S.A.F.E. Recovery Protocol
Program Purpose and Scope
Designed for rapid recovery, this program primarily covers body contouring surgeries such as abdominoplasty and liposuction, as well as complex procedures such as facelifts.
The goal is to ensure that patients safely complete the first phase of recovery within the first six days after surgery, allowing them to return home safely, and then create a roadmap for a smooth and rapid recovery. This includes integrating nutritional supplements, physical activity plans, breathing exercises, and other supportive practices based on scientific literature to shorten recovery time and minimize the risk of complications. This improves patient quality of life and gives our clinic a competitive advantage in the healthcare tourism industry.
S.A.F.E PROTOCOL NUTRITION CONTENT
- Encouragement of daily protein intake of 2g/kg (supported with protein-based formulas)
- Postoperative daily use of 10 g glutamine
- Postoperative daily use of 10 g creatine
- Postoperative bromelain-containing supplements for edema reduction, multivitamin support (vitamin C, B-complex, and zinc-focused)
- Strict avoidance of smoking for at least 1.5 months for program success
- Daily water intake >2 liters (patients may be gifted a 1.5L BPA-free water bottle after cost calculation)
Prevention of Atelectasis with Breathing Exercises
After general anesthesia, especially abdominal surgeries, patients may find it difficult to breathe deeply, leading to atelectasis (collapse of alveoli), which predisposes to lung infections (e.g., pneumonia) and slows recovery. Breathing exercises are crucial to prevent or resolve this.
Patients should perform deep breathing and effective coughing exercises several times per hour starting from the first postoperative day. A triflow device, commonly used in many centers, should be provided and demonstrated. Studies show that patients performing regular deep breathing exercises after abdominoplasty maintain better lung function and have significantly reduced atelectasis areas (3). Combining deep breathing with pursed-lip breathing, diaphragmatic breathing, and effective coughing further improves respiratory function compared to isolated exercises (4).
Thus, patients are advised to take 5-10 deep breaths followed by coughing (supporting the abdomen with a pillow if needed) at least hourly. Preoperative teaching of these exercises is also beneficial.
S.A.F.E PROTOCOL BREATHING PHYSIOTHERAPY CONTENT
Early activation of respiratory muscles with triflow starting from the first postoperative hours to prevent atelectasis
Basic respiratory physiotherapy training by nursing staff (first postoperative day: correct coughing, breathing techniques, triflow use)
Early Mobilization and Physical Activity
Early mobilization is a cornerstone of rapid postoperative recovery. Prolonged bed rest increases muscle weakness and delays healing, while also elevating risks of deep vein thrombosis (DVT) and pulmonary embolism (5). Therefore, patients should be mobilized as soon as safely possible.
Studies report fewer complications in patients who get up and take short walks within the first 24 hours after surgery. Pneumatic compression devices used intraoperatively and postoperatively until mobilization reduce embolism risk (6). Early mobilization, part of ERAS protocols, also facilitates early return of bowel function and enhances well-being.
In this program:
On day one, patients are encouraged to perform leg stretching and bending exercises in bed and sit up.
As soon as blood pressure allows, they take assisted steps or short indoor walks.
Walking distance and duration are gradually increased over the following days.
Smoking cessation is recommended at least 4 weeks before surgery to reduce pulmonary embolism risk (7). CAPRINI risk scoring (8) is used to assess embolism risk, and prophylactic anticoagulants are administered postoperatively in high-risk patients.
Table 2. Caprini risk categories (University of Michigan)
| Numerical Caprini Risk Score | VTE Risk Category |
|---|---|
| 0-2 | Low Risk |
| 3-4 | Moderate Risk |
| 5-6 | High Risk |
| 7-8 | Highest Risk |
| >8 | Super-High Risk |
Daily goal: Several corridor laps or short walks around the clinic/hotel, as tolerated, to improve circulation, enhance lung ventilation, and prevent muscle atrophy. Patients may walk slightly bent forward due to compression garments post-liposuction and abdominoplasty; this is normal and improves over time.
Bed exercises such as ankle pumps and simple leg exercises are advised hourly to prevent clots. Simple stretches and shoulder rotations maintain joint mobility. Heavy lifting, strenuous exercise, or high-intensity cardio are strictly prohibited during the first 6 days. From day 6 onwards, with medical approval, light stretching and extending walking times are allowed. Heavy sports and abdominal straining movements remain prohibited for approximately 6 weeks. Gradual return to normal exercise routine is possible thereafter if recovery is progressing well.
