Top 9 Reasons to Call Your Plastic Surgeon After Surgery

By: Dr. J. Timothy Katzen


Ariel: Okay. Hello, welcome to another episode of Doc Talk: Beverly Hills. My name is Ariel, and we're here with a plastic surgeon, Dr. Katzen. Hello, Dr. Katzen.

Dr. Katzen: Hi, Ariel.

Ariel: How are you doing?

Dr. Katzen: Good, and yourself?

Ariel: Good. Keeping busy.

Dr. Katzen: Yes

Ariel: What did you do today?

Dr. Katzen: Today, we did a breast implant capsulectomy. Unfortunately, scar tissue had been set up around the breast implant, so we had to take out the scar tissue and then return the implant. This is called remove and replacement. Then we also did liposuction on the patient's abdomen.

Ariel: Today, we will discuss post-op, what to do, and what to expect. When should you call the doctor and go to the hospital? So, let's start covering some of those.

Dr. Katzen: Yes. You must discuss the expected postoperative course with your plastic surgeon. Every plastic surgeon is different in their approach and treatment of specific criteria. So, you must talk with your plastic surgeon and ask them what is expected after the surgery. Our office has about a 10-page form, what to expect after a particular procedure. We want you to read that before the surgery, so you are prepared for the surgery. So, you need to be aware of things that could go potentially wrong. Usually, nothing goes wrong after your surgery.However, if things arise your plastic surgeon should be made aware so we, we get those treated either within the office, or you may have to go to the hospital.

Ariel: All right, so let's go down that list of things. I know you give your patients this list as well, so they have a copy of it, but for those that might not know where those who go with a different plastic surgeon, maybe they're coming to your video or your podcast for advice.

Dr. Katzen: Yes, I've got the Top 9 Reasons to call your plastic surgeon.The top 9 things that could happen after the surgery that you need to give your plastic surgeon a call about if they happen. So, the number one thing is bleeding around the wound. You should call your plastic surgeon if you're bleeding and oozing around a wound. Sometimes we put drains in.The drains sucking out fluid and sometimes blood.

Sometimes, if those drains fill up quickly, you should call your plastic surgeon, "Hey, my drains are filling up quickly; do I need to be concerned?" your plastic surgeon will guide you on what to do about the bleeding from the wound and the excess drainage into the drain. So, excess bleeding is the number one reason to call your plastic surgeon.

Ariel: How do you know if it's filling up quickly? What is quick?

Dr. Katzen: Basically, If you're concerned. You should call your plastic surgeon. The appropriate amount of post-op bleeding it depends on the nature of the surgery. If it's a tummy tuck, appropriate drainage will be a certain amount. If I did liposuction without a tummy tuck, it would be more because a lot of fluid comes from the liposuction in addition to the tummy tuck. If it's a facelift, there shouldn't be too much blood. So it depends on the procedure and whether liposuction has been associated with the procedure.

Ariel: So, case-by-case?

Dr. Katzen: Yes, Case-by-case.

Ariel: Your plastic surgeon will talk to you about what to expect.

Dr. Katzen: Exactly, and every plastic surgeon has a different set of numbers.That increase awareness or concern. regarding bleeding. So, if you're concerned about anything, always give your plastic surgeon a call. If you're bleeding from the incision the drain is filling up significantly, give your plastic surgeon a call.

Ariel: Okay, what's number two reason to call your plastic surgeon after surgery?

Dr. Katzen: Number two for me is a temperature or a fever. Now, almost always after surgical procedures, patients will have an elevated temperature. Our body temperature goes up and down throughout the entire day. Just because it goes up doesn't mean you have a post operative surgical fever does not mean you have an infection. It's just that your temperature went above normal. Typically, with my procedures, you're under general anesthesia. You're entirely asleep. There's a breathing tube placed in your lungs. Part of the little tips of your lungs, (the little grapes at the end).The alveoli at the end absorb oxygen. After surgery, these alveoli When they collapse, you get a slight fever.

Almost always, you'll get this condition called atelectasis after the first 24-48 hours after general anesthesia. The collapse of those little lungalveoli gives you that elevated temperature. It's very rarely an infection. Very rarely plastic surgery infections start within 48 hours after surgery. So, the first 48 hours of elevated temperature is usually caused by collapsed alveoli and is called atelectasis. However, if you have a temperature over 101.5, you should give us a call because that's too concerning. That's too high for atelectasis. You could still have atelectasis, but you should notify your plastic surgeon if your temperature is that high.

Ariel: So, 101.5.

Dr. Katzen: 101.5 is my number. Other plastic surgeons may have a different number, but if your temperature is 101.5, it may not be a surgical infection. If it's over 102.0, definitely give your plastic a call.

Ariel: Okay, great. Number three reason to call your plastic surgeon after surgery?

Dr. Katzen: Number three reason to your is, if you have any signs of infection. The infection could present as redness around the incision, extreme tenderness, or extreme swelling. Pus is the fluid your body expresses after infection. Typically pus looks like a dairy creamer. You can't see through pus. Pus is cloudy and pale white. Sometimes pus will have a foul odor, but not necessarily. So, call your plastic surgeon if you see any signs of infection or pus.

