Plastic Surgery Guide

Surgery Guide and Checklist

1. Prior to Surgery
2. After Surgery

Thank you for your confidence in choosing our office for your aesthetic surgery. We fully realize that this decision is a major step in your life. Although Dr. Sayah has performed many plastic surgery procedures, this may be your first. It may even be your first surgical experience of any kind. We wish to inform, support, reassure and guide you through this most exciting experience.

Every year more than one million plastic surgery procedures are performed. Just a few decades ago, improving one's appearance through surgery was considered by many to be only for the vain or the wealthy. Today, however, cosmetic surgery is performed on people in all walks of life. A recent survey revealed that 99% of women and 94% of men would improve their appearance if they could. With the advancement in revolutionary techniques, safer anesthesia, faster recovery and superb results obtained by many highly visible entertainers, the popularity of cosmetic surgery has soared up. This personal Guide and Checklist has been prepared for you, with our patient in mind.

We will do all we can to provide personalized, individual care, making every provision for your comfort while maintaining the highest degree of medical excellence. Reading this material and following its suggestions will add tremendously to the experience. We want this experience to be as comfortable and gratifying as possible, so please call us if we can provide any other assistance.

Three Weeks Prior to Surgery

• We will provide you with a list of lab tests or x-rays that will be required prior to surgery from your doctor. You must have all of your laboratory tests, primary physician visit and specialist consultations (ophthalmologist, cardiologist, etc.) completed by 2 weeks prior to surgery.
• Confirmation of surgery.
• Questions you may have should be answered at this point.
• Review of your medical history and further assessment of any areas that may require the doctor's further attention, such as high blood pressure, allergies, etc.
• Discussion of any medical requirements not yet completed and arrangements to be made.
• Postoperative follow up appointments to see Dr. Sayah need to be scheduled.

You must Stop at this Time

• Smoking.
• Alcohol: If you are a regular or heavy drinker, try to eliminate or cut down to a minimal level. Alcohol causes easy bruising, lessens the ability of the liver to metabolize medications, and interferes with the general healing process.
• Prohibitive substances: see separate list.
• Sunbathing, self-tanning products, or using sunbooths.
• Facials, steaming masks, or other skin irritants if you are undergoing facial surgery.
• Getting run-down. Eat well, get sufficient sleep and avoid being around anyone who is sick.
• Women MUST be certain that they are not pregnant before surgery.

Seven to Ten Days Prior to Surgery

• Read and review this material with the person who will be taking care of you after surgery.
• Schedule hair cutting and nail appointments.
• Arrange for childcare, pet care, and mail pick-up.
• Pay any bills that will fall due while you are recovering.
• Clean your house and arrange for any housekeeping you may require during your recovery.
• Refer to “Diet suggestions” section. Prepare and freeze individual meals that can be quickly reheated in a microwave.
• Refer to the “Comfort Station” section. Shop for regular household items and any extras you may need for your recovery.
• Men who are having facelift surgery should let their sideburns grow at this time.
• If you are going to the hospital for surgery and have not already called the admitting department to confirm your arrangements, do so at this time.
• Check your personal calendar for birthdays, meetings, etc., that will require your attention during your surgery or recovery period.
• Notify the office if you develop any skin infections, boils, or pustules around your anticipated surgery site or if you become ill within a week prior to your operation.

Your Comfort Station at Home

A little simple preparation and organization of your home recovery area will go a long way toward making you safer, more comfortable, and happier during your recovery. The following suggested purchases may be helpful to you, depending upon the type of surgery you have and your expected recovery.

