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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 should start to look like your normal self.

2. How does Dr. Karam know how much to inject and how much will I maintain?

Based on his experience from performing over 5,000 fat transfer cases, Dr. Karam determines how much fat to add based on how much of a deficiency there is to correct. Each case is unique and the amount of fat chosen is based on the individual patient and on the patient’s 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. When can I wear eye makeup?

Patients are free to wear makeup 10 days after surgery. However, it is recommended that all incision lines only be covered with breathable makeup to allow for those areas to heal properly. Some common breathable makeup includes mineral make up, such as Bare Minerals. 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 the doctor 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?

There are no sutures used on the face after a fat transfer procedure. You will have small “poke-sized hole” scabs that form 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 for the first year to prevent scarring.

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 so as to achieve that refreshed look.

8. How long will results last?

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

9. When should I start using sunblock?

Sunblock is an important beauty element that should be part of your daily routine. Sunblock should begin 10 days after surgery and should be 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 becomes red, itchy, and/or inflamed.

10. Is there a risk for nerve damage?

No, the technique that Dr. Karam performs purposely avoids the facial nerves.

11. 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.

12. How long before the bruises go away?

The yellow, green, and/or brown colorations you might see are signs that you are at the end of the healing phase. Bruises usually last days to weeks after the surgery. Eventually everything is reabsorbed or excreted by the body and the bruises disappears.

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 from a few weeks to a few months to completely smooth out.

2. When will the incisions heal?

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 makeup 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 only be covered with breathable makeup to allow for those areas to heal properly. Some common breathable makeup includes mineral make up, such as Bare Minerals. 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 the doctor 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 which risks pulling the eyelid down.

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 help 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 also great for cleansing deeper inside the nose. 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 noticing 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 the drainage?

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. You can take an over-the-counter oral antihistamine, such as Benadryl, but it is 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 bruising 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 first night, 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 it for a few days and up to several weeks.

12. When can I resume the following?:

A. Exercise– You can begin doing long walks three to four days post-surgery. 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 preoperative exercise routines, but stop if you have pain or discomfort.

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

C. Taking vitamins and/or regular medications– You can resume all your medications and vitamins two weeks post-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 post-surgery. 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 post-surgery. 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 have any questions regarding your meds, please call the office before you take any.

17. How long before the swelling totally resolves?

It generally takes two to three weeks for most of the swelling to subside. At two to three weeks post-surgery, it is difficult for most people to be able to tell that you’ve had surgery.

18. What changes should I 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.

Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley, Encinitas, Rancho Bernardo and La Jolla in Southern California.

If you are ready to schedule an appointment with Dr. Karam, contact us today.

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