Post-Op Care Guidelines Nip & Tuck Plastic Surgery

Presurgery

• Shower night before surgery with Hibclens (should have received from our nurse practitioner).
• Signed consent and given preop and postop instructions.
• Fill prescriptions for postop medications (pain, nausea, stool softener, muscle relaxant).
• Good night rest, nothing by mouth after midnight, unless otherwise instructed.
• Make sure you have been assigned a time to arrive at the surgery center.

What To Expect

• Swelling and bruising of breasts is normal and will gradually resolve over 2 – 4 weeks
• If you develop any redness, drainage, or intense pain, nausea, vomiting, difficulty breathing, please contact us immediately
• Implants may initially appear too high, but over time they will settle

Postsurgery

• WALK, GET OUT OF YOUR BED EARLY AND OFTEN (WITH ASSISTANCE) TO HELP PREVENT POSTOP PROBLEMS
• OK to shower 24 hours after surgery, wet incisions, do not scrub until instructed; blot all incisions dry; DO NOT BATHE, SUBMERGE CHEST WATER UNTIL CLEARED BY DR. JONES.
  • Eating after surgery
  • Start with clear liquids, as you may experience discomfort from anesthesia
• Advance slowly to a soft diet for first 3 days; Avoid spicy foods and sugar-free candy ( liquids > Jello > crackers > soup)
• Take pain medication as instructed
• NO SMOKING, smoking may cause wound healing problems
• DO NOT perform any strenuous activity or lifting for at least 3 weeks (including sex)
• 1st 2-3 days, limit arm movements and do not use arms to lift objects
• Resume driving when narcotics have been discontinued and turning the steering wheel can be done without pain
• Incisions
  • Avoid direct exposure to the sun as UV light can cause hyperpigmentation of scar
  • Start scar therapy to promote healing and use sunscreen as directed.

Breast Exercises

• Massage breast up and medially and hold for a few seconds then release; (Perform exercise 3-4 times daily (10 repetitions).

Remember, it is vital that you make your initial post-op appointments and be seen by Dr. Jones. He will see you at least once in the first two weeks, then at one month, 6 months and 1 year.

IF YOU HAVE ANY CONCERNS OR PROBLEMS, PLEASE CALL US IMMEDIATELY. IF IT IS URGENT OR AN EMERGENCY DIAL 911 OR REPORT TO YOUR NEAREST EMERGENCY ROOM.

If you are not sure, please contact us and schedule an appointment to be seen. There is no such thing as a bad question or concern. We want to make sure you receive the appropriate care; the worst decision is to wait!

Presurgery

• Shower night before surgery with Hibclens or soap
• Please shave vaginal area 3-4 days before surgery (makes marking easier for surgeon)
• Signed consent and given preop and postop instructions
• Fill prescriptions for postop medications (pain, nausea, stool softener, muscle relaxant)
• Hydrate, drink plenty of water days leading up to surgery
• If you have high blood pressure, take as instructed;
• Good night rest, nothing by mouth after midnight, unless otherwise instructed
• Make sure you have been assigned a time to arrive at the surgery center
• Schedule your postoperative lymphatic massage

