What NOT To Do During Recovery After Plastic Surgery

Monique Ramsey (00:04):
Thinking about plastic surgery and wondering what recovery actually looks like? Dr. Salazar is with me to discuss everything you need to know about what happens after the procedure. Welcome back Dr. Salazar.

Dr. Salazar (00:16):
Thanks so much, Monique. And think today's topic, it's a very good topic because sometimes the unknown is actually what prevents patients from pulling the trigger, right? I mean, they want to obtain a certain look, but then what's going to be after surgery or what do I need? Or how are things and changes are going to happen? So I think it's a great topic.

Monique Ramsey (00:35):
Yeah. So I'm going to get into probably the most talked about thing, which is when do I see my final results and how long do I have to wait? And why is it that we have to sometimes wait because we like instant gratification, right? We want it yesterday. So why is it important to have some patience?

Dr. Salazar (00:59):
I think with plastic surgery, one of the things in that patients, they kind of have an idea, but still, I mean the spirit is we want to see the results as soon as we can. But the thing is that we work with human tissue. We're not tailors, we're not fashion designers, we're not working with leather like with creating a nice purse. When you buy the purse, you buy that bag and the bag already looks good and then it looks exactly the way you're going to be wearing it. But with human tissue, I think that one of the important things that we have to understand is that it evolves, it changes, it stretches. So it depends. Different surgeries have different times of when am I going to see my final result? But normally I tell patients, do not expect to look at your best before, or to see the final result before three to six weeks. As a matter of fact, Monique mainly, and most of the time, for most of the surgeries that we do, the first set of pictures that start looking amazing are going to be around six weeks because you're going to have all that swelling down. The bruising is going to be gone, then things start looking better. Then at three months things look even better. But yeah, it's a matter of some patience and it's a process.

Monique Ramsey (02:13):
And I think one of the things that patients don't realize that's going on, I hear the word swelling, but what does that mean? What's happening in the tissues and why does it take so long to resolve? And what can you do to help speed it up?

Dr. Salazar (02:29):
Everything we do, the incision, the dissection, the sewing, the cauterizing, all that, it's injury to the tissue. So the tissue, the way it responds, it's response by mounting an inflammatory reaction. It is good. In a way, it's very good because what that reaction is is going to bring a lot, it's going to bring more blood. So more blood, imagine more blood to your feet, it causes swelling, right? So it's going to bring more blood to the area, more blood to prepare your body for recovery. By bringing more blood, it's going to bring more defense cells to the area. And that's important because we want to prevent infections. So that's how the body is helping you to prevent infections. When you bring more blood to the area, it's called hyperemia, more blood in the area, it brings more nutrients and it's going to bring more proteins, and it's going to bring all the bricks that you need to heal those incisions and to heal the areas of operation.

(03:23):
So just by doing all those things, you're causing more or you're bringing more volume, more blood. Then when we are doing dissection, so dissection, imagine you're separating some of the natural layers that we have either to remove some stuff or to pull or to make things tighter. So when you do that, you're disrupting some of the microscopic lymphatic drainage that your body normally has. So let me go a little bit back there and say that we all know that we have veins and we have arteries, but not everybody knows that we have lymphatics. So lymphatics are a third type of vessels that what they carry is they carry the fluid that causes inflammation or edema or swelling. So we disrupt that natural drainage of the body by just separating the different planes, like the muscle from the skin, from the fat and pulling and all that. So that's another injury that happens. The only thing that it needs, it's time and the body will automatically repair that. But that also all those things together cause the fact that your tissue that you expect to look thinner, for instance, initially can look thicker or can look a little bit swollen. That's a reason why we need time, how to expedite it. Well, we have multiple tips and tricks. I don't know do you want me to go into those?

Monique Ramsey (04:56):
Well, just a few. Yeah, because I think the other thing is out there on social media, and if you're thinking about plastic surgery, one thing you'll run into a lot is people talking about lymphatic drainage. So that kind of is a good segue to, you're talking about that lymph system and you're trying to get things maybe moving again. And do you recommend for your patient's lymphatic drainage before or after or both?

