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Hi All, Have compiled a guide below, for those who are new to PS in Korea. Thank you to all who have selflessly shared your research/experience; which I have credited in the respective sections. 1. Navigating Korea 1.1 Travelling 1.1.1 Travelling from Incheon Airport to Seoul Airport Bus Cost: Approx. 15,000 won to Gangnam area Time: Approx. 1.5 hours Airport buses travel to all major areas of Seoul. Tickets to Gangnam area are around 15,000 won and the travel time is approximately 1.5 hours, depending on traffic and the destination. Tickets can be purchased at designated ticket booths outside the passenger terminal. The fare can be paid in cash, T-money, or credit card (at Incheon Airport). AREX Cost: Approx. 5,000 - 10,000 won to Gangnam area Time: Approx. 2 hours The AREX operates two types of trains: the Express train, which makes no stops along the way, and the All-Stop train, which makes 10 stops before it reaches Seoul Station. All stop train: The tickets are around 4,500 won and the estimated travel time is around an hour. The train departs regularly around every 6 to 7 minutes and operates from 5:20 till 23:57. Express train: This train does not make any stops and goes to Seoul station directly, and the tickets are around 8,000 won and the estimated travel time is around 45 minutes. The train departs around every 40 minutes and operates from 5:20 till 22:33. Keep in mind that the all stop train can be crowded especially during peak hours and if you cannot get a seat can be quite a long ride. The benefit of the express train is that there are pre-assigned seats and there is also WiFi. Once you arrive at Seoul Station you can easily transfer to other subway lines or get a taxi with your luggage, as the station has facilities like escalators and elevators (this is the case with most other stations in Seoul as well). Taxi Cost: Approx. 60,000 won to Gangnam area Time: Approx. 1.5 hours There are 4 types of taxis: Standard, international, deluxe, and jumbo taxi vans. International taxis are 20 percent more expensive than standard taxis and drivers speak English, Japanese, or Chinese. Deluxe taxis are approximately 40 to 50 percent more expensive than standard taxis, but use larger, more luxurious sedans. Jumbo taxi vans can accommodate up to 8 passengers at once and are the same price as deluxe taxies. Taxi stands for each type of taxi are located outside the arrival terminal. 1.1.2 Travelling around Korea Google Maps is not as updated as Naver and Kakao maps. Kakao and Naver have been the lead when it comes to navigation apps in Korea. If you understand Korean, Naver maps tend to be more detailed, including real time updates on arrival/departure timings for buses and trains. Naver maps instructions are in English – so that would be the recommended app if you do not understand Korean. Subway Korea (by Malang, yellow colour icon on Google Playstore, blue colour icon on Apple Store) is a handy map app that not only gives you the subway routes, but also lets you see to-the-minute train schedules, calculate the quickest routes to your destination, and even tell you which train car to get on for the quickest transfers. Best of all, it works offline, making navigating in transit a breeze. There are several online guides on how to use the app (https://thechelseabracket.wordpress.com/2016/05/29/best-apps-for-seoul-subway-지하철-2/) 1.2 Sim Card It is advisable for you to get a SIM card that allows you to get online with your phone, so you can use kakaotalk and maps. There is a detailed link here on the different type of sim cards (https://prepaid-data-sim-card.fandom.com/wiki/Korea_(South)). There are usually discounts if you pre-order ahead of your trip (https://www.krsim.net/). Do take note of the pickup times if you are arriving very late / super early. 1.3 Food Delivery Apps For English speakers, UberEats and Shuttle Delivery are some possible options. McDelivery is another option. If you understand Korean or are willing to spend some time to read up other online guides on Yogiyo app, there are a lot more food options there. 2. Research 2.1 Best time to visit Korea Credit to JLBCGP (https://beautyhacker.com/topic/1010768-best-time-to-visit-korea/) JLBCGP has made a detailed post, taking into account variables such as temperature, local holidays, high school/university students and yellow dust. Please refer to her post linked above. 