Peri-Operative Guide


Introduction:
Cosmetic Surgery unlike other surgical specialties, involves the application of surgical procedures in order to change our appearance and thereby improve our self-image. The improvement in self-image, more accurately termed Body Image, does not always follow after a technically successful operative procedure. The lack of understanding of, and the predictability of how and why cosmetic surgery works or does not work is a testimonial to the complexity of the psychological change preceding and following surgical intervention. Most often, good feelings follow technically good results. But feelings are difficult to define and manage particularly if the patient experiences undesirable negativity after the procedure, when the healing processes are incomplete and visual appearances may be temporarily distorted.

Cosmetic Surgery is only successful if the patient feels that he or she has had an improvement of the self-consciousness experienced in their lives. Studies have shown that 60 % of the patients seeking cosmetic surgery wish to improve their mirror or photographic image, in order to be socially more acceptable. Thus, unlike functional surgery aesthetic surgery has to surpass function and produce a psychological gain all at the risk of functional loss, disfigurement, pain and disruption of our pre-surgical lives. This is a task that almost defies logical understanding yet, on a daily basis in any experienced plastic surgeon’s office, patients who have been carefully prepared for surgery and have a clear understanding of what can and cannot be achieved, are a testimonial to the almost miraculous change which cosmetic surgery can produce.

While the most dramatic part of surgical therapy is the operation itself, it is only a part of the entire process known as the peri-operative period.

Often, details of the surgical procedure itself, legal consents, and financial issues cloud the nebulous period before or after your surgery, however attention to these “details” is most important to a good surgical outcome. Every operation, in addition to the to the procedure itself, entails local as well as total body physiologic changes, subjecting the patient to continuous strain before, during, and after the operation.

Part of the decision-making process should include a detailed discussion of the pre-operative and post-operative procedures for your care.

Pre-Operative Preparation:

Schedule an ample amount of time to adequately prepare for your surgery. The amount of preparation usually varies with the complexity of the procedure, but any operation requires some planning.

    • Is this the appropriate time for me to have surgery?

    • Am I psychologically “ready” for a cosmetic change?

    • Am I physically fit to undergo the stress of surgery?

    • Can I stop bad habits in enough time before the operation so that I won’t
      have to deal with them after the procedure?

    • Am I medically “cleared” to undergo surgery?

    • Have I taken aspirin, anti-inflammatory medications, or herbal/vitamins
      (i.e. garlic) which may increase my chances of excessive bleeding?

    • Do I have any respiratory problems (i.e. asthma, bronchitis, difficulty
       breathing,shortness of breath) which may increase my risk of anesthesia?

    • Do I have any heart problems (i.e. lack of exercise tolerance,
      chest tightness or pain, chronic fatigue, valvular heart disease, rapid or
      slow heart rates, swelling in the ankles or feet)

    • Did any member of my family expire during anesthesia, if so why?
      (abnormal reactions to anesthesia can be inherited)

    • Did I ever have hepatitis, jaundice (yellow eyes), irritable bowel
      syndrome, ulcers, or chronic abdominal pain.

    • Did I ever have a seizure, chronic headaches, loss of consciousness,
      weakness or loss of sensation in the arms, legs or feet?

    • Do I have any skin problems (rashes, boils, acne, etc.) which may affect
      my surgery?

    • Do I have any blood problems, bruising, bleeding from cuts which may
      increase the chances of bleeding during surgery?

    • Are there any bladder problems, difficulty in passing water, fluid
      retention, or kidney disease ?

    • Have I been disappointed, displeased, or upset with any previous
      healthcare issues and why?

    • Do I have unrealistic expectations and have I expressed myself openly
      with my surgeon as to my expectations of the outcome of the surgery?

    • Can I go on with my life if the result is not what I wanted?

    • If I have a complication, will it be devastating to me or will I be able to
      “work it out” with my surgeon until the problem can be resolved?

    • Will my surgeon be supportive if a complication does arise and does my
      surgeon have “escape” plans at the ready just in case I may need them?

The above list of questions represents a general outline of potential issues which may have to be addressed during or after the surgical procedure. Remember, failure to fully appreciate the necessity of evaluating your health issues prior to your surgery may adversely affect your result or even worse: Preclude a good result had these issues been corrected prior to surgery.

Medicine aside, the psychological issues which play before, during and after surgery may be intense. Do not be afraid to ask your surgeon for medications to calm or relax you prior to your surgery—a calm, and relaxed (as much as can be expected) body and mind require much less medication during surgery than an excited overly-tired or stressed physiology.

Remember, cosmetic surgery is elective, therefore it can be postponed until your body, your mind, your finances, your fiancé, or most importantly YOU are Completely, entirely, spiritually, wholly, thoroughly and meticulously ready!



