Recovery after facelift or neck lift surgery always involves some degree of swelling and bruising, independent of technique, surgeon, and your individual anatomic factors. “I do both SMAS lift surgery and deep plane face lifts and neck lifts,” says our facial plastic surgeon Dr. Inessa Fishman, “and recovery is, of course, always a big concern for patients.” For best results and most reliable, least complicated recovery, Dr. Fishman likes to use surgical drains after face lift and neck lift surgery, and she addresses some of the most commonly asked questions about drains below.
What are drains, and how are they used?
Drains are small plastic tubes–about the diameter of a skinny shoelace–which Dr. Fishman places under the skin of the face and neck during facelift surgery to remove excess fluid during post-surgery recovery. Part of the drain has openings along its length, and this part is placed under the skin to suck out old blood, excess numbing medicine, the serum which the body builds up during healing, and sometimes saliva (if the salivary glands under the jawline were trimmed during surgery). While the perforated or hole-filled part of the drain is within the tissues, the solid and non-perforated part is on the outside of the skin, usually secured to the skin with a few small stitches, and connected to a plastic reservoir called a hand bulb. The bulb applies a low-grade continuous suction to the tube, to withdraw excess fluid from the tissues.
“Drains are very helpful to minimize the amount of swelling and bruising I see after surgery,” notes Dr. Fishman. “I used drains for big cancer surgeries and reconstruction during my training, but was taught not to use them for elective and cosmetic lifting procedures,” she says. Dr. Fishman did not use drains for the first 5-6 years of her practice, but changed to drains when she started doing deep plane face and neck lifting procedures. “My bruising rates are decreased by over 50% with drains, and the amount of swelling and delayed seromas (or fluid collection under the skin) has decreased by probably more than two thirds for patients,” she reports.
Surgical drains are not a new concept, with their first use extending back to Hippocrates around 400BC. Drains are used in the setting of infection and abscesses, and clean surgery, like an elective neck lift procedure.
How long do drains stay in? Do they come out by themselves?
Dr. Fishman keeps post-surgery drains for 3-7 days; she removes them in our office by taking off the small stitch holding them in place, and then pulling out the drain tube. The drains are not meant to come out by themselves.
The amount of time the drain stays in really depends on your recovery, medical history, medications, and the exact maneuvers Dr. Fishman carries out during your surgery. “I want the best outcomes and the easiest recovery for my patients,” says Dr. Fishman, “and while few people love drains, they do an excellent job of helping speed recovery.”
Do drains hurt?
Drains in themselves do not hurt. The stitch holding them in place may produce a bit of tenderness, but this tends to be intermittent, and is very manageable with Tylenol and Motrin.
Can I shower with drains in place?
Yes, absolutely. Clean water from the tap is ok on both the drains, the stitches holding them in place, and the plastic drain reservoirs. Dr. Fishman recommends against dirty water (such as that from lakes, pools, and oceans) on fresh incisions and drain sites for 3 weeks after surgery.
I had a facelift 12 years ago, and my surgeon did not use drains–why?
The use of drains is ultimately the surgeon’s preference, and depends on his or her experience and surgical technique. “I don’t think skipping out on drains is wrong, and I didn’t use drains for the first few years of my practice,” says Dr. Fishman, “but at the same time, I don’t think that not having drains makes your recovery easier, and I have found drains to be beneficial in my hands and for my patients.”
Are you interested in facial rejuvenation? Have you been pondering a neck lift or a facelift? Schedule your consultation with Dr. Inessa Fishman and our expert team to learn more about your treatment options.