What are some post op complications I should be aware of?

Fever

Fever is a vague symptom that can be normal and even expected after surgery; up to 90% of surgical patients have a low grade fever due to the body’s inflammatory response to injury. However, it can also be a sign of something more serious, such as atelectasis (collapse of small air sacs in the lung), urinary tract infection (especially if you had a foley catheter placed for surgery), wound infection, or blood clots.

A slight fever in the first two days after surgery is most likely nothing to be concerned about. However, if you develop other symptoms or if your fever worsens or persists, contact your doctor. The best way to deal with post-op fever is by preventing the more serious causes, as described in the following.

Atelectasis (collapse of air sacs in the lung)

Atelectasis can stem from the effects of anesthesia as well as a decrease in physical activity and shallow breathing after surgery. It can lead to pneumonia and other more serious respiratory complications. Depending on your procedure, coughing and deep breathing exercises may cause discomfort, but they play an important role in your recovery. Splinting (holding a pillow firmly against your incision) and adequate pain control can help make deep breathing less painful, especially if your surgery involved your chest or upper body.

You may also be sent home with an incentive spirometer. This is a device you’ll use to help expand your lungs thoroughly and gives a give visual representation of your breathing. Not everyone will need an incentive spirometer but everyone should practice some form of deep breathing and coughing to prevent atelectasis during recovery.

Urinary Retention or UTI

Blood Clots

Blood clots can form in the larger veins, commonly in the arms or legs; they can also break loose and travel, making them potentially life threatening. However, proper surveillance and preventive techniques can help reduce the risk. We screen every patient with a deep vein thrombosis (DVT) risk assessment tool and certain patients are required to have a pre-op ultrasound of their legs to check for existing blood clots.

There are also a number of techniques surgeons can use to help reduce the risk of clot formation, including “blood thinners” – anti-thrombotic medications given to help keep blood from clotting; the use of compression or ted hose during and after surgery; and the use of sequential compression devices that massage the calves to keep the blood from pooling.

While recent data call into question these risk reducing techniques for DVTs, the easiest and cheapest form of prevention during recovery is early ambulation. Ambulation, or walking, has several benefits besides blood clot prevention; it also helps promote deep breathing and helps with gas, bloating, and constipation. We want our patients up and walking by the evening of their surgery day, but always follow your surgeon’s instructions for activity limitations.

Written by Jennifer “Coop” Cooper MS, APRN, AGACNP-BC, Sergeant, US Army (veteran)

Click here for the original blog post written by Jennifer Cooper MS, APRN for BuildMyHealth.

The post Preventing Post Op Complications first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

A few things I wish I knew before surgery

Post-op constipation is real.

The combination of narcotic pain medications, decreased activity, and poor dietary intake can lead to some serious constipation, so drink all the water, eat all the fiber, and walk, walk, walk. Unless you have other medical issues, you’ll need 2-3 liters of water (sorry, your coffee doesn’t count), and 20-30 grams of fiber every day. For reference, a serving of bran cereal has about 5.5 grams; fiber supplements like Metamucil can help you meet your goal and are actually pretty tasty these days.

As for walking, we like our patients up and walking the same evening of surgery (but always defer to your doctor’s instructions). Walking not only staves off constipation, it’ll also help prevent potentially fatal blood clots, so win-win.

What you eat, drink, and do can affect wound healing.

We already discussed the copious amounts of water and fiber you’ll be consuming, but there are other nutrients you’ll need to be aware of to help maximize your recovery. Low fat protein, zinc, calcium, and vitamins C & D are important factors in wound healing. And while it’s always better to get your nutrients from whole food sources, supplements may be beneficial to some people. Try a calorie tracking app on your phone to see how your nutritional intake stacks up.

On the flip side, there are a few things you should avoid, as they are known to delay or complicate wound healing. Nicotine is the biggest “NO” out there, but you should also monitor your intake of caffeine (like that coffee we talked about), alcohol, and excessive salt and sugar. A balanced diet of fresh fruits, veggies, and lean protein is almost always best.

What about lymphatic massage? We get asked this a lot. Lymphatic massage purportedly helps relieve pain and swelling, break up scar tissue, and improve blood flow to the area, thus promoting healing. There isn’t much data available to back up these claims, but some people swear by it (while others find it painful). We tell our patients they are welcome to try it if they’re interested, but we can’t promise any specific results from it.

Post-procedure depression can happen.

