Healing after Plastic Surgery; State-of-the-Art for 2017.

“Time is a cruel thief to rob us of our former selves. We lose as much to life as we do to death.” Elizabeth Forsythe Hailey

Living in the modern world becomes more complex and harder as life in the 21st-century becomes faster and faster. We are burdened with responsibilities and distracted by an interminable onslaught of media in all forms including the capricious internet. It seems as if everything is competing for our attention in one way, shape or form while stealing precious time we could otherwise devote to family, friends and simply to our  own selves. Therefore, when it comes to saving time, the need to heal quickly after any cosmetic procedure is almost rapacious.

Unfortunately, there is no magic pill or formula to bypass the post operative inflammation of  bruising, swelling and discomfort at this current time. However, there are things you can do both at home and in the clinical setting to accelerate your healing.

First of all, it is a good idea to focus on whole foods as much as possible while avoiding processed ones as the former will contain the highest levels of vitamins and amino acids your body will need for a speedy recovery.  Amino acids help wounds heal faster and obviously, these are found in  chicken, meats, egg whites, fish, brown rice, healthy nuts like walnuts and almonds or sunflower seeds. Taking supplemental vitamin C in your diet while increasing zinc in your diet can be helpful. Instead of taking vitamin C for a bottle, you can eat strawberries, papayas and citrus fruits which are great sources of vitamin C.  500-1000mg  is the usual amount that is taken. Zinc is found in oysters which have one of the highest levels of zinc found in any food. If you are going to take a supplement, 15 mg of zinc daily is the recommended amount but you can increase your zinc intake to 30–50 mg for 2 weeks before and 2 weeks after surgery, using zinc picolinate.

Other useful supplements to take in preparation for your surgery include:

B12 and Iron – Iron and B12 both aid bone marrow in forming new blood cells, so incorporate foods like fish and eggs.

Vitamin B6  250mg, twice a day for a week, starting 3 days after surgery. This helps reduce post-surgical fluid retention, such as swelling of the face, hands, feet or legs. With B6, you can experience substantial reduction within 24 to 48 hours.

CoQ10- Surgical trauma (particularly from cardiac surgery) causes an increase in free radicals, which  damage cellular function. For this reason alone, you should take at least 50 mg of CoQ10 as part of your daily routine before your cosmetic surgery and 100–200 mg/day for at least 4 weeks after.

Fiber and probiotics – This combination helps boost the immune system and also keeps your digestive tract moving along. Eating yogurt with granola is just one easy way to get a serving of both fiber and probiotics! When choosing a probiotic, consider one that contains acidophilus and bifida bacteria (follow label instructions for dosage). Surgical patients often receive oral or intravenous antibiotics in the hospital, which creates the potential for  yeast infections, digestive disturbances and diarrhea. A probiotic may help counteract these problems.

One amino acid that has been shown to speed with healing is glutamine and a study from Harvard and Dave showed that it shortened healing by about four days. Apart from supplements, glutamine can be found in beef, chicken and all types of fish. Dairy products such as cheese, milk, yogurt and eggs contain glutamine with ricotta and cottage cheese being the two richest sources. Vegetarians can find glutamine in beans and lentils. For most of my patients, I also recommend supplemental Arnica Montana, Bromelain/ Bromezyme (this pineapple enzyme helps prevent blood clots, aids digestion while decreasing inflammation and pain after surgery) and Pycnogenol/Pine bark. This triumvirate is aimed at reducing bruising, soreness and inflammatory edema. Apart from the above, many patients inquire about any other additional medications, exercises or procedures that can be done to maximally reduce their healing times after surgery. Of course, all patients should ask their individual physicians or surgeons about their own personalized recommendations to speed up recovery which is beyond the scope of this post.  
Bioptron® Light employs a combination of polarized infrared and visible light (480nm-3400nm) considered beneficial in the treatment of wound problems and injuries by exerting its effect at the cellular level. Bioptron® therapy has a low energy density (fluency) of 2.4 J/cm2 at a distance of 10 cm and can penetrate the skin up to 2.5 cm.
This patient had impending skin necrosis around her here after a facelift. Only 7 days of Bioptron ® light therapy were administered and notice the rapid improvement in reversing the damage.
After 5 days of Bioptron® therapy to resolve bruising resulting from lower eyelid procedure to treat her dark circles/tear troughs.
After 3 days of Bioptron® light therapy to accelerate the resolution of bruising and skin injury after a breast reduction by Dr. HAWORTH.

It has been used effectively in the treatment of burns, pressure sores, leg ulcers, wounds, pain and recently, postoperative healing. I have found it very useful in my clinic to reduce both swelling and bruising. Supporting my experience, other plastic surgeons here and abroad have noted decreased resolution times of eccymosis and edema following surgery by over 33% with Bioptron®. Indeed, it has been used to also reverse the course of cutaneous necrosis as well as accelerate granulation of open wounds, either alone or in conjunction with hyperbaric oxygen therapy (HBOT).

