Sleeping Beauty
A few notes on the critical role of sleep following surgery
I’m often asked by patients what they can do to optimize their recovery following surgery. Patients sometimes seem to expect something revolutionary - a secret food, medication, or diet. While I always recommend a healthy and balanced diet with lots of protein prior to and after surgery (and obviously even if you never have surgery), the other not-so-revolutionary key to healing is sleep.
A few years ago when I was still taking all of my surgical patients to the hospital (as opposed to the outpatient center where I operate now), I noted that many of my breast surgery patients would return for their postoperative appointments appearing exhausted, with swelling and dark circles under their eyes. When I asked about their sleep, I discovered that they had been advised by the staff in the recovery room that they needed to sleep in a sitting position for at least three days after surgery to help decrease swelling in their breasts. If there were any data in the surgical literature to support this random advice, I’d be all for it. But in fact, there’s no data linking sitting upright to a reduction in breast edema. In contrast, there’s some good science supporting the benefits of good sleep for wound healing. The body repairs itself during sleep. During sleep, the levels of cortisol (our stress hormone) drop, and melatonin, our sleep hormone, rises. The body takes this time to repair itself, internally and externally. Blood flow to the skin increases, permitting collagen production and damage repair from exposure to ultraviolet (UV) exposure.
The effects of sleep deprivation on wound healing
A study by Das et al observed 110 consecutive patients undergoing emergency laparotomy (the abdomen is opened surgically) and recorded their sleep quality and wound healing for eight days after surgery. Postoperative poor sleep quality was statistically significantly correlated with impaired wound healing beginning at the third postoperative day.
Another study performed by Smith et al assessed the effects of sleep deprivation over a 72 hour period with attention to local immune function and restoration of the skin barrier following an experimental injury. The authors found that skin barrier recovery time was significantly prolonged for study participants who had been sleep deprived. When supplemental nutrition consisting of arginine, glutamine, zinc sulfate, vitamin C, vitamin D3, and omega-3 fatty acids was added, there was some mitigation of the local immune response but no effect on the rate of wound healing. In summary, then, adequate sleep following surgery is a key element of healing.
Beauty sleep
Once the wounds have healed (80% of wound healing occurs within the first 6 weeks after surgery), good sleep continues to provide benefits. Sleep is also a critical element of beauty, and there’s data to support this, too.
A 2015 study performed by Dr. Elam Baron showed that poor sleep quality can accelerate signs of skin aging and weaken the skin's ability to repair itself at night. In their study, poor sleepers showed higher level of transepidermal water loss (TEWL), diminished skin barrier recovery, limited recovery from redness after exposure to UV light, and a worse perception of their own appearance and physical attractiveness.
Some of the most notable beauty benefits of adequate sleep include:
fewer wrinkles: the skin is able to generate new collagen during sleep – which translates to fewer fine wrinkles.
a natural glow: your body sends increased blood flow to the skin while you sleep, allowing you to wake to a healthy glow.
brighter eyes: dark circles and swelling around the eyes are one of the telltale signs of a lack of sleep. Limited blood flow around the eyes secondary to a lack of sleep can manifest as dark circles.
skincare products that work better: when your skin is resting, it focuses on repair and renewal. Blood flow allows the ingredients from your products to work synergistically with your body.
Some sleep recommendations
The importance of sleep can’t be overstated. Simply put, it’s the body’s way of allowing for healing and renewal. Here are some basic suggestions for sleep, before and after surgery:
hydrate: keep a glass of water at your bedside, especially if you sleep in an environment with low humidity. Hydration is especially important in the weeks after surgery.
chin up: there’s truly no need to sleep sitting upright, but elevation of your head can help to reduce swelling and dark circles around your eyes by limiting the accumulation of fluid. Add an extra pillow or use a wedge on the mattress.
back versus side versus abdomen: while sleeping on your back can help to reduce creases on the face, it’s not absolutely necessary after surgery despite what you may have heard. I routinely tell my patients to sleep in a comfortable position, and that if they move themselves into a place that compresses the surgery site uncomfortably, they’ll wake themselves up and move out of it.
love the dark: you don’t need to be Dracula to appreciate the dark of night. It’s been shown that sleeping with your skin exposed to the light can damage your skin’s health, in addition to disturbing your sleep rhythm. Try blackout curtains if you can’t escape the glare.
And don’t skimp – we need 7-9 hours of quality sleep per night. Now go and get that shut eye.
references:
https://www.goodhousekeeping.com/beauty/anti-aging/tips/a14912/sleep-beauty/
https://www.healthline.com/health/beauty-skin-care/beauty-sleep#How-sleep-affects-your-skin
Oyetakin-White P, Suggs A, Koo B, et al. Does poor sleep quality affect skin ageing? Clin Exp Dermatol 2015; 40(1): 17-22.
Das A, Gupta R, Huda F, et al. Effect of sleep quality on wound healing among patients undergoing emergency laparotomy: an observational study. J Clin Sleep Med 2025; 21{3); 503-512.
Smith TJ, Wilson M, Karl JP, et al. Impact of sleep restriction on local immune response and skin barrier restoration with and without “multinutrient” nutrition intervention. J Appl Physiol 2018; 124: 190-200.