Download Gerald W. Johnson, MD

Gerald W. Johnson, MD
Plastic, Reconstructive and Endoscopic Assisted Surgery
4265 San Felipe, Suite 620
Houston, Texas 77027
Telephone Number: 713-960-9334
Fax Number: 713-960-9477
Web Site http//www.certified-plastic-surg.com
Email : [email protected]
Patient Handbook for
Surgical Procedures
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Scheduling Your Surgery
SURGERY DATE:________________________________________
SURGERY TIME:_________________________________________
ARRIVAL TIME TO OFFICE:_________________________________
LOCATION OF SURGERY: Surgical Center in Suite 620


ALL SURGICIAL PRICES QUOTED ARE VALID FOR 30 DAYS.
If you must cancel your surgery and you do not cancel within seven
(7) days prior to surgery, 20% of your surgery deposit is
nonrefundable.
Recovery Location Options
Your safe and comfortable recovery is important to us. We must insist that you not
be left unattended for 24 hours following surgery. The following recovery options are
available to you and will be discussed during your consultation:

Specialized Recovery Facilities: These facilities will provide you with expert,
specialized nursing care in a comfortable, confidential hotel or home like
setting for as long as you like. Fees are usually charged hourly.

Going Home or Staying With A Friend: We recommend that you travel to a
recovery location no more then 20 minutes from the office the day of your
surgery in order to ensure your comfort and safety. A responsible adult must
be available to care for you during the first 24 to 48 hours following surgery.

Stay in a Local Hotel Without a Friend or Relative: If a friend or relative is not
available, we can provide you with a list of health care nursing names and
phone numbers.

See our link to local hotels in the office vicinity on our website at
http://www.certified-plastic-surg.com/accomodations.htm
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Medical Insurance
If you are considering insurance reimbursement, please read the following section.
Most medical insurance plans will not cover aesthetic or cosmetic surgery. It is
important that you read your policy carefully or speak with your insurance
representative prior to scheduling your surgery in order to determine whether or not
your surgical procedure is eligible by your carrier.
If you are eligible for insurance reimbursement, it is important that you:
1. You will be responsible to file the claim with your insurance company.
2. Call your insurance company to determine requirements and restrictions, such
as pre-authorization, second opinion, etc.
3. Inform our office that you will need an itemized statement of the charges
incurred to enable you in filing your claim.
4. Although we will assist you in discussing insurance matters, we can not be
responsible for following up on delayed or disputed claims.
OUR OFFICE REQUIRES PAYMENT IN FULL TWO WEEKS PRIOR TO SURGERY.
IF YOU CANCEL THE SURGERY WITHIN THE TWO WEEKS PRIOR TO YOUR
SURGERY, THERE WILL BE A 20% CANCELLATION FEE.
THINGS TO DO PRIOR TO SURGERY
Your appointment with the surgery coordinator, will involve the following:
1. Confirmation of the type of surgery you will undergo and the date you have
chosen.
2. Highlight of pre and postoperative instructions.
3. Discussion of any medical requirements not yet completed and arrangements
to be made as follows:

Physical examination: Any patient who is over 50 years of age should
arrange for a complete physical exam and EKG at this time.
i. NOTE: A woman that is undergoing any type of breast
procedure is requested to bring the results of her most recent
mammogram. Dr. Johnson advises that if a mammogram has
not been done in the past one (1) year that a woman has a
mammogram done prior to having elective breast surgery.

Eye examination: We recommend patients having eyelid surgery who
have not had a complete eye exam within the past twelve months to
do so at this time. Insurance companies may not consider
reimbursement for eligible eyelid procedures unless an eye doctor has
performed a visual field study. Patients who wear contact lenses
should be aware that contacts are not be worn for five to seven days
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after eyelid surgery. Glasses should be available for use during this
time.

Out of Town Patients: You may arrange to have these procedures
completed near your home. All physical exams, EKG’s must be in our
office at least 2 weeks prior to your surgery.

Female Patients: Any female patients over the age of 45 who plan to
have breast surgery should have a complete mammogram report that
has been performed within the last year.

Within the week prior to your surgery, the surgery coordinator will
contact you with the scheduled surgery time and your arrival time to
the office.
4. Upon discharge from the office, we will make arrangements for your immediate
postoperative appointments. During these visits you will be seen by our medical
assistant or nurse for necessary dressing changes and removal of stitches. Once this
is completed, you will have follow up appointments with Dr. Johnson. During your
nursing appointments, Dr. Johnson is available to see you as necessary.
5. Any surgical fees outstanding must be paid in full two weeks prior to surgery. If
you have not paid by within this time, your name may be kept on the schedule at
our convenience, however if any patient with payment requests your time, your
name will be removed.
6. Second Opinion: Insurance carriers who allow reimbursement for certain
procedures (such as nasal sepal surgery, upper eyelid surgery, breast reconstruction,
breast reduction and revision surgery) may require a second surgical opinion.
Contact your insurance company to arrange a second opinion appointment through
their physician panel. Failure to obtain a required second opinion may decrease or
eliminate any insurance reimbursement.
7. You should continue regular prescription medications such as high blood
pressure, birth control, thyroid or hormone pills. These may be taken the morning of
surgery with a small sip of water.
8. Schedule any necessary hair cutting, coloring and perm appointments at this
time.
NUTRITION

Begin a good vitamin program but do not overdo it. Excessive vitamins can
do more harm than good. We recommend the following:
1. A good multiple vitamin with minerals, once daily. (Theragram M, One-ADay with Minerals, etc)
2. Vitamin C, 500 mg with Bioflavonoids, morning and night doses above this
amount may increase bruising.
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Begin a healthy, well-balanced diet. Very restrictive weight
reduction diets should be modified or eliminated at this stage to
ensure that your body has enough nutrients for proper healing and
stress management. Crash diets before surgery are not
recommended. A visit to your local health food store can help get
your dietary regimen in shape. We recommend a diet high in
carbohydrate, protein, and fiber and low in fat.

