Post Operative Instructions

GETTING READY FOR SURGERY

  1. Schedule elective surgery when you’re healthy. A good immune system improves your chances of a speedy recovery. Call your primary care doctor to discuss your upcoming surgery if you are over 55 years old or have any medical conditions. Your doctor will decide if you need any tests before surgery and will notify us in writing that you are healthy to undergo the procedure. Some surgeries require tests before the procedure, regardless of your age.
  2. Build a support structure. Rely on your family and friends to help you. Ask them to bring healthy foods. Talk about your fears or worries with supportive friends.
  3. Drink plenty of water. It is important to drink at least 6-8 glasses of water each day and especially the day before surgery as you will not be able to drink much on the day of surgery.
  4. Do not drink alcohol one week prior to and three weeks after surgery. Alcohol holds back the immune system and can increase the risk of infection. It can also cause unwanted bleeding. After your procedure, do not drink alcohol while you are still taking prescription pain medication. The combination of narcotic pain medications and alcohol can lead to serious consequences including death from respiratory arrest.
  5. Do not smoke four weeks before and after surgery. This cannot be stressed enough! Quitting smoking is essential for the best healing and fine scars. Smoking increases your risk of other complications as well. Do not use gums or patches that contain nicotine for the same period of time before and after surgery.
  6. Certain nutritional supplements can thin your blood. These include vitamin E, fish oil, omega 3, herbal and homeopathic medications. Please stop these 10 days before the procedure
  7. Certain vitamins and minerals promote healing. They include bioflavonoid, Copper, Selenium, Zinc, and Vitamins A and C.
  8. Do not drive, operate machinery or make important decisions when taking narcotic pain medicine. They can make you sleepy and slow your reaction time.

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MEDICATIONS TO AVOID BEFORE AND IMMEDIATELY AFTER SURGERY

  1. Do not take aspirin, or non-steroidal anti-inflammatory medication (NSAID’s), such as ibuprofen or naproxen, for two weeks prior to and 10 days after surgery. These medications are blood thinners and can cause excessive bleeding during surgery. In addition, ensure that any over the counter sinus or cold remedy that you take during this time period does not contain these drugs. If you wish to take something for headaches or other minor discomfort, you may take acetaminophen-containing products such as Tylenol. Please note that this is not a complete list.
  2. Estrogen-containing pills, injection, or patches including birth control pills thicken blood and increase the risk of clots in your legs and lungs. Stop using estrogen four weeks before surgery if at all possible. They may be resumed after surgery once normal activity and walking has been resumed. Your primary care physician will advise you on alternative methods of contraception during this time.
  3. Stop diet pills two weeks before surgery. Blood thinners/Anticoagulants such as Coumadin or Plavix will need to be stopped before surgery. This will be co-coordinated with the doctor who prescribed these medications.
Non-Steroidal Anti-Inflammatory Drugs (NSAID’s)
Advil
Celebrex
Ketoprofen
Aleve
Mobic
Daypro
Lodine
Toradol
Anaprox
Diclofenac
Mobic
Relafen
Ansaid
Feldene
Motrin
Vicoprofen
Arthrotec
Ibuprofen
Naprosyn
Voltaren
Bextra
Indocin
Naproxen
Medications Containing Aspirin
Alka-Seltzer
Bufferin
Fiorinal
Anacin
Darvon Compound
Pepto-Bismol
Asprin
Ecotrin
Percodan
Bayer Arthritis
Excedrin
Estrogen Products
All oral contraceptives and hormone replacement therapy
Anticoagulants and Antithrombotics
Aggrenox
Halfprin
Persantine
Coumadin
Herapin
Plavix
Ecotrin
Lovenox
Ticlid
Fragmin
Orgaran
MAO Inhibitors
Nardil (Phenelzine)
Parnate (Tranylcypromine)
Herbal Medications and Supplements
Vitamin E (14 days before)
Garlic
Lovaz
St. John’s Wort
Valerian
Multivitamins
(containing Vit.E)
Ginkgo Biloba
Ginseng
Ma Huang
Echinacea
Saw Pilmetto
Kava
Fish Oil
MEDICATIONS THAT MAY BE TAKEN PRIOR TO SURGERY
Acetaminophen (Tylenol)
Duragesic
Roxanol
Darvocet
Fioricet
MSIR
Tylenol + Codein
Darvon
Lorcet
Oxycontin, oxycodone
Vicodin (Hydrocodone)
Dilaudidt
Lortab
Percocet

