Cosmetic Surgery Pain Relief: What's Best Heat or Cold?

Global Courant

I am finding that we receive many of the same questions coming into our blog regularly. Although many of these questions are addressed specifically in the Before/After sections for each procedure, I sense that readers perhaps prefer to get that information in one click. On the top of the list of most frequently asked questions is whether the use of a heating pad or ice pack following cosmetic surgery is effective for pain reduction.

Let me first address if applying heat is best during cosmetic surgery recovery. While heating pads are common home remedies for a number of musculoskeletal ailments and sports injuries, heating pads are not advised during convalescence from cosmetic surgery. A normal part of any surgical procedure is swelling, bruising and pain. Swelling of the skin and subcutaneous tissues not only reduces sensation, but also makes the skin more susceptible to injury.

Nothing feels better when you have a localized painful muscle strain, than a heating pad applied to the area. It goes a long way to relax a muscle spasm and relieve the pain. But we must exercise caution after cosmetic surgery. Small nerves are damaged during surgery, which leaves you with temporary numbness around the surgical site. So you can imagine what happens when you put a hot heating pad on these areas. It is impossible for you to determine the exact temperature of the pad. Normally when the pad gets too hot for comfort, you remove it. This is natural defense mechanism, which is temporarily lost following surgery. The skin is numb and susceptible to being burnt quite easily.

I have seen terrible scarring when patients have unfortunately chosen to use heating pads following cosmetic surgery. I instruct my patients not to use heating pads because of the risk of skin burns and scarring. This risk can remain present and last for six months after surgery during the recovery process.

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How about using ice packs to control pain after cosmetic surgery? This answer is not as straight forward, because the answer is a “qualified” yes. Using ice bags after surgery is a commonly recommended practice to reduce postoperative pain, swelling and bruising. The application of cold temperature at or just above freezing temperature (32F or 0C) is an effective and safe way to help in the initial healing and swelling phase. I recommend patients use ice sealed in plastic bags, such as Ziploc style bags, filled with ice and water for this purpose. It is very important to make sure there is water (liquid) in the bag, because this assures that the temperature of the ice is at or just above the freezing temperature of water.

My patients report that nothing feels better than the cooling effect of ice after breast enlargement surgery. Besides feeling good, it helps to reduce the need for narcotic pain relievers. However, we must also be careful with the temperature of the cold application. The same risks are present regarding both heat and cold. Similarly, patients are unable to feel warning signs for potential damage due to the improper use of cold packs.

Ice, gel pads and bagged frozen vegetables applied directly from the freezer will be well below freezing, are too cold and are not suitable. If these are applied to the skin, which is numb and susceptible to injury, frostbite and scarring can result. Therefore, I do not recommend their use. One important exception to any ice application after cosmetic surgery is following fat grafting procedures, because the cold is particularly detrimental to the survival of the grafts. For this reason we do not recommend the use of ice after natural breast enlargement or facial rejuvenation using the fat grafting technique.