A lot goes into your emotional wellbeing after surgery, such as a personal history of depression/anxiety, reaction to medications, concerns about recovery, feelings of guilt for depending on others, or financial stress. For some people, these negative emotions can linger to become post-op depression. If you can’t shake the negativity or if you’re having excessive fatigue, changes in appetite or sleep, increased irritability, or any other symptom of depression, it’s important to get the help you need. Talk to your doctor if you have concerns about post-operative depression.

Good help will be invaluable and meal prep is a life saver.

In the days leading up to your surgery, go over your needs and expectations during recovery with your primary caregiver. Will you need dressings or other supplies? Get them now. Depending on the surgery, you might want to have gauze, medical tape (look for soft fabric or paper tape, not plastic), and maybe some “chux”/puppy pee pads  – those absorbent pads you can put down to catch drainage, etc. Have some gloves available if you need help with dressing changes. Check with your doctor to see what you might need. Don’t forget your personal hygiene needs during this time as well. You might want to pick up some dry shampoo, baby wipes, or body powder if full showers are limited. A bidet attachment on your toilet might be worth the investment – they’re under $50 and easy to install. Do you have periods? Stock up on your supplies and discuss any assistance you’ll need with your caregiver.

Also use this time to meal prep – whip up some big pans of lasagna or casserole to freeze for later. Stock up on easy to eat, nutritious foods like whole grain toast with peanut butter, soups, and produce. If you know you’re prone to nausea, crackers and ginger ale are good to have on hand. Fresh out of anesthesia, the B.R.A.T. (bananas, rice, applesauce, and toast) diet is nutritious and easy to digest.

One last consideration is maneuverability in your home. If you’re going to need assistance – whether it’s another person or it’s equipment like a walker or crutches – you’ll probably need to make space. Take some time to move trip hazards like area rugs or power cords and consider if you’ll need things like grab bars in your shower or near your toilet.

Written by Jennifer “Coop” Cooper MS, APRN, AGACNP-BC, Sergeant, US Army (veteran)

Click here for the original blog post written by Jennifer Cooper MS, APRN for BuildMyHealth.

The post Postop Recovery Tips first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

During plastic surgery, one of the biggest concerns patients and their surgeon’s have is the potential for the development of blood clots in the patient’s legs. These are referred to as a DVT or Deep Vein Thrombosis. The pathophysiology, or the reason these clots develop, has to do with three possible factors. 1) Stasis, or lack of movement of blood in the legs during surgery, 2) Hypercoagulability, increased clotting in the blood which could be due to genetic disorders, or 3) Injury to the blood vessels themselves.

Under normal circumstances, when a patient is not under anesthesia, their calf muscles act as a pump to keep blood moving. But during general anesthesia, the “calf pump” doesn’t function to the same degree. So blood pools in the deep veins of the leg, leading to an increased risk of the blood developing into a blood clot. By itself, the development of the clot isn’t deadly. But that clot could subsequently travel to the heart and lungs in what’s referred to as a pulmonary embolism. A “small” pulmonary embolism (ie a small clot traveling to the heart/lungs), could lead to mild shortness of breath that passes with time. On the other end of the spectrum, a pulmonary embolism consisting of a large clot could lead to sudden death. This is why DVT’s and pulmonary embolisms are of such great concern for the surgeon and their patient.

How do you reduce DVT’s in surgery?

This is a controversial question. For almost two decades, one option was to give patients chemoprophylaxis, or medications like blood thinners, to reduce the risk of forming a DVT in the leg. However, these medications are not without risks. In an amazing book chapter on the subject by Dr. Eric Swanson, he explains why blood thinners aren’t the answer. The annual risk of an adult having a DVT is 0.1-0.3%. But the risk of having a major bleeding complication (hematoma) from a blood thinner is 3% annually. So the risk of having a hematoma is higher than the risk of having a DVT.

You might think, well if it reduces my risk of a DVT to any extent during surgery, maybe it’s worth the risk? Despite conventional wisdom, there’s very little evidence that these blood thinners actually reduce the risk of DVT during surgery. So do you just accept the risk of a DVT by avoiding blood thinners because you don’t want a hematoma?

The alternative to blood thinners

Luckily there are alternative methods to reduce your risk of a DVT and ultimately, pulmonary embolisms. Dr. Swanson describes SAFE anesthesia. This is an acronym for Spontaneous breathing, Avoid inhalation gases, Face up and Extremities mobile.

