I had an upper and lower blepharoplasty, a...
Many people go to Bangkok for inexpensive cosmetic surgery, and my initial plan was that I would go to Bangkok and have facial surgery and liposuction of the thighs and abdomen, and I would be saving a lot of money. I planned to have these two areas of the body operated on at two separate times, a few days to a week apart. However, after reading many reviews of plastic surgery cases, I came to understand that recovery from a facelift can take a long time and can involve a lot of discomfort and anxiety. Things can and occasionally do go wrong. My original plan for back-to-back surgeries was way too optimistic. I realized that it would be best if I had surgery on the face only. In retrospect, this was a wise decision. I have read reviews by people who have had several areas of the body operated on in a short period of time, and some of them seemed to fare okay, but I think I would have been very unhappy if I had done that.
I would like to advise anyone reading this to allow plenty of time after facial surgery before going back to work, if you don’t want it to be apparent to your co-workers that you had surgery. You will be able to carry on your activities of daily living after two weeks, but you are likely to still have some bruising if you have blepharoplasty, and you will have swelling for months after a facelift. I would recommend planning for at least three weeks off work afterward, and more would be better. I still had some under-eye bruising when I went back to work at 19 days post-op, and my make-up didn’t disguise it completely.
I think it’s important to understand how your face feels after a facelift; I didn’t really get the message. I had very little discomfort from the incisions; in fact, I didn’t need anything more than anti-inflammatories for pain. My incisions healed very well. The discomfort from a SMAS facelift comes mainly from what is done to the muscles underneath the skin that is flapped up. The feeling is similar to what you get from a bad sprain of a joint such as an ankle. Your cheeks will feel very firm and sore, and this feeling will subside very gradually. It will hurt at first to chew anything. Think back to a time when you have injured a joint or muscle. The recovery time was much greater than what is required for a cut to the skin. So even if your skin has always healed fast after a cut or scrape, don’t expect the healing from a facelift to be like that. It’s a slow process that requires patience and a lot of TLC (tender loving care) of your face.
I prepared obsessively for the trip. I made some hits and some misses concerning what was needed. Some of these items could have been found in Bangkok, but I didn’t have the time or the knowledge of the neighborhood to shop for them while there:
• I understood that I would need to sleep with my head elevated for quite awhile after the surgery. It was impossible to find an inexpensive hotel room with a recliner. Pillows alone don’t work too well, in my experience, for keeping the head up while sleeping. I ordered the Wellness Wedge from Amazon. It’s a lightweight plastic perforated wedge that can be slipped under a mattress. It comes as a set of two wedges, and I bought two sets. The four wedges result in an incline of about 45 degrees under my upper body. They fit into my large suitcase, and small items can be packed in the perforated areas. I’m still using the wedges at home at four weeks post-op to help keep swelling of my face to a minimum. I’m very glad I have them.
• I was very concerned about icing my face a lot in the first few days after surgery. I brought several cold packs of difference sizes and styles. However, I worried needlessly, because two 4” X 10” 3M cold/hot gel packs with fabric covers were included in my surgical package. This was the best shape to place over the face and neck. I did bring one more of the same shape and these three were the ones I used exclusively. My hospital room had a refrigerator with a freezer.
• I bought in advance a pressure garment called a French drape. I followed the measuring instructions and bought a size medium, but it barely fit my head pre-surgery. It turned out to be a waste of money, because Dr. Chartchai supplied a stretchy pressure bandage that fits around the neck and the face. It was a size large, and was much more comfortable and versatile than the one I bought. The brand was Cheer, an Asian brand.
• On the recommendation of a reviewer, I took some make-up remover towelettes. These were wonderful for later removing the black marks that Dr. Chartchai had made on my face right before surgery.
• I took a small bottle of hydrogen peroxide and plenty of cotton squares and swabs. Three days after surgery, I make a 50-50 solution of hydrogen peroxide and water and daubed it all over my incision lines, in my ears, and over my eyes to remove old blood. This made me feel much better.
• I found bacitracin ointment at WalMart. I wanted this because I read somewhere that Neosporin can cause increased redness of incision lines. I only used the bacitracin ointment one time, though, and I had no problem with infection. (I was prescribed routine amoxicillin pills post-surgery.) Dr. Chartchai did apply some terramycin ophthalmic ointment to the incisions around my eyes at the dressing change on the second post-surgical day, and he left the tube with me, but I didn’t use it.
