Recovery Riddle

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue, plastic surgeon,

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educator, and technology innovator.

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Today's episode is Recovery Riddle.

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Okay, Dr. Bass, I have an idea about
what this is about, but to be sure,

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fill me in a bit. What's
the riddle with recovery?

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We all know treatments and
surgeries can have recovery,

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and we accept this as part of the way
things are at least in the abstract.

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But when it comes time to
go ahead with a treatment,

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many people are reluctant to step

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out of their day-to-day schedule.

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We all lead busy lives and it's hard
to make the time to get something done,

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and in a lot of ways we become more
reluctant to be pulled out of full

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activities. After the pandemic,
we spent so many months,

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years locked up at home, not going
into the office, not socializing,

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not traveling.

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And so now that we're back,

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we have that fear of missing out.

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We don't want to have to be
laid up again and spend a

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few days or a week or whatever
the recovery interval will be.

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A lot of people during the pandemic
actually took advantage of the fact that a

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lot of those activities stopped.
Some of my patients who had business

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travel for the last 20 years
and never had a good time,

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finally had no business travel and they
were at home and able to do it or they

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were working remotely and it was
easier to put in or remote interval

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recovering at home than
before the pandemic.

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So some people squeeze things
in during the pandemic.

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That's part of it.

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Part of it is how to
explore recovery time,

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but basically if you're avoiding
avoiding avoiding recovery

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time, you end up with pent up desires.

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And then often there's precipitous
decision making that I'm going to go ahead

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with something or you have to go ahead
with something because you have a wedding

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coming up, a big family event,

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something where you have to refine
your appearance and you end up doing

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it when you don't have enough time.
When if you planned a little better,

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it would've fit in much
better with your schedule.

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So I'm kind of beating the drum
here for planning for biting

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the bullet and getting the benefit,

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and that's what this episode is
about, how to figure that out.

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That makes sense. So how does all of
this factor into patient decision making?

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So the number one factor
that I see in my patients in

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deciding to go ahead
with a surgery or even a

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treatment, it's not surgery,
is the recovery time.

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That's the number one thing that makes

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patients decide whether or not
they're going to do something.

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They're willing to have
this or that surgery,

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and then when it's time to actually put a

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number on it, basically pick
a date when you can do it.

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That's yet another stumbling block
when the idea of recovery time

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arrests people, they can't
commit to a date, okay,

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I'm going to take a week off
starting the 5th of November or

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whatever. They know they want to do it,

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but they're not ready to step out of daily

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routine and make that commitment.

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Got it. I know it's
intuitive to an extent,

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but what do you mean by recovery?
Can you give me a working definition?

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So this is actually really important
and that's a great question.

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Traditional recovery time means a limit in

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activity that could be mild,

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like you can't go to the gym or it
could be almost total like you have to

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stay at home lying in bed.

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And so that's one kind of recovery
time where you're really sidelined

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from work, socializing,

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running errands because you
need to rest at home to allow a

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surgery to heal safely. That's
one kind of recovery time.

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There's the recovery time where
you're off sports spending,

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lifting heavy exertion, that's
another kind of recovery time.

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That interval's going to be different
from your lying around at home time.

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And then there's something we
sometimes call social recovery time.

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This is a period of
time when you feel well,

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you're able to do everything physically,

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both in terms of how you feel and
in terms of it being medically safe,

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but something is showing in
your appearance that makes
you not want to be seen

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by family, friends, coworkers, the public.

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So social recovery time,

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and this is more associated with
treatments than with surgery.

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But even with surgery, there's a
period of time when there's bruising,

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swelling when you may feel perfectly fine,

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you could work on the telephone,

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do paperwork at home,

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but you don't really want people to see
you yet because they would be able to

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see that you are
recovering from something.

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Okay. Now that we know the definitions,
we need to talk about amount,

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what do you tell patients
about recovery, Dr. Bass?

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Usually patients hear are a
simple bottom line number.

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Recovery is two weeks, but
as we just pointed out,

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first of all, what kind of
recovery? There's more than one.

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And if you have a surgery, there's going
to be some lying around recovery time,

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and then there's going to be some
out of the gym recovery time,

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and there may be a third number
for social recovery time.

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But separate from that,

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those numbers represent an average.

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And if you want to look deeper at
each of those kinds of recovery,

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you have to think of an average number.

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That's what if we took a
hundred people, lined them up,

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gave them a certain treatment and
measured how much time it took till

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they could go back to work
or till they could socialize.

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That would be the average number.

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But there's also a range in that group
of a hundred people. Most of the people

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are going to be clustered around that
average number cluster or minus a day or

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two. But a few people are
going to be really lucky.

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They thought they were
going to have two weeks off,

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but at a week they look good and
they feel well and they're ready

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to be back out and around. And there'll
be some people who are unlucky,

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they bled a little more,

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they really got knocked out
by the stress of the surgery

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more than most people do or some
reason we can't put our finger on.

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But it's just taking them
longer to get back to normal.

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And so no one can promise you a number.

