Any procedure can leave you with a certain level of uncertainty. So I’ve compiled a few guidelines so you know what to expect. Being well informed and prepared before and after cosmetic or reconstructive plastic surgery turns the unknown into the familiar and makes you feel at ease. Remember, we are always available to answer any questions you may have, and to be of assistance to you throughout your treatment.

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Pre Surgery

Motivations and Expectations

Consider your reasons and expectations before undergoing plastic surgery, and be as honest as possible in your consultation. Understanding and being realistic about the results you can expect from your plastic surgery is an essential step to achieving a successful outcome.

General health and fitness

Being physically and psychologically healthy is essential for successful plastic surgery. A medical illness does not necessarily prevent you from undergoing successful 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 and how they may affect your surgery.

High blood pressure

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.

Diabetes

People with 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

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).

Blood clots

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. It’s vital to inform your plastic surgeon and anaesthetist if you have had a previous deep vein thrombosis, pulmonary embolism or have experienced multiple miscarriages or have a family history of blood clots.

Heart Attack or Heart Disease

If you have had a recent heart attack this may increase your risk of fatal heart attack or arrhythmia during surgery. If you suffer from heart failure, your heart may not be able to withstand the stress of surgery. Discuss the risks with your plastic surgeon and anaesthetist.

Anaemia

Anaemia, or a low haemoglobin level, will increase 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) carries an increased 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 will preclude you from cosmetic surgery as it may worsen liver disease.

Very importantly, HIV (AIDS) and hepatitis do increase the risk of infection to the surgical team in the case of blood exposure from an accidental sharps injury (an incident in which a needle, blade or scalpel contaminated with an infected person’s blood pierces the skin). Your consent to testing and your openness with your plastic surgeon will be appreciated.

Multiple Sclerosis

Plastic surgery in the setting of Multiple Sclerosis is generally safe provided you are in remission and not having an acute relapse. Surgery does stress the body and has been associated with triggering a relapse. You should consult with your neurologist before considering surgery.

Asthma and COAD

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.

Rheumatoid Arthritis and SLE (lupus)

If you have Rheumatoid Arthritis or lupus, surgery runs the risk of increased wound complications and infection, because these connective tissue diseases require treatment with steroids and immunosuppressive medications. Well controlled connective tissue disease should not prevent you from having plastic surgery, but you should discuss this with your rheumatologist or medical physician beforehand.

Psychiatric illness

A diagnosis of a 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.

Medical clearance for surgery

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 from a specialist physician, e.g. medical physician, neurologist, pulmonologist, haematologist or cardiologist etc. it is advisable to get medical clearance before proceeding with your planned plastic surgery. Medical clearance is a good investment in ensuring your safety during and after surgery.

Allergies

An allergic reaction to medication is potentially life threatening. If you have had an allergic reaction to medication, it is critical to relay this information to your plastic surgeon and anaesthetist, 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. Please inform your plastic surgeon.

Medications

Medications to take: your prescription medication, e.g. your antihypertensive medication should be taken as prescribed by your treating physician and your plastic surgeon.

Medications to stop taking before surgery: Please avoid Aspirin, Ecotrin or Ibuprofen for 10 days before surgery as they can cause bleeding. Paracetamol (Panado) can be taken as an alternative for pain management.

Warfarin is a blood-thinning medication that can cause severe bleeding. If you are taking Warfarin you will need to stop taking it prior to surgery and change to an injectable blood thinner like Heparin or Clexane. Your PI level (Perfusion Index – it measures pulse strength at the time of monitoring) will need to be confirmed to be safe before surgery. Please make sure you are clear on when to stop your Warfarin. This decision will be taken together with your treating physician and your plastic surgeon.

Hormonal treatments such as the oral contraceptive pill, HRT or Tamoxifen can increase your risk of abnormal clotting. Discuss the need to stop hormonal treatments with your plastic surgeon.

Corticosteroids may be prescribed to treat a variety of medical conditions. Long term use of steroids will increase the risk of delayed wound healing, poor scarring and infection. Chronic steroid use must be discussed with your plastic surgeon.