Eat plenty of fruits, vegetables, bran, whole grain breads, chicken
and fish. If it swims, flies or grows in the ground, it is usually good
for you!!

Substitute jelly spread for fatty butter, skim milk for whole milk
and cream, and eliminate fatty meats, ice cream, animal and dairy
fats, along with rich desserts.

Fiber is extremely important in maintaining the health of the
intestinal tract. We recommend that you eat bran muffins, oat
bran cereals, Cheerios and wheat germ. An excellent source of
fiber is Metamucil or an equivalent. Taken regularly during the pre
and postoperative period, these products will decrease abdominal
bloating and constipation as well as lower cholesterol.

Eliminating added salts, spices, and caffeine at this time will
decrease swelling after surgery. You may use a salt substitute
such as Nu-Salt.
EXERCISE

For patients who do not exercise regularly, a light program will help decrease
preoperative stress and anxiety, tone the heart and lungs, improve blood
circulation to the skin, and decrease stiffness of muscles and joints after
surgery. Patients who exercise regularly prior to surgery generally have a
faster recovery period.

If you are more than fifty years old or do not exercise on a regular basis, we
suggest you have a physical examination before embarking on any exercise
program.

For the exercise enthusiast who extensively jogs, lifts weights, rides a bicycle,
etc., we recommend tapering and cutting back on your exercise program a
little for a week or two before surgery. You will be limited in your physical
activities for a short time after surgery, and this will help you avoid the slight
“withdrawal” that is sometimes experienced when exercise is curtailed.
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THINGS TO DO TWO WEEKS BEFORE SURGERY
YOU MUST STOP THE FOLLOWING AT THIS TIME:
 ASPIRIN AND ALL ASPIRIN-CONTAINING PRODUCTS
These products increase bleeding and bruising. If you are taking anti-inflammatory
medication and are uncomfortable without it, our office can provide you with a
substitute. You may take Tylenol or Acetaminophen instead of aspirin. The following
is a list of drugs that contain aspirin-like medications.

