Post Op Care Instructions St. Louis
SLEEPING: If you are having a tummy tuck, the best option is to sleep in a recliner for the first 1-2 weeks. If you do not own a recliner, a recliner or lift chair can be rented (e.g. Rent a Center). A bed that flexes will also work. The knees will need to be bent and the torso flexed slightly to relax the abdominal muscles and take tension off the incision line. Pillows can also be used to get into this position. Patients often times need help getting out of a chair or recliner for the first several days after tummy tuck and lower body lift surgery and a lift chair makes this easier.
WALKER: This is optional and may make it easier to move around after tummy tuck or lower body lift surgery and to minimize the chances of falling. A wheelchair is usually not needed.
SHOWERING: Patients can shower 48 hours after surgery. Remove ALL garments (these may be washed and air dried), dispose of all loose gauze/bandages and expose your skin. Leave ALL adhesives and glue on your incisions. Remove any yellow gauze inside your belly button. If you have drains, hang them on a lanyard or shoelace (or similar) tied around your neck, do not let them hang down! Take a shower with regular soap and water and pat dry (there is no benefit to antibacterial soap). You may reach up and shampoo your hair if you’ve had breast or arm surgery. Do not rub incisions with washcloths, use only your fingertips. Replace ALL garments immediately after showering and use foam on areas where liposuction was done (see below). Gauze is only needed for additional comfort or if there is drainage present from the incision. Blisters can be treated with Vaseline.
SHOWER CHAIR: A shower chair may be helpful for patients, especially if you faint easily at the sight of blood. Many patients get light – headed when taking showers the first week or so after major body contouring, so make sure someone is there just in case to help you.
DRAINS: Drains should be stripped regularly, and the bulbs should always be collapsed to retain suction. Do not let the bulbs get more than halfway full. Record the amount of fluid per drain in milliliters and bring to your follow up. Apply polysporin ointment where the drain exits the skin to prevent drain site infection. The drain is stitched to the skin to prevent the tube from sliding out; if the drain slides out, never try to push it back in as this pushes bacteria inside the body. Drainage around the tube may be normal if liposuction was done in the area or it may represent a clogged drain tube where it exits the skin. If this occurs, strip the drain tube to see if you can unclog it. There should always be some fluid moving through the tube and into the drain.
Increasing redness around the drain site may be a sign of a drain site infection, particularly if there is increasing pain. A small rim of red skin can be normal after several days, but this should be minimal and not increasing in size or pain. Call immediately if you are concerned about this, make sure you are using antibiotic ointment. Often times this irritation or infection does not improve until the drain is removed.
GARMENTS: Bras and garments are placed immediately at the time of surgery at our discretion and are worn minimum of 3 months postoperatively for best results. Wear your compression garments continually, day and night, to prevent swelling and fluid build- up. The idea is to prevent your skin from stretching due to swelling after surgery to maximize your results. The garments may be washed, and it is helpful to have extras on hand (link below).
FAJAS: A FAJA is the best option for body contouring and you may need to purchase more than one size as swelling decreases and fits can be variable. FAJA’s compress the entire torso more evenly than separate garments. Foam will be used with the garments to create even compression. The idea is to always be as tight as comfortable.
BRAS: A sports bra will substitute for a surgical bra, which opens in the front. A bandau is occasionally provided for breast augmentation patients. This sits on top of the bra, above the breasts, and puts downward pressure on the implants to help them “settle”. A bandau does not prevent a capsular contracture, and if mesh is placed, these are rarely used. See below for implant massage detail.
STOCKINGS: Have extra TED hoses or compression stockings on hand as legs and feet will frequently swell after surgery. Elevating legs and feet is also helpful to minimize this. Bring underwear to follow-up visits to be worn after drain removal if you had a tummy tuck.
BINDERS: An abdominal binder is provided in cases where muscle tightening was done in order to support the abdominal wall. This binder can also be used to provide additional compression on the lower abdomen in conjunction with foams or boards or to fill the gap between the lower body garment and bra if you do not have a FAJA. These can be washed and customized/cut for comfort.
LIPO FOAM: You will also want to purchase lipo foam to insert inside the garments along your flanks and back after surgery if liposuction was done. This includes breast surgery patients when liposuction was done on the outer chest. There are some companies that make 360-degree lipo foam products, be careful selecting the correct size, your size will change after surgery and you may need more than one size (increase immediately after then decrease back down as swelling decreases).