2.2 How to check if a doctor is Board-certified There are several pointers to note: The Korean website is more updated than the English version (a few years dated). The mobile version of the Korean website allows you to search by clinic's and/or doctor's name (whereas the web version only allows you to search by doctor's name). Sometimes, the clinic's name may be spelled differently (e.g. DA Clinic may be reflected as 디에이성형외과, 디에이 성형외과 or DA성형외과). It may be better to search by doctor's name in this case. Also, sometimes when a doctor moves to a new clinic, the site may not be as updated and the doctor's name may still be reflected under the old clinic's name which he practiced at. For oral and maxillofacial dental surgeons, there is no English database to check board membership status. For ENT doctors, there are 2 medical societies in Korea (Credit to Kino on Discord): i) Korean Society of Otorhinolaryngology-head and Neck Surgery Email: [email protected] Website: http://eng.korl.or.kr/ ii) Korean Rhinologic Society Email: [email protected] Website: http://www.ksrhino.or.kr/eng/ I have attached screenshots (see this link https://beautyhacker.com/topic/1012254-checking-if-a-doctor-is-certified-by-the-korean-association-of-plastic-surgeons/) on: How to search by clinic name (click here http://www.prskorea.co.kr/mobile/search/search_h_name.asp) How to search by doctor (click here http://www.prskorea.co.kr/mobile/search/search_h_dr.asp) If there are no results, it means that the doctor is not certified by the board to begin with. See the link above on the screenshots on how to differentiate those who were suspended because they did not pay their membership renewal fees vs other reasons. For other pointers on how to check if a doctor is certified, you may refer to the English write-up on the page (click here http://www.prskorea.co.kr/English/mobile/sub/sub_02.asphttp://www.prskorea.co.kr/English/mobile/sub/sub_02.asp). 2.3 What to research Types of procedures: Clinics’ websites, Plastic surgery concierge services Pros, cons and risks of procedures: Realself Recovery: Makemeheal Simulating how the PS procedure looks on you: Meitu (the app is easy to use and you can simulate smaller alars, higher bridge, smaller nose tip, philtrum reduction, zygoma reduction, vline surgery, etc). Clinics / Doctors: Purseforum, Beautyhacker, Soyoung (Chinese), Gangnam Unnie (Korean), Babitalk (Korean), Anti-PS cafes (http://cafe330.daum.net/_c21_/home?grpid=KY9Q), Korean forums on Naver, Nate *As there are many fake/planted reviews online, please use discretion and do not take everything you see at face value. Some clinics also photoshop their before/after photos. 3. Pre-Surgery 3.1 Packing List Notebook and pen to write notes during consultation Medical history / Drug allergies to inform clinic Button tops or loose fitting tops Electrical adapter Cotton bud / Q-tips (to apply medicine, dig nose, remove food particles for those with stitches inside mouth) Antibacterial wet wipes Lip balm (for rhino and FC as lips will get dry from breathing through the mouth) Pain relief medication Tissue paper (for running nose/teary eyes post-surgery & bleeding) Camouflage items (hoodie, sunglasses, face masks, caps) Vitamin K cream (e.g. Auriderm) (for bruising) Scar healing & reduction gel (e.g. Kelocote, Dermatix) Simple dressing set Arnica (e.g. Sineech) (for bruising) Bromelain (for swelling) Collagen powder (promotes healing) Vitamin C (promotes healing) Protein powder (if you have to be on a liquid diet) Dry shampoo 3.2 Pre-Surgery Pointers Avoid alcohol for 2 weeks before surgery No smoking at least 1 week before surgery Take vitamin supplements if needed (vitamin c, vitamin a, zinc, vitamin k, vitamin b, vitamin d, magnesium, amino acids) Avoid Vitamin E (increases bleeding) or ginseng/ ginko/ garlic/ ginger/ dongquai/ omega3 fatty acids Take good care of your skin (surgery may be postponed if there is pimple) Stop taking any medication or dietary supplements 2 weeks before surgery and notify during consultation Do not take any drugs with aspirin as they may have an undesirable side effects that may affect your surgery (abnormal bleeding and bruising). You may take Tylenol as a substitute for discomfort. The following is a summary taken from the Journal of American Medical Association on eight herbs that can potentially pose harm during and after surgery. It is recommended that the following herbs be stopped before surgery in order to avoid any potential complications from their use: St. John’s Wort can significantly increase the breakdown of other routinely administered drugs during surgery, some of which are vital to the care of patients after surgery. This should be discontinued at least 5 days before surgery. Echinacea should be used with caution in patients with asthma or allergic problems and should be discontinued as far in advance of surgery as possible. Ephedra causes a potential increase in blood pressure and heart rate. This herb has also been associated with sudden death under