Dissolving Versus Non-dissolving Stitches in Blepharoplasty Procedures
It has been a growing concern to my patients about what kind of stitches I will be using in their surgery, especially belpharoplasties or eyelid surgeries.
The dissolving sutures (Generically called Polyglactin 910) dissolve usually within 2-3 weeks.
The non-dissolving ones (Polypropylen or Nylon) will not dissolve and will need to be removed after surgery.
There is not a certain number of days that all wounds will primarily heal after and become safe to remove stitches. It depends on wound site, skin thickness and nature, and other individual differences like age, personal habits like nutrition, smoking, sun exposure, etc.
So far there is no evidence that supports using non-dissolving stitches versus dissolving regarding skin scarring. There are three different publications that found no difference in scarring
In summary I can state the following regarding stitch material used in blepharoplasty surgeries
Non-dissolving stitches:
Pros:
- After a week you have no stitches on your eyelids
Cons:
- It may be relatively too early for the stitches to be removed even after a week if you are a slow healer. Segments of the wound may re-open and can’t be re-stitched. They will have to heal by secondary intention and will leave a more noticeable scar.
- Threads used on eyelids are really fine and very easy to snap during removal. That may leave you with non-dissolving stitch material under your skin permanently. Skin deals with non-dissolving stitch material as a foreign body and will react to it leaving a noticeable scar.
- Threads used on eyelids are really fine and a stitch may be missed during the removal procedure. Skin deals with non-dissolving stitch material as a foreign body and will react to it leaving a noticeable scar.
- Using non-dissolving stitches is inconvenient as you will have to book another appointment at the clinic. Inconvenience will be there if you don’t stay close to the clinic or you go to a different facility like your GP to remove them. They are healthcare professionals. However, they are not aware where stitches are positioned.
Dissolving stitches
Pros:
- They dissolve in 2-3 weeks after wounds are healed even in slow healers
- Convenient as you don’t need to come back to remove them
- There is no difference in scarring with using them. Scarring is the final event of wound healing regardless of the stitch material used.
Cons
- You will have visible thread knots on your skin for 2-3 weeks, especially if you need to go back to work and keep your surgery confidential.
Is there a sweet spot?
Definitely yes, use dissolving sutures and trim the thread knots a week later. That ticks all the boxes for the patients.
Swelling and Bruising
Here’s a more detailed breakdown of advice for managing post-surgical swelling and bruising:
1. Cold Compresses:
- Application: Apply a cold compress (ice pack wrapped in a cloth) to the surgical area for the first 24-48 hours to reduce swelling and bruising.
- Duration: Alternate between 10-15 minutes of compression and 10-15 minutes without.
- Type: Use gel packs or moistened washcloths placed in the freezer.
2. Elevation:
- Purpose: Elevate the affected area above heart level to help reduce fluid buildup and swelling.
- How: Use pillows to prop up the area, especially when sleeping. You don’t need to sleep sitting up.
- Do I have to sleep sitting up?
- It would be very hard and uncomfortable to sleep setting up. I usually advise sleeping with the head elevated around 30°. I recommend SoftBuy Orthopaedic 12 in 1 Bed Wedge Pillow with Head Rest to help you sleep in the right position during the early recovery period Without experiencing any discomfort or lack of sleep. You can find it here https://amzn.to/4hMSzHo
3. Rest:
- Importance: Rest is crucial for healing and can help prevent further swelling and bruising.
- Activity: Avoid strenuous activities and prolonged periods of sitting or standing.
- Sleep: Ensure you get adequate sleep to support your body’s healing process.
4. Hydration:
- Importance: Staying hydrated helps your body flush out excess fluids and promotes overall healing.
- Recommendation: Drink plenty of water throughout the day.
5. Other Tips:
- Compression Garments: Consider using compression garments or bandages as directed by your surgeon to help reduce swelling. You will be given one pressure garment on the day of the surgery. I strongly advise using foam sheets under the garments to enhance compression quality and prevent skin increasing and folding after surgery. I personally recommend Medcore 4 Pack Lipo Foam Board from here https://amzn.to/4kZls5Q
- Diet: Eat a healthy diet to support your body’s healing process.
- Avoid Smoking: If you smoke, try to quit or at least avoid smoking for several weeks before and after surgery, as smoking can interfere with healing.
- Follow Doctor’s Instructions: Always follow your surgeon’s specific post-operative care instructions, as they will be tailored to your individual surgery.
- Seek Medical Advice: Contact your doctor if you experience any unusual or concerning symptoms, such as a sudden increase in swelling, signs of infection, or a change in skin color around the incision.
