Plastic-Surgery-Surgeon-Ziyad-Hammoudeh

After Surgery

With

Dr. Ziyad Hammoudeh

During business hours (Monday – Saturday 9 am – 5 pm), please call the main Xiluet phone number at 305-615-4200 or come to the clinic for evaluation. No appointment is necessary during normal business hours. For non-emergencies outside of business hours, please wait until normal business hours to call. For emergencies outside of business hours, please call 305-520-9227. The doctor will return your call as soon as possible. For life- threatening emergencies, please call 911. Otherwise, please speak to the doctor first.

Feeling lightheaded after surgery is common, especially when going from laying down to standing. This is often due to dehydration. Make sure to drink plenty of fluids (8-10 bottled waters per day) after surgery to stay hydrated. Move from laying down to a seated position and stay seated for a minute or two before standing. Adjusting positions slowly well help your body adjust your blood pressure to the new position to avoid feeling lightheaded or faint. Make sure to take an iron pill with every meal to help elevate the iron level in your blood after surgery.

Fevers are not uncommon after surgery, especially Brazilian butt lift (BBL). Fever and elevated white blood cell count is a sign of an inflammatory response happening in the body, but this does not necessarily mean infection. Surgery itself can cause an inflammatory response. Therefore, you should not rush straight to the Emergency Room (ER) for a fever. You should come to the office to be evaluated first. If there is concern for infection, you may be switched to a different antibiotic. If you need to go to the ER, it is preferable to go to a hospital where Dr. Ziyad Hammoudeh has privileges to treat patients.

Swelling frequently occurs in the legs after surgery due to the effect of gravity on swelling in the torso. All normal post-surgical swelling will go away eventually and takes weeks to months. You can continue to wear the compression stockings and elevate your legs above your torso so that gravity drains the swelling out of the legs. I do not recommend taking a diuretic if you do not take one normally because this will just remove fluid from your blood stream and not your tissues and can dehydrate you. If swelling is much greater in one leg than the other, associated with leg pain on one side, worsens after flying, or is persistent on one side, you should consider evaluation for a blood clot.

You can switch to ibuprofen 600 mg every 6 hours as needed for pain as soon as wish postoperatively. That means you can take three of the 200 mg over-the-counter ibuprofen tablets at a time. Ibuprofen often works better than narcotics for many patients and can be started as soon as desired after surgery as long as you do not have any bleeding problems. You can also take acetaminophen (Tylenol) 1000 mg every 6 hours. That means you can take two of the 500 mg over-the-counter Tylenol tablets at a time. Be sure not to exceed the maximum doses on the bottles per 24 hours period. Ibuprofen and Tylenol can be mixed without a problem. However, Tylenol cannot be combined with Percocet, Vicodin, or Percocet because these medications already contain Tylenol. Narcotics can cause constipation, nausea, drowsiness, or confusion; therefore, it is best to transition off of narcotic to over-the-counter pain medications as soon as possible.

You can shower 2 days after surgery. Just let soapy water run over the incisions, but do not scrub over the incisions.

Leave the tape bandage in place because it protects your incision. The tape bandage will fall off on its own in a few weeks. You can let the tape bandage get wet with showers. If part of the tape bandage starts falling off, you can trim the hanging piece of the tape bandage with scissors and leave the remaining portion in place.

Once the tape bandage has fallen off completely, you can use silicone scar tape or cream over the incisions to improve the appearance of the scars. You can purchase silicone scar tape online and use it daily for at least 3 months after surgery. Do not use the silicone scar tape on any open portions of your incision until they are completely closed. Only silicone based products have been shown in studies to improve the outcome of scars. You may use other creams of your choosing, but silicone-based scar therapy is the treatment proven to work in studies.

For the first 3 weeks following a BBL, you should sleep on your belly. For the first 6 weeks, you should sit on a BBL pillow. After 6 weeks, you may sit normally. If you had a BBL plus tummy tuck at the same time, you will not be able to sleep on your belly; in that case, you will sleep on your back on sides as long as you have the cushion of a mattress. As long as you do not sit on a hard, narrow surface, your buttocks should be ok.

The timing to travel home after surgery depends on the type of surgery you had. We recommend that you stay for at least 5 days following breast surgery, 7 days following Brazilian Butt Lift (BBL), 7 days following tummy tuck, and 7-10 days following combination surgery (e.g. mommy makeover, BBL + tummy tuck, etc). If you are driving a far distance, we recommend that you take a break every hour on the road to get out of the car to stretch your

legs to improve circulation to avoid getting blood clots. If you are flying home, we recommend that you get up and walk up and down the aisle of the plane every hour to avoid getting blood clots.

Patients should wear the compression stockings for at least 1 week after surgery. If you are staying in Miami longer than 1 week, you should continue to wear the compression stockings until after you fly/drive home. The stockings are worn to reduce the presence of blood clots in the legs and to reduce swelling in the legs. If you get more swelling in one leg than the other, especially if the swelling is associated with calf pain, please let us know because you may need to be evaluated for a blood clot.

All stitches are dissolvable unless otherwise specified to you after surgery. Therefore, the stitches do not need to be removed and will dissolve on their own.

You can eat normally after surgery as long as you are feeling well. You can start with liquids and advance to solid foods as soon as you are able without nausea. Protein is best to help with healing. We recommend patients drink protein shakes 3-4 times per day if not able to tolerate solid food. You need nutrition to heal, and you need more calories than usual after surgery because you need more energy to heal. Be sure to also take your iron supplements with each meal. Following lipo360 and BBL, it is very important to drink a lot of water; we recommend that those patients drink 8-10 bottled waters per day to avoid feeling dizzy because your body will need more water than usual as it makes swelling.

