Wound Management Following Facial Plastic Surgery

After 48 hours, nature [usually] does a great job, Dr. Futran said.

The wound should not be exposed to water for the first 24 hours after surgery; after that, it can gently get wet, but Dr. Futran said patients should be careful of the incision when washing their hair.

For incisions in the neck (but not on the face), double antibiotic ointment alone is sufficient. For a face wound, Dr. Futran uses Mastisol adhesive on either side of the wound and Steri-Strips to hold the wound together.

Dr. Wax uses Steri-Strips or petroleum-based antibiotic ointments to protect the scar. Sometimes ointments are enough, he said. However, Steri-Strips are useful for wounds that will be exposed to the cold or to potential trauma, he added.

Either a silicone-based gel, such as Mederma, or silicone sheets can promote wound healing, Dr. Wax said, although the mechanism for this is not well understood. He also suggests vitamin E cream, cocoa butter, and aloe vera for expediting wound healing.

In patients with a predilection for keloids, I inject the edges of the wound at the time of closure with Kenalog to minimize widening of the scar, Dr. Futran said.

The night before surgery, Dr. Futran instructs patients to shower and wash their hair and tells male patients to shave. Patients use an antibiotic cleanser such as Hibiclens the night before and the morning of surgery.

Post-surgery, patients should be instructed to keep the wound dry for 24 hours; after that, gentle cleansing is allowed. Patients should avoid direct trauma, irritation, or stress/tension to the wound for five to seven days. Exercise and heavy lifting should be avoided until the wound heals.

Size or length of incision does not change the management for wound healing. It is straightforward, relying on local care, Dr. Futran said.

The Future

Biomaterials, such as artificial skin, are useful for wounds that cover large surface areas of the body, such as burns, but they do not play a big role in typical facial cosmetic/reconstructive surgery, agreed all experts interviewed for this article. Dr. Futran said that the newer biomaterials would probably be useful for problematic wounds (i.e., those that don’t heal or break down and get infected), but in general, if wound healing is uneventful, there is no role for biomaterials or bio-dressings.

Dr. Wax said that artificial skin such as Integra or Alloderm is useful when there is a gap in the wound, but he rarely uses these products. Most cosmetic or reconstructive surgery doesn’t require these biomaterials. Cosmetic/reconstructive surgeons try to use adjacent skin or skin grafts to close the wound, he said.