The First Forty-Eight Hours, Hour by Hour

Consultations cover risk and results. They tend to compress recovery into a number of days off work. The forty-eight hours after a facial procedure are the period patients most often describe as the part nobody prepared them for — and the period in which the most regret is felt, almost all of it temporary.

Hours 0 to 6

You will be groggy, cold, and thirsty. Swelling is minimal at this stage, which misleads people into thinking they have escaped it. Vision may be blurred if the eyes were involved, from ointment as much as from oedema. Most people sleep.

Hours 6 to 24

Swelling begins in earnest and does not peak yet. Sleeping upright is not optional and is uncomfortable. Bruising, if it is going to appear, starts to surface — often in places that were not operated on, because blood tracks downward with gravity. Discomfort is usually described as pressure and tightness rather than sharp pain.

Day one I felt fine and thought everyone had exaggerated. Day two I understood.

A patient, eight months post-operative

Hours 24 to 48

This is generally the worst window: peak swelling, peak bruising, and the first honest look in a mirror. Almost every patient reports a version of the same thought at this point — what have I done. It is close to universal and it is not predictive of the eventual result.

• Arrange a second adult for the first night, not just the first evening.
• Set out everything you need at waist height before surgery; bending increases pressure.
• Expect not to want to eat. Have cold, soft, unambitious food ready.
• Cover mirrors if you know yourself well enough to know you will look.
• Write down the on-call number and put it somewhere you will find it at 3 a.m.

When to call

Sudden asymmetric swelling on one side, pain that escalates rather than plateaus, fever, or a rapidly expanding bruise are all reasons to call immediately rather than wait for the morning appointment. Practices expect these calls. Making one is not an imposition.