A plastic surgery patient arrives at the surgery center, she’s anxious about the operation that she’s about to go forward with. But after two children she’s decided it’s time to get her pre-pregnancy body back. On the top of her lists of worries is the pain she’s sure to encounter after surgery. How will she take care of her two small children? Will she be forced to sleep away the days or be nauseous from the narcotics she’ll take to ease the pain?
The subject of pain after surgery, especially in cases of elective cosmetic surgery is not always easily addressed by the patient or the surgeon. The patient knows the pain will be there but is determined to go forward because it will be worth it in the end. The surgeon hates to make it an issue because after all, it is elective and he or she doesn’t want to scare the patient away.
New options in dealing with pain after plastic surgery opens up the discussion between patients and doctors and gives the patient one less thing to worry about.
By Carolynn Grimes
The Plastic Surgery Channel (PSC) wanted to bring this topic to the forefront, so we interviewed a handful of plastic surgeons across the country about the topic of pain after plastic surgery.
PSC-“Are your patients concerned about pain?”
Dr. Lee Thornton, Meridian Mississippi – “All patients have anxiety about pain and really, it keeps some patients from having a procedure.”
Dr. Richard Baxter, Seattle, Washington - “It’s natural to be fearful of pain particularly when you’re considering something that’s purely elective such as cosmetic surgery.
Dr. William P. Adams, Dallas, Texas – “Most patients are very concerned about pain; it’s probably their primary worry about having surgery.”
Dr. Stephan Finical, Charlotte, North Carolina – “In cosmetic surgery people aren’t in pain when they come in to see us. Any pain they have after surgery is from us, and we need to do anything we can to stop or alleviate the pain.”
PSC - “What do you tell patients about pain when they come in for a plastic surgery consultation?”
Dr. William P. Adams – “There are a number of things we tell patients. The first step to minimizing pain is handling the tissues atraumaticallly, meaning there’s a lot of surgical technique that contributes to minimizing pain. Selecting the right procedure for the patient is important and in the case of breast augmentation, selecting the right size implant. We will also use medications that can be injected into the surgical wound to help with pain after surgery.”
Dr. Lee Thornton – “I tell patients there are many ways to control pain, and the most important way is how we handle the tissues. We do that very gently and delicately so that it doesn’t give much discomfort and they have an easier healing period.
Dr. Stephan Finical – “We are going to use a more sophisticated anesthetic than they’ll get in a hospital. We are going to control post-operative nausea by using no annihilation agents. We’re also going to do things that prolong the anesthetic post-operatively, so they’re more comfortable in the long run.”
Dr. Richard Baxter – “It starts at the surgery itself; we can inject numbing agents into the surgical site. There are also pain pumps that infuse the numbing agent over a period of a few days, but those can be cumbersome. The newer agent is called Exparel; it’s a numbing agent that’s in a sustained relief formulation. We inject it into the surgical site; it releases over three days and that’s the most critical time for people.”
PSC – “Tell me about your experience of using Exparel in your practice?”
Dr. Stephan Finical - “I’m very enthusiastic about Exparel. It’s a medication that’s bupivacaine, that’s in a longer acting form. It’s very safe and it’s very reliable. I’ve used it on abdominoplasties exclusively and I’ve had great results. I had a patient that said her abdominoplasty was more comfortable than her breast enhancement that I did for her seven years ago; and that’s never the case. The real difference was, they were standing upright instead of being hunched over and guarded and they were breathing easy, talking normally, very comfortable to have their dressings changed.”
Dr. Richard Baxter – The number one procedure that has been transformed by Exparel is tummy tucks. A tummy tuck is a significant operation. We’re normally tightening up the muscle and it’s difficult for people to get up after surgery and start walking around. We want them to get up and move so they don’t develop blood clots and so they recuperate more quickly. Exparel has made it easier for them to do this.”
Dr. Lee Thornton – “If you can keep someone out of pain for 2-3 days after a procedure or significantly decrease their pain for 2-3 days, it makes their whole healing course much better.”