Spontaneous breathing – avoidance of paralyzing the patient during surgery with medications called paralytics. If paralyzed during surgery, the patient is dependent on the ventilator to breathe. Paralyzing a patient for general anesthesia can also reduce blood pressure. If the anesthesiologist avoids paralytics, then the patient can spontaneously breathe on their own, blood pressure doesn’t drop and the calf muscle pump continues to work, thereby reducing stasis and DVT formation.

Avoid inhalation gases – think stronger versions of laughing gas. By using propofol (yes, the Michael Jackson drug) instead of gas to keep the patient asleep, the risk of DVT is lower.

Face up when possible, meaning keeping the patient on their back with their face up. This is obviously difficult in situations where the surgeon needs to operate on the patients back wherein they’re laying face down. But switching the patient from side to side, to always avoid being face down is one option.

Extremities mobile. Moving the limbs at some point during surgery, either by turning the patient, or repeated checking of limb position, can reduce stasis and DVT’s forming.

Checking for DVT’s preoperatively

Many offices, including ours, utilizes Doppler ultrasound surveillance to determine if someone has a deep venous thromboses before surgery. By knowing the patient doesn’t have a DVT ahead of time, they’re that much safer going into surgery.

What about those squeezers?!

SCDs (sequential compression devices) are the “squeezers” doctors use to reduce DVT formation in the legs. Some patients even rent or purchase these machines after surgery for home use. All in an effort to reduce the formation of a DVT and thereby a pulmonary embolus.

In truth, there is no evidence that sequential compression devices affect the frequency of deep venous thromboses in plastic surgery patients.

It may not be profound, and certainly not technically advanced, but the best way to avoid DVTs after surgery is to get up and walk around. In our office, we recommend showering hours after the procedure to force the patient to get up out of bed and take a walk to the bathroom.

Concerned about too much activity? Our mantra is, “If it hurts, stop doing it. If it doesn’t hurt, you can do it!” Listen to your body so you don’t overdo it. Don’t push through the pain. But stay out of bed as much as possible and get back to regular activity. The muscles in the calves were designed to reduce the risk of blood clots. So let them do their job but getting up and walking around rather than depending on devices like SCDs that are not proven to work.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Avoiding blood clots in the legs during and after surgery first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Dr. Bae:
Hey, Greg.

Greg:
What’s going on?

Dr. Bae:
Things are good. We are seeing patients regularly, busy. Everybody’s like kind of getting their COVID face on. They’re ready to get back out into the world, getting recovered so they can enjoy the summer.

Medical Tourism

Greg:
That’s true, absolutely. People are getting out and about and people want to look better. And that’s one reason to go see Dr. Bae. I have a friend and she just did one of your favorite procedures or one of your expertise procedures, the mommy makeover. But when she told me she was doing it, I was a little concerned because she went to a foreign country, medical tourism. I won’t say where. But she went to another country. It was a whole process when she was explaining it to me. She’s going to be down there for a couple of weeks and they’re moving her to another facility after. I mean, I’m concerned and I just wanted to talk to you about… Yeah, it’s cheaper, right? It’s cheaper maybe to go to another country. But what are the risks and how do you figure out? How to get a good person if you’re going to do that? And can somebody talk to you before they make a bad decision?

Don’t just focus on cost

Dr. Bae:
Absolutely. Unfortunately, people are really just focused on the cost. And of course, cost is a big part of everything, I know. We provide pricing on our website, so people can check pricing before they come in for a consultation. But you don’t want to boil everything down to cost. It’s like the ultimate decision. But you have to keep in mind that, yes, you’re going to save some money if you go to another country. And I’m not going to make a blanket statement that all surgeons in other countries are bad surgeons. But the thing that you have to realize is whether it’s a good surgeon or a bad surgeon, whether it’s in this country or out of this country, there’s always the risk of complications. And just because its cosmetic surgery doesn’t mean it’s not real surgery.

Dr. Bae:
So if you come to me and unfortunately you might have a complication like the wound doesn’t heal right, or the breast implant gets infect, or something like that, at least I’m here locally to take care of you and it won’t cost you anything else for me to take care of that complication or at least I’ll do everything I can to make sure it doesn’t cost you anything. Whereas if you get that procedure done in another country and then you come back home and then you start looking around for a doctor to help you when you’re having this complication, they’re going to charge you. That’s not your… They’re not your original doctor. You’re not their original patient. That’s what they do. They have to charge you to provide those services and it’s going to get really expensive. So whatever money you may have saved by going out of the country, you’re going to spend twice that treating a complication because you’re working with the doctor that’s not your original doctor.