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NIGHT BEFORE AND MORNING OF SURGERY

  1. Do not drink anything after midnight the night before your surgery, unless your doctor tells you otherwise. This to prevent anesthetic complications and your procedure may be cancelled if it is not followed. No gum, candy, mints or coffee the morning of surgery.
  2. Shower with regular soap and water the morning of surgery and the night before. For facial procedures, wash your face and neck thoroughly with soap and water. Remove all makeup, especially mascara and eyeliner. This will diminish the chance of a wound infection.
  3. Do not use any creams, lotions or hair sprays on the morning of surgery.
  4. You may brush your teeth the morning of surgery but do not drink anything.
  5. Do not wear contact lenses to surgery. If you wear glasses, bring them with your eyeglass case.
  6. Wear comfortable, loose-fitting clothes that do not have to be put on over your head. The best thing to wear home is a button or zip-up top and pull on pants. You will want flat shoes that are easy to slip on.
  7. Do not bring any money or valuables. Do not wear any jewelry (no rings, earrings, chains, body piercings or watches).
  8. You must have an adult drive you to and from surgery. Please note that a private driver, cab or bus will not be allowed to take you home after surgery. When you arrive, be sure we know your driver’s name, phone number and contact information. Transportation to the office for drain and suture removal during the first week after the procedure is also required and will be discussed before the procedure.
  9. If you are not going home to recover, it is very important that we have your number and contact information where you will be after surgery.
  10. If you are staying overnight after surgery, you should also bring all your regularly prescribed medicines (heart, blood pressure, diabetes or thyroid pills) with you.

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BREAST SURGERY

Showering and incision care

You may start to shower 48 hours after surgery. However, you will need to wait for 4 weeks before you can soak the incision in a bathtub or pool. During the first few weeks after surgery, you may wear a soft cup bra or a camisole. Do not wear a bra with underwire for 6 weeks after surgery. An underwire may cause skin breakdown or cause the incision to open up.

Paper tapes/strips are usually placed on the incisions. You may use soap and water over these and dab the area dry. With time as they begin to peel, trim only the peeled portions. Do not remove the entire strip unless it is loose.

You may use new strips to replace ones that have become loose. Keeping these paper tapes on the incision for 3 months will significantly improve the quality of the final scar.

You may resume normal activity in one or two weeks.

Activity

Exercise your lower extremities while you are in bed. This will reduce the risk of developing blood clots in your legs.

*Flex and point your feet

*Do ankle rolls

*Bend and straighten your knees

Do this several times a day until you are walking as much as usual

You may walk and climb stairs as soon as you feel fit to do so without any restrictions.

Do not lift anything over 10 pounds for 6 weeks after surgery.

Do not take part in sports or any strenuous activities for 6 weeks after surgery

Smoking

Do not smoke for at least 4 weeks before and after surgery. Stay away from places where people do. Smoking can slow healing and cause skin breakdown. It can also cause death of tissues.

Sun and heat exposure

Your surgery will leave a scar and it may take well over a year to fade and blend in with surrounding skin. No matter how small the scar, sunlight can cause permanent darkening of your scar. Sunlight can even go through your clothes.

Do not expose your incision/scar to direct sunlight for a year from the time of surgery. Use sunscreen with a SPF for at least 30 when you go out. Wait for 3 weeks from the date surgery before starting to use sunscreen.

Do not use heat of any kind (heat lamp, heating pad, sauna, hot tub, tanning booth) for at least 12 weeks after surgery or permanently if you have areas of decreased sensation around the scars.

Other instructions

For two weeks after the operation, do not use Aspirin, ibuprofen or similar medications. Please see enclosed list for details. You may use regular Tylenol.

You should do breathing exercises for one week after surgery or until you are able to get up and walk around comfortably. This is to prevent pulmonary complications of general anesthesia.

Do not drive, operate machinery or make important decisions when taking narcotic pain medicine. They can make you sleepy and slow your reaction time.

Do not use any scar creams or ointments on the incision without consulting your surgeon.

When to call

Call the office if you are unable to tolerate food or liquids for more than 24 hours; are vomiting for more than 24 hours or become dehydrated even if less than 24 hours.

Call the office immediately for a fever of 101F or higher.