• Here’s a hint for the ladies: you may want to have something on hand in case you get a yeast infection after taking antibiotics for several days.
• I recommend taking some facial cleanser that is milder than what you normally use. Your facial skin is very taut after a facelift, and if your facial cleanser strips oil from your skin, it’s going to feel even tauter. I liked Cetaphil’s Gentle Skin Cleanser. I had bought a travel size at Target. They also have travel size containers of Johnson & Johnson’s baby shampoo.
• I took some protein powder with vitamins, probiotics, and fiber to mix with milk. It was handy to have this because chewing was uncomfortable for a few days. I felt better knowing that I was getting plenty of protein, as well as the other ingredients. I took Metamucil, too, but after a few days of amoxicillin, a laxative definitely wasn’t needed.
• I took a quick-drying travel towel to the hospital, because I had read a review of a different Thai hospital which complained about the lack of a towel. However, Samitivej Hospital has everything you could want and more. I didn’t get to use their shower, though, because I was advised not to wash my hair for six days. I did take an extra gentle wash cloth on the trip, and it was nice to have back at the hotel.
• I took a nightshirt to the hospital, but again, they had plenty of gowns and pajamas, and the quality was good.
Bangkok has several very nice full-service private hospitals that cater to foreigners. It's easy to get information on these hospitals, but it is not so easy to get information on individual plastic surgeons in Thailand. I communicated by email with four hospitals through their international desks. Many international patients go through a medical concierge, but I preferred to book an appointment directly with the doctor(s) of my choice. I eventually found favorable online comments about two doctors, both of whom have their own web sites. One consulted with me by email after I sent photos, but was not available for surgery during my time in Bangkok. I did not receive a reply to an emailed question I sent to Dr. Chartchai's web site, but I booked a consultation with Dr. Chartchai through the hospital for the day after my arrival in Bangkok, and had another appointment elsewhere as a back-up. These appointments were on a Sunday; the Thai plastic surgeons seem to work very hard! They see patients at the hospitals rather than maintaining independent offices, it seems, although there are also many free-standing plastic surgery clinics there.
I would only have surgery in a hospital setting in a foreign country. In a hospital, there is more accountability than in a stand-alone clinic. Samitivej Sukhumvit Hospital is Joint Commission International accredited.
I had registered with the hospital by filling out a form online a few days previously. At the time of my appointment, I went to the Esthetic Institute of Samitivej, where Dr. Chartchai consults with patients. The receptionists sent me to the Medical Records department to get a hospital card. Medical Records made a copy of my passport. (Be sure to take your passport to your first appointment with any practitioner in Thailand). Once Medical Records activated my record, Dr. Chartchai was able to see the medical history I had filled out online.
Dr. Chartchai's fees are higher than any of the other fees I was able to find (some of the hospitals post their surgery fees). I had learned from another review on Real Self that his fees are high, so it wasn’t a surprise. However, after consulting with him, I realized that I felt comfortable with him and his recommendations for my face. He was friendly but straight-forward. He speaks very good English. He patiently addressed my questions and concerns. I realized that I should not base my decision on price, but on how much confidence I had in him. I canceled the appointment I had with another surgeon.
I confessed to Dr. Chartchai that there was one supplement that I hadn’t mentioned in my medical history. I had taken a couple of doses of Vitamin K pills since arriving in Bangkok. He asked my why. I explained that I had read that Vitamin K might help to prevent excessive bleeding. He respectfully explained that unless I had a deficiency, the supplements would not provide any benefit. His response only increased my confidence in him. I appreciated his honesty, and I want my doctors to treat me based on science and not on what makes people feel good mentally.
Dr. Chartchai asked me if I had had an online consultation with him via his web site. He was sorry to hear that I had not had a reply to my initial inquiry, and mentioned that other patients had had similar complaints. His schedule was full, but he offered to reschedule something else to work me in to his surgery schedule in four days' time. I greatly appreciate his kindness in the matter. He assured me that he is revamping his web site in 2014 to make it more responsive to inquiries from patients.
I had become aware by reading reviews that lower blepharoplasty, especially, can result in complications. I mentioned this to Dr. Chartchai, and he responded that the complications can result from the surgeon not knowing thoroughly the anatomy of the underlying muscles and nerves. His web site states that he routinely does a tarsal suspension when he does a lower blepharoplasty. I assume that he did this on me, although we didn’t discuss it specifically.