- Medications: Several medications are proved to control swelling and bruising like Arnica, Bromelaine and Vitamin K.
- Can I take Arnica tablets before surgery to minimize swelling and bruising?
- Please, don’t use Arnica orally before surgery. It may encourage bleeding during and after surgery. Arnica has Ibuprofen like effect. Wait till day 2 or 3 after your procedure to start oral Arnica.
Do I recommend certain products?
Arnica Products:
Arnica montana has been used as a herbal medicine, for its anti-inflammatory and analgesic effects for treating pain, swelling and bruising
I recommend Weleda products for Arnia extracts. They are available in different forms:
Pills (two concentrations): https://amzn.to/4kAIgsz and https://amzn.to/4bCHmYx
Cooling Gel: https://amzn.to/4kBupSR
Massage Palm (two sizes): https://amzn.to/4iWyyiL and https://amzn.to/4hieN3O
Bromelain products
Bromelain, a concentrate of enzymes from the pineapple plant, is used in medicine for its anti inflammatory effects.
Highest concentration of oral Bromelain in The UK market goes to Toniiq. it is 3600 GDU/Gram. The link is https://amzn.to/4ineVk0
Vitamin K Products
Vitamin K is actually a group of compounds, with the most important ones being vitamin K1 and vitamin K2. Vitamin K1 and vitamin K2 are both fat-soluble vitamins that are essential for blood clotting and bone health. They are also involved in other physiological processes, such as brain development and cardiovascular health.
For oral products, I recommend Vitamin K Complex (K1 & K2) by Vitamaze for the combination and the highest concentration in the market (K1 1.000 mcg MK4 + K2 200 mcg MK7 Menaquinone). You can find it here https://amzn.to/4hNoTtT
For topical products, I recommend Pharmaceris N Capinon K 1%, Cream, for being accurate about Vitamin K concentration in their product (1%). You can find it here https://amzn.to/4iLekZ0
Therapeutic Concealers
I worked on the first therapeutic concealer formula in the world, I named it Irn Bruise to express my pride of Scotland, where I live. Irn Bru is considered the national Beverage of Scotland. I developed Irn Bruise to be the best topical swelling and bruising treatment. it conceals bruising while treats it, and swellig, at the same time.
What is Irn Bruise?
Irn Bruise is the first therapeutic concealer in the market.
Irn Bruise cures and conceals bruising and swelling after surgical and non-surgical procedures.
Why Irn Bruise?
First therapeutic concealer formula in the market that effectively cures and conceals bruising and swelling all at the same time.
Faster recovery from bruising and swelling after surgical and non-surgical procedures, or any skin contusions by the combined action of three different active ingredients.
Available in different shades to match all skin complexions
Irn Bruise hides and heals swelling and bruising
Irn Bruise moisturizes and nourishes your skin too.
Active ingredients: Arnica, Bromelain, Hirudin, Vitamin C, Vitamin E.
Safe to use from day 1 after surgery
Apply three times daily on the treated area till swelling and bruises go away
Irn Bruise will take care of you in the early recovery days.
Irn Bruise comes in four different shades to match your skin complexion.
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Cold / Warm Compresses
After surgery, applying cold compresses intermittently (on and off) helps reduce pain and swelling by constricting blood vessels, minimizing inflammation, and potentially reducing bleeding. Gel pads are safer than ice packs. Ice packs may cause frost bites or nerve damage.
Here’s a more detailed explanation:
- Benefits of Cold Compresses:
- Reduces Swelling and Inflammation: cooling constricts blood vessels, limiting blood flow to the area and reducing fluid buildup (edema), which causes swelling.
- Reduces Pain: By numbing the area, cooling can lessen the perception of pain and discomfort.
- May Reduce Bleeding: Constricting blood vessels can also help to minimize bleeding in the early stages after surgery.
- How to Use cold compresses Safely:
- Always Use a Barrier: Never apply ice directly to the skin. Always place a cloth or towel between the ice pack and your skin to prevent frostbite or skin damage. It’s always safer to use cooled gel pads
- Apply Intermittently: Apply cold compress for 15-20 minutes, followed by a period of the same length without, and repeat this cycle as directed by your surgeon or healthcare provider.
- Follow doctor’s instructions: Some doctors recommend 4-5 cycles daily in the first 48-72 hours.
- Be Mindful of Nerve Blocks and local anesthesia : If you had a nerve block or local anesthesia, use extra caution when icing because you may not be able to sense how cold your skin is. It’s always safer to use gel pads.
- When should I switch to warm compresses?