Any change in your prescriptions or new medications, especially blood-thinning medications, should be discussed with your plastic surgeon and anaesthetist prior to your procedure.

Supplements

Please avoid the use of any homeopathic, herbal, Chinese medicine or other supplements for two weeks prior to your surgery. Many of these supplements can cause bleeding, high blood pressure and changes in blood glucose, which may adversely affect your surgery.

Garlic, turmeric, Ginkgo, ginseng, dong quai, salmon oil and high doses of vitamin E can cause increased bleeding. 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 with your plastic surgeon.

Pregnancy

If you are a woman of child-bearing age, it is advisable to make sure that you are not pregnant prior to surgery. Take a pregnancy test to confirm that you are not pregnant. Elective plastic surgery and anaesthesia may pose unnecessary risk to your pregnancy.

Obesity and dieting

It is best to be at your ideal weight when undergoing plastic surgery. However, a crash diet to get to your ideal weight a few weeks prior to your surgery is definitely not a wise decision. Depriving yourself of essential micronutrients, minerals and proteins prior to surgery may have a detrimental effect on wound healing. The safe approach is not a quick-fix solution. The safe approach 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. Enlisting the help of a knowledgeable dietician may be necessary to help you achieve your goal.

Occasionally, plastic surgery can be performed to kick-start a healthier exercise regime. For example: when an abdominal panniculus (flabby, hanging tissue) or excessively large breasts limit physical activity.

What about liposuction? Unfortunately this is not a 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 treatment for obesity.

Smoking, Recreational Drugs and Alcohol

It is very important to avoid smoking or secondary smoke six weeks before your surgery and during your recovery period. Smoking is proven to delay healing and is associated with an increased chance of complications after surgery. These include delayed wound healing, wound dehiscence (wound breakdown), poor scarring, infection, breathing problems and blood clots (venous thromboembolism). Please avoid any nicotine containing products − cigarettes, cigars, pipes and nicotine replacement therapy or e-cigarettes.

Avoiding alcohol before and after surgery is advised. Chronic heavy drinking can lead to liver disease which may affect the metabolism of certain medications and anaesthetic agents. Please inform your plastic surgeon and anaesthetist if you suffer from alcoholism or alcohol dependancy as this will increase your risk of life-threatening alcohol withdrawal syndrome after surgery.

The use of recreational drugs can place you at risk of increased complications during surgery and anaesthesia. Drugs like cocaine can dangerously raise your blood pressure, causing bleeding and may cause fatal arrhythmias.

It is very important to be honest about your recreational drug use. Avoiding recreational drugs two weeks prior to surgery is important to limit complications. In the recovery period you should not take prescription medication with recreational drugs or alcohol as this can lead to life-threatening drug interactions.

Financing and Medical Aid

Medical aid schemes do not cover cosmetic surgery.

Reconstructive plastic surgery is covered, at least in part, by your medical aid scheme. It is essential to confirm authorisation for your procedure prior to surgery. Financing for cosmetic surgery is possible through cosmetic financing companies. My team will gladly assist you with authorisation and financing advice.

Risks and Complications

Although complications are rare, they do happen and it is essential to be aware of them.

Surgical complications include: Bleeding, bruising, infection, swelling, seroma (fluid collection), wound dehiscence, delayed healing, wound necrosis (cell death), fat necrosis, pigmentation, unfavourable results and scarring.

Modern anaesthesia has a very good safety record but complications can occur.

Possible anaesthetic complications: Nausea and vomiting, difficulty passing urine, sore throat, nerve damage, chest infection, allergic reaction, brain damage, stroke or paralysis, heart attack, blood clots in the lung or legs.

Please discuss the specific complications associated with the procedure you are planning with your plastic surgeon and anaesthetist.

The night before surgery and the day of surgery

Have a good sleep the night before your procedure. A late night of clubbing and drinking is not a good idea. Be rested and ready for your plastic surgery.