anesthesia. This should be discontinued at least 7 days before surgery. Garlic supplements have a potential for reducing clotting function and platelet function and should be stopped 7 days prior to surgery. Ginseng has also been shown to have effects on clotting pathways and should be discontinued approximately 7 days preoperatively. Ginkgo should be discontinued 7 days prior to surgery because it can inhibit platelet clotting factors. Kava should be discontinued 7 days preoperatively because it can increase the sedative effects of anesthetics. Valerian can increase the sedative effects of anesthetics. This should not be discontinued abruptly because there is risk of physical dependency to Valerian and withdrawal symptoms may develop. This should be tapered over several weeks before surgery. 4. Consultation 4.1 General consultation pointers to note Consult 3 Clinics / Day (space out start times by at least 2 hours, but spacing out by 3 hours buffer is recommended). Prepare some photos of how you want to look. Negotiate price - a) List example prices from other clinics b) State your budget is significantly lower than it actually is c) Offer to write them a review / before and after pictures for them to use on their site Always ask about the available dates for your surgery at the end of your consultation. Make sure you clearly understand the clinic’s revision policy and it is a good idea to get this in writing. You can get this by sending your consultant a mail/message where you summarize this policy and ask the consultant whether your understanding of this is complete and correct. Bring along something to take notes. MUST notify during consultation of any allergies or hypersensitive reactions towards certain medication 4.2 List of consultation questions Doctor Are you certified by the Korean Society of Plastic and Reconstructive Surgery? Were you trained specifically in the field of plastic surgery? How many years of plastic surgery training have you had? Is doctor X specialized in (procedure)? Or does he focus on other areas? Cost What is the exact breakdown of fees for this procedure? Are there any hidden fees? What is the total cost of the surgery including drugs and treatment aids needed after the surgery? What is included in my aftercare and what not? For example things like overnight stay, medications, scar cream, pumpkin juice, pressure garment, ice packs, deswelling treatment, hair treatment, etc.? Is there VAT refund? Where is the nearest downtown VAT refund point (i.e. apart from the airport refund counter)? What is the name of the VAT refund counter operator? If possible complications may occur, does the patient have to pay for the treatment? What is the cost for this treatment? If the patient decides to discontinue the surgery for any reason, does the patient still need to pay for the entire surgery? Surgery What procedures do I need to do or would you recommend me to do? Am I a good candidate for this procedure? How will you perform my procedure? Where will the procedure be performed? How many of these procedures do you perform a week? A month? What is the most popular surgical procedure you perform in your clinic? How many other medical staff will assist with this procedure? Will there be an anesthesiologist present during my surgery? What type of anesthesia method and anesthetic are used? Is some or all of the surgical equipment and instruments sterilized and used only for my surgery? What are the risks of the surgery? What are the complication occurrence rates and the surgeon’s surgery success rates of this clinic? How are complications handled? Can I see before and after pictures of the surgery? Post-Surgery What type of treatment will I need after the surgery? Will I need to take painkillers after the surgery? Does swelling or bruising occur after surgery? If so, is it treatable? How long will it take for me to return to day-to-day activities after the surgery? How long will the surgery results last for; if not permanent? If I need to consult the surgeon, can I meet him/her even months after the surgery? What is the clinic’s revision or refund policy in case there are complications or when I am not satisfied? What is exactly included & excluded in the revision policy, like revision excludes anesthetics costs? How many follow-up visits will I need? When is the next follow-up visit? When will the stitches be removed? How long does it take for the scars to disappear? Surgical Records Is any information about my surgery recorded? If so, how is it recorded? Will my surgical records or photos be shown to anyone else? Will my approval be sought before any of my records, including photos, are shown to someone else? Can I keep a copy of my surgical records? How long does the clinic store surgical records after the surgery? Where can I find my surgical records if the clinic which performed the surgery closes? 