- While cooling is primarily used for the first few days after surgery, after the initial inflammation subsides, heat therapy may be recommended to promote blood flow and healing.
Important Notes:
- Consult Your Surgeon: Always follow your surgeon’s specific instructions regarding icing after surgery, as procedures and recovery processes can vary.
- Listen to Your Body: If you experience any discomfort or numbness, remove the ice pack immediately.
- Hydration is Key: Ensure you stay well-hydrated as swelling and inflammation are fluid related.
Do I recommend a certain product?
Cold Compresses
Eyes: I would use Grace &Stella Eye Mask. You can find it here https://lvnta.com/lv_tnq5xWQXVQWixtFaDu
Face and Eyes: I recommend after research Medi Grade Cooling Face Mask set with Cooling Eye. One set contains all different pieces for cooling the whole face after any facial surgery. You can find it here https://amzn.to/41RF2bL
For Scalp, Ears and Neck
Hilph Face cold wrap is my recommendation from here https://amzn.to/4bUo7Ke
Warm Compresses:
I would recommend products that don’t contain gel beads as they are unsafe to microwave.
For Face
NEWGO Face Heating Mask from here https://amzn.to/4hrvUjG
For Eyes
If you prefer to microwave, Myhalos Heated Eye Mask for Eyes from here https://amzn.to/4hszwlD
If you prefer electric powered pads, Comfytemp eyes Heat Pad would be my favorite from https://amzn.to/4kNFCQk
For Scalp, Ears and Neck
Comfytemp face Heat Wrap would be my favorite from https://amzn.to/4bSkNPE
Red Light Therapy. Is it really effective?
Red light therapy can help with healing by stimulating the mitochondria in cells, which are the cells’ energy source. This can improve cell function, which can lead to pain relief, reduced inflammation, and improved blood circulation.
How it works
- Red light therapy is a low-level laser therapy that uses red and near-infrared light.
- The light is absorbed by mitochondria in skin cells, which then make more energy.
- This energy helps cells repair themselves.
- Red light therapy can also increase collagen production, which gives skin its structure, strength, and elasticity.
Benefits
- Red light therapy can help with:
- Healing skin, muscle tissue, and other parts of the body
- Reducing inflammation
- Improving blood circulation
- Repairing muscle and tissue
- Offering pain relief
- Relieving aches, pains, and stiffness in joints
- Reducing wrinkles, acne scars, and hypertrophic scars
- Healing of burns
Results
Most people see visible results after around three weeks of 15-20 minute use three to five times a week as early as possible after surgery.
Do I recommend a certain product?
For face surgeries such as facelift, necklift, brow lift, buccal fat pads removal, cheek dimpleplasty and fat transfer surgeries, I would recommend Stylpro and Myhalos products
For the area around the eyes, https://amzn.to/4isTJJl
For the lower eyelids,
For the face
Does Lymphatic Massage Really Work after Liposuction and Gynecomastia Correction Surgeries?
If you had liposuction or a gynecomastia Correction surgery, lymphatic drainage massage can help improve circulation, reduce swelling, and promote healing by gently manipulating the skin and underlying tissues to encourage the flow of lymphatic fluid.
Here’s a more detailed explanation:
- What is Lymphatic Drainage Massage?
- It’s a gentle massage technique that encourages the flow of lymphatic fluid, which helps remove waste and toxins from the body’s tissues.
- The lymphatic system plays a crucial role in the body’s immune function and fluid balance.
- Why is it important after Liposuction?
- Reduces Swelling: Liposuction can cause fluid buildup in the treated area, leading to swelling and discomfort. Lymphatic drainage massage helps to move this excess fluid out of the area, reducing swelling and promoting faster healing.
- Improves Circulation: Gentle massage can improve circulation in the treated area, which can help reduce the risk of lumps and bumps and promote more even healing.
- Reduces Discomfort: Lymphatic drainage massage can help reduce pain and discomfort in the treated area, making the recovery process more comfortable.
- Enhances Healing: By promoting circulation and removing waste products, lymphatic drainage massage can help speed up the healing process and improve the overall results of liposuction.
- How is it performed?
- Lymphatic drainage massage uses soft, rhythmic movements to gently move the lymphatic fluid towards the lymph nodes, where it can be processed and filtered using different tools.
- It’s a very gentle and therapeutic massage that focuses on the skin and underlying tissues.
- When should you start lymphatic drainage massage after liposuction?
- It’s generally recommended to start lymphatic drainage massage within 3-5 days of the surgical procedure, but it’s crucial to consult with your surgeon first.
