Post-Operative Care Guidelines: The Complete Version
By Dr. Rushapol Sdawat, MD — Thai Board-certified Plastic and Reconstructive Surgeon, Medical Licence No. 17689
Last reviewed: 28 AUG 2026
You have just been handed a discharge folder, a bag of medications, and a smiling wave — and somewhere between the hospital lobby and your hotel room it dawns on you that you are now the person in charge of your own recovery. In Bangkok, thousands of kilometres from your GP, that realisation lands harder than it does at home.
This page is the reference I wish every patient read before surgery rather than after. It is general — your procedure-specific instructions from your surgeon always override anything written here — but the fundamentals of healing are remarkably consistent whether your incision is on your eyelid, your breast or your abdomen. I have practised plastic and reconstructive surgery for around twenty-six years, and the patients who recover smoothly are rarely the luckiest ones. They are the ones who treat aftercare as a daily discipline for six weeks, not a set of suggestions for the first three days.
Read it all once now. Then come back to the section you need at 10pm when you cannot remember what the nurse said about showering.
How do I look after my wounds and dressings?
The core principle: your job is protection, not intervention. A surgical wound wants to be clean, dry, supported, and left alone. Do not lift dressings "to check"; every peek disturbs the fragile new surface and introduces the bacteria on your fingers. Dressings are changed on the schedule we give you — by us in clinic where possible, or by you with washed hands, prepared supplies laid out first, and the old dressing off for the shortest time possible.
Some seepage of thin pink fluid onto a dressing in the first days is normal; a dressing soaked through, frank blood, or anything with an offensive smell is not. Do not apply antiseptic creams, vitamin E oil, or anything from a pharmacy shelf to a fresh wound unless we have told you to — well-meaning ointments keep wounds soggy, and soggy wounds break down. Steri-strips and surgical tapes stay on until they lift off or we remove them; they are doing quiet work holding tension off the scar.
When can I shower, and what are the rules by closure type?
"When can I shower?" is the most-asked question in any recovery ward, and the answer genuinely depends on how you were closed. As a general guide:
Closure typeTypically may showerThe rulesSutured wound with waterproof dressingOften 24–48 hours after surgeryBrief, lukewarm shower; water may run over the dressing; no soaking, no scrubbing; pat drySutured or stapled wound, standard dressingWhen your surgeon confirms — commonly around 48 hours, sometimes laterKeep the wound itself out of direct spray; dressing changed after if dampWound with drains in placeUsually sponge-bathe only until drains are out, unless told otherwiseExit sites stay dry; never submergeTissue glue or dissolving sutures with sealed skinOften 24–48 hoursWater over is fine; do not pick at glue as it flakes
Two rules have no exceptions. First: no baths, pools, spas or the sea for at least three to four weeks, and longer if any area is still open — submerging a healing wound in standing water (and especially a Thai hotel pool or the ocean) is how infections are born. Second: lukewarm water and short showers early on, because fresh surgical patients faint in hot bathrooms. Sit on a stool if you feel weak, and have someone within calling distance the first few times.
How do I manage my medications without missing doses?
Your discharge bag typically holds some combination of simple analgesia, a stronger opioid for breakthrough pain, sometimes an antibiotic course, sometimes an anti-nausea tablet, and sometimes a blood-thinning injection or tablet if your VTE risk warranted it. The discipline that matters:
Take pain relief by the clock for the first days, not "when it gets bad". Chasing established pain takes twice the medication for half the relief. Stay ahead of it, then step down.
Finish any antibiotic course completely, even if the wound looks perfect on day three.
Never double a missed dose. Take it when remembered unless the next dose is close, in which case skip it.
Set phone alarms and use the checklist we give you. Jet-lag, anaesthetic fog and hotel time-zones destroy medication memory. Alarms do not get jet-lagged.
No alcohol while on opioids or antibiotics, and ideally none for the first two weeks regardless — it thins the blood, dehydrates you, and worsens swelling. No smoking or vaping nicotine at all; nicotine strangles the small blood vessels your skin flaps are depending on, and it is a genuine cause of wound necrosis.
