Surgical FAQ

General Surgery FAQs

Breast Augmentation FAQs

• Will breast augmentation increase my risk of breast cancer?

  There are multiple high-quality, large studies which show that the presence of breast implants does not increase the risk of breast cancer. Having implants does not hinder the patient or physician in finding breast tumors. Having implants does, however, change the way mammograms need to be done. Typically, additional views are necessary. It is important to have mammograms done at the centre with experience with patients who have breast augmentation

• Am I too old for the surgery?

  Many women in their 40s and 50s who have successfully undergone breast augmentation however, the most common patient who undergoes breast augmentation is in their 20s or 30s.

• Should I wait until I am done having children to have augmentation?

  This is a very personal decision with no right or wrong answer. Many women have breast augmentation prior to having children. There are significant physical and hormonal changes that happen in pregnancy and the presence of breast implants does not change those. Breast augmentation is very unlikely to change a woman’s ability to breast feed. If there is a decrease in nipple sensation after surgery, this may alter some nipple reflexes needed during breast feeding. In general, breasts, whether augmented or not, will undergo a loss of volume, especially in the upper pole, after the hormonal and size changes associated with pregnancy.

• Will breast augmentation be effective if I have sagging breasts?

  In general, augmentation is effective in addressing sagging, or ptosis, only when the degree of ptosis is minimal, and the original breast size is relatively small. In most cases of ptosis, augmentation alone is not adequate. As the size of the breast and degree of ptosis increase, the need to remove excess skin (breast lift) to achieve a good result increases. This involves making an additional incision around the areola (pigmented part around the nipple), and occasionally on the front of the breast if the ptosis is severe. Without this breast lift, also called a mastopexy, the relationship of the breast implant to the rest of the breast is not correct and the lift is needed in order to make the result visually pleasing. When a mastopexy is added to the augmentation procedure, it is called a mastopexy augmentation.

• How do I choose the size?

  This is typically the hardest part of the journey. There are multiple factors that go into making this decision. Many patients have an idea of what they are seeking and this is the best place to start. For patients who really don’t know how big they would like to go, there are multiple ways to use your body size and body type to determine a good size. We also have 3D modelling software which can show you what different sizes look like on you, both with, and without clothing. We have a sample of breast implants you can try on as well. Dr. Chitte and the ODC team will help you with expert suggestions, but ultimately, you will make the decision that suits you best.

• What is covered in the surgical fee?

  All hospital, anesthetic and implant fees, as well as all of your follow ups, are covered in the surgical fee. HST and prescriptions are additional.

• Will my nipple sensation/feeling change after surgery?

  I generally counsel patients that there will be some sensation change (either more or less feeling) for a short time after the surgery, especially with larger implants. Generally speaking, these changes resolve over the course of 3-6 months. The risk of sensory loss from the inframammary incision is accepted to be less than 5-10%, which is typically the best incision for preservation of sensation.

• What is the recovery after breast augmentation? When can I exercise?

  Breast augmentation is done as day surgery, meaning that you go home the day of the surgery. You should be walking around the night of the surgery and keep walking every day. The incisions are generally healed by 2 weeks post-surgery and you can return to regular activities by 6 weeks. You can return to intense exercise approximately 6 weeks post-surgery. Waiting this long allows your body to heal and decreases the risk implants will shift or that you will have complications with the incision.

• When can I go back to work?

  This very much depends on the nature of your job. Reaching overhead should be avoided for the first 1-2 weeks. Lifting more than 5-10 ( 2-5 kg) pounds should be avoided for the first 6 weeks. These restrictions may affect when patients return to work. If you have a job where heavy lifting is not necessary, a return to work can happen as quickly as a few days post-surgery, but usually happens at least 2 weeks post-operation. It can be very helpful to arrange for additional help at home for 1-2 weeks, especially if you have responsibilities, such as young children

• How much does breast augmentation hurt?

  Pain is certainly a consideration after any time of surgery. Pre-operatively, Dr. Chitte at the ODC team will guide you regarding post-operative pain control. For breast augmentation, post-operative pain would be considered mild to moderate. If you have an implant placed below your chest muscle, it is likely to hurt more than if you have the implant placed below your breast. In both cases, Dr. Chitte will discuss a pain management plan with you and ensure that you have adequate medication to get you through your recovery.

• When can I drive?

  The most important consideration for driving involves being off all medications that may cause sedation. Typically, these are prescription pain medications. Once you are no longer taking these, as soon as 2 weeks after surgery, you may begin driving.

• Can I breast feed after breast augmentation?

  Breast augmentation typically does not change a woman’s ability to breastfeed with the caveat that not all women produce adequate volumes of milk to breast feed. The exception to this is seen in the use of a peri-areolar incision for implant placement (not for mastopexy alone) where up to approximately 10% of women can have difficulties breastfeeding post-surgery.

• Will I need additional surgeries?

  Additional surgeries may be required. Over time, you may wish to undergo a breast lift to address changes see with gravity and aging. You may have complications such as implant rupture or capsular contracture which may require additional surgeries.

• What is BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma)?

