The Center for Plastic Surgery at MetroDerm, P.C.
Before & After Surgery Instructions
Dr. Nahai put this information to help you. It will answer many of your questions and provides good advice in preparation for your operation. Your surgery date and location will have been provided by Cathy Oldroyd. Surgery Time As of your pre-op visit your surgery is scheduled for ________________(date/time) at ___________________(location). Be aware that sometimes the operating schedule changes and the surgery time you were given at pre-op may change. If this happens you will get a call from my office 24-48 hours before surgery to inform you of the change. Meds to take Continue to take any medication that are prescribed by your physician unless you are specifically told to do otherwise by Dr. Nahai or your anesthesiologist. This includes the morning of your operation. Arnica and bromelian starting 3-5 days prior to surgery are particularly effective at reducing post operative bruising and swelling. Multivitamins are also good at helping with the healing process especially vitamins C (2gms -4 gms/day) and A (~300% of RDA). Meds to avoid In general any pill you are taking that is NOT prescribed by your physician should be stopped at least one week prior to surgery. This includes supplements and very high dose vitamins. Many of these thin the blood and contribute to bruising. NSAIDS like asprin, ibuprofen, and many arthritis medications are powerful platelet inhibitors that increase bleeding and should be avoided for at least one week before surgery. Try to use Tylenol instead. An easy rule of thumb is just eat food and take Tylenol. Smoking For all plastic surgery procedures, smoking increases the risk of delayed healing, wound infections, and skin necrosis (dead skin). For this reason I require that all patients who smoke completely stop smoking at least two weeks prior to surgery and for two more weeks after surgery. I have canceled patients in the past who have not followed this requirement.
Constipation can often be a problem after surgery due to decreased mobility, dehydration, and use of narcotic pain medications. All of these conspire to slow down the GI tract. If you are prone to constipation I advise that you start a healthy bowel regimen one week before surgery (especially body contouring surgery) including high fiber foods (fresh fruits and vegetables), stool softeners or Metamucil.
Keep up your usual activity level (working out, walking, etc…) leading up to your surgery. If you are a particularly active person, get as much activity in before your surgery because you will not be able to work out the same way for a period of time afterwards. This includes sexual activity. Keep yourself very well hydrated, especially the 48 hours leading up to surgery.
If you have questions leading up to your surgery please contact our office or the Northside outpatient center where you are scheduled.
DAY OF SURGERY
Surgery at the office (meds, what to wear, ride home)
On the day of surgery at the office, go ahead and start your antibiotics and steroids pills (if you were prescribed them) that morning. When you arrive you can take the relaxation and/or pain pills. Please do not apply any make-up or any sort of creams or moisturizers on your face or body the day of surgery. Also, wear little or no jewelry as we will ask you to remove it. It is best to wear loose fitting clothes that you do not mind possibly getting soiled with betadine or body fluids.
If you are taking relaxation pills and/or pain pills for your procedure we insist that you have a ride home with someone you know. We will not put you in a cab or Uber with a stranger after a procedure. If getting a ride is difficult for you let us know and we can help arrange a car service with a company that we know and trust.
Surgery at the outpatient center (meds, when and where)
You should receive a phone call 24-48 hours before the day of surgery confirming your arrival time to the surgery center. Hang on to your medications as there is no need to take anything that we prescribe you the day of surgery. You can start the pills we prescribed on the first postoperative day. If you are spending the night at the outpatient center you can bring your other home meds with you. Please do not apply any makeup or any sort of creams or moisturizers on your face or body the day of surgery. Also, wear little or no jewelry as you will be asked to remove it. If getting a ride is difficult for you let us know and we can help arrange a car service with a company that we know and trust.
Activities to do
Take it easy but do not be a couch potato. I understand that moving around after surgery can sometimes be challenging. It is important to move all parts of your body to some degree at least every two hours (while awake). You should be getting up to use the bathroom and moving from room to room in your house. It is important to maintain good blood flow in your legs and avoid stagnation. This will help prevent pneumonia and blood clots in your legs. If you went home with the surgery socks, keep wearing them.
Activities not to do
Do not do anything that causes severe pain. Do not do anything that makes you short of breath, break a sweat, gets your heart rate up, raises your blood pressure, or that you would consider strenuous. This includes sexual activity. Often times even work related phone calls and emails can be stressful enough to raise your blood pressure and negatively affect the healing process. House work should be left for others to do while you are recovering from surgery. A safe rule of thumb is not to lift anything heavier than a laptop computer.
