title: Putting it all together: recommendations for improving pain management in plastic surgical procedures-surgical facial rejuvenation.
abstract: BACKGROUND
  Postoperative pain is a major concern for patients undergoing facial aesthetic surgery. Aggressive efforts to reduce postoperative pain while avoiding adverse sequelae, such as nausea and vomiting, will result in an improved patient experience. Newer pharmaceuticals, medical devices, and longer-acting local anesthetics offer the potential to reduce pain and enhance patient satisfaction. The purpose of this report is to review the options and apply them to 3 specific facial aesthetic procedures: face-lift, brow lift, and blepharoplasty.
  
  
  METHODS
  Our review investigates methods used for pain control in the surgical facial rejuvenation patient. We highlight those techniques that have been documented efficacy. We share specific methods of pain management for the more common surgical facial rejuvenation procedures that we perform.
  
  
  RESULTS
  In an effort to maximize patient comfort, we assess the effectiveness of various devices, technologies, and treatment modalities available for pain control after surgical facial rejuvenation. These include local anesthetics, topical creams, intravenous acetaminophen, perioperative ketorolac, local anesthetic wound catheter delivery systems, liposomal bupivacaine, tarsorrhaphy/frost sutures, postoperative pharmacologic therapeutics, prophylactic steroids, and tricks to eliminate pain with suture removal. Additionally, we summarize the primary investigator's preferred method of pain management for the common surgical facial rejuvenation procedures performed.
  
  
  CONCLUSIONS
  Recent advances in postoperative pain control can significantly improve the patient's surgical experience. This multimodal therapy includes new pharmaceuticals, longer-acting local anesthetics, and devices designed to minimize postoperative pain. Adoption of these techniques may also reduce the need for narcotics and prevent postoperative adverse sequelae.
authors.affiliation: Cleveland, Ohio From the Department of Plastic Surgery, Cleveland Clinic. The first two authors contributed equally to this work.
authors.forename: Bryson G
authors.initials: BG
authors.lastname: Richards
authors.forename: William F
authors.initials: WF
authors.lastname: Schleicher
authors.forename: James E
authors.initials: JE
authors.lastname: Zins