5. Surgery 5.1 Anaesthesia Credit to Lemontea1234 (https://beautyhacker.com/topic/996406-anaethestics-terminology-and-general-thread/) 5.1.1 Anaesthetics 101 What exactly is Anaesthetics? According to webdictonary Anaesthetics is 'a substance that induces insensitivity to pain.' It’s a pharmaceutical substance in which is directly injected into your veins or inhaled. This thread hopefully can impart some knowledge of anaesthetics and the importance of pre-operative, post-operative care. Types of Anaesthetics: Gas: The simplest form of inhaled sedation drug. Commonly known as sevo gas or nitric oxide. Simply known to most as laughing gas to most. It is used for induction of surgery. The half life of those gases are only 15seconds. It won’t take away your pain, but distracts you and relaxes you so that they can insert a cannula. Gas form of anaesthesia isn’t common for the duration of the surgery as it’s too unpredictable. Rather it is used to help calm the patient and allow them to feel relaxed. It leaves the body when you exhale. Twilight sedation or Sedation: Twilight sedation is simply sedation. It is used so the patient can be conscious but also like a trance. It’s a state where you're awake but not aware. Most common sedation medication is known as Midazolam. Half life of midazolam is approx 1.5hours to 2.5hours. The common side effect of such drugs is grogginess, headaches, dizziness and memory loss in the period that the medication is used. If twilight sedation is used, the patient should be breathing on their own and can protect their own airway. Thus reducing the need to be 'intubated' or having a breathing tube down. Blocks or Local Anaesthetic: Another form of anaesthetic is just using a nerve block or spinal block for the surgery. It means the patient will be fully conscious and aware of their surroundings during surgery. The medication is injected directly into the nerve and should completely numb the area. This is not often fool proof and upon wearing off. Can cause pins and needles sensation. Spinal blocks are commonly used to paralyse the patient from the waist down in order for surgeons to perform surgery. However, it can cause permanent paralysis if not correctly administered. There's also simple local anaesthetic that surgeons use intraoperative by directly injecting to operative site. Some of them contain adrenaline which in small doses in healthy adults be no problem. But those with underlying heart conditions should be mindful of. General Anaesthetic: Often associated with what Michael Jackson got for sleep. Medication of choice is generally propofol. Half life is 2 to 24 hours. However actual pharmacological effect peaks at 2 mins mark, and effective for only 5 to 10 minutes. It puts you to complete sleep, and makes you unconscious. A side effect of this, is it causes respiratory depression. In which you don't breathe enough or deep enough to maintain optimal oxygen level in your body. Thus, patients undergoing GA usually will have a breathing tube, and will be connected up to a ventilator (machine that gives calculated breaths). However, you may still move some of your muscles in your chemically induced sleep. Much like natural sleep. Common side effects are dizziness, nausea, grogginess, headaches etc. Some are known to 'shiver' post anaesthetics, as their bodies try to get rid of the medication from your system. These are the most common form of anaesthetics. There are some that used combination of GA with local infiltration by surgeon or can give twilight sedation to start off. But then put into deeper sleep by general anaesthetics. 5.1.2 Importance of following pre-operative instructions For those who are new to surgery. You may be given a set of instructions to follow in order to prepare yourself for surgery. But! I bet you have questions on why it is important to follow them. Most important rule is DISCLOSE any medication and medical history that you may have. EVEN if you do think it’s relevant. Sometimes something small that happened a long time ago, may be important when you do surgery. When you're being operated on, your body will be under stress. And some old medical conditions can flare up under body stress. So please be mindful of this! Fasting: Fasting means to be nil by mouth. This means no water, no food, nothing that can stimulate saliva production in mouth to stomach. The only things you can take orally is your medications. ANY medication that is used to treat medical conditions can be taken, with as minimal water as possible. Ideal fasting times are: If your surgery is in the