Patient Forms

Sleeping:

• Keep your head elevated on at least 2-3 pillows at all times for the first week after surgery.

Wound care:

• Ice your eyelids.
• Apply ice (frozen peas, soft lightweight cold packs, or gauze or washcloths soaked in ice cold water) to the eyelids for 10 minutes every hour while awake for the first three days after surgery.
• You will apply erythromycin ophthalmic ointment to your eyelids three times a day for the first two weeks.
• It is extremely important to keep incisions moist, until they are completely healed. 
• If you had lower eyelid surgery you will also apply antibiotic ophthalmic drops to your eyes three times a day.
• You must wash your hands before applying ointment to or touching the eyelids.
• There are a number of over the counter homeopathic medications, such as arnica, which can reduce bruising and swelling, leading to a faster return-to-work.
• It is ok to shower the day after your surgery. Try to keep most water off of your incisions, wash your face with a washcloth rather than letting shower water run over your eyes. If you do get water on your eyelid incisions, use a clean washcloth or paper towel to gently pat the incisions dry.
• Wash your hair with a mild shampoo (like a no-tears baby shampoo) for the first week after surgery.

Activity:

• Avoid strenuous activity or lifting more than 10 lbs for 2 weeks after surgery. Talk to Dr. Irvine before you resume your exercise routine.
• Do not bend your head down below your waist or lie flat for the first week after surgery.  
• It is ok to go out, watch TV, and read as you feel comfortable.
• You should only drive a car when it feels safe. In this instance, refrain from applying ointment to the eyelids for a few hours before driving as this can blur vision.

Medications:

• You will receive an oral antibiotic to take for one week after surgery. If this causes any diarrhea or stomach upset, please let Dr. Irvine know immediately.
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day). If you need a stronger medication to help with bowel movements, you can take over the counter Miralax daily.

Sleeping:

• Keep your head elevated on at least 2-3 pillows at all times for the first week after surgery.

Diet:

• Start by drinking clear liquids, then advance to soft foods.
• Avoid chewy, hard, salty, or spicy foods for one week after surgery.

Wound care:

• Ice your cheeks.
• Apply ice (frozen peas, soft lightweight cold packs, or gauze or washcloths soaked in ice cold water) to the cheeks for 10 minutes every hour while awake for the first three days after surgery.
• You will have a wrap around your face after surgery. You can remove this to go out in public and to go to work, but wear it as much as you can while at home and while sleeping for the first week after surgery.
• You will use a mouthwash called chlorhexidine to rinse your mouth 3 times per day for the first week after surgery.
• There are a number of over the counter homeopathic medications, such as arnica, which can reduce bruising and swelling, leading to a faster return-to-work.

Activity:

• Avoid strenuous activity or lifting more than 10 lbs for 1 week after surgery. Talk to Dr. Irvine before you resume your exercise routine.
• Do not bend your head down below your waist or lie flat for the first week after surgery.
• It is ok to go out, watch TV, and read as you feel comfortable.
• You should only drive a car when it feels safe as long as you are not taking any narcotic pain medications.

Medications:

• You will receive an oral antibiotic to take for one week after surgery. If this causes any diarrhea or stomach upset, please let Dr. Irvine know immediately.
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day). If you need a stronger medication to help with bowel movements, you can take over the counter Miralax daily.

• Keep your head elevated on at least 3 pillows at all times for the first week after surgery.
• Do not sleep on your side.
• Do not bend your head down below your waist or lie flat.
• Ice under your chin and on your neck with frozen peas or frozen gel packs as much as possible for the first week.
• On the second day after surgery, you may wash your hair gently with baby shampoo. If you must dry your hair, please use the cool setting on your hair dryer only.
• Wear loose clothing that fastens in the front or back for 1 week. Avoid slipover sweaters, t-shirts or turtlenecks.
• Avoid all sun exposure on your scar for at least 2 months after surgery.

DRESSING CARE:

• You will have a bandage on your chin. Leave this in place until Dr. Irvine removes it in clinic, usually 6-8 days after surgery.
• With assistance, you may bathe in a tub, showering is allowed on the second post-operative day. It is all right to carefully wash your face with a mild soap and a clean washcloth or cotton balls. Keep your chin dressing dry while it is in place.
• After the dressing is removed you will apply ointment to your incision, usually aquaphor, for one week, followed by a scar gel or cream such as Biocorneum, Scar Away gel or sheets, or any other silicone based scar product, for 6 months.

POSTOPERATIVE DIET:

• Probiotics (for example, Align) should be taken daily.
• Drink plenty of liquids: juices, broth, tea (not hot) and plenty of water in addition to other liquids. Please note that citrus juices may irritate your stomach if consumed without food.
• Avoid foods that are hard to chew and digest.
• Avoid caffeine for at least 5 days after surgery.
• Avoid ALL alcoholic beverages for 14 days after surgery.
• SOME SUGGESTIONS:
  • Baked or mashed potatoes, creamed vegetables, non-dairy frozen yogurt, fruit yogurt, Jell-O or pudding, apple sauce, bananas, canned fruit or cottage cheese, tuna fish, eggs, oatmeal, Cream of Wheat, any type of baby food, warm soups
  • Make protein smoothies (not too cold) and eat a lot of berries and raw vegetables
  • Soups (low in salt if possible)
  • Wholesome / healthy nutritious foods on the first 2-3 days are very important in the healing process and will help you feel stronger sooner. Please start with soft foods.
• WHAT NOT TO DO:
  • No diet foods or diet drinks
  • No spicy foods
  • No hot foods after surgery (may cause bleeding), warm is OK
  • No heavy or large meals, start with small and light meals, then slowly increase as tolerated
  • No hard to chew foods (like steak) for one week after surgery

MEDICATIONS:

• Avoid medications that contain aspirin or ibuprofen for two weeks after surgery.
• It is normal to have significant chin pain for the first few days after surgery.
• If you are taking narcotic pain medications (Norco), this medication may cause constipation. Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy. Take as directed on the package insert (usually one twice a day).
• Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. If the prescribed medication does not control your symptoms, please let us know. Nausea may occasionally be related to the above medication. Taking the medication with food may help alleviate the nausea. After the first 72 hours, Tylenol or Extra-strength Tylenol may be sufficient.

