Post Op Care Instructions St. Louis

How to use foam with your compression garment/FAJA

How to perform implant massage

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, they can be rented (Rent a Center, for example). A bed that flexes will also work. 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.

WALKER: This 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: Most 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. 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. Do not rub incisions with washcloths, use only your fingertips. It is OK to wash your incisions with gentle soap if you had a facelift. Replace ALL garments immediately after showering. Gauze is only needed if more comfortable or if there is some drainage present.

A shower chair may be helpful for some patients, particularly if you get light – headed taking showers the first several days after major body contouring (this is not uncommon).

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 and a band aid 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 if you are concerned about this, make sure you are using antibiotic ointment. Often times this will not improve until the drain is removed.

BRAS/GARMENTS/FOAM/BOARDS/BBL PILLOWS: Bras and garments are placed immediately at the time of surgery and are worn for 6 weeks – 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 skin stretching from swelling after surgery to maximize your results. The garments may be washed, and it is helpful to have extras on hand (link below). 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.

A sports bra will substitute for a surgical bra, which opens in the front. A bandau may be 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”. See below for implant massage.

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 for breast surgery patients on the outer chest. Additionally, if you are having abdominal work done, a foam board is recommended to be used starting about 1 week after surgery to help flatten the abdomen.
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.

If you are having fat transfer to the buttocks or hip dips, it is recommended that you purchase (BBL) pillows 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.

Visit the following page for frequently recommended products:

Dr. Samer Cabbabe Garment Protocol:

  • White binder up to 3 weeks post-op (muscle support)
  • Stage 1 faja x 1 month then switch to stage 2 (one that goes up the back and over the shoulders for even compression)
  • 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 and back for 3 months.

IBUPROFEN: If you have not had weight loss surgery, ibuprofen/Aleve is recommended for pain relief, in addition to any pain medicine prescribed. 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.

ASPIRIN: Do not take Aspirin or any blood thinners until told to do so directly by Dr. Cabbabe.

TYLENOL: Tylenol may be taken in lieu of the pain medicine because most pain medications contain Tylenol already. Ibuprofen is much more effective at pain relief and fever reduction than Tylenol.

IRON: After major body contouring surgery, continue taking iron for about 2 weeks to recoup lost red blood cells. This should have been started in advance of surgery.

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. If you do not have a bowel movement within 48 hours of surgery, a laxative is recommended. 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 with glue. Leave this in place for 3-4 weeks after surgery. You will need to phsycially 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 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). Call us and we may prescribe an oral steroid as well if it is significant. 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.

Patients such as mole removal or face lift patients will have black stitches that are removed within 7-10 days of surgery. Polysporin ointment should be applied three times a day to the incision before and for a couple days after suture removal to keep it moist. Eyelid lift patients should receive special ophthalmic antibiotic ointment to apply to their incisions to prevent eye irritation from regular antibiotic ointment.

Dr. Cabbabe recommends silicone – based scar therapy for all scars. This includes silicone adhesive gel or tape (preferred due to added benefit of compression). Our office has silicone gel for sale. Silicone tape is the best for larger scars.

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 common in most surgeries.

WOUNDS AFTER SURGERY: Certain procedures such as breast reduction surgery, thigh lifts and mastectomies are more likely to lead to healing issues. This includes any patient with a higher BMI >30, advanced age, nicotine use or steroid use. If there is a scab, Dr. Cabbabe recommends applying BETADINE-IODINE two times a day. Once the scab comes off, Aquaphor or Wet to Dry dressings may be initiated.

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. 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. 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. These are often recommended 2-3 times/week for the first month then 1-2 times/week for one month, tapering off as you noticed 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 St. Louis area (we have no affiliation with any of the parties listed and recommend you also research them prior): Lymphatic Massage Therapy

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.

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