Preparing for Surgery
Preparing for surgery ahead of time can help support a smoother healing and recovery experience afterward. The following guidelines are designed to help you feel prepared, comfortable, and supported as your surgery date approaches while helping optimize the healing process before and after your procedure.
Starting Now
- Stop smoking and all nicotine products (including patches and gum). Nicotine slows healing.
- Lab work: Dr. Balikian requires certain laboratory tests to be performed either prior to or following surgery. If any tissue is removed during your surgery (skin lesions), Dr. Balikian may choose to send it for pathologic examination. All laboratory work will be an additional expense and may be covered by your insurance company.
- Medical clearance: If required, you will be notified to obtain medical clearance from your primary care physician or specialist prior to surgery. Our team will guide you through the process and assist with coordinating any necessary testing or documentation.
- Medications: Your prescriptions are important for surgery and recovery. These are not included in your surgery fee. A list of your medications will be provided to you.
Starting 2 Weeks Before Surgery
- Take Vitamin C (1000mg daily) to help reduce swelling and bruising and aid in your healing process.
- Do NOT take aspirin or ibuprofen. These can cause bleeding. See list of all medications to avoid.
- Use acetaminophen (like Tylenol) instead.
- Stop drinking alcohol at least 10 days before and after surgery.
- Stop all vitamins and supplements unless your doctor says otherwise.
- Hair coloring:
- OK up to 1 week before surgery.
- Wait at least 4 weeks after surgery.
- Remove false eyelashes prior to surgery.
- Driver/caregiver: Please arrange for a responsible adult to accompany you home and remain with you for the first 24 hours after surgery. Your driver should plan to be available for the entire day of your procedure, as surgery times may change and pickup timing can vary.
Have Ready at Home
To help make your recovery experience more comfortable, we have curated a list of optional recovery items that many patients find helpful during the healing process.
- Extra pillows and old sheets
- Low-sodium, soft foods:
- Toast, oatmeal, yogurt, applesauce, fruit (avoid citrus, as they can interact with prescribed medications).
- Avoid salty and processed foods, as they can increase swelling.
- Supplies for aftercare of suture lines (complimentary and provided by our office).
- Aquaphor, Q-tips, hydrogen peroxide.
The Day Before Surgery
- Our team will contact you prior to surgery to confirm your arrival and surgery time. If you happen to miss our call, please contact our office at 858-230-8938 so we can review your final surgical details with you.
- Start following your medication chart, your medication timeline will be provided to you.
- Do not eat or drink anything after midnight (including water).
Morning of Surgery
- Shower and wash your hair and face thoroughly with antibacterial soap (if available).
- Remove all jewelry and valuables.
- Do NOT apply:
- Makeup
- Lotion, cream, moisturizers
- Deodorant
- Contact lenses
- Hairpins or wigs
- Wear:
- Loose, comfortable clothing (nothing over your head)
- Comfortable, slip-on shoes
- You may bring sunglasses, a scarf, or other articles to cover your dressings when leaving the surgery center.
- Take essential medications with a small sip of water (as instructed). This includes blood pressure or heart medications, thyroid medications, and/or an inhaler for asthma – your nurse will advise you.
- If you have opted to take Emend, please take one (1) tablet within one hour of your arrival for surgery with a small sip of water.
- If you have opted to take Journavx, please take two (2) tablets within one hour of your arrival of surgery with a small sip of water.
- Report to Ranch & Coast Plastic Surgery Center, 1431 Camino Del Mar, Del Mar, CA 92014.
- Check-in is typically scheduled approximately 30 minutes prior to your surgery time. Your nurse will contact you before surgery to confirm your arrival time, as scheduling and check-in times may occasionally change.
- Patients under 18 years old must be accompanied by a parent or guardian.
What to Expect on Surgery Day
We understand that the day of surgery can feel both exciting and emotional. Our goal is to help you feel comfortable, prepared, and supported throughout the entire experience. From the moment you arrive, our team will guide you through each step of the process and be available to answer any last-minute questions before your procedure begins.
The Operating Suite
- Your procedure will be performed in a fully accredited surgical suite with experienced specialists focused on your comfort and safety.