Declare every regular medicine and supplement to us before surgery — fish oil, ginkgo, and various herbal products increase bleeding, and some Australian patients arrive taking three of them.
How should I sleep after each procedure?
Position is treatment. After facial surgery, rhinoplasty or blepharoplasty: head elevated on two or three pillows (or a wedge) for the first one to two weeks, sleeping on your back — elevation visibly reduces swelling and bruising. After breast surgery: on your back, slightly elevated, for several weeks; no lying on your front until we clear it. After abdominoplasty: the beach chair position — head and shoulders raised, pillows under the knees, hips flexed — so there is no tension on your abdominal closure; most patients need this for one to two weeks. Side-sleepers find the first fortnight genuinely hard, and it is worth practising back-sleeping before you travel. A travel neck pillow, a firm wedge, and the hotel's spare pillows are the cheapest recovery equipment you will buy.
What is the activity ladder?
Recovery is a ladder climbed one rung at a time, and both extremes cause trouble — the patient who lies motionless for a week risks clots and chest infections; the patient who walks a night market on day four risks bleeding and swelling. The general sequence: gentle walking around your room from the first day, several short walks daily thereafter, because walking is your main protection against venous thromboembolism. Light daily activity and short outings build over weeks one to two. No lifting anything heavier than a few kilograms — think a full kettle — for the first two weeks, and nothing genuinely heavy (groceries, toddlers, luggage) for four to six weeks after body procedures. No driving while on opioids or while pain would stop you doing an emergency stop. Exercise that raises your heart rate returns around week three to four with your surgeon's agreement; whatever loads the operated area directly comes last, often six weeks or beyond. When in doubt, the rule is: if it hurts, swells, or raises your pulse hard in the first fortnight, it is too early.
What should I eat and drink while healing?
Healing is construction work, and protein is the building material. Appetite is often poor in the first week — eat anyway, in small frequent amounts, and make protein the priority: eggs, fish, chicken, tofu, dairy, legumes, or a protein shake when a meal will not go down. As a practical rule I give patients: a palm-sized serve of protein at every meal, every day, for six weeks. Add fruit and vegetables for vitamin C and micronutrients, which wound healing consumes at an increased rate.
Hydration matters more in Bangkok than at home — heat, air-conditioning and anaesthetic recovery all dry you out. Drink steadily through the day (bottled water in Thailand); pale-yellow urine is your gauge. Restrict salt somewhat while swelling is at its peak, and be gentle with your stomach for a few days: bland food first, then normal Thai food when it clearly agrees with you. There is no supplement that accelerates healing beyond fixing a deficiency — save your money for the compression garment.
Why does bowel care matter so much on opioids?
This section is unglamorous and genuinely important. Opioid painkillers constipate almost everyone, anaesthesia slows the gut, and travel plus dehydration finishes the job. For most operations constipation is miserable; after an abdominoplasty with muscle repair, it is actually dangerous, because straining hard against a blocked bowel loads the very muscle closure we have just stitched, spikes your pain, and can contribute to bleeding or disruption of the repair.
So we treat bowels prophylactically, not reactively: start a gentle laxative or stool softener from day one of opioid use — do not wait until day four's misery; drink well; walk; add fibre as your appetite returns; and come off opioids onto simple analgesia as soon as pain allows, which fixes the cause. If you have not opened your bowels by day three, tell us — it is a two-minute fix early and an emergency-department visit late. Nobody has ever regretted raising this too soon.
When do stitches come out, and what are spitting sutures?
Many modern closures use dissolving sutures under the skin and need no removal at all. Where removable sutures are used: on the face, typically five to seven days; eyelids often earlier; body incisions commonly ten to fourteen days. If you fly home before removal day, we arrange it with a GP or practice nurse at home and put it in writing in your discharge summary.
