Facelift: What Recovery Really Looks Like, Day by Day

Dr. Koehler (00:00):
I had a lady the other day, she was like, "Oh, my husband is so glad I had this done. He was all worried." And he goes, "But you look great." And so the spouses come around.

Announcer (00:11):
You are listening to Alabama the Beautiful.

Kirstin (00:14):
I'm Kirstin Jarvis and I'm here with Alabama Cosmetic Surgeons, Dr. James Koehler and Dr. Vincent Gardner. Hey, Dr. Koehler and Dr. Gardner.

Dr. Koehler (00:24):
Hey, Kirstin.

Dr. Gardner (00:25):
Hey, Kirstin.

Kirstin (00:27):
All right. Now we're going to have Dr. Koehler talk about life after a facelift, because the facelift is not the hard part. It's the months after that nobody really talks about. So we're going to talk about what the first day, the first month, and the first year actually kind of look like.

Dr. Koehler (00:46):
Sounds good.

Kirstin (00:47):
Okay. So Dr. Koehler, the first 24 to 48 hours, I know you have your patients normally come back about 24 hours after surgery. What kind of happens at that appointment?

Dr. Koehler (00:59):
Well, we usually put a light dressing on, kind of cover things up. And so this is sort of when we remove that and people get their first opportunity to look at themselves completely without any kind of garment or dressing on. And I don't want to say it's a stressful moment, but somebody's just had the first night of surgery, they've had some discomfort, we're taking the dressings off. So there's a little bit of that fear of the unknown. They don't know what they're going to look like and now they get a chance to see it. But I'd say for the vast majority of people, it's kind of like, okay, this is better than what I anticipated. But yeah, there's some swelling and there's some discomfort in those first 24 hours. There's no question it's not a pain for your operation. But compared to a lot of surgeries I do, it's actually surprisingly not that bad.

(01:49):
I've had people just, I wouldn't say this is across the board, but I've definitely had people that have just taken things like Tylenol after surgery. So everybody's pain response is different. But yeah, we've also started using some newer medications and this has been very helpful in decreasing the amount of narcotic use, which is great because the narcotics make people feel kind of yucky in the head, clouded, groggy, nauseated. But first 24 hours, yeah, they finally get to take a look at themselves.

Kirstin (02:23):
Okay. Do they need help at home that first night?

Dr. Koehler (02:26):
Yeah, absolutely. For any surgery, I would never want a patient unattended the first 24 hours. Somebody needs to make sure that they are getting the medication as they need to and make sure they're taking the right medication because if they need their glasses and don't read their pill bottles correctly and they're taking the wrong stuff or taking too much and they've had anesthesia, so they may not be clearheaded right away. So you definitely need somebody there to help you those first 24 hours to get your medicines when you're supposed to and just assist you getting up and moving around.

Kirstin (02:57):
So weeks like one and two, the part that nobody is online posting about, when do the bandages come off or sutures come out or what does the face look like that first couple weeks?

Dr. Koehler (03:12):
I really don't use a lot in terms of bandages. I put a light dressing on just a curlex gauze, wrap their head right after surgery. That comes off the next day. And then we do give them a little chin band thing. It's kind of an elastic strap that they can use to help provide. It has some little pouches in the side so they can put some ice packs in there to just help hold the ice in place. But we don't really use dressings per se to. In my opinion, it doesn't change the surgical outcome at all. So if it's comfortable, great. If it's not comfortable, if they don't want to wear it, they don't have to wear it. But yeah, they have that. I usually tell them to wear that the first week if they find it comfortable and they want to use the ice packs.

(03:59):
Suture wise, I use all internal stitches for the incision under the chin, and then there's dissolvable sutures that go behind the ear, so there's nothing to remove there. And then I do use some stitches that are removable on the front side of the ear and those come out at one week. So at the one week post-op visit, we're taking whatever sutures need to come out and going over just sort of postoperative care instructions in terms of applying antibiotic ointment to the incisions, when to start the scar cream, which is usually a couple weeks after surgery. And really in that first week, bruising varies highly amongst patients. And there's a lot of things that we do now that when I first started doing facelift surgery, we didn't have some of these newer drugs and techniques that now really decrease the amount of swelling and bruising people have.

