PREPARING FOR SURGERY TIPS
Choosing your plastic surgeon
Perhaps the most important initial decision when electing to undergo cosmetic or reconstructive surgery is to choose the right surgeon. Choosing a Board Certified Plastic Surgeon is of utmost importance to ensure that you have a well-qualified and well-trained physician. These days, many doctors can legally perform cosmetic surgery and label themselves as a cosmetic surgeon but may not be formally trained as a plastic surgeon.
A “Board Certified Plastic Surgeon” is someone who:
- Has completed at least five years of surgical training with a minimum of two years in plastic surgery.
- Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
- Operates only in accredited medical facilities
- Adheres to a strict code of ethics.
- Fulfills continuing medical education requirements, including standards and innovations in patient safety.
- And has passed the rigorous written and oral examination administered by The American Board of Plastic Surgery. This certification takes two years to complete and involves an in depth oral examination that tests each individuals fund of knowledge, code of ethics and safety in treating aesthetic and reconstructive patients.
Make sure you ask your doctor these key words, “Are you a board certified plastic surgeon?”.
Once you have chosen your board certified plastic surgeon, Dr. Hsu always recommends at least two consultations with different doctors. Picking the right plastic surgeon when undergoing elective surgery is very important. You need to find someone that you’re comfortable with and more importantly, that you trust. Ask Dr. Patrick Hsu about other reputable plastic surgeons that you are considering visiting. He is more than happy to confirm who is a qualified colleague in the community.
Who is a good candidate for plastic surgery?
Good candidates for plastic surgery include those individuals who are healthy, have a stable weight and have realistic and reasonable expectations. It is important to know your risks because every surgical procedure has potential complications. Some patients may have more serious health problems such as diabetes, high blood pressure, and heart disease which may make those individuals less optimal candidates with more associated risks.
If you’re obese or you smoke or drink too much alcohol, you may not be a good candidate for cosmetic surgery. Dr. Hsu may ask you to make some changes before surgery. For instance, smokers need to quit for two to four weeks before surgery and not smoke for at least two to four weeks after surgery. This allows the body to heal properly from the surgery. If you don’t smoke, you should avoid second hand smoke before and after surgery.
Before your surgery, Dr. Hsu will speak with you in depth about your health, your lifestyle (including exercise, drinking, and smoking), any conditions you have, and any medications or supplements you take. That discussion will help you know if surgery is a good option for you.
Be sure you tell Dr. Hsu about everything you take, even vitamins and herbal products that don’t require a prescription. Some may affect bleeding risk or interfere with other medications used during surgery. It is important to be truthful and upfront with all of your medical and surgical history to ensure a safe and a fast recovery.
What are the potential risks and complications of surgery?
Every surgical procedure carries risks. The most common risks to any surgery include bleeding, infection and scarring. This is true for whether you have a simple mole removed to something more invasive such as a mastectomy for breast cancer or breast augmentation surgery. Every specific surgery carries additional risks depending upon where on the body it is and what adjacent structures and tissues may be close by.
Bleeding occurs with any sort of cut or incision on the body. During surgery, blood vessels are delicately cauterized to prevent continuous bleeding. It is equally important to prevent postoperative bleeding so a hematoma does not occur. A hematoma is a blood collection under the skin in the surgical site. The risk of hematoma is increased if you have bleeding after surgery related to increased heart rate or blood pressure, or if you have been on any blood thinners before surgery.
Infection is rare however can occur with even a simple cut. Precautions are taken with each and every individual who undergoes a surgical procedure. Patients are given a preoperative dose of antibiotic through their IV and the skin is thoroughly cleansed with an antiseptic solution (betadine or chlorhexadine). It is common to also have postoperative antibiotics prescribed as well depending upon the surgical procedure.
Unfortunately, any incision on the body will lead to a scar. There is no such thing as scarless surgery at this time since any cut on the body that goes through the entire skin will result in a scar. Dr. Hsu takes extra precaution to keep scars hidden and as small as possible. Additionally, patients are started on scar therapy between 2-4 weeks after surgery with over the counter products that have been shown in the literature to help with scarring.
Risks and complications are not common otherwise many surgical procedures whether aesthetic or reconstructive would not be offered. It is important to know that complications can occur with any surgical procedure and being an educated and well-informed patient is of paramount importance.