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They can tell you what
the average number is,

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what the average number is in their
experience, in their practice,

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but they also are going to hopefully
give you an idea of what the range

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is like,

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and they may be able to tell you a
little bit about if you have a risk

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factor that might modulate
your risk up a little bit.

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If you know you're a bruiser,

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you brush by a desk and you get a big
purple bruise on your thigh for two or

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three weeks,

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you're probably going to have a little
bit longer recovery time than average if

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you have a mild clotting disorder
or some other medical condition that

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can just increase for your recovery
time a little bit, your healing time.

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That's really interesting. I didn't
realize how in depth recovery can be.

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Based on these numbers,
how should patients plan?

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So this is the practical
dimension because the idea behind

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doing this episode was to help people
think a little bit about how they should

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think and make decisions
with their aesthetic plan.

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So I suggest the first thing
is to get a consultation or

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sometimes two or three if
you want a few opinions,

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find out what procedure you need,

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don't assume you know
what procedure you need,

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and then find out from the surgeon
what their projection is of recovery

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time because a lot of
people think they know,

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but that may not be
what it is currently in

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2024.

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So you try to work on
recovery estimates that the

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expert is telling you
work in their practice,

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and the name of the game for us in modern
aesthetic plastic surgery is telling

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patients as close to hitting
the nail on the head as we

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possibly can what recovery is
like, I can't tell someone,

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well, it could be up to three months.
I mean,

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no one can take three
months off in modern life.

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That just doesn't work the way
it worked decades ago in plastic

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surgery. We've got to be able
to let you plan very precisely.

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We can never promise. There can
always be variation, but we've got,

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it's our job to get as close as
we can so that you don't have

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some disruption so that you can plan.

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I also recommend that
you don't put it off.

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You plan a time that will give you
a window of activity around major

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work obligations, big trips,
big family obligations,

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but you have to put some priority
around getting the procedure done.

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And it depends very much on how
much recovery is involved. For many,

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many things, it's just a long weekend,

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and so you wait for the time of year
when there are some three day weekends or

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when it's easy to take a day off of work,

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something like that.
It's never a good time,

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but it's fun to do these things.
It's fun to get the change,

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and so it's worth the commitment
of time. Sometimes it's a vacation.

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A lot of my patients really want to
save those for fun. They want to travel,

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they want to go out and do sports,

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and being laid up with the surgery
is not going to let them do that.

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But sometimes you get that

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years long result of doing
a surgery and that aesthetic

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change that you've really been
bothered and bothered for years

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by an aesthetic feature, you
finally get that addressed.

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That's really worth
putting some priority on.

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A lot of patients will come in the
office and do the consultation they

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can because for a reason,

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because some future was bothering
them enough to make a visit to

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the doctor's office. If it's
bothering you enough to do that,

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it's probably worth the bother of doing
the procedure if there's a reliable way

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of improving the feature.

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So it's worth leaving enough
time to do those things,

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and that's the final point.

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He didn't need to leave enough time
to heal properly so you get a great

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result. And trying to
short circuit things,

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going back to activities prematurely,

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is asking for a complication
or a healing delay,

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something that we're really,

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really trying to avoid in
aesthetic plastic surgery.

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And that is avoidable if
you play by the rules,

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but all of those rules
exist for a good reason.

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All of that makes a lot of sense. Now,

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can you give me some specific
examples for surgical procedures?

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Well, they can. First of all,

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each surgeon's going to be a little bit
different based on his or her technique

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and his or her management
program for patients

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afterwards. But typically for
most facelifts or neck lifts

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period, somewhere between
one and two weeks is enough.

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I usually tell patients a week
to a week and a half is you're

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out of the public eye
recovery time and two

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weeks if you're really trying to
keep it a state secret. For eyes,

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it's usually five to seven
days. For liposuction,

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for most liposuction areas
and for an average liposuction

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volume, say two to three liters,

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it might be a few days off of
the office like a long weekend.

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If you're doing a very large volume
liposuction, that's a different story.

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And for very small areas,
the recovery is very short,

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typically minimum.

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Adominoplasty is the big one.

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Adominoplasty is somewhere
between one and two weeks off of

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work. Breast augmentation,
typically a week off of work,

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breast lifts, breast reductions
between one and two weeks. Typically,

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this is going to be modulated.

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If you're doing multiple
procedures at the same time,

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you're going to start
inching up on recovery.

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And if you're just doing
a single treatment,

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most of the time can hit these numbers.

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And what about nonsurgical treatments?

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So these numbers are all over the map,
depending on what the treatment is,

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where injectables, Botox, fillers,

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there's usually no recovery,

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but there's often a little drop
of swelling or shape irregularity

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early on, settles for a few days.

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You are more aware of it
than other people are,

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but there's always a bruising risk.
Anytime you break the skin with a needle,

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you can get a bruise and
if you get a bruise that,

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it's not going to keep you out of the gym,

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it's not going to keep you from
traveling, but it's social downtime.

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A little faint bruise might
hide with little makeup,

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but for a very dense purple bruise,

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takes a couple of weeks to go away
and does not conceal very easily with

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makeup. So that's the injectable
story. Energy treatments, again,

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are all over the map and
there's a lot of variation,

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both based on what the
treatment is and on how

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skin reacts.
Some people have very sensitive skin,

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they get red, they stay very
red or very swollen longer,

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and other people have very tough
resilience skin that doesn't react

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very much when they get even
fairly aggressive treatment.

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So there are treatments like Ultherapy
and sSofwave that are skin tighteners or

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skin lifters and they have no social

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downtime. You look and feel
normal right after the treatment.

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There are things like IPL,

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intense pulse light treatments
or broadband light treatments,

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microneedling treatments where
you can have almost no recovery.

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The skin might look a little
kicked up for a day or two,

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but you can do most of your
social and work activities

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or you could get a lot of
redness, a lot of swelling,

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a lot of irregularity on the surface
with a microneedling treatment that may

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take several days to settle down.

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That's going to depend on the energy
device. It's going to depend on your skin.

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It's going to depend on how aggressively
the treatment needs to be done,

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how severe your features
are that you're treating.

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And actual resurfacing
treatments that leave a raw

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skin surface obviously have healing time,

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and that's both social recovery and
sometimes some staying at home recovery

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time.

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But those things usually won't keep
you out of the gym or exertion or

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affect how well you feel.
They just affect how you look.

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Okay, so in summary,

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what would you tell patients about
recovery time and surgery or procedures?

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So nowadays, procedures are
faster, easier, and more reliable.

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That's the good news,

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and that means that recovery
time is telescope down,

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but there still is some
recovery time required.

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So before you do something,

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understand what exactly to expect
so you can plan an appropriate

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amount of time and also
build a small buffer

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in because there is some
variation. Don't say,

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"well,

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I assume this is going to go the
same as the best person who ever had

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this treatment in the history of
humanity," because you might be the second

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person, but not likely.

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You're probably going to be
somewhere around that average.

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But give plus or minus a day just in case.

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Get a consultation from an experienced
aesthetic plastic surgeon to find

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out what the number is.
Don't assume you know,

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and doctor internet doesn't
always give you the right answer,

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and it may not apply to the particular
technique or approach that the

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surgeon you are working with uses

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overall. What I'd like to say
to patients is build enough time

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in your life to pursue your
priority aesthetic items.

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If you're going to do
something sooner or later,

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you may as well do it
now and enjoy it longer.

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If you really think you're going
to live to be 90 or 100 and never

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do X, Y, Z procedure, fine.
Put it off. Put it off.

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If you change your mind, you can do it.

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But if you're going to do it sooner or
later and you have a moderate amount of

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that change or that undesired
attribute that the procedure's going

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to fix, if you do it sooner, you're going
to get to enjoy it that much longer.

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That's true with anti-aging
or rejuvenation aesthetic

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surgeries. And it's especially true
with things that change your appearance,

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rhinoplasty, facial implants,

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other face shaping or body shaping
things where you're going to keep that

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change for years, years,

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years rather than suffering
with a future you're not happy

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with. Bite the bullet, commit the
recovery time and get what you want.

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As I said, plan enough time to heal
well so you get a great result.

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Don't break the rules.

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The rules are designed to prevent
you repeating someone else's problem.

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We learned a lesson, a rule
was made, how to avoid that.

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They're not arbitrary. They're not
just to make things inconvenient.

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You modulate your recovery a little
bit based on where your privacy

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thermostat is set.

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Some people don't want anyone to know
except the one or two immediate family

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members and other people are
much more public about it.

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Practicing in the Northeastern United
States where people tend to keep it a

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secret except from one or two
close friends and family members,

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and if you live in other
parts of the country,

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you tell everyone and show everyone.

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But if you are in a place
where you're not telling,

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you need to plan a drop more time
than if you're in a place where you're

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comfortable telling and showing
everyone, I will tell you,

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it's hard to keep it a
secret from immediate family
members who you live with,

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but some people try and
succeed in doing that. But

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you don't want to get caught
and outed if you don't have to.

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So sometimes it's better
to just stay ahead of time.

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So there's never a good time to do
a plastic surgery because we lead

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busy lives. We have a lot of fun,
interesting, and important things to do.

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It's like having children.
There's never a good time,

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but you want to be sure to get it done
or you'll really miss out on something

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worthwhile.

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So everyone at the end of the day has
their own solution to the recovery

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riddle, the right time
and the right place.

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It's a very worthwhile riddle
for everyone to solve for

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themselves,

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and I wish the listeners good luck
in solving this recovery riddle.

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Thank you Dr. Bass for giving me a better
understanding of the ins and outs of

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recovery time and the
reasons and motivations for
working aesthetic treatments

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into my busy New York schedule.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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Follow us on Apple Podcasts,

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00:21:11,230 --> 00:21:13,450
write a review and share
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00:21:13,630 --> 00:21:17,140
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00:21:17,140 --> 00:21:20,710
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contact us with comments or questions,

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Send us an email at
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00:21:26,500 --> 00:21:27,250
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