(04:51):
So the technique has definitely evolved, but I have some people at a week that have hardly a bruise to be found, and then there's other people that have bruising that extends down into their chest. And bruising typically takes two to three weeks to fully resolve. But surprisingly, a lot of people don't have much in terms of bruising. Used to use drains for a number of years, but now, for many years now, I don't use any drains. It's a drainless technique in the facelift surgery. It's called a preservation deep plane facelift, and there's ways that we've modified the technique so there's not nearly as much undermining of areas that require drainage. So we don't use drains, so there's nothing to remove.

Kirstin (05:38):
When can someone shower and wash their hair and sleep like a normal human again?

Dr. Koehler (05:43):
Well, we give you a full shampoo at surgery, a blowout and styling.

Kirstin (05:50):
Styling.

Dr. Koehler (05:51):
We don't style, but my nurses do wash their hair and they blow dry their hair. I just want my patients to smell fresh and clean and look good after surgery. So it's kind of one of these things. I mean, we kind of joke about the styling of the hair after surgery, but patients, the next day, they feel good. I let people shower after 24 hours if they want to shower, but a lot of times their hair and everything's already clean, so they may not do that right away. It just depends on their comfort level. But after 24 hours, they can wash their hair.

Kirstin (06:26):
Yeah. When I first started working here and Sarah was like, "Hey, will you order me a new blow dryer?" I was like, "Girl."

Dr. Koehler (06:34):
Yeah. No, actually I picked that up from a surgeon many years ago at the hospital that he was at, I was out there observing him. And anyhow, it was a fairly long case, but at the end of the case I thought, oh good, we're done. And then they pulled out the shampoo and stuff and I'm like, "What?" I'm like, "You're going to wash their hair?" And they're like, "Oh yeah, we do that for all of our patients." I was like, "Hmm." And then I thought, "Well, it's not a bad idea." I started doing it and I actually really, I like it. I think patients look and feel better having that done. So we do that for everybody.

Kirstin (07:07):
Okay. So six weeks after a facelift, when you are starting to look normal, look like yourself again, are they camera ready at six weeks or is there still some swelling or what does that come out?

Dr. Koehler (07:22):
Oh, there's still some swelling, but I think a lot of people would be totally fine having pictures taken at six weeks. I mean, depending on what it was for, I mean, you're not looking the way you're going to ultimately look. Six weeks. Well, I just saw a lady a few weeks ago, not last week, a couple weeks ago. She was three weeks out from a facelift. And I promise you, this lady at three weeks, she could have gone to the grocery store or wherever she wanted to go and there's not a single person that would probably look at her and go, "Oh, you've had a surgery." Yeah, she was probably still swollen for how she normally looks, but not the kind of thing that somebody who'd never met her before would perceive. There was no bruising. So a lot of times people are even very presentable at three and four weeks, but I know how women are about pictures.

(08:07):
I mean, maybe at six weeks, I would be fine with a picture, but maybe you wouldn't. But a lot of times people are looking pretty good at six weeks. Usually tell people it's really more like the three to six month range when the swelling is completely resolved.

Kirstin (08:26):
Okay. What about tightness and numbness in that six week period?

Dr. Koehler (08:30):
Tightness, I mean, sometimes early on after surgery, people, when they swallow, they may feel like it feels a little tight because we have tightened up some muscles and things. So that's only maybe for a few weeks. So definitely by six weeks you're not going to have that tight feeling. And then numbness, yeah, there will be some areas of numbness around the ears. So some of the areas of the skin, if you touch it, you might be like, "I can't really feel it. That doesn't feel normal." That can take months to completely come back, but it comes back so slowly that it's not even something that you really notice. And it's not like you're touching your face all the time. So having loss of sensation to an area, unless you're actually touching it, you don't really notice that. Probably the bigger thing and the thing that it doesn't happen very often, but it's definitely a risk of deep plane facelifting is injury to the nerves that move the muscles of your face because that's what we're doing.

(09:24):
In a deep plane facelift, we are going in that deeper area of the face where the nerves that move your muscles live. And so it can be from retraction, it can be from the heat of the cautery that these nerves get bruised or injured in some way and they take a little vacation. So if that happens, let's say a common area might be the nerve that supplies the muscles that depress the lower lip. So if you get an injury to that nerve, when you smile, one side of your lip comes down, but the side that's affected kind of stays elevated. So you look like Sylvester Stallone a little bit and it's stressful for the patients, but we talk about this before surgery. The good news is that, well, one, it's very rare that that's going to happen, but if it does, the vast majority. They come back.