There is no doubt that patients who smoke have higher complication risks. This has been shown over and over in the literature from various surgical sub-specialties including plastic surgery. The chemicals in cigarettes affect how your body works, and how well it copes during and after surgery.
Specifically, nicotine in cigarette smoke increases your heart rate and blood pressure every time you smoke. Your heart works harder, and so it needs more oxygen. Other chemicals in cigarette smoke can paralyze or destroy the tiny hair-like cilia in your lungs which work to keep your lungs clear. If you smoke, you may have more mucus in your lungs and narrower airways. Also, your airways and air sacs in your lungs are more likely to partially collapse making it harder to breathe.
Smoking also significantly impairs wound healing to bones, skin and other body tissues. Especially in plastic surgery, the skin at the site of surgery is far more likely to die if you smoke. Smokers are more likely to have wound infection after surgery, longer healing times, problems with new scars opening up, and bad scarring, compared to people who have stopped smoking for four weeks or more.
Depending on the surgery, Dr. Hsu will almost always recommend quitting for 4 weeks before surgery and 4 weeks after surgery.
How to prepare positively for your surgery and ready your body for surgery
First you can get your body in shape — the healthier it is going in, the faster it can heal. Now if you only have a month and are really out of shape this may not be realistic, but it doesn’t hurt to increase your workouts or yoga sessions or stretches before surgery.
This can also be a good time to evaluate your diet. Eating more protein and fiber, and less processed junk food, will provide your cells with the building blocks of wound healing. Some women have used their surgery as an opportunity to start afresh, with a healthy cleanse and detox prior to surgery to create their new selves. Cleansing your system prior to surgery can also help to metabolize anesthesia drugs. Eating healthy and keeping unnecessary weight off is important in maximizing your results after surgery.
It is normal to feel anxiety in the days leading up to surgery and especially on the day of surgery. If you’ve done all your homework and prepared your body for surgery, you need to remain positive that you’ve made the right decision. Any last questions should be answered either by the staff prior to surgery or by Dr. Hsu the day of surgery. Make sure you jot down a list of questions so that they can be answered efficiently.
Ultimately, you have to remember that you made the right decision in going with a plastic surgeon that you trust.
Make sure you are thorough in all the medications that you are taking when consulting with your board certified plastic surgeon. It is important to list all medications including over the counter ones such as herbal supplements. Many medications have side effects, the most common being bleeding. Be sure you are off medications such as aspirin, coumadin, Advil, ibuprofen, heparin or any other medications that are associated with increased bleeding. Our doctors and staff will specifically go over which medications to avoid prior to surgery.
The most common medications prescribed are anti-nausea, antibiotics, and pain medication. These medications help alleviate the pain and nausea associated with any surgical procedure as well as help reduce infection. All medications will be called into your pharmacy of choice weeks prior to surgery so that you can pick them up and have them available when you get home. It is important to use this medication as needed and to get off of them as fast as possible to prevent addiction and side-effects. The short course of antibiotics should be completed until the last pill and nausea medication taken only as needed.
What to expect postoperatively
Pain and discomfort should be expected with any surgery. Dr. Hsu always tries to minimize pain and discomfort by providing more local anesthesia injections and nerve blocks than other surgeons. Pain medication should be used on an “as needed” basis but if the pain is hard to control, it can be used on a scheduled basis for the first 24 hours. That means giving yourself pain medication every four hours scheduled. This allows the medication to build up in the system so you don’t fall behind. Dr. Hsu usually recommends going to “as needed” on the second day and thereafter. Nausea medication is only indicated if there is nausea. Frequently, patients will develop nausea as a result from anesthesia or most commonly, the pain medication itself. The faster you can get off pain medication, the more likely you will resolve your nausea and constipation. Dr. Hsu allows his patients to transition to Advil or ibuprofen immediately after surgery. Advil and ibuprofen can be effective pain relievers and are better than Tylenol, which is better for fevers.
What kind of follow-up will I have after surgery?
Follow-up is extremely important to Dr. Hsu. In addition to the operation being executed to plan, close follow-up is just as important to assure the best results and to detect complications early before they become a bigger problem. Dr. Hsu’s follow-up after the date of surgery are 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year. Dr. Hsu or one of the staff will almost always see you unless there is a scheduling difficulty.