If your physician, as a means to prevent a heart attack, has
prescribed you aspirin, do not stop the aspirin or undergo the surgery
without getting a written physician’s release.
DRUGS TO BE DISCONTINUED FOR FOUR WEEKS
(TWO WEEKS PRIOR TO AND TWO WEEKS AFTER SURGERY)
A.P.C.
A.S.A Compound
Advil
Alka-Seltzer
Anacin
Anaprox
Arthritis Pain Formula
Ascodeen 30
Ascriptin
Aspergum
Aspirin
Aspirin Suppositories
Bayer Aspirin Tablets
Buff-a-Comp
Buffadyne
Bufferin
Butabital
Cama
Cheracol Capsules
Clinoril
Congespirin
Copron Capsules
Cope
Coricidin
Coricidin D
Coumadin
Counter Pain
Darvon Compound
Defort-Deful
Dolor
Dristan
Duargesic
Ecotrin
Empirin
Emprazil
Equagesic
Excedrin
Feldene
Fiorinol
Indocin
Liquiprin Tablets
Midol
Measurin
Monacet with Codeine
Motrin
Naprosyn
Norgesic
Nuprin
Pabirin Buffered Tab
PAC
Panalgesic
Percodan
Persistin
Phensol
Robaxisal
Sine-Off
Sodium Salicilate
Supac
Tolectin
Triaminicin
Trigesic
Vanquish
Zomax
You may return to your regular aspirin containing medication schedule two weeks
after surgery unless instructed otherwise.
RECREATIONAL OR SOCIAL DRUG USE
Even a small amount of marijuana, cocaine, or other drugs can have an impact on
your anesthesia and healing. Please stop completely at this time. Stopping
altogether would markedly improve your health and extend your life.
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SMOKING
It is extremely timely and important that you gradually decrease and then totally
stop smoking at least 48 hours before surgery. Smoking is one of the most
destructive things you can do when your body is trying to heal.
IF A HISTORY, BLOOD/URINE TESTS OR OTHER SOURCES SHOW YOU HAVE
SMOKED IN THE FIRST THREE WEEKS POST-OPERATIVE PERIOD, ANY AGREEMENT
WE HAD WITH YOU TO TAKE CARE OF POST-OPERATIVE COMPLICATIONS FOR NO
PROFESSIONAL FEE WILL BE VOIDED.
Nicotine containing or nicotine like aids to stop smoking MAY NOT BE USED in the
first three weeks post-operative.
ALCOHOL
If you are a regular or heavy drinker, try to eliminate or cut down to a minimal level.
One that is comfortable for you. Alcohol may cause easy bruising, it lessens the
ability of the liver to metabolize medications, and alcohol interferes with the general
healing process.
If you are a heavy drinker, excessive bruising following the surgery can be a
problem. We can provide extra Vitamin K medication for you and your regular
physician can suggest liver testing to ensure your good health.
SUBSTANCES THAT INCREASE BRUISING
Supplemental Vitamin E above 400 unites per day and fish oil tablets, oriental food,
garlic, papaya juice, meat tenderizer and large amounts of herbal supplements all
increase bruising. Eliminate them from your diet completely or, if this is not
possible, reduce their intake as much as possible.
STOP SUNBATHING OR USING SUNBOOTHS AT THIS TIME.
STOP USING FACIALS, STEAMING, MASKS, OR OTHER SKIN IRRITANTS IF YOU ARE
UNDERGOING FACIAL SURGERY.
DO CONTINUE THE USE OF RETIN-A, if prescribed for you.
Try to avoid getting run-down before surgery. Organize your time, eat well, and get
sufficient sleep. Benadryl, 25-50mg., is available without a prescription at drug
stores and can be taken at bedtime to help you sleep.
Try to avoid being around anyone who is sick. You do not want to run the risk of
catching something before surgery.
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Women MUST be assured that they are not pregnant before surgery. If there is any
doubt, you must perform or have a pregnancy test performed.
HAVING SECOND THOUGHTS
As the date of your surgery approaches, you may experience feelings of anxiety and
indecisiveness. Almost everyone does. Millions of patients have had successful
aesthetic surgery, yet the majority probably had the same concerns before their
surgery. You are probably asking yourself if you are doing the right thing. You
wonder how you will look afterward. What will your family and friends think? Will
the surgery hurt? Is it all worth it?
In addition to our operating on thousands of patients, many of our staff has had very
successful aesthetic surgery performed by Dr. Johnson, and we understand your
concerns. We do not pressure our patients into surgery. We will answer your
questions and provide all the information you need to make an informed decision.
There is little need to be apprehensive or fearful about pain. With today’s methods
of anesthesia, you will feel no pain during the procedure and usually only mild-tomoderate discomfort for a short time afterward. Any discomfort you may experience
can be controlled with medication.
We believe that CHANGE favors the PREPARED mind. It is important, therefore, that
you prepare for your surgery by carefully reading the information we have compiled
for you, which addresses the questions most frequently asked about aesthetic
surgery. Any patient who feels unusually anxious may find a new exercise program
to be beneficial. Again, 50 mg. of Benadryl (available without a prescription from
any drug store) can be taken at bedtime to help you sleep.
THINGS TO DO SEVEN TO TEN DAYS BEFORE SURGERY
If you have not done so, it would be very helpful at this time if you could read and
review this material with the family member or friend who will be taking care of you
after surgery.
Arrange for meals during recovery. You might want to prepare and freeze individual
meals that can be quickly reheated in a microwave or arrange for someone to cook
for you.
Refer to “Comfort Station” on page 13. Shop for regular household items and any
extras you may need for your recovery.
Arrange for visiting nurses, if necessary.
Arrange for transportation to and from office visits.
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.
Often, early treatment is successful and may prevent cancellation and re-scheduling
of your surgery.
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If you are having the Endoscopic Breast Augmentation through the belly button, you
should carefully clean your belly button using a cue tip and beta dine solution
(available from your Pharmacy) daily starting 3 days before the surgery. If you have
a belly button ring you should remove it before you start the 3-day cleaning. If you
have any redness, infection, irritation or tenderness around the belly button ring,
you should remove it 7 days before surgery, clean as instructed above, get some
decolorized (clear or white) iodine from the Pharmacy and apply it 3 times daily to
the “belly button ring tunnel” trying to get the iodine to penetrate into the tunnel. If
you will bring the ring with you on the day of your surgery, we will sterilize the ring
and reinsert it for you when we finish the surgery.
DISCONTINUE: With your medical doctor’s permission all medication containing
blood thinners. If your doctor will not allow you to do so, notify us and we will
decide if we need to cancel your surgery. You may resume these a week after
surgery. You may continue taking your birth control pills.
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 might be helpful to you, depending upon the type
of surgery you have and your expected recovery. Go over them now and make a list
of those items that apply to your situation.
From the pharmacy or drug store:
