The Surgical Process
The surgical process can vary surgeon to surgeon slightly. It takes approximately 45 minutes for one implant, about twice as long when having bilateral implants. The following is a guidance to what might be expected. Before surgery a small area of the head is shaved behind the ear where the implant is to go. (In children this may be done while they are under general anaesthetic). An adult patient might be given the choice of a general anaesthetic or local, this may depend also on their health status as to which would be best. Mostly the surgery is carried out as a day case. The pros and cons for a general anaesthetic. A slower recovery period and, potentially, if a person is not deemed fully recovered it might lead to an overnight stay. Some people do not “get on” with a general anaesthetic and may have after effects lasting a day or so. On the positive side, they are not aware of the surgery.
Pros and Cons of a Local
The injections to numb the area are not “pleasant”, but not overly painful either. The local anaesthetic is fast acting. Usually there is a hand holder, someone to reassure the patient, close by, who will also act as a go between for communication between them and the surgeon. The person is aware of what is happening, can hear sounds carried by bone conduction of the drill etc. But by many it has been reported that this is not as bad as they had imagined it to be, and maybe no worse than a major filling at the dentist. Very little recovery time, a cup of tea within moments of coming out of theatre, and a quick return to “normal”.
A small machine, similar to a shaver, is used to lift a 3 sided piece of skin. This small flap will, once healed remain hairless. This is to help avoid irritation and infection around the abutment, and helps with day to day care of the abutment site. A dummy sound processor is placed to help the surgeon decide where to place the implant, the sound processor needs to be clear of the outer ear parts to ensure there it is free to vibrate, and to avoid feedback noise. The surgeon will place the implant approximately central within the area of the flap. In adults and older children the abutment will also be attached during surgery. For younger children the site will be sewn up, covering the implant, and allowing it to have time to integrate with the bone undisturbed. The abutment will be attached via a small cut in the skin generally two weeks before the sound processor is to be fitted. Once the implant and abutment are in place, the graft has a small incision which will slip over the abutment. The skin is then stitched into place. Dissolving stitches are used, but sometimes it is decided they will be removed two weeks post implant, to avoid any potential complications while they dissolve. After the graft is back in place, a healing disc, which looks like a plastic washer, is snapped onto the abutment. This will hold in place a gauze or foam dressing. Over that will be a gauze square, and over all this there will be a tight bandage. This reduces the post implant swelling, and can usually be removed by the patient the next day, leaving the healing disc and dressing under that in place. For a few days post implant a person might experience some minor leakage which over the first week will gradually lighten and become clear, and then stop. As the healing progresses there will be a tightness felt around the area, this eases once the dressing and disc are off, and stitches removed, if that is also done. Numbness is experienced over a large part of the head and is normal, this numbness with go over time. Some people it takes longer than others. There may be tenderness on the head at the edge of the numbness for a time too; this will also subside in time. These symptoms do vary person to person in their intensity and longevity. Be sure to ask your own surgeon for advice before surgery on how soon you can wash your hair.
Once the site is well on the way to healing, usually within two to four weeks, it is safe to get the area wet. But do ask your surgeon when you go for your post implant check up. When you are told that you can begin to clean the area you may find there is scabbing round the area. This can be gently eased away by teasing it away with a wet cotton bud after washing your hair. The more gently it is removed, the less likely there is to be any damage to the new skin growth and there is less likely for more scabbing to develop. Any scab that does not come away easily, leave it till the next time. Between hair washing you could use warm water to wet a square of gauze and lay the gauze over the area for 5 or 10 minutes. This will help soften the crusting, easing its removal. Over time it should all settle down, and you will settle into a care regime which suits and works for you. The rule of thumb is that the more gentle you can be the better, enough care is enough, aggressive cleaning can cause more harm than good.