Frequently Asked Questions

Fat Transfer:

1. How long will I be swollen? Majority of swelling will settle between the first and second week. Swelling will continue to improve up to two months after the procedure; however, you will not look distorted or unusual during this time.

2. How does Dr. Karam know how much to inject and how much will I maintain? Based on his experience of performing over 5000 fat transfer cases, Dr. Karam knows how much fat to add in order to correct a certain deficiency. Each case is unique and the amount of fat chosen is based on the individual patient and on the goal. Dr. Karam always errs on the side of under-filling as opposed to over-filling. This ensures a natural outcome. In general, most patients retain about 50% of the fat that is injected. In some rare instances, some patients may keep slightly less.

3. Is it normal for one side to be more swollen than the other? Swelling is very common after surgery and it is normal and expected for one side to be more swollen than the other side. In addition, do not be surprised if the next day it's the opposite side that is now swollen even if you are following all the instructions correctly. However, some patients experience more swelling on one side because they are sleeping on that side, which is why we ask that you sleep inclined and on your back for at least the first week.

4. What are the lumps and hardness that appear under the skin? The lumps and hardness is swelling and it will diminish with time.

5. Why does it look like the fat is diminishing between 1-3 months after the transfer? Fat is living tissue. We are essentially transplanting a fat graft (a small amount of fat tissue). Since it is a living and functional tissue, it needs to establish a blood supply in its new home. During this period, the fat is living but the fat cells haven't started storing fat (which is what fat cells do to make them plump). So during this period, the fat grafts deflate (1-3 months following the procedure). Then starting 6-9 months following the procedure, they begin acting as they normally do and they start to re-inflate and get more full. This is why patients look best 1-2 years following a fat transfer. This process is the same for hair transplants and even trees/plants that are transplanted.

6. Will there be stitches where he injects the fat? There are no sutures used on the face after a fat transfer procedure. You will have small "poke hole size" scabs that form from where Dr. Karam injects the fat, but those usually go away on the third to fifth day. However, absorbable sutures are placed where we harvest the fat. These stitches will fall out on their own within 5- 10 days. It is recommended that sunscreen be used to prevent scaring for the first year.

7. Where is the fat harvested? Dr. Karam has found that the best sites for harvesting fat are from the thighs or the stomach.

8. Does he freeze the fat if I need a touch up in the future? Dr. Karam only harvests the amount of fat that is needed for the procedure. He does not take out any extra fat for any reason, including for future use. Frozen fat is unreliable at best since the freezing and thawing process is too harsh for the delicate fat cells.

9. Will massaging help with the swelling? No, massaging is not needed and can actually be harmful in terms of your results. There may be specific times and situations that Dr. Karam will recommend massaging; however, this is rare and if he does not suggest it, then that indicates that you do not need to do it.

10. Are there other sources that can cause swelling? Increased activity level can increase your swelling, especially the first month post surgery. In addition, changes in weather, especially heat, can cause you to swell more.

11. Is it Permanent/ what happens if I need a touch up? Fat transfers performed by Dr. Karam are a permanent procedure. Since it is a living graft it achieves a blood supply in the same way that a skin graft or hair graft would. Once that process of neovascularization (new blood supply) has been established, the fat grafts not only survive in their new environment but they thrive. This process can take several months to occur. The general rule of thumb is that whatever you have by 2-3 months is your lowest point. It will not get less, but you might see an increase in fullness over the following year as the fat grafts make the transition from survival to returning to their biological natural ways of storing fat. Very limited cases have ever needed another fat transfer touch up and it is always best to wait until at least one year after the surgery to see the true result before any touch up procedure is scheduled.

12. My skin is yellow? Why? The yellow, green, and/or brown colorations you might see are signs that you are at the end of the healing phase of a bruise-usually days to weeks after the surgery. Eventually everything is reabsorbed or excreted by the body and the bruise disappears.

13. How long before the bruises go away? Not all patients experience bruising with a fat transfer procedure. However, those who do will commonly experience bruising for about one to two weeks. Makeup and/or concealer can be applied to camouflage bruising, if needed. In cases of dark bruising or bruising that does not seem to be resolving, Dr. Karam will recommend that you see a laser specialist for treatment. This has been shown to speed up the healing process.

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Face/Neck/Brow Lift:

1. How long until the incisions heal? Everyone heals at a different rate. As a rule of thumb, incisions look the worst between weeks 2-6 and they then start to settle up to one year following the procedure. While they are red and slightly raised, camouflaging them with make up is needed. It is important to be patient during this process. Our incisions heal extremely well in the overwhelming majority of cases.

2. Why is there rippling where the sutures are or used to be? Rippling/Bumps commonly occur where the sutures are placed; the swelling along the incision line causes this. The skin will relax and the rippling will begin to smooth out once the sutures are removed at your one-week post op appointment. The bumps will take a few weeks to a few months to completely smooth out.