Ariel: Okay, number four reason to call your plastic surgeon after plastic surgery.

Dr. Katzen: Number four is if you have a lot of pain. If you have been doing okay, and suddenly, all of a sudden, "Ouch, this hurts," give your plastic surgeon a call. Also call if your pain is not being controlled well with the pain medication prescribed. Perhaps you're taking pain medication, and it still hurts. In some patients, the pain medication may not work or is absorbed well, or maybe you don't tolerate the pain medication. Your plastic surgeon have to give you a different medication—a different class of narcotics or painkillers. Sometimes we have to switch from pills to liquid. Maybe your stomach's going to absorb pain medication better as a liquid. Sometimes we have to change from pills to a liquid, and then if those don't even work, we may have to go with a patch for pain control.

So sometimes, if you have intense pain or the pain medication isn't working. It’s essential to call. Also, if you notice a significant amount of swelling or redness around the surgical sites, definitely give your plastic surgeon a call.

Ariel: Okay. So, what's number five reason to call your plastic surgeon after plastic surgery?

Dr. Katzen: Number five is, if you see any pus or any bad smell in the wound or on the bandages, you should give your plastic surgeon a call. Call, take pictures of the bandages, take pictures of the wounds, or even do a little video of the dripping pus. Email and send the images/video to your plastic surgeon. Get connected with your plastic surgeon if you see pus in the wound.

Ariel: Okay, great and number six reason to call your plastic surgeon after plastic surgery?

Dr. Katzen: Six; if you notice any red streaks around the wound. They look like lightning strikes. They'll be little red lines emanating from the infection. Those are usually signs of early infection. Those red streaks around the wound are a reason you should call your plastic surgeon.

Ariel: Okay, great, and seven reason to call your plastic surgeon after surgery?

Dr. Katzen: Call if you have any numbness around the wound. In surgery, I give local and general anesthetics. Anesthetics numb things and put the nerves to sleep. Sometimes, numbness can be a residual from my anesthetic injections. Sometimes, there can be untoward effects like swelling and compression of nerves. Sometimes, it can be just the compression of nerves. So if you have numbness in a specific area, maybe your leg is numb, maybe your hand is numb, or maybe part of your face is numb, you should call your plastic surgeon.

Ariel: Okay, and what is the solution to that?

Dr. Katzen: It depends on the situation. Sometimes, the treatment for compression can be as simple loosening the garment. We take off the garment. Sometimes, it's more invasive; maybe there is swelling. We may have to give a pill to get rid of the swelling. Sometimes, a pocket of fluid may collect. I may need to release the fluid by drawing it with a needle. putting a drain in the pocket of fluid, or even going back to the operating room and, releasing that area of pressure. It depends on a case-to-case basis.

Ariel: So, you said that you numb up the patients with lidocaine or whatever local anesthetic it is during the surgery. How long after the surgery should they call for that numbness? Like, when should the lidocaine wear off?

Dr. Katzen: It depends on the patient, but usually after about 48 hours, most of that numbness from the lidocaine should be gone.

Ariel: So, within the first 48 hours, if you're numb, that could be normal?

Dr. Katzen: That could be normal. It depends on the surgical procedure that's being done. If it's liposuction, you may have some migrating areas of numbness throughout your body. It just depends on where that lidocaine has been injected. However, say I am performing a face and neck lift, and your hand is numb. Well, that causes lots of concerns because I didn't operate on that and then maybe from positioning or something else. Perhaps, I performed an arm lift or breast procedure, and your leg is numb and swollen. That's a different concern. So, if you get numbness, that's a red flag that you should call your plastic surgeon.

Ariel: If you're unsure, call to be safe.

Dr. Katzen: Yes, in general, if you're worried about anything, call your plastic surgeon. We're here to answer calls and treat any issues, so give us a call.

Ariel: Okay, number eight reason to call your plastic surgeon.

Dr. Katzen: Sometimes, when I put drains in, the drains will stop working. The drains will become plugged, or maybe the draill suck air. You should call your plastic surgeon if the drain doesn't hold its suction and is not absorbing fluid anymore. There could be a hole in the drain fluid. Maybe there's a defect in the drain. There is a hole in the the drain tubing, or perhaps one of the sutures popped. Maybe the drain has partially come out. There are a lot of different variables that can happen if the drain stops functioning. For me, I put drains in to drain fluid. If the drains are not draining, they're not working, so we need to get them working. If the drain stops working and or fills with air, or with a lot of fluid or, maybe the drain can't even hold suction, definitely give your plastic surgeon a call.

Ariel: Great, and what is lucky number nine reasons to call your plastic surgeon.

Dr. Katzen: Lucky number nine is the drain stitches come loose or break off, give us a call. When I put drains in, I suture the drains in to keep them in place. But, sometimes, those drain sutures can become loose with activity motion, swelling, garments, or going to the bathroom. So, if those- drain sutures become loose, the next thing that falls out is the drain. We don't want drains falling out, so if some of those drains' sutures become loose, please call your plastic surgeon. Maybe you come to the office that day or the next day, and I will numb it up and just put another stitch in it.