Hope for the best, prepare for the worst

Dr. Bae:
So, I get it that you want to save some money. But for the peace of mind, and just put it out of your mind first of all that you might not get a complication, that certainly you have to go into it kind of preparing for the worst. I mean, that’s just kind of a good way to look at it because hopefully everything will be great. And yeah, so if you have a problem, you’re going to want to have your doctor there locally because you’re probably not going to be able to go back across the country even if it’s in the United States or go outside of the country to get that complication treated.

Greg:
Well. And of course, whatever decision anybody makes, it’s always so smart to do your research. But do realize if you go out of the country and you have a health problem and you’re having it there, it’s going to be difficult because you’re not at home with your insurance and stuff. And then again, it’s going to be hard if you have an issue with that doctor and you’re back here, what can you really do about it there?

Dr. Bae:
Another interesting thing is a lot of people will tell me like, oh, but when you go to another country, because it’s less expensive, you get more for your money. You get the operation that you’re going to get here. And you can then stay there and recover for two to three weeks or a month even. [crosstalk 00:03:49] hotel.

Greg:
Which is what my friend is doing. Yeah. She stayed in a hotel for two weeks.

Benefits of getting home as soon as possible

Dr. Bae:
And so you’re thinking, oh, that’s great. I get so much for my money. But the thing is, after you do your operation with us here in office operating room, you go home. And that’s, I don’t think there’s any better place to recover than at home. And if you’re staying at these hotels or these post recovery centers for an extended period of time, other patients are staying there also. So just like, there’s a risk of getting an infection from somebody else at a hospital, there’s a risk of getting infection in these long-term facilities and other places in other countries. So, it’s not so great that you have a place to stay for a long period of time. It actually increases your risk of infection potentially. So, that would be my opinion is get home as quickly as possible. And if you want a home health nurse to help you out, sure, no problem.

Dr. Bae:
But most of the things you’re going to be dealing with after your surgery, you don’t really need a nurse. You just need a family member that’s there available to help you. You don’t really need somebody that’s got additional degrees. Because even if you get a home health nurse, they maybe mostly a cardiology nurse. They’re not necessarily a post-op cosmetic surgery recovery nurse. And that’s a big difference. Just like, you don’t come to me for your diabetes management, you don’t go to a internal medicine doctor for plastic surgery. So, same thing. Nurses are sort of specialized as well. So, they might not necessarily be perfectly suited to take care of you in your recovery. So, get home as soon as possible after your surgery. Try to avoid being around other people or other institutions where you could get additional infections. And so, that would be my argument why you should stay in the country.

How to get more information from Dr. Bae

Greg:
Well, whatever you decide, just make sure you do your research. Take your time. Don’t rush into anything. And if you have questions you want to reach out, you want to ask anything, you can always go to Dr. Bae social media. Ask him anything. And it is?

Dr. Bae:
@realdrbae, R-E-A-L-D-R-B-A-E, not B-A-Y, and realdrbae.com. You can always reach me there through website, social media. I’m always available to answer questions through direct messages.

Greg:
I’m going to test you now. I’m going to send you a message. See how long it takes you to answer me.

Dr. Bae:
Hopefully not asking me what’s the capital of North Dakota or something.

Greg:
You could look that up. All right. We’ll see you next time, Dr. Bae.

Dr. Bae:
Thank you so much, Greg.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Beware of Medical Tourism [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Dr. Bae:
All is well. Thanks for having me, Greg.

Botched

Greg:
My camera’s sliding over here. I’ve got to be careful. I’m banging too much over here. Hey, Dr. Bae, I had a question for you. I’m sure you’ve seen some of this, but I know people are obsessed with that show, reality show, Botched, on E!, right?

But some people really do have an issue. Maybe they have bad plastic surgery. Maybe they had an accident when they were younger in life. Maybe there’s just something on their body that they look at, it just doesn’t look right.

Do you see these kinds of patients often? And I don’t know, I feel like some of them are embarrassed maybe to go talk to anybody about it, and how do you make people feel comfortable going to talk about these issues in your office?

Botched or postop complication?

Dr. Bae:
No, it’s a tough thing because when we’re talking about botched, we’re really talking about just a problem result, or it wasn’t a great result. It doesn’t necessarily mean that anybody did anything malicious, or it was an unqualified person doing it [crosstalk 00:01:10].