3. What is "poking" out along the incision line? I think I have sutures left in. Some patients will experience a stitch that feels like a wire poking out from the facelift/browlift incision line. This stitch is one of the sutures beneath the skin and the tail end of the suture can "work its way out" through the skin. The stitch is harmless and any of the staff members can easily clip the suture so you do not feel it sticking out anymore. There is no increased risk of infection or negative results occurring from this minor nuisance. The sutures will dissolve in 4-6 months.

4. When will the numbness and tingling go away? Numbness is common and will last a few months.

5. It has been a couple weeks and my face and jaw still feels very tight, when will this go away? This procedure is effective and lasting because your facial muscles are literally lifted and tightened in a more youthful position. You will typically experience this for 3-4 weeks.

6. Are there sutures under the skin in the muscle? There are sutures under the skin. These sutures are the ones that physically lift and hold your facial muscles into their new "younger-looking" position.

7. Will the Browlift change the shape of my eyes? The Browlift will not change the shape of your eyes. The purpose of the procedure is to simply lift the tail end of the eyebrows so they are no longer sagging and to make the transition from the facelift to the brow area more seamless to achieve that refreshed look.

8. How long will the results last? This is always difficult question to answer because it is hard to define "lasting." The real answer is that it is permanent. However, aging does continue even after the procedure. The rate of your aging will be significantly slower once you have this done. The average patient will feel satisfied for 10-15 years.

9. When can I wear makeup? Patients are free to wear makeup 10 days after surgery. However, it is recommended that all incision lines be only covered with breathable makeup to allow for those areas to heal properly. Some common breathable makeup include mineral make up, such as Bare Minerals, or we also sell a foundation called Oxygenetics. Please be mindful to discontinue any products if your skin becomes red, itchy, and/or inflamed.

10. When should I start using sunblock? Sunblock is an important beauty element that should part of your daily routine. Sunblock should begin 10 days after surgery and applied especially to the incision lines. Although sunblock should be part of your life long beauty routine, it is particularly important the first year post surgery or you run the risk of your incision lines discoloring. Please note that it is not necessarily the SPF that protects you but the Zinc Oxide of at least 9% AND Octinoxate of 7%. A good product line that carries those levels of protection is Obagi. Again, please be mindful to discontinue any products if your skin because red, itchy, and/or inflamed.

11. Is there a risk for nerve damage? No, the technique that Dr. Karam performs purposely avoids the facial nerves.

12. Can I use scar gel to speed up the healing process of my incisions? For patients who want to be proactive as possible, scar gel is a good option. We do recommend a medical grade scar gel that creates a silicone barrier over the incision line, such as BioCorneum.

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Eyes:

1. Why is there "rippling" where the sutures are or used to be? Rippling/Bumps commonly occur where the sutures are placed; the swelling along the incision line causes this. The skin will relax and the rippling will begin to smooth out once the sutures are removed at your one-week post op appointment. The bumps will take a few weeks to a few months to completely smooth out.

2. When will the incisions heal? The eyelid skin is some of the best healing skin on the body. Even though, in the end those incisions will hardly be noticeable, everyone heals at a different rate. As a rule of thumb, incisions look the worst between weeks 2-6 and they then start to settle up to 1 year following the procedure. While they are red and slightly raised, camouflaging them with make up is needed. It is important to be patient during this process. Our incisions heal extremely well in the overwhelming majority of cases.

3. When can I wear eye makeup? Patients are free to wear makeup 10 days after surgery. However, it is recommended that all incision lines be only covered with breathable makeup to allow for those areas to heal properly. Some common breathable makeup include mineral make up, such as Bare Minerals, or we also sell a foundation called Oxygenetixs. Please be mindful to discontinue any products if your skin becomes red, itchy, and/or inflamed.

4. Why is my vision a little blurry? Typically, this is because of the lubricant that is placed in the eye.

5. How does he know where to make the incision? And why is one side healing faster than the other? The incisions are made in the natural upper and lower eyelid crease (superior and inferior tarsal crease, respectfully). Be mindful that the natural crease in one eye may be higher/lower than the other eye. Incisions are closed exactly the same in every case and there is never a difference in technique between the 2 sides of the face, however, the two sides do heal differently. They eventually even out and look the same.

6. Why are the skin pinch incisions so low? It is made in the inferior tarsal crease. This location is the safest position to place the incision. When placed higher the muscle that functions to hold the lid up will be weakened and risk pulling the eyelid down.

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Rhinoplasty:

1. If Dr. Karam didn't pack my nose, why am I stuffed up? It is very common to be "stuffed up" after surgery. The reason is that there is swelling inside the nose, as well as outside the nose. This swelling will peak on the third day, and then go down slowly thereafter. Expect to breathe mainly through your mouth the first week following the procedure.

2. How long will my nose stay swollen? Because the nose is not very vascular, swelling of the nose can last several months and even up to a year. In most cases the swelling is not distracting or obvious.