FOAM BOARDS: Additionally, if you are having abdominal work done, an “abdominal board” is recommended to be placed on the lower abdomen starting 1 week after surgery to help flatten the abdomen with additional compression. If a lower body lift or 360 lipo is done, a “back board” is also used starting one week after surgery in the lower back.
BBL pillows/offloading: If you are having fat transfer to the buttocks or hip dips, it is recommended that you purchase (BBL) pillows/boppy pillows etc. to “off-load” pressure on the areas where fat was injected. You want to stay off the area as much as possible for up to 6 weeks to increase “take” of the fat for best results. This helps improve blood flow to the area to maximize fat “take”. Pillows can be used under the back and thighs to offload the buttocks also. There is no one best way to do this, as every patient has different areas where fat was injected. Once you are able to sleep on your abdomen, you may do so.
Visit the following page for frequently recommended products: https://www.stl-psc.com/products/
Dr. Samer Cabbabe Garment and Scar Protocol:
- Use abdominal binder up to 3 weeks post-op (muscle support)
- Wear stage 1 faja x 1 month with foam/boards then switch to stage 2 (one that goes up the back and over the shoulders for even compression). Stage 2 is more compressive, can still use foam or board as needed. As tight as is comfortable is the goal.
- Bring lipo foam to the hospital. Add lipo foam all around for the first week. Approximately 1 week post-op, switch to ab board in front and lipo foam on sides/back for 3 months. You can use a board or foam in back.
- Remove adhesive tape on incision lines approx 3-4 weeks after surgery (should be off before your 1 month follow up visit)
- Apply silicone gel after tape is removed for 1-2 weeks. Once the incision is fully healed (no tiny openings etc), switch to silicone tape. Using a covering, non-breathable silicone tape in presence of moisture or drainage will result in skin irritation/redness.
- Never apply any adhesives to skin, this will result in skin tears!
- See below for blister/wound care
IBUPROFEN: If you have not had weight loss surgery, ibuprofen/Aleve is recommended for pain relief, in addition to any pain medicine prescribed. This is the most effective pain reliever in the world. For most normal weight adults, the ibuprofen dose is 600-800 mg three times a day. Aleve is usually taken 1-2 pills every 12 hours depending on your weight. If you choose not to take ibuprofen, expect to need more narcotics and get more side effects such as nausea and constipation, your recovery will be more difficult. Do not take ibuprofen if you have kidney problems or weight loss surgery.
TYLENOL: In addition to the Ibuprofen, take Tylenol regularly until you have no further pain. The maximum dosage for an adult is 4 grams/day. Take 500-650 mg every 4-6 hours, alternating with Ibuprofen for best pain relief. Ibuprofen is more effective at pain relief and fever reduction than Tylenol. Do not take Tylenol if you have liver problems.
ASPIRIN: Do not take Aspirin or any blood thinners until cleared to do so directly by Dr. Cabbabe.
IRON: This should have been started in advance of surgery. major body contouring surgery, continue taking iron for 1- 2 weeks after surgery to recoup lost red blood cells. Beware of constipation issues. Calcium can facilitate iron absorption, talk to your local pharmacist to get their opinion if you are taking straight iron (and not a multi – vitamin)
BLOOD CLOTS AND BLOOD THINNERS: After certain procedures, Dr. Cabbabe may prescribe subcutaneous heparin injections to be taken twice a day for 7-10 days after surgery to reduce the risk of blood clots, a.k.a. DVT’s. This can be administered in any area surgery was not done. Procedures that may benefit from blood thinners after surgery include: tummy tuck (where muscle tightening was done) and thigh lift surgery. IF you are flying home, it is recommended you stay 10 days after surgery to reduce the risk of blood clot.
CONSTIPATION: Anyone taking narcotics is at risk for this. Senna/Colace can be taken twice a day to help prevent constipation; however, this is not a laxative. We recommend starting laxatives within 48 hours of surgery until your first bowel movement. This is in addition to any Colace you are given. You should have a bowel movement within 3-4 days of surgery. If you do not, continue taking laxatives until you do so. Recommended laxatives available over the counter include MiraLAX, Milk of Magnesia, and Dulcolax (oral or suppository).
SCAR CARE: Most patients will have absorbable sutures placed, covered by surgical glue or surgical adhesive tape. Leave this in place for 3-4 weeks after surgery. You will need to physically remove it within 4 weeks, if it is still on, and it will come off easily once you start to remove it. Patients can develop allergic reactions to the tape or glue after surgery, and if this starts to happen, immediately remove the tape (even if it’s been less than 3 weeks) and begin to apply hydrocortisone ointment (OTC). If you still have a rash, add an anti-fungal. Most rashes are made worse by moisture and non-breathable coverings. Steri-strips around the nipple-areola of the breast tend to fall off within 1-2 weeks. No scar care is needed while these adhesives are in place.
