Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.

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Anesthesia and Monitoring

Facial correction surgeries are generally performed under general anesthesia to ensure the patient is completely unconscious, immobile, and pain-free. The airway is secured, often with a specialized nasal tube for jaw surgeries, to leave the mouth accessible.

Advanced monitoring is used throughout the procedure. In microsurgery cases, blood pressure is carefully managed to ensure adequate flow to the transferred tissue. Nerve monitoring devices may be used to identify and protect the facial nerve during dissection.

  • Administration of general anesthesia with airway security
  • Use of nasotracheal intubation for oral access
  • Intraoperative facial nerve monitoring
  • Hemodynamic regulation for tissue perfusion
  • Thermal management to prevent hypothermia

The Surgical Environment

PLASTIC SURGERY

These procedures take place in fully accredited hospitals or surgical centers. The operating room is a sterile environment equipped with specialized lighting, microscopes for nerve and vessel repair, and power tools for bone work.

The surgical team is extensive, including the lead surgeon, assistants, scrub nurses, and circulating nurses. For complex cases, two teams may work simultaneously—for example, one harvesting a bone graft from the leg whilst the other prepares the face.

  • Sterile hospital operating theater environment
  • Utilization of surgical microscopes and loupes
  • Availability of powered osteotomes and drills
  • Coordination of multiple surgical teams
  • Strict adherence to aseptic technique

Executing the Plan

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The surgery follows the preoperative virtual plan. Incisions are made in concealed locations—inside the mouth, within the hairline, or in natural skin creases. Bones are cut and moved, secured with titanium plates and screws.

Soft tissues are handled gently to minimize swelling. If flaps are used, the blood vessels are connected under the microscope. The surgeon constantly checks for symmetry and proper contour, adjusting the reconstruction as needed.

  • Precision placement of concealed incisions
  • Execution of osteotomies and rigid fixation
  • Microsurgical anastomosis of free flaps
  • Gentle handling of soft tissue envelopes
  • Intraoperative verification of symmetry

Wound Closure and Drains

Closure is critical for the final aesthetic result. Deep sutures relieve tension on the skin edges. The skin is closed with fine sutures that minimize scarring.

Drains are often placed to remove fluid and blood from under the skin, preventing hematomas, which could compromise the result. These are typically small tubes exiting behind the ear or in the hair.

  • Layered closure to reduce skin tension
  • Use of fine caliber suture materials
  • Placement of suction drains for fluid removal
  • Application of antibiotic ointments
  • Dressing of donor and recipient sites
PLASTIC SURGERY

Immediate Post Operative Phase

The patient wakes up in the recovery room. The head is elevated to reduce swelling. Cool compresses are applied to the eyes and face. Pain is managed with intravenous medications.

Airway monitoring is intensive, especially after jaw or tongue surgery, as swelling can compromise breathing. Patients may remain in the hospital for 1 to several days, depending on the complexity of the surgery.

  • Head elevation to 30 45 degrees
  • Application of hilotherapy or ice masks
  • Intensive airway and respiratory monitoring
  • Management of postoperative nausea
  • IV pain control and transition to oral

Swelling and Bruising

Facial surgery causes significant swelling and bruising. This is a normal inflammatory response. Swelling peaks around day 3 or 4 and can be alarming, sometimes closing the eyes.

Patients are reassured that this distortion is temporary. Lymphatic drainage is initially impaired but gradually improves. Bruising travels down the neck due to gravity.

    • Expectation of significant peak edema
    • Distortion of facial features temporarily
    • Gravitational migration of ecchymosis
    • Impairment of lymphatic drainage
    • Gradual resolution over 2 to 3 weeks

Pain and Discomfort Management

Pain varies by procedure. Bone surgery is often described as a deep ache, while skin surgery stings. Muscle spasms can occur with jaw surgery.

A multimodal pain plan is used, combining narcotics, acetaminophen, and muscle relaxants. Nerve blocks placed during surgery provide relief for the first 12 to 24 hours. Most patients transition to non-narcotic pain relief within a week.

  • Multimodal analgesic regimen
  • Use of muscle relaxants for jaw spasm
  • Transition from narcotics to OTC meds
  • Role of long-acting local anesthetics
  • Management of discomfort vs acute pain

Dietary Restrictions

Diet is strictly modified after oral or jaw surgery. A liquid or non-chew diet is mandatory for several weeks to allow bones to heal without stress.

Patients must maintain high-calorie and protein intake through shakes and soups. Syringes or squeeze bottles may be needed if the patient cannot open their mouth wide. Hydration is emphasized.

  • Strict adherence to a non-chew or liquid diet
  • Use of nutritional supplements and shakes
  • Adaptive feeding techniques syringes
  • Maintenance of caloric and protein intake
  • Gradual advancement to soft foods

Hygiene and Wound Care

Oral hygiene is critical to prevent infection of intraoral incisions. Patients use prescription mouth rinses and baby toothbrushes. Water picks are generally avoided initially to protect incisions.

External incisions are cleaned with saline and covered with ointment. Patients must avoid getting the wounds soaked, but can usually shower within 48 hours.

    • Strict oral hygiene with chlorhexidine rinses
    • Gentle cleaning of external suture lines
    • Avoidance of water pressure on wounds
    • Protection of dressings and casts
    • Monitoring for signs of infection

Activity Restrictions

Activity is restricted to prevent bleeding and injury. No heavy lifting, bending over, or straining is allowed for several weeks. Raising blood pressure can cause a hematoma.

Contact sports are prohibited for months if bones are cut. Patients should rest but walk gently around the house to prevent blood clots in the legs.

    • Avoidance of Valsalva maneuvers and straining
    • Restriction of heavy lifting and cardio
    • Prohibition of contact sports for bone healing
    • Gentle ambulation for DVT prevention
    • Head elevation during sleep

Emotional Recovery

The early recovery period can be emotionally challenging. The face looks swollen and bruised, and the final result is not yet visible. “Post op blues” are standard.

Support from family and reassurance from the surgical team are vital. Patients are reminded that healing is a marathon, not a sprint, and that the distortion will pass.

  • Management of postoperative blues
  • Coping with temporary facial distortion
  • Reliance on social support systems
  • Patience with the slow healing timeline
  • Visualization of the end goal

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FREQUENTLY ASKED QUESTIONS

Will my jaw be wired shut?

In modern orthognathic surgery, jaws are rarely wired shut. We use rigid titanium plates and screws to hold the bones. You will likely have rubber bands to guide your bite, but you will be able to open your mouth to drink and speak immediately.

The majority of visible swelling (about 70-80%) goes down in the first 3 to 4 weeks. However, the residual subtle swelling can take 6 to 12 months to fully resolve, especially in the tip of the nose or the jawline.

You can usually brush the teeth away from the incision sites gently with a baby toothbrush the day after surgery. You must be very careful not to disturb the stitches in the gum line. Rinse gently after every meal.

If you have had nasal or jaw surgery, try to sneeze with your mouth open to release the pressure. Sneezing with the mouth closed can force air into the tissues or disrupt healing bones.

You must sleep on your back with your head elevated on 2 or 3 pillows (or in a recliner) for the first 2 to 3 weeks. This uses gravity to help drain the swelling away from your face. Sleeping on your side can cause asymmetrical swelling.

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