Call the office if there is increasing pain, redness, swelling, and warmth or pus drainage at the incision.

Drain care

When you get home, keep a track of how much is drained from each drain (in milliliters) over a 24-hour period (7AM to 7AM, noon to noon or any other 24 hour period that is consistent from day to day).

Empty the drain bulb when it is half full. If the drain bulb fills completely, it will not be effective in removing fluid from the area where it is placed.

Make sure to keep track of each drain tube separately

You may shower with the drains in place; after the shower, apply an over the counter antibiotic ointment to the skin around the drain.

You may use a gauze sponge around the drain site if there is leakage of fluid

Call the office if there is sudden rapid filling of the drain bulb with blood, if the hourly drainage is over 50cc for 3 continuous hours or if the drainage appears cloudy or infected.

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TUMMY TUCK

Showering and incision care

You may start to shower 48 hours after surgery. However, you will need to wait for 4 weeks before soaking the incision in a bathtub or pool.

Paper tapes/strips are usually placed on the incisions. You may use soap and water over these and dab the area dry. With time as they begin to peel, trim only the peeled portions. Do not remove the entire strip unless it is loose.

You may use new strips to replace ones that have become loose. Keeping these paper tapes on the incision for 3 months will significantly improve the quality of the final scar.

You may resume normal activity in one or two weeks.

Using a abdominal binder

Cover the incision with gauze before putting the binder on. Do not let the binder touch your incision for 3 weeks after surgery. Alternatively, you may wear a long T- shirt and have the binder over it.

Wear the abdominal binder at all times for 4 weeks after surgery except when you shower. You may wash the binder if it becomes soiled.

Activity

Exercise your lower extremities while you are in bed. This will reduce the risk of developing blood clots in your legs.

*Flex and point your feet

*Do ankle rolls

*Bend and straighten your knees

Do this several times a day until you are walking as much as usual

You may walk and climb stairs as soon as you feel fit to do so without any restrictions.

Do not lift anything over 10 pounds for 6 weeks after surgery.

Do not take part in sports or any strenuous activities for 6 weeks after surgery

Smoking

Do not smoke for at least 4 weeks before and after surgery. Stay away from places where people do. Smoking can slow healing and cause skin breakdown. It can also cause death of tissues.

Sun and heat exposure

Your surgery will leave a scar and it may take well over a year to fade and blend in with surrounding skin. No matter how small the scar, sunlight can cause permanent darkening of your scar. Sunlight can even go through your clothes.

Do not expose your incision/scar to direct sunlight for a year from the time of surgery. Use sunscreen with a SPF for at least 30 when you go out. Wait for 3 weeks from the date surgery before starting to use sunscreen.

Do not use heat of any kind (heat lamp, heating pad, sauna, hot tub, tanning booth) for at least 12 weeks after surgery or permanently if you have areas of decreased sensation around the scars.

Other instructions

For two weeks after the operation, do not use Aspirin, ibuprofen or similar medications. Please see enclosed list for details. You may use regular Tylenol.

You should do breathing exercises for one week after surgery or until you are able to get up and walk around comfortably. This is to prevent pulmonary complications of general anesthesia.

Do not use any scar creams or ointments on the incision without consulting your surgeon.

When to call

Call the office if you are unable to tolerate food or liquids for more than 24 hours; are vomiting for more than 24 hours or become dehydrated even if less than 24 hours.

Call the office immediately for a fever of 101F or higher.

Call the office if there is increasing pain, redness, swelling, and warmth or pus drainage at the incision/wound.

Drain care

When you get home, keep a track of how much is drained from each drain (in milliliters) over a 24-hour period (7AM to 7AM, noon to noon or any other 24 hour period that is consistent from day to day).

Empty the drain bulb when it is half full. If the drain bulb fills completely, it will not be effective in removing fluid from the area where it is placed.

Make sure to keep track of each drain tube separately

You may shower with the drains in place; after the shower, apply an over the counter antibiotic ointment to the skin around the drain.

You may use a gauze sponge around the drain site if there is leakage of fluid

Call the office if there is sudden rapid filling of the drain bulb with blood, if the hourly drainage is over 50cc for 3 continuous hours or if the drainage appears cloudy or infected.

