Recovery is often the difference between a positive and a negative surgical experience. The question I’m asked most is simply: how bad will it hurt? Between the fear of poorly controlled pain and nausea, it’s no wonder surgery feels daunting. That’s exactly the problem Enhanced Recovery After Surgery (ERAS) is designed to solve.
What Is ERAS?
ERAS is a set of evidence-based protocols with consistent goals across specialties: recoveries that are safer, more comfortable, and more efficient. It’s been used for years in general, colorectal, bariatric, neurologic, orthopedic, and gynecologic surgery, and a growing body of research shows clear benefits when it’s applied to plastic surgery — less discomfort, shorter hospital stays, and lower cost. I review the ERAS literature routinely and adopt well-supported findings. For our general-anesthesia patients, I use a modification of the Vanderbilt plastic surgery group’s protocol.
1. Blocking Pain Through Multiple Pathways
The core idea is to interrupt pain at several points — before, during, and after surgery — rather than relying on opioids alone.
- Before surgery: acetaminophen (Tylenol), celecoxib (Celebrex), and gabapentin (Neurontin).
- During surgery: I place local anesthetic blocks with lidocaine and bupivacaine before any incision, so the pain signal never reaches the brain, while the anesthesia team minimizes opioids using agents like propofol, ketamine, and ketorolac.
- After surgery: we continue the multi-pathway medications and add an opioid only for breakthrough pain.
2. Reducing Nausea and Constipation
By minimizing narcotics we avoid much of the GI distress they cause. We also prescribe a stool softener and use anti-nausea medications like Zofran and Phenergan proactively.
3. Preventing Blood Clots (DVT)
Sequential compression devices are running before anesthesia even begins, helping keep the blood moving. For longer body-contouring cases — lipoabdominoplasty, body lifts, or high-volume liposuction — I routinely prescribe about a week of enoxaparin (Lovenox) to further reduce clot risk.
The Bottom Line
If you’re researching a breast augmentation, breast lift, tummy tuck, liposuction, or facelift in the Austin area, ask your surgeon whether they use ERAS — it can make your recovery meaningfully safer and more comfortable. Come see us and we’ll walk through exactly how it applies to your procedure.