Ariel: Okay, great. So, those are all the things to do or that could happen that would lead the patient to call you.

Dr. Katzen: Yes.

Ariel: Now, do you have anything else to say about that topic?

Dr. Katzen: No. Those are some of my golden nine rules, However, call your plastic surgeon if you're concerned or worried about anything.

Ariel: Are you available to patients 24 hours a day?

Dr. Katzen: Yes, plastic surgeons are available all the time. All plastic surgeons should be available by phone, their answering service, or their plastic surgery team.

Ariel: So, sometimes you get calls at 3:00-4:00 A.M.?

Dr. Katzen: Yes, 3-4 A.M., it's a familiar routine.

Ariel: Sometimes, people are just concerned and have questions, right?

Dr. Katzen: Yes, patients call for all sorts of reasons. Patients call concerned and worried because the garment is not fitting right, or some blood's coming out through the garment. Maybe the blood on their bed sheets, etcetera. Maybe the blood procedure was liposuction so, blood on the sheets is a common expected occurrence. However, blood on the sheets would not be so common if the patient had a tummy tuck. So depending on the surgery bleeding on the sheets and through the garment may be an issue. So it depends on a case-to-case basis. This blog provides a global view of when to call your plastic surgeon.

Ariel: Great, and I was talking to a patient today about how she wanted to know more about the process in between, from getting right after the surgery to recovering fully, where we take yours after photos. Now, there might be a little bit of swelling. What else can patients expect besides the things you mentioned, which are possible complications?

Dr. Katzen: In general, most surgeries will have swelling. That's the only way your body can react. It rushes blood to the area, and fluid leaks through the capillaries leading to swelling. Initially, the only way the body can heal is by swelling. There will be swelling; that's expected. Is swelling a complication? Usually not, that's just the way the body heals. So, there will be swelling.

You will have some degree of pain. Some patients tolerate pain better than others. Some patients do not tolerate pain; it just depends on the type of patient you are, the procedure you had, and the type of pain medication you require. Swelling and the pain levels are expected, depending on the procedure, your physiology, your ability to heal, the procedure that was done, and how quickly you heal. In some procedures, you will be healed in about 3 to 5 days. Some procedures will take about 2 or 3 months to heal. It depends on the procedure. So, it just takes some time.

Then the other very important thing is to take your time with things. Work with your plastic surgeon. Don't compare yourself to other patients. Don't say, "I had a friend, and she had the same procedure. She went back to work 12 hours after the procedure.." Well, you're not that patient, and you heal up differently. So, don't compare yourself to other patients. Yeah.

Ariel: So, if there's swelling, that's just normal. Please don't freak out about it.

Dr. Katzen: Correct. Again, consult with your plastic surgeon. Just make sure that it's not anything to worry about.

Ariel: Is there a certain amount of time that you would suggest that your patients have patience with their results?

Dr. Katzen: It's essential to have realistic expectations of the procedure, what it can do for you, and the expected results. Now, again, as I've mentioned, every patient is a little bit different, so your results are probably not going to be identical to anybody else, and your timeline, your recovery line is probably not going to be identical to everybody else because you're you, and you heal up differently.

Ariel: Yeah. So, be patient with your results. Your results will come.

Dr. Katzen: Yes.

Ariel: Call your plastic surgeon if you don't think you can make your appointment.

Dr. Katzen: Results will take time. However, if you're worried or concerned about your progress and the speed of your progress, give your plastic surgeon a call.

Ariel: Do you have anything else to add for post-op care?

Dr. Katzen: Again, these are just global views on global plastic surgery procedures. You need to meet with your plastic surgeon and decide what kind of surgery is indicated. Then talk with your plastic surgeon about what to expect after plastic surgery. My office has a 10-page form on what to expect after each procedure. We give that to the patient so that they can read it before the surgery. Also, you don't want to read that 'what to expect pamphlet' after the surgery. We do not want to hear, "I didn't know I would have drains. I didn't know I was going to have garments." You need to be prepared. You must thoroughly read that form to know what you're getting into.

So, after the surgery, you're going to go, "Oh yeah, I knew there's going to be some swelling. Oh yeah, I knew there would be some blood on the sheets. Oh yeah, I knew there would be some pain, and I'm going to take some pain medication. Everything's going to be good. I know I'm only three days after the procedure, and I don't have to call Dr. Katzen and say, "Are these my permanent results? Because I know he told me it's going to take 6 to 8 weeks to show the results." So, be prepared; don't freak out. Lots and lots of people have plastic surgery.

Ariel: Okay, great. Awesome. Thanks, Dr. Katzen, and if anybody has questions, they could call you at?

Dr. Katzen: (310)859-7770

Ariel: Or they could DM us on Instagram at @drkatzenmd All right. Thank you. I will see you next week.

Dr. Katzen: Thanks, Ariel.

Check out this video on How to Empty Catheter/What is a Pain Pump?

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.