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Brow lift and eyelid surgery

Iced compresses to the eyes for 15 to 20 minutes of every hour when awake for the first 3 days after surgery will help to keep the swelling down

Use preservative free eye drops as needed during the day (Refresh plus) and at bedtime (Refresh PM) for 10 days after eyelid surgery. This can be discontinued when swelling around the eyelid and irritation has diminished.

After 24 hours, you may start washing your face with a neutral or bland soap. A baby soap/shampoo is preferable, as it will not cause irritation if it accidentally enters the eye. Crusting over the eyelids is normal and can be gently washed with a little baby shampoo and warm water. You may use a moisturizer on the face but keep it away from suture lines.

You may wash your hair using a mild shampoo/baby shampoo about 24 hours after the procedure. It may take several washings before all crusts are out of your hair.

If you use a regular shampoo, avoid getting it into your eyes as irritation and consequent rubbing of the eyes can disrupt the sutures and breakdown the incision.

Do not use hairsprays, conditioners, gels, and etc. for 2 weeks after the operation if there are incisions over the scalp (brow lift). Hair color should be delayed for 4 weeks after the surgery.

Be careful using a comb or brush as it may get caught in the suture line

Your hair may be blow dried but only in the cool setting!! (If scalp incisions are present)

Do not apply any cream or ointment containing vitamin E or Mederma over the incision after surgery.

You may walk and climb stairs as soon as you feel fit to do so without any restrictions.

Gradually work back up to pre-surgical activities after three weeks. Strenuous activity can be resumed after 6 weeks.

Smoking

Do not smoke for at least 4 weeks before and after surgery. Stay away from places where people do. Smoking can slow healing and cause skin breakdown. It can also cause death of tissues.

Sun and heat exposure

Your surgery will leave a scar and it may take well over a year to fade and blend in with surrounding skin. No matter how small the scar, sunlight can cause permanent darkening of your scar. Sunlight can even go through your clothes.

Do not expose your incision/scar to direct sunlight for a year from the time of surgery. Use sunscreen with a SPF for at least 30 when you go out. Wait for 2 weeks from the date surgery before starting to use sunscreen. Wear a wide brim hat.

Do not use heat of any kind (heat lamp, heating pad, sauna, hot tub, tanning booth) for at least 12 weeks after surgery or permanently if you have areas of decreased sensation around the scars.

Other instructions

For two weeks after the operation, do not use Aspirin, ibuprofen or similar medications. For a complete list please see above. You may use regular Tylenol.

You should do breathing exercises for one week after surgery or until you are able to get up and walk around comfortably. This is to prevent pulmonary complications of general anesthesia

When to call the office

Call the office if you are unable to tolerate food or liquids for more than 24 hours; are vomiting for more than 24 hours or become dehydrated even if less than 24 hours.

Call the office immediately for a fever of 101F or higher.

Call the office if there is increasing pain, redness, swelling, and warmth or pus drainage at the incision/wound.

Drain care

When you get home, keep a track of how much is drained from each drain (in milliliters) over a 24-hour period (7AM to 7AM, noon to noon or any other 24 hour period that is consistent from day to day).

Empty the drain bulb when it is half full. If the drain bulb fills completely, it will not be effective in removing fluid from the area where it is placed.

Make sure to keep track of each drain tube separately

You may shower with the drains in place; after the shower, apply an over the counter antibiotic ointment to the skin around the drain.

You may use a gauze sponge around the drain site if there is leakage of fluid

Call the office if there is sudden rapid filling of the drain bulb with blood, if the hourly drainage is over 50cc for 3 continuous hours or if the drainage appears cloudy or infected.

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Facelift surgery

Iced compresses to the face and eyes for 15 to 20 minutes of every hour when awake for the first 3 days after surgery will help to keep the swelling down

POSITIONING IN BED

Sleep flat on your back without a pillow. A neck roll may be used for support.

It is NOT necessary to sit up or sleep on a recliner

It is important not to flex the neck (point chin down towards the neck) for about a week after surgery. Reading should be done by elevating the material to eye level without flexing the neck

During the first week after surgery, keep a pillow beneath the knees and one on each side of the body, between the side of the body and the arms/forearm. This prevents accidental rolling over to the side

Use preservative free eye drops as needed during the day (Refresh plus) and at bedtime (Refresh PM) for 10 days if eyelid surgery was also performed. This can be discontinued when swelling around the eyelid and irritation has diminished.

