative swelling and bruising was so little that she could go outside and see people only after 3 days. The fact was that her surgeon was not a plastic surgeon and he spent only 1-2 hour to do only skin lifting. Literally this means pure skin excision. Facelifting by skin excision is proved to be ineffective. and not longlasting. The technique is usually done by non-plastic surgeons, some facial plastic surgeons and those who have no training to do this in correct way. Currently standard technique is to lift the facial skin, tighten the muscle (SMAS) and remove skin excess. What happened in this case was her face looked so tight and unnatural. This wind-tunnel looking is known to happen in skin lifting tecnigue.
A lady had breast augmentation and felt very little pain afterward. She could go out shopping and attend parties on the next days. The face was that her surgeon put breast implants above the chest muscle and, not very long, capsular contracture developed and caused unnatural firmness in the breasts. Under-muscle implant placement is known to be much better to prevent capsular contracture but, unfortunately, it causes more pain and longer recovery. Above-muscle technique is much easier to do and is the favorite technique of non-plastic surgeons.
Bruising is a result of bleeding into soft tissue (extravasation of blood). It depends mainly on the amount of blood that leaks out of the blood vessels after surgery wound is closed.
Bruising is likely to be obvious in persons who: -
- easily bruise by small force, e.g. normal grabbing, gentle hit
- have thin and white skin
- undergo surgery with wide area of dissection
- do not have adequate pressure or cold treatment at the operated area
- regularly intake herbs in their foods
- do not stop aspirin or other blood thinning agents long enough prior to the surgery (7-10 days)
- have coagulopahty by any causes
Bruising is usually more visible after 3-4 days, not on the first postoperative day. Do not be panic if you see more and more bruising. As long as the area does not turn into a lump (hematoma = should be removed), the bruising is ok and will resolve completely.
Once bruising happens, it normally lasts at least 1-2 weeks.
Most people can walk and do daily activities after 24 hours after cosmetic surgery done under general anesthesia. After 48 hours anesthetic agents are completely eliminated from the body. Patient should feel like normal after 2-4 days, depending on her/his health and fitness, duration of operation and extent of surgery.
Because surgery causes swelling and bruising, it is recommended that patient should rest with operated organ higher than the heart and cold pack on top for a few days.
There is no contraindication for flying after cosmetic surgery, even with breast augmentation with implants. Just make sure you get a medical certificate saying you are fit to fly otherwise airline staff might not allow you to get on board.
Light exercise can be resumed within a month while vigorous exercise should be after 2 months.
Most stitches will be removed after 5-7 days. Stitches in the hairbearing and high-tension areas, e.g. scalp, back, might be left for 10-14 days. If patient would like to fly back to her/his country, it is possible but the stitches must be removed by another surgeon.
Please do not misunderstand that wound closure by resorbable suture material is always an advantage. Dr. Nond always use resorbable suture material to close his incisions but for the inside layers. Even after having very good approximation of incision edges by resorbable suture material, he still puts another row of non-resorbable stitches to make sure that the incision edges are tightly closed and well leveled. This is for the best scar quality.
Most doctors who say they used resorbable stitches and there is no need to remove the stitches usually do not want to spend more time to suture the wound and to remove the stitches in later follow-up. They usually use skin tape or glue instead. The fact is skin tape and glue are never as good as meticulous suturing. It is all about being too lazy. This is the fact I am not supposed to tell anyone.
There are a few situations that having only inside suturing or resorbable stitches on the outside skin is acceptable.
- in children
- wounds at very non-mobile and low tension area
- incisions at mucosa and genitalia
- wounds in hair-bearing area
- If you want to have private nursing care after discharge from hospital, please contact Thai Nurses Group for more information.
- There will be at least one follow-up after the surgery, at the 5th - 7th day. Stitches will be removed on that day if wound heals well.
- You should keep the operated part(s) higher than the heart for 2-3 days, with cold packs on it as much as possible. This means you should prepare more than one cold pack.
- Older-generation anti-inflammatory drugs, e.g. ibuprofen, diclofenac, aspirin, are not recommended.
- For all sutured wounds, daily rinsing with clean water is recommended. Thailand is hot and humid, not to mention sweat and dust. Keeping dry does not make wounds cleaner. Clean water includes new bottle of sterile normal saline, new bottle of drinking water, and cool boiled water. Make the wounds dry with clean cloth afterward.
- Daily wound dressing at hospital is not necessary.
- Sutured wounds can be left opened, not covered by any dressing, after 2-3 days when there is no more oozing. Dressing is mainly for protecting your clothes and/or compression garment from being stained by your blood. Having a surgical wound covered with gauzes or water-tight dressing material does not prevent infection. Germ gets into the wound during surgery, not after the wound is already closed. Without dressing, you can easily check your wound everyday and tell if there is problem.
- As a rule, the operated area and wound(s) should be kept still for at least 1-2 weeks. Please avoid moving or massaging the operated area too much.
- If not sure, just call me at my mobile: +66897798283 (or 0897798283 if using local phone number), at any time 24 hours. If I do not accept your phone call, please wait for a while and try again and again. When working with patients or attending meetings, I might not be able to accept phone calls right away. It is not always possible to call back to missed call numbers either. Do not use email for urgent or emergent situation as it might take 2-4 weeks before I see your email.
- Long-term follow-up is necessary for verifying the final result and surgeon's self improvement. If possible, please keep in touch with Dr. Nond by emailing him your symptom together with hihg-quality photos, as guidelined in this web, at 1, 3, 6 and 12 months after surgery.
January 2, 2014 8.31AM