Dr. Salazar (05:21):
Lymphatic drainage helps a lot. And one of the things that if you tell a patient that they're going to get a massage after an abdominal plasty, the eyes will go wide open and say like, oh my God. Because what they're imagining is like a Swedish deep tissue massage for relaxation. But in reality, lymphatic drainage is very, very superficial. The lymphatic system is localized in the subcutaneous tissue, so just below the skin. So you do not need to go that deep. So for that reason, it's not very painful and always around a week after surgery, some people like to start at three to four days after, it can definitely help. Then as we provide for our patients compression garments or different garments or different bras and different things that we think that are the best for their postoperative period for certain areas to be compressed. Sometimes, for instance, if we do liposuction to the legs, we want to start compressing at the level of the ankles, for instance, and compress from the abdomen to the ankles, even if we were just doing liposuction to the legs. But that is the way to compress that area in a much, much nicer, more uniform way. Then you start to phase other things that we know as civilians and that say like, oh, I got some swelling, let me put some ice.

(06:45):
Not good. No, not good, right? Because that what we always have it, right? We know that, oh, I got some trauma in my elbow, I got a big hit, give me a bag of eyes and I'll put it there to decrease the inflammation. It works. It's very effective. It's really good. But here are some of the reasons why we don't want to use it. So remember that in plastic surgery, we're always stretching, we're always pulling, we're always making things tighter. We are generating pressure. Pressure and blood flow, I'm putting some pressure here for our audience that can see our podcast. I'm putting some pressure and you can see that my blood flow to my hand when I put some pressure, it's not great. It kind of starts going blanche. It goes white. So if you add ice to an area that already has some pressure or tension, then you're going to decrease the blood flow to that area.

(07:43):
So even though it's fantastic to get to try to decrease the amount of volume, amount of fluid, the amount of blood that you have in that area, but for blood perfusion for keeping the tissue alive, it's really bad. So every time that we're doing a breast lift, every time that we are doing a facelift, all that tissue, what we want is to be well perfused. So we don't want any ice shutting down the small vessels and then killing that tissue because the tissue can die, the skin can turn black and then sloughs off, and then you don't have skin in that area. The other thing is that, as we all know, extreme temperature, either hot or cold, can burn your skin. You can get a bad burn from having or holding ice in a certain area, but what tells you that it's creating or causing some damage is that it hurts.

(08:37):
But after surgery, your sensation has changed, at least temporarily. So you have superpowers, you might not feel pain in that area, but at the same time, then you don't have that protection, the natural protection, and then if you just leave a bag of ice for 20, 30, 40 minutes in the same area, that can cause a bad burn to the skin in that area. And then the same thing, skin dies. So those are the reasons why I would say applying ice. I mean, unless it was fully indicated by the surgeon and very specifically directed, it's not a good idea. Ice doesn't go very well with postoperative plastic surgery.

Monique Ramsey (09:22):
So getting into, you're talking about the garments and the function of the garments. What does it help the body do?

Dr. Salazar (09:30):
It's like two big purposes. One is remember if you're molding an area, if you just think about, let's talk about liposuction. So what, you have an area that you did liposuction, so you remove the fat, you scooped the fat out. So now what you have is you have the skin and you have the fascia of the muscle, and then there is a space where the fat used to be. So you want to help the skin shrink and retract to mold to the area that's underneath as much as you can. Of course it depends on the patient's skin elasticity. I mean that intrinsic capacity of that skin to shrink back. But the only thing that we can do other than praying is adding that external compression and allow that skin to shrink. The second one is, imagine if also let's, let's talk about a facelift. So you lift up the skin so the skin is floating, and then you want that skin to stick back again to the underlying tissues. So that's why what you need is you need a facial dressing to keep it and allow the undersurface of the skin to get reattached and to stay attached.

Monique Ramsey (10:52):
They're kind of keeping everything together in its new home. And along that same thought is, and people hate thinking about drains and it's more like they hear these stories, I don't want the drains, blah, blah, blah. Drains are really important. Tell us why drains, if your doctor says you need drains in your tummy or your breast or your face, what are they doing and why are they important?