I was also worried because I had read online that the removal of too much fat around the eyelids can give a person a hollow-eyed look. One doctor’s web site said not to let anyone remove fat from the area. Dr. Chartchai explained that cosmetic surgeons used to remove more fat from around the eyes than is done nowadays. They learned that it can result in a hollow-eyed look as a woman ages. I told him I preferred a conservative approach.
Here is a break-down of what the prices that Dr. Chartchai quoted me at the initial consultation. At that time, the exchange rate was about 31 Thai baht per US dollar, so if you divide these figures by 31, it gives you an idea of the prices in US dollars at that time:
• Upper eyelids, done separately: 40,000 Thai baht
• Lower eyelids, done separately: 40,000 Thai baht
• Upper and lower eyelids, done together: 75,000 Thai baht. This is an outpatient procedure, I think.
• Facelift: 160,000 Thai baht
• Neck lift with liposuction: 160,000 Thai baht
• Upper and lower blepharoplasties with facelift and necklift: 300,000 Thai baht. This includes surgeon fees, facility fees, the anesthesiologist, two nights in the hospital, medications directly related to the surgery, and follow-up visits. It does not include pre-operative medical tests.
Dr. Chartchai referred me for a medical evaluation including a physical exam, blood work, a chest x-ray, and an EKG. There were a couple of unexpected findings, and I ended up seeing a cardiologist as well. All of this took place within a few hours, except for the fasting blood draw, which took place the next morning. The pre-op tests cost me $395 USD and were not included in the surgery fees. I had my second appointment with Dr. Chartchai after all the results were in, and the surgery date was confirmed.
On the surgery day, I reported to the Esthetics Institute, where I paid for the surgery by credit card. At Samitivej, they show you the price in Thai baht and in your home currency (at least, they do in US dollars). They ask you which currency you would like to pay in.
I was taken to the surgical suite, where I talked with the scrub nurse and the anesthesiologist. Then I was taken to my deluxe hospital room, which was huge. I was given a gown and locked my personal things away in the safe. I was hungry and looking forward to eating after the surgery. In a couple of hours, during which I watched the big screen TV and played with the iPod app that controls the curtains and the heating, they brought a gurney to take me to surgery. This was overkill, but apparently it is their usual way of doing things. Once I arrived in the surgery area, I was asked by the scrub nurse to wash my face with Betadine. Her English was good and she told me exactly what would happen to me during surgery.
One mistake I made was that I had applied body lotion that morning. The scrub nurse had to apply a pad to my thigh to ground (I think) the electrocautery instrument, and she had to wash my thigh first to get the lotion off so the pad would stick. I think I actually missed some of the pre-op and post-op instructions because my consultation with Dr. Chartchai was not made through his web site. That is the only flaw I can name in my entire experience with the doctor.
Dr. Chartchai arrived, took photographs, and marked up my face with a black felt-tipped marker.
First, the doctor did my eyelids under local anesthetic and 5 mg. Valium, so I could hear the scissors snipping and the sizzle of the electrosurgery (cauterizing). He does it while the patient is awake because he asks you to open and close your eyes at certain times. The only thing that hurt was when he injected the anesthetic. There were about six injections per eye. The doctor explained what he was doing as he went along. After finishing the eyelids, he applied ointment to my eyes and they applied a cool compress that felt so good (I could feel the cold even with the local anesthetic). I heard the anesthesiologist tell me that she would begin the general anesthesia. That’s the last thing I remember about the surgery itself.
I think they told me that the eyelid surgery took about an hour and the facelift and necklift took about two hours, but I can’t remember exactly. The scrub nurse spoke to me when they moved me to the recovery room and then to my hospital room, but I didn't really wake up until I was back in bed. I threw up a couple of times; that happens to me when I have general anesthesia. I had a urinary catheter the first night. My throat was sore when I woke up from being intubated. The nurses brought me some sort of a rice porridge which tasted good, but I could only eat a little. The hunger I had had earlier had been replaced by nausea.
The nurses came quickly whenever I called that night, and I used the cold packs a lot. The hospital seemed to be overstaffed, which works to the patient’s advantage. I have to admit that the catheter made it easy; I didn’t have to drag an IV pole to the bathroom. They removed the urinary catheter the morning after the surgery.