The Early Pre-Operative Phase
While some surgeons merely operate without pre-operative care, several issues need to be controlled in the days preceding the surgery.

    • Prepare an environment that will not be disruptive to your recovery.

    • Often work pressures accumulate prior to vacation or time-off for recovery—it is essential that work partners, employers, and staff be supportive, without necessarily informing them that you are going to have cosmetic surgery. Tell your employer, etc. that you will need some time off (at least a week or two) to have elective surgery. It is not necessary that everyone in your workplace knows that you may be having a personal improvement—often they will “take it out on you” either consciously or subconsciously.

    • Family pressures need to be decompressed and family members need to show active support. If a family member or friend expresses negativity toward your decision to have surgery, tell them politely that you will not need their help and enlist someone who will support you when you are recovering. The last thing any patient needs is someone telling them they look bad, they should not have done the surgery, or that the surgery was all for vanity’s sake. These negative remarks, especially in the early post-operative period can have a surprisingly devastating effect on a great surgical outcome—producing long-lasting negativity which may be permanent.

    • Child care duties especially for the young (ages 0-8) need to be transferred to another responsible adult, other than the person who will be responsible for your care. Make sure that you will not have to worry about your children during the early post-operative period, so that you can rest comfortably for the first 48-72 hours or until adequate healing has taken place.

    • Be sure that there is extra money on hand for additional medications, nursing care and your budget.

    • Check with your insurance company to inform them that you are having elective surgery and that you will have coverage for emergency hospitalization. HMO is not insurance. Private carriers often say: “We will not cover complications from cosmetic surgery; however, pre-approval for emergency admission after elective surgery may be a different matter.

    • Clean your home, bed and bed linens at least 2-3 days prior to surgery but not the night before. Exposure to excessive dust or dirt just before surgery and in the early post-operative period will definitely increase your rate of complications.

    • 2-3 Days prior to surgery begin to decrease your dietary intake, gently clean your bowels, and try to regulate your bowel movements. Constipation usually follows most surgical procedures.

    • Do hydrate yourself well. Check with your surgeon about dietary restrictions 12 hours prior to surgery (never eat garlic or heavily the night before your surgery).

    • Check with your surgeon about special medications for increasing coagulation (Vitamin K), antibiotics, special surgical soaps for decontamination of the skin and hair, shaving, hair and skin care. (Surgery should not be performed in the midst of a skin infection or rash)

    • Pay attention and understand the operative site. Where will the surgeon operate? How can I assist in preparing that site for the surgeon?

    • Never, Never, eat or drink anything (unless specifically directed to do so) after midnight, the night before your surgery. (Retained stomach contents may block your airway, if you vomit during or after the surgery. Treatment for this condition called “aspiration” is not always effective and the acid from the stomach may produce a “lung burn” which often cannot be reversed. Food contents which block the airway cannot be easily removed, if they go beyond the vocal cords.)

    • Eat lightly Eat bland foods. If you have excess stomach acid notify your surgeon and treat it before you have your operation.

    • If you have trouble sleeping, ask your surgeon for a sleeping medication or something calming. (Never take medications unless they are prescribed by your surgeon).

    • Never smoke prior to surgery. (Carbon monoxide binds irreversibly to the red blood cell decreasing the availability of other red cells to carry oxygen—this cannot be reversed, even with 100% oxygen).

    • All other medical issues need to be completely stabilized and controlled to the best degree possible in order for your surgery to go well. (It is best to have your surgeon’s attention directed to your procedure, rather than correcting your medical problems during the surgery).

    • If you have a premonition (an extremely bad “gut” reaction) prior to your surgery—postpone it! When in doubt—don’t!



Day of Surgery

    • Arrive at your surgeon’s office at least thirty minutes or an hour prior to your surgical time, or as instructed.

    • Notify the office staff of any changes in your medical or psychological condition. Do not be afraid to inform them of any changes, even if you do not think they are important—let your surgical team decide if these will affect your surgery.

    • Shower thoroughly as directed using an anti-bacterial soap.

    • Do not wear make-up, false eyelashes, wigs, jewelry, hair pins, or anything which can easily be removed.

    • Long hair should be placed in a pony tail or a braid away from the back of the head where your head will rest. If you are having surgery which involves the hair-bearing areas, check with your surgeon.

    • Dress simply: Loose fitting clothing, with openings in the front and loose shoes. Underwear should be cotton and bring an extra pair. Also bring something extra to warm yourself on your ride home.

    • Minors must always have a legal guardian or parent with them at all times.

    • Have a responsible adult accompany you to the office and pick you up.

    • Driving after receiving medications may be considered “driving under the influence.” Also, it is more important AFTER the surgery to have your care giver with you to receive special instructions directly from the surgical team, to avoid misunderstandings about your aftercare.

