Surgical Instructions

After Facial Reconstructive Surgery

Now that you have had facial reconstructive surgery you probably have lots of questions:

  • How long will my recovery take?
  • Will there be any discomfort?
  • What can I eat and when? Will I look different?

Hopefully, we have had a chance to address many of your concerns and questions during the consultations and also the work-up appointment. But, just in case we didn’t or if you need a reminder, here is some information about what to expect in the days and weeks following surgery.

Please remember that we are partners in caring for your health. Your doctor and nurses have done their best to minimize your discomfort and start you off promptly on the road to wellness. The next phase of recovery is in your hands. There is much you can do to assure that your recovery time is short and as complication-free as possible. Please take a few moments to look over these suggestions for the days and weeks ahead.

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Can I drive? | When can I exercise?What if I notice bleeding after leaving the hospital or surgery center?What if the oozing is heavy?When can I have something to eat and what?Will my recovery be painful?Will my face become swollen?Is it normal to run a temperature after surgery?Why do I need an antibiotic?Will I have sutures (stitches)?Can I brush my teeth?Can I smoke? | Why do I feel depressed? | Why is my face numb?Why is my temporomandibular joint (TMJ) sore?Will I look different? | When do I remove the bandage?When do I see my doctor for post-operative follow-up? | How can I reach my doctor if I need to?

Can I drive?

For the first 24 hours following anesthesia or if you are taking narcotic pain medication or any other medications that can alter your coordination, you should not drive or operate any other type of mechanical device. If you feel well enough and your stamina has returned, driving and doing minor tasks should not pose a problem.

When can I exercise?

Exercising is similar to driving. If you feel well enough and you are not taking narcotic pain medication, light exercises for the first two to three weeks following surgery should not pose a problem. Following that time, you may resume a normal exercise regimen. However, you are not allowed to be involved in any activity which could result in something striking your face for approximately twelve weeks following surgery. This includes baseball, basketball, football, diving in a swimming pool, etc.

What if I notice bleeding after leaving the hospital or surgery center?

Some oozing from the nose and mouth is normal after this type of surgery. In fact, oozing can occur for up to ten days following the surgery, especially from the nose. This may be controlled by just blotting the ooze. Please do not blow your nose for at least three weeks following surgery. If the nasal dripping or oozing is persistent, a gauze sponge can be rolled up, placed underneath the nose, and taped in that position to catch the persistent ooze.

What if the oozing is heavy?

Sometimes, the ooze can seem quite heavy. You can place the gauze pad under your nose as described above. You can rinse your mouth out with warm salt water, elevate your head, place pressure on any area that seems to be oozing persistently, and hold pressure for at least sixty minutes. In most cases, pressure will stop persistent oozing. If active bleeding continues despite these measures, please call the office and let us know.

When can I have something to eat and what?

Your diet after the surgery will be somewhat modified. However, the kinds and types of food you can eat do not need to be modified. We request that you remain on a non-chew diet for approximately three to four weeks following surgery until the doctor allows you to progress to a soft diet. A non-chew diet means that you are not allowed to chew. However, you may eat normal food; you will just need to cut it into smaller pieces so that you can easily swallow it. At approximately three weeks after surgery, you may progress to a soft diet. A soft diet means nothing harder than a McDonalds hamburger. The doctor will let you know when you are allowed to proceed to this type of diet.

Will my recovery be painful?

The amount of discomfort you will feel after surgery usually depends on the extent of your surgery. Pain medication was prescribed for you at the time of work-up. The pain medication, which is usually prescribed, is a narcotic. If you feel you don’t require medication as strong as a narcotic, you may switch to over the counter pain relievers (i.e. Ibuprofen or Acetaminophen).

It is always better to stay ahead of the pain with pain medication and take it as it is prescribed. The directions should be on the bottle with respect to the dosage and time interval between the dosages.

Following this type of surgery, the sensory nerves are not functioning in the immediate post-operative period. Approximately four to seven days following the surgery, the sensory nerves begin to wake up. You may experience an increase in discomfort at that time. This is not unusual and you will need to manage it with additional pain medications, if necessary. If the pain is not managed adequately for you with the pain medication prescribed, please call the office.

Remember, do not drive a motor vehicle, operate machinery, or drink alcoholic beverages while taking prescription pain medication.

Will my face become swollen?

Swelling is an individual phenomenon. Most patients will experience some swelling following any type of surgery. Swelling peaks approximately four days following surgery and then beings to recede. The first seventy percent of the swelling will usually recede by approximately two weeks following surgery, and the last thirty percent of the swelling takes approximately twelve to eighteen weeks to reverse.

In most cases, you may minimize the amount of swelling by applying ice to the areas of surgery on your face for the first twelve to eighteen hours and you should also keep your head elevated. If you had surgery on both sides, switch the ice pack from one side to the other every 30-minutes. If your swelling is secondary to an infection, do not use an ice pack.