Now, spitting sutures — the phenomenon that frightens patients most because nobody warned them. Weeks or even months after surgery, a small red pimple-like spot appears on a well-healed incision, sometimes with a tiny whitish thread emerging. This is a buried dissolving stitch your body has decided to expel rather than absorb. It is common, it is usually trivial, and the management is simple: keep it clean, do not dig at it with tweezers, and have a doctor or nurse lift the fragment free if it presents itself. It only needs escalation if the area becomes increasingly red, hot, swollen or discharging — occasionally a spitting suture becomes a genuinely infected one.
What follow-up schedule should I expect?
While you are in Bangkok, I typically review patients the day after surgery, again around days five to seven for wound checks and drain decisions, and once more for a fitness-to-fly assessment before departure — more often if anything needs watching. After you fly, follow-up continues by scheduled photo and video review at roughly two weeks, six weeks, three months and beyond, and you can contact my team between those points.
I will be candid about the structural weakness here, because it is real: remote follow-up is inferior to hands-on follow-up. I cannot palpate a seroma or smell a wound through a phone. This is the honest cost of surgery overseas, and it is why I insist patients identify — before travelling — a GP at home willing to see them post-operatively, and why every patient leaves with a written surgical summary that names the procedure, materials used and dates. Some Australian and New Zealand patients also face doctors reluctant to manage overseas complications; a documented handover reduces that friction but does not always erase it. If you cannot arrange any home follow-up at all, that is, frankly, an argument for having surgery at home instead.
When to seek care
Know the difference between a question, a same-day review, and an emergency.
Contact the team (same-day review) — in Bangkok or from home: fever of 38°C or higher; spreading redness or heat around a wound; discharge that is thick, increasing or smells offensive; a wound edge opening; a swelling clearly larger than yesterday, especially one-sided; pain that escalates instead of easing; a drain that blocks, falls out, or turns frankly bloody; no bowel motion by day three; persistent vomiting that stops you keeping medication down.
Emergency — go, do not email: sudden breathlessness, chest pain, coughing blood, fainting, or a swollen painful calf (usually one-sided) — these raise the question of a clot on the lung or in the leg and are ambulance-grade whether you are in a Bangkok hotel or back in Ballarat. A rapidly expanding, tight, painful swelling in the first day or two after surgery may be a haematoma needing return to theatre. A wound turning dusky, purple-black or breaking open widely needs hospital review at once. In Bangkok, my team will direct you straight to Intrarat Hospital at any hour. In transit, tell cabin crew immediately. At home, go to your nearest emergency department, say "recent surgery overseas and a long-haul flight" at triage, and hand over your surgical summary — Medicare and the public system will treat you even though your surgery was overseas, so never let cost anxiety delay the presentation. Loop us in afterwards; we want to know.
The habits that carry recovery
Six weeks of small disciplines beat any single heroic effort: dressings left alone, medications by alarm, walks taken, protein eaten, water drunk, bowels managed early, garment worn, sun avoided, alcohol and nicotine refused, and every niggling worry reported early rather than Googled late. None of this removes surgical risk — haematoma, seroma, infection, wound breakdown, clots and disappointing scars can happen to careful patients of careful surgeons. But aftercare shifts the odds meaningfully in your favour, and it is the one part of this whole journey that is entirely in your hands.
Dr. Rushapol Sdawat (known to international patients as Dr. Dominic) is a Thai Board-certified plastic and reconstructive surgeon practising at Intrarat Hospital, Bangkok, Medical Licence No. 17689. He holds Thai Board certification in General Surgery (Phramongkutklao Hospital) and in Plastic and Reconstructive Surgery (Ramathibodi Hospital, Mahidol University), has been a member of ISAPS since 2008 and is an international member of the American Society of Plastic Surgeons. Dr. Rushapol holds Thai specialist certification; he is not registered with Ahpra and does not hold Australian or New Zealand specialist registration. His registration can be verified on the Medical Council of Thailand register at checkmd.tmc.or.th.
This article is provided for general information and education. It is not medical advice and cannot substitute for individual assessment by a qualified practitioner who knows your history. Surgery carries risk, including risk of serious complications and of outcomes that do not meet expectations. Results vary between patients.