ACTIVITY:

• The First Week
  • Limit your activity sharply during the first week following surgery. You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects. If you overexert yourself, bleeding may result. When you rest or sleep, keep your head elevated on 2 – 3 pillows and try to avoid turning on your side. Keep your emotions under control. It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better. Anger or crying will only add to the swelling or initiate bleeding.
• The Second Week
  • It takes six weeks for the face to fully heal. Resume your activity gradually. After the first week, let your body tell you how much to do. Strenuous exercise may be resumed in 2-4 weeks. Build up to this level slowly. Semi-contact sports are to be avoided for four to six months. Swimming is allowed after six weeks. Do not let your face become sunburned after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with an SPF of at least 30.

POSTOPERATIVE VISITS:

• You will be seen on the day after surgery.
• Sutures will be removed at one week after surgery.
• Any touch up surgery that may be necessary is generally not performed for at least six months.

FRACTIONAL ABLATIVE CO2 LASER RESURFACING PRE- AND POST- PROCEDURE INSTRUCTIONS

Before your laser treatment:

• Avoid all sun exposure for at least 4 weeks prior to your procedure (use a broad rimmed hat and mineral sunblock if going outside).
• Start your laser preparation between 2 and 6 weeks prior to your procedure date. The exact start date depends on your skin type and Dr. Irvine’s instructions.
• If you were prescribed an antibiotic or antiviral medication, make sure you take it as directed.

After your laser treatment:

• The goals in the immediate post-procedure period are to keep your face moist, cool, and out of the sun.

Day of your laser treatment:

• Irvine will apply a coat of Aquaphor or laser balm to the entire treated area
• It is important to continue to apply Aquaphor or laser balm to the entire treated area to keep the skin moist (avoid an excessively thick layer of Aquaphor to avoid getting ointment in your eyes)
• Place ice packs or frozen vegetables on the treated areas throughout the evening, keeping ice in place for at least 10 minutes of every hour while awake
• You may want to keep a spray bottle with distilled water in the refrigerator to mist onto your face throughout the evening
• Sleep with your head elevated on 2 pillows
• You may want to place a towel or paper towel on your pillow to protect bedding from ointment

Day 1 (the day after your laser treatment):

• If you are outside in any sunlight, even for 1 minute, during the first week after the procedure, treated areas must be covered with a protective hat or clothing
• You can shower and wash your face with cool or room temperature water (NO hot water or hot shower and no soap on the face)
• Reapply Aquaphor or laser balm after washing your face and throughout the day in order to ensure the entire treated surface stays moist

Day 2:

• You can wash your face with Cetaphil soap and cool water 2-3 times per day
• DO NOT use any exfoliating products
• DO NOT pick any crusts from your face

Day 3-7:

• As soon as the top layer of skin starts to peel, fresh baby-like skin will appear
• On approximately postoperative day 2,3, or 4, as soon as the skin starts to peel and exposes a silver dollar-size area of underlying fresh skin, switch from Aquaphor to Cetaphil lotion
• Continue to wash your face with Cetaphil soap and cool water followed by Cetaphil lotion
• You can resume Skinceuticals CE Ferulic serum at this time to aid in healing
• Mineral powder makeup can be worn toward the end of the first week
• Mineral sunblock (titanium dioxide and zinc oxide) can be worn toward the end of the first week
• Continue to avoid strenuous exercise or any activities that cause flushing of the face
• Continue to avoid hot showers or steam rooms

Weeks 1-4:

• Continue to protect all treated areas from the sun completely using mineral sunblock plus a hat or clothing
• You may wear mineral sunblock and mineral powder makeup
• Continue to use moisturizer daily (Cetaphil or other Dr. Irvine-approved product)
• DO NOT use any exfoliating products
• You may resume normal exercise

Sleeping:

• Keep your head elevated on at least 2-3 pillows at all times for the first week after surgery.

Wound care:

• Ice your forehead.
• Apply ice (frozen peas or soft lightweight cold packs) to the entire forehead for 10 minutes every hour while awake for the first three days after surgery.
• You will have 2 to 5 incisions in your hairline after surgery. These will have metal clips in them. You can apply bacitracin to these incisions twice a day beginning on the day after surgery.
• There are a number of over the counter homeopathic medications, such as arnica, which can reduce bruising and swelling, leading to a faster return-to-work.
• It is ok to shower 2 days after your surgery. Try to keep most water off of your incisions, wash your hair in a sink or wash the front of your hair with a washcloth.
• Wash your hair with a mild shampoo (like a no-tears baby shampoo) for the first week after surgery.
• Pat incisions dry gently and if they seem very wet you can use a hairdryer on cool (NOT hot – this may burn your scalp due to the metal clips) to gently dry the incisions.

