Before surgery: what to prepare
Stop aspirin, ibuprofen, naproxen, and blood thinners 10–14 days before. Stop fish oil, vitamin E, ginseng, ginkgo. Smoking and vaping must stop 4 weeks before and through 6 weeks after. Dental cleaning at least 2 weeks pre-op. Bring complete records of the previous facial contouring surgery including operative notes and any CT imaging, the surgical plan depends entirely on what bone is left and where the previous nerve corridors went. Be ready for the surgeon to tell you the limits of what is achievable; over-resected bone cannot be added back without complex grafting that most patients do not want.
The day of surgery
Revision facial contouring is performed under general anaesthesia, runs 3–6 hours depending on what needs correcting, and requires 1–2 nights in hospital. Incisions are again inside the mouth, often through or near the previous scar tissue. You wake up with a compression bandage around the lower face, drains, mouth packing, and significant swelling. Pain may be slightly worse than primary cases because of the scar tissue work.
Days 1–3: peak swelling
Swelling peaks day 3–5 and is comparable to or slightly worse than a primary case. Pain is moderate to significant. The risk of permanent inferior alveolar nerve injury is higher in revisions (roughly 8–15%) than in primary cases (roughly 3%); the surgeon will discuss specific risk based on what was done previously. For procedures running 3 hours or longer, sequential compression devices on the legs and early ambulation reduce DVT risk and are standard. Drains usually come out before discharge. Liquid diet only. Cold compresses outside the bandage, head elevated 45 degrees. Mouth rinses after every meal are even more important than in primary cases because the scarred tissue heals more slowly and is more vulnerable to infection.
Week 1: stitches out, bruising fades
Bandage comes off around day 5–7. Swelling is dropping but still dramatic. Mouth opening is restricted; some revision patients open less than primary patients at the same point. Liquid diet continues. Mouth rinses after every meal. If a nerve was previously injured in the first surgery, expect any residual numbness from the prior procedure to be temporarily worse before improving.
Weeks 2–4: back to public
Office work from week 3–4 for most patients. Soft diet starts week 2 and gradually expands. Mouth opening continues to improve. Numbness in the lower face and chin can be more persistent than primary cases because the nerves have been disturbed twice. No tough or crunchy food until cleared, usually week 6.
Months 2–3: swelling resolves
Swelling drops significantly between week 4 and month 3 but the curve is slower than primary surgery. The result begins to take shape. Numbness improves but full sensory recovery is less predictable in revisions; some patients retain partial numbness in the lower lip or chin past 12 months.
Months 6–12: the final result
Bone consolidation runs 6–12 months, sometimes longer in revisions if the bone bed was already thinned by the previous surgery. Final result is typically assessed at month 12 minimum, not month 6, because revision tissue settles more slowly. Further revision is rarely advisable; each pass reduces what is anatomically possible and adds nerve risk.
Red flags: when to call the clinic
Call the clinic the same day for: fever over 38.5°C after day 3, sudden firm painful one-sided swelling (haematoma), pus or foul taste from mouth incisions, sudden inability to open the mouth, numbness getting worse rather than better, or visible drainage from a previous scar opening (suture line dehiscence). Go to an emergency room for: difficulty breathing or sudden severe airway swelling in the first 72 hours. Routine numbness, mouth-opening restriction, and asymmetric swelling in the first 4 weeks are not red flags.