Greg:
Or it’s been overdone. Some people get something done five times. It’s like, “Enough already.”

Dr. Bae:
Exactly. There’s lots of different factors. Done too many times, overdone, didn’t stop when they should have, qualified person, unqualified person, or just something didn’t heal the way you wanted when nothing necessarily was done wrong. It’s… people just have to have an open mind that the body heals the way the body wants to heal. And yes, maybe somebody with a little more experience will be able to kind of push the healing in the right direction, but things happen.

It happens to me. It happens to any doctor, even the doctors on the show that talk about botched and look at other botched cases, they’ve had botched cases before themselves. Again, just cases that didn’t come out the way you wanted, but Botched is just a funner word that people like to use, but it really is just a case that didn’t turn out the way you wanted.

Reasonable Expectations

But we have patients who come in who’ve had surgery somewhere else, and that things didn’t heal the way they wanted, and they come in to see me. And so you really just have to start with what’s possible because the truth is the best chance you have of getting something right is the first time you operate on somebody because after that, scar tissue sets in, and so you don’t know how that’s going to respond if you go back in again and introduce more scar tissue because, obviously, you’re building up scar tissue every time.

So when people talk about, “I don’t like the way my scar looks. Can you fix the scar?” Well, they have to understand that to fix the scar as you’re cutting out that scar, replacing it with a new scar and hopefully, maybe this scar will stay thinner this time. Maybe it won’t spread, and you can’t really predict what’s going to happen to everybody for the first operation or even subsequent operations.

So yes, it is. These are tough cases. I do see them. I’m sure somebody else has seen a patient of mine that maybe that patient wasn’t as happy with the result as they wanted to be, and I may not have been as happy as I wanted to be, but you just got to talk to the patient about reasonable expectations of what’s possible. And you kind of hold their hand throughout the whole process and hope to get them where they need to be at the end of the day. And it may take multiple procedures to get them back to that point. And you may eventually be able to hit a home run, and they’re thrilled, or they’ll-

Greg:
And sometimes, you talk about managing expectations and stuff like that. You have to sort of get your mind right. You can’t… it’s like anything else. You have to get your mind right. I’m sure you talk to patients all the time and try to talk them through these things before you just boom, do the surgery.

Dr. Bae:
… right. That’s actually one of the hardest things is I’m here talking about having reasonable expectations, and I’m trying to get a sense from them whether they have reasonable expectations, but I don’t, at the end of the day, know really what’s in their minds’ eye.

I mean, they may say… I might say, “Hey, you may have a little bit of droop after this procedure because there was so much excess skin, and there’s a fear of injury to the nipple if we do too much of a lift.” And so they’re like, “Well, no, I’m all right with those scars. I’m all right with a little bit of droop.” But then after the operation, “Well, that’s too much droop, or are those too many scars?”

And even though we might’ve talked about all of these things explicitly, at the end of the day, you don’t really know what the patient’s thinking, and the patient maybe can’t read my mind either. So it’s a very tricky situation, and the only thing I can say is communication before, during, and after the operation is key.

That’s why I give patients my phone number. I call them the night after the operation, give them my phone number so that instead of them going online and reading things that may or may not be true that I wish they would just call me, text me, send me a photo, so we can hopefully nip any confusion or miscommunication in the bud.

Greg:
And I appreciate your honesty. I’ve been to your office several times, and I’ve asked you to make me look like Michael B. Jordan or Zac Efron. And I bring in the picture, and you’re just like, “Sorry, it’s just not possible,” and I go off again, then I come back with another photo. So I’ll just keep trying. We’ll see. But I would love to [crosstalk 00:04:54] with that perfect body.

Dr. Bae:
You come in wanting to look like Kate Middleton with the nose, and I’d tell you we can’t do that either.

Greg:
Well, I’d like you to stretch me. I’d like… I’d kill to be 5’11” or 6 foot.

Dr. Bae:
There are-
Greg:
That’s not possible, is that?

Dr. Bae:
… there are surgeons in the… I don’t know about the US, necessarily. I guess there’s surgeons everywhere, but I know for sure in Europe, there are doctors that do limb lengthening procedures, and they tend to lengthen the femur which is… I’ve seen these results, and maybe they’re getting better techniques now, but I’ve definitely seen patients who come in, and they want me to fix the scars associated with the pins that were going into their femur to lengthen their femur, so I know that this exists.

Greg:
[crosstalk 00:05:31].