Activity:

• Avoid strenuous activity or lifting more than 10 lbs for 2 weeks after surgery. Talk to Dr. Irvine before you resume your exercise routine.
• Do not bend your head down below your waist or lie flat for the first week after surgery.  
• It is ok to go out, watch TV, and read as you feel comfortable.
• You should only drive a car when it feels safe and if you are not taking narcotic pain medications.

Medications:

• You will receive an oral antibiotic to take for one week after surgery. If this causes any diarrhea or stomach upset, please let Dr. Irvine know immediately.
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one pill twice a day). If you need a stronger medication to help with bowel movements, you can take over the counter Miralax daily.
• Avoid taking over the counter pain medications that contain non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen/Advil/Aleve/Excedrin or aspirin for 10 days after surgery.

Sleeping:

• Keep your head elevated on at least 2-3 pillows at all times for the first week after surgery.

Wound care:

• You will have a head wrap/bandage in place for one week after surgery.
• On the day after surgery you will see Dr. Irvine. She will remove the bandage and apply ointment to your incisions and then re-apply the bandage.
• Apply ice (frozen peas or flexible cold packs) to the face and neck for 10 minutes every hour while awake for at least the first three days after surgery.
• You will apply bacitracin ointment to your incisions twice a day for the first week after surgery.
• It is extremely important to keep incisions moist, until they are completely healed. 
• Wash your hands before applying ointment to your incisions.
• After 1 week, you will stop bacitracin and apply aquaphor to your incisions.
• After 2 weeks, you will stop aquaphor and apply a scar ointment to your incisions.
• There are a number of over the counter homeopathic medications, such as arnica, which can reduce bruising and swelling, leading to a faster return-to-work.

Showering:

• It is ok to shower on the second day after your surgery.
• Wash your hair with a mild shampoo (like a no-tears baby shampoo) for the first week after surgery.
• Use distilled water to wash your hair.
• Try to keep most water off of your incisions. Wash your face with a washcloth rather than letting shower water run over your incisions. If you do get water on your incisions, use a clean washcloth or paper towel to gently pat the incisions dry. You can also use a hair dryer on cool to dry the incisions.

Drain care:

• You will have drains in place with clear plastic bulbs attached to them.
• Make sure that the bulb is always collapsed (holding suction), unless you are emptying it.
• If the bulb does not remain collapsed or loses suction by repeatedly expanding after the cap is replaced, please call the office.
• Once the bulb gets more than half full with liquid, the suction becomes less effective. When this happens, empty the liquid that is in it and record the quantity emptied.
• While the drain is in place you must take oral antibiotics. If you do not have antibiotics or run out while the drain is still in place, please let Dr. Irvine know immediately.

  Medications:

• You will receive an oral antibiotic to take for one week after surgery. If this causes any diarrhea or stomach upset, please let Dr. Irvine know immediately.
• Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. If the prescribed medication does not control your symptoms, please let us know. Nausea may occasionally be related to the above medication. Taking the medication with food may help alleviate the nausea. After the first 72 hours, Tylenol or Extra–strength Tylenol may be sufficient.
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day). If you need a stronger medication to help with bowel movements, you can take over the counter Miralax daily.
• Avoid medications that contain aspirin or ibuprofen for two to three weeks after surgery.

Diet:

• Drink plenty of liquids:  juices, broth, tea (not hot) and plenty of water in addition to other liquids.  Please note that citrus juices may irritate your stomach if consumed without food.  
• Avoid foods that are hard to chew and digest. 
• Avoid caffeine for at least 5 days after surgery. 
• Avoid ALL alcoholic beverages for 14 days after surgery. 
• SOME SUGGESTIONS:
  • Baked or mashed potatoes, creamed vegetables, non-dairy frozen yogurt, fruit yogurt, Jell-O or pudding, apple sauce, bananas, canned fruit or cottage cheese, tuna fish, eggs, oatmeal, Cream of Wheat, any type of baby food
  • Make protein smoothies (not too cold) and eat a lot of berries and raw vegetables
  • Soups (low in salt if possible) 
  • Wholesome / healthy nutritious foods on the first 2-3 days are very important in the healing process and will help you feel stronger sooner.  Please start with soft foods. 
• WHAT NOT TO DO:
  • No diet foods or diet drinks 
  • No spicy foods 
  • No hot foods after surgery (may cause bleeding), warm is OK
  • No heavy or large meals, start with small and light meals, then slowly increase as tolerated
  • No hard to chew foods (like steak) for one week after surgery 

Pain, swelling, bruising, or infection: 

• It is unusual to have significant pain after facial procedures. Please let us know if the prescribed medication does not control pain. There will be some discomfort, but remember that it will quickly pass. You can expect some swelling and bruising, especially for the first 72 hours. The swelling and bruising will gradually subside within 2 weeks or longer.
• Fever and/or localized swelling with redness and tenderness may signify a developing infection and should be reported to us immediately so that appropriate treatment can be initiated. 

Activity:

• Limit your activity sharply during the first week following surgery.  You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects (no more than 10 lbs).  If you overexert yourself, bleeding may result. 
• You should only drive a car when it feels safe.
• Keep your emotions under control.  It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better.  Anger or crying will only add to the swelling or initiate bleeding.
• It takes six weeks for the face to fully heal. Resume your activity gradually. After the first week, let your body tell you how much to do.  Strenuous exercise may be resumed in 2-4 weeks.  Build up to this level slowly. Semi-contact sports are to be avoided for four to six months.
• Swimming is allowed after six weeks.
• Do not let your face become sunburned after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with an SPF of at least 30.    