- I recommend starting with gentle self-massage techniques, while in certain cases, I may recommend professional massage therapy.
- What to expect during a lymphatic drainage massage?
- The massage will be gentle and focused on the treated area.
- You may experience some mild soreness or tenderness, but it should not be painful.
- You may notice a reduction in swelling and an improvement in circulation after a few sessions.
- Other tips for reducing swelling after liposuction:
- Wear compression garments: Compression garments can help reduce swelling and promote skin retraction. You will be given one pressure garment on the day of the surgery. I strongly advise using foam sheets under the garments to enhance compression quality and prevent skin increasing and folding after surgery. I personally recommend Medcore 4 Pack Lipo Foam Board from here https://amzn.to/4kZls5Q
- Stay hydrated: Drinking plenty of water can help flush out excess fluid and promote healing.
- Follow your surgeon’s instructions: It’s important to follow your surgeon’s instructions regarding post-operative care, including massage techniques and timing.
- Do I recommend a certain product?
- I would personally use Grace and Stella Dry Brushing Body Brush for Lymphatic Drainage. You can use it on your own without having to pay for pricey lymphatic massage sessions. Find it in this link https://lvnta.com/lv_FxlbBLt0zrj08cLFzz
- If you wish to be more sophisticated, and do a classic lymphatic massage, this 9 piece toolkit is the right choice https://amzn.to/4kTjkNd
Multivitamins and Optimum Wound Healing
Multivitamins can support wound healing by providing essential nutrients like vitamins A, C, and zinc, which are crucial for tissue repair, immune function, and collagen synthesis. However, it’s important to ensure adequate intake through a balanced diet or supplementation under the guidance of a healthcare professional.
Here’s a more detailed look at how multivitamins and specific nutrients can contribute to wound healing:
Key Nutrients and Their Roles:
- Vitamin C: Essential for collagen synthesis, which is vital for wound closure and tissue repair. It also acts as an antioxidant, supporting the immune system.
- Vitamin A: Plays a role in the inflammatory and proliferative phases of wound healing, helping to control inflammation and promote tissue regeneration.
- Zinc: Important for cell growth and division, which are necessary for tissue repair and wound closure.
- Iron: Crucial for carrying oxygen in the blood, which is essential for healing.
- Protein: Essential for cell health and development, playing a key role in all stages of wound healing.
- Arginine: An amino acid that has been shown to enhance healing in certain people.
How Multivitamins Can Help:
- Addressing Deficiencies:If your diet is lacking in certain vitamins and minerals, multivitamins can help fill those gaps, supporting optimal wound healing.
- Supporting Immune Function:A strong immune system is crucial for fighting off infections, which can hinder wound healing.
- Promoting Tissue Repair:The nutrients in multivitamins can help the body produce the necessary building blocks for tissue repair, such as collagen.
Important Considerations:
- Focus on a Balanced Diet: Prioritize a balanced diet rich in fruits, vegetables, lean protein, and whole grains to ensure you’re getting the nutrients you need for optimal health and wound healing.
- Don’t Overdo It: Excessive intake of certain vitamins and minerals can be harmful, so it’s important to follow recommended dosages.
- Individual Needs: Wound healing can vary depending on individual factors, such as age, overall health, and the type of wound.
- Other Factors: In addition to nutrition, other factors, such as proper wound care, hygiene, and addressing any underlying medical conditions, are also important for successful wound healing
Do I Recommend A Certain Brand?
I would say the best so far is Inessa Multivitamin with CoQ10 100mg, Vitamin D3 2000 IU, K2 100mcg, B Complex, Vitamins A 800mcg, Folic Acid as 5-MTHF 400mcg, Zinc 20mg and Lutein. You can find it here https://amzn.to/4isJULs
Scars
A scar is a mark on the skin after a wound or injury has healed. You cannot get rid of a scar, but most will fade over time. This can take up to 2 years or more, but there are some things you can do to help it heal or improve how it looks.
- Massage: Gently massage the scar to help flatten it.
- Protect from sun: Wear protective clothing or use sunscreen to prevent discoloration and hyperpigmentation.
- Avoid picking: Don’t pick at the scab, as this can delay healing and increase the risk of infection.
- Keep clean: Change bandages daily and keep the area clean and dry.
- Wear loose clothing: Avoid clothing that rubs against the scar.
- Use Silicone products: Silicone, moisturizers and others are proved to improve scars.
Do I recommend a certain product?
I developed SCARBUCKS® myself to be the best topical scar gel. A Unique and specialized formula designed by a cosmetic surgeon for scar management with extreme care for the highest efficacy and an efficient application.