From the pharmacy or drugstore:

• Vitamins (Theragram M or comparable product)
• Throat lozenges and cough drops (for dry throat)
• Chapstick or lip balm (for dry lips)
• Baby shampoo (after scalp or facial surgery)
• Mouth spray
• Skin moisturizer
• Ultrasonic humidifier (helpful following nasal surgery)
• Shower cap (use after scalp surgery)
• Heating pad
• Tylenol
• Eye drops (moisturizing)
• Milk of Magnesia (for relief of constipation)
• Maalox (for relief of indigestion)
• Metamucil or laxative
• Vicks or Mentholatum (after nasal surgery)
• Sunblock
• Lactobacillus capsules (decrease yeast infection)

For your bedroom:

• Bedside clock
• Bedside table
• Warm socks or booties
• Night light
• Small bib (to protect clothing when eating in bed)
• Paper towels
• No spill glass/cup
• Kleenex
• Magazines
• Soft food
• Trash container (at bedside)
• Baby wipes (for quick clean-ups)
• Paper plates and cups (saves washing dishes)
• Loose clothes - jogging suit (warm, front zipper in the – avoid pullovers / sweaters)
• Towels

After facial surgery:

• Water spray bottle (after peel or facial surgery)
• Rolled bath towels (use behind your neck after facial surgery)

Food and Drink Supplies: (refer to diet suggestions)

Three Days Prior to Surgery

• Stop all alcohol, smoking, coffee and tea (caffeine) consumption.
• Use an antibacterial soap such as Dial, Zest, or Phisoderm when showering.
• If you are having facial or scalp surgery, gently clean your ears with a water-moistened cotton-tipped applicator. Eliminate any impacted wax with Murine or Debrox ear wax remover to prevent growth of bacteria (This is only to be done if there is a large burden of wax in ears).
• If you are undergoing breast surgery, do not shave under your arms for three days prior to surgery.

One Day Prior to Surgery

• Comfortable clothing that is loose, and buttons or zips up the front. A warm-up or jogging suit is ideal. Flat, comfortable shoes are also recommended.
• Do not wear panty hose or girdles.
• Leave jewelry, earrings, rings, hairpins, or false eyelashes at home.
• If you wear contact lenses, eyeglasses, or dentures, bring your case with your name on it.
• Do not set or style your hair. Wash with a mild shampoo the night before surgery.
• If possible, leave your purse at home.
• Have a light, late night snack, preferably chicken or fish, which are high in protein.
• If you are having morning surgery, do not eat or drink anything after midnight the night before. You may rinse your mouth out with water but do not swallow it. When brushing your teeth, you may use mouthwash.
• If you are having afternoon surgery, you may have a clear liquid breakfast such as juice, but nothing for six hours before surgery.
• Pick up any required medications or prescriptions for after surgery.
• Patients having a tummy tuck (abdominoplasty) procedure should start their bowel preparation.

The Morning Of Surgery

• Take regular prescription medications such as blood pressure, thyroid, or birth control pills with a small sip of water, if you have discussed this with our office earlier.
• Do not use facial moisturizer. (Men may shave and use aftershave lotion.) Brush your teeth, avoid swallowing any water.
• Inform the nurse if you wear a wig, contact lenses, eyeglasses, false eyelashes, dentures, partial plates, loose teeth, etc.
• The nurse will take your vital signs, ask some standard medical questions, and have you sign a surgical consent form. For relaxation, you will then be given a mild sedative.
• Dr. Sayah will see you before surgery. He will again discuss your planned surgery, do markings on your skin in front of a mirror, and answer any questions you may have. He may also take additional photographs. The nurse will then bring you into a warm operating room.
• The anesthesiologist will gently put you to sleep. Dr. Sayah performs most of his surgeries with sedation. You will breathe on your own while asleep during your procedure. Modern intravenous anesthesia techniques are extremely safe and comfortable.
• Dr. Sayah will also administer a special long-acting local anesthetic to your surgical site. When you wake up, these areas will be numb. You will probably feel no discomfort. Once the local anesthetic wears off, most patients experience very little pain. Any discomfort is easily controlled by pain medication.

In The Recovery Area

The following will be in your recovery room for your comfort and safety.

