Northern Virginia Plastic Surgery Patient information

Pre & Post Operative Instructions
Shervin Naderi, MD, FACS

• Make sure all your questions & concerns are answered by Dr. Naderi or his staff prior to the actual surgery.
• Arrange your post-operative appointment time before your surgery.  Most major surgeries will need to be seen in the office for follow-up the day after surgery.
• Fill all your prescriptions prior to surgery and bring them with you on the day of your surgery. Start taking your antibiotics 24 hours before your surgery for any surgery which will be under local anesthesia.  For other types of anesthesia, you will start your antibiotics immediately after your surgery.
• You may take your blood pressure & heart medicines with a small sip of water the morning of your surgery.
• Stop taking Aspirin 2 weeks prior to surgery.  Ibuprofen, Motrin, Alleve, Advil and all NSAIDs will make you bleed excessively as well.  Only take Tylenol for aches & pain within 2 weeks of your surgery if OK’ed by your family doctor. 
• High dose Vitamin E, Fish oil, Herbal supplements and health food store products often make you bleed excessively as well.  Avoid these 2 weeks prior to surgery.  If in doubt, check with your doctor. 
• If you Take Coumadin or Plavix or Aspirin, check with your family doctor to make sure these are OK to be stopped with enough time prior to surgery.  (2 weeks to 5 days depending on medication type)
• Drink plenty of fluids the afternoon prior to surgery as well as after your surgery to avoid dehydration and fainting spells.
• Make sure you are well nourished.  You need energy and protein to heal properly.  This is no time to diet!  A simple Multi-vitamin is a good supplement.
• Make sure you do not eat or drink past midnight the night before surgery IF YOU ARE being sedated or being put to sleep for surgery.
• Take a shower the morning of your surgery and wash your face and hair with a mild soap & shampoo.  DO NOT USE ANY MAKE-UP or products on your face or hair after your shower or after your surgery until cleared by Dr Naderi.
• Wear loose fitting & comfortable clothes with a shirt that buttons down the front.  (No tight or crew – neck collared shirts)
• Make sure you have someone drive you to your surgery and pick you up afterwards.  Make sure you have a friend or relative stay with you for at least 24 hours after your surgery. (You cannot drive or stay alone)
• Use Hydrogen Peroxide diluted with water in a 1:1 ratio on a Q-tip to clean all your incisions and suture lines then cover the area with a thick layer of antibiotic ointment.  Do this at least 4 times a day for 10 days on all areas that are NOT covered by brown tape or dressing, or if the tape should fall off before your follow-up appointment.
• You may have certain incisions covered with brown 3M Micropore tape or “Steri-strip” tape for up to 3-4 weeks.  You will use 3 layers of tape on the incisions as instructed.  This usually applies to skin lesion or mole excision sites.
• Use Cool Compresses to decrease swelling: Purchase new baby washcloths.  Make an ice-water bath in a clean bowl.  Soak the washcloths, then drench them out till merely moist and use these on your face as "cool compresses."  20 minutes on and 20 minutes off.  DO NOT place actual ice-packs or frozen pees  on your face. 
• No lifting over 10 lbs and no bending over for 10 days.  You may NOT exercise for 2 weeks.  Refrain from sexual activity for 2 weeks.  No contact sports for 3 months. 
• Sleep with your head up on 2-3 pillows or on a recliner for at least 1 week after surgery to reduce swelling.  Also sleep by yourself so your partner does not inadvertently hit your face while asleep.
• When in doubt - call! Call with any questions or any signs of allergic reaction (redness, induration, itching) or infection (redness, swelling, pain, pus, discharge, blisters, or fever) or excess bleeding or broken sutures.  (703-481-0002)
• Always check with your family physician, heart and diabetes doctors as well as eye doctor if it's OK for you to have surgery and anesthesia!  We require a clearance letter from them most of the time prior to scheduling surgery.
• You will have bruising.  It may take up to 3 weeks for complete resolution but after 10 days you can cover the areas with water-based make-up.  YOU WILL HAVE SWELLING.  THIS IS A NORMAL PART OF THE HEALING PROCESS.  70% of the swelling will be gone by one month and 90% will be gone by 3 months.  BE PATIENT and feel free to ask questions.  You will have 'lumps & bumps' and irregularities and slight asymmetries.  These will even out with time as the swelling resolves.  IT IS ALSO NORMAL to get depressed or anxious before and especially after your surgery.  Understanding this will help you get through it.  Sometimes an anti-depressant or Valium prescribed by your family physician can help you get through this period.  Do not feel ashamed or frustrated.  Everyone goes through this to different degrees.  The end results are what counts.