- After arriving, you will change into surgical attire and your belongings will be securely stored during your procedure.
- Before surgery, you will meet with Dr. Balikian and your anesthesia specialist for final preparation, surgical confirmation, and any necessary markings. This is also an opportunity to ask any remaining questions before surgery begins.
- Monitoring equipment will be used throughout your procedure to help ensure your safety and comfort.
- Prior to surgery, you may receive a detox photobiomodulation treatment designed to help support circulation, reduce inflammation, and optimize the healing environment before surgery begins.
Detox Treatment – Supporting The Healing Process
In this video, Dr. Richard Balikian explains how detox photobiomodulation therapy is designed to help support circulation, reduce inflammation, and optimize the body’s healing environment before surgery as part of the recovery preparation process.
The Recovery Room
- After surgery is complete, you will recover in the recovery room with a nurse closely monitoring you throughout the early stages of healing and recovery.
- Most patients begin waking up within approximately 15–45 minutes after surgery and may remember very little about their time in the recovery room.
- Recovery room time varies by procedure, but most patients spend approximately 1–3 hours recovering before being discharged home.
- Following surgery, you may receive a postoperative cellular repair photobiomodulation treatment designed to help support healing, reduce inflammation, and optimize the early recovery process.
Cellular Repair Treatment – Advanced Recovery Support
In this video, Dr. Richard Balikian explains how postoperative cellular repair photobiomodulation therapy is used after surgery to help support healing, reduce inflammation, and optimize the early recovery process.
Going Home/The First 24 Hours
- You cannot drive or go home alone; you must have someone (friend or family member) drive you home after surgery. You cannot be discharged to a taxi or rideshare unless you are with a caregiver.
- A responsible adult must stay with you for the first 24 hours after surgery.
Postoperative Care – Outpatient Surgery
The first few days after surgery are an important part of the healing process. The following guidelines are designed to help support a smoother recovery, minimize discomfort, and help you feel more comfortable and prepared as your body begins to heal.
First 48 Hours
- Very important, call us at 858-230-8938 if you have:
- Heavy bleeding
- Severe swelling
- Severe pain, unrelieved by pain medication
Care Instructions
- Showering: After 24 hours, you may briefly get your stitches wet in the shower (do not soak) and wash your hair. Pat the area dry after. Please shower at least once a day for the first postoperative week and follow cleaning instructions.
- Dressings: Keep clean and dry and do not remove unless instructed.
- Activity: Light walking is OK on a flat surface for the first two weeks. No heavy lifting or exercise no matter how good you feel.
- Cold compress: Dip a clean washcloth in ice water and apply to face. This will help reduce swelling, bruising and pain. Do not wake up from sleep to apply.
- Day 1: 20 minutes on / 20 minutes off
- Day 2: 20 minutes on / 40 minutes off
- Pain medication:
- Take as directed
- Always take with food to avoid nausea
- Take Extra Strength Tylenol (Acetaminophen) for pain and Benadryl (Diphenhydramine) for rest if needed
- Sleeping: Elevate your head with extra pillows or sleep in a recliner for the first night after surgery. After this and your dressing is removed, sleep on your back with one or two pillows.
- Diet: Start with light, non-greasy, non-spicy foods then return to normal as tolerated. If nausea is present, use prescription medication Zofran.
- Avoid salt: Causes swelling and prolonged recovery.
- No smoking for at least 10 days. Please tell us if you smoke.
- No alcohol until at least 10 days post op and you are off prescription pain medication.
- No driving for at least 5 days after surgery or while on pain medication.
- Follow-up appointments: Please attend all scheduled appointments. We can confirm these with you if needed.
First Week After Surgery
- Most patients return to normal activities (work, school) 10-14 days after surgery depending on amount of physical activity, public contact, swelling, and discoloration.
- A body temperature under 100°F is normal after surgery. If you develop a fever (above 100°F), it is likely due to dehydration from insufficient intake of fluids.