The first few days after surgery, we prefer patients to wear an abdominal binder for compression. The reason for this is that the faja often does not fit immediately after surgery due to the swelling and increased volume of the buttocks following fat transfer. If you wear a faja that is too tight, you can get damage to your skin with blisters. A shirt/camisole can be worn under the abdominal binder for comfort since the binder fabric is rough, and the binder can be worn on top of the shirt/camisole to still provide compression. Patients may switch from the abdominal binder to the faja after about a week once the swelling has started going down. The faja can be worn for as long as the patient desires.

Swelling will be worst in the first week and start improving by the second week after surgery. However, there will still be some swelling for months, and we do not recommend evaluating your results until you are at least 3 months out from surgery. It is important to be patient during this time period as your results will change as this time passes. Revision surgery cannot be performed until at least 3-6 months after a surgery because of the presence of swelling. Liposuction tends to have a great deal of swelling, so it takes time for that swelling to resolve and the skin shrink to your new shape. Similarly, the tight feeling in the abdomen after

a tummy tuck will resolve over several weeks. The mons (pubic area) in women (and scrotum in men) is often very swollen and bruised following liposuction or a tummy tuck because gravity brings the swelling and bruising downward. This is very normal following these procedures and should be observed during the first few weeks.

You can start getting lymphatic massages the next day following surgery. This will help drain out any fluid following liposuction, which many patients find helps them feel more comfortable. Following a drainless tummy tuck, you can have the massages on the sides (love handles) but not over the central abdomen to avoid disruption of the stitches placed on the inside. You can have as many massages as you wish

We want you to walk the same night after surgery. You should get up and walk to circulate the blood in your legs every two hours after surgery to avoid blood clots. The drainless techniques used by Dr. Ziyad Hammoudeh will allow you to be more mobile. After a tummy tuck, you will be hunched over for 1-2 weeks; all patients are able to stand completely upright eventually, so do not worry about that.

You can drive as soon as you are off of all narcotics because narcotics can make you drowsy, which would be dangerous while driving. You should also make sure you can turn your neck and body well depending on your surgical site so that you can react to traffic and check for vehicles behind your vehicle.

You can begin exercising 2 weeks after surgery with walking/jogging. You can then advance to running at 4 weeks. Finally, you can advance to heavy lifting (and situps after tummy tuck) at 6 weeks. It is very important not to do any heavy lifting prior to 6 weeks to avoid stress on your incision (and abdominal muscle repair with tummy tuck).

You should avoid elevations in your blood pressure for the first 2 weeks after surgery, so it is best to avoid sexual activity at least until that time. You do not want to over exert yourself and separate any surgical incisions until you are 6 weeks postop. Therefore, you must be careful prior to 6 weeks.

Having itching following a BBL is very normal. The itching has to do to the histamine response from fat grafting, and can also be due to the narcotics. To treat the itching, you can take Benadryl over-the-counter. Just be aware that Benadryl will also make you drowsy, and you should not drive while taking it. You should also transition from narcotics to over-the- counter pain medication.

When an inverted (“innie”) belly button is created and swelling happens, the belly button skin edges can rub together and get irritated, especially when normal drainage causes moisture to collect inside the belly button. Therefore, it is important to keep your belly button clean and dry after surgery. You should clean your belly button daily with Peroxide on a Qtip. If the belly button skin is moist from drainage or getting irritated, you should use a dry Qtip to stuff a gauze pad into the belly button and tape it in place to keep the area dry. Please change the gauze as often as needed to keep the belly button dry. If the gauze gets moist throughout the day, the gauze should be changed more than once per day.

Nearly all patients have bunching/ruffling of the abdominal skin along the upper edge of the tummy tuck incision, particularly on the sides, right after surgery. Over time, the skin will contract as the swelling goes away and these bunches/ruffles will smooth out. Similarly, you may see puckers/indentations from the internal stitches immediately after surgery. These stitches are dissolvable, and as they dissolve, the puckers/indentations will soften and go away. You have to wait at least 3 months for the skin to relax for bunching/ruffling or puckers/indentations to resolve. It is normal for patients to have the sensation of numbness, particularly between the belly button and the incision. This can take a year or more to resolve, but will improve slowly and is almost never problematic for patients long-term.

When fat is injected, the skin is often lumpy at the beginning. While some areas can appear lumpy, other areas may appear sunken in or dented. These lumps or dents often smooth out with time as swelling resolves and some of the fat goes away. Initially, these lumps or dents may be due to swelling, which causes certain areas of the buttocks or hips to bulge more than others. Therefore, you should just observe for the first month. After a month, you can begin firmly massaging those areas to help them soften. This is a mechanical massage that you can perform yourself at home or have performed by a message therapist if you choose. A mechanical massage is different from the lymphatic massages you get right after surgery to help get fluid out. These lumps or dents may take 6 months or more to resolve. It is important to compare with your preoperative shape when evaluating lumps or dents before considering revision or a second round BBL.

Redness is often caused by an internal dissolvable stitch coming to the surface, particularly when at the corner of an incision. When that is the case, the redness will resolve once the stitch dissolves. However, it is important to rule out the possibility of a more serious infection. If you are having other signs of infection such as pus draining, warmth, elevated heart rate, or feeling overall unwell, be sure to contact the office. For most infections, an oral antibiotic will be sufficient to treat the problem. If you have any questions about your incision, please take a photo and email/text it to us to be evaluated.

Please also remember to send your coordinator before-and-after photos after surgery to let us know how you are doing. We love to see how great you look!

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