• For Resurfacing patients (Laser, Chemical peel, Dermabrasion...):  Clean the areas 4 - 6 times a day with tap-water soaked cotton balls.  Pad dry, then cover with a THICK layer of Aquaphor ointment.  Also get in the shower and let plain water clean your face another 2 times a day.  Do not use soap or products on your face.  Do not let your face dry or scab.  Call if you have excess pain, or individual ulcers or pustules on your face as this may be a herpes outbreak.  Take your antibiotic and antiviral medicines as prescribed.  Stay out of the sun completely. For the next 3 months you must use sun-block and a rimmed hat.  Most of the time you will be using a bleaching cream skin preparation for 4 weeks prior to your procedure.  Stop this the day before your procedure and do not restart unless instructed by your physician.  Stop Retin-A products 1 week prior to the procedure.  Start your Anti-viral medication 48 hours prior to the procedure and continue for the full week. 
• For Eyelid Surgery patients:  You may have swelling, blurry vision, excess tearing or dry eyes for several weeks.  Pain, burning, or scratchy eyes may be a sign of inadequate lubrication and require immediate attention.  LUBRICATE, LUBRICATE, LUBRICATE using the antibiotic eye ointment prescribed for the first week then then Artificial Tears and Lacrilube there after.  Use cool compresses as described above.  Clean your incisions as described above 4 times per day but apply antibiotic EYE OINTMENT instead of regular antibiotic ointment.  Also place the prescribed eye ointment & eye drops inside your eye WITHOUT pulling down on the lower eyelid.  DO NOT use contacts, false lashes, or makeup until instructed by your doctor.  Call immediately if you have excessive pain or sudden swelling or change in vision. 
• For Nose Surgery: Do not get your splint wet!  The splint must stay on for one full week. You will have some bloody discharge from your nose for several days.  This is normal.  Do not wipe your nose.  Change the small gauze dressing under your nose as needed.   DO NOT BLOW your nose or SNIFF forcefully for 2 weeks. (You will have swelling inside your nose as well as outside, which will make breathing out of your nose difficult).  Clean the inside of your nostrils with hydrogen peroxide soaked Q-tips and apply antibiotic ointment at least 4 times a day. (Place the entire cotton tip gently inside your nose but no deeper!  This correlates to about 1/4 inches inside the nose).  Purchase "Nasal Saline Spray" and start gently sniffing every 2-3 hours 5 days after your surgery to soften up the dry blood and crusts inside your nose. Keep a stiff upper lip.  Avoid excess smiling for one week.   Brush your teeth with a baby toothbrush.  Take frequent sips of water through a straw to avoid your throat drying out due to the constant mouth-breathing.  Use Vaseline on your lips to avoid chapping.  If you have to sneeze, do it with your mouth open.   Do not wear glasses on your nose for 4 weeks.  If you develop a brisk nose bleed, sit in a recliner....take a pain pill....put cool compress cloths across your face and eyes and hold pressure on each side of the base of your nostrils for 10 minutes.  You may use 2-3 sprays of Afrin or Neosynephrine in your nose and repeat in 10 minutes if necessary.  Call if the bleeding is excessive or concerning.  Go to the nearest E.R. when in doubt.  If your surgery was done “open” you will usually be seen 3-5 days after your surgery to get sutures removed.  If the surgery was “closed” then the small nose cast will be removed a week after surgery since there are no outside sutures to be removed.  You will always be seen the day following your surgery as well.  Routine follow-ups are at 1, 3, 6 and 12 months after surgery. 
• For Facelift & Neck lift patients: Empty the drain bulbs as shown by recovery room nurses.  You will have a dressing with drains for the first night.  These will be removed on your one-day follow-up appointment.  You will be instructed to wear a chin-strap for an additional 48 hours.  Watch for 'goose egg' shaped areas of swelling as these may be fluid collection.  Clean your incisions around the ears and apply ointment as described above 4 times per day without pulling on the ear.  Get in the shower at least once a day starting 2 days after your surgery and wash your hair with baby shampoo.  Make sure you also do this prior to your one-week appointment to help make your suture removal more comfortable. Wear shirts that button down the front to prevent tearing your earlobes.  DO NOT rub your face or neck, or turn your head from side to side to allow the lifted skin to adhere to the underlying muscle.  Turn your head, neck and shoulders as one unit.  For men: DO NOT SHAVE for 3 days before and 10 days after your surgery. You may not drive for at least one week. Call immediately if there is excess pain or swelling as this may be a sign of fluid or blood collection under the skin.  Five to 8% of all patients will get fluid collections that need to be evacuated. YOU MUST NOT SMOKE or use Nicotine for 3 weeks before and 3 weeks after surgery!  Large parts of your skin will likely die if you smoke, as Nicotine compromises blood flow to the skin!!! This is not something to be taken lightly!
• For Otoplasty Surgery patients:  You will wear an elastic post-op Velcro strap around your ears for one week after surgery.  Purchase a sport type elastic head-band.  You will wear this for 3 additional weeks at bedtime to avoid inadvertent trauma to the ears. Clean the incisions and apply ointment 4x/day without pulling on the ear.  Take your antibiotics as instructed. 
• For cheek and chin implant patients (and Mid-face lift):  Rinse the inside of your mouth gently with half strength hydrogen peroxide 3-4 times a day and after meals.  This is to keep the sutures clean.  Take your antibiotics as there is always a slight chance of infection with implants.  DO NOT manipulate your face or sleep on your face for 3 weeks to prevent shifting of the implant.
• For brow/forehead lift patients:  Wash your hair gently with baby shampoo.  Avoid rubbing or massaging your scalp aggressively during your shower to allow the scalp to adhere back down.  You will have numbness of your scalp followed by some tingling and itching for several months.  Your hair may go through a "shock phase" and thin out initially.  These are all normal and will resolve with time.  Do not use hair products other than mild baby shampoo. 
• For Fat Injection patients:  Wash your face 3 times a day gently with mild soap like Ivory Soap.  Keep some antibiotic ointment on the very tiny incisions 3-4 times a day.  Wear your elastic or Ace wrap around the fat-harvest site as instructed for the week after surgery to prevent fluid collection. 
• For Scar Revision & Mole or Skin Cancer patients:  Keep your incisions clean and scab and crust free.  Dr. Naderi may ask you to clean the area with a mild soap and water rinse then cover with Antibiotic ointment 3-4 times a day.  Alternatively, he may have taped the area with Steri-strips or brown Micropore tape.  In such cases, take the tape off 48 hours after surgery and daily thereafter, wash, dry and re-tape in the same manner as before.  Continue this for 3 weeks after surgery.  Call with questions or signs of irritation or allergic reaction.  Your sutures (if any) will often be removed 3-7 days after surgery. 
• For neck liposuction & Submentoplasty patients:  Your dressing will be removed the day after surgery and you will be given an elastic Velcro strap to wear at all times for the week after surgery.  Avoid excess head or neck movement.  Call if you see any swelling under your chin as this may represent fluid collection.  Slight little lumps and bumps are normal for a few weeks.  These will resolve over time. 
• For Lip Implant patients:  Clean your incisions with half strength peroxide and use antibiotic ointment on the area 3-4 times a day.  Avoid excess mouth or lip movement for 3 weeks.  Use a small tooth brush to brush your teeth.  Take your antibiotics.  Start the antibiotics 48 hours before surgery. 
• Call 703-481-0002 with questions or comments.
• Call 911 or go to the nearest Emergency Room if you cannot reach your doctor. 
• Visit our main website www.VirginiaFacialPlasticSurgery.com for additional information.
• Good luck and enjoy your experience.  It is an elective luxury and you should enjoy it.  We are here every step of the way to make this as easy as possible for you.