- Call the office if persistent temperature over 101°F
- It is completely normal to experience a range of emotions during the healing process after cosmetic surgery. Swelling and discoloration during the early stages of recovery can sometimes feel surprising or discouraging, but these changes are temporary and improve gradually with healing. Following your postoperative instructions carefully and allowing yourself time to recover can help support a smoother healing process. Please remember that your nurse and surgical team are here to guide and support you throughout recovery.
Patient Recovery Stories
1
/
4
I'm 52 and Wanted to Look Refreshed, Not Different, After My Deep Plane Facelift
My Deep Plane Facelift Recovery : What it's Really Like 5 Weeks After Surgery
At 64, She Finally Did It — Her Facelift Results Are Life-Changing
1
/
4
Every recovery experience is unique. These patient healing journeys are shared to help you better understand the normal stages of recovery, healing timelines, swelling, and emotional ups and downs that can occur during the postoperative process.
Activity timeline
Reminder to start back into activity slowly and gently.
- Weeks 1-2: Light stroll on a flat surface only. Avoid aerobic and impact cardio exercise
- After 2 weeks: Resume light exercise, light upper body weightlifting
- After 3 weeks: Resume aerobic exercise, light lower body weightlifting
- Note: Keep your head above your heart while exercising.
- After 6-8 weeks: Resume yoga, Pilates, golf, gym classes, swimming, tennis
General Surgical Risks and Additional Information
We want you to understand fully the risks involved in surgery so that you can make an informed decision. Although complications are infrequent, all surgeries have some degree of risk. All of us at Balikian Facial Plastic Surgery will use our expertise and knowledge to avoid complications in so far as we are able. If a complication does occur, we will use those same skills in an attempt to solve the problem quickly. The importance of having a highly qualified medical team and the use of a certified facility cannot be overstressed.
- In general, the least serious problems occur more often, and the more serious problems occur rarely. If a complication does arise, you, Dr. Balikian, and the nursing staff will need to cooperate to resolve the problem. Most complications involve an extension of the recovery period rather than any permanent effect on your final result.
Normal Symptoms
- Moderate swelling and bruising. If severe, this may indicate bleeding or possible infection.
- Mild to moderate discomfort or pain. If pain is severe and not relieved by pain medication, please call us at 951-719-2950.
- Crusting along incision lines, to be cleaned with soap and water in the shower and/or hydrogen peroxide. Do not pick at these and allow them to come off gently.
- Numbness (temporary) due to small sensory nerves being disrupted from the incision or undermining of the skin.
- Sensation gradually returns as the nerve endings heal spontaneously, usually within 2-3 months, often up to 9 months.
- Itching or tingling as the nerve endings heal. Moisturizers, gentle massage, and ice can be helpful.
- Scar discoloration of red, dark pink, or purple while healing. Scars on the face usually fade within 3-6 months, but it takes the body 12 months to fully mature incision lines.
Risks
All surgery has some risk, but most issues are minor and temporary.
Possible complications include:
- Hematoma/seroma: Small collections of blood or fluid under the skin that usually absorb spontaneously. Larger collections may require aspiration, drainage, or even surgical removal to achieve the best result.
- Watch for any abnormal swelling shaped like a walnut or goose egg. Please call the office if you suspect this.
- Infection that may require additional antibiotics.
- Abnormal scarring regardless of the most modern plastic surgery techniques. Treatment may include steroid injection into the scar, use of silicone sheeting, or further surgery to correct the scar. Some areas on the body scar more than others and some people scar more than others.
- Scarring on the face is usually minimal, even with a history of keloid scarring.
Medications to Avoid Before and After Surgery
The following list of medications does not include every medication that contains Aspirin or Ibuprofen. Before taking any medication prior to or after surgery please read the label carefully for the active ingredient aspirin, salicylates, and/or ibuprofen. If you are not sure whether it is okay to take a medication, please consult your pharmacist or contact your physician.