Dr. Bae:
But the funny thing about it is that they lengthen their femur, and it’s all disproportionate. They got these shorter legs below their knee, and then they got these tall femurs and yes, it’s given them height, but you can kind of-

Greg:
It’s bizarre looking.

Dr. Bae:
… it’s bizarre… it’s reverse stilts. It’s very odd.

Greg:
All right. I’m going to skip that one, though. I’m fine.

Dr. Bae:
[crosstalk 00:05:48].

Greg:
I’ll just stay where I am. Dr. Bae, where does everybody find you?

Dr. Bae:
They can find me right on my website, www.realdrbae.com. Thanks so much for watching us.

Greg:
All right, thanks.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Botched, smotched with Greg and Dr. Bae [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

We had a recent postoperative patient compliment us on our blog and how informative it is. However, she pointed out that one thing she couldn’t find was a blog post on what to expect after surgery. So here goes!

What you should expect from yourself and your surgeon after surgery

This listicle should serve as a general outline of expectations after surgery. These include things you shouldn’t be surprised about also what you should expect from your surgeon.

1. You may have drainage from your incisions regardless of the type of surgery. That’s normal.
2. You may have redness immediately around your drain or incision but that often represents inflammation not infection. If the redness spreads further, contact your doctor, which leads to the next expectation…
3.  You should have access to your doctor after surgery either via text, email or phone. It’s the 21st century! There’s no excuse for not being able to get in touch with your doctor after surgery.
4. Pain is normal so take pain medication as needed. But don’t set an alarm to wake up to take pain medication because if you’re sleeping, you’re not in pain.
5. Have some gauze available at home after surgery.
6. After a breast reduction, breast lift or tummy tuck, the incision may have some pleating. That’s normal and will flatten out with time.
7. If you have a breast augmentation, it’s normal for the implants to sit high initially but don’t worry, they will drop.
8. Drains need to be “stripped” or “milked” to avoid clotting.
9. It’s critically important to walk around after surgery to avoid blood clots in the legs.
10. Ask your doctor, but showering is recommended in our office to keep incisions clean.

Again, see what your doctor recommends but if they don’t provide you with a way to contact them postoperatively, seek out another doctor!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post What you should expect from yourself and your surgeon after surgery first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Red flags are something a potential patient does (or doesn’t do) that can portend future problems. After 12 years of practice, I’m getting better at noticing these red flags but there’s always room for a heightened sense of awareness. Check out our “listicle” below for a few of these red flags. In case you’ve never seen the word before, a listicle is an article whose content is a list.

Red flags

1. Credit card not present to pay for services, ie tries to pay with a photo of a credit card
2. Is rude to the front office staff and nurse, but nice to the doctor
3. Everything is a production from paying the consult fee to filling out the standard patient paperwork
4. Complains about other doctors
5. Thinks of Yelp as a weapon
6. Asks a question but doesn’t listen to the answer
7. Doesn’t accept your opinion because of something they read online
8. Their wish pics are totally detached from reality
9. “This is my 8th consultation” (2 or 3 are reasonable)
10. They send a follow up email with tons of questions that were already answered in the consultation

If you think of others, please add them to the comments section below.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Listicle: The red flags we look for in our patients first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

How to take care of postop wounds

With the separation of skin, a deeper wound becomes visible. Even though the skin separates, the wound isn’t necessarily infected. Maybe inflamed, but not infected. Patients often think the doctor can simply stitch the skin back together. But that that doesn’t allow the underlying wound to heal. If the doctor stitches the overlying skin back together, the wound will fill with fluid and then the wound can become infected.

So better to let the wound heal from the inside out so the skin closes last. While closing, any fluid that collects will be able to drain and again, avoid fluid collection and infection. To assist this process of closing from the inside out, our office employs the time tested, relatively inexpensive, wet to dry dressing change. As the video below demonstrates, a wet to dry dressing change, when done properly, allows the wound to heal, leaving no evidence behind. Even better, it doesn’t require an expensive trip to a “wound clinic.”

The Wet to Dry Dressing Change for Postop Wounds

Have any questions? Post them below.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Just like $h!t happens, postop wounds happen! [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

This recent article makes an incredibly interesting argument. That cosmetic surgery can lead patients to quit smoking! It’s not as far-fetched as you may think. It’s starts with the notion that smoking affects small blood vessels in healing skin.

Cosmetic surgery to quit smoking?