Vitamins (Theragram M or comparable product)
Throat lozenges and cough drops (for dry throat)
Chap stick or lip balm (for dry lips)
Baby shampoo (after scalp or facial surgery)
Mouth spray
Dusting powder (helps avoid sticky skin in bed)
Witch hazel and small sponges or Cloet pads for eye compressed
Skin Moisturizer
Vaseline
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 Osco’s Orange-flavored Natural Fiber laxative
Vicks or Mentholatum (after nasal surgery)
Sun block (i.e. Bullfrog, Photoplex)
1% hydrocortisone cream (after face peels) Cortaid 10
Caladryl (to relieve itchy skin)
Lactobacillus Capsules (to decrease yeast infection when taking antibiotics)
Pill cutter (if you have trouble swallowing pills)
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For your bedroom or recovery area:
Bedside clock
Bedside table
Warm socks or booties
Nightlight
Small bib (to protect clothing when eating in bed)
Baby cup (easier to use after facial surgery than a regular cup)
Paper towels
No spill cup
TV guide
Kleenex
Magazines
Baby food (easy to eat)
Soft food
Trash bags (at bedside)
Baby wipes (for quick clean-ups)
Paper plates and cups (saves you from having to wash dishes during recovery)
Answering machine
Loose clothes – jogging suit (warm, easy to get in and out of)
Pens/pencils/paper
Towels
Older sheets (softer, less likely to cause creases or irritation of the skin)
Personal phone book
After facial surgery:
Children’s toothbrush (after nasal or chin surgery)
Water spray bottle (after peel or facial surgery)
Murine earwax remover (before facial surgery)
Cetaphil soap substitute (after peel or facial surgery)
Rolled bath towels (use behind your neck after facial surgery)
Food and Drink Supplies:
Water
Prunes
Yogurt
Frozen dessert bars
Soft fruit cups
Pineapple or tomato juice (help to decrease bruising)
Pudding
Healthy snacks
Ice cube trays (to make ice compresses following eyelid and nasal surgery)
Tea bags
When you venture outside:
Hat and scarf
Sunglasses
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Cover-up make-up
Sun block
Suggestions for setting up your room:
Remove anything you might trip over
Set up an extra bedside table or night stand
Keep the phone near your bed. An answering machine can pick up your calls when
you are resting and do not want to be disturbed. Keep emergency phone numbers
handy (doctor, pharmacy, etc.)
Have a fan available in case you get warm
Install nightlights in the bedroom and bathroom for your safety
Keep an extra large wastepaper basket near the bed
Have a robe and pair of slippers nearby
An ultrasonic humidifier can keep your hair, eyes, skin and nose from becoming too
dry
Have a chair near your bed and another in your bathroom so you can sit down and
rest when necessary
THINGS TO DO FIVE DAYS BEFORE SURGERY
Confirm transportation arrangements to our office.
Again, remember to have the family member or friend who will be caring for you
after surgery read over your pre-operative checklist and post-operative procedure
instructions so that he/she will know in advance what to expect.
THREE DAYS BEFORE SURGERY
Shower daily with an antibacterial soap such as dial, zest, lifebuoy or phisoderm.
If you are having facial or scalp surgery, gently clean out the crevices around and
inside your ears with a water-moistened cotton-tipped applicator. Eliminate any
impacted wax with Murine or Debrox earwax remover to prevent growth of bacteria.
This is only to be done if there is a large burden of wax in ears.
You might want to place a small stool in your shower. Early in your recovery you
may need to sit down when you shower.
Contact the office, if we have not contacted you, for specific surgery and arrival time.
THINGS TO DO ONE DAY PRIOR TO SURGERY
Set out clothes for the next morning.
Wear clothing that is loose and buttons or zips up the front. A warm-up or jogging
suit is ideal.
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Wear flat shoes that are easy to get in and out of.
Do not wear panty hose or girdles.
Bring an extra set of underpants.
Do not wear make-up.
Do not wear jewelry, earrings, rings, hairpins or false eyelashes. Please leave all of
these at home.
If you wear wigs, hair weaves, etc. please notify our nurse.
If you wear contact lenses, eyeglasses or dentures, bring your case with you. Be
sure your name is on the outside.
Do not set or style your hair the day before your surgery. Wash your hair with a
mild shampoo the night before your surgery. Do not tint, dye or bleach your hair
less than 48 hours before facial surgery.
You may bring a favorite pillow to the office if it will make you more comfortable.
Cover it with a plastic sleeve, put your name on the inside and then cover it with a
cotton pillowcase.
If possible, leave your purse at home. You can bring your personal phone book.
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. Your stomach must be empty
to decrease nausea and avoid anesthesia problems.
If you have trouble sleeping, take one 50-mg. Benadryl capsule before retiring. Use
a “double alarm” system (i.e. two alarm clocks, an alarm clock and a wake up call
from a friend, etc.).
THINGS TO DO THE MORNING OF SURGERY
Do not worry. The anxiety you feel is quit normal and will rapidly be dispelled once
you reach the office.
Be sure you do not eat or drink anything prior to surgery. You may take regular
prescription medications such as blood pressure, thyroid or birth control pills with a
small sip of water. Be sure you do not take any aspirin or aspirin-containing
products, blood thinners, etc. Bring your prescription medications with you to the
office.
You may shower and wash your hair, but do not set or spray it. DO NOT USE FACIAL
MOISTURIZER, BODY OILS, OR LOTIONS AS THEY INHIBIT THE MARKS WITH OUR
SURGICAL MARKERS. Men may shave and use aftershave lotion. Brush your teeth
with minimal water and use mouthwash.
When you arrive at our office, your transporter may park in the parking garage.
Family members and friends are not allowed to stay with you in the surgical facility.
They are welcome to stay in our waiting room.
Please inform our nurse if you wear a wig, contact lenses, eyeglasses, false
eyelashes, dentures, partial plates, loose teeth, etc.
Once your surgery is completed and your dressings are in place, you will be taken to
the recovery room where you will be under close observation. You will also be
monitored by modern equipment that will keep track of your pulse and blood
pressure.
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IN THE RECOERY ROOM
You may wear your socks and a blanket will be provided for your comfort.
A blood pressure cuff may be attached to your upper arm. Intermittently, it may
become snug as it measures your blood pressure. A computer that signals the
doctor and nurse if a change is noted records your blood pressure reading.
You may have an intravenous line I.V.) In your arm to provide fluids. Medication can
be added to the I.V. as necessary for your comfort.
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.
Your may hear regular “beeps” around you. These come from the computers that
monitor your vital signs (blood pressure, pulse, oxygen saturation, etc.)
