Pain is usually well controlled. Early postoperative numbness limits
pain. If bone grafts are used from the hip an indwelling catheter
infuses local anaesthetic into the hip area and pain should not be
The degree of swelling is probably genetically determined in facial
surgery and as such is not related solely to surgical technique. Intravenous
steroid drugs are used to reduce facial swelling; in some patients
this works very well with little or no swelling - in others swelling
is marked despite steroids and the eyelids may be closed for around
72 hours (rare).
Patients undergoing orthognathic surgery will be screened for the
common blood disorders associated with bleeding and clotting disorders.
On occasion bleeding may be severe enough to return to theatre for
an exploratory operation. This is rare circa 0.5% risk. In a potential
life threatening situation incisions in the neck may be required to
stop bleeding by tying off major blood vessels. If bleeding is associated
with major facial swelling a temporary tracheostomy may be required
to maintain the airway until swelling subsides.
Bruising may be marked in some patients and has an association with
smoking and drugs such as aspirin. Bruising is more likely in patients
who smoke, and persistent smokers should abstain from smoking for
a minimum of 1 month prior to surgery. Some bruising tendency runs
in families. The amount of bruising is not necessarily related to
surgical technique. Rarely bruising may be a manifestation of an underlying
undiagnosed blood disorder. Bruising may be visible for 6 weeks following
surgery and may travel down the tissue planes from the jaws to the
neck and even the chest (rarely).
In jaw operations the teeth are deliberately put into a position so
that the incisor teeth meet and the molar teeth are kept apart. This
is known as a posterior open bite ensures that the incisor teeth touching
for reasons of cosmesis biting, and speech. Following surgery the
bones move - especially in the maxilla which may be paper thin. The
incisor teeth act like a fulcrum and the molar teeth can be guided
into place with elastic bands. In some cases a small gap may persist
in the molar region. Generally this is clinically and aesthetically
acceptable and requires no additional treatment.
Infection is rare (circa <0.5%). Surgery is carried out under the
cover of intravenous antibiotics. Oral hygiene measures are required
pre and post surgery, when the teeth are cleaned with sponges soaked
in chlorhexidine (Corsodyl) mouthwash. This may temporarily stain
the teeth and tongue Teeth may require scaling and polishing to remove
the stain. It is important to keep the mouth as clean as possible
All wounds heal with a scar; there is no such thing as invisible mending
in cosmetic surgery. Scars are hidden by virtue of their positioning
in skin creases. Whilst most scars heal well, some scars become large
and noticeable (hypertrophic scars) and some scars may thicken abnormally
(keloid scars). The ability to form such scars may run in families.
Other scars may be related to infection.
It is the remit of the surgeon to make incisions in areas of skin
creases (Langers Lines) for the best cosmetic effect. Healing is generally
good in the facial area, but may be affected by inherent poor scarring
that is not in the control of the surgeon. Healing may also be poor
in areas where the scar breaks down in relation to poor blood supply.
This may be seen in facelift patients (especially smokers) behind
the ear where the scar approaches the hairline. Healing may be adversely
affected in patients who bruise excessively (smokers, aspirin, non
steroidal anti-inflammatory drugs, garlic, Chinese food etc). Wound
breakdown from infection is rare in facial surgery. Revision surgery
may be required in cases of poor primary wound healing.
A particular problem may occur with cartilage of the ear and nose,
and is related to the poor blood supply of cartilage. If cartilage
becomes surrounded by excessive bruising, or becomes infected, it
may die; this affects the contour and shape – resulting in the cauliflower
ear often seen in rugby players or in collapse of the cartilaginous
skeleton of the nose. The cartilage may become painful and inflamed
(chondritis) in some patients. Treatment may involve further complex
surgery and reconstruction of the deficit.
||Titanium Screws and Plates - Why Titanium
There are 6 good reasons to utilize this material:
i) Titanium has, as a pure metal, an extraordinary tissue compatibility
and resists corrosion from exposure to air and the biological environment.
Therefore, Titanium is especially suited for long-term implants and
can, according to today’s knowledge, remain indefinitely in the body.
ii) Titanium implants remain chemically inert and corrosion-free.
Material-related damage to the tissues is impossible.
iii) Titanium plates can easily be fully adapted to the contour of
iv) Titanium screws can be anchored tightly into bone and resist loosening.
v) There have been no reports of allergic reaction to titanium.
vi) The use of stainless steel screws and plates interfere with future
CT scan and MRI scan images. The use of titanium overcomes many of
Some titanium screws and plates may be palpable under the skin in
some patients. This may be annoying and is more likely to occur where
the skin is thin e.g. near the lower eyelids eyebrows and nasal bridge.
The problem may often be prevented by using small plates or microplates
in the areas of thinnest skin. Collagen sheeting may be placed over
the plates in these areas to reduce this complication.
Some patients (circa 3%) may find some irritation in areas of screw
placement and may request that the screws and plates be removed as
a short procedure under general anaesthetic.
Some degree of facial asymmetry is within normal anatomical boundaries,
and is not possible to eliminate. Whilst some asymmetry should be
expected following any surgical procedure, this should be compatible
with pre-existing anatomy that has not been altered.