first thing in the morning. Try to have a small meal at midnight, and then nothing from 12 o'clock midnight onwards. If your surgery is in the afternoon, (after 1pm). You can have a light breakfast at 5am in the morning then it’s nothing from then onwards. •Why fasting is important? In the evident that you may involuntarily vomit, you would want no chance that whatever you vomit may end up in your lungs. The chances of this happening under GA is low, as your airway is protected. BUT, after the removal of your artificial airway. You may vomit and may be too groggy to protect your airway. If any solids or fluids that are foreign end up in your lungs. You may end up with a condition known as aspiration pneumonia. Treating it is much harder, and often mortality rate is high if you acquire this. Medications: Some people take supplements to add to their diets. Please still always seek medical advice before stopping some of your medications. ALWAYS disclose whatever medication you take as it can affect how your recovery and anaesthetics are metabolized. Importance of declaring allergies: Allergies are vital to be declared to treating doctors and anaesthetists. Did you know some medical products contain same protein as foods? Parts of latex gloves have the same protein as kiwifruit. So please tell your doctors and explain your symptoms of allergies when you go for surgery. Even if you think it’s just minor, please let them know! 5.2 Morning of surgery Wake up early & wash your face Make sure you are not wearing any accessories or nail polish Bring your contact lens case to store your contact lens (if applicable) NO breakfast (not even a small biscuit or a cup of water) Wear comfortable clothes (button down shirt) and bring cover-ups like caps or sunglasses to protect your eyes after surgery Prepare your appointment card including fees for the operation in advance so that you are on time for the surgery. Go over to clinic early to check in Bring socks - The surgery room can be a bit cold and socks can keep you warm thus calming you down before the surgery. 5.3 Pre-surgery process Change into your surgery clothes. Take everything off except for your underwear. Tie your hair back Wash hands first, then your entire face. Make sure it’s completely cleaned. Wait in patient waiting room Consultant brief you about the risk, liability, warranty (in my case, for the 1st year it's free revision, and in the 2nd year it's free revision but you have to pay anesthesia and consultation fees). Sign the waiver of liability form. Make sure that in the contract you sign with the clinic before your surgery, it is clearly stated what the full name is of the doctor that is operating on you. The clinic is legally obliged to put this in the contract. This is to avoid a clinic using another doctor for your surgery. Go into another room to take a photo of you pre-surgery Doctor comes in and analyses you for the second time (the first time should be at your consultation). He will make small notations on your face/body and discuss the shape again. Go into surgery. Rest in recovery room 6. Post-surgery 6.1 Recovery tips General Avoid spicy and high sodium food Sleep with head elevated 45 degrees for several days to minimize swelling Apply antibiotic ointment (if prescribed) to the incision site as directed Use ice packs (~10 mins on 10 mins off) for the first 3 days after surgery as often as you can to reduce swelling and bruising Do not take aspirin or any aspirin based pain medication unless approved by your surgeon Do not use scar reduction cream/gel on the incision site until the wound has fully healed No alcohol for 3 weeks as it causes fluid retention Do not smoke, as smoking delays healing and increases the risk of complications Limit your activity right after surgery (for the first 3 days) to reduce post-operative swelling and bleeding. Start walking as soon as possible from the 4th day onwards, this helps to reduce swelling and lowers the chance of blood clots Avoid activities that raise your blood pressure, including bending, lifting and rigorous sports Before you attempt to pull any dead skin, be absolutely certain that it’s not a stitch. Eye surgery-specific You can take showers from the neck down any time after your surgery. Don’t take full showers until your surgeon tells you it’s safe to do so. This is usually after stitches are out (~5 to 7 days). You may gently wash below your eyes with wipes or a soft washcloth. You can use dry shampoo for your hair. Once you can take full showers, you can wash your eyelids and shampoo your hair with mild products, such as baby shampoo. Wait at least 2 weeks before wearing contact lenses Do not apply any irritants or make-up on your eyelids or incision