After 24 hours, you may start washing your face with a neutral or bland soap. A baby soap/shampoo is used if eyelid surgery was also performed, as it will not cause irritation if it accidentally enters the eye. Eyes irritation and consequent rubbing of the eyes can disrupt the sutures and breakdown the incision.

Crusting over the eyelids/suture lines is normal and can be gently washed with a little baby shampoo and warm water. You may use a moisturizer on the face but keep it away from suture lines.

You may wash your hair using a mild shampoo/baby shampoo about 24 hours after the procedure. It may take several washings before all crusts are out of your hair.

Do not use hairsprays, conditioners, gels, and etc. for 2 weeks after the operation. Hair color should be delayed for 4 weeks after the surgery.

Be careful using a comb or brush as it may get caught in the suture line

Your hair may be blow dried but only in the cool setting!!

Do not apply any cream or ointment containing vitamin E or Mederma over the incision after surgery.

You may walk and climb stairs as soon as you feel fit to do so without any restrictions.

Gradually work back up to pre-surgical activities after three weeks. Strenuous activity can be resumed after 6 weeks.

Smoking

Do not smoke for at least 4 weeks before and after surgery. Stay away from places where people do. Smoking can slow healing and cause skin breakdown. It can also cause death of tissues.

Sun and heat exposure

Your surgery will leave a scar and it may take well over a year to fade and blend in with surrounding skin. No matter how small the scar, sunlight can cause permanent darkening of your scar. Sunlight can even go through your clothes.

Do not expose your incision/scar to direct sunlight for a year from the time of surgery. Use sunscreen with a SPF for at least 30 when you go out. Wait for 2 weeks from the date surgery before starting to use sunscreen. Wear a wide brim hat.

Do not use heat of any kind (heat lamp, heating pad, sauna, hot tub, tanning booth) for at least 12 weeks after surgery or permanently if you have areas of decreased sensation around the scars.

Other instructions

For two weeks after the operation, do not use Aspirin, ibuprofen or similar medications. Please see attached list. You may use regular Tylenol.

You should do breathing exercises for one week after surgery or until you are able to get up and walk around comfortably. This is to prevent pulmonary complications of general anesthesia

When to call the office

Call the office if you are unable to tolerate food or liquids for more than 24 hours; are vomiting for more than 24 hours or become dehydrated even if less than 24 hours.

Call immediately if there appears to be excessive swelling/ a golf ball under the skin like appearance over the neck.

Call the office immediately for a fever of 101F or higher.

Call the office if there is increasing pain, redness, swelling, and warmth or pus drainage at the incision/wound.

Drain care

When you get home, keep a track of how much is drained from each drain (in milliliters) over a 24-hour period (7AM to 7AM, noon to noon or any other 24 hour period that is consistent from day to day).

Empty the drain bulb when it is half full. If the drain bulb fills completely, it will not be effective in removing fluid from the area where it is placed.

Make sure to keep track of each drain tube separately

You may shower with the drains in place; after the shower, apply an over the counter antibiotic ointment to the skin around the drain.

You may use a gauze sponge around the drain site if there is leakage of fluid

Call the office if there is sudden rapid filling of the drain bulb with blood, if the hourly drainage is over 50cc for 3 continuous hours or if the drainage appears cloudy or infected.

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Aftercare Instructions for In-Office Procedures

  • Keep incision completely dry for 24 hours. Once wet, gently pat dry over the incision, do not rub.
  • A Small amount of bleeding can be normal after your procedure. Hold gentle compression to the area until bleeding subsides.
  • Expect some bruising and swelling after your procedure. This is temporary and will resolve with time.
  • If paper tape (steri-strips) was placed over your incision:
    • Keep steri-strips on. No dressing changes are required.
    • If steri-strips peel or lift off, trim the peeled off portion and leave the stuck on portion.
  • If antibiotic ointment was applied to your incision:
    • Re-apply a thin smear of ointment over the incision 2-3 times/day for 2 or 3 days.
    • No dressings or bandages are needed.
  • If it was necessary, you may have been given an oral antibiotic prescription. Take as directed
  • Take Tylenol, ibuprofen (Motrin, Advil) or Aleve as needed for pain after your procedure.
  • Do not apply scar cream (Mederma, Vitamin E, etc.) to your incision for at least 6 months. They all initially cause the incision to soften and stretch.
  • Return to the clinic as scheduled for either suture removal or follow-up.