• An oxygen mask may be lightly applied to your face to provide pure oxygen
• A blood pressure cuff may be attached to your upper arm. Your blood pressure reading is recorded by a computer which signals the doctor and nurse if a change is noted.
• You may have an intravenous line (I.V.) in your arm to provide fluids.
• A small plastic finger clip will be attached to one of your fingers to measure your pulse and the exact amount of oxygen in your blood.
• Two or three sticky pads may be attached to your chest or back. These monitor your heart rate and are also attached to an EKG computer.
• Dressings will be applied, depending on the type of surgery you have. You may also have a small drain, consisting of a small plastic tube connected to a drain bulb. This collects fluid and helps to decrease swelling and bruising. It will only be used if Dr. Sayah feels it is necessary, and will be removed 24 to 48 hours later under local anesthetic. You may also have ace bandages on your legs to keep them warm. In the case of abdominal surgery, a bladder catheter may be used.
• Your eyes may be a little blurry from protective ointment used during your surgery.

For The Journey Home

• We recommend a pillow, blanket, and a box of tissues. Reclining the front passenger's seat will add to your comfort.
• It is important to drive slowly and cautiously. It is not unusual for the patient to feel light-headed.
• The person who transports you should also help you get in and out of the car and provide support as you walk from the car to your house. Once inside, lie down on the couch or bed with one or two pillows behind your back.

Signs to Look Out for

• Your temperature is over 101 degrees, with or without chills.
• Excessive swelling with resultant tight, restrictive dressings, particularly if you see a large difference when comparing one side of your body to the other.
• Excessive bleeding which will not stop. With oozing or bleeding, ten minutes of direct pressure, non-stop, on the area should be maintained. Remain calm. Call our office or have someone drive you to the Emergency Room.
• Persistent vomiting.

Immediately Following Surgery

Do not make any important decisions or sign any important papers for 24 hours after surgery.

Refrain from alcohol or other sedating substances for at least 24 hours.

• Physical activities: During the first day or two take deep breaths and gently cough in order to exercise your lungs. Change positions in bed or while lying on the couch to decrease back discomfort. Try moving your legs from side to side and up and down and flexing your ankles intermittently. These activities will improve your circulation and decrease stiffness. Do not exert yourself the first few days after surgery, as this will increase swelling and bruising. Elevate your operative area and avoid lifting or bending as much as possible. It is preferable that you slowly begin to resume your normal activities and progress a bit each day. Listen to your body. If you feel tired or sore when performing an activity, slow down or stop.
• Getting up from bed: It is not unusual to feel light-headed if you get up quickly. It is best to have someone assist you for the first day or two. Sit at the side of the bed for a minute or two until you gain your bearings, then stand up very slowly. If you have had breast, abdominal or liposuction surgery, use a technique called “logrolling.” Roll over gently on your side and bring your knees up. Slowly move your legs over the side of the bed until they are hanging down, then gently lift yourself into a sitting position by keeping your knees bent and pushing up on your elbows. Never walk alone if you feel light-headed. Ask for assistance. Don't forget to keep a nightlight and a chair in both your bedroom and your bathroom. You may feel a little helpless at this stage, as if you are moving in slow motion, but this will quickly pass.
• Climbing stairs: take one step at a time. Face the railing or banister and hold on with both hands. An assistant should walk behind you as you go up the stairs and in front of you as you come down. If you feel dizzy, sit down immediately without worrying about where you are.
• Hair washing: Depending on your type of surgery, you may be unable to wash your hair for several days. If this is the case, you can use "No-Rinse" in place of shampooing. Unless instructed otherwise, you may gently brush your teeth and use mouthwash.
• Compression garments should be removed every 2 hours for approximately 10-15 minutes in order to allow blood circulation at the site of surgery. You may leave your garments on overnight without removing them so you enjoy a comfortable sleep.

Diet Recommendations

You may be very thirsty for a few days. This is common after surgery. Keep a supply of juices handy. If your throat is sore (which sometimes happens following anesthesia) try drinking lukewarm decaffeinated tea with honey or non-citrus fruit juices such as apple, pear, or peach juice. Throat lozenges or ice cream can be very soothing. It is normal to have little appetite for a few days following surgery. Fluids, particularly electrolyte balanced drinks such as GATORADE are important at this time to prevent dehydration and decrease constipation. You also might try chicken soup (low salt, if it is available).