(10:17):
It's just how long is it going to take? Usually it might take somewhere in that six to eight week range. So if you did have some weakness, usually by that point it's resolved because it's just a bruising of the nerve. The nerve's not cut, it's just injured and it's bruised. That's why if people are getting this done and they're like, "Oh, my daughter's wedding's coming up." I mean, you don't want to do this six weeks before a wedding. Now, three months, okay, sure. I think you'd be pretty good for that. So usually three to six months before a big event, I would say would be ideal. Some people probably would look fantastic in six weeks, but if you're that one rare person that has some weakness, that would be a stressful thing before a big event. So we usually try to make sure you have enough recovery there.

Kirstin (11:06):
Okay. Well, let's talk six months and beyond. How life actually changes. Six months out, what do patients tell you about how they feel, not just how they look? Does it change how they feel about themselves? Is that a major life change? A facelift to me is a big deal.

Dr. Koehler (11:25):
Yeah. I mean, I think there's a reason people had it done. They didn't like how they looked on their Zoom calls or whatever, or they just don't like that laxity under the neck, can't wear certain outfits because it bothers them. Yeah, I mean, I'd say it's a very rewarding surgery.

Kirstin (11:45):
Have people really told you that, that's why they had a facelift because they didn't like how they looked on Zoom calls?

Dr. Koehler (11:50):
Absolutely. Oh my gosh. There was a big uptick in facial surgery in general during COVID and after COVID because we moved to all these meetings on Zoom and people started looking at themselves on these calls going, "What in the heck? I hate how I look on this camera." And they're staring at their own face on the camera. So yeah, I mean, Botox was more popular, facial surgery in general. So yeah, I mean, I think I've definitely heard that. But yeah, it's a very gratifying thing. And I think the biggest stress relief for people is that not only do they look good, but they look like themselves. And there's that concern that a lot of people have, and I see a lot from spouses because the pushback from spouses, the husbands, let's say, "We're going to do facelifts on men too," but typically it's the man that's like, "I don't want my wife to have this done.

(12:44):
I like how she looks. I don't want her to look different." That's the stressful part. They don't want their wives to look odd and operated. And then when they get to that three and six month point, I had a lady the other day, she was like, "Oh, my husband is so glad I had this done. He was all worried." And he goes, "But you look great." And so the spouses come around. So that three to six month mark is when everybody's starting to feel good about it because in that first maybe four weeks, I think the spouses are a lot more stressed about it than the patients because I've spent time talking to the patients and usually the husbands are at the consult too, but sometimes they're not. And so if they're not and they haven't heard or looked at pictures of the progress, like I show pictures of early recovery and later recovery, they don't know what's normal and what's not.

(13:33):
So they're like, "Oh my God, my wife, what does she look like now?" And they're worried about it. But then when all the swelling comes down and the bruising goes away, then oh, there's this relief. I do think there is one area where we tend to see they look good at six weeks, but a lot of times people will still have some firmness and sometimes even some fullness up under the chin here. And that swelling does take somewhere between three and six months to fully resolve. So they'll look good even at six weeks, but they look better in six months. And so it's not like they're disappointed in how they look at six weeks, but they're like, "Oh man, I look that much better." So it just kind of gets better with time.

Kirstin (14:14):
Okay. So for someone who's weighing a facelift, what's the one thing about recovery that you wish they understood before booking?

Dr. Koehler (14:23):
Well, I think the biggest thing is just trying not to compare themselves to friends and the highlight reels on social media. And unfortunately, we're all guilty of it. We all want to show our greatest results and we put them on our social media and everything else, but not everybody's one week recovery is the same. Like I said, some people have a lot of bruising and they'll bruise easier. And so the hard part is I recently had a patient that had a facelift surgery and then her friend was going to get it done three weeks later. And the friend actually had an easier recovery than the first one, but they both had good recoveries, but you start comparing yourself and you can't compare yourself. Somebody might be looking fantastic at three weeks and the other person takes them another week to get to the same point.

(15:11):
So I mean, I think it's good to have that experience from other patients to know generally what to expect, but just because you're a little slower in recovery doesn't mean your surgery didn't go as well.

Kirstin (15:25):
All right. Do you have a burning question for Dr. Koehler or Dr. Gardner or me? You can leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Koehler and Dr. Gardner.

Dr. Koehler (15:39):
Thanks, Kirstin.

Dr. Gardner (15:40):
Thanks, Kirstin.

Kirstin (15:41):
Go back to making Alabama Beautiful.

Announcer (15:45):
Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShorecosmeticsurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.