• Keep your head elevated on at least 3 pillows at all times for the first week after surgery.
• Do not sleep on your side.
• Do not bend your head down below your waist or lie flat.
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day).
• Probiotics (for example, Align) should be taken twice a day.
• Ice the swollen areas with frozen peas or frozen gel packs as much as possible for the first week.
• Have small balanced nutritious meals often (i.e. yogurt, smoothies, protein bars – remember to eat protein at every meal to keep your blood sugar level even).
• To cleanse suture areas of debris or blood that has accumulated around the wound: Use a clean Q-tip dipped in hydrogen peroxide (put a small amount of peroxide in a clean cup) 2-3 times a day.
• Use a clean Q-tip to moisten suture line completely with antibiotic ointment 2 -3 times a day.
• It is extremely important to keep incisions moist at all times, until they are completely healed. 
• Scarves should not be in direct contact with the skin since they may cause an infection.
• Do not have direct contact with a telephone receiver for 2 weeks since it may cause infection.
• On the second day after surgery, you may wash your hair gently with antibacterial mild shampoo. If you must dry your hair, please use the cool setting on your hair dryer ONLY.
• Wear loose clothing that fastens in the front or back for 1 week.  Avoid slipover sweaters, t-shirts or turtlenecks.
• Avoid all sun exposure for at least 2 months after surgery. 

DRAIN CARE:

• If you have a drain in place with a clear plastic bulb attached to it, make sure that the bulb is always collapsed (holding suction), unless you are emptying it.
• If the bulb does not remain collapsed or loses suction by expanding after the cap is replaced, please call the office.
• Once the bulb gets more than half full with liquid, the suction becomes less effective. When this happens, empty the liquid that is in it and record the quantity emptied.
• While the drain is in place you must take oral antibiotics. If you do not have antibiotics or run out while the drain is still in place, please let Dr. Irvine know immediately.

Top picture: Holding suction (collapsed)
Bottom picture: Not holding suction

POSTOPERATIVE DIET:

• Drink plenty of liquids:  juices, broth, tea (not hot) and plenty of water in addition to other liquids.  Please note that citrus juices may irritate your stomach if consumed without food.
• Avoid foods that are hard to chew and digest.
• Avoid caffeine for at least 5 days after surgery.
• Avoid ALL alcoholic beverages for 14 days after surgery.
• SOME SUGGESTIONS:
  • Baked or mashed potatoes, creamed vegetables, non-dairy frozen yogurt, fruit yogurt, Jell-O or pudding, apple sauce, bananas, canned fruit or cottage cheese, tuna fish, eggs, oatmeal, Cream of Wheat, any type of baby food, warm soups
  • Make protein smoothies (not too cold) and eat a lot of berries and raw vegetables
  • Soups (low in salt if possible)
  • Wholesome / healthy nutritious foods on the first 2-3 days are very important in the healing process and will help you feel stronger sooner.  Please start with soft foods.
• WHAT NOT TO DO:
• No diet foods or diet drinks
• No spicy foods
• No hot foods after surgery (may cause bleeding), warm is OK
• No heavy or large meals, start with small and light meals, then slowly increase as tolerated
• No hard to chew foods (like steak) for one week after surgery

PAIN, SWELLING, BRUISING, or INFECTION: 

It is unusual to have significant pain after facial procedures. Please let us know if the prescribed medication does not control pain. There will be some discomfort, but remember that it will quickly pass. You can expect some swelling and bruising, especially for the first 72 hours. The swelling and bruising will gradually subside within 2 weeks or longer. Infection is unusual. Fever and/or localized swelling with redness and tenderness may signify a developing infection and should be reported to us so that appropriate treatment can be initiated.

MEDICATIONS: 

Avoid medications that contain aspirin or ibuprofen for two to three weeks after surgery. Medication for pain will be prescribed. Take it as needed. Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. If the prescribed medication does not control your symptoms, please let us know. Nausea may occasionally be related to the above medication. Taking the medication with food may help alleviate the nausea. After the first 72 hours, Tylenol or Extra–strength Tylenol may be sufficient. 

 ACTIVITY:

The First Week 

Limit your activity sharply during the first week following surgery.  You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects.  If you overexert yourself, bleeding may result.  When you rest or sleep, keep your head elevated on 2 – 3 pillows and try to avoid turning on your side.  Keep your emotions under control.  It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better.  Anger or crying will only add to the swelling or initiate bleeding.

With assistance, you may bathe in a tub, showering is allowed on the second post-operative day. It is all right to carefully wash your face with a mild soap and a clean washcloth or cotton balls.

 The Second Week 

It takes six weeks for the face to fully heal. Resume your activity gradually. After the first week, let your body tell you how much to do.  Strenuous exercise may be resumed in 2-4 weeks.  Build up to this level slowly. Semi-contact sports are to be avoided for four to six months.  Swimming is allowed after six weeks. Do not let your face become sunburned after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with an SPF of at least 30.

POSTOPERATIVE VISITS:

• You will be seen on the day after surgery.
• Sutures will be removed at one week after surgery.
• Any touch up surgery that may be necessary is generally not performed for at least six months.

Sleeping:

• Keep your head elevated on at least 2-3 pillows at all times for the first week after surgery.