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. It is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with HBOT include serious infections, bubbles of air in blood vessels and non-healing wounds as a result of diabetes or radiation injury.

In a HBOT chamber, the air pressure is increased to 3 times higher than normal air pressure and under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure. However, there is some confusion about what actually is “true” HBOT. Those employing “soft” tent like enclosures are essentially useless since they are unable to obtain a true hyperbaric environment of 2 to 4 atmospheres absolute (ATA). In fact, these personal or home-use “hyperbaric”  tent enclosures can usually only attain a pressure of 1.3 ATA. There is a debate as to how much and how many treatments are necessary to speed up recovery after plastic surgery. While most plastic surgeons perhaps recommend one preoperatively and at least 3 to 5 postoperatively, experts in the field say one needs at least 15 to 20 treatments in order to see significant results. In my experience, 3 to 5 treatments are all that is necessary to achieve the more modest goals of reducing edema, bruising and discomfort resulting from elective  plastic surgery.

After certain surgeries, I may also recommend selective lymphatic massage/drainage to resolve edema (swelling)  of the extremities, particularly after liposuction or liposculpture.

The above aforementioned vitamins, nutritional supplements and clinical interventions may not be the panacea to surgical healing which comes in a pill form, but they certainly are a step in the right direction in making recovery from any procedure as smooth as possible in 2017.

Dr Randal Haworth

2017 Beverly Hills

       

Kybella ® vs. liposuction for a double chin

While we in the cosmetic industry are getting better and better at delivering the results that patients expect, I still hold fast that 60 to 70% of modern high-tech materials and devices in plastic surgery over promise and under deliver ! Considering that the future of plastic surgery will be less about actual surgery as more more and more technological advances are made in the lab (think genetic engineering, better fillers, better lasers, etc.), this 60-70% statistic is rather disappointing. What makes this all the more egregious is the fact that doctors are forced to pay an arm and a leg for such underperforming technologies (Ulthera ® Thermage®, etc.). In light of the fact you can get a state-of-the-art Tesla  with all the bells and whistles for around $100,000, paying $150,000 or more for a machine that just delivers fuddy-duddy ultrasound technology through a wand to aid in liposuction is frankly outrageous. However, the medical tech companies can’t be solely blamed for this-they are basically governed by the FDA’s policies which, in turn, are a response to precedents extrapolated to an absurd degree by  lawyers. Unfortunately, I have seen it all too many times – a new plastic surgery technology coming out amidst a flurry of media only to fade into relatively rapid obscurity. This is similar to a Billboard chart topper only to turn out to be a one-hit wonder! In my opinion the latest overhyped snakeoil is Kybella® from the big pharma conglomerate Allergan®, proud makers of Latisse®, Botox®, Voluma®, Juvéderm®, etc. I was glad to hear from some of my esteemed colleagues at the recent American Society of Plastic Surgery meeting in Los Angeles that their thoughts on Kybella ® echoed mine.   Taking into account Kybella’s negative points, which include: 1.  relative risk of damaging important facial nerves, 2.  cost (though one treatment is less expensive than liposuction, more often than not multiple treatments are necessary and these, of course, add up), 3.  associated pain, 4.  longer recovery (which, ironically, is worse than surgical liposuction since remarkable swelling can occur after every injection session) and 5.  inferior results to those obtained  with aesthetically and skillfully performed liposuction …there is little to no advantage in utilizing Kybella® for my patients except perhaps for its superior multi-million dollar marketing campaign! Indeed, micro liposuction can provide unprecedented control in removing  fat to treat a double chin while refining the jawline and addressing the jowls as well-all with less downtime and more economically so in the end. Case in point:
Dramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transfer
Dramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.
Dramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.
After combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.
After combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.

COSMETIC SURGERY MAGAZINE (2000) – COSMETIC LIP SERVICE

Treating lips on an individual basis is vital, according to aesthetic surgeon Randal Digby Haworth, because “Lips are very unforgiving they must be done perfectly from the beginning in order to get a natural result. The important thing is harmony with the face.” Haworth has devised a number of lip enhancement procedures, each achieving a particular look or style. “Or you can have a combination of all these procedures, where I mix and tweak like a cook.” The upper lift, or paranasal lip lift is employed to enhance an overly long or aged upper lip says Haworth. “The upper lip is a dead give-away of your age-a long, old upper lip can mean a ‘horsy’ appearance where no upper teeth are visible when the mouth is in repose.” The procedure involves surgery that is performed regionally as opposed to directly on the or in the lip. “The results display more of the upper teeth when the mouth is in repose and everts the upper lip to expose more vermilion. Shortening the upper lip restores a youthful balance to the lower face,” explains Dr. Haworth. Recovery time is usually about five days, and the scar becomes invisible in a short time.