Postsurgery

• WALK, GET OUT OF YOUR BED EARLY AND OFTEN (WITH ASSISTANCE) TO HELP PREVENT POSTOP PROBLEMS
• Walk with trunk (abdomen) in “slouched or bent over position to avoid excessive tension on the incision
• Sleep with hips in a flexed position; avoids tension on incision; Elevate head and keep knees flexed
• Take pain medication as instructed
• NO SMOKING, smoking may cause wound healing problems
• Strip and record drainage output at least twice daily, if more drainage will have to record more
• Keep drainage bulbs collapsed.
• Some patients may be instructed to take Lovenox to help prevent blood clots; you should start this 24 hours after your surgery. DO NOT INJECT INTO SURGICALLY OPERATED AREA.
• WEAR COMPRESSION GARMENT AT ALL TIMES FOR 4 WEEKS, OK TO REMOVE to shower;
• DO NOT WEAR tight fitting clothing or a brassiere over the garment;
• OK to shower 24 hours after surgery, wet incisions, do not scrub until instructed; blot dry; DO NOT REMOVE steristrips from incisions
• Eating after surgery
• Start with clear liquids, as you may experience discomfort from anesthesia
• Advance slowly to soft diet for first 3 days; Avoid spicy foods and sugar-free candy
• Eating after surgery
• Resume home medications unless otherwise instructed
• Begin scar treatment after drains and sutures have been removed
• Continue scar therapy for at least 6 months
• OK to get massage 36-48 hours after surgery; At home, focus on any hardened areas and gently massage 6x daily to help soften scar; Make sure that you see a licensed therapist that is experienced with lymphatic massage.

Presurgery

• Shower night before surgery with Hibclens or soap
• Please shave vaginal area 3-4 days before surgery (makes marking easier for surgeon)
• Signed consent and given preop and postop instructions
• Fill prescriptions for postop medications (pain, nausea, stool softener, muscle relaxant)
• Hydrate, drink plenty of water days leading up to surgery
• If you have high blood pressure, take as instructed;
• Good night rest, nothing by mouth after midnight, unless otherwise instructed
• Make sure you have been assigned a time to arrive at the surgery center
• Schedule your postoperative lymphatic massage

What To Expect

• Bruising and swelling typically peaks in 3-4 days
• Some fluid drainage after surgery is expected due to the use of tumescent solution used in performing liposuction
• Mild to moderate pain of liposuction areas

Postsurgery

• WALK, GET OUT OF YOUR BED EARLY AND OFTEN (WITH ASSISTANCE) TO HELP PREVENT POSTOP PROBLEMS
• SLEEP ON STOMACH, DO NOT LAY OR SIT ON BUTTOCKS
• Take pain medication as instructed
• NO SMOKING, smoking may cause wound healing problems
• Drainage is expected and will be blood-tinged. Recommend that you buy pads (can use sanitary napkins)
• WEAR COMPRESSION GARMENT AT ALL TIMES FOR 6 WEEKS, OK TO REMOVE to shower
• It may be necessary to buy different size garment as swelling resolves or get your garment altered; ALSO, MAKE SURE GARMENT IS FLUSH WITH SKIN, AVOID ANY RIDGES/CREASES IN GARMENT
• OK to shower 24 hours after surgery, wet incisions, do not scrub until instructed; blot all incisions dry
• Eating after surgery
• Start with clear liquids, as you may experience discomfort from anesthesia
• Advance slowly to soft diet for first 3 days; Avoid spicy foods and sugar-free candy
• Avoid salty foods as they may contribute to prolonged swelling
• Resume home medications unless otherwise instructed
• OK to massage liposuction areas at home; focus on any hardened areas and gently massage 6x daily to help soften scar
• LYMPHATIC MASSAGES ARE RECOMMENDED, make sure you see a licensed therapist and would start on postoperative day 2 and continue for at least one month;
• USE “BOOTY PILLOW” TO SIT, PLACE UNDER THIGHS SO NO PRESSURE DIRECTLY ON BUTTOCKS

CARING FOR YOUR JACKSON PRATT SYSTEM

Caring for your drain at home involves the following:

1. Stripping the tubing to help move clots.
2. Emptying the drains several times a day and recording the amount of drainage on the JP DRAIN OUTPUT RECORD.
3. Caring for your insertion site (the area where the catheter enters your skin).
4. Recognizing when there is a problem.

STRIPPING THE TUBING

These steps will help move clots through the tubing and promote the flow of drainage. Do this before you empty and measure your drainage.