Wound care:

• Ice your upper lip: Apply ice (frozen peas, soft lightweight cold packs, or gauze or washcloths soaked in ice cold water) to the upper lip and mouth for 10 minutes every hour while awake for the first three days after surgery.
• You will apply mupirocin ointment to your incision three times a day for the first 5 days.
• It is extremely important to keep incisions moist until they are completely healed.
• After day 5, you will begin to apply Aquaphor to your incision three times a day.
• You must wash your hands before applying ointment to or touching the incision or nose. There are a number of over-the-counter homeopathic medications, such as arnica, which can reduce bruising and swelling, leading to a faster return to work.
• It is ok to shower the day after your surgery. Try to keep most water off of your incisions, wash your face with a washcloth rather than letting shower water run over your nose and lip. If you do get water on your upper lip incisions, use a clean washcloth or paper towel to gently pat the incisions dry.
• Wash your hair with a mild shampoo (like a no-tears baby shampoo) for the first week after surgery.

Activity:

• Avoid strenuous activity or lifting more than 10 lbs for 2 weeks after surgery. Talk to Dr. Irvine before you resume your exercise routine.
• Do not bend your head down below your waist or lie flat for the first week after surgery.
• It is ok to go out, watch TV, and read as you feel comfortable.
• You should only drive a car when it feels safe.
• Your smile will feel stiff and strange for 3 months after surgery. Avoid all major events for three months.
• Avoid any sun exposure on your upper lip incision for 6 months to let the scar heal properly.

Medications:

• You will receive an oral antibiotic and an antiviral to take for one week after surgery. If this causes any diarrhea or stomach upset, please let Dr. Irvine know immediately.
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.
  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day). If you need a stronger medication to help with bowel movements, you can take over-the-counter Miralax daily.

• Keep your head elevated on at least 2-3 pillows at all times for the first week after surgery.
• Do not bend your head down below your waist or lie flat.  
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day). 
• Probiotics (for example, Align) should be taken twice a day. 
• Ice the swollen areas with frozen peas or frozen gel packs as much as possible for the first three days. 
• To cleanse suture areas of debris or blood that has accumulated around the wound: Use a clean Q-tip dipped in hydrogen peroxide (put a small amount of peroxide in a clean cup) 2-3 times a day. 
• Use a clean Q-tip to moisten suture line completely with antibiotic ointment 2 -3 times a day. 
• It is extremely important to keep incisions moist at all times, until they are completely healed. 
• Scarves should not be in direct contact with the skin since they may cause an infection. 
• Avoid all sun exposure for at least 2 months after surgery. 

DRESSING:

• You will have a dressing on your incision. You can remove it on the day after your procedure or sooner if it gets soiled with blood.
• Apply Bacitracin or Neosporin ointment to your incision for 1 week after your procedure.
• You can leave the incision uncovered or cover it with a gauze or bandaid as long as the sticky portion of the tape or bandaid does not touch the suture line.

PAIN, SWELLING, BRUISING, or INFECTION: 

It is unusual to have significant pain after facial procedures. Please let us know if the prescribed medication does not control pain. There will be some discomfort, but remember that it will quickly pass. You can expect some swelling and bruising, especially for the first 72 hours. The swelling and bruising will gradually subside within 2 weeks or longer. Infection is unusual. Fever and/or localized swelling with redness and tenderness may signify a developing infection and should be reported to Dr. Irvine immediately by calling the office. Appropriate treatment will be initiated. 

• Dr. Irvine will see you one day after surgery to remove small drains behind your ears.
• You will have a head wrap in place for 1 week after surgery.
• You may have cotton balls sutured onto the front part of your ears for a total of 2 weeks after surgery.
• After the head wrap comes off at the 1 week postoperative visit, you will need to wear a sport headband to compress the ears at night for 6 weeks.
• Keep your head elevated on at least 2-3 pillows at all times for the first week after surgery.
• Do not bend your head down below your waist or lie flat.  
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day). 
• Probiotics (for example, Align) should be taken twice a day. 
• Ice can be placed over the ears, using frozen peas or frozen gel packs as much as possible for the first week. 
• To cleanse suture areas of debris or blood that has accumulated on the incisions behind your ears: Use a clean Q-tip dipped in hydrogen peroxide (put a small amount of peroxide in a clean cup) 2-3 times a day. 
• Use a clean Q-tip to moisten suture line completely with antibiotic ointment 2 -3 times a day. 
• It is extremely important to keep incisions moist at all times, until they are completely healed. 
• Scarves should not be in direct contact with the skin since they may cause an infection. 
• Do not have direct contact with a telephone receiver for 2 weeks since it may cause infection.
• On the third day after surgery, you may wash your hair gently with antibacterial mild shampoo. If you must dry your hair, please use the cool setting on your hair dryer ONLY.  
• Wear loose clothing that fastens in the front or back for 1 week.  Avoid slipover sweaters, t-shirts or turtlenecks. 
• Avoid sun exposure on your ears for at least 2 months after surgery. 

POSTOPERATIVE DIET:

• Eat small balanced meals in the first few days after surgery.
• Drink plenty of liquids:  juices, broth, tea (not hot) and plenty of water in addition to other liquids.  Please note that citrus juices may irritate your stomach if consumed without food.  
• Avoid foods that are hard to chew and digest. 
• Avoid caffeine for at least 5 days after surgery. 
• Avoid ALL alcoholic beverages for 14 days after surgery. 
• SOME SUGGESTIONS:
  • Baked or mashed potatoes, creamed vegetables, non-dairy frozen yogurt, fruit yogurt, Jell-O or pudding, apple sauce, bananas, canned fruit or cottage cheese, tuna fish, eggs, oatmeal, Cream of Wheat, any type of baby food, warm soups
  • Make protein smoothies and eat a lot of berries and raw vegetables
  • Wholesome / healthy nutritious foods on the first 2-3 days are very important in the healing process and will help you feel stronger sooner.  Please start with soft foods. 
• WHAT NOT TO DO:
• No diet foods or diet drinks 
• No spicy foods 
• No hot foods after surgery (may cause bleeding), warm is OK
• No heavy or large meals, start with small and light meals, then slowly increase as tolerated
• No hard to chew foods (like steak) for one week after surgery 

PAIN, SWELLING, BRUISING, or INFECTION: 

It is unusual to have significant pain after facial procedures. Please let us know if the prescribed medication does not control pain. There will be some discomfort, but remember that it will quickly pass. You can expect some swelling and bruising, especially for the first 72 hours. The swelling and bruising will gradually subside within 2 weeks or longer. Infection is unusual. Fever and/or localized swelling with redness and tenderness may signify a developing infection and should be reported to us so that appropriate treatment can be initiated. 