Everyone’s perception of pain is different, and it is very difficult to predict how much pain any one individual will experience. My goal is for all my patients to have as little pain for the least amount of time after surgery as possible. The prescriptions you are given contain multiple different medications of varying strength and mechanisms of action designed to mitigate your pain in multi-modal approach. The narcotic containing medications are for severe pain and the Tramadol for mild to moderate pain. The muscle relaxers often help with pain originating from muscle inflammation due to surgery. Anti anxiety medications (eg., Valium or Xanax) often reduce the anxiety component of pain and can be helpful as well. If you have any specific questions about the medications, please call the office. (see the table below for a summary on medications)
Ices packs, frozen peas, or other cooling methods are helpful in reducing pain and swelling at the surgery site. I highly recommend icing for at least the first 48 hours, especially on the face. There is no need to ice without giving yourself a break, so generally 10-15 minutes on then 5-10 minutes off works well.
Heating pads or other sources of heat on the surgical area are to be avoided. Burns can occur. Do not apply heat to any areas where surgery has been done.
Dressings are placed over your incisions to prevent soiling your clothes and protect the incision. In general most dressing can be removed two days after surgery. Some special situations exist where you will be given specific instructions not to remove your dressings. These special situations will be made apparent to you after surgery before going home.
Dressings that become soiled with blood should be removed as they can harbor bacterial growth. Most incisions do not need a dressing after 48 hours, however if you still have some minor drainage of fluid, continue cycling fresh dressings.
Garments are generally used after surgery to help support and compress areas where surgery was performed in order to help with pain and swelling. They are especially effective after liposuction, breast and body contouring, and face/neck lift procedures. For the first week I recommend that the garment be worn the majority of the time, think 22 out of 24 hours. It can be taken off for bathing and to wash the garment.
After the first week we will assess your progress and switch to wearing it just half the day (for example just at night or just while awake) if indicated. If the garment is too tight and cutting into your skin, let us know. Often just releasing a couple clasps and placing something soft between the garment and your skin is all that needs to be done. If the size is simply wrong, we can order another garment. Also, we want to avoid deep creases in the garment that can cut into your body so adjust and pull the garment to keep it flush against your skin without deep creases. Lastly, if you have drains, we do not want the drain tubing compressed against your skin (this can happen after tummy tuck). This can cause skin damage. Cut a hole in the garment near where the drain comes out from your skin and run the tubing out from there.
Medications for after surgery
Before your surgery, you should have a prescription from Dr. Nahai that contains a combination of medications for severe pain, moderate pain, antibiotics, eye drops/ointment (for eyelid surgery only), anti-inflammatory steroids (for most procedures of the face), muscle relaxants, and possibly anti-anxiety medications. Most medications can be renewed over the phone. Certain narcotic pain medications and anti-anxiety medications require a paper prescription that must be picked up at the office. Think ahead, if you anticipate needing more narcotic pain medications or anti-anxiety medications, ask for a prescription when you are in the office. See the table below for a summary of the medications typically used and what purpose they are intended to serve.
* for procedures done in the office start the antibiotic and steroid pills until the day of your procedure
**for all procedures done in the operating room at the surgery center hold on taking the antibiotic and steroid pills until the day after your procedure
In office procedure (day of procedure):
- If you were prescribed prednisone (Medrol dose pack), start it in the morning as directed by the blister pack
- • Start the antibiotic in the morning 30 minutes prior to your procedure take a Xanax and/or a half tablet of the pain pill, and the anti-nausea pill, we can help you decide what is best for your situation
Procedures done in the OR:
If you are prescribed Xanax or something for anxiety you may take it the evening prior to your procedure to help you sleep Start your pain medications when you get home as needed The steroid pack (Medrol) and the antibiotic (usually Doxycycline) is started the morning after your procedure (you will be given an IV form of these medications in the surgery)
***a common scenario is as follows;
a) leading up to surgery: take arnica and bromelien tablets
b) the day of surgery: do not take any of the meds I gave you, only what the surgery center tells you to take
c) the first night: pain pills and/or muscle relaxants as needed
d) the first day after surgery: start the antibiotics and steroids and continue the pain medications as needed.
I recommend ‘staggering‘ your pain meds and relaxants at first so that you are not taking too much at once. You will soon figure out what works best for you and your situation.
Some normal things that happen after surgery
- changes in skin sensation (decreased or increased sensation)
- minor oozing from the incision (especially after liposuction)
- swelling (usually peaks on the second day after surgery)
- sore throat (usually from the breathing tube)
- nausea (especially the first 24 hours)
When to call
If for any reason you are not sure about what to do or what is going on with your body, you can call us. There will always be someone knowledgeable available to answer your question. The main number is 404-835-4191. If for some reason the main line is down, please call the answering service directly at 770-928-5285. Several circumstances exist where you should call the office without delay…
- rapidly increasing pain and swelling anywhere on your body that you had surgery
- bleeding that will not stop despite gentle pressure for 15 minutes
- a fever higher than 101 degrees within 10 days of your surgery
- the incision opens up
- difficulty with breathing, inability to catch your breath