1. Wash your hands thoroughly with soap and water. Dry them thoroughly.
2. At the point closest to the insertion site, pinch and hold the tubing between the thumb and forefinger of one hand.
3. With the thumb and forefinger of your other hand, pinch the tubing right below your other fingers. Keeping your fingers pinched; slide them down the tubing as far as they will reach. If there is still tubing between the fingers of your lower hand and the bulb, keep the lower fingers pinched and release your upper fingers. Pinch the tubing right below the fingers of your lower hand. Slide them down the tubing as far as they will reach. Repeat until you reach the bulb. You may want to use alcohol swabs to help you slide your fingers down the tubing more easily.
4. Repeat steps as necessary to push clots from the tubing into the bulb. If you are unable to move a clot into the bulb, call your doctor’s office.
5. The fluid may leak around the site if a clot is blocking the drainage flow. If there is fluid in the bulb and no leakage at the site, then the drain is working in spite of what appears to be a clot.

How to Empty Your Jackson Pratt and Record the Drainage

You will need to empty your Jackson Pratt in the morning, lunch and afternoon.

Equipment Needed:

1. Measuring container
2. JP drain output record

Steps to Follow:

1. Prepare a clean area on which to work and gather your equipment.
2. Wash your hands thoroughly with soap and water. Dry them thoroughly.
3. Unplug the stopper on top of the Jackson Pratt. This will cause the bulb to expand.
4. Do not touch the inside of the stopper or the inner area of the opening on the bulb.
5. There are hash lines on the drain with measurements in mL (typically up to 50mL), record the amount.
6. Turn the Ja ckson Pratt upside down, gently squeeze the bulb, and pour the contents into the measuring container (Figure 2).
7. Turn the Jackson Pratt right side up.
8. Squeeze the bulb until your fingers feel the palm of your hand.
9. Continue to squeeze the bulb while replugging the stopper.
10. Check to see that the bulb remains fully compressed to assure a constant gentle suction.
11. Pin the collar of your Jackson Pratt securely to a piece of your clothing. Do not allow your drains to dangle. A “fanny pack” or loose belt bag may be helpful to hold the drain.
12. Check the amount of drainage in the measuring container.
13. Record this amount on your sheet.
14. Empty the drainage down the toilet and rinse the measuring container with water.
15. At the end of each day, add the total amount of drainage for the 24-hour period and record it in the last column of the drainage record.
16. If you have more than one drain, measure and record each separately.

CARING FOR THE INSERTION SITE

Once you have emptied the drainage, wash your hands again. Check the area around the catheter insertion site.

Look for tenderness, swelling, or pus from the insertion site. If you have any of these or a temperature of 101° F (38.3° C), you may have an infection. Call our office at 404-777-8825. Sometimes the drain c auses redness the size of a dime at the insertion site. This is normal. Apply antibiotic ointment around the tubing and dress the wound with a piece of gauze attached by tape.

PROBLEMS YOU MAY ENCOUNTER WITH THE JACKSON PRATT SYSTEM

1. BULB NOT COMPRESSING
   • Not squeezed tightly enough
   • Stopper not closed securely
   • Suction catheter dislodged

   WHAT TO DO?

   • Compress the bulb
2. NO DRAINAGE, SUDDEN DECREASE IN DRAINAGE

   WHAT TO DO?

   • Follow instructions for tub stripping
3. CATHETER FALLS OUT FROM INSERTION SITE
• Rarely happens, but if it does, place a dressing over the site and call our office during normal business hours
4. REDNESS GREATER THAN THE SIZE OF A DIME, swelling, heat, or pus around drain insertion site
   • Take your temperature & call our office, this could be an infection.
   • Keep insertion site clean and dry by washing with soap and water and gently patting it dry.

What do I report to my doctor?

• Redness, swelling, and drainage around the area where the tube exits the body.
• Immediate refilling of the bulb with drainage/ blood after emptying.
• Inability to flatten the bulb or drainage bottle.
• The tube falls out.
• A fever.