MEDICATIONS: 

Avoid medications that contain aspirin or ibuprofen for two weeks after surgery. Medication for pain will be prescribed. Take it as needed. Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. If the prescribed medication does not control your symptoms, please let us know. Nausea may occasionally be related to the above medication. Taking the medication with food may help alleviate the nausea. After the first 72 hours, Tylenol or Extra–strength Tylenol may be sufficient. 

ACTIVITY:

The First Week 

Limit your activity sharply during the first week following surgery.  You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects.  If you overexert yourself, bleeding may result.  Keep your emotions under control.  It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better.  Anger or crying will only add to the swelling or initiate bleeding. 

The Second Week 

It takes six weeks for the ears to fully heal. Resume your activity gradually. After the first week, let your body tell you how much to do.  Strenuous exercise may be resumed in 2-4 weeks.  Build up to this level slowly. Semi-contact sports are to be avoided for four to six months.  Swimming is allowed after six weeks. Do not let your ears become sunburned after surgery. This may result in prolonged swelling and erythema (redness). When outside, wear sunscreen with an SPF of at least 30.   

• Do not blow your nose for approximately 2 weeks.  Wipe or dab your nose very gently around the nostrils with gauze.
• Change the gauze dressing under your nose as needed.
• If you need to sneeze, sneeze with your mouth open.
• Keep your head elevated for 1-2 weeks.  At night, sleep with your head in an upright position on 2-3 pillows.
• Do not sleep on your side.
• Do not bend your head down below your waist or lie flat.
• Avoid all sun exposure for at least 2 months after surgery
• If you are taking narcotic pain medications (Norco), this medication may cause constipation.  Colace (Docusate sodium), a stool softener, is recommended for any patients on these medications and can be purchased at your local pharmacy.  Take as directed on the package insert (usually one twice a day).
• Antihistamine/Decongestant (Zyrtec-D or Claritin-D) should be taken as needed to decrease mucus/congestion but do not take this medication for more than one week.
• Probiotics (for example, Align) should be taken twice a day.
• Brush your teeth gently with a soft toothbrush.  Avoid excessive facial movements (smiling, grimacing, etc.) for at least 2 weeks.
• On the second day after surgery, you may wash your hair gently with mild shampoo. If you must dry your hair, please use the cool setting on your hair dryer ONLY.
• Keep your nose cast absolutely dry at all times. Do not remove. Call the office immediately if your nasal cast loosens. Wash your hair in a manner that keeps your nose dry. Use saran wrap to cover cast when bathing.
• Wear loose clothing that fastens in the front or back for 1 week.  Avoid slipover sweaters, t-shirts or turtlenecks.
• Ice the swollen areas, especially the forehead and neck, with frozen peas or frozen gel packs as much as possible for the first week.
• Carefully clean around the nostrils and nasal incision (if present) with a Q-tip and a mixture of 50% hydrogen peroxide and 50% water three times a day.  Immediately after cleaning, place a bit of bactroban (also known as mupirocin) ointment around the inside of the nostrils to keep them from drying out.
• Use a clean Q-tip to moisten suture line completely with bacitracin antibiotic ointment 2 to 3 times a day for the first week after surgery.
• It is extremely important to keep incisions moist at all times, until they are completely healed.
• Between 7 and 14 days after surgery, use aquaphor on the incision between your nostrils to keep the incision moist.
• From two to six weeks after surgery, use a scar gel such as biocorneum or silogen on your incision 2-3 times per day.
• Nasal irrigation begins on the day after surgery. Ocean spray or a generic salt-water spray for the nose should be sprayed into each nostril every hour while awake.
• The external nasal cast and internal nasal splints are removed at the one week postoperative visit. After removal of the splints, the nose should be irrigated with saline (Neti pot or neilmed sinus rinse purchased at a pharmacy or made by adding ½ teaspoon of iodized salt to 8oz. of water). While leaning over a sink, insert the nozzle of the bottle or bulb into each nostril and squeeze bulb while inhaling. Let the water be expelled through your nose and mouth. This should be repeated 3 times a day. Continue this process for at least two weeks or as otherwise instructed by Dr. Irvine.
• For the first 4-6 weeks, refrain from wearing eyeglasses. If it is absolutely necessary, tape your glasses to your forehead so that no pressure is applied to your nose.

Post Operative Dietary Instructions:

DRINK PLENTY OF LIQUIDS:  juices, broth, tea (not hot) and plenty of water in addition to other liquids.  Please note that citrus juices may irritate your stomach if consumed without food. Avoid foods that are hard to chew and digest. Avoid caffeine for at least 5 days after surgery. Avoid ALL alcoholic beverages for 7 days after surgery.