Day of Surgery:

Immediately after surgery, begin with a clear liquid diet and advance your diet to more regular foods as you are able to tolerate:

• Clear Liquid Consist of:
  • Decaffeinated tea
  • Decaffeinated coffee
  • Cranberry juice
  • Apple juice
  • Clear broth

As your appetite increases: Easily digested foods such as soups, low-fat ice cream, low-calorie milkshakes, pudding, yogurt, ground-up food, or even baby food. Avoid added salt, caffeine, spices, excessively fatty or salty foods, or high-fat dairy products. If you have had abdominal surgery, you may be given additional dietary instructions.

Following facial surgery, you should adhere to a full liquid or a soft diet for one week. In particular: please avoid chewing on firm foods such as apples, pizza, thick steak or breast of chicken as we want your face to heal without too much repeat tension with firm chewing or wide mouth opening.

• Full Liquid consist of:
  • Cream of tomato soup
  • Clam chowder soup
  • Fruit juice
  • Malts
  • Milk shakes
  • Soft ice cream
  • Eggnog (Don't overlook blender diets.)

• Soft Diet consist of:
  • Cream of wheat
  • Cottage cheese
  • Oatmeal
  • Bread
  • Eggs
  • Spaghetti
  • Bananas
  • Rice
  • Tuna
  • Custard
  • Soft fish
  • Ice cream
  • Pudding
  • Yogurt (Don't overlook baby food.)

Mouth surgery

If you have undergone surgery inside your mouth, rinse frequently with Peridex. You should be on a liquid diet for 48 hours followed by a soft diet for an additional three days.

Medications

• Refer to the prohibitive substances list.
• Antibiotics: eat yogurt, drink acidophilus milk, or take lactobacillus capsules daily to decrease the possibility of yeast infection.
• Regular prescriptions: continue as prescribed by your physician.
• Two days following surgery: Take pain medication regularly, such as one to two Tylenol every four hours. Scientific evidence has proven that following surgery, a low but definite blood level of mild pain medication goes a long way toward controlling discomfort. Stronger pain medicine is available if you need it. (Many patients find that their discomfort slightly increases late in the afternoon or evening.). If you are not bothered by pain or discomfort or do not have trouble sleeping, you do not have to take pain or sleep medication.
• Irritation to intravenous site: apply a warm moist wash cloth can help to alleviate it.
• Menstrual cycle: Women may experience irregular, or even miss a period or two, for a month or two following surgery. This is normal. Your body will soon adjust and return to its regular cycle. Continue with your regular birth control program.

Care of Your Incision Line

A scar is part of the healing process, the idea of scarring is frightening to the patient. We attempt to compromise by treating your incisions in a way that allows proper healing while camouflaging the incision sites and minimizing scarring as much as possible. Most plastic surgery scars are very inconspicuous. Your incision lines heal in four phases, as follows:

• Day one through fourteen: Characterized by slight oozing and crusting; bruising and soreness resolve in seven to ten days; ice compresses are helpful. (See care instructions below.)
• Week two through six: Formation of early supportive scar tissue, pink to light red; itchiness and tenderness are common; some thickening of incision site. (See care instructions below)
• Six weeks to six months: lose their redness, itchiness and tenderness subside; areas flatten and begin to blend.
• Six months to 24 months: Softer and smoother.