Dr. Salazar (11:18):
So the goal of the drain is to remove the fluid of that your body's going to try to create. So normally we are not creating additional fluid in that area. So let's go back to the example that I said. You lift up the skin and so you separate the tissues, right? You separate the skin and the fat from the muscle and the fascia. So you're creating a space that wasn't there before. And then you want that space to collapse, but your body does not like empty spaces or new spaces. So your body says, oh, you know what, let me put some fluid in here. And that's the best solution or the best way that your body can try to react. So in that new space that you created, the fluid that's being accumulated, it's going to be drained by the drain. Your body has the ability to create fluid, put it in an area and drain it.

(12:14):
Your body can get rid of it. But after surgery and after all certain things that we do in certain surgeries, then the capacity of your body to reabsorb that additional fluid is overcome. Then that's the reason why you put in that little tube. And when I say little, imagine it's little in terms of caliber, right? In terms of the caliber, it's little but tends to be very long and sits in there and when we remove it and patients get surprised, oh my god, all that was inside. So that's the main mission of the drain. The way they work is they work based not on gravity. It's not a tube that it's like you have to keep down and remember that all the fluid gets collected in this plastic grenade, but it's not that it works through gravity, it works through negative pressure. So it's also generating internally negative pressure, like a little vacuum in there, which is also helping collapse that tissue. So that's another benefit of having the drain that you can imagine. You have a little suctioning machine inside and it's allowing your tissue to shrink and collapse. So that's really good.

Monique Ramsey (13:26):
One of the things that we talk about and people are always like, when can I work out? When can I go on a walk? When can I take Buster out on a walk or Bubbles? Because you have the cutest dog in the world Bubbles. Everybody has to go to his Instagram and see Bubbles because Bubbles is, I'm not even a dog person. Bubbles is adorable.

Dr. Salazar (13:48):
Thank you.

Monique Ramsey (13:48):
So if we want to take Bubbles on a walk, when can we do that and why might you as a surgeon say not yet?

Dr. Salazar (13:56):
I would say that the number one goal is when we say or we restrict from exercise or a certain activity, the main goal is to keep the heart rate and blood pressure down. Heart rate goes up, blood pressure goes up, and then the possibilities of bleeding go up. So that's what we want to prevent. Why? Remember, and I'm going to go back again to what we were talking about. You separated tissues, you created new spaces that didn't exist before. So if patients bleed regardless, either from a liposuction, from a facelift, from a breast augmentation, from a tummy tuck, remember you lifted up the tissue, you put it back down. Now there's a big space that you created. Then the bleeding most likely is not going to be coming out of the body, it's going to stay. So patients are going to see that they were flatter, but then all of a sudden they started going chubbier.

(14:56):
There is the implant, let's say that they got 300 cc implants and one side looks like she got 300 and the other one like 600 double the size and all that can be blood. That's what we want to try to prevent. That's the main thing. And that's when we restrict for exercises, walks that are power walks. As a matter of fact, you know that we like our patients to be ambulating. We don't want them in bed because we want to prevent some blood clots. We want to prevent some pneumonias. We want to prevent all those bad complications after surgery especially, I mean the key is to move. Don't stay in bed all the time. Wake up in the morning, stay in bed for 10, 15 minutes, walk to the restroom, come back, stay in bed for another 10 15, then sit up in a couch, then go to the kitchen, have some breakfast over there, then walk back.

(15:49):
So those transfers, those transfers do the job that keeps your blood pumping in your body, that keeps you mobile, moves your muscles, that's fine, but then you feel better. You can go for a stroll. You can go for like a window shopping. I mean, if you asked me can I go and do some window shopping at the mall, yes, fine, as long as your heart rate doesn't go up. It depends on the different type of surgeries. But normally we don't want any heart rate going up anywhere from two to three weeks. So that's when we restrict that exercise and anything that can get your heart rate up.

Monique Ramsey (16:27):
Okay. What's the craziest request you've had about exercise from a patient?

