Plastic Surgery Guide
Before undergoing plastic surgery at our Beverly Hills clinic, you'll need to prepare. Our comprehensive guide will help guide you in your preparation both before and after your procedure. Please read this guide first, and then request a consultation with Dr. David Sayah to discuss your individual needs.
We will do all we can to provide personalized, individual care, making every provision for your comfort while maintaining the highest degree of medical excellence. Reading this material and following its suggestions will add tremendously to the experience. We want this experience to be as comfortable and gratifying as possible, so please call us if we can provide any other assistance.
Three Weeks before Surgery
- We will provide you with a list of lab tests or x-rays that will be required before surgery from your doctor. You must have all of your laboratory tests, primary physician visit and specialist consultations (ophthalmologist, cardiologist, etc.) completed by two weeks before surgery. Please follow-up with your primary physician shortly after your visit to assure they have sent all of your documents to our office.
- Your surgery date and procedure details will be confirmed this week.
- Questions you may have should be answered at this point.
- We will review your medical records including pre-operative clearance by your primary care physician to be sure all of your health issues such as Hypertension and allergies have been addressed. If applicable, insurance pre-authorization for your procedure needs to be received by our office. While we will be in regular contact with your insurance company to obtain their payment authorization, you are your best advocate. Please contact your insurance company and encourage them to process your file as soon as possible. All of your post-operative follow-up appointments will be scheduled at this point for your convenience.
- Payment for your procedure is due at this time.
You Must Stop at This Time
- Smoking: the earlier you quit smoking, the better.
- Alcohol: If you are a regular or heavy drinker, try to eliminate or cut down to a minimal level. Alcohol causes easy bruising, lessens the ability of the liver to metabolize medications and interferes with the general healing process.
- Sunbathing, self-tanning products or using sun booths.
- Facials, steaming masks or other skin irritants if you are undergoing facial surgery.
- Getting run-down. Eat well, get sufficient sleep and avoid being around anyone who is sick.
- Women MUST be certain that they are not pregnant before surgery.
Seven to Ten Days before Surgery
- Read and review this material with the person who will be taking care of you after surgery.
- Schedule hair cutting and nail appointments.
- Arrange for childcare, pet care and mail pick-up.
- Pay any bills that will fall due while you are recovering.
- Clean your house and arrange for any housekeeping you may require during your recovery.
- Refer to the dietary suggestions section. Prepare and freeze individual meals that can be quickly reheated in a microwave.
- Refer to the “Comfort Station” section. Shop for regular household items and any extras you may need for your recovery.
- Men who are having facelift surgery should let their sideburns grow at this time.
- If you are going to the hospital for surgery and have not already called the admitting department to confirm your arrangements, do so at this time.
- Check your personal calendar for birthdays, meetings, etc.; that will require your attention during your surgery or recovery period.
- 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 before your operation.
- Organize a ride from the Ambulatory Surgery Center or hospital to your home.
- Arrange a family member or friend to assist you at home for at least the first 24 hours after surgery. If you wish, we can arrange an experienced nurse to care for you during this time at your home or hotel. Another option one of the few post-surgical care centers our office recommends. You may not drive yourself home after any form of sedation or general anesthesia.
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 may be helpful to you, depending on the type of surgery you have and your expected recovery.
From the pharmacy or drugstore:
- Throat lozenges and cough drops (for dry throat)
- Chapstick or lip balm (for dry lips)
- Baby shampoo (after scalp or facial surgery)
- Mouth spray
- Skin moisturizer
- Ultrasonic humidifier (helpful following nasal surgery)
- Shower cap (use after scalp surgery)
- Heating pad
- Eye drops (moisturizing)
- Milk of Magnesia (for relief of constipation)
- Maalox (for relief of indigestion)
- Metamucil or laxative
- Vicks or Mentholatum (after nasal surgery)
- Lactobacillus capsules (decrease yeast infection)
For your bedroom:
- Bedside clock
- Bedside table
- Warm socks or booties
- Small bib (to protect clothing when eating in bed)
- Paper towels
- No spill glass/cup
- Soft food
- Trash container (at bedside)
- Baby wipes (for quick clean-ups)
- Paper plates and cups (saves washing dishes)
- Loose clothes - jogging suit (warm, front zipper in the – avoid pullovers/sweaters)
For Facial Surgery:
- Water spray bottle (after peel or facial surgery)
- Rolled bath towels (use behind your neck after facial surgery)
- Multiple pillows or a wedge to help elevate your back while in bed
Three Days before Surgery
- Stop all alcohol, smoking, coffee and tea (caffeine) consumption.
- Use an antibacterial soap such as Hibiclens when showering.
- If you are having facial or scalp surgery, gently clean your ears with a water-moistened cotton-tipped applicator. Eliminate any impacted wax with Murine or Debrox ear wax remover to prevent the growth of bacteria (This is only to be done if there is a large burden of wax in ears).
- If you are undergoing breast surgery, do not shave under your arms for three days before surgery.
One Day before Surgery
- You will have an appointment on the day before surgery to discuss your personal preferences and surgical plans in detail. Dr. Sayah will mark your surgical area today, so you have time to think about the particulars of your procedure.
- After discussing your procedure and the associated risks and benefits, you will be asked to sign an informed consent form giving Dr. Sayah permission to perform your surgery.
- 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.
- Pick up any required medications or prescriptions for after surgery.
- Patients having a tummy tuck (abdominoplasty) procedure should start their bowel preparation.
- Our anesthesiologist will call you today to review your planned procedures and health history to assure an excellent surgical experience.