Personal Incision Care Program

This program will improve the contour and final appearance of your incision lines.
(PLEASE NOTE: This program is not to be used for eyelids)

• icy cool compresses during the first 48 hours.
• You may shower after 48 hours when your incision line is sealed and bandages and surgical tape are removed.
• Apply prescribed cream or ointment lightly twice daily until the area is completely healed.
• To prevent forming problematic scars, you may be advised to use Retin-A combined with Eldoquine Forte before and after surgery. This can decrease thickness and possible changes in pigmentation caused by incision-line scars. Prior to surgery, apply a pea-size amount of Eldoquine Forte to anticipated surgical sites every other night; rub it in well. Repeat with Retin-A. If you develop irritation or redness, cut back to every third night. If not, progress to every night. 1% Hydrocortisone cream (available over the counter) can be applied twice a day if irritation occurs. Treated areas must be protected from sun exposure before surgery and for six to twelve weeks after.
• For six months your incision line must be totally protected from sun exposure. Brown camouflage micropore tape (available at most drug stores) can be used over the area.
• Always test new products on a small area of your incision line overnight to ensure that you don't develop a rash or irritation.
• If the patient has a genetic tendency toward hypertrophic scarring or keloids, the following treatments can be instituted one month after surgery:
  1. Topical cortisone, such as hydrocortisone 2'/2%, applied twice per day for two to four weeks.
  2. Small injections of Kenalog, two to four treatments, two to four weeks apart.
• In rare cases where permanent excessive scarring is still present after one year, surgical revision and/or x-ray treatments can be used.

Two to Three Days After Surgery

• Visitors: Family and friends are very important during the recuperation period. However, you may want to be left alone to sleep or rest. It is important to decide how often you will have visitors, and for how long.
• Activity: You will probably feel better and eager to be up and about. Alternate periods of activity with periods of rest throughout the first several days. You can take brief walks, be sure to wear your hat, scarf, and sunglasses.
• Site swelling: As part of the healing process, your body absorbs extra fluids and nourishment during the first 24 to 48 hours after surgery. By the second day, you will notice an increase in the amount of swelling at your operative site. This is normal, and will resolve over the next several days to several weeks. Elevating the area and applying icy cold compresses will help decrease swelling. Also, be sure your room is not too warm, as elevated air temperature will increase swelling.
• Oozing: Small capillaries may continue to ooze for several days, and bruising is the result. Your body absorbs this fluid over the next week to ten days. As small blood cells break down during this absorption process, you may notice residual discoloration for a few weeks. This is rare and usually quite minimal. Limit direct sun exposure while bruising and discoloration is present, as the sun will exacerbate these conditions. You may find relaxing in a warm tub very soothing. If you still have dressings, however, be sure they are kept dry or wait until they are removed. Normally, you may shower after two days, and bathe after one week.

Three To Five Days After Surgery

• Fever: You may continue to run a low-grade fever for a few days. It usually signifies that you need to take deeper breaths. If your temperature rises above 101 degrees call the office.
• Constipation: Mild constipation may occur caused by pain medication, inactivity, and surgery. Continue drinking plenty of liquids–six glasses of water or juice a day--and take one or two tablespoons of Metamucil or a comparable product each morning. A glass of prune juice or an ounce of Milk of Magnesia may also help.
• Swelling: Beginning to resolve at this point. You may notice slight, shooting discomfort. This is a sign that nerves are returning to normal. Some firmness of the operative site is also normal while swelling is present. Remember that your stitches will still be tender.
• Appetite: may still be decreased. Continue to avoid excess salt, sugar, spices, fatty dairy products, and alcohol.
• Activity: Rest as much as necessary. You may increase your level of activity each day, but stop when you feel tired.
• Intimacy: Shortly after surgery, many patients desire closeness and intimacy with the one they love. Hugging, embracing, and kissing is certainly recommended. When you feel up to it, you may resume sexual activity. Explain to your partner that you must go very slowly and gently until your soreness resolves and you are totally recovered.
• "The blues": Almost everyone experiences symptoms of mild depression or anxiety during recovery, usually about five days postoperative. You may find yourself short-tempered or withdrawn, lashing out angrily at family and friends, or crying. The depression, which occurs after cosmetic surgery, planning a new, more attractive YOU--a letdown is natural when the goal is reached and the time has come to move on to the next phase in life. You CAN get through this period by reminding yourself that what you are going through is perfectly normal. Keep yourself busy and your mind off your temporary appearance. You can probably think of dozens of projects you've been putting off that will fill up your time without tiring you out. Fresh air will make you feel better. Walking can also help to decrease depression, as well as speed up the healing process.