I was offered antinausea medication by injection and a narcotic, but I declined. There wasn’t much pain. The only pain medication I took was the anti-inflammatory, Celebrex, which I took twice a day for about a week, along with amoxicillin.
Dr. Chartchai came by the next day. He asked me to look at myself in the bathroom mirror because he wanted me to notice the improvement in my eyelids that could already be seen. He takes pride in his work! I agreed that my eyelids looked better, but it was a shock to see myself in the mirror, even after seeing the post-surgery pictures of others here on Real Self. Mostly I saw bruising, black lines from the pre-surgical marking, swelling, and messy hair poking out from under a well-padded bandage. Who was that stranger in the mirror?
I was glad to have the adjustable hospital bed. I spent most of the time dozing and occasionally watching TV, and icing my face often. The food was pretty decent (they served me western food), but I didn’t have a big appetite.
On the second day, Dr. Chartchai removed the drains and changed the dressing to the pressure garment, plus some cotton padding, before I left the hospital. I was discharged with extra gauze and ophthalmic ointment. I had an appointment for post-op day 6 to remove the stitches around the eyes, and I was told that I could wash my hair on that day.
At the serviced apartment, I had prepared my bed with the bed wedges so that I would have my head propped up. I removed as much of the black marker as I could by gently wiping my face with Neutrogena make-up remover wipes. I spent the next couple of days just loafing in bed, icing my face often, sipping water and eating soft foods. I had a traveling companion (my brother) to help me out, so I didn’t leave the apartment for a few days. If I had been alone, I could have walked to the 7-11 a couple of doors down for food and drink. 7-11s seem to be everywhere in Bangkok. I was not adventurous enough to try the food from the street vendors, who are also everywhere.
On post-op day 3, I cleaned myself up as best I could with the hydrogen peroxide. Then I could inspect my face a little better. I’ve never had a very full face, but the swelling made my cheekbone area very prominent, and my face and neck looked unnaturally wide. The wide neck gave me a masculine look. When I looked at my face under light from the window, I saw a yellow cast to my cheeks. I took this as a good sign; my body was metabolizing the blood trapped under the skin. The sides of my cheeks had some dark spots that I think were deeper trapped blood showing through.
By post-op day 5, I was dying to wash my hair, so I cheated a little and did it a day before I was told to. That made me feel so much more comfortable. I lathered several times with the baby shampoo, because the bacitracin ointment I had used on the incisions was hard to remove. I didn’t rub my face, but just gently applied face cleanser and let the warm water run over it.
During the first week post-op, I wore the elastic bandage around my face and neck about 23 hours a day, even when I ventured out of the hotel room.
The sutures around my eyelids were making them feel kind of irritated, so I was glad to get them out on post-op day 6. Dr. Chartchai removed them himself and also the sutures under my chin. He prescribed a gel called Reparil Gel N which he instructed me to apply twice daily to the swollen and bruised areas. It’s “an anti-inflammatory, pain-relieving aescin gel which combats swelling and oedema,” according to the box. I had to pay separately, about $25 USD, for this gel. I’m still using it about once a day as of this writing on post-op day 30. Aescin is derived from the horse chestnut. The gel also contains diethylamine salicylate. Dr. Chartchai told me at this appointment that I appeared to be healing well. He said that the bruising would be gone in a week and the swelling will last for months.
I saw some improvement each day. The swelling was decreasing, but my cheeks had some odd hills and valleys, shall I say, which made me look a little odd, and the bruising under the eyes was still quite prominent. I saw Dr. Chartchai on post-op day 10, at which time he removed the sutures at my temples and nape. He told me I should wear the elastic bandage at night and while in the hotel room, but didn’t have to wear it while out and about. Once the sutures were out, I ventured out into the city of Bangkok more and did quite a bit of walking. I didn’t bother to try to hide the bruising, since I knew that I wouldn’t run into anyone I know. I tried to avoid getting too hot to keep from getting more swollen.
