So you are planning to go under the knife. And you feel a little nervous (that may be a bit of understatement). Being well informed and well prepared before your surgery turns the unknown into the familiar and makes the process much easier. I’ve put together for you, 8 essential questions you need to ask yourself before your surgery.
1 What are your motivations and expectations?
Consider the reason why you are having surgery. And be realistic about your expectations before undergoing plastic surgery. If you are as honest as possible in your consultation it will allow your doctor to help you make a well informed decision about surgery. Understanding what to expect and being realistic about the results of your procedure is an essential step to achieving a successful outcome.
2 How is you general health and fitness?
Being physically and psychologically healthy is essential. A medical illness does not necessarily prevent you from undergoing plastic surgery, however, some medical illnesses may increase the risk of a serious condition following surgery.
Here are some of the more common medical conditions:
- High blood pressure and Diabetes
- Bleeding disorder and lood clots
- HIV (AIDS) and Hepatitis
- Heart Disease and Lung Disease
- Rheumatoid Arthritis and SLE (lupus)
- Psychiatric illness
I will explain a little about how each may affect your surgery.
High blood pressure and Diabetes – Elevated blood pressure increases the risk of bleeding during surgery and in the recovery period. This may result in the formation of a haematoma − a collection of blood, which may require you to go back to surgery to drain the haematoma. Haematomas may cause wound complications such as infection, wound dehiscence (wound breakdown) and poor scarring. Your blood pressure should be under control on antihypertensive treatment prior to your surgery to limit your risk. People who have diabetes are prone to infections therefore diabetes may increase your risk of infection and wound healing complications after surgery. Good blood-sugar control will limit your risks. Your prescription diabetes medication may need special management prior to, and after, surgery to prevent hypoglycaemia (low blood sugar).
Bleeding disorder and Blood clots – If you have experienced prolonged bleeding after dental work or minor surgery, have required a blood transfusion for surgery in the past, have had repeated miscarriages, liver disease, or have a family history of bleeding abnormalities, you may have a bleeding disorder. If so, or if you have been diagnosed with haemophilia, lab tests and a consultation with a haematologist will be needed prior to surgery. A bleeding disorder can put you at risk of excessive bleeding (requiring a blood transfusion).
Lengthy surgery, age, smoking, oral contraception or HRT (Hormone Replacement Therapy), cancer, obesity, prolonged bed rest and clotting abnormalities can increase your risk of developing a blood clot in your leg (deep vein thrombosis) or lungs (pulmonary embolism). Wearing compression stockings, intra-operative calf pumps and sometimes blood-thinning medication may be needed to reduce this risk. Getting out of bed and gentle walking (with assistance) after surgery will also help your circulation.
Anaemia – A low haemoglobin level, known as anaemia, increases your risk of wound-healing complications and may require you to have a blood transfusion in surgery. Blood transfusions do carry a small risk of transmitting blood-borne diseases and should be avoided if possible. Treatment of anaemia with iron supplements may be needed prior to your surgery and consultation with a haematologist may be necessary if you have severe anaemia.
HIV (AIDS) and Hepatitis – HIV (AIDS) may increase the risk of wound infection after surgery. If you are healthy, on treatment and living with HIV (AIDS), and your CD4 count is above 500 with your viral load undetectable, your surgery risks are similar to that of an HIV-negative person. Hepatitis may preclude you from cosmetic surgery as it can worsen liver disease.
Heart Disease and Lung Disease – If you have had a recent heart attack or you suffer from heart failure, your heart may not be able to withstand the stress of surgery. Both severe asthma and COAD (Chronic Obstructive Airways Disease) increase your risk of wound complications and lung complications after surgery. The risks of surgery may indeed outweigh the benefits and your should have a frank discussion with your surgeon and anaesthetist.
Rheumatoid Arthritis and SLE (lupus) – because these connective tissue diseases often require treatment with steroids and immunosuppressive medications they carry the risk of increased wound complications and infection.. Well controlled connective tissue disease should not prevent you from having plastic surgery, but you should discuss your particular situation this with your rheumatologist.