  Approximately 10 years ago, as association was found between textured breast implants and a rare form of a blood cancer called lymphoma. This is a cancer of the immune system and not a breast cancer. BIA-ALCL is typically diagnosed years after augmentation and treated with removal of the breast implant and capsule. Occasionally, adjuvant treatments such as chemotherapy are necessary. Dr. Chitte uses only smooth breast implants and as per the American Society of Plastic Surgeons, there have been no cases of BIA-ALCL associated with smooth implants.

• Will implants be placed under my breast, or under my chest muscle?

  This depends on your body type and your goals. For example, there are benefits of placing implants under the muscle, especially in very thin women. As well, there are benefits in placing the implants under the breast in women who have had children. With all patients, Dr. Chitte and the ODC team will talk with you at your consultation and help guide you to the best decision for you.

• What is capsular contracture?

  Capsular contracture is a condition where the scar tissue envelope which forms around all breast implants tightens up. This may become painful and hard. Occasionally, an additional surgery is required to address this complication. Dr. Chitte will discuss with you at your consultation. The most common factors implicated in capsular contracture include infection and bleeding. Before, during and after your procedure, antibiotics are used to try to decrease the risk of infection. Dr. Chitte also uses a Keller Funnel and a no-touch technique to minimize the risk of infection. This has resulted in a very low risk of capular contracture During the surgery, Dr. Chitte meticulously ensure the surgical field is irrigated, washed out and free of any blood before the implant in placed in to decrease the risk of hematoma and capsular contracture.

• Who is a good candidate for breast augmentation?

  A good candidate for breast augmentation is a relatively healthy women who has given some thought to having the surgery done and has a good idea of how the implants will enhance her body. The best candidates have thought about increasing the size of the breast for years to better fit into clothes and improve body proportions. Women who have had children and wish to return their breasts to a more youthful appearance also makes excellent candidates.

• Who is not a good candidate for breast augmentation?

  Patients who are not generally in good health are not good candidates for breast augmentation surgery. Smoking at the time of surgery significantly increases risks of wound healing complications and therefore, smoking needs to be stopped before considering surgery.

• What kind of anesthetic will be used?

  General anesthesia (going to sleep) is used.

• What are the risks of the procedure?

  The major risks of the procedure include: bleeding, infection, asymmetry, implant malposition, capsular contracture and rippling. Dr. Chitte and the ODC team will discuss these and other risks with you at your consultation.

• What is the risk of implant rupture?

  Dr. Chitte uses the newest generation cohesive gel “gummy bear” silicone implant. The extensive cross-linking of the silicone molecules makes this implant very strong and stable. While nothing is 100% failsafe, the risks of implant rupture are exceedingly rare (less than 1% per year) so you should be able to enjoy your implants for years to come

• What is the location of the incisions?

  Dr. Chitte typically uses an incision hidden in the fold below the breast. In other cases, an incision around the areola (pigmented area around the nipple) is used.

• What kind of implants are used?

  What kind of implants are used? Dr. Chitte uses the newest generation cohesive gel “gummy bear” silicone implant. The extensive cross-linking of the silicone molecules makes this implant very strong and stable. https://youtu.be/FxEM5C15gQU

• What is rippling and how can it be prevented?

  Rippling occurs when the skin overlying the implant is too thin. An outline of the implant can be seen through the skin. In patients who have thin skin, placing the implant below the muscle places a thick, healthy layer of tissue over the implant. This significantly decreases the risk of rippling.

• What happens if I get pregnant after breast augmentation?

  Many women have breast augmentation prior to having children. There are significant physical and hormonal changes that happen in pregnancy and the presence of breast implants does not change those. Breast augmentation is very unlikely to change a woman’s ability to breast feed. If there is a decrease in nipple sensation after surgery, this may alter some nipple reflexes needed during breast feeding. In general, breasts, whether augmented or not, will undergo a loss of volume, especially in the upper pole, after the hormonal and size changes associated with pregnancy.

• Do my implants have to be replaced every 10 years?

  This recommendation is a holdover from a previous generation of breast implants which were filled with a liquid silicone. Dr. Chitte uses the newest generation of breast implants that are filled with heavily cross-linked silicone which is like a “gummy bear” and does not flow. Most experts agree that as long as your breast implants are monitored regularly and are not giving you problems, they do not have be replaced.

• Can I get a breast augmentation if I smoke?

  Smoking at the time of surgery significantly increases risks of wound healing complications and therefore, smoking needs to be stopped before considering surgery.

Rhinoplasty FAQs

• How long will it take for bruising to go away after a rhinoplasty?

  “This is one of the most common questions we are asked after surgery. The first thing to note, is that not all patients will bruise. Often times, bruising occurs when we have to cut or move the bones of the upper part of your nose. In patients who don’t have a cut in the bone, bruising is less likely—but still possible—so it is always best to plan, just in case.

  If you do have bruising, it usually lasts about 7-10 days, but everyone is different. It depends on how thick and dark your skin is, as well as your body’s ability to remove the old blood under the skin from the surgery, which causes the bruising. It is very rare for people to have bruising after 14 days, but as mentioned, most will see their bruising clear up between 7-10 days. If you have light bruising, you may be able to use make up to subtlety cover it up.

  People have tried many things to reduce bruising. This includes taking steroids during surgery and using Arnica. At this point in time, there is no research suggesting that these treatments work and therefore, treatments, like steroids, are not recommended. It is unlikely that Arnica causes damage or harm to the nose, so if patients are interested, this is something they can try.”