Helpful Hints:

• It is recommended that you safety pin the drainage bottle to your clothing during the day and to your night clothes during the night. Allow enough slack to prevent the tube from being pulled out.
• Be very careful not to puncture the tubing or the drainage bottle with the safety pin—use the plastic tab on the drain to put the pin through.
• Attach the container below the level of the tube exit site.
• Be very careful with daily activities so that you do not dislodge the tubing.

Please bring this form with you to each office visit.

JP DRAIN OUTPUT RECORD

Presurgery

• Shower night before surgery with Hibclens (should have received from our nurse practitioner)
• Signed consent and given preop and postop instructions
• Fill prescriptions for postop medications (pain, nausea, stool softener, muscle relaxant)
• Good night rest, nothing by mouth after midnight, unless otherwise instructed
• Make sure you have been assigned a time to arrive at the surgery center
• Take home medications as instructed; INFORM NURSE PRACTITIONER IF YOU TAKE ANY BLOOD THINNERS (ASPIRIN, PLAVIX, ETC.)

Postsurgery

• WALK, GET OUT OF YOUR BED EARLY AND OFTEN WITH ASSISTANCE) TO HELP PREVENT POSTOP PROBLEMS
• KEEP HEAD ELEVATED, AVOID BENDING NECK FORWARD FOR 2 WEEKS
• Take pain meds as instructed; take w/ crackers
• Apply ice packs or Swiss eye masks to face for first 24 hours to reduce swelling
• NO SMOKING, smoking may cause wound healing problems
• Eating after surgery a. Start with clear liquids, as you may experience discomfort from anesthesia b. Advance slowly to soft diet for first week; Avoid spicy foods and sugarfree candy
  • Take home blood pressure meds as directed
  • Avoid blowing nose if possible, sneeze with mouth open
• Keep head wrap in place, it will be changed on postoperative day #1
• Swelling is normal and typically peaks on Day 3, however, if one side appears to be more swollen than the other, or a sudden increase in swelling, contact us immediately or report to the nearest emergency room.
• After the dressings and drains are removed, it is ok to wash and shower hair w/ mild shampoo and gently wash face avoiding the stitches;
• No hair care products, conditions, gels, hairspray, grease, makeup over face while stitches in place; Make sure you get approval by Dr. Nicholas Jones before wearing makeup
• No strenuous activity, weightlifting, sexual activity for one month
• Wear sunscreen for at least 6 months to protect the skin from excessive sun exposure as this may affect the color of your scar
• Begin scar treatment after drains and sutures have been removed
  • SEE WOUND CARE INSTRUCTION SHEET FOR GENERAL INSTRUCTIONS
  • Continue scar therapy for 6 months

Presurgery

• Shower night before surgery with Hibclens or soap
• Please shave vaginal area 3-4 days before surgery (makes marking easier for surgeon)
• Signed consent and given preop and postop instructions
• Fill prescriptions for postop medications (pain, nausea, stool softener, muscle relaxant)
• Hydrate, drink plenty of water days leading up to surgery
• If you have high blood pressure, take as instructed;
• Good night rest, nothing by mouth after midnight, unless otherwise instructed
• Make sure you have been assigned a time to arrive at the surgery center
• Schedule your postoperative lymphatic massage

What To Expect

• Swelling and bruising is normal and will gradually resolve over 2 – 4 months
• If you develop any redness, drainage, or intense pain, nausea, vomiting, difficulty breathing, please contact us immediately