You will be provided fluids orally when you are ready.
WHEN YOU ARE READY TO GO HOME
We recommend that your car be stocked with a pillow, blanket and box of tissues. A
car with a reclining front passenger’s seat will also add to your comfort during the
ride home.
It is important that the driver proceed slowly and cautiously. It is not unusual for
the post-surgical patient to feel light-headed; sharp turns and bumps may contribute
to this.
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.
RETURN TO ACTIVITY
Each patient’s recovery period varies in length and intensity, so you should use the
following chart as a general guide to post-operative activities. Keep in mind that you
may not feel up to strenuous activities as soon as other patients might; however you
may recover faster. Take it into consideration how you feel and use this as a gauge
when planning activities.
With all activities, it is best to begin slowly and increase the level of activity, as you
are comfortable. If you jog, start by walking for a few days. If you enjoy aerobics,
try a few days of stretching before you plunge into your regular exercise program.
In general, be patient. Very soon you will be back to your normal schedule of
activities.
DAY ONE (DAY OF SURGERY):
Perform only necessary activities
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Rest in bed or on the couch
Use the bathroom with assistance
Take meals in bed
Dress with assistance
Move your legs in bed
Cough and take deep breaths
Dangle legs over the side of the bed, turn or sit up (unless restricted by
abdominal surgery) to prevent back stiffness
Visit with family
We believe that generally your activity during recovery should be governed by
the rule, “if it hurts, do not do it”. Generally, this “rule” also means that, “if it
does not hurt, you and do it”, however if you want some more specific
suggestions, read the following.
DAY TWO:
Walk to the bathroom alone
Get up for meals
Move about the house
Dress unassisted
Read or watch TV
Take a sponge bath
Return to our office for an appointment – if applicable
Visit with family and possibly friends
DAY THREE:
Prepare your own meals
Bathe or shower and shampoo hair
Shave
Visit with family and friends
DAY FOUR:
Begin to care for children and pets
Consider return to light intimacy
DAY FIVE:
Joggers start a walking program
Begin stretching
Begin driving
Go out to restaurants
Light shopping
Light housework
DAY SEVEN:
Consider returning to work or school
(You may be off longer, depending on your type of surgery)
Consider treating yourself to a massage
SECOND WEEK:
Light, short-term swimming
Increase aggressive walking, longer distances
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May return to gentle chiropractic care
Dental appointment (unless you have had facial surgery, wait six weeks)
THIRD WEEK:
Light aerobics
Light bicycling
Light jogging
Light nautilus
Light tennis
Lightweight training
Light physical education class
Push-ups
Swimming
FOURTH WEEK:
More vigorous aerobics
More vigorous nautilus
Light basketball
Light golf
Light horseback riding
Light racquetball
Baseball
Bowling
Hair coloring or perm (after facial surgery)
FIFTH WEEK:
Heavy basketball
Heavy bicycling
Heavy racquetball
Heavy weight training
Light scuba diving
Long trips
Hiking
Jumping rope
Volleyball
SIXTH WEEK:
Electrolysis or waxing (after facial surgery)
Sunbathing of non-surgical areas
Light skiing
Jacuzzi
Windsurfing
Vigorous dental work or cleaning
TENTH WEEK:
Vigorous water sports
Vigorous contact sports
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Vigorous skiing
Vigorous surfing
Rock climbing
Steam bath
Wrestling
TWELFTH WEEK:
If needed, sunbathing of all areas with protective sunscreen
(We do not recommend any sunbathing.)
Deep scuba diving
Skydiving
WHAT TO EXPECT IMMEDIATELY FOLLOWING SURGERY
Your mind may be active at this point, but your body wants to rest. You may feel
like lying down much of the time or require long periods of sleep. By following our
instructions for setting up a bedside or couch side “comfort station” you will be as
comfortable as possible during your recuperation.
APPEARANCE:
Naturally, you are excited about your surgery. You may want to stand in front of a
mirror to see how you look, but we do not recommend this during your early
recovery period. Some degree of bruising, swelling and numbness is expected and
asymmetries are common. After receiving anesthesia and various medications your
emotional state may be somewhat vulnerable and your overall appearance can be
upsetting if you are not prepared. Anxiety and nervousness is normal at this point.
We want to reassure you that all patients feel this way, but these feelings will
diminish rapidly as your recovery progresses and swelling and bruising resolve.
PHYSICAL ACTIVITIES:
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
During the first day or two following surgery, we recommend that throughout
the day you take deep breaths and gently cough in order to exercise your
lungs. Also, 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.
It is normal to feel tired, sedated or woozy for a day or two after surgery,
particularly if you are taking pain medication. For the first day or two, you
should not drive, travel alone on public transportation, make important
personal or business decisions, or sign important papers. You should also
refrain from operating complex machinery or kitchen equipment. Do not take
any over the counter medications during this period without previous
instructions or authorization from our office.
Do not exert yourself the first few days after surgery, as this may increase
swelling and bruising. Elevate your operative area and avoid lifting or
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bending as much as possible. It is preferable that you slowly begin t 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.
Remember if it hurts, do not do it unless we tell you to. Slowly and gradually
increase your level of activity, as you feel stronger.
Remember that smoking and drinking alcohol (particularly red wine) will
appreciably increase swelling and bruising and should be avoided for a week
or two.
It is not unusual, after some surgeries, to feel light-headed if you get up
quickly. It is best to have someone assist you for the first day or two. Make
sure your feet and legs are not tangled in the bed sheets or blankets. 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
and then gently lift yourself into a sitting position by keeping your knees bent
and pushing up on your elbows. Rest a moment, and then slowly stand up.
If you have house pets, be especially careful that they do not jump or climb
on you while your incisions are healing.
Before you get up, put on your glasses if you need them. It is a good idea to
have them readily available, especially if you have had eyelid surgery and do
not have contacts in place.
If you must climb stairs, take one step at a time. Face the railing or banister
and hold on with both hands. If possible, 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.
Never walk alone if you feel light-headed. Ask for assistance. Do not forget
to keep a nightlight and a chair in both your bedroom and our bathroom. You