3. When will my external sutures and external nasal splint be removed? Your sutures and nasal splint will be removed at your one-week post-op appointment. Some dissolvable internal sutures will remain in place for six months.

4. Are there sutures inside my nose? There are dissolvable sutures in your nose that remain for about 3-5 months. These sutures are used to support the nose during healing and to close the incisions.

5. Can I remove the tape from my nose? The tape and splint must remain on your nose for the entire week until we take it off at your scheduled 1 week post-op appointment. They both help support the healing process and helps with your swelling so you can have a speedy recovery.

6. Can I clean my nose? After 48 hours, you should start using a Q-tip soaked with hydrogen peroxide to gently wash the scabs and any dried blood outside the nose. You may also clean inside the rim of the nose. Saline spray is great for cleansing deeper inside the nose as well. This can be started after the nose has stopped draining.

7. Why do I have drainage down the back of my throat? Normally the nose secretes about 8oz. of mucus (1 cup), which goes down the back of your throat, without you knowing it. However, after you have surgery the nose is stuffed up and you become more aware of this normal secretion.

8. Why do I have more drainage from my nostrils one day after surgery? Can I take an antihistamine/ allergy medicine to help/stop it? The nose drains blood for about 24-48 hours after surgery until a scab forms. The combination of "normal mucus drainage" and "intranasal swelling" can cause the drainage to come out the nostril rather than to go down the back of the throat. Yes, you can take an over the counter oral antihistamine, such as Benadryl, but not necessary.

9. Is bruising normal? Bruising after rhinoplasty is normal, although only about 5% of Dr. Karam's patients have any noticeable signs of brusing after the first week.

10. I have a headache and trouble sleeping. Is this normal? Can I take anything for it? Unfortunately, headaches are common due to the swelling of the nose and for some patients, sleeping on their back is the cause for sleepless nights. It is often a good idea to try something like extra-strength Tylenol for your headache and save the Hydrocodone for pain. After the night of surgery, you may take a light sleeping aid, such as Tylenol PM, if needed.

11. My teeth are sensitive, is that normal? Teeth, gum, and/or upper lip sensitivity is normal after rhinoplasty. Some patients may experience for a few days to several weeks.

12. When can I resume:

A. Exercise- You can begin doing long walks by three to four days postoperatively. You can go to the gym and use a treadmill or stationary bike (no spin class) by the second postoperative week. You can begin to do light weights and non-head-down exercises by the third week (avoid heavy weights that would raise your blood pressure). By the fourth week you can try and resume pre-operative exercise routine, but stop if you have pain or discomfort.

B. Swimming- You can resume swimming after one month.

C. Taking my vitamins and/ or regular medications- You can resume all your medications and vitamins after two weeks from the surgery.

D. Wearing glasses/sunglasses- Only those patients who have their nose broken during surgery need to worry about glasses and sunglasses sitting on the bridge of your nose. This is only relevant for the first four weeks.

13. How long do I have to sleep elevated and on my back? It's best to remain on your back and elevated for the first two weeks. Because some swelling will naturally follow gravity, keeping your head up is very beneficial. Those who sleep on their side will definitely notice swelling on one side more than the other.

14. Can I blow my nose or sneeze after surgery? You can blow your nose and sneeze normally at about six weeks. However, if a sneeze is unavoidable just make sure to sneeze leaving your mouth open to avoid pressure within the nose.

15. Why is there so much numbness at the tip of my nose? Numbness is very common and will last from a few weeks to a few months.

16. What medications/ supplements should I avoid 2 weeks before and 2 weeks after surgery? You should avoid all NSAIDs, such as Advil, Motrin, aspirin, Excedrin, ibuprofen, Aleve, Naprosyn, etc. Additionally, you should avoid omega-3 supplements, such fish oils, chia seeds and flaxseed for two weeks before and two weeks after the surgery. If you any questions in regards to your meds please call the office before you take it.

17. How long before the swelling has totally resolved? It generally takes two to three weeks for most of the swelling to subside. At two to three weeks it is difficult for most people to be able to tell if you have had surgery.

18. What are the changes I should expect while my nose is healing? Your nose will continue to get smaller and more refined as the months go on. Your body heals at its own rate and it is important to be patient during this time.

19. Regarding donor sites for ear cartilage grafts or fascia grafts from the scalp.

A. Why is there bleeding and oozing? These areas are highly vascularized, and once the epinephrine wears off from the local anesthesia, you may have "reflex bleeding or oozing". The bleeding and oozing are both normal.

B. How do I clean the area? scalp wet where the fascia graft was harvested. However, do not get the yellow ear donor site or the nose cast wet. It is best to have someone else wash your hair for you.

C. When can I wash my hair? It is usually best to wait 48 hours after surgery to wash your hair and it is often beneficial to have someone wash your hair for you.

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