Postsurgery

• Make sure you have someone to stay with you for the first 24-48 hours
• WALK, GET OUT OF YOUR BED EARLY AND OFTEN (WITH ASSISTANCE) TO HELP PREVENT POSTOP PROBLEMS
• Take your time getting out of bed, because you may initially be somewhat weak
• Avoid crossing your legs while in bed
• Take pain medication as instructed
• NO SMOKING, smoking may cause wound healing problems
• COMPRESSION GARMENT AT ALL TIMES FOR 4 WEEKS, OK TO REMOVE to shower after the first 24 hours
• OK to shower 24 hours after surgery, wet incisions, do not scrub until instructed; blot all incisions dry; Remove all BANDAGES
• Make sure someone is available for assistance as you may feel dizzy or light-headed;
• Avoid strenuous activity for at least 3 weeks
• Eating after surgery
• Start with clear liquids, as you may experience discomfort from anesthesia
• Advance slowly to soft diet for first 3 days; Avoid spicy foods and sugar-free candy
• Resume home medications unless otherwise instructed
• OK to massage liposuction areas after 2 days after surgery; focus on any hardened areas and gently massage 6x daily to help soften scar
• Recommend lymphatic massage therapy by 2nd or 3rd day, recommend 1-2 sessions a week for 1 month by a trained massage therapist.

Rhinoplasty Instructions

• Elevate your head with two pillows while sleeping for first week.
• After surgery, apply cool eye pads or crushed iced in a bag to eyes to help with swelling and bruising. Avoid any pressure over nasal splint. Swelling can continue to increase for first 4-5 days.
• If you have pain, take the pain medication every 4-6 hours. It is best to take it with crackers, jello, etc. If you have no pain, do not take the medication. Alcohol should not be used while you are taking a pain medication.
• If you feel anxious, take the anti-anxiety medication (Xanax) every 8 hours for the first 24-48 hours. DO NOT TAKE THE SLEEPING PILL IF YOU TAKE XANAX.
• Following surgery begin with a light diet: liquids only. The next day you can begin a soft, regular diet but for 2 weeks avoid foods that require excessive lip movement such as apples, corn on the cob, etc.
• You will probably have a bloody nasal discharge for 3-4 days and may change the drip pad under your nose as often as needed. Do not rub or blot your nose, as this will tend to irritate if. You may discard the drip pad and remove the tape on your cheeks when the drainage has stopped.
• To prevent bleeding, do not sniff or blow your nose for the first 4 weeks after surgery. Try not to sneeze, but if you do, sneeze through your mouth.
• While the nasal splint is on, you may have your hair washed beauty salon fashion. Take care to prevent the nasal splint from getting wet.
• Keep the inside edges of your nostrils and any stitches clean by using a Q-tip saturated with hydrogen peroxide followed by a thin coating of Polysporin ointment. This will help prevent crust from forming. You are to advance the Q-tip into the nose as far as the entire cotton tip, but no further. You will not hurt anything inside your nose as long as you are gentle in your actions.

General Postoperative Instructions

• Avoid strenuous activity (INCREASING YOUR HEART RATE ABOVE 100 BEATS PER MINUTE, - i.e. aerobics, heavy lifting, and bending over) for the first 3 weeks after surgery. After 2 weeks you should slowly increase your activities so you will be back to normal by the end of the 3rd week.
• Avoid hitting your nose for 4 weeks after surgery.
• After the splint is removed, do not wear glasses or allow anything else to rest on your nose for 4 weeks. Glasses should be taped to the forehead. (We will show you how.) Contacts can be worn as soon as the swelling has decreased enough for them to be inserted.
• The incision of your nose is sensitive to sunlight after surgery. Protect the incision line from sun exposure for 12 months. Wear a wide brim hat and/or a good sunscreen (SPF20 or greater) with both UVA and UVB protection if you are in the sun, in water or on snow for prolonged periods.
• The nasal splint will be removed in 6-7 days after surgery.
• After the nasal splint is removed, the nose can be washed gently with a mild soap and makeup can be applied. Moisturizing creams can be used if the nose is dry.
• The tip of the nose sometimes will feel numb after rhinoplasty and occasionally the front teeth will feel “funny.” These feelings will gradually disappear.
• Much of the swelling will be gone in 2-3 weeks after surgery. It often takes approximately 1 year for the last 10% of the swelling to disappear. Your nose may feel stiff when you smile and not as flexible as before surgery. This is not noticeable to others and things will gradually return to normal.
• Take your medications carefully and only as directed.
• If you have nausea, vomiting, rash, shortness of breath, or diarrhea after taking your medications, or if you develop a fever (oral temperature greater than 101°), develop redness or have increased pain at the site of your surgical incisions, call the office immediately.
• After your sutures are removed and the internal/external splints are removed it is recommended that you use a saline solution (salt water) (Ocean or Ayr Nasal Spray) two squirts, each nostril, 4-5 times daily, to gently remove crusty formation from inside your nose, especially if you had internal nasal surgery such as septal reconstruction or inferior turbinate resection.
• You can use nasal spray (Afrin) intermittently ONLY after the first week post-op for improved nasal breathing. And then stop it after 5-7 days.
• If you experience increased nasal bleeding with bright red blood (with a need to change nasal pad every 30-40 minutes) notify Dr. Jones immediately. You should sit up and apply pressure to the end of your nose for 15 minutes and you can use Afrin spray to stop the oozing in the interim. Bleeding usually stops with these maneuvers. It is important to be seen by Dr. Jones after your initial post-op checks