- If you have any last minute questions, feel free to contact our office again and again.
The Morning of Surgery
- Take your regular prescription medications such as blood pressure, thyroid, or birth control pills with a small sip of water.
- Do not use facial or body moisturizer. Men should avoid shaving. Brush your teeth, avoid swallowing any water.
- Comfortable clothing that is loose, and buttons or zips up the front. A warm-up or jogging suit is ideal. Flat, comfortable shoes are also recommended.
- Do not wear pantyhose or girdles.
- Leave jewelry, earrings, rings, hairpins, or false eyelashes at home.
- If you wear contact lenses, eyeglasses, or dentures, bring your case with your name on it.
- Do not set or style your hair. Wash with a mild shampoo the night before surgery.
- Bring your medications to the ambulatory surgery center for review.
- If possible, leave your purse at home.
- Inform the nurse if you wear a wig, contact lenses, eyeglasses, false eyelashes, dentures, partial plates, loose teeth, etc.
- The nurse will take your vital signs, ask some standard medical questions and have you sign a surgical consent form.
- Our anesthesiologist will re-check your health history one more time to assure maximum safety.
- Dr. Sayah will see you before surgery. He will again discuss your planned surgery, do markings on your skin in front of a mirror, and answer any questions you may have. He may also take additional photographs.
- For relaxation, you will then be given a mild sedative.
- The nurse will then bring you into a warm operating room.
- The anesthesiologist will gently put you to sleep. Dr. Sayah performs most of his surgeries with sedation. You will breathe on your own while asleep during your procedure. Modern intravenous anesthesia techniques are extremely safe and comfortable.
- Dr. Sayah will also administer a special long-acting local anesthetic to your surgical site. When you wake up, these areas will be numb. You will probably feel no discomfort. Once the local anesthetic wears off, most patients experience very little pain. Any discomfort is easily controlled by pain medication.
In the Recovery AreaThe following will be in your recovery room for your comfort and safety.
- An oxygen mask may be lightly applied to your face to provide pure oxygen.
- A blood pressure cuff may be attached to your upper arm. Your blood pressure reading is recorded by a computer which signals the doctor and nurse if a change is noted.
- You may have an intravenous line (I.V.) in your arm to provide fluids.
- 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.
- Dressings will be applied, depending on the type of surgery you have. You may also have a small drain, consisting of a small plastic tube connected to a drain bulb. This collects fluid and helps to decrease swelling and bruising. It will only be used if Dr. Sayah feels it is necessary and will be removed 24-48 hours later under local anesthetic. You may also have ace bandages on your legs to keep them warm. In the case of abdominal surgery, a bladder catheter may be used.
- Your eyes may be a little blurry from protective ointment used during your surgery.
For the Journey HomeThe following will be in your recovery room for your comfort and safety.
- You must have someone drive you home after surgery if you have had any form of sedation or general anesthesia.
- We recommend a pillow, blanket, and a box of tissues. Reclining the front passenger's seat will add to your comfort.
- Driving slowly and cautiously is important. It is not unusual for the patient to feel light-headed.
- 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.
Signs to Look Out For
- Your temperature is over 101 degrees, with or without chills.
- Excessive swelling with resultant tight, restrictive dressings, particularly if you see a large difference when comparing one side of your body to the other.
- Excessive bleeding that will not stop. With oozing or bleeding, 10 minutes of direct pressure, non-stop, on the area should be maintained. Remain calm. Call our office or have someone drive you to the emergency room.
- Persistent vomiting.
Immediately After SurgeryDo not make any important decisions or sign any important papers for 24 hours after surgery. Refrain from alcohol or other sedating substances for at least 24 hours.
- Physical activities: During the first day or two, take deep breaths and gently cough to exercise your lungs. 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. Do not exert yourself the first few days after surgery, as this will increase swelling and bruising. Elevate your operative area and avoid lifting or bending as much as possible. If you have had a tummy tuck or abdominoplasty, you will need to walk with your back flexed at the hips to about 30 to 45 degrees. After a face or neck lift, you should avoid neck flexion or rotation. After facial surgery, you should sleep with your back elevated at 30 to 40 degrees using a wedge or pillows under your back. After breast or abdominal surgery, avoid sleeping on your sides. It is preferable that you slowly begin to 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. You should not drive or operate heavy machinery for at least 24 hours after your procedure or after stopping your narcotic pain medications.
- Getting up from bed: It is not unusual to feel lightheaded if you get up quickly. It is best to have someone assist you for the first day or two. 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 enhancement, abdominoplasty 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, then gently lift yourself into a sitting position by keeping your knees bent and pushing up on your elbows. Never walk alone if you feel light-headed. Ask for assistance. Don't forget to keep a nightlight and a chair in both your bedroom and your bathroom. You may feel a little helpless at this stage, as if you are moving in slow motion, but this will quickly pass.
- Climbing stairs: Take one step at a time. Face the railing or banister and hold on with both hands. 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.
- Bathing: you must keep your surgical site clean and dry for at least 48 hours after the end of your surgery. If you have drains 48 hours after your surgery, you may not shower until all of your drains are removed.
- Hair washing: 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.
- Compression garments: Compression garments should be removed every 2 hours for approximately 10-15 minutes to allow blood circulation at the site of surgery. You may leave your garments on overnight without removing them, so you enjoy a comfortable sleep.
You may be very thirsty for a few days. This is common after surgery. Keep a supply of juices handy. If your throat is sore, which sometimes happens following anesthesia, try drinking lukewarm, decaffeinated tea with honey or non-citrus fruit juices such as apple, pear or peach juice. Throