What To Expect Before & After Surgery

What to Expect Before Surgery

Scheduling

After your evaluation at Kahana Oculoplastic and Orbital Surgery, our surgery scheduler will determine if a prior authorization is required through your insurance. Sometimes, this can take a few months to obtain. We cannot schedule your surgery until your insurance has approved it. Please be patient while we work hard to ensure your surgery is approved. Our surgery scheduler will call you when it is approved and will help you schedule at that time.

Hospitals where Kahana Oculoplastics and Orbital Surgery operates

St. Mary Mercy Main Hospital in Livonia
St. Mary Mercy Outpatient Surgery Center in Livonia
William Beaumont Hospital in Royal Oak
Blakewoods Surgery Center in Jackson

Medications to stop prior to surgery

If you take blood thinners or medications that inhibit clotting, you will be asked to stop these prior to surgery. The length of time before surgery will depend on the specific medication. Your primary care doctor and/or cardiologist will need to approve this, and you will be asked your cardiologist’s name, phone number and fax number if cardiac clearance is required.

Additionally, a pre-op nurse from the hospital will call you prior to surgery to discuss all your medication and when to stop which medications prior to surgery. These will include supplements and vitamins.

COVID-19 testing

You will be asked to follow specific hospital guidelines for Covid testing – we will advise you on policy, and you will be called by the hospital with instructions.

Considerations for surgery

You will be required to have a driver present the day of surgery, and someone to stay with you the first night after surgery.
You will be required to stop eating by midnight the night before surgery, or 8 hours prior to surgery.

What to Expect After Surgery

Every patient will have detailed post-operative instructions provided to them on the day of surgery.

Medications prescribed on the day of surgery

Antibiotic ointment – for any periocular skin incision
Eye drops – for any surgery involving incisions behind the eyelids or on the eye surface
Anti-nausea medication – for any general anesthesia
Pain medication – based on patient history and specific procedure
Oral antibiotics – for patients at increased risk of infection post operatively

Resuming medication

You may resume all medication stopped prior to surgery on the day following surgery
EXCEPTIONS: blood thinners/clotting agents – to be discussed day of surgery
- Aspirin, Eliquis, Plavix, Ticlid, Lovenox, Xarelto, Effient, Brilinta

Common signs and symptoms to expect after oculoplastic surgery

Swelling
Bruising
Aching
Discharge from eye or crusting at eyelashes
Blood-tinged tears
Bloodshot eye
Blurry vision
Itching
Dry, scratchy eye sensation

Swelling and bruising will increase over the first few days following surgery. Swelling typically peaks at about 3-4 days after surgery. Bruising may last for 2-4 weeks, depending on whether you are on blood thinners. For these symptoms, you may ICE (unless strictly told not to after surgery) and ELEVATE the head of your bed while sleeping. After 4 days, you can alternate COLD and WARM compresses. For any eye irritation, you may use over the counter ARTIFICIAL TEARS, gels, or ointments as needed. Itching is a very common and normal part of the healing process. Ointment, icing and possibly oral Benadryl can help alleviate the itching. However, if the itching is excessive, you may have an allergy to the antibiotic ointment, and you should let us know.

If you had surgery in the tear drainage system, you may experience:

Bloody drainage and discharge from your nostrils
Blood-tinged tears
Tickling sensation in nose

Surgeries involving the tear drainage system often include STENTING, where a small silicone tube is placed in the tear drainage passageway to allow for proper healing. This tube is often tied in the nose, and so a small suture can tickle your nostril. It can also lead to excessive crusting in the nose. After surgery, please use over the counter SALINE NASAL SPRAY 3 times daily to the nose. Your stent will likely stay in place for 6 months, and then will be REMOVED IN CLINIC. Avoid picking your nose, wiping your eye, or anything that might move the stent out of place.

If you had surgery that requires your eyelids to be sutured closed, you may experience

Significant crusting at the eyelashes
Tearing

Surgeries that require the eyelids to be sutured closed often require additional healing time of the tissues operated on. Surgeries may include: removal of the eye and fornix or ocular surface reconstruction. You will not be able to see out of this eye while it is sutured shut. There is no drop or ointment to use while the eye is sutured shut. You will have white foam pieces (“BOLSTERS”) sutured to the eyelid that should remain until removed in clinic. If you have a PATCH placed, your discharge instruction will detail when to remove it, and you may then get the area wet.

If you had a skin, cartilage, mouth, or fat graft, you may experience

Itching
Redness
Tenderness
Swelling
Bruising
Pain with eating

Sometimes, it is necessary to harvest a graft from elsewhere on the body. This may include a fat graft from your abdomen or inner thigh, a skin graft from an eyelid, neck or arm, a graft from inside your mouth, or a cartilage graft from behind your ear. For skin grafts and fat grafts, there may be a clear BANDAGE over the incision following surgery. This bandage (“Tegaderm”) tends to peel off on its own after about 1 week. If not, you may remove it at that time, then begin using over the counter dermatologic antibiotic ointment to the incision (e.g. Neosporin or Bacitracin). For any incision behind the ear, there will be no bandage and you may immediately begin using the antibiotic ointment to the incision. For mouth grafts, you will feel sore in the mouth; however the mouth tissue heals very quickly. Please swish and spit with dilute SALTWATER RINSE after each meal of the day. When you get a skin graft, you should avoid using cold compresses on the graft because it will interfere with blood supply to the graft. You may, however, use cold compresses on the DONOR site (where the graft was obtained from).

When to call Kahana Oculoplastic and Orbital Surgery (warning signs)

Loss of vision
Sudden onset bulging of the eye
Skin rash around the eyelids
Persistent bleeding
Drainage from the eye that is thick and yellow or has a foul odor
Persistent pain unresolved by pain medicine
Fever (greater than 102.5°F), coughing, shortness of breath, inability to urinate, persistent vomiting
New onset diarrhea
While post-operative swelling and bruising are normal and to be expected, they should begin to improve after 2-3 days. Some patients improve rapidly while others improve slowly. However, if you experience increasing eyelid swelling and pain 3-4 days after surgery, call us.