Top Ten “Before Surgery” Preparations
July 15th, 2009
Preparation for surgery is essential to make the post operative course for patients easier and safer. Both pain and risk of complications can be reduced. I can’t stress more strongly the importance of patience responsibility in regard to these instructions. Following these guidelines can significantly reduce both pain and risk of complications. Here are my Top 10 recommendations for our patients, although it is important for patients to follow whatever instructions their chosen surgeon provides. Surgery by and large is safe. Complications are always an inherent risk, however you can help in reducing post-operative risks by doing these simple recommendations before surgery.
- Stop all aspirin and NSIDs. Both of these drugs affect platelet function in the blood. The result is a reduced ability to clot the blood when tissue is divided in surgery. This can lead to unwanted bleeding and bruising after surgery. These effects last for two weeks. Stop taking these medications two weeks before surgery.
- Take A Shower. Any time you shower, the number of bacteria on the skin is reduced. Taking a shower the night before and the morning before surgery can go a long way in reducing the risk for infection. Regular soap is fine for the task.
- A Dose Of Celebrex. Pain after surgery is inevitable. We do everything we can do to reduce the post operative discomfort. One of the most dramatic changes has been the institution of a single oral dose of Celebrex immediately before surgery. This alone reduced the need for strong pain pills after surgery in my practice by 30%! Of course, this is not a choice if a patient is allergic to the medication or related medications. This must be given by the physician or their staff at the surgical facility. This must not be done yourself.
- Do Not Eat or Drink Before Surgery. Eating solid food before surgery is dangerous. It can lead to vomiting during surgery which can result in aspiration. Aspiration pneumonia is very serious and can result in death. Always know the recommendations regarding how long before surgery you are not supposed to eat or drink. Generally this 8 to 12 hours before surgery.
- Avoid Health Store Medications. Unfortunately, natural medications can be variable in preparation and strength. Some of the lead to unsafe increased blood pressure during surgery. Excess intake of some vitamins can interfere with clotting. For this reason, consider only taking a single multivitamin for two weeks before surgery. Stop taking other over the counter medications as directed by your surgeon. Continue taking prescription pills. Make sure you tell your surgeon and your anesthetist all the drugs you have been taking before anesthesia and surgery.
- Stop All Illicit Drugs. Illicit drugs can be dangerous. Their formulation and content is unknown. Their interaction with anesthetic drugs is serious and can lead to death during and after surgery.
- Stop Smoking and Alcohol. The nicotine in tobacco products and in “stop smoking” aids makes blood vessels smaller as a result of its action on the blood vessel muscle. Many plastic surgery procedures (face lift, tummy tuck, breast reduction) reduced blood flow to the skin. The risk of skin loss and bad scarring is increased ten-fold when these two effects are combined. Smoking tobacco or weed also increases the chance of coughing after surgery. Coughing can lead to unwanted bleeding. It is best to quit all nicotine containing products two to four weeks before surgery.
- Drink A Gallon Of Water. The day before surgery drink a gallon of water. Drink water before you go to bed. This will insure you are well hydrated the morning of surgery. This will make it easier to start your IV if necessary and it will help stabilize your blood pressure during the anesthetic.
- Arrange To Have Someone Stay With You. The first 24 hours after surgery are critical. You may need help to get around at home after surgery. In addition, emergencies can occur and you safety will be assured by having assistance. Home nursing care is also an option. We provide this service for all our face-lift patients.
- Read All Your Materials. Most physicians give written instruction prior to surgery. We provide before surgery instructions, after surgery instructions, a list of medications to avoid, and the surgical consent. Go over these things a couple of times and make sure you understand everything. If you have questions, call and get them answered.
In summary, follow all Before and After Surgery Instructions. This bears repeating! When in doubt or unclear about something, contact your surgeon to check. Surgery by and large is safe. Complications are always an inherent risk, however you can help in reducing post-operative risks by doing these simple recommendations before surgery.
Female Genital Surgery
July 10th, 2009
New York City now boasts of an art exhibit featuring before and after plastic surgery pictures. According to Allure Magazine, all aspects of plastic surgery are featured in the exhibit, including cleft lip and palate correction, nose surgery, and face lift surgery. The surgical photos which drew the greatest attention were the before and after pictures of genital surgery for women. It was not clear if the fascination was because this type of surgery was so novel to the viewers or because there was a genuine interest in the procedure.
It was pointed out that this seems to be inconsistent in a world where female mutilation still occurs. Yet it is embraced in some circles as an acceptable alternative for women. In fact, women who have undergone genital mutilation often turn to reconstructive surgery once they have emigrated to western cultures. Female genital mutilation is an involuntary lay practice carried on outside the purview of medial care. Genital aesthetic surgery is an elective surgery performed by physicians in appropriate hospitals and clinics. In addition, mutilation is designed to minimize sexual desirability while cosmetic genital surgery is designed to maximize sexuality. They are completely different and unrelated.
An interesting study is now underway by the World Health Organization. The title, “Female genital mutilation and other harmful practices, a multi-country study on gender, sexuality and vaginal practices” seems to be inconsistent with its own findings. It was supposed to be, “A study on harmful sexual practice that is being conducted in: Indonesia, Mozambique, South Africa and Thailand.” The study seems to be confusing and perhaps attempts to avoid any politically incorrect findings. Their findings seem to minimize harmful aspects and focus on some of what genital aesthetic surgery is trying to accomplish:
- “Vaginal practices to tighten the vagina during sex are more common than acknowledged”
- “Practices are not always aimed at “drying” the vagina; women focused more on “closing, warming and tightening”
- “Motives for the practices are linked to anxiety and competition among women to gain or hold on to sexual partners”
- “Many practices are linked to a desire to improve sexual relations and necessitate ‘skin to skin’ contact and thus eliminate the possible use of condoms”
- “There are similar practices in different countries.”
The Allure article goes on to quote 2008 statistics from the American Society for Aesthetic Plastic Surgery which report a sharp decline in female genital aesthetic surgery among plastic surgeon members. I suspect this number is inaccurate overall, since much of this surgery is being done by gynecologists, not plastic surgeons. In fact, recently a med-spa dedicated solely to vaginal and female genital surgery, called Phit, has been established in New York City. You have to give them credit on the name!
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