If you’re a smoker, you know surgeons always say to avoid all nicotine products. The nicotine in cigarettes or dip or nicotine patches/gum can cause small blood vessels to constrict. Those small blood vessels are critical to tissues healing after some type of damage, including an incision from surgery. It can also affect the skin after some type of skin resurfacing like a laser or chemical peel.

Doctors tell patients to quit smoking for two weeks prior to surgery so the affects of nicotine can wear off in active smokers. What happened in the study?

“In the follow-up, about 40 percent of those patients said they no longer smoked on a daily basis, and nearly 25 percent had not smoked at all since their surgery. Also worth noting: Most people said they had reduced their smoking habit by some amount, and 70 percent said that discussing their increased surgical risks with the plastic surgeon positively affected their ability to quit or reduce smoking.”

And all those warnings from doctors about the risk of postop complications from smoking?

‘The complication rate was higher in those [smoking] patients — 24 percent of them had post-surgical issues, as opposed to 14 percent of patients who stopped smoking. Serious wound-healing complications also occurred in two people, both of whom kept smoking before their procedure.”

Moral of the story, listen to your doctor when it comes to smoking and get cosmetic surgery to quit smoking! Just kidding on the last one…no I’m not…of course I am. But seriously, patients are more likely to quit smoking when they understand specific risks associated with nicotine.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Get cosmetic surgery and quit smoking…maybe first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Important to remember these things after surgery

Regardless of what type of surgery you’re having, the incision will always have a little redness immediately adjacent to the incision. That doesn’t mean you have an infection. If the redness is spreading a large distance away from the incision, or there’s is thick white or green drainage, that’s a different story!

But if there is redness around the incision with light drainage, that may be a sign of inflammation, not infection. In that case, monitor it closely and contact your doctor if you continue to be concerned.

Also, with the prevalence of smartphones and cameras these days, take a quick photo and email or text your doctor, the area of concern. You don’t have an email address or cell number for your doctor? That’s a different problem and should be addressed before surgery! Good communication is key.

One question we get a lot after liposuction relates to firm noodles you may feel under the skin. During liposuction, most of the fat is sucked out of the body and into a canister. But in some cases, fat is pulled away from it’s blood supply but doesn’t get completely sucked out. Since that fat no longer has a blood supply, the fat will die. Dead fat turns into firm, calcified nodules. But don’t worry! It’s not permanent. The fat will eventually be reabsorbed by the body and the area will soften.

Bruising after surgery

No surprise here but you will have bruising after surgery. It’s completely normal but if it’s the first time you’re having surgery, you may worry that some bruising is too much bruising. It’s hard to know when it’s “too much” but there will be some. And it will turn from a purple to a yellowish color over time and will even track far away from the operative site. Totally normal in most cases.

High riding breast implants

While your doctor probably told you before your breast augmentation, you may forget. But your implants that seem really high after surgery, will drop…I promise! Give it about 3 months for implants to settle in their final position.

If you have other questions, contact your doctor.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Don’t freak out about these things after surgery first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

1. Avoid opioid overdose and addiction

The current opioid crisis has contributed to over $55 billion in health and social costs. Could marijuana use after surgery ironically be the answer to the opioid crisis in America?  When you consider the following facts, it’s not such an unreasonable conclusion. In this recent study, most consumers try opioids (Percocet, Vicodin, etc) for the first time after undergoing surgery. Of those, 6% continue using opioids for at least three months after surgery. So what if those patients were never offered opioids in the first place? What if they were given a pain prescription for marijuana instead?

There’s reason to believe the replacement of opioids with marijuana can reduce dependency on opioids. According to this study in JAMA Internal Medicine, “Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates.” The article goes on to say, “In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected…”

And it’s not just the risk of dependency that’s concerning. There’s also the risk of an accidental overdose. I prescribe Percocet for all of my postop patients. Usually there’s not a problem with dependency or overdose but an overdose occurred once, and once is enough. Instead of taking their Percocet “prn pain,” the patient took their pain medication around the clock. When combined with the fact that the patient was opioid naive, their respiratory rate dropped and had to go to the hospital. The patient recovered without any need for reversal medications like Narcan but obviously it was a scary, avoidable situation for the patient and family (and me).

In contrast to opioids, the risk of overdose with marijuana is impossible because according to the National Cancer Institute, “cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration.” In other words, my patient whose respirations slowed from Percocet would not have had the same experience with marijuana.