If you have any medical problems and are taking Aspirin, Coumadin, or Plavix, you must speak with your prescribing physician to determine how to adjust your medication in preparation for surgery. Failure to do so could result in the cancellation of your surgery. You are responsible for informing us if you have been taking any of the following:
| Advil/Motrin/Ibuprofen | Alka-Seltzer | Aspirin |
| Anacin | APC | ASA Compound |
| Ascriptin | Aspergum | Aleve/Naproxen/Naprosyn |
| Bufferin | CAMA | Contact |
| Coricidin | Coumadin | Daprisal |
| Darvon Compound | Dolene Compound | Dristan |
| Ecotrin | Equagesic | Excedrin |
| Femcaps | Fiorinal | Liquiprin |
| Midol | Norgesic | Novahistine with APC |
| PAC | Pepto-Bismol | Plavix |
| Phenaphen | Relafen | Stanback |
| Synalogos | Talwin Compound | Trigesic |
| Triphen | Trilisate | Triaminic |
| Vanquish | Zactrin |
NO BLOOD THINNERS TEN DAYS BEFORE AND TEN DAYS AFTER SURGERY – TYLENOL IS OKAY
NO Herbal Supplements/Vitamin Supplements/Non-prescription Medications
EX: St. John’s Wort, Evening Primrose Oil, Fish Oils, Ginko Biloba, Vitamin E, Energy Drinks.
Pure Vitamin C is OK
NO NON-STEROIDAL ANTI-INFLAMMATORY MEDICATIONS (NSAIDS) AND OTHER ANTI-INFLAMMATORY DRUGS
FOR EXAMPLE: ADVIL (IBUPROFEN), ALEVE, CELEBREX, MOBIC (MELOXICAM), MOTRIN, NAPROSYN (NAPROXEN).
NO WEIGHT LOSS INJECTIONS (OZEMPIC, MONJAURO, WAGOVY) 4 WEEKS PRIOR
NO ALCOHOL 10 DAYS PRIOR AND AFTER
Post-Surgical Recovery Support
Your comfort, safety, and healing experience are our highest priorities throughout the recovery process.
Aftercare Accommodations
We can help you arrange a stay at a recovery-friendly hotel or private setting with 24/7 nursing available upon request.
- 23 hour stay at Ranch and Coast Plastic Surgery Center
- Borrowed Hands- Julia Russell- She can call and set up a hotel room if needed. Phone: (760) 415-9998 – Price $795 and up
Kathleen Helen Listen, a certified lymphedema therapist and massage therapist, explains how manual lymphatic drainage massage can support recovery after facelift and neck lift surgery.
Lymphatic Massage
Treatments usually begin 10-14 days after the surgery date. Some patients find that twice-weekly massage works well for reducing the heavy, tight feeling of swelling.
Kathleen Helen Lisson
5755 Oberlin Dr. #333
San Diego, CA 92121
619-880-6538 • SanDiegoLymphaticMassage.com
Waisted Body Bar
2213 El Camino Real St. Suite A-118
Oceanside, CA 92054
760-470-7337 • waistedbodybar.com
Hyperbaric Oxygen Therapy (HBOT)
Enhance your healing and reduce downtime with hyperbaric oxygen therapy, a cutting-edge treatment designed to accelerate recovery, minimize swelling and bruising, and support optimal surgical outcomes by delivering concentrated oxygen directly to the tissues where it’s needed most.
Ranch and Coast Plastic Surgery
1431 Camino Del Mar
Del Mar, CA 92014
858-450-1555
Lymphedema therapist and Board Certified Massage Therapist Kathleen Helen Lisson shares a five minute breathwork and lymphatic drainage protocol that can be used after facial plastic surgery.
Guided Breathing and Meditation
Guided breathing after surgery may help promote relaxation, support circulation, and encourage the body to remain in a calmer healing state during recovery. Gentle breathing exercises can also help patients feel more grounded and comfortable during the early postoperative period.
Kathleen Helen Lisson
5755 Oberlin Dr. #333
San Diego, CA 92121
619-880-6538
Out-of-Town Concierge Experience
Your Journey, Seamlessly Managed
We understand that traveling for facial plastic surgery is a big decision and we’re here to make the process smooth, comfortable, and stress-free from start to finish. Our dedicated Patient Concierge Team is here to support you every step of the way.
Personalized Travel Assistance
Whether you’re flying in from across the country or internationally, we’ll help coordinate every aspect of your stay:
- Travel Planning: Flight coordination support and recommendations for nearby airports.