Dr. Salazar (16:33):
Oh, the craziest was a patient that was jiu jitsu fighter and she practiced that with her partner. She was big on this and we did a breast augmentation. And then after surgery we talked to her about activities and then I think it was around week number three, but she was dying and she wanted to really fight. We didn't know this part, but we released her to start doing some cardio and started ramping it up little by little. But then she decided to have a little simulated fight with her partner, and then she was picked up by the lapels of her jiu jitsu suit, and then she was slammed against the floor, and then she sent me some pictures and one breast went double the sizes the other. And then she had some impressive bleeding actually, and we took care of her. That's why you are having surgery at La Jolla Cosmetic with a board certified plastic surgeon and a team that's always there for you.

(17:34):
It was a Saturday morning we saw her. We had to take her back to the operating room drain, take out those big clots that a lot of very active bleeding, solve the problem, put the implant back in, and she was up running and we didn't let her do jiu jitsu for another two to three weeks. So I think we restricted her for another two weeks and then start slowly, and then she was fine. But in reality, I think it's something that it rarely happens one of those complications, but it is because we have long talks with our patients. We prepare them well. They get a booklet, they have that preoperative visit of an hour. We follow them closely after that. It's really important.

Monique Ramsey (18:16):
Getting into medications in terms of what a patient might take on their own. Like let's say they take ibuprofen for inflammation or they are a drinker. Maybe they have a glass of wine every night or two or vaping or smoking. Why do we say don't do that for a certain period of time before and after? And how long do you really need to pause these little vices? We'll call them the little vices.

Dr. Salazar (18:45):
Right? It's pretty much, I mean, there's some people that are big exercise aficionados. There are some people that are smokers, cigar aficionados. There are people that enjoy other type of recreational activities. So it's important that around surgery, if there is, for instance, if there's active smoking or use of nicotine or use of marijuana that you stop. And the reason is because remember, we're going to be when you have anesthesia, we all think about, oh, they put a little mask on my face and it's a nice gas and I go to sleep and that's it. That's not reality there. That's great for movies or great for cartoons. But in reality, the anesthesiologist is giving you medications, different type of medications that those medications get metabolized by your liver, your kidneys, and again, we have our operating rooms are quad A accredited. You have board certified anesthesiologists.

(19:45):
We have the most professional of the professionals taking care of you, but every single thing they do, all those substances are going to interact with any other substance that you have been using, even if it's a glass of wine before surgery. So you don't want to do that. You don't want to be smoking marijuana a couple of days before your surgery. You don't want to be smoking cigarettes with nicotine and shutting small vessels down and restricting blood flow to certain tissues, or you don't want to increase your blood pressure unnaturally. So all those things, it's really important. And again, depending on which procedure, it's the amount of time that we ask patients not to do it. Before surgery, literally your body is going to be responding and recovering from tissue injury, even if it's like a breast augmentation, your body to your body. What we're doing is we are creating some injuries. So that's why it's important before. And then after number one, you still have some of the general anesthesia in your system that your body is cleaning up. The second thing is remember we want to keep you as comfortable as we can. So we are giving you some medications that also need to be, they're going to be in your system, so you don't want to combine those medications with alcohol or tobacco or recreational drugs. Don't add any other variable to your recovery.

Monique Ramsey (21:08):
Now, when you go into some stores these days or look online, there's about 7 million different kinds of compression garments, and I know we send patients home with whatever garments they need, but at some point they transition into maybe if they want to wear something to just feel more put together. Do you have recommendations for that or you sort of let them after a certain point choose their own?

Dr. Salazar (21:35):
So we are very strict with compression, depending, again, I mean we're talking in general for certain surgeries, it's a certain amount of time, but for let's say big surgeries, when you're talking about mommy makeovers, we're talking about full liposuctions or high definition talking about six weeks of 24/7 of wearing compression and then another six weeks of weaning off that compression. Then I think, and speaking of lymphatic drainage, remember that lymphatic, those lymphatics are going to reconnect and then are going to start draining in a more normal way. Then you also start taking that compression off because now we want the flow of your lymphatic drainage, your flow, your regular flow of fluid in your body to be as normal and natural as possible. So I would say after six weeks for big surgeries, they show me a different type of compression that they find online, or it's very common that they bring, I found these, I found these shorts, I found this leggings, I found this type of bra, and they bring it, and then we see and we test it and we feel it, and they're like, okay, yeah, go ahead and use it.

