Postoperative Care

Proper postoperative care of the facelift patient will insure the best result with the fewest complications. All patients are discharged to the overnight care of a skilled nurse well versed in the postoperative plan of care. A physician is always available.

All patients return the day after surgery and are carefully examined. The drain is removed if the output is less than 20 ml. Any sutures appearing unduly tight are snipped and left in situ. This avoids tension alopecia but averts annoying bleeding from the stitch hole. All flaps are carefully inspected. Patients are forbidden to hold a book or magazine in their hands, sit up straight without a headrest or lay supine or on their side without the chin-neck angle being more than 90° for 10 days. These activities all result in inadvertent neck flexion. Patients must rely on a second-party observer to remind them to keep the chin elevated since proprioception of the chin-neck angle is lacking. A good position that insures an open cervi-comental angle is one in which the patient sits with "elbows on knees." This posture allows reading, writing, eating, TV watching, etc. Any time compromise of the postauricular flap is noted, and a check should be made to insure that a tight closure has not created lateral tension across its base strangling it. If in doubt, offending sutures should be removed without hesitation, as secondary healing is always superior to slough.

Sutures are removed as indicated usually in stages over a period of 6-9 days. Fine sutures are removed from areas of low tension first, usually on postoperative days 3 and 5. Half-buried vertical mattress sutures are removed later over postoperative days 5-10. Sutures in relatively higher tension areas at the side-burn and behind the ear are removed last.

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