• How long does the cast stay on after a rhinoplasty?

  “A cast is used after a rhinoplasty (or nose job) for a few reasons. Most importantly, it helps you remember to keep your fingers and hands away from you nose! It also helps keep the nose in a straight position, but unlike casts on other parts of the body, it can move because it does not completely protect the nose. However, not all patients need a cast on their nose after a rhinoplasty. If you have the bone cut or you have a bump on your nose removed, you will likely have a cast after surgery. For other types of rhinoplasties, it is unlikely you will have a full cast.

  A cast stays on the nose between 5-10 days, but we try to remove it a week after your surgery. If it falls off prior to that, it is usually not an issue, but we always tell patients to never remove the cast on their own or try to move the cast; this can result in your bones moving and making your nose a bit crooked.

  The majority of patients do not find removing the cast painful. It is like removing a bandage; it’s a little uncomfortable for a minute, but it is rare that patients require pain medication during the removal.”

• After a rhinoplasty, my nose looks crooked with the cast on, what should I do about this?

  This is also a very common question. People often ask me why their cast looks off-centre, twisted, or a bit crooked. A cast for the nose is made out of a material that softens when warmed. At the end of the surgery, we place this piece of hard material in warm water to soften it. Then, we put it over your nose and hold it in place. It’s almost impossible to make it “perfectly” straight as the cast tends to warp as it hardens. What’s important is that the tissue under the cast is not warped, which is an uncommon occurrence. The look of the cast in almost all situations has no relationship to how the tissue looks under the cast. It is important to remember that you do not want to try to change or move the cast, as this can alter the shape of the tissue under your nose. In some cases, there is a reason why we make the cast a certain shape, so it is best to leave it and try your best not to worry about the shape.

• My nose really hurts with the cast on after a rhinoplasty. What should I do about this?

  It is not common to have a lot of pain after a rhinoplasty. Many people have mild to moderate pain, but taking your pain medication will help significantly. If you find that your pain is worsening or your pain medication is not working, it is very important to call your surgeon or Dr. Bonaparte as soon as possible. If you cannot get in touch with your surgeon and the pain is getting worse, some patients need to go to an emergency department or walk-in clinic. However, this is only in very rare situations.

• After I took the cast off, my nose looks big. Why does it look so big?

  “Before I answer, let’s do a little review of anatomy and physiology. When we do a rhinoplasty –nose job—we have to cut the skin, as well as “lift” the skin of the deeper tissues of the nose. Normally, blood and fluid flow all around your skin and tissue, and there are microscopic channels that the flow. Surgery disrupts this normal flow and there is no way to avoid this. Any time you cut the skin, you disrupt the flow of blood and fluid. Additionally, your body wants to heal after surgery, so it secretes hormones and other chemicals to trigger the healing response. Healing results in more swelling. So, the combination of healing and a disrupted flow causes the swelling to increase and your nose to look big.

  But remember: this is the early phase of healing. Swelling usually peaks at about two weeks after surgery and then, it slowly goes away over time as your body starts to make new channels to drain all the fluid. This can take up to a year or more in some people.
  Even though it can take up to a year, your nose will still look good during this time. Patients should expect their nose to be swollen for the first month after surgery. After about two months, your nose will look great, but not perfect. The tip is often still round, shiny, and very firm. This is all due to swelling. After about six months, the swelling will improve. The tip will soften a bit and will be less full, but you will still find it a bit swollen. By a year, the tip should be soft and look great. However, some patients require even longer for all the swelling to go away.”

• How long does the swelling last after a rhinoplasty?

  This is a complicated question and one of the most common questions we get asked after a rhinoplasty. There are two possibilities: If you have a closed rhinoplasty, the swelling of the skin usually resolves around the first month. However, the bone can change during the first year. If you have an open rhinoplasty, the swelling often takes longer. The problem is that swelling can last up to a year and sometimes longer, but that doesn’t mean your nose doesn’t look good during the year after surgery. It will look good, but not “perfect”. Your nose will be very swollen and puffy for the first two weeks after surgery. But after a month, you nose will look natural, but the tip will be swollen and firm. By the sixth month, the swelling will improve; the tip will soften a bit and will be less full, but you will still find it a bit swollen. In a year’s time, the tip should be soft and look great. However, some patients require even longer for all the swelling to go away.

• Why does the tip of my nose look so big after a rhinoplasty?

  We have to cut the skin, as well as “lift” the skin of the deeper tissues of the nose, which disrupts the normal flow of blood and fluid around your skin and tissue. There are microscopic channels that also continue to flow. There is no way to overcome this disruption. After surgery, your body wants to heal so it secretes hormones and other chemicals to trigger the healing response. Healing results in more swelling. As a result, the combination of healing and disrupting causes the swelling to increase and your nose to look big.

• It’s been a few months after my rhinoplasty and the tip of my nose still looks big. How long does it take to go away?

  The tip of the nose is often the last part of the rhinoplasty to heal. If you look at some of the other questions about swelling, you will see that the tip can take up to a year to heal. However, the tip will look great, but not “perfect” after one month.

• It’s been a few months after my rhinoplasty and I can still feel a bump on my nose. Does this mean it is going to come back?