Psychiatric illness – in itself does not prevent you from undergoing plastic surgery, provided it is well controlled and you have medical clearance from your psychiatrist to proceed with surgery. Certain mental illnesses such as Body Dysmorphic Disorder should not be treated with surgery and it is advisable to seek psychiatric counselling.
Getting medical clearance for surgery is always a good idea if you have a medical illness that may affect your ability to have safe surgery or anaesthesia, or are receiving treatment for a medical condition.
3 Do you suffer from drug allergies?
I am not talking about hay-fever, but about drug anaphylaxis, which is an allergic reaction to medication that is potentially life threatening. If you have had an allergic reaction to medication, it is critical to relay this information to your doctors, even if the allergy occurred once only, or didn’t seem severe at the time. Allergies to Latex or wound dressings can be troublesome and avoiding these products is best.
4 What prescription medications do you take?
Take a few minutes to look through your medicine cabinet and make a complete list of your regular medications. Then take this with to your consultation with your plastic surgeon.
Some medications can interfere with surgery. Such as Aspirin, Ecotrin or Warfarin, that are used to thin blood. Hormonal treatments such as the oral contraceptive pill, HRT or Tamoxifen can increase your risk of abnormal clotting. Corticosteroids can increase the risk of delayed wound healing, poor scarring and infection.
Ask your surgeon which medications you should avoid before your surgery.
5 Do you use any supplements?
Many supplements can cause bleeding, high blood pressure and changes in blood glucose, which may adversely affect your surgery. And the problem is that most non-prescription treatments are not studies rigorously in clinical trials, so we just do not know the good, and harm that they can do.
The practical thing to do is just avoid the use of any Homeopathic, Herbal, Chinese medicine, “Natural” or other Supplements for two weeks prior to your surgery.
Even if a alternative-health practitioner advised it to treatment another ailment. Arnica, Garlic, turmeric, Ginkgo, ginseng, dong quai, salmon oil and high doses of vitamin E can all cause increased bleeding with surgery. Echinacea, ephedra, kava and St John’s Wort can increase blood pressure and cause drug interactions. The use of multivitamins is generally safe but should be cleared before surgery.
6 Are you pregnant?
You should know, right?
But if you are a woman of child-bearing age, it is advisable to make sure that you are not pregnant prior to surgery by taking a pregnancy test. Elective plastic surgery and anaesthesia may pose unnecessary risk to your pregnancy.
7 How’s your diet?
It is best to be at your ideal weight when undergoing surgery. A crash diet to get to your ideal weight a few weeks prior to your surgery is definitely not a good idea. Depriving yourself of essential micronutrients, minerals and proteins prior to surgery may have a detrimental effect on wound healing.
The safest approach to weight loss is a lifestyle change, set in motion many months before your surgery. A healthy eating plan and regular exercise will help get you as close as possible to your goal weight. Speak to a knowledgeable dietician to help you achieve your goal.
Occasionally, plastic surgery is performed to kick-start a healthier exercise regime. For example: when an abdominal panniculus (flabby, hanging tissue) or excessively large breasts limit physical activity. I hear you asking: “What about liposuction?” Unfortunately there is no quick-fix solution to weight loss. Liposuction is ideally suited to shape and contour a specific problematic area that is diet resistant, such as the inner thighs or love handles. Liposuction is not a reliable treatment for obesity.
8 Do you have any harmful habits?
Be open about your habits – safe anaesthesia and surgery depend on it. Smoking is proven to delay healing and is associated with an increased chance of complications after surgery. These include delayed wound healing, wound breakdown, poor scarring, infection, breathing problems and blood clots.
If you are planning surgery, you should avoid nicotine containing products (including e-cigarettes) six weeks before your surgery and during your recovery period. The use of recreational drugs or alcohol before and after surgery also place you at risk of increased complications during surgery and anaesthesia.
Having a plan for surgery is the first step to a great result. I hope that these 8 simple questions will guide you during your preparations. Always check with your surgeon and anaesthetist if you feel uncertain about your readiness for surgery.
You can download a free PDF printable version of “Plastic Surgery Companion – a Patient Guide”. Look out for my next post in the series: “Tips for the day before surgery”.