James J. Romano, MD
The best recovery after plastic surgery begins with careful preparation. This involves all of the things we teach you and provide as covered in the previous section. Taken together these best decisions and best measures, prepared mutually, lead to the best outcomes. Recovery from plastic surgery may be considered in categories and in stages. The common denominator for all of this lies in the fact that all of your preparation, my careful technique, and mapping out the events of your recovery, taken together, will stand for less pain; less swelling and bruising; and quicker return to activity, work, and your lifestyle.
Anesthesia for cosmetic surgery is truly an art unto itself. Nowadays it is a specialty in which there are anesthesiologists skilled principally in these procedures. I use just these individuals. My anesthesiologist will monitor your brain-wave activity (BIS monitor) to make sure you receive the most perfect level of anesthetic: not too much so you wake up alert and relaxed, and not too little so you are comfortably asleep. This and much more contributes to the “balanced” anesthetic. What I do expertly in concert with my anesthesiologist is one of the greatest determinants of your quick, safe, and comfortable recovery.
Immediately after surgery is an important time reference for patients. You awake in a quiet and very private recovery area. You are alert and minimally groggy but not disoriented, frightened, or fearful. You have no nausea or sickness. Most of the time you have no pain, just some sensation of pressure. You are cared for by an expert nurse, and there is not any rush to leave or go home. Often I arrange for my patients to stay overnight in the hospital in a private room or go to my plastic-surgery aftercare facility.
Pain after plastic surgery is a concern to all. Cosmetic surgery involves procedures on the “surface” of our body and does not involve structures that hurt. Specifically, much more pain is related to when surgery is done cutting through muscles, ligaments, or bone, or going deep into our body cavities like the abdomen or lungs. These things hurt, and cosmetic surgery either does not involve these structures, or does so minimally. In my practice, long-lasting local anesthetics used at the time of surgery, combined with minimally invasive techniques, means you wake up with little or no pain. When you wake up with no pain, I break your pain “cycle” and you usually have little or no pain in recovery.
Bruising and swelling are a minimum after my procedures. This lies in the fact that your surgical sites and entire body are prepared to prevent this from happening. This is accomplished by skincare techniques in addition to strict education about what foods to eat, what to avoid, activity and exercise levels, supplements to take, and what not to take. These factors, combined with my careful technique of minimal blood loss and minimal tissue trauma and an excellent anesthetic results in the lowest amount of bruising and swelling.
Return to activity, work, and school is the sum total of all of the above. With rare exceptions, most patients are up and around independently the evening of surgery or, by the latest, the next day. I am a strong proponent of early return to activity, ambulation, and exercise. I am not a doctor who allows you to be at home in bed. Most breast augmentation patients, for example, have surgery on a Friday and can return to clerical or office work by Monday. Most of my facelift patients will be presentable in public in four to five days. All patients can shower the second day after surgery.
Follow-up with me after surgery is different from most doctors. I want to see you often and over the course of many years. I want to make sure you and I both are satisfied with the results. I teach you about what to do to preserve my results, and what to do to delay or prevent the need for further plastic surgery. I will see you as often as needed, but not too much. I go beyond just your plastic surgery; for instance, I teach my breast patients about their breast health, mammograms, and breast self-exam. Like your family doctor, I plan for you to be my patient for life.