Heat or cold after surgery?

In cosmetic plastic surgery, like in most other surgeries, swelling after surgery is a common though unloved sequel. Swelling causes pain. On a daily basis I get asked whether my patients should place ice or a heat source on the area of swelling in order to make it dissipate faster.

The answer is that it depends!

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Skin’s response to injury

After any type of cosmetic plastic surgery, or any trauma for that matter, there is an initial period of the blood vessels in an area of surgery becoming “leaky.”  Blood flow to the injured region also increases.  Lymph, blood without cells, that leaves the actual blood vessels takes white blood cells, nutrients, oxygen and other chemicals necessary for the healing process to begin into the injury. This “leakiness” of the blood vessels is initiated by chemicals that injured cells release. Lymph that accumulates around cells and the enlargement of  cells themselves is what we call swelling!

Ice and swelling

Placing ice or otherwise cooling the skin directly after injury will cause several things:

1. Blood flow decrease as the blood vessels constrict

2. Less blood flow means less lymph is delivered to the skin, which means less swelling

3. Cellular chemicals causing the leakiness are reduced

On the other hand, ice will also decrease delivery of  important nutrients, oxygen, white blood cells and proteins needed for the healing process to begin. Not only that, the ability to fight infection is decreased and normal mechanisms of our biochemistry begin to fail.

If you cool the skin for too long, it will not heal, and the cold can even cause a burn and injury. That is frostbite!

Heat and healing

Heat does the opposite in terms of skin blood flow:

1. Blood vessels dilate and more blood comes to the skin

2. More lymph is leaked into the tissues, causing more swelling

3. Cellular engine is revved up and more energy is used up

Another important factor in applying heat to an injury is that with injury, the skin is usually numb; the danger of burning skin is real and unfortunately all too common from our misconception that heat always helps healing. It doesn’t.

What to do after plastic surgery

It is apparent that after cosmetic and plastic surgery, there is a need for both ice and heat, and both temperature extremes affect the healing process. It is thus important to know what to do and when.

Immediately after plastic surgery: ICE

– Place ice on the area of surgery and the skin above and below it. Blood reaching the injury site has to travel through the skin surrounding the site and can be cooled off. Putting ice on a thick bandage is not particularly helpful if it does not actually cool the area.
– Ice the area for 48-72 hours; the rule of 20 minutes on and 20 minutes off applies only to placing ice on the same area. Ice the whole time—just move the ice pack from region to region every 20 minutes.
– Do not forget to also elevate the injured part. That alone will decrease swelling and pain.

3 days after cosmetic surgery to 3 weeks after surgery:

– The need for ice is lower at this stage and it will do less for you because the swelling has already set in. Continue to use it, though, in areas of swelling to allow for your comfort, as ice can help decrease pain by simply numbing the skin.

3 weeks after cosmetic surgery to 6 months after surgery: HEAT

– Heat may be helpful during this time to soften areas of scarring and skin tightness that occur as part of the normal healing process. Warm baths, Jaccuzis and showers are best. I would still be very careful with applying heating pads to an area of injury, as I have seen horrific burns occur from just such a practice.
– Heat will increase the circulation of blood, bringing proteins for healing and taking away waste.

Be very sure you do not apply heat after surgery as you can risk major burns in the areas of operation!

In conclusion: Ice now, heat later!

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