S.A.F.E PROTOCOL PHYSIOTHERAPY & POSTOPERATIVE CARE CONTENT
Pneumatic compression device use in surgeries >4-6 hours to minimize life-threatening complications
Pre-op and post-op risk assessment and prevention strategies for complications including pulmonary embolism
Early mobilization and continued support (first days in hospital, then daily nursing service at hotel)
Daily dressing changes, lymphatic drainage massage if needed, assisted showers and aftercare
Simple physiotherapy exercise program in postoperative period (performed and demonstrated by nurses – bed mobility, joint range of motion exercises)
Pain Management and Other Recovery Applications
Effective pain management is critical for patient comfort and early mobilization. A multimodal pain strategy is used, incorporating paracetamol, NSAIDs, local anesthetic blocks (e.g., TAP block for abdominoplasty), and minimal opioids if needed. Such approaches reduce narcotic use, thus minimizing nausea, constipation, and drowsiness, accelerating recovery.
Safe and effective painkillers (e.g., paracetamol + dexketoprofen) are prescribed for discharge. In resistant cases, mild opioids such as tramadol can be used within daily limits. Compression garments (for abdominoplasty/liposuction) and elastic face bands (for face/neck lifts) are applied. Head elevation with two pillows aids swelling reduction post face surgeries. Cold application (no direct contact, max 15 min intervals) reduces bruising and swelling within the first 48-72 hours.
Lymphatic drainage massage is beneficial in extensive liposuction cases to reduce edema and avoid subcutaneous irregularities. Smoking is strictly prohibited pre and postoperatively due to severe negative impacts on wound healing, infection, and necrosis risk. Alcohol should also be avoided in the early weeks due to its potential to increase inflammation, interfere with medications, and raise bleeding risk.
Psychological Support and Relaxation
Fast recovery depends on mental well-being as well. Guided relaxation techniques, breathing exercises, and positive motivation are provided. Melatonin supplements or herbal teas can be suggested for short-term sleep support if needed.
Daily Guide for the First 6 Days
Day of Surgery
Monitor vitals closely upon anesthesia recovery, initiate breathing exercises (triflow), seat patient up in bed, start leg exercises, and mobilize with short walks as tolerated. Start with clear protein-rich broths and electrolyte drinks as oral intake allows.
Postop Day 1
Continue mobilization and walking in corridors. Transition to soft solid foods (yogurt, puree, protein formulas). Continue glutamine (10 g/day) and start creatine (5-10 g/day) if indicated. Encourage deep breathing and coughing hourly. Begin bromelain + vitamin C supplements. Pain management is reassessed, transitioning to oral medications.
Postop Day 2
Postop Day 3
Postop Day 4
Postop Day 5
Postop Day 6
Patient may return home if recovery is adequate.
Post-Discharge Roadmap
- Nutrition & Supplements: Continue high protein intake and glutamine for 2-4 weeks. Creatine if used, can be stopped after 4 weeks. Maintain vitamin/mineral support for at least a month.
- Exercise & Activity: First week with light walks and rest. Gradually add moderate activities from weeks 3-4. Return to intense exercise and abdominal workouts only after 8-10 weeks.
- Breathing Exercises: Continue for at least 2 weeks to maintain lung function.
- Wound Care: Maintain strict hygiene, use antiseptics as instructed, and monitor for infection signs (redness, swelling, discharge, fever).
- Follow-up & Communication: Online check-ups scheduled for day 14 post-discharge. Patients remain in contact via WhatsApp/email for questions or concerns.
- Possible Complications: Informed about wound dehiscence, DVT, pulmonary embolism, and infection symptoms, with instructions for emergency situations.
COMPLETE S.A.F.E PROTOCOL CONTENT SUMMARY
Daily protein intake of 2g/kg with supplemental formulas
Daily 10g glutamine
Daily 10g creatine
Bromelain-based supplement for edema reduction, multivitamin (C, B-complex, zinc)
Strict smoking cessation ≥1.5 months
Daily water intake >2 liters (gift of BPA-free 1.5L bottle)
Early respiratory activation with triflow
Basic respiratory physiotherapy training
Pneumatic compression device for surgeries >4-6 hours
Pre- and post-op risk assessments for complications
Early and ongoing mobilization support
Daily dressings, lymphatic drainage massages, assisted showers
Basic postoperative physiotherapy program