By post-op day 12, I was starting to wonder if the bruises would be gone by the time I went back to work on post-op day 19. I was using the Reparil Gel N and the anti-inflammatory pills as prescribed. I had read that there is a laser treatment that can help bruises to dissipate faster. Knowing that laser treatment would be less expensive in Bangkok than at home, I decided to visit a different hospital near my hotel and see if I could have the treatment. I walked in without an appointment, but I was able to speak to a dermatologist. He did not recommend laser treatment for the under-eye bruising; I’m not sure of the reason. I also inquired about having some permanent lipstick removed by laser, but he didn’t recommend that, either. He said that using laser on red pigments can sometimes make them darken. He did recommend some Vitamin K serum to be applied to the bruises, and two weeks of a systemic form of Reparil (Dragees) to be taken twice daily for two weeks, so I purchased those. I was disappointed that something more definite could not be done about the bruising.
My final appointment with Dr. Chartchai was on post-op day 14, the day before I left Thailand. He took photos and I told him that I would email photos at 6 months. I asked him what type of SMAS facelift I had. He told me that there are three basic types of SMAS facelift: plication, excision, and suspension. His is a mix of plication and suspension, with the vector of the pull depending on the needs of the patient. I forgot to ask him specifically what he did to my neck, although I know there was some liposuction and a suspension involved. I don’t know what exactly was done, if anything, to my platysma muscle.
The undereye bruising still showed quite a bit, and after I returned home to the US, I spent quite a bit of time for the next few days tending to my face with warm compresses, light pressure on the skin, and application of Reparil Gel N and Vitamin K serum. Still, the bruises were there when I returned to work on post-op day 19, and they showed a bit through the concealer and foundation I used. I had been hoping that I could just go back into the office without telling people that I had had surgery, but no such luck. One of my co-workers asked about the bruising right away. I had to say something, so I told everyone that I had my eyelids done. I skipped any mention of the facelift, or where I had the surgery done.
My daughter and my significant other both told me that I looked good before I had surgery, but I look nice now. I’m very happy with the improved appearance of my eyelids and wish I’d had them done years ago. I still have very slight bruising under the eyes even now. My lower face and neck look better, too, at 30 days post-op, but I’m wondering if they’ll start to sag more as the swelling continues to go down. My nasolabial folds have improved, and I had a marionette line on my left side which has diminished. I like the increased volume in my cheek area, but I expect that will probably subside some, too.
Correction of error about prices listed in middle of review
Update at 6 weeks post-op
As for the incisions in the neck, it seems to me that they became a little more bothersome starting at about 4 weeks. They got bumpier and itchier, and I began to feel some tightness in them. I think this is all due to collagen forming and remodeling itself. Cortisone cream or even just plain moisturizer helps to relieve the feeling. I tried Mederma gel, but I don't care for it much. It seems to make the scars feel stiffer.
The scars from the blepharoplasties are a little bumpier, too, and when I raise my brows, I feel tightness in them. That's no big deal, really; it'll go away eventually. One thing that is a nuisance is that when I remove my (washable) mascara, little bits of it get caught in the scars under my lower eyelashes and I have to pick at it a bit. I would really rather not have to do that; I'm still trying to treat my face as gently as I can.
I've never been a big make-up person, but I do like to wear mascara when I'm out of the house. It would be nice if I could avoid using mascara for a few weeks. I've experimented with false eyelashes, but I'm not too good at applying them yet. I was thinking that if Latisse actually works and makes the eyelashes darker, a good use for it might be to start it a few weeks before blepharoplasty. It's too late for me to try this, but it's something that somebody might want to do some research on if they are just planning their surgery.
I am very pleased with my upper eyelids. Getting rid of that droopy excess skin in the upper lids sure makes a difference! If somebody is mulling over whether to do just a blepharoplasty or just a facelift, I would say, go for the blepharoplasty! You can always do a facelift later.
Now at 6 weeks, I am noticing a little softening of the cheeks. There seems to be a layer of softer, more normal-feeling tissue between the skin and the still swollen muscle layer. The lumpiness is a little less and the angles are a little softer. These are hopeful signs.
You will notice in the pictures that I still have crow's feet and lines under the eyes. They have improved, though, and I am overall quite happy with my results so far. I didn't expect perfection, just improvement. My jowls and neck look better than before. When I look back at my "before" pictures, I look at lot less tired and sad. I'm still glad I did this.
Dr. Chartchai always greeted me warmly. He listened to my desires and patiently answered my questions. He is well known in Bangkok for his blepharoplasty experience. He has a calm and confident manner. He doesn't talk down to the patient. At the consultation appointment, he gives the patient his personal cell phone number.