Ice may still be used after the eighteen-hour initial post-operative period if that makes you feel better. You may also use heat following this if that makes you feel better. Remember, the use of ice in the immediate post-operative period is very important with respect to reducing the amount of swelling you may experience.

The swelling may make it difficult to open your mouth wide. However, we do encourage you to open your mouth and move your jaw as directed by your doctor to prevent the muscles from becoming still and frozen.

Is it normal to run a temperature after surgery?

Yes. Following oral surgery and head/neck surgery, patients will develop an increased oral temperature. This is secondary to an increase in the metabolic rate of the healing tissues. You should not be concerned about the elevated temperature unless the fever goes above 101.5 degrees. If it does, please call the office.

Why do I need an antibiotic?

Operating in the oral cavity, which is considered an unclean environment, requires the use of an antibiotic prior to and after surgery. This reduces the chance of developing post-operative infections and allows the healing and recovery to progress more uneventfully. Is it important that you continue the antibiotic until it is completely finished by following the directions on the bottle. If you feel you are developing a reaction to this or any medication, please call the office.
Please note that some antibiotics may interfere with the ability of birth control pills to prevent pregnancy. If you normally use oral contraceptives, please be sure to use an additional method of birth control during your current menstrual cycle.

Will I have sutures (stitches)?

Yes. An oral surgical procedure, like any other surgical procedure, requires suturing of the tissues to aid healing. Most of the sutures we use fall out by themselves over four to fourteen days.

Can I brush my teeth?

Good hygiene practices are essential after oral surgery. You may use a small toothbrush with regular toothpaste to clean your teeth and also your mouth. It is imperative that you keep your mouth clean following surgical procedures. It may also help to gently rinse your mouth every so often with mild salt water or regular water. Do not use mouth wash, hydrogen peroxide, or a water pick for four weeks following facial reconstructive surgery.

Can I smoke?

No. Smoking of any kind after oral surgery interferes with the normal healing process and will increase your chances of developing post-operative complications.

Why do I feel depressed?

Following facial reconstructive procedures some patients will go through a short period of post-operative depression. This is usually short-lived as long as there is a good support group at home. This is secondary to the surgery, the post-operative discomfort, the change in your diet, and also taking a number of medications following the surgical procedure.

Why is my face numb?

During the surgical procedure, the sensory nerves that supply feeling to your face are identified and protected during the surgical procedure. Once the surgical procedure has been completed, the sensory nerves are re-draped into their normal position. Nerves stop functioning normally when they are moved or manipulated during surgical procedures. It will take weeks to months until the sensation begins to return. However, there may be areas on the side of your nose, your gums, your teeth, your lips, or part of your chin area that will remain numb or have an altered sensation for an indefinite period of time following surgery.

Why is my temporomandibular joint (TMJ) sore?

Most TMJ problems are caused by improper tooth alignment. If you had a TMJ problem prior to the surgical procedure, it will take time for the problem to stabilize following your facial reconstructive procedure. Sometimes, TMJ problems may become worse following facial reconstructive procedures. The philosophy with respect to the TMJ is from a non-surgical approach, if possible. The use of medications, splints, and physical therapy may be helpful. In some instances, additional surgery on the TMJ may be necessary. However, it may take two years more following facial reconstructive surgery for the TM joint to adapt to the new jaw position.

Will I look different?

Any type of facial reconstructive surgery will cause an alteration in facial appearance. This may range from minimal to significant. The reasons for facial reconstructive surgery are to provide correct positioning of the jaws and also to provide better facial balance and symmetry. There are also additional cosmetic procedures the doctor will discuss with you if he feels it is necessary to obtain the more ideal result. Please remember that one of the benefits of this type of surgery is improved facial aesthetics.

When do I remove the bandage?

The bandage or pressure dressing may be removed three days following surgery. Apply an antibiotic ointment to the small skin incisions on the cheeks three times a day.

When do I see my doctor for post-operative follow-up?

We routinely see our patients post-operatively at 2, 4, and 6 weeks after surgery; sooner if necessary. Following the 6-week appointment, you usually will be instructed to see your orthodontist for your post-operative orthodontics.

How can I reach my doctor if I need to?

One of the doctors can be reached 24 hours a day, 7 days a week by calling either our office number at Warminster Office Phone Number 215-672-6560 or our answering service at 215-750-4745. After you call, please keep your line free so that the doctor may return your call. If no one has responded after 30 minutes, please try again. If you feel this is an emergency, please go to the nearest hospital emergency room or dial 911. Please note, if you need medication or medication refills, you will need to call during regular office hours. Prescriptions will not be phoned in to your pharmacy after hours.