may feel a little helpless at this stage, as if you are moving in a slow motion,
but this will quickly pass.
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. A child’s toothbrush is easier and more comfortable
following facial surgery.
DIET:
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You may be very thirsty for a few days. This is common after surgery. Keep
a supply of juices handy.
It is normal to have little appetite for a few days following surgery, but fluids
are important at this time. You might try some good old America chicken
soup. Drink plenty of juice to prevent dehydration and decrease constipation.
As your appetite increases, start with easily digested foods such as juices,
cool or lukewarm tea with honey, 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 undergone surgery inside your mouth, rinse frequently with salt
water. You should be on a liquid diet for 48 hours followed by a soft diet for
an additional three days.
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You may find that you need to make frequent trips to the bathroom. This is
not unusual and is due to fluids provided during your surgery. If you walk to
the kitchen or move from the bedroom to the couch, stop by the bathroom on
your way. It may save you an extra trip later.
PRE AND POST OPERATIVE DIETS
CLEAR LIQUID:
Decaffeinated tea
Decaffeinated coffee
Cranberry juice
Apple juice
Clear broth
Example: Generally for two days when surgery is done inside your mouth.
FULL LIQUID:
Cream of tomato soup
Clam chowder soup
Fruit juice
Malts
Milk shakes
Soft ice cream
Eggnog
(Do not overlook blender diets.)
Example: For one to two days following facial surgery.
SOFT DIET:
Cream of wheat
Oatmeal
Eggs
Bananas
Tuna
Soft fish
Pudding
Cottage cheese
Bread spaghetti
Rice
Custard
Ice cream
Yogurt
(Do not overlook baby food.)
Example: For one to two days after other types of surgery.
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MEDICATION:
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If you are taking antibiotics you should eat yogurt, drink acidophilus milk, or
take lactobacillus capsules daily to decrease the possibility of yeast infection.
Although rare, if you notice a genital rash, slight itching, or whitish discharge,
call our office for a prescription that will combat the yeast infection. Over the
counter medications are also available. If antibiotics are prescribed, take
them regularly and continue until they are gone.
Unless instructed otherwise, continue with your regular prescriptions, such as
blood pressure, birth control and thyroid medications.
For the first two days, take a “baseline” of pain medication regularly, such as
one to two Tylenol every four hours. There is scientific evidence that during
the first day or two following surgery, a low but definite blood level of mild
pain medication goes a long way toward controlling discomfort. Of course,
you will have stronger pain medicine available if you need it. Many patients
find that their discomfort slightly increased late in the afternoon or evening.
If your pain does not respond to these baseline measures, stronger
medication can be added every three to four hours. Take pain medication as
soon as you begin to feel discomfort. Do not wait until it becomes stronger
and more bothersome.
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.
While you are on pain medication, you should refrain from driving, operating
machinery or kitchen equipment, signing important papers, or making
business decisions. If you are scheduled to return to our office within a day
or two of surgery, have a light meal and take a pain pill just before leaving
home.
Some patients experience stomach irritation and nausea when taking pain
medication and antibiotics. To avoid this, take your medication with a small
amount of food, such as toast, crackers or a banana. If you have trouble
swallowing pills or capsules, they can be cut in half or opened and mixed with
food or juice. Commercial pill cutters are available at pharmacies, or you
might also try placing the pill on a spoon, adding a small amount of water,
crushing the pill with a second spoon and then mixing with food or juice.
If you are taking several medications, you might find it helpful to place
colored tape around the pill containers or mark them with sticky colored dots
(available at any stationary store) for identification.
For a few days after surgery, you may look and feel feverish. Your face may
be flushed and your skin warm and slightly sweaty. This is a normal,
physiological response to excitement and surgery and although this is rare,
may also be aggravated by the medications you are taking.
If your intravenous site on your arm should develop a skin irritation, applying
a warm moist washcloth can help to alleviate it. You may also notice light
oozing from your incision line or slight staining of your dressing for a day or
two after surgery. If, of course, the dressing becomes soaked or you notice
excessive swelling, notify our office immediately.
Women may experience irregular menstrual periods, or even miss a period or
two, for a month or two following surgery. This too is normal. Your body will
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soon adjust and return to its regular cycle. Meanwhile, you should continue
with your regular birth control program.
In addition to these general instructions that apply to all surgical cases, refer
to the additional instructions specific to eyelid, nasal, cheek, chin, breast,
abdominal surgery or if you are having lip suctioning of the face, neck,
abdomen, waist, hips or thighs, please refer to the specific instructions
regarding that procedure.
DEALING WITH VISTORS
Friends and relatives may be anxious to drop by and see you after your surgery and
your feelings about these visits may fluctuate. At times you may want to share your
excitement with the people you feel close to. Their visits may also alleviate some of
the fears and concerns that everyone experiences after surgery. This “support
system” is very important during any period of recuperation. Much of the time,
however, you may want nothing more than to be left alone to sleep or rest. You
must decide how often you will have visitors and for how long.
Communicate to your family and friends how important their visits are, but explain to
them that you need your rest. Assure them that as you regain your strength, they
will be welcome to come more often and stay longer. Keep in mind that for a few
days, you must limit your activities and the amount of stress in your life. If you
have had facial surgery, you must also limit your talking, chewing and laughing
during the first few days of your recovery. A positive attitude actually helps you to
recover faster, so when friends ask how you are say, “Great!”
ON THE ROAD TO RECOVERY
During your recovery, your mental, physical and emotional systems may return to
normal at different times. For the first few days, you may feel that mentally you are
in a “fog” and need to sleep a great deal. This is normal following any type of
anesthesia and pain medication.
Following any pregnancy, trauma, injury, illness, surgery or major emotional distress