line for 2 weeks after the surgery Your physician may recommend Natural Tears (OTC eye drops) or OTC ophthalmic ointment or antibiotic eye drops as part of your post-op treatment. Don’t pull on your eyelids while using the eye drops. Nose surgery-specific You can take showers from the neck down any time after your surgery. Don’t take full showers until your surgeon tells you it’s safe to do so. This is usually after the nose splint and stitches are out (~7 to 10 days). For the first month after rhinoplasty, you should not rest your glasses on the bridge of your nose. Either wear contact lenses or suspend the glasses with the use of a small tape from your forehead. Bruising around your nose in your cheeks and lower eyelids is very common after this type of surgery. Numbness over your nose is also quite normal. You will slowly regain sensation over the top of your nose. But you can expect the tip to be slightly numb and “stiff” feeling for up to three months after surgery. Breathing through your nose will slowly improve after we clean your nose out at your first clinic visit. Go to bed on time. Yawning may cause you quite a bit of pain, so prevent it by getting the right amount of sleep during the proper hours. FC surgery-specific Post-Surgery Keeping your head lifted up and above your chest (for at least a week) will speed up the healing process. Use the ice pack for at least 3-4 days and after the 4th day, change to a hot pack. Be sure to treat both sides of the face equally. Any bruises or swelling will lessen in a week and heal after 3 weeks, so you do not have to worry. After the surgery, you must abstain from food for one day. You may drink 6 hours after the surgery, and eat after 48 hours. For those with jaw or cheekbone surgery, you may eat rice porridge after going on a liquid diet (such as juice, milk, rice gruel) for a day. *Spicy or salty food: You may eat after 2 weeks; tough and chewy food after one month When blood comes out of the mouth, spit it out. If you think you have swallowed too much blood or too much blood is coming out, then please contact the doctor. Gargling with the disinfectant that we prescribe is very important. If you do not want any wounds or infection, you must gargle at least 10 times per day. First, gargle your mouth with water a couple of times then use the disinfectant last. Until the seam in your mouth is completely gone, you must gargle for at least 2 weeks. You may use a toothbrush 1 week after the surgery. At first, use a smooth children’s toothbrush to brush your teeth (do not brush your gums). Keep the bandage around your head for at least one day. Wearing the bandage will help reduce the swelling faster. You may wash your face or hair after taking off the bandage and you may go to the sauna or the hot springs after 2 weeks. After the surgery, if the bandage is too tight or your neck feels uncomfortable, please tell the doctor. You can wash your hair after 3 days, you can take a shower after 5 days Fitness workouts (sports, health centers) after one month In order to prevent infections, you must take the prescribed medicine. No matter how perfect the surgery came out, if you do not diligently take precautions after the surgery, problems may arise or your face shape may change. Therefore, caring for your face after the surgery is just as important as the surgery itself. Diet Even though you can open your mouth a small amount, you still will not be able to chew for approximately 6-8 weeks. You therefore will be on what we term as a swallowing diet. This means anything that you can swallow without chewing. Anything blended or liquid is acceptable. You may also have any foods that are soft enough or small enough to be mashed between your tongue and teeth without chewing. These things may include any liquids, soups, scrambled eggs, applesauce, pie, cake, ice-cream, yogurt, pasta that is well chopped and small and soft, as well as meat which is ground up fine. High-calorie, high-protein meals are the best with plenty of liquids. This may require eating a small meal 5-6 times a day rather than three large meals. Use a cup or glass when eating. Pull the lower lip forward on either side and just pour the contents of the cup into your mouth. Straws are okay to use, but you may find this difficult at first. The reason it is difficult is because your lips may be swollen and with decreased feeling in the upper or lower lip creating a vacuum necessary to use a straw may be difficult. If you can use a straw, it is okay. Take in smaller amounts and eat more frequently, it may be necessary for you to eat 5-6 times a day in order to satisfy your body requirements. Try not to miss any meals. A small, plastic syringe with a piece of rubber tubing or