Five to Seven Days After Surgery

• Stitches: During your first few visits, Dr. Sayah will change your dressings and give you helpful hints. Remember that wounds often heal with slight crustiness or swelling. Once your stitches have been removed, you will have regular postoperative follow-up appointments. Also, if after a few weeks you notice a few small absorbable surface stitches still left they are easily removed or often fall out on their own.
• Makeup: If you have had facial surgery, you can use a standard cover-up make-up to hide black and blue areas. DO NOT put any make-up directly on any incision line.
• Bruising: Your soreness and swelling is resolving, and your bruises are changing color as they, too, resolve. If the healing process seems to "plateau" for a few days, don't worry. Soon you'll notice your bruises fading again.
• Activity: Your energy reserves may be very limited, and you may find that you still need to rest a great deal. Many patients go through a period of frustration because they don't look as good or feel as well as they would like. Be patient! Your body needs a good four to six weeks to recover from the trauma of surgery. Gradually you will feel better and require fewer and shorter rest periods.
• Diet: Continue drinking plenty of juices. There is evidence that pineapple juice and tomatoes decrease bruising at this stage, so you might want to include these when planning your daily meals.
• Constipation: If it continues, a daily ounce of Milk of Magnesia should help. If you are taking vitamins, particularly those with added iron, your stools may be dark.
• Driving: Go out for a test-drive with a friend before setting out on your own. If you've had facial surgery, continue to use a sunblock on any exposed incision site.
• Returning to work: Be careful not to overdo it. Your body will let you know if you try to do too much. If possible, begin by scheduling a shorter workday than usual, or take more breaks during the day. Try to postpone any meetings or projects that may be especially stressful.

Two Weeks After Surgery

• Diet: You may resume Vitamin E supplements, Oriental foods, papaya juice, meat tenderizers, and any other food associated with increased bruising. You may also take aspirin or aspirin-related products. As long as you are not taking any medications, you may drink light alcoholic beverages. You should still avoid excess salt and spices, as these cause your body to retain fluids and prevent the resolution of swelling.
• Activity: Light exercise. Moderate to fast walking, stretching, and light lower extremity exercises should be started slowly. Do a bit more each day. Don't be discouraged if you are stiff and somewhat slow at first. The increase of body fluids during the past two weeks may result in temporary weakness and some muscle stiffness.

Three weeks After Surgery

• Appearance: You are probably back to work now or, if you are a student, back in the swing of things at school. You may find yourself at a plateau stage where most of the swelling is resolved, and now you see little difference from day to day. You will be happier with your appearance every day.

Six weeks After Surgery

• Activity: Jogging, nautilus training, light aerobics, and swimming in a pool. Continue to protect your skin from the sun by wearing hats, scarves, sunglasses, or sunblocks. Avoid electrolysis or waxing around your operative sites for at least ten to twelve weeks.
• Emotionally: Patients feel they are back to normal–emotionally as well as physically. Whatever soreness remains at your surgical site is rapidly resolving and should be minor at this point. Keep in mind that it will take three months or longer before all swelling and asymmetry resolve.
• Office appointment: Doctor Sayah will check your progress.

Six To Twelve Months

• Appointment: You may be having your last check-up appointment with Dr. Sayah at this time., we hope you have had a pleasant and satisfying experience. Many of our patients are so pleased with the improvement in their appearance that they choose to have additional cosmetic procedures performed.

We Want To Hear From You

Frequently during the administration of medical care, patients remain too quiet regarding their needs, recommendations, questions, and concerns. We encourage and desire your comments and are always open to ways we might better meet your needs. We would appreciate your telling us if you had a good experience. We also want to know if your experience was less than you expected.

Dr. Sayah wants you to continue “looking great” your whole life. In addition to successful plastic surgery, many factors contribute to an attractive, youthful appearance. If there is anything we can do, please contact the office.

Other plastic surgery related pages: Glossary – Procedures – Surgical Guide – Procedure FAQ's – Before & After Gallery