the body puts itself into a “rest phase” for four to six weeks. This is the most
noticeable during the first week and progressively improves during the next several
weeks. Most patients feel back to normal physically at the end of six weeks and can
return to their pre-surgical schedule of work and exercise.
Emotional ups and downs are also experienced for four to six weeks. Periods of
excitement, satisfaction, elation, and well-being alternate with depression, anxiety
and concern. Most patients find that within four to six weeks after surgery, their
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mental, physical and emotional “musical strings” are once again “in tune” with each
other.
The following section will provide you with additional detailed information about the
recovery period.
TWO TO THREE DAYS AFTER SURGERY:
You probably feel better now and are eager to be up and about. You should
alternate periods of activity with periods of rest throughout the first several
days. You can take brief walks outside, but if you have had facial surgery, be
sure to wear your hat, scarf and sunglasses. Remember that it can take four
to six weeks before you feel completely like yourself. For now, rest whenever
you feel tired.
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 to warm, as elevated air temperature
will increase swelling.
Small capillaries may continue to ooze for several hours to 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. It is important that you 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 bathe or shower after two days.
As your incision site heals you may experience slight itching. This is a good
sign, as it means that your body is healing. You may be tempted, but do not
scratch! Apply light ice compresses or gently pat the area. You may also find
that taking a baseline of Tylenol every three to four hours for a day or two
will alleviate this discomfort.
CARE OF YOUR INCISION LINE:
Contrary to popular opinion, “scar” is actually a good word to your body,
because scarring is part of the healing process. To the patient, however, the
idea of scarring is frightening. 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
should be inconspicuous.
Your incision lines heal in four phases, as follows:
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Phase I: Day one through fourteen. Characterized by slight oozing
and crusting; bruising and soreness resolve in seven to ten days; ice
compresses are helpful.
PhaseII: Week two through six: Formation of early supportive scar
tissue, pink to light red; itchiness and tenderness are common; some
thickening of incision site.
Phase III: Six weeks to six months. Scars lose their redness,
itchiness and tenderness; areas flatten and begin to blend.
Phase IV: Six months to 24 months. Scars become softer, looser and
smoother.
The following is a step-by-step guide to the healing process:
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Stitches are used to support your incision site while it heals during the
first several days to several weeks after surgery. We seldom use
sutures that leave stretch marks. Deeper stitches add strength to
your incision line closure and will absorb over a period of six to eight
weeks. In all likelihood you will not even be aware of this process.
Occasionally some minor irritation develops and a tiny bump may be
felt under the skin as you wash. This is nothing to be alarmed about,
as it is usually temporary and resolves in time.
If stitches are used on or near the surface of the skin, they are
removed in our office one to three weeks after surgery.
Your incision lines will be protected by dressings for a day or two after
surgery. These dressings also absorb the normal, slight oozing of
blood- tinged fluid from the surgical site. If this oozing persists,
applying continuous pressure on the area with a clean dry cloth for ten
minutes can usually stop it.
Elastic compression garments can be helpful in decreasing the
formation of scar tissue following burns, injuries or extensive
reconstructive surgery. Depending on your specific procedure, the
doctor may recommend that you be fitted for such a garment. If so,
our office can provide you with a prescription and the location of a
supplier.
You may notice some crusting of the incisions for a few days. This
crusting can be softened with Vaseline or antibiotic ointment. Your
stitch lines will seal very rapidly usually within 24 to 36 hours. At this
point, the softened crusts can be washed away gently with mild soap
and water. Avoid irritating soaps, powders and oils until the area is
completely healed.
As your incision lines heal, the new blood vessels and nerves grow in
the area. This can result in slight itchiness. Gentle washing of the
incision line, followed by the application of Vaseline or antibiotic
ointment will help decrease irritation.
Intermittent swelling can also occur in the first few weeks and
consequently lumps may develop under the skin. Once your stitches
have been removed, you can treat any lumpiness with gentle pressure.
Press the tip of your index finger gently over the area for ten seconds
once an hour. Do not press hard enough to cause pain. It should feel
like you are pushing a putty pea into a small pancake. This technique
has been successful in decreasing scar swelling in burn patients.
If excess redness or swelling continues along the incision line, the
doctor can give you a prescription for light cortisone ointment or an
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injection of dilute cortisone. If we have used an elastic type tape on
your skin to provide support, it must be left there until we remove it.
If you start to itch and blister under the tape margin, you need to
remove the tape and use some baby oil to remove the adhesive from
your skin. Apply over the counter cortisone cream.
PERSONAL INCISION CARE PROGRAM:
The following skin care program will not only improve the contour and final
appearance of your incision lines but, also will facilitate the healing process.
PLEASE NOTE: This program is not to use for eyelids.
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Apply icy cool compresses during the first 48 hours and then as
needed (usually morning and evening) after two days.
You may shower after your incision line is sealed and bandages and
surgical tape are removed.
Apply the following antibiotic ointment to minimize infection, provide
relief from discomfort and promote healing.
For six months, your incision line must be totally protected from sun
exposure by using a good sunscreen. Brown camouflage micro pore
tape (available at most drug stores) can be used over the area. A
good, complete sun block is skin colored zinc oxide paste. Photoplex,
Pre-Sun 29 and Bullfrog are good sunscreens. These products are
available over the counter.
Always test new products on a small area of your incision line
overnight to ensure that you do not develop a rash or irritation.
Remember that certain medications, such as birth control pills,
antibiotics and high blood pressure pills can increase your sensitivity to
the sun, so be sure to protect your skin.
In those unusual cases where there is a genetic tendency toward