catheter at the tip can be helpful in the feeding process. You may use one of these at the hospital and this may be helpful when you go home from the hospital. These syringes and rubber tubing may be picked up at any pharmacy or drug store and may be quite useful Try to get something fresh every day. A malt or a shake with fresh fruit and a vitamin supplement blended in it is ideal. (e.g. juices, smoothies, puddings, yogurt, etc.) Start drinking from a cup as soon as you’re physically able to. Your upwards trek back to having full energy begins the day you can throw your syringes in the garbage. Eat solid food as soon as your surgeon gives you the go-ahead. It’ll be a slow, tedious and frustrating process, but you need to go through with it in order to build your jaw muscles back up and learn how to chew properly once again. Hygiene Brush and rinse using a small amount of toothpaste and mouthwash. Oral hygiene is the single most important thing you can do to minimize possible infections. After each meal, brush your teeth with a soft-bristled toothbrush (child-size works well). Stand over the sink with your head tilted down and use a circular motion and angle the brush at 45 degrees toward the gum line. Use Peridex or a mouthwash without alcohol such as Biotene instead of toothpaste. Brush to the best of your ability and take your time. You may not be able to brush the inside of your teeth. Rinse your mouth with a solution of warm salt water (1 teaspoon salt in one 8 oz glass of warm water). Oral rinsing should be done after every meal. A moistened Q-tip or cotton swab may be used to wipe over the gums and tooth surfaces when brushing is impossible. You may follow brushing with a mild fluoride mouthwash to leave your breath and tongue feeling refreshed. Avoid the use of products such as lemon glycerin swabs and commercial mouthwashes containing alcohol (these products can have a drying or irritating effect on the mucous membranes in the mouth). Use a Waterpik ONLY if ordered by your surgeon. If any skin incisions were made, clean them with 50% peroxide-water solution, remove scabs and apply Neosporin. At times, your breath may be indicative of the fact that you are not allowed to brush your teeth or floss during the first several weeks of recovery. To aid in freshening your breath, try gurgling with warm salt water a few times each day. Soon enough, you’ll be given the go-ahead to brush and floss again. Activities Take it easy the first week. You may resume most of your normal routine after the first week as tolerated. Avoid activities that might cause an injury to the face (athletic like football, basketball, racquetball, weight lifting, etc.). Aerobic exercises may be started after two weeks. For the first 3-4 days following surgery please limit your activity. It is important that you not confine yourself to bed. Try to spend most of the day sitting in a comfortable chair and taking short walks around the house. You should limit your visiting time to 1-2 hours. Although you may feel well, you have had a major procedure and your body needs to recover. Uninterrupted rest is very important in your healing period. Do not participate in sports or strenuous activities, or return to work until permitted by your surgeon. Driving any motorized machinery or vehicle or signing any legal documents while taking pain medications is not recommended. The pain medications may cause alterations of visual perception and impair judgment. Medications Antibiotics use only the first 4-6 days following surgery. Use pain medications only as needed. Anti-nausea use as instructed and notify doctor if relief is not quickly obtained. Acute pain management should always start with over-the-counter pain medications, such as acetaminophen (Tylenol®) or ibuprofen (Motrin, Advil). If your surgeon approves these medications for you, you should take them as directed on the pill bottles, or by your surgeon. If you take the first pill before the anaesthetic has worn off, you will be able to manage any discomfort better. Precede each pain pill with a small amount of food, and chances for nausea will be reduced. The effects of pain medications vary widely among individuals. For severe pain, you may take your prescription opioid (narcotic). Do not take more opioid pills, or more often, than prescribed by your surgeon. If prescribed, Vicodin / Norco may be taken every 4-6 hours for pain. DO NOT USE TYLENOL. If you notice that the pain medication is not providing comfort for long enough, alternate the Vicodin / Norco and Ibuprofen throughout the day (ex: take 1 Vicodin, then 2 hours later, take ibuprofen. 