Dr. Cabbabe recommends silicone – based scar therapy for all scars. This includes silicone adhesive gel or tape (preferred due to added benefit of compression). Silicone gel is used for the first couple weeks then silicone tape can be used once the incisions are completely healed. The non-breathable nature of silicone tape can create rashes in the presence of moisture/incompletely healed incisions.
It is common for internal sutures to break through the skin 2-4 weeks after surgery and these can be trimmed with scissors/nail clippers or tweezed out. They feel like fishing line and as swelling decreases, they will sometimes break through the skin and create a tiny wound.
If your scar becomes red and raised, Dr. Cabbabe may also recommend steroid injections to flatten the scar and decrease the redness. This is not uncommon in most surgeries.
WOUNDS AFTER SURGERY: Certain procedures such as breast lift/reduction surgery, arm lifts, thigh lifts, lower body lifts and mastectomies are more likely to lead to healing issues. Common areas include the bottom of the breast at the “T junction”, the hips and middle of the butt on a lower body lift and the arm pit area on an arm lift. This includes any patient with a higher BMI >30, diabetes, advanced age, nicotine (vaping/smoking) use or steroid use. We recommend using Medi-honey or Aquaphor on the wound until it is healed. Keeping a dry gauze over the wound will minimize skin irritation from moisture. Avoid adhesives to prevent skin tears. If there is a scab, Dr. Cabbabe recommends applying BETADINE-IODINE two times a day. Once the scab comes off, use the other products.
BREAST IMPLANTS AND WOUNDS: IF you had breast implant surgery and develop ANY wound, notify us immediately. Our protocol is to start antibiotics if a wound is present to minimize the risk of implant infection. Using hypochlorous acid solution on the wound is also recommended to decrease bacterial load. This can be found online, known as Phase 1 solution but also sold in a similar form on Amazon, Vashe wound solution: https://www.amazon.com/Vashe-Hypochlorous-Acid-Preserved-Non-Cytotoxic-Skin-Neutral/dp/B019660RPG/ref=sr_1_2?keywords=vashe&qid=1707421498&sr=8-2
IMPLANT MASSAGE: After breast augmentation, you will begin to massage your breast implants. We will review how to do this with you on your first post-operative visit. The idea is to keep the implant pocket “loose” to allow the implants to settle and be soft. This is done several times a day at first and then decreases over the next 1-3 months based on how loose the pocket is. The implants are generally massaged up and in, not down or out. If mesh was placed we do not want to stress the mesh repair (bottom and outer chest), unless Dr. Cabbabe specifically instructs you to do so. If you are a breast cancer patient, you may not need to massage your implants if your skin is very stretchy, please discuss this with Dr. Cabbabe.
LYMPHATIC DRAINAGE THERAPY(LDT): Dr. Cabbabe recommends this with any liposuction procedure, starting approximately 1 week after surgery. LDT will help you get a better result, faster, and can help prevent unevenness than can become visible as a result of scarring, or fibrosis. In conjunction with compression garments, benefits include:
- Reduction of bruising
- Reduction of pain
- Reduction of inflammation
- Fewer lumps and bumps
- Helps minimize scar formation
- Prevention of subcutaneous fibrosis after liposuction
- Helps the body heal more quickly from surgical trauma
Dr. Cabbabe recommends beginning massages within 1 week of surgery. The more lipo that was done, the greater the benefit. These are often recommended up to 2-3 times/week for the first month, then 1-2 times/week for one month, tapering off as you notice reduced benefit (length and frequency depend on amount of lipo done and amount of swelling).
Please refer to the following page for a list of LDT’s in the Greater St. Louis area (we have no affiliation with any of the parties listed and recommend you also research them prior): https://www.stl-psc.com/files/2023/12/lymphatic-massage-therapy.pdf
WHEN TO CALL: Call for ANY concerns. Low grade fever can be normal for the first 24-48 hours after surgery and is often the result of not taking deep breaths, make sure you are walking and using an incentive spirometer to encourage deep breathing. Infections are relatively uncommon in the first week after most elective surgeries. After 24-48 hours, make sure to call for fever >100.4 degrees F, spreading redness or increased pain at the surgical site. One leg significantly more swollen than the other could indicate a blood clot and you should call immediately.
Please visit an E.R. if there are any life-threatening concerns, otherwise please contact the office at (314) 842−5885.