Remember to not eat anything in the 6 hours before your surgery – only drink 50 ml of clear fluids such as water or diluted apple juice if necessary. If you are having a procedure under general anaesthesia this should happen 2 hours before your procedure at the very latest

On the morning of surgery

  • You can brush your teeth without swallowing water.
  • Avoid cosmetics on the area planned for surgery.
  • Take your prescription medication with a sip of water.
  • If you are menstruating, use a sanitary pad rather than risk forgetting to remove a tampon.
  • Wear your spectacles and not contact lenses.
  • Leave your jewellery and valuables at home.

What to pack

  • Prescription medication.
  • Toothbrush and tooth paste
  • Toiletries
  • Feminine hygiene products
  • Comfortable clothing and sleepwear such as zip- or button-up tops and loose bottoms
  • Comfortable shoes, e.g. slip ons
  • A light read may be helpful to keep you distracted while you wait for surgery.
  • Medical aid membership card and ID book

DO

  1. Be on time
  2. Remember to set your alarm.
  3. Please leave enough time to get to your appointment on time.
  4. Remember to account for rush hour traffic.

Please don’t hesitate to contact us. We are always available to answer any questions you may have and to be of assistance to you, throughout your treatment. So, go ahead and get in touch.

FOR MORE INFORMATION contact Dr Clare Neser Email dr@clareneser.co.za
Tel +27 21 510 8534/2546

POST SURGERY

Recovery after surgery will take time, so don’t rush it. Allow yourself time and space to heal. Be prepared and know that we are here to assist you throughout your recovery. Remember, we are always available to answer any questions you may have and to be of assistance to you, throughout your treatment. So please don’t hesitate to get in touch.

Prepare your ‘recovery nest’

Take some time to prepare your home for convenience and accessibility. You should be prepared with some books, magazines and maybe some DVDs or a TV series to keep you entertained during your recovery. Put unfinished work or studies aside – after anaesthesia you will be too tired to concentrate on intellectually taxing activities.

Have some extra pillows handy for positioning yourself comfortably. Have some light throws or blankets handy too. Linen protectors can be very useful after surgery to protect your sheets. Have a clean set of sheets handy.

Position a side table within easy reach of your bed, and pack out the things you will need after surgery – treats like mints, Sparkles or gums; tissues; Lip-ice; water; straws; your supply of entertainment including the remote control; phone and chargers; and prescription medication.

Programme your phone with important numbers like our office numbers: (021) 5108534/2546 and after hours number: 0768128559

Your kitchen and fridge should be stocked up. You are not going to feel like making any effort in the kitchen. Organise your kitchen and fridge so that everything you need is easy to reach. Buy or pre-cook single portion meals and have small sized drinks handy for convenient eating and drinking. Remember to have some healthy snacks handy too.

Arrange your bathroom to make sure that the items you use frequently are easy to reach. Make sure you have enough sanitary products and toilet paper available. Also stock up on micropore tape, gauze, dressings and baby shampoo.

Organise your cupboard to have your comfortable sleepwear within easy reach. Loose bottoms, button up tops or night-shirts are convenient especially after breast or body surgery.

Have some cash on hand for your caregiver to use to stock up on food or necessary items for you.

Contingency plans for kids and pets

If you have young, energetic children who wake you in the morning by jumping on your bed, or need to be picked up often and may not understand your reluctance to do so, you may want to arrange for them to visit their grandparents for a few days or consider prolonging your in-hospital stay.

Although short walks are important for your circulation, a walk around the block with your labrador is not quite what the doctor ordered. If you have a dog, consider arranging someone to walk your dog for the first few times until you are able to do so. Remember to stock up on enough pet food and kitty litter if needed.

Recovery down-time guide

After your surgery you will need to give your body time to heal. Rest and relaxation is the name of the game. Every person heals and recovers at their speed. For some it will be faster and for others it may take a little longer. It is best to schedule enough time for recovery, rather than trying to rush back to work or a social engagement.