- Hotel Accommodations: Access to our preferred hotel partners with special rates and recovery-friendly amenities or Air BNB.
Pre-Arrival Coordination
Before you even arrive, we’ll make sure everything is in place.
- Virtual Consultations with your surgeon to discuss goals, surgical plans, and expectations.
- Preoperative Instructions & Timelines tailored to your travel schedule.
- Medication Coordination so your prescriptions are ready for pickup upon arrival.
Medication
For questions regarding medications, prescriptions, or recovery instructions, please contact our patient concierge nurse, Sam. She is available to help guide you throughout the surgical and recovery proces
Phone: 858-230-8938
Email: sbausback@drbalikian.com
From arrival to departure, our goal is to make your experience feel less like surgery and more like a personalized wellness retreat right at the beach. Our discreet and supportive team is here to help you feel confident, cared for, and completely at ease.
After Your Surgery
We recommend that out-of-town patients stay in the Del Mar area for 8 to 10 days following surgery, depending on the procedure performed. This allows Dr. Balikian to closely monitor your healing and ensure you’re recovering comfortably and safely before returning home.
Bespoke Post-Operative Support
For patients traveling alone or seeking added peace of mind, we offer access to a private recovery attendant through our trusted partner. This experienced professional provides one-on-one support during the first night after surgery, assisting with incision care, medications, and any post-operative needs that may arise, ensuring comfort and confidence during the most critical window of healing.
Once cleared by Dr. Balikian, you’ll be free to return home. Follow-up appointments can be conducted virtually to keep your recovery on track, wherever you are.
Daily Check-ins
You’ll receive regular follow-ups from our expert staff, and we are always available for any post-op questions or concerns.
Hotel Accommodations
To help make your surgical experience as comfortable and stress free as possible, we have provided a selection of nearby hotel accommodations for traveling patients and their families, including preferred rates when available.
Rough estimated cost for a 10 day stay, including taxes and fees. Final pricing may vary as hotel rates fluctuate based on availability, season, and travel dates.
- AirBNB $8,000 – connected to L’Auberge so can use amenities and across the street from the office
- L’Auberge $11,000 1 king or $12,000 for 2 double beds
- Hotel Indigo $2,700 – has a fridge and microwave in lobby
- Rancho Valencia & Spa $20,000
- Hilton Del Mar $3,100
- Hilton Garden Inn – Carmel Valley has a fridge, stove and microwave $1,900
L’Auberge Del Mar
Located in the heart of Del Mar, L’Auberge offers a coastal escape with estate-style rooms, a full-service spa, ocean-view dining, and a tranquil pool. This boutique resort blends luxury with laid-back charm, just minutes from the beach.
1540 Camino Del Mar
Del Mar, CA 92014
858-386-1336
Hotel Indigo San Diego Del Mar
This boutique hotel captures Del Mar’s equestrian and coastal spirit with stylish rooms, pet-friendly accommodations, and a relaxed vibe. Enjoy spa services, ocean views, and a location close to beaches, dining, and the racetrack.
710 Camino Del Mar
Del Mar, CA 92014
858-755-1501
Rancho Valencia Resort & Spa
This Spanish Colonial Hacienda-inspired enclave in the heart of Rancho Santa Fe offers 49 luxuriously-appointed, guest casitas with their own patios and fireplaces and 3 opulent private residences, all of which provide the perfect backdrop for your next weekend escape or extended family gathering.
5921 Valencia Circle
Rancho Santa Fe, CA 92067
858-756-1123
Hilton San Diego / Del Mar
Just off I-5 and steps from the fairgrounds and racetrack, the Hilton offers comfortable, pet-friendly rooms, a resort-style pool, whirlpools, and onsite dining. It’s a convenient and welcoming stay near Del Mar’s top attractions.
15575 Jimmy Durante Blvd
Del Mar, CA 92014
858-792-5200
Richard V. Balikian, MD, FACS
Double Board-Certified Facial Plastic Surgeon
Balikian Facial Plastic Surgery: Richard V. Balikian, MD, FACS