  The short answer is no. In rare situations, the bump will still be present after surgery, but this is the exception. After you cut the bone of the nose—or remove the bump on the nose—the bone has to heal. It forms what is called a “callous” that is kind of like a scab on the skin. This allows the bone to heal underneath it. You can, sometimes, see this bone healing and it looks like a small bump. Over time, the body will absorb this and the swelling will go away. In rare situations, your body may scar or form a thick bone. In this situation, it is possible to see the bone or a small bump. If this was to happen, you should talk to your surgeon to see what can be done to fix it. In nearly all cases, this can be easily fixed with a minor surgery.

• It’s been a month after my rhinoplasty and the scar under my nose looks uneven. How can I improve this and why did it happen?

  A rhinoplasty (nose job) requires the cutting of the skin, as well as the “lifting” of the nose’s deeper tissues. Microscopic channels allow blood and fluid to freely flow all around your skin and tissue. Surgery disrupts this normal process and there is no way to overcome this apart from your body forming new channels within the skin. Anytime you cut the skin, you disrupt the flow of blood and fluid. The scar on your nose is called the columellar scar and acts like a water dam. It disrupts the flow of fluid and the fluid tends to build up above the scar. This gives the impression that your scar is not perfectly lined up as the skin above the scar is swollen and the skin below is not. All patients who have an open rhinoplasty have this for 6-12 months while the swelling goes down. It is usually not a concern, but some patients are worried the scar will not heal perfectly. This scar usually looks fantastic once the swelling is gone.

• How long do I have to wait to get the final result of my rhinoplasty?

  If you scour the internet, you will find the same answer: 12 months. This is a bit arbitrary and it’s different for all patients. I usually tell patients that by the second month, your nose will look great and by the sixth month, it will look fantastic. However, it can take one to two years for it to be fully healed. Most people are not bothered by the small amount of swelling that resolves over time, but it’s important to remember that it can take time for all the swelling to go away.

• When can I start blowing my nose after a rhinoplasty?

  After a rhinoplasty, there are a few parts of the nose that could potentially move if you blow your nose: the bone, stiches, or septum. If you had the bone of your nose cut, there are some pieces that can move if pressure is applied to them. If you blow your nose, there is a chance that they could move. It is also possible that a stitch will pop out because of this. When we do a rhinoplasty, its common that have a septoplasty at the same time. This allows us to harvest some material to help build and shape your nose. If you blow too hard, you can potentially damage this. I tell my patients that they cannot blow their nose for the first week. After a week, if you spray some saline water in your nose you can do a very gentle blow to help remove some mucus. After three weeks, you can start to blow a bit harder while applying the saline spray before doing so to loosen up the material. After a month, you can get back to normal.

• When can I go back to the gym and start exercising after a rhinoplasty?

  After a rhinoplasty, there is the potential for bleeding in your nose. This can be severe in rare cases and if it happens, it can affect the result of your surgery. This is why we are very cautious about anything that may increase the risk of bleeding. Exercise can increase your heart rate and blood pressure and that can increase the risk of bleeding. I recommend people wait at least three weeks before they start exercising; it is uncommon to have a nose bleed after three weeks. However, exercise can also increase the swelling in your nose. Some people find their nose swells a little more after they exercise in the first month or two.

• Why are there red pimples on my nose after my cast was removed?

  When we do a rhinoplasty, we use special glue and tape on your nose. This helps keep the swelling down, as well as allow all of the tissue and skin to stay in the right place. In some people, the tape can block your pores and cause a breakout similar to acne. If you are prone to acne, we can help limit this by starting a special skin treatment prior to surgery. Ask us about this and we can help. In almost all cases, the breakout will go away once the tape is removed and the skin is cleaned, but we are here to help if there are any issues.

• Some of the stitches fell out after my rhinoplasty/nose surgery. Is this a problem?

  When we do a rhinoplasty surgery, we use different stitches for different purposes. Some of these stitches are dissolvable and fall out on their own; some are designed to be removed by our professionals. However, the tissue in the nose tends to heal quickly and once this happens, the stitches fall out. In some situations, the stitches can fall out in a few days while others can last a few weeks if they are not removed. In almost all cases, a stitch that falls out early is likely to not impact the results of your surgery. If you are concerned, we always recommend following up with Dr. Bonaparte to take a look and see if anything needs to be done. But rest assured, most times one or two stitches falling out early is not a problem.

• Why is it so difficult to breathe after my nose surgery/rhinoplasty?

  One of the most important things that patients need to consider when they plan for a rhinoplasty or any type of nose surgery, is the risk to their breathing after surgery. Although we do our best to limit any effect the surgery has on breathing, there is always a risk that people temporarily or permanently have reduced breathing through their nose. After surgery, almost all patients have trouble breathing through their nose. This is due to some swelling in the nose, as well as the stiches. Additionally, the mucus doesn’t move around the way it should after surgery and this can also affect your breathing. Between the second and fourth week after surgery, this will usually return to normal. Understandably, patients are concerned about permanent breathing problems. Any time you make the nose smaller, you risk affecting breathing through the nose. This is a part of cosmetic surgery, although we do everything we can to prevent this. If you do have breathing problems after surgery, it is important to talk to your rhinoplasty surgeon. In many cases, this can be improved and/or fixed.

• My nose feels numb after a rhinoplasty. How long does it take to go away?