As a general guideline, recovery down-time for abdominoplasty, body lift, combined body and breast procedures and breast reconstruction with an abdominal flap is about six weeks.

The first two weeks you will be home bound, mostly in bed and on the couch, the next two weeks you will feel stronger and will be able to do the light home activities of daily living. By week 4 you can do non-strenuous activities like gentle walking on a treadmill or cycling on a stationary bike and by week 6 you should be back to doing most of your activities.

You won’t be able to drive a car for 4 weeks after most upper body, breast or body contouring procedures. And you should not lift any heavy objects or do activities that place strain your wounds. This includes picking up a baby or toddler.

You should feel well enough for sexual activity by week 3 of 4. Lower body surgeries like abdominoplasty or body lifts may take a bit longer. Be careful with your wounds and don’t over-exert yourself.

Recovery after breast reduction, breast lift, breast augmentation and liposuction is four weeks. Recovery after most facial procedures such as face and neck lift, facial fat grafting, and rhinoplasty is four weeks. Eyelid surgery (blepharoplasty) recovery time is two to three weeks. Bruising and swelling may still be visible for some time.

Obviously if you have a physically demanding occupation, you may require a longer recovery period. As a rule of thumb: “if it hurts you are not ready to do it”.

Get moving early

It is important to get out of bed after the surgery. This must be done with the help of a nurse or physiotherapist while in hospital. You should sit out of bed, in a chair and take short walks to keep your circulation going. Walk with assistance. This is important as you may feel light-headed and could fall. If you have had an abdominoplasty you will need to walk bent slightly over for the first week or two, to avoid straining your wounds.

Take deep breaths and cough to clear your chest, but support your wounds when you cough.

Going home after your plastic surgery

When going home it is important to have a friend, family member or caregiver with you to help during the recovery period. It is also important that they drive you home. Share this ‘Plastic Surgery Companion – a Patient Guide’ with them. The extent of your surgery will determine the level of care you need, but it is really nice to have someone around to help you especially for the first few days following a procedure.

Wound care basics

Wound care is simple – keep your wounds clean and they will heal.

A general guideline to wound care is to clean your surgical wounds with baby shampoo or a mild antimicrobial wash, removing any clots or old blood on the wound edges. Pat dry and replace the dressings. Repeat daily. Remember to wash your hands before doing your dressings.

If you have wounds with secretions such as after liposuction, sanitary pads provide an excellent absorbent dressing that can be held in place with micropore tape, or under a post-surgical pressure garment.

On clean and dry post-surgical wounds, flesh-coloured micropore tape can be applied to the wounds. These need only be replaced every two to three days, or when they peel off spontaneously. Getting the micropore tape wet when showering is not a problem, simply gently pat the micropore dry.

I recommend taping for a three-month period after surgery to support wounds while they mature and grow stronger.

Prescription medication

Take your pain medication as prescribed to control your pain. You may experience nausea in the early post-operative period. It is important to take anti-nausea medication as prescribed to alleviate symptoms. If an antibiotic is prescribed post operatively, please use it as directed and complete the course. You should continue your regular chronic medication as prescribed, unless otherwise advised by your plastic surgeon.

Washing and showering

For the first 2 days after surgery you should not submerge wounds. Depending on the surgical procedure bed-washes may be required for the first few days. Thereafter you can take a shower, but with assistance. Assistance is important when you shower, as you may feel light-headed when standing up in the shower. A shower chair may be handy for sitting in the shower. You can shampoo your hair. If you have had facial or scalp procedures, you will initially need assistance with washing your hair.

Eating and drinking

You can eat normally after surgery, but a liquid or soft diet is easier in the first days after surgery. A high protein diet will help with healing. Drink plenty of fluids to stay well hydrated. Constipation may be a problem. Short walks and drinking plenty of water will help, but medication can be used, if needed, to avoid straining.

Sleep

Sleep is your body’s way of recharging its batteries. After surgery you will be tired and in need of extra sleep. This is due to the effects of general anaesthesia and to the stress of surgery itself. Allow yourself lots of beauty sleep time. Have plenty of pillows handy to help you lie in a comfortable position. But remember to take gentle walks to get your circulation going.