- Unlike other scar gels, it has two different active ingredients (Silicone and Allium cepa)
- A formula designed especially to treat scars around the eye
- Treats scars on any body part (Silver)
- Special edition for surgeries around the eye (Gold)
- Clinically tested on actual patients
- Evidence based formula
- Designed by cosmetic surgeons
- For old and new scars
- Flattens, softens and smoothens all scars
- Prevents excessive scarring
- Relieves scar itching, redness & discomfort
- Smart package for amount control and no-touch massage
- Odour free
- Colour free
- Stain free
- Self-drying
- Water proof
- Make up friendly
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Why do I have numbness after my procedure? When will that improve?
Most of the time, numbness after a procedure is often due to temporary nerve ending disruption or damage during surgery, and in most cases, sensation returns within weeks or months as nerve endings heal.
Here’s a more detailed explanation:
Causes of Numbness After Surgery:
- Anesthesia:Local or regional anesthesia can cause temporary numbness, which typically wears off as the anesthetic wears off.
- Surgical Incision:Making an incision can disrupt or damage tiny nerve endings in the skin, leading to temporary numbness or altered sensation.
Massages usually help. However, you will need to make sure you have high levels of Vitamin B complex in your system.
B vitamins, particularly B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin), are crucial for nerve health and can play a role in nerve repair and regeneration.
Here’s a more detailed explanation:
How B Vitamins Support Nerve Health:
- B1 (Thiamine): Helps convert carbohydrates into energy, which nerve cells need to function properly, and acts as an antioxidant, protecting nerve cells from damage.
- B6 (Pyridoxine): Plays a role in nerve signal transmission by helping the body produce neurotransmitters, the chemical messengers that relay messages from the brain to the body.
- B12 (Cobalamin): Essential for maintaining the myelin sheath, the protective covering around nerve fibers, and promotes nerve cell survival and regeneration.
- B Vitamins and Nerve Regeneration: Studies suggest that B vitamins, especially B12, can promote nerve regeneration and improve functional recovery after nerve damage.
- Vitamin B12 and Myelin: Vitamin B12 may aid in remyelination, or the regeneration of myelin sheaths, which are protective layers around nerve cells.
- Vitamin B Complex and Nerve Repair: Some studies indicate that a vitamin B complex, containing B1, B6, and B12, can enhance nerve healing and reduce pathological changes following nerve damage.
Do I Recommend A Certain Brand?
I prefer SUPERSELF Vitamin B Complex High Strength – Slow Release Super B Complex – Enriched with Vitamins D & C – Complete Vit B Supplement All 8 Vitamin B12, B6, Folic Acid, Biotin, B1, B2, B3, B5. Find it here https://lvnta.com/lv_sYOAWXfb8B6ID9Q3Vp
Why Doesn’t My (Botox) Last Anymore?
Several factors can contribute to Botox not lasting as long, including individual metabolism, muscle activity, the quality of the product, and the technique used for injection, Zinc levels in your system, as well as the possibility of developing resistance to the treatment.
Do I recommend any supplements to optimize Zinc levels?
I developed BTXL® myself to be the best Zinc supplement to optimize (Botox) effect.
BTXL® is a unique supplement (Zinc Phytase). Botulinum toxin (Bøtøx) is a potent protein that causes muscle relaxation and improves dynamic skin wrinkles. Zinc in BTXL® enhances Bøtøx effects, while Phytase enzyme boosts zinc absorption. Several studies found that BTXL® ingredients increased Bøtøx effect strength and longevity up to 130%. We’ve carefully balanced BTXL® concentrations for optimal results. Regular Zinc supplements will never do the same job.
Recommendations
Take two capsules daily for four days prior to Bøtøx injection day and on the same day of injection. Each package contains only ten tablets.
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Hair Thinning
After face and neck lifts, brow lifts and forehead reduction procedures, hair follicles, as sensitive structures, may start shedding. Fortunately, hair thinnning in such cases is temporary and not that common. Topical hair restoration products are useful in such cases. Topical hair treatments such as Minoxidil, Finasteride, Azelaic acid and other products are very useful in such cases.
Do I recommend a certain product?
After meticulous research, I find MinoxidilMax company products outstanding for their unique ingredient combintions in higher concentrations than any other product in the national market. Click http://www.minoxidilmax.com/?hair=922 for an exclusive discounted price for my patients. They have a wide range of topical products and even a 272 Laser Diode Hair Regrowth Cap.
Mr. Ahmed Alsayed (M.Ch., MRCS, FEBOPRAS) 