  After you have an open rhinoplasty, it is not uncommon to have some numbness at the tip and under the nose. This is due to cutting some small nerves in this area and happens whenever you cut through the skin. In almost all cases, this will resolve itself between six to eight months after your rhinoplasty, but it can take up to a year in some cases.

• I had a revision (second) rhinoplasty. What should I expect after the surgery?

  A revision rhinoplasty is significantly more complicated than a primary rhinoplasty. This is mainly due to scaring from the previous surgery. The most important thing to remember is that healing can take longer. The swelling often lasts longer than a primary rhinoplasty.

Facelift FAQs

• I cannot move the corner of my mouth after a facelift? Is this permanent? How long will it take to heal?

  “When we do a facelift, we are close to a collection of nerves called “The Facial Nerve.” The facial nerve is what is known as a cranial nerve. This nerve leaves the brain and actually travels through your ear. It then leaves the bone of the ear in front of the entrance to your ear, but deep in your face, within your salivary gland called the Parotid Gland. The nerve then travels within the Parotid Gland and eventually leaves the deep protection of the gland and connects to muscles that move your face. All the muscles of facial expression (Muscles that move your mouth, eyelids, forehead) are under the control of the facial nerve.

  When Plastic Surgeons perform facelift surgery, we pull, reposition and move tissues of the face. This often pulls and tugs on these delicate nerves. During the process of a facelift, pulling on these nerves can cause swelling. The problem with swelling in nerves, is that when a nerve is swollen the signals that leave from the brain and travel to the muscle, telling them to move, get blocked. Because of this, you may not be able to move your face temporarily after surgery. About 5-10% of people have this problem and it is almost always temporary. It can be very concerning, but rest assured, the vast majority resolve in a days to a few weeks. It is important to note, that in some people, it can take many months to resolve but be patient and in the majority of people, it will eventually come back to normal. Very rarely, this can be permanent but as I mentioned, this is rare.”

• Is there anything I can do to speed up the recovery of the loss of movement on my face after a facelift?

  Unfortunately no. After a facelift, It takes time for the swelling to go down in the nerves and it takes time for the nerves to heal. Nerves can heal slowly and this can be very frustrating, but rest assured, the vast majority of people heal quickly in days to weeks although in a small minority, the healing can take months. The loss of movement after a facelift is very rarely permanent. Some people say that steroids or other treatments may help, but time and patience is the best treatment. In addition to this, if you ever notice a loss of function or the inability to move your face after a facelift, you should always talk with your surgeon (Dr Bonaparte) to ensure there are no other signs of complications.

• What is a hematoma and why is it dangerous after a facelift surgery?

  A hematoma is the medical word for a collection of blood (heme means blood). After a Facelift Surgery, there is a change that blood can collect under your skin. If this happens, the blood itself is not dangerous. The concern is the pressure the blood can place on the skin. Your skin needs all the little blood vessels inside it to work so it stays healthy after a facelift. If the pressure from the hematoma under the skin is greater than the pressure of the blood getting into the skin, the blood flow into the skin can stop and the skin can die. This is a VERY serious complication (the skin dying) if the hematoma is not recognized and treated as soon as possible. The good thing is, if you get a hematoma after surgery and it is treated, there is little risk involved. If you ever notice swelling on your face after surgery that looks tense, red or purple or is bigger on one side you should always be safe and check with your doctor immediately. If it occurs overnight and you are worried, you should go to the emergency department and get checked to ensure it is not dangerous. As I mentioned, a hematoma in itself is not the danger, but rather the pressure on the skin. One other important piece of information, if you smoke cigarettes, your risk of a hematoma goes up as does the risk of skin loss after a facelift. It is important to try to quit smoking for at least a month prior to facelift surgery.

• I had a hematoma after my surgery, it was stopped and fixed, but will this cause long term damage?

  “Hematomas can occur in any patient who is having a facelift however the risk is higher in people with problems with bleeding, on certain medications or who smoke. Most times, they are noticed in the first hours to first days after surgery. A hematoma is a collection of blood under the skin. There are different reasons why this can happen.

  Sometimes after surgery, you can cough or strain and get your blood pressure up (elevated). This can cause a small blood vessel or a blood vessel that was treated during your surgery to open and bleed. This is very unpredictable, but can happen. Another reason is sometimes blood vessels go into what we call ‘vasospasm’ during surgery. This means they tighten and squeeze so blood will not leak out of them. However, after time passes, the blood vessel starts to relax and open up causing it to bleed. So, during surgery the surgeon may not see any bleeding but after surgery, the blood vessel can start bleeding. We look for this during surgery, but in some cases it is almost impossible to identify.

  In all these cases, as the blood increases under your skin, it starts to put pressure on your skin (expanding hematoma). The problem with this is that if the pressure on the skin is greater than the pressure needed for blood to bring oxygen and nutrients into your skin, it will cut off the blood supply to the skin and result in skin loss and potentially serious scaring on your face. This is why we want to see patients who think they have a hematoma. It is better to be safe in this situation.

  Now, all this may sound scary but rest assured, as long as it is treated within a 24 hours (ideally less) the odds are you are fine and it will heal with no problems. Sometimes little lumps and bumps under the skin that form after a hematoma can appear scary, but they almost always resolve without issues. So in the end, if you get a hematoma and it is treated, you will most likely heal like everyone else.”