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IMMEDIATE POST-RHINOPLASTY INSTRUCTIONS (After Surgery)

·         This is a summary of the more comprehensive instructions that were given to you by our staff.  Those are also available above or online at www.NaderiCenter.com 

·         These are your instructions for tonight and this week:

o    Keep your head elevated by sleeping on a recliner, or in bed with 3 pillows under your shoulders

o    Do not get your nose cast/splint wet for the next 7 days

§  You can take a shower from neck down but don’t get your face wet.  Use a wash cloth to clean your face.

§  However, on the day of your cast/splint removal, do get the cast and your face wet in order to help soften up the adhesive.  Stand in the shower for 5 minutes with your face under water but do not remove the splint / cast yourself.

o    Take your antibiotics when you get home

o    Drink plenty of fluids

§  You may use a straw.  That is fine. 

o    You can eat what you want but avoid hard foods and cut the food into small bites

§  Ensure or Boost Protein drinks are a good source of calories

o    Use a small fork, spoon and tooth brush

o    Do not wipe your nose

o    Do not blow or sniff

o    Breathe from your mouth.

§  Put Vaseline on your lips so they don’t dry or get chapped.

o    Do not raise your heart rate or blood pressure.  Relax. 

o    You may sit up and go for gentle walks with assistance.  Do not lie down too much.

o    If you have to sneeze or cough, do it with your mouth open to release the pressure.

o    Take only the pain medicine you were given or Tylenol (if you have no liver disease).

o    Ibuprofen, Motrin, Aspirin, Aleve and other NSAIDs are not to be taken after surgery.

o    Apply cold compresses to your eyes, forehead and cheeks but avoid your nose and the cast/splint so the cast won’t get wet.

§  Apply as much cold compress as possible the first 48 hours after surgery even if you don’t see any swelling or bruising!

o    Take your Arnica to help reduce bruising / swelling

o    Avoid the list of foods, herbal supplements, vitamins, and energy drinks that were discussed pre-op to prevent bleeding.

§  Vitamin C and a regular multi vitamin with no herbal additives is OK

o    Nausea can occur.  It’s OK.  Take the anti nausea medication given to you if needed.  Vomiting up a little blood once or twice is not rare. 

o    You do not need to start cleaning your nose with q-tips till after you see Dr. Naderi the next day

o    Do not take the tape off of your nose and do not trim it.

o    You will have some bloody drainage from your nose the first night.  Change the gauze drip pad every 20-30 minutes as needed under your nose.  Do not wipe your nose.  Do not blow or sniff your nose.  Do not move your nose!

o    Excess bleeding (such as a faucet opening up…) is not normal.  Call the office and go to the nearest Emergency room if it does not stop in 15 minutes.

o    Call 703-481-0002 with any other serious questions.  You will be seen tomorrow and other instructions will be given.

 
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