The goal of the Texas Center for Facial Plastic and Reconstructive Surgery is to make your surgical experience and recovery comfortable and pleasant. By studying and applying the following recommendations for postoperative care and the other written and verbal information you have received from Dr. Alford, you will play an active and essential role in your recovery process thus speeding your recuperation time.

Sedation
You will receive sedative medication and/or general anesthesia which may make you drowsy for as long as 24 hours:

• Prior to surgery, ARRANGE FOR SOMEONE TO TAKE YOU HOME
• ARRANGE FOR SOMEONE TO STAY OVERNIGHT, if you are having outpatient surgery.
• DO NOT drive or operate machinery for 24 hours.
• DO NOT drink alcoholic beverages for 24 hours.
• DO NOT make major decisions, sign contracts, etc. for 24 hours.

Swelling / Discoloration
After this type of procedure, the eyelids are usually swollen and may show noticeable bruising. Most swelling usually resolves quickly over 1-2 days (more slowly if you suffer from allergies), while the discoloration will diminish more gradually over 7-10 days. You may notice that one eye will be slightly more or less swollen than the other - this is normal and is not a cause for concern. The feeling of tightness is normal.
Occasionally, swelling may cause the lower lid to become separated from the eye and may lead to incomplete eyelid closure for a few days. Both of these conditions will resolve as swelling diminishes. Tearing or eye irritation, if present, will usually resolve as swelling decreases and eyelids close.
Some patients may experience discoloration in the whites of their eyes. This condition is painless, generally subsides within 7-10 days, and will not harm your vision.
Following, are some recommendations directed at relieving discomfort and speeding the recovery process:

1. REST IN BED OR A CHAIR for the first 24 hours following surgery. Be sure to keep your head elevated.
2. USE YOUR EYEDROPS, as prescribed, to help ease any discomfort or irritation caused by incomplete eyelid closure.
3. AVOID HITTING OR BUMPING YOUR FACE AND NECK. It is wise not to pick up small children and you should sleep alone for one week after your operation.
4. APPLY COLD COMPRESSES (see "Frozen Pea Packs) as often as possible for the first 48 hours.
5. AVOID BENDING, STRAINING, HEAVY LIFTING for the first week following surgery. In addition to aggravating swelling, these activities may elevate blood pressure and start bleeding.
6. AVOID EXCESSIVE SMILING OR YAWNING for one week.
7. AVOID EXERCISE for two weeks.
   
8. DO NOT SMOKE and AVOID ALCOHOL CONSUMPTION for 3 weeks after surgery. Both of these activities can significantly slow the healing process.
9. REPORT ANY SUDDEN SWELLING OR INCREASED DISCOLORATION to Dr. Alford.
10. SLEEP IN AN UPRIGHT POSITION (preferably on your back) by elevating the head of the bed and using extra pillows for at least one week following surgery.
11. AVOID STRAINING DURING ELIMINATION. If you need a laxative, we recommend Correctol™ (your pharmacist will give it to you without a prescription). Proper diet, plenty of water and walking are strongly recommended to avoid constipation.

Medications
You will be given an antibiotic (Keflex^®), an anti-nausea prescription (Phenergan suppositories), eyedrops, and a prescription for pain relief (generally, Loratab^® or Tylenol-3^®, if you have no history of sensitivity to these products). Be diligent about taking your antibiotic until completely gone. Nausea rarely occurs following blepharoplasty surgery; however, if you should experience nausea follow the instructions for administration of Phenergan suppositories. Anti-nausea medication will provide relief for the nausea but will cause you to feel drowsy and dizzy. Use the eyedrops as often as prescribed, as these help to keep the eyes moist. There is little, if any, pain with blepharoplasty surgery; therefore, it is recommended that prescription-strength pain relievers be used sparingly, if at all.

Frozen Pea Packs
Frozen English peas (from your grocer), placed in ZipLock^® bags, provide the simplest and most effective cold compresses to reduce swelling, discoloration, and discomfort following surgery. During your waking hours, apply the pea packs to your eyes as often as possible for the first 48-hours following surgery. You may continue to use the pea packs as much as you like for up to 7 days after your surgery.

Pain
As mentioned above, there is little, if any, pain associated with blepharoplasty surgery. You may experience a dull ache and tightness in the eyelids, but it is very unusual to have significant, sharp pain. If cold compresses do not provide sufficient relief from the discomfort associated with blepharoplasty, take Extra Strength Tylenol^® according to the package instructions. Under no circumstances should ASPIRIN or medication containing aspirin or salicylates be taken (See comprehensive list of medications to be avoided, which you received with "General Preoperative Surgical Instructions"). If you are not sufficiently relieved of pain, try alternating doses of Extra Strength Tylenol^® and the pain medication prescribed by Dr. Alford. (We recommend alternatives to prescription-strength pain relievers because they can cause sensations of light-headedness, particularly in the immediate postoperative period and, consequently, seem to make recovery more difficulty). If you have increasing eye pain or any "burning" of the eyelids, please inform Dr. Alford.