2 hours later another Vicodin / Norco). If your pain is chronic (i.e. consistent and throbbing), you may have an infection and should schedule a visit with your surgeon just to be safe. On the other hand, if your pain comes in small bouts, it’s likely your nerves reawakening or your teeth being pulled by the elastics. In this case, just be patient and the pain will subside in due time. If you were prescribed pain medication, that may help as well. Nausea/Vomiting DON’T PANIC. Use medications as instructed. For mild vomiting or any empty stomach feeling lay in a face down position to allow fluids to drain out of mouth and nose. Notify the doctor of any nausea problems. Swelling The swelling will not become apparent until 1-2 days following surgery and will not reach its maximum until 2-3 days post-operation. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the side of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 48 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of gentle moist heat to the sides of the face is beneficial in reducing the swelling and stiffness. Sleep with your head elevated on two pillows for the first week. Exercises Most often following these type of procedures, teeth must be kept together with wires or elastics after surgery. This allows the jaw bones to be held still while healing. Most of the time small bone screws and plates are used to hold the bone segments together during the healing period. With the use of these screws and plates, the jaws can still move slightly during the post-operative period. It must be remembered that the bones are not healed and are simply held together by screws and plates. Therefore, a gradual progression of movement and use of the jaws is encouraged, keeping in mind that complete healing does not take place for approximately two to three months after surgery. Immediately following surgery: Since surgery causes soreness in the muscles and bones of your jaw, movement will be difficult initially. We do not recommend any specific exercises during the first week to ten days after surgery. 10-14 days following surgery: Stand in front of a mirror and attempt to open and close your mouth. At ten days you should be able to get at least 1 finger between your teeth. This will increase gradually in the next several weeks. Simply move your jaws open and closed then side to side. Moist heat to the side of your face prior to these exercises can be beneficial. Do not use your fingers to force open your jaw. 4-8 weeks after surgery: At this time you should be able to get 2 fingers between your teeth comfortably and can begin using gentle finger pressure to stretch your jaw muscles. By week 8 you should be able to get 3 fingers between your teeth. Again, stretch the muscles open and closed as well as side to side. Breathing Difficulty Following your procedure, you will develop difficulty breathing through your nose. This is a transient problem that peaks at about day 3-4. You may feel that your airway passage is being blocked by the swelling, but be assured that there is plenty of room to breathe through. Limit your activity to reduce post-operative swelling and bleeding. Dried blood in the nasal passages is best cleaned by the spraying of saline spray and gentle suction with the bulb. Repeat this process as needed until nasal passages are free of dried blood. You may use a facial humidifier or steam in the shower to help loosen nasal secretions prior to suctioning. DO NOT blow your nose following surgery for a minimum of two weeks. Use Afrin Nasal Spray as directed by your surgeon. Sleep with your head elevated on two pillows for the first week. Miscellaneous Use nose spray if needed and no more than twice a day. Use ointment on lips to reduce swelling and avoid drying and chapping. Sleep with head elevated (2 pillows) the first week then normal elevation after that. Sleep with your head elevated on two pillows or in a comfortable recliner chair for the first week following surgery. Before you attempt to pull any dead skin off of your lips, be absolutely certain that it’s not a stitch. Start using medicated lip balm immediately following your return to your own home. If you don’t, you’ll end up with flaps of dead skin that are half an inch in diameter, and I promise you they won’t feel good when they catch on your braces. Begin each day at a decent time. If you sleep most of the day, you won’t be able to sleep at night, and you’ll hate yourself for it. Get out of bed, shower, eat some breakfast and brush your teeth and you’ll enjoy each day a lot more. (This is good advice for any day of your life, but it especially applies when you’re on the verge of depression from having jaw surgery.) Go to bed on time. Yawning will cause you quite a bit of pain, so prevent it by getting the right amount of sleep during the proper hours.