(22:45):
But for the first six weeks, we're very strict in terms of use. Please use what we gave you.

Monique Ramsey (22:52):
Now as they get into back into life and they, let's say they had a breast augmentation or breast lift with augmentation, they want to take the girls to the beach. Do you let them be in the sun? Let's say it's August, it's warm out. You want to show off your new curves. Is it like dangerous for when can they have the skin, cuz maybe the sensation's different. They don't feel if they're burning.

Dr. Salazar (23:21):
Right. So I would say three, I normally restrict water submersion for about, again, depending on the surgery, but two to three weeks depending on what we do. If there is a bigger incision, then we go for three weeks. If it's like liposuction, smaller incisions and they have healed about two weeks. But normally that's what we are aiming for, I would say about three weeks, no water submersion. Now, even though incisions, you can see them that they're close and they're healed, completely healed at about three weeks, and then to your naked eye looks like this is ready inside, there is a lot of action happening. Still your body is depositing collagen to that area. You're depositing proteins to that area. We were talking about that lymphatic channels, the nerves are regenerating. You're still feeling like little electric shocks and little funny sensations here and there, and that talks about all the action that's happening.

(24:19):
You have some sutures that are deep sutures, but they're dissolving sutures. So your body is working, your defense cells. I mean, when we hear that sutures are dissolvable, we think that they magically disappear and no, I mean nothing disappears. What happens is that your body, your defense cells look at those sutures and they say, this is not part of my guy, this is not part of my girl, so I'm going to start attacking those sutures and spitting all those substances that actually kill foreign bodies, bacteria, and all along those lines. That's how your body dissolves the stitches. So there's a lot of action. There is, remember in your skin there are melanocytes, and those are the cells that provide color. So scars have, as all this new cells are coming in, and then scars are very susceptible to the sunlight, and then what you don't want is either if you have dark skin to end up with a perfect white line or if you have lighter skin to end up with a perfect dark line that it's going to be very noticeable.

(25:27):
So what I tell patients after, so let's say that they had, you were talking about a breast lift, breast augmentation, after three weeks, they can get some merchant water, they can go to the beach. I wouldn't advise at least for the first six, eight weeks to get a lot of sun exposure after that. I still recommend, I mean, one of the things that we are very conscious about is we apply it very well in our face, but then sometimes we do liposuction to the chin and then down here you need to apply some sunblock over here. When you do, I mean, you might apply it in your chest, right in the center, in your neck sunblock, but what if we put some implants through an incision underneath your breast? You also need to rub some of that sunscreen right there, and normally you don't do it, so you have to kind of be very conscious about this.

Monique Ramsey (26:22):
And there's some good clothing out there and bathing suits that have some SPF sort of built in on top of, because you don't think about, if I put on my bathing suit and I put on some SPF on my incisions, well, you wouldn't think about putting it on if you've got clothing on top that you really still do, the sun can penetrate.

Dr. Salazar (26:42):
Right. Your clothing, it only gives you, I mean, there's different studies, but they talk about 10, 17, 20 SPF. That's what clothing provides for 10, 17, 20 minutes, you're protected, but after that, then you're exposed. So it's important that you apply your sunscreen and reapply it, but be very conscious about the fact that you have, even though it looks like it has healed, yes, it's closed, but internally there's a lot of action. There's active construction happening.

Monique Ramsey (27:16):
Now kind of into the last thing is what are some key things that might help make a patient, you were talking about nesting, that nesting period, make recovery go a little smoother. Do you have any tips and tricks for patients to help them during that time?

