The treatment of this problem, once it occurs in the recovery area, has not received as much study as its prophylactic management. If it does occur, ?uid hydration with normal saline or lactated Ringer's solution should be continued until nausea and emesis are under control. Oral intake never should be forced because it can increase the incidence of vomiting. Patients should be allowed to drink only if they wish. Because pain and nausea may be related, quick and effective treatment of pain is important.

Postsurgical pain should be treated quickly and effectively to minimize the stress of surgery and foster a quick convalescence. Uncontrolled pain can elevate catecholamine release, which results in elevated blood pressure, tachycardia, and increased oxygen consumption and cardiac work. Elevated blood pressure increases the risk of postoperative bleeding, particularly hematoma formation. Fortunately, postoperative pain is usually not a major issue that complicates the recovery and discharge of patients who undergo facial cosmetic procedures. This is mainly because local anesthesia in?ltration intraoperatively, including the tumescent technique, is typically performed.

Immediate control of pain can be achieved by incremental titration of small doses of a short-acting narcotic analgesic. Oral analgesic agents should be considered as soon as a patient can tolerate oral ?uids.

Each facility should develop recovery criteria to be met before patient discharge. The postanesthetic discharge scoring system is a simple and practical tool for providing a uniform assessment for all patients. When it is used every 30 minutes to score a patient, it establishes a routine of repeated re-evaluation of home readiness, which can lead to a safe and expeditious discharge. It also may have added medicolegal value. It is essential, however, that the scoring system be combined with medical judgment and common sense. Patient discharge is ultimately the responsibility of a doctor who has assessed the patient.

Unlike inpatient care, once the patient leaves the office-based facility, no medical supervision is provided. Adequate written instructions that are verbally reinforced must be given to the patient and the responsible adult who will provide care at home. Counseling should include what the patient can expect as far as side effects of surgery and anesthesia, how to minimize these effects, wound care instruction, dietary and activity restrictions,

The facility should have a written protocol in place for the safe and timely transfer of patients to an alternative care facility when extended or emergency services are necessary. The doctor must have admitting privileges at a hospital or center that provides inpatient care. The facility also should have a written protocol for managing after hour emergencies that require a patient to return to the operating room. A full operating room team must be on call and be readily available.

Each operation in cosmetic surgery has to be designed to provide a smooth, flat, graceful, athletic and nice contour to the body. The small additions such as a groove in the upper midline, a vertically oriented navel and an elevated mons pubis all speak of a youthful, taut abdomen.