• Why do I feel pins and needles or tingling on my face after a facelift? Will it go away?

  When your Facial Plastic Surgeon (Dr Bonaparte) performs a facelift, we use a scalpel to make a cut in the skin of the face near the ear and sometimes behind the ear. There are small nerve fibers that are cut during this. There is no way to prevent cutting these nerves. These nerves called, sensory nerves, meaning, they are responsible for sensation of the skin. This includes touch, pressure and pain. These nerves are VERY different than Motor Nerves, which move the face. As mentioned, the sensory nerves are responsible for the feeling of touch, pressure as well as pain on the skin of your face. It is very common to feel numbness on the skin of your face after a facelift due to cutting these nerves. However, over time these nerves will grow back. When they start to grow back, you may feel tingling and pins and needles on the skin of your face. Remember, this is a good sign in the long term as it means the feeling will almost certainly start to come back. Very rarely do people not get any feeling back. Eventually, the pins and needles and tingling sensation will go away.

• The facelift scar behind my ear is thick, will this go away?

  “There is always a scar with a facelift; the goal of the facelift plastic surgeon is to make the scar look as good as possible. It is important to ensure you have a qualified surgeon like Dr Bonaparte. Having a good understanding of scar placement and treatment is the key to making sure you get the best result. However, there are individual factors that are out of the control of the surgeon. These are the things we need to monitor and treat if they occur.

  The most common area for a poor scar is behind the ear. The skin is thicker in this area and there is often more tension and stress behind the ear in the hairline. Because of this, in the early phases of healing (the first few months after your facelift) the scar may not look as good as you want. Although we always do what we can to make the scar look perfect, it is not uncommon to have some thick parts of the scar. The good thing is this often fades over time. If it is not fading as quickly as we would like, we can use treatments to improve this. Typically, it takes up to a year for a scar to fully mature, so patience is required.

  With respect to treatment of these scars, we often can soften and reduce the size by injecting steroids. In addition to this, I often recommend that people use silicone gel or silicone sheets placed directly on the scars early after the facelift. Another method that can be helpful is to massage the thick scars behind the ear. If these things don’t work, we typically will use a laser or do a surgical scar revision. Rest assured however, your scars will look great when everything is completed.”

• There is swelling in front of my ear after I had a facelift; it gets worse when I eat. What is this?

  “This could be one of a few things, but is most represents a minor injury to your parotid gland, a glad that produces saliva. This gland sits deep under the skin in front and below your ear. When you eat, this gland produces saliva. During a facelift, there is a chance that this gland be injured and some clean saliva can leak under the skin. When this happens, it is very rare for it to cause serious problems but we typically need to drain it with a small needle. This is often painless and completed in under a minute in clinic.
  To stop further swelling, facial plastic surgeons often ask people to eat bland food for a week or two and put pressure over the swelling site when they eat (with their hand). It will often resolve in a week or two with these simple methods. The style of facelift Dr Bonaparte performs has a lower risk of this than other methods. In addition to receiving advanced training in Facial Plastic and Reconstructive Surgery, Dr Bonaparte is a certified Head and Neck Surgeon who received very specialized training with respect to surgery of the Parotid gland. This helps limit the chance of unnecessary injury. However, if you ever notice swelling on your face, you should contact your surgeon to make sure it is not another type of swelling like a hematoma.”

• How long until I can go back to normal activity after a facelift?

  This is a common, but difficult question as everyone heals differently after a facelift. We always advise that people take a week off of any significant activity. This means, no heavy lifting or bending or straining. No work and no exercise. It is ok to do some light work around the house, but ideally you spend the week watching movies, reading and listening to good music. The main issue for the need for rest is that we do not want you to move too much and potentially open the incision or cause changes that can occur under your skin. Also, if your blood pressure gets high, there is a risk of bleeding and a hematoma. After the second week, you still do not want to exercise or do any significant activity. You can do normal things around the house, however we still advise rest. After the third week, you likely will want to get out more and do things outside; this is fine, but still, not exercise. By Week 4, you can get back to fully normal with no concerns.

• Can I play sports after a facelift?

  No, you should not play sports or exercise in the first three to four weeks after a facelift. You risk complications if you do. Please discuss exercise and activity with Dr Bonaparte or your Plastic Surgeon to ensure it is safe for you

• The muscles in my neck feel tight after a facelift, what can I do about this? Will it go away?

  Almost everyone who has a neck and facelift will have tightness in their neck. This is often due to the muscles in the neck going into spasm or from the actual tightening of the procedure. This is a good thing in the early phases of surgery. Most people find that after a week or two this resolves. We typically advise people to take their pain medication to help with this. If the tightness doesn’t go away after a few weeks, massage can often help. It is very rare for neck tightness after a facelift to last longer than a week or two. In some cases, you can actually see the tight muscles, rest assured, this will go away. However, you should always check with Dr Bonaparte or your plastic surgeon if you are concerned.

• My face is very swollen after a facelift, my doctor says I do not have a hematoma, but is this swelling normal?