Pain, swelling, bruising, or infection: 

It is unusual to have significant pain after facial procedures. Please let us know if the prescribed medication does not control pain. There will be some discomfort, but remember that it will quickly pass. You can expect some swelling and bruising, especially for the first 48 hours. The swelling and bruising will gradually subside within 2 weeks or longer. Please remember that pain medication may impair your reactions. Avoid driving or performing hazardous activities while taking this medication. Nausea may occasionally be related to prescribed pain medications. Taking the medication with food may help alleviate the nausea. After the first 24 hours, Tylenol or Extra–strength Tylenol may be sufficient.  Avoid medications that contain aspirin vitamin E or ibuprofen for two weeks after surgery.

It is normal to have bleeding over the first 12 hours after surgery.  It may be necessary to change the gauze a dozen or so times over this period.  It is normal to have a pinkish-reddish discharge from your nose and throat for the first 3-4 days.  This will gradually subside.  If you have profuse nasal bleeding after this time, immediately lie down with your head elevated on 3 – 4 pillows.  Iced washcloths on the back of the neck and over the eyes may help.  Using nasal decongestants (such as Afrin) as directed will often help with bleeding.  Please call our office if these measures do not suffice.

Fever and/or localized swelling with redness and tenderness may signify a developing infection and should be reported to Dr. Irvine immediately. Appropriate treatment will be initiated.

Activity: The First Week 

Limit your activity sharply during the first week following surgery.  You are encouraged to walk about the house, but avoid bending at the waist or picking up heavy objects.  If you overexert yourself, bleeding may result.  Keep your emotions under control.  It is not unusual to feel a bit depressed for a few days after surgery. This quickly passes as you begin to look and feel better.  Anger or crying will only add to the swelling or initiate bleeding.  Restrict your diet to plenty of fluids and easily chewable foods.  Avoid picking up babies, small children or pets; a flailing little arm may or playful paw strike your nose.  You probably will hit your nose accidentally one or more times during the first week.  This will hurt, but will not cause a problem unless the force is excessive.

Activity: The Second Week 

It takes six weeks for the nose to fully heal so resume your activity gradually.  After the first week, let your body tell you how much to do.  Strenuous exercise may be resumed in 5-6 weeks.  Build up to this level slowly.  Semi-contact sports are to be avoided for four to six months.  Swimming is allowed after six weeks.  When outside, wear sunscreen with an SPF of at least 30.

If you had rib cartilage harvest:

Please do not wear underwire bras for the first 6 weeks after surgery. These may cause irritation on the rib incision and can make scarring worse.

PAIN/DISCOMFORT

You will experience moderate to severe discomfort/pain in the first 5-10 days. Generally the pain is worse at night. This should be controlled with the prescription narcotic pain medication. Once the discomfort or pain improves, then you may find that plain Tylenol is sufficient. You should not take plain Tylenol within four hours of the narcotic prescription as this already contains Tylenol. You should never take more than 3 grams of Tylenol in a 24 hour period.

Constipation may occur with regular narcotic use and an over-the-counter laxative such as Colace or milk of magnesia should be considered.

An ice pack or frozen peas in a bag alongside the neck may also help to relieve pain.

ANTIBIOTICS AND/OR STEROIDS

Take your antibiotics and/or steroids post-operatively as directed (if they were prescribed). If you have had a septoplasty or turbinate reduction, apply Bacitracin or Polysporin ointment to each nostril opening twice each day.

NASAL DRAINAGE

It is normal to have some blood-tinged drainage or mucus from your nose after surgery. This usually lasts 3-4 days. Change the nasal mustache dressing as needed to protect your clothing. Dr. Irvine should be contacted if the dressing is saturated with blood more frequently than every 30-60 minutes for the first 24 hours and more than every 2 hours in the days after that.

IRRIGATION

If you have had sinus surgery, you should begin irrigating three times a day as described at the preoperative visits. Occasionally, patients will be instructed to not irrigate until the first post-op visit. The discharge nurse will instruct you whether or not you should irrigate. If you have ONLY had a septoplasty or turbinate reduction, you do not need to do this unless you were doing it routinely before surgery.

NAUSEA

Nausea is quite common after surgery and may be associated with several factors including the anesthetic medication, or the narcotic pain medication. Nausea and vomiting generally resolve after the first 12 hours.

Some tips to help you deal with nausea:

1. Avoid taking narcotic pain medications on a completely empty stomach.
2. If nausea or vomiting occur shortly after a dose of narcotic medication, then try taking plain Tylenol until the nausea improves.
3. Some patients find that small sips of ginger ale or a cola drink may help to relieve nausea. Small portions of bananas, applesauce, moistened graham crackers, or soda crackers may be helpful prior to taking medications.
4. You may wish to avoid acidic products such as orange juice.

ADDITIONAL INSTRUCTIONS

Keep your head elevated on at least 3-4 pillows for the first 36 hours after your operation. Avoid heavy lifting, coughing, athletic or other strenuous activity. Sneeze with your mouth open. Do not blow your nose for the first month after surgery. Do not fly in an airplane for 3 weeks.

DIET

As a rule, one should begin with clear liquids such as ice chips or water then advance in color and texture until a soft diet is tolerated. You should maintain a diet of soft foods for 3 weeks. Fluids make a tremendous difference in the healing process. If patients do not drink enough, they usually have worse pain. If after 24 hours, you are unable to drink, then you should contact Dr. Irvine.

