Which pain medication is best after facelift/fat transfer?

Question

Have COPD and asthma.

Steven H. Dayan, MD · Answer

Dear vickielp,
Thank you for your question. I typically prescribe narcotics and avoid blood thinning medications such as NSAIDs for patients who undergo facelift. I recommend you discuss this further with your surgeon who can prescribe you the appropriate pain medication depending on your medication allergies, level of pain tolerance, and medical history.

Ashley B. Robey, MD · Answer

Every patient has different perceptions of pain, so it is hard to say there is one best pain medication. Facelifts and facial fat transfers, in the spectrum of surgical procedures, aren't particularly painful. Of course, in fat transfers, you also have the fat donor sites to contend with - I usually prescribed a narcotic with a dose range. Initially, right after surgery, you may feel like you need more that what you would need to feel comfortable after a day or so.

Kenneth D. Steinsapir, MD · Answer

Many of these procedures are actually not that uncomfortable post operatively.  Your medical status and any prior reactions to pain medications need to be considered when determining what is best for you.  In my opinion, it is essential for patients to be comfortable and also have the smallest exposure to narcotics after surgery consistent with this.

John L. Burns Jr., MD · Answer

A facelift is not a very painful procedure.  The majority of my patients can control their pain with tylenol.  You want to avoid aspirin or medications that thin your blood to avoid bruising and bleeding.

Daniel Barrett, MD · Answer

Dear vickielp,
every plastic surgeon has his own postoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Janet Turkle, MD · Answer

Thanks for your question, Vickie. Please discuss your post operative pain medication concerns with your Plastic Surgeon. Less is usually more when it comes to pain medication. Consideration of the various options needs to be carefully coordinated with your other medical conditions. Best of luck to you!

Dean P. Kane, MD, FACS · Answer

Dear vickielp:

Thank you for this important question! There are many factors a facelift surgeon, anesthetist/anesthesiologist nursing team and your pre-operative medical consultants must consider in postoperative pain care. Some of these include:

1.   Your medical well-being and metabolism

2.   Your anxiety level

3.   Your home environment and support team

4.   Individual sensitivities to each medication option

5.   The doses and onset of narcotic medication, sedative/anti-anxiety medications and the spacing between each dose.

6.   Cautioned use of blood thinning pain-relieving medications such as ibuprofen, naproxen and aspirin.

7.   Use of over-the-counter pain medications, sedatives such as anti-histamine; sleep supplements such as melatonin and valerian; personal use of alcohol or cannabinoids and so many other metabolically active ingredients such as caffeine and nicotine.

8.   Use of desensitization such as distraction massage or a TENS unit

Following surger, the only time when you will be completely free of pain is when the local anesthetic is numbing the pain fibers. I therefore use LidoDerm, a xylocaine medicated patch, cut into postage stamp size squares to diminish the most uncomfortable area’s for the facelift patient. These are behind the ears and along the front of the sternocleidomastoid muscle where the free ends of the pain fibers are.

All the above (1-8) will alter your sensation and interpretation of pain and not erase it!  It is best to use the least amount of pain medication, usually in a “cocktail” of small doses to make yourself comfortable so no – one single medication can cause a side-effect or complication. The faster you get back to your normal daily rhythm of staying awake during the day and sleeping at night will also help your normal diurnal cycles to comfort pain as well.

Each patient is unique and this should be discussed with the surgical team.

Use a well experienced Board Certified Plastic Surgeon with a supportive team to answer your needs. I wish you the best!

Christopher S. Jones, MD · Answer

I have found that my patients have little physical pain after facial procedures. I give prescriptions for a mild narcotic, but suggest breaking the tablets in half to try a smaller amount first.

Robert V. Mandraccia, MD · Answer

You will generally NOT have much pain from a facelift. Speaking from experience, as a man, I did not take a single pill but people vary. Keep the dosages low of whatever yoiu do wind up taking. I dont think there is much risk to oral meds taken at proper dosage.Best, Dr Mandraccia, Ft Myers, FL

Jeffrey Jumaily, MD · Answer

my patients rarely need strong pain medicine after a facelift. They are often given Tylenol 3 or something similar just in case but rarely anyone needs it after 2 days. Extra strength Tylenol often suffices after that. Best wishes