  All patients will have swelling after a facelift. It is an unfortunate, but necessary part of the surgery. Anytime you see swelling or get pain, you should have Dr Bonaparte take a look, but as the title of this questions suggests, if it is not dangerous swelling, then what else could it be? Often, it is fluid and ‘inflammation’ within the tissue under your skin. This can look distressing early on, but about 60% of the swelling will be gone by 2 weeks. After 2 weeks, you must be patient as the remainder of swelling will resolve over the course of 3-6 months. It can be slow, but in the end, it is worth it. There is not much you can do to speed this up apart from avoiding smoking and trying not to eat too much salt in your diet

• I still have some loose skin under my neck after a facelift, what can be done about this?

  When we perform a facelift, our main goal is to tighten the tissue layer under the skin. Pulling too hard on the skin can result in a ‘fake’ and abnormal appearance. This is especially difficult under the chin. Almost all patients have some loose skin under the chin after surgery. There is no safe way to make this completely tight. In some situations, this is due to your anatomy. Also, as time goes on the skin will normally relax, this can result in some loose skin under the chin. The good thing is, there are options to improve the loose skin under the neck after a facelift. We often try things like radiofrequency skin tightening or other skin treatments. IN the end, we can often improve this after treatments, however, patients do need to expect some loose skin under the chin after a facelift.

• How long does it take for the scars to fade after a facelift?

  Any time you have surgery, you need to be prepared to have a scar. Any time the skin is cut a scar will result. It doesn’t matter who does the surgery, what type of surgeon performed the surgery or what type of stich (suture) was used, everyone scars after the skin is cut. However, Facial Plastic Surgeons and Head and Neck Surgeons use special techniques to make sure you get the best and smallest scar possible. The problem is, everyone is different. No matter how perfect the stitching is, some people form bad scars. The key to remember, is that over time, almost all scars, good or bad, will fade and improve. If you look at the science and biology of scars, you will see that the human body puts a lot of effort into scars. Initially, the body lays down the scaffolding of the scar. This is like the beginning of building a house. Its all the structure. If is the framework in which you are going to start building. Think about it as the plans for the house. This isn’t strong yet, but it is ready to start working to improve the strength. Next, the body starts to replace some of the weaker structural parts with stronger more long lasting tissue. At this point, the scar still looks red and thick. This occurs starting a few weeks after surgery and takes a few months. Once this is completed, the body then starts to mature the scar. It starts to break down all the big bulky tissue and replace it with smaller, stronger and more efficient tissue. This can take up to 12 months or even longer. During this phase, the scar will flatten and become closer to skin colour. So the answer is, after a facelift, it may take up to 12 months for the scar to look ideal. Remember however, after a facelift, you can then treat the scar with lasers and medications as well as silicone sheeting to improve the scars.

• When should I change the dressing after a facelift?

  “This is one of the most common questions I get asked after surgery. If you ask 100 Facial Plastic Surgeons or Plastic Surgeons, you will probably get 100 different answers, however, we likely all are reasonable close in terms of our thinking. I recommend people do their best to keep the dressing on for the first 48 hours. This is the most important time. It is ok to change the dressing if it gets a bit dirty, but it should be placed back on after changing. This helps keep the skin in contact with the underlying tissue and places a very small amount of pressure on the tissue to help prevent unnecessary bleeding. However, you do not want too much pressure, just enough so it is comfortably snug. After 48 hours, I recommend having the dressing on as much as you can handle, however I strongly recommend keeping it on over night. The reason is, if you turn over or get your ear or incision caught on something, there is a risk you can open the incision. The risk is highest where the ear attaches at the earlobe. One week after a facelift, there really is no significant benefit, apart from wearing it at night.

  Like all facelift surgery, the dressing should be clean and you should still put Antibiotic ointment (i.e. Polysporin) on your incision a few times a day. The other benefit of changing the dressing 2 times a day, is that you can look and make sure you do not have any abnormal swelling. If you notice this, you should alert Dr Bonaparte.”

• What should I be putting on the incisions after a facelift?

  For the first two weeks after a facelift, you should put an antibiotic ointment like Polysporin. It should have the consistency of Vaseline. You can do this every time you change your dressing. Keeping the wound covered and moist with the Polysporin will help healing and potentially improve the scar. After two weeks, we then recommend people NOT use Vitamin E or any other Herbal medication on their scars. The only treatment that Dr. Bonaparte recommends is Silicone Gel or Sheets. There is evidence that this works. Vitamin E can actually make your scars look more red. You can purchase silicone gel or silicone sheets at your local pharmacy under the wound care sections. Ask the Pharmacist if you can not find what you are looking for. We recommend using this for the next 3-6 month or longer to help the scarring. In addition to this, after 3 weeks, you can start to message the scars to help break down the dense tissue.

• Is it ok to take the facelift dressing off after surgery?

  Yes, you can take the dressing off to change it. The key is, for the first 24 hours, you want to keep the facelift dressing on as much as possible. It is ok to change it if it gets dirty, but if you can, keep it on for the first 48 hours. Once the first 48 hours is over, you can change the dressing daily.

• I am having trouble moving parts of my face after facelift surgery, is this normal and when will it go away?