Cool compress

After eyelid, face or nasal surgery, ice-water soaked gauze pads will help with comfort and limit bruising and swelling. Put them on for fifteen minutes at a time, while you are awake. You can use your cold packs for 24-48 hours.

Smoking

It is very important to avoid smoking or secondary smoke six weeks before your surgery and during your recovery period. Smoking is proven to delay healing. Smoking is associated with an increased chance of complications after surgery including delayed wound healing, wound dehiscence wound breakdown), poor scarring, infection, blood clots (venous thromboembolism) and breathing problems. Please avoid any nicotine-containing products – cigarettes, cigars, pipes and nicotine replacement therapy or e-cigarettes.

Swelling and tightness

You will feel swollen around the wounds after surgery. This is common especially after abdominoplasty, liposuction and rhinoplasty but swelling will subside in the recovery period. You will feel tightness around the wounds initially, and this will improve as your wounds heal. Walking may help with swelling by improving your circulation. Avoid salty food and don’t take diuretic medication unless they have been specifically prescribed. A supportive (or compression) garment after body procedures may be used for comfort.

The “Day Three the Down-in-the-dumps Phenomenon”

Surgery places stress on the body and mind. Emotional stress is a real thing in the post-operative period. Often on the third day (or fourth day) after surgery your mood will be at an all-time low. You may feel down in the dumps. You may second guess your decision to undergo surgery, you may have feelings ranging from anger to guilt, you may even find yourself in tears just wanting to feel like your normal self again.

This can be a very difficult time for you and those close to you. Being prepared for the ‘Day Three Down-in-the-dumps Phenomenon’ is important. If it happens, you and your caregiver will realise that your response is normal and expected. The good news is this emotional hurdle does not last long and it soon becomes a distant memory. Please share any emotional stress or worries with a close friend.

The itchy and scratchy show

Itching of the wounds is a rather common and very irritating occurrence after surgery. It may signify healing of nerve endings. A post-operative itch can be helped by applying a cold compress to the area, being in a cool environment, and making sure the wounds are clean. If very severe, antihistamine can be prescribed to alleviate the symptoms. Fortunately itchiness improves after two to three days.

Warning signs
If you notice any of the following changes: bright redness of the wounds, increasing pain that cannot be controlled by your prescribed pain medication, a high temperature, severe nausea and vomiting, excessive oozing, odor or bleeding of the wounds, increase in size or rapid bruising of one area of the body e.g. one breast compared to the other, inability to pass urine, an allergic reaction to medication, ongoing dizziness, confused behavior or hallucinations, please call us immediately on (021) 510 8534/2546 or after hours on 076 812 8559.

Medical emergencies

If you experience any of the following symptoms: severe chest pain, difficulty breathing or uncomfortable shortness of breath, loss of consciousness, or any other medical emergency, immediately call your nearest emergency room or Life Vincent Pallotti Hospital Paramedic Response Services at 0860 532 532.

Your scars

Every surgical incision will result in a scar. The ultimate quality of your scars depends on a number of factors – genetics, general health, smoking, scar care and the position of the scar.

To minimise scar visibility once healed, surgical incisions are placed in natural transition areas of the face or body such as in a crease, behind the ears, or hidden under the bra line or a bikini line.

Sun avoidance and strict sunscreen use for 6 months after surgery will help to avoid darkening (hyper-pigmentation) of your scars. Scar therapy with massage, scar taping with micropore, and using silicone gel may have a beneficial effect on the ultimate appearance of your scars.

Follow up

We will support you throughout your recovery and keep a close eye on your progress. In the first week after your surgery we will see you for a wound check and a dressing change and at week 2 a second wound review is done. After that, further follow-up appointments will be scheduled as needed. It is important to see us for your appointments even if you are happy that all is well.

Please don’t hesitate to contact us for any questions or concerns. We are always available help throughout your treatment. So, go ahead and get in touch.