Additionally, opioid addiction can be evident in other ways. As I wrote in this post, opioid addicted patients can skewer their doctor with a negative Yelp review if they don’t receive the meds they demand. While this could also occur if a doctor doesn’t refill a patient’s marijuana prescription, that is less of a problem since recreational marijuana use is becoming more prevalent in several states (Oregon, Washington, California and Colorado to name a few).

2. Decrease pain and increase appetite

In addition to the benefit of avoiding an overdose, marijuana decreases pain and increases the appetite. Increasing appetite for chemotherapy patients is well documented but the importance of eating after any major operation can’t be overstated. Consuming foods high in protein contributes to wound healing. Marijuana clearly reduces pain, nausea and vomiting whereas opioids can actually increase nausea and vomiting.

For those of you worried about prescribing a medication that will make patients “high,” there’s an alternative that can avoid that stigma.

3. CBD vs THC

Cannabidiol, also known as CBD, is one of many active ingredients in marijuana. The more commonly known chemical compound is THC – tetrahydrocannabinol – the psychoactive ingredient in marijuana. As explained in this article here, CBD, in appropriate ratios can actually counteract the negative effects of THC. So by using a marijuana strain that is relatively higher in CBD than THC, the typical paranoia and euphoric effects of the marijuana high are less. At the same time, the beneficial effects of less pain, nausea and vomiting are still present.

4. Lack of nicotine avoids issues of wound healing associated with cigarettes and other tobacco products

As noted here, nicotine before or after surgery can constrict blood vessels and adversely affect wound healing. Marijuana on the other hand does not contain nicotine. Additionally, the risk of lung cancer seen with tobacco products doesn’t translate to marijuana either. According to this article,

“Marijuana use also was not associated with tobacco-related cancers or with cancer of the following sites: colorectal, lung, melanoma, prostate, breast, cervix. Among nonsmokers of tobacco cigarettes, ever having used marijuana was associated with increased risk of prostate cancer (RR = 3.1, CI = 1.0-9.5) and nearly significantly increased risk of cervical cancer (RR = 1.4, CI = 1.0-2.1).”

5. No constipation

With either short or prolonged use of opioids, patients complain of constipation. This is a vicious cycle. As patients take more opioids for pain, the resulting constipation can cause more pain and the cycle begins anew. That is not an issue with marijuana.

Conclusion

Granted, the use of marijuana to control pain postoperatively only pertains to the states where it is legal. In a situation where there is a process for obtaining marijuana, the stigma is less. Whereas, in states where medical marijuana is not approved, going to a drug dealer to fill your prescription is obviously a non-starter for most consumers. And exceedingly awkward for law-abiding citizens.

So, should you use medical marijuana postop instead of opioids? That’s a decision for you and your doctor. However, the point is that this is a legally viable option in many states and no longer on the fringes of society.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post 5 reasons to consider rolling a joint after surgery! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Don’t submerge in water

While every surgeon is different (and you should check with your surgeon before believing everything you read on the internet!), submerging your fresh breast aug incisions in water is not a good idea. If you’re bathing in a bath tub or hot tub, just think of all of the filth that collects in the water. All of those bacteria are then in contact with your brand new incisions.

While we don’t recommend submerging in water, we definitely recommend letting soap and water run over the incisions in the shower. This will keep the incisions so fresh and so clean. I know everyone thinks incisions should be kept dry and while there’s nothing wrong with dry, not showering or cleaning the incisions leaves behind sweaty, grimy skin. That can’t be good either.

Check with your doctor but we recommend waiting 6 weeks before submerging your incisions in water. That’s not an arbitrary number. That’s how long it takes for the collagen in your incisions to heal and mature.

The 6-week rule also goes for wearing underwire. While we understand you want to show of your new babies, please wait on the push up bra or underwire. The underwire could theoretically put undue pressure on the incisions so just wait. The implants will naturally ride high initially so you don’t even need the push up bra.

And do we really need to tell you not to use any tobacco products before or after your surgery?! The nicotine can affect the blood vessels bringing oxygen, white blood cells and fibroblasts to your new incisions. All of these blood borne cells help with the healing process. So if there’s nicotine on board, the blood vessels constrict and bring less of those helpful cells to the area, increasing the risk of infection.

If you want to know about smoking other things and whether it’s ok before surgery, you can read more here. Lastly, for a nice summary of what you should and should not do, watch this funny video produced by our office staff!

Postop Breast Recommendations

Bottom line: be a good, compliant patient!

To check pricing on breast augmentation from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Postop Breast Surgery Do’s and Don’ts [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.