Visual Disturbance
You can expect to have very slight blurring of vision for a few days due to the swelling and ointment still present in the eyes from surgery. Any progressive or one-sided decrease in vision should be reported to Dr. Alford immediately.

Cysts
It is not uncommon for very small, white inclusion cysts to appear near the suture line in the first few weeks to a few months following surgery. These can easily be managed in Dr. Alford's office during a postoperative visit.

Temperature
Generally, the body temperature does not rise much above 100 degrees following a surgical procedure. A rise in temperature is an appropriate part of the healing process. You should check your temperature by mouth three times per day. If you have a persistent fever above 101.5 degrees that is not relieved by Tylenol^®, call Dr. Alford's office.

Bleeding
If you experience oozing or bleeding along the suture line, do not rub the area but apply gentle pressure to the area using a sterile pad followed by a cold compress. Pressure and cold compress should be effective; however, if these measures do not stop any oozing/bleeding, please inform Dr. Alford.

Daily Wound Care
If no Steri-Strips^® are in place, gentle cleansing of the suture line along the lower lashes and the upper eyelid should be done 2-times daily with hydrogen peroxide on a cotton swab (taking care to keep the swab on the eyelid, avoiding contact with the eyeball). Cleansing will help to loosen any crusting or debris that forms. After cleansing, a small amount of Bacitracin Ointment™ should be applied to the suture lines.
In most patients, small anti-tension adhesive strips (Steri-Strips^®) will be placed over the sutures of the upper eyelids to support the outer corner of the eyes. Leave these and all sutures undisturbed until Dr. Alford removes them.

Resuming Activities

1. WEARING GLASSES AND CONTACT LENSES. Eyeglasses may be worn immediately. Contact lenses should not be used until Dr. Alford tells you that it is safe to do so. When you do resume using your contact lenses, be careful not to put any tension on the suture lines when inserting the lenses.
2. PERSONAL GROOMING. In order to improve and speed wound healing, we recommend the following:
   • You may SHOWER AND WASH YOUR HAIR with Neutrogena™ shampoo on the second day after surgery, allowing an indirect flow of warm water to wash over the wounds. (Do not let water directly strike the wound and do not immerse or soak the wound).
   • You may USE A BLOW DRYER on cold setting only.
   • You may have your HAIR WASHED AT A SALON one week after your surgery, but DO NOT SIT UNDER A HAIR DRYER - use a hand blow dryer on cold setting.
   • FACE MAKEUP may be used sparingly on the lower lids, below the sutures only, 48 hours after surgery. Avoid the suture line.
   • EYE MAKEUP may be applied ONE DAY AFTER SUTURES HAVE BEEN REMOVED.
   • DO NOT PULL OR STRETCH THE EYELIDS for the first ten days following surgery.
3. HOUSEHOLD ACTIVITIES. On your second postoperative day, you are encouraged to be up and around the house with your usual activities except those specifically outlined previously (no bending, no heavy lifting, etc.). No strenuous activity.
4. PULLOVER CLOTHING. For 1 week following surgery, you should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head.
5. AVOID EXERCISE for two weeks following surgery.
6. AVOID PROLONGED READING AND/OR TELEVISION/COMPUTER VIEWING for the first 2-3 days, to avoid eye fatigue.
7. REDUCE EXPOSURE TO SUNLIGHT. Following surgery, your eyes may be more sensitive to bright light for a few days. Wearing sunglasses is recommended.
8. RETURNING TO WORK AND RESUMING SOCIAL ACTIVITIES. When you return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling and discoloration you develop; the average person is ready to return to work or go out socially 5-7 days following surgery.

Scars
During the first several days following surgery, the scars will be imperceptible. They then go through a period of slight swelling and reddening, especially at the outer corners. As this subsides, the scars become virtually invisible again. This is the normal maturity process of scars. Any unevenness of the edges of the incisions or lumpiness of the scars is usually temporary and will subside with the passage of time.

Your Postoperative Office Visits
Sutures will be removed at your first postoperative visit, generally, 3-5 DAYS AFTER YOUR SURGERY. Following suture removal, you will be asked to return to the office for followup evaluation at 2-WEEKS AFTER YOUR SURGERY and again at 1 MONTH POSTOPERATIVELY. Please arrange your schedule to accommodate these appointments, which we urge you to make immediately following surgery.

Summary

• Do not be discouraged by swelling and discoloration. These conditions are a normal part of the blepharoplasty procedure and will subside within two weeks.
• Call Dr. Alford's office if you experience:
  • Sudden swelling or increased discoloration.
  • Increasing eye pain or any "burning" of the eyelids.
  • Any progressive or one-sided decrease in vision.
  • Persistent temperature above 101.5 degrees that is not relieved by Tylenol^®.

Your surgery, recovery and ultimate result is very important to us. Please read this handout carefully and keep it readily accessible as a reference after your surgery. If you have any questions or problems not addressed in this handout, please do not hesitate to call us, at anytime at 713/532-3223.