Days 1 – 5

• Apply a thin layer of antibiotic ointment to incision for first three days only. Stop using the ointment after three days as it can irritate the skin or cause a reaction.
• If you have a subcuticular skin closure or skin adhesive (dermabond), you do not need to apply ointment.
• If you had a keloid surgery and you are undergoing radiation, do not use ointment.
• It is ok to shower 24 hours after your surgery and is encouraged; Allow water to run over the incision and pad the area dry. Do not scrub or pick at the wound
• If steristrips or paper tape has been placed, keep them in place, if they appear moist or if there is drainage from the wound, please call the office or nurse practitioner
• Swelling and discoloration is expected and typically begins to subside at day three or four

Days 5 – 7

• Remove steristrips and tape on day 7 and reapply weekly for the first 4 weeks;
• Swelling and bruising should be resolved or nearly gone

Weeks 2 – 4

• Scar therapy – if wounds have healed; start scar massage, massaging scar cream into the incision in a circular motion two to three times daily;
• For best results, scar therapy should be continued for the first 6 – 8 weeks
• Scar cream can be purchased in our office and contains special ingredients including Vitamin C and E, and sunscreen
• Also recommend using a silicone- based product such as (Scar Away); aids in wound healing and optimizing scar appearance o FOR SILICONE SHEETS! Ensure wound is clean before applying and dry of any creams, lotions, or ointments! Wear daily for 6-24 hours, remove once daily to allow site to be washed and dried! If gel sheet becomes dirty or loses adhesiveness, wash gently with mild soap and water. Allow to air dry before reapplying
• Follow-up appointment with Dr. Nicholas Jones; all patients should be seen by Dr. Jones within the first two weeks after surgery
• If you had a facial procedure or neck procedure, your sutures need to be removed within 5-6 DAYS
• Avoidance of the sun when possible, and sunscreen to protect the surgical site from UVA/B; aids in preventing discoloration • OK to gently cleanse wound (directly)

Weeks 4 – 6

• Critical period for wound remodeling • No strenuous activity including sexual activity; • Continue scar therapy

Months 6 – 12

• Follow-up appointment with Dr. Nicholas Jones to reassess healing and scars; during this time, wounds some times need to be revised • Sunscreen with protection against UVA and UVB

V-Beam After Treatment Instructions (KELOID PATIENTS ONLY)

• You may apply ice, cold packs, or frozen peas to the treated area for 20 minutes each hour for 3-4 hours to avoid swelling
• You may apply polysporin antibiotic ointment twice daily should any area blister, do not use more than 4 days.
• A bruise usually occurs from this treatment and can last 10-14 days or more, depending on the setting of the laser.