Tips for maintaining fluid intake:

• Begin with sips of water or ice chips or juice.
• Gatorade is an excellent fluid source and may also be frozen in cubes or ice chips.
• Classic favorites such as popsicles, smoothies, ice cream, frozen yogurt, yogurt, ice cream shakes, and other frozen drinks are usually tolerated well.
• Once the patient tolerates liquids then the diet may be advanced.
• Avoid hot (temperature) liquids or foods. After the first 18 hours, lukewarm foods are allowed. Some suggestions include: Lukewarm soup, macaroni or pastas, eggs, or other materials that are soft.

FOLLOW-UP APPOINTMENT

Dr. Irvine will see you a week after surgery, but call the office if concerns arise before the appointment.

EMERGENCIES

If you have a fever above 100, persistent nausea/ vomiting, or visual changes, or any questions or concerns, you may contact Dr. Irvine’s office. If you are unable to contact the doctor and there is an emergency then you should call 911 or proceed to the nearest emergency room.

Your tonsils and adenoid region will heal over a three week period. Most healing is accomplished within the first 10 days.

PAIN/DISCOMFORT

It is normal to have a shaggy gray or tan coating at the back of the mouth and bad breath during this time. You will experience moderate to severe discomfort/pain in the first 10-14 days. Generally the pain is worse at night. This should be controlled with the prescription narcotic pain medication. Once the discomfort or pain improves, then you may find that plain Tylenol is sufficient. You should not take plain Tylenol within four hours of the narcotic prescription as this already contains Tylenol. You should never take more than 4 grams of Tylenol in a 24 hour period.

Constipation may occur with regular narcotic use and an over-the-counter laxative such as Colace or milk of magnesia should be considered.

An ice pack or frozen peas in a bag alongside the neck may also help to relieve pain.

Beginning on postoperative days 4-7, you may experience ear pain. Generally, this is referred pain from the throat and will resolve as the tonsillar/throat area heals. Jaw pain may occur after the first 3 days. This is often due to inflammation and resulting immobility around the muscles which open and close the mouth. In addition to Tylenol, any oral motion such as chewing gum, swallowing, or drinking may be helpful.

NAUSEA

Nausea is quite common after surgery and may be associated with several factors including the anesthetic medication, or the narcotic pain medication. Nausea and vomiting generally resolve after the first 12 hours.

Some tips to help you deal with nausea:

1. Avoid taking narcotic pain medications on a completely empty stomach.
2. If nausea or vomiting occur shortly after a dose of narcotic medication, then try taking plain Tylenol until the nausea improves.
3. Some patients find that small sips of ginger ale or a cola drink may help to relieve nausea. Small portions of bananas, applesauce, moistened graham crackers, or soda crackers may be helpful prior to taking medications.
4. You may wish to avoid acidic products such as orange juice.

FEVER

A low grade fever is common. This fever typically occurs in the late afternoon or evening and may reach 100 degrees F. Fevers usually improve with the prescription pain reliever or Tylenol. For temperatures higher than 100 F, please contact Dr. Irvine or the physician on call.

BAD BREATH

Bad breath or an odor from the nose is common after surgery and usually resolves after 2 weeks.

BLEEDING FROM THE NOSE

There is a risk of bleeding during the first 3 weeks after surgery. The risk is generally highest in the first 24 hours, then 7 – 10 days after surgery when the eschar or scab begins to fall off.

You may experience drainage of a small amount of old, bloody mucus from the nose. Old blood from the nose is generally brown. This should resolve after the first 24 hours. Red blood is generally fresh blood and you should contact Dr. Irvine if this occurs.

BLEEDING FROM THE MOUTH

You should contact Dr. Irvine immediately if you experience any bleeding from the mouth or if you notice a red or purple clot in the mouth or throat. If you are unable to contact Dr. Irvine immediately then you should call 911 or proceed to the nearest emergency room.

DIET

As a rule, one should begin with clear liquids such as ice chips or water then advance in color and texture until a soft diet is tolerated. You should maintain a diet of soft foods for 3 weeks. Fluids make a tremendous difference in the healing process. If patients do not drink enough, they usually have worse pain. If after 24 hours, you are unable to drink, then you should contact Dr. Irvine.

Tips for maintaining fluid intake:

• Begin with sips of water or ice chips or juice.
• Gatorade is an excellent fluid source and may also be frozen in cubes or ice chips.
• Classic favorites such as popsicles, smoothies, ice cream, frozen yogurt, yogurt, ice cream shakes, and other frozen drinks are usually tolerated well.
• Once the patient tolerates liquids then the diet may be advanced.
• Avoid hot (temperature) liquids or foods. After the first 18 hours, lukewarm foods are allowed. Some suggestions include: Lukewarm soup, macaroni or pastas, eggs, or other materials that are soft.
• A soft diet should be maintained for 3 weeks to minimize risk of postoperative bleeding.
• Do not eat sharp, salty, spicy, or crunchy foods such as chips or even pizza crust and avoid using straws which might hit the back of the throat and cause bleeding.
• You may brush the front of your teeth but do not brush at the back as this may promote bleeding.

ACTIVITY

Patients will usually be out of school or work for 7-10 days, though some need 2 weeks for recovery. No strenuous or athletic activity is allowed during the 3 weeks following surgery. This includes any activity which may cause a significant elevation in the heart rate or blood pressure.

TRAVEL

During this 3 week postoperative period, travel outside of a 30 minute radius from Santa Barbara is not recommended.

FOLLOW-UP APPOINTMENT

Dr. Irvine will see you a week after surgery, but call the office if concerns arise before the appointment.

EMERGENCIES

If you have any questions or concerns, then you may contact Dr. Irvine. If you are unable to contact the doctor and there is an emergency then you should call 911 or proceed to the nearest emergency room.