hypertrophic scarring or, in very rare cases, keloids the following
treatments can be instituted one month after surgery:
Topical cortisone, such as hydrocortisone 2-1/2%, applied twice per
day for two to four weeks.
Small injections of Kenalog, two to four weeks apart.
In rare cased where permanent excessive scarring is still present after
one year, surgical revision and/or x-ray treatments can be used.
THREE TO FIVE DAYS AFER SURGERY:
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You may continue to run a low-grade fever for a few days. This is not
unusual as your body is working very hard to heal. If your
temperature should rise above 101 degrees, call the office.
You may also be bothered by mild constipation 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
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of Metamucil or a comparable product each morning. A glass of prune
juice or an ounce of Milk of Magnesia may also help.
Your swelling is beginning to resolve at this point. You may notice
slight, shooting discomfort. This is a sign that nerves are returning to
normal. Cold compresses and a mild analgesic such as Tylenol should
provide relief.
Some firmness of the operative site is also normal while swelling is
present. Remember that your stitches will still be tender, move
cautiously and continue to apply ointment to the surgical site as
recommended.
Your appetite may still be decreased. As long as you continue drinking
plenty of juices, this is nothing to be concerned about. As you regain
your strength, you will feel more like eating. Continue to avoid excess
salt, sugar, spices, dairy products and alcohol.
Continue taking pain medication as needed. If you were prescribed
antibiotics, take them until they are gone. If you have trouble
sleeping at night, take one Benadryl 50 mg. tablet or a sleeping pill
(only if prescribed by the doctor).
Continue to rest as much as necessary. You may increase your level
of activity each day, but stop when you feel tired. If you venture
outside for a brief shopping trip or a walk, be sure to protect your skin
form the sun by wearing your hat, scarf and sunglasses and using a
sun block.
IMTIMACY:
Shortly after surgery, many patients desire closeness and intimacy with the
one they love. Hugging, embracing and kissing are 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. Remember, if it hurts, do not do it.
COPING WITH THE BLUES:
It is not unusual for a patient to develop a case of “the blues” several days
after aesthetic surgery. 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. You will be able to cope with this brief period of
emotional turmoil as long as you understand why it happens and what kind of
activities will help to alleviate it.
The depression that occurs after cosmetic surgery is similar to postpartum
depression following childbirth or the depression one might experience
following discharge from the service or graduation from college. After any
period of intense effort and concentration, whether it be preparing for
motherhood, completing your education or military training or planning a new
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more attractive YOU – a let down is natural when the goal is reached and the
time has come to move on to the next phase in life.
Five days after your surgery, you may look in the mirror and find a familiar
stranger looking back at you. Bruising and swelling is beginning to resolve,
but it will be a few weeks or longer before you see the final result of your
procedure. Meanwhile, you are easily fatigued, anxious about your
appearance and possibly taking pain medications. You may be on leave from
your job and probably miss socializing with your friends. All of these can
affect your emotional state.
You can get through this blue period by reminding yourself that what you are
going through is perfectly normal. Be creative. Think of ways to keep
yourself busy and your mind off your temporary appearance. Drag out those
boxes of photographs and arrange them in albums or start in on the stack of
books you have been meaning to find time to read. You can probably think of
dozens of projects you have been putting off that will fill up your time without
tiring you out. Go outside a bit – the fresh air will make you feel better – or
listen to a relaxation tape. Walking or starting a light exercise program early
on can also help to decrease depression as well as speed up the healing
process. Before you know it you will be back at work, your social calendar
will be full and you will be looking great.
WEEK 2 THROUGH WEEK 4:
If you have had dermabrasion or a face lift, starting every other night (then
slowly progressing to every night) wash your face, pat it dry and apply a thin
layer of Retin-A to your entire face and neck. Do not apply too close to your
eyes, the corner of your mouth, lips or within your nose or mouth. These
areas are usually more sensitive. Rub it in well. A sunscreen or sunscreen
make-up should be used daily. The first few days, the skin may become
slightly reddened and flaky and the regular use of moisturizer is
recommended. If irritation is troublesome, decrease the frequency to every
third night. If you do not experience slight redness or dryness, progress to
every night or even twice daily. Avoid direct unprotected sunbathing or sun
tanning machines for three months. If you desire a tanned appearance, use
“Q-T’ or a comparable self tanning lotion. If you cannot avoid direct sunlight
exposure (for instance, if you are going on vacation) you should stop Retin-A
use one-week prior and one week after this exposure.
WEEK 4 TO 6 MONTHS:
As your skin becomes accustomed to the medication and redness, the flaking
disappears, increase the use of Retin-A to every night or twice daily. After six
months, use three times per week.
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Darker skinned individuals may need to use the medication more
frequently.
Red spots or areas of scaling and peeling are signs that sun or age
spots are resolving.
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Facial peels; eye surgery, facelifts and collagen injections can usually
be safely performed in conjunction with Retin-A treatment.
Elldoquine Forte, a mild bleaching agent, may be prescribed along with
your Retin-A treatment to decrease blotchiness and pigmentary
abnormalities. Apply twice per day, rubbing in well, while following
your recommended regimen of Retin-A.
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 you telling us if you had a good experience. We also want
to know if your experience was less than you expected.
A FINAL NOTE
Dr. Johnson wants you to continue “looking great” your whole life. In addition to
successful plastic surgery, many factors contribute to an attractive, youthful
appearance. This information contains numerous instructions and suggestions
concerning diet and weight loss, exercise and skin care. When you have the
opportunity re-read these sections.
We want you to be healthy, youthful, attractive and happy. If there is anything we
can do to be of further service to you, please call on us.
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