Dr. Salazar (27:35):
It varies a lot from patient to patient, from surgery to surgery and from occupation to occupation, right? You have some patients that are their job, let's say it's a hundred percent intellectual, and they say, I work from home and I sit in front of a computer, or I have my laptop and I put in my lap and I can work. When do you think I can go back to work? So literally, as soon as you're not taking a narcotic, your mind's going to be clear, and depending on the procedure, sometimes it is like three to four days after, so you just need a long weekend, you're going to be ready. Different is if that person's, I don't know, a firefighter or we've had taken care of patients that actually need to wear a lead vest, right? A bulletproof vest. And that also changes things because of, oh, if I don't wear the vest, I cannot go back to work. All that is covered during that visit. Same thing. I was like, how many pillows do I need? Can I turn to my side? I'm a side sleeper. Oh, no, you can't. Depending on the surgery. And then we tell them to find which or how many pillows. Same thing. If they have either a couch or that's a recliner or either they have, there's some patients that actually have almost hospital beds at home, which is,

Monique Ramsey (28:59):
Yeah, you have an adjustable bed. That's a nice thing.

Dr. Salazar (29:02):
It's a very nice thing to have. Or if they don't, then we find a solution for that, which a great majority of people don't have one of those beds. You have extra pillows that you can kind of help creating the same effect. So it's very individualized. 99% of the surgeries that we do, we ask patients, we see them the following day, we ask them not to shower that morning, and then we tell them and remind them how to shower, when to shower, and tips and tricks of how to do it and how to keep things clean.

Monique Ramsey (29:33):
The one thing that some people come to you or to any of our surgeons at La Jolla Cosmetic, they're coming from out of town, and so we're not going to really cover that today, but I want to let everybody know, we did talk about places to stay around San Diego are in La Jolla that are close to us, and sort of some tips on traveling because if you come from somewhere, you got to go home at some point. So we have a whole episode kind of talking about if you come to San Diego and you want to stay, how long do you need to stay? And so we'll put that in the show notes because that is another aspect of recovery and how to take that into account when you are planning for this big life event that if you're traveling on top of that.

Dr. Salazar (30:24):
I think it's a good reference for our audience to go and look at that episode or listen to that episode because it's really, it covers it very thoroughly, but it's very doable as long as you do it correctly. And I would say that since we are located in one of the best places in the world, I mean, we live where people come in vacation all the time, it's a great excuse. I mean, we tell that patients all the time, yeah, use me as an excuse and we're follow you up at your, this is going to be your six month postoperative visit, but stop by, get some pictures and then forget about us and go to the beach, go shopping, go to great restaurants and enjoy San Diego.

Monique Ramsey (31:06):
Yeah, a little rejuvenation vacation.

Dr. Salazar (31:08):
Exactly.

Monique Ramsey (31:09):
Alright, well, thank you Dr. Salazar. This was super helpful and informative and everybody's got questions about recovery. So I think we covered just about everything today. Is there anything we missed?

Dr. Salazar (31:21):
No, I think it was a very nice conversation. I think it's very helpful for patients. I mean, demystifying this process after that, if you start thinking too much about it, you might get a little confused. Or if you look online, you start getting too many answers. It's really hard to find a concise response and then guess what's going to happen? You're going to find multiple opinions out there, and then you're going to find multiple, I mean, contradictory information. Come have a consultation, we'll create a plan, and then we'll go over that. It's very frequent that they say, great, now I know what I need. Now I know what resources I need to pull from, meaning either I need my mom to come or I need my sister to join me. It makes everything so clear that then at that point, then you can plan. Then you can say, okay, now I know what I need. Let's do the surgery in a month. Or let's do the surgery in a couple of months from now. So coming and talking to us makes things so much clearer that then at that point in time, you need exactly what you need for your recovery.

Monique Ramsey (32:28):
Well, that's perfect. Well, thanks everybody for listening, and thank you Dr. Salazar for lending your expertise for the morning, and we'll see you guys on the next one and the show notes for the links that we talked about.

Dr. Salazar (32:41):
Thanks much for the invitation.

Monique Ramsey (32:42):
Thanks. Bye.

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