  It is common to have some temporary weakness, particularly around you mouth, after a facelift. This can be due to the freezing that was injected or to pulling and tugging on the tissues of the face. The tugging on the tissue can stretch the nerves that move your face and cause them to temporarily not work. The type of facelift Dr. Bonaparte performs has a very low risk of permanent loss of movement, however, there is always a very small risk. Most people will find the movement returns in a few weeks, however some people do take longer. This can take up to 6 or more months in rare situations. The best advice if this ever happens to you, is try your best to be patient. It is not easy as it can be very concerning. Rest assured, in the vast majority of people this will resolve. It is important to remember, that all surgery has risks, but the risk of permanent paralysis or loss of motion is very low. There is no medication that can speed up the healing.

• How long will it take for bruising to go away after a facelift?

  “All patients will have Bruising after a facelift. Some, more than others. Most people find the worst of the bruising goes away after about a week. The rest of the bruising is typically gone by two weeks. In rare situations, people can have longer than 2 weeks of bruising, but it can usually be covered with make-up. Unfortunately, there is no really method to speed up the healing process with respect to bruising. There are naturopathic medications available, but if you look at the research evidence, they have no effect.

  One of the keys with bruising, is to make sure it is not swelling. If you ever are not sure if the bruising is in fact swelling or bleeding, you should contact Dr Bonaparte or your Facial Plastic Surgeon”

• The skin on my face feels numb after a facelift, how long will this take to go away?

  Although this is a frustrating and strange issue after surgery, it is typically not serious. Nearly all patients will have some numbness on the skin of their face after Facelift Surgery. The reason for this, is that then we make our incision in front of the ear, we cut some very some nerves that provide sensation to the skin. This is different than the nerves that move your face. The nerves that provide sensation are from a nerve called the Trigeminal Nerve. The nerve the moves your face is called The Facial Nerve. When you damage the small sensation and touch nerves, this results in numbness of your face. Over time, (months – year) the nerves grow back and you start to get feeling back. It is not uncommon to get a tingling or pins and needles sensation in your face after a facelift, this is due to those nerves growing back. Be patient and in almost all cases, the feeling comes back.

• My ear feels numb after my facelift, how long will this take to go away?

  Similar to question number 18, this can be due to cutting small nerves after a facelift. However, in some situations (particularly if you have a neck lift) this can be due to cutting a nerve call the Auriculotemporal Nerve. This is a branch of the Trigeminal and is bigger than other sensory nerves. If you cut this, you may lose some sensation in your ear. However, commonly this nerve isn’t cut but stretched and like other nerves will come back with time.

• There is red skin behind my neck after a facelift, will this last forever?

  After a Facelift is performed, there is often some redness on the skin behind the ear. The skin behind the ear and neck is often thicker with more attachments to the muscle underneath. Also, bruising tends to build up in this area after a Facelift. In most people, this will fade after a few weeks. However, the scars tend to last longer as the wound is under more tension and stress. In very rare situations, we need to do treatment to reduce the redness. In my practice, I will use IPL treatment, a non-surgical treatment that can get rid of redness. Another thing to consider, is that if you use antibiotic ointment for more than 2 weeks, you may be causing some of the redness. After 2 weeks, it is just as effective to use regular Vaseline as opposed to things like Polysporin.

• I still have wrinkles on my face after my facelift, is this normal?

  The answer is yes. A common question that is asked of Facial Plastic Surgeons, is whether a facelift will get rid of wrinkles on the face. Although some wrinkles will improve after a facelift, this is not the primary purpose of a facelift. The goal of a facelift is to reduce the sagging and tired appearance of the skin. It helps to tighten the tissue under the skin and remove loose skin. If a patient’s primary goal is to remove wrinkles, we often recommend laser treatments to help with this. Some patients have both, a facelift and then a laser treatment. If you still have wrinkles in your skin after a facelift, this is normal. Be sure to ask about laser treatments that can go hand and hand with your surgery to help get the best results.

• The folds below my nose (nasolabial folds) are still present after a facelift, is this normal?

  “This is a common question and an often misunderstood aspect of a Facelift. When Facial Plastic Surgeons perform a facelift, the primary goal and purpose of the facelift is to rejuvenate the lower face and in many cases the neck. There is a misconception that a facelift improves the entire face from forehead to chin. This is not the case. A facelift focuses on the lower face, improving the jowls, chin-line and neck. The folds by the side of your nose (The Nasolabial Folds) are typically improved with a procedure called a “Midface Lift.” The problem with a mid-Face Lift, is that it is technically more difficult and there is a slightly higher risk to the nerve the moves your face (the facial Nerve). So, in many cases, the nasolabial folds will remain after a facelift.

  However, in my practice, I utilize the cutting edge and most advanced facelift techniques that allow me to improve your lower face and in many cases, the mid face without doing a standard mid-facelift. The technique I utilize allows me to lift the tissue under your skin and reposition it in a more youthful part of your face. This will help provide volume to your midface (which is lost with aging) and give you more youthful appearing cheeks. In many cases, this helps improve the Nasolabial Folds. It is important to note, that this technique does not improve the Nasolabial folds in all people, but in many cases it does help.”

• Some of my hair fell out after my facelift, what should I do about this?

  Although it is uncommon to have hair loss after a facelift, it does occur in some people. In Men, you can have some hair loss in the facial hair in front of your ear. You can also have some hair loss in the temple region. In women, you can also have some mild hair loss after a facelift. In almost all the cases, it is due to swelling and cutting the hair during the incision. This will grow back. Rarely, if the cut is not made in the correct area, you can have permanent loss, but fortunately this is very uncommon after a facelift.