    • Never smoke, drink alcohol, or use any other “substances” for at least a week prior to surgery. Dangerous interactions can occur during surgery which may result in cardiac arrest or inability to recover from the anesthesia and other problems. If you cannot stop your habits, tell your doctor and they can assist you. Never sneak or hide your bad habits, they will only come back to “haunt” you at your weakest moment—when you are recovering from your surgery.



Post-Surgical Care
Post-operative care varies according to the procedure performed and the surgeon who performed it.

    • Before leaving the surgery center make sure the surgical team members have your phone number where you can be reached that night and make sure that you are accessible by phone after the surgery to maintain contact at all times.

    • Always have someone with you who can assist you with your aftercare. That means going to the bathroom, cleaning up if you vomit, emptying bloody drainage, awakening you for the next 24 hours on a schedule, assisting with dressing and undressing, being able to change blood-stained bandages and functioning as a nursing assistant.

    • Have towels and plastic bowls in the car in case you vomit on the way home.

    • Have a blanket in the car to keep warm.

    • Medications: as directed by your surgeon. Never take pain medication on an empty stomach as this will always produce nausea and vomiting.

    • Always have help going to the bathroom and while you are in the bathroom. In hospitals, patients often faint and injure themselves when they are left on the toilet alone because straining directs the blood away from the brain.

    • Have an alarm clock at the bedside to awaken you for medications, fluid intake, food, and wound care during the night.

    • Never smoke

    • Never drink alcohol

    • Expect to be in some discomfort. Excessive pain or swelling may be a danger sign warning you to call your surgeon.

    • Progressive discoloration, blueness, continued bleeding, blackness of the wound or anywhere, rashes, fever, unusual symptoms of any kind, pain away from the operative site may require immediate attention. Notify your surgeon that there may be a serious change in your condition requiring immediate attention.

    • If your lungs seem congested, try to cough and deep breathe every two hours for the next 12 hours after the surgery.

    • Position yourself comfortably. Elevation decreases edema (swelling).

    • Never sleep on your operative site.

    • Never fall on your operative site.

    • Never “pick” at the surgical site.

    • Never sleep with animals or in soiled bed clothing.

    • Always wash your hands after going to the bathroom.

    • Never get your operative site wet.

    • Never remove a dressing, garment, or device.

    • Never take aspirin, or other medications, herbs, unless directed by your physician.

    • Don’t exert, strain, bend over, or engage in sexual activity.

    • Do not bathe or shower until you are told to do so.

    • Do not exercise

Once the early post-operative period has passed, care needs to be directed to preserving the operative result. Normal activity cannot usually be resumed until the surgical site has healed sufficiently to withstand the stresses of everyday life.

Excessive concern in the early postoperative stage is not productive to healing. Ask for anti-anxiety medication if you cannot sleep or if you cannot control your fears and work with the surgeon’s staff to alleviate your concerns. Fortunately, most injuries heal uneventfully even without treatment unless it is a surgical emergency such as excessive collection of blood, infection which is characterized by progressive swelling, pain, warmth, and redness, fever, air hunger or shortness of breath, wheezing, chest pain, uncontrolled pain, or any other symptom which is not improving.

Baring all of this, gradually within two to five days you will begin to improve. Usually your office visits will depend upon the complexity and risk of the surgical procedure. If complications arise, try to be patient and work to resolve your problems with your surgeon. Remind yourself that changing horses in midstream is not a good idea, unless continued deterioration of your condition warrants a second opinion.

Analysis of the final result should occur in the next three to twelve months following the procedure. Emergency corrections rarely ever result in anything other than increasing scarring and making it more difficult to revise the surgery later on.

Follow the directions of your surgeon regarding exercises, massage, resumption of normal activity, restrictions, and the use of post-surgical garments. Never assume that post-operative care is unimportant.

Sometimes patients have difficulty resuming normal activities. Sleep cycles can change along with appearance. Significant others may become unsupportive. Fellow workers may reinforce your own insecurities lend them a deaf ear. Psychological gains may be delayed.

Unlike functional surgery in which pre-operative pain is often relieved by the surgical process, cosmetic surgery inflicts pain and discomfort which may persist beyond the early postoperative period. Rather than relief from psychological stress, patients experience increased anxiety and agitation after awakening and viewing their distorted image in the mirror. Never judge your surgical result from your early post-operative appearance. It takes years of experience by a seasoned operator to evaluate and treat early post-operative issues. Swelling is not symmetrical and can obscure even the best results; however, if you feel excessively concerned then have your surgeon take a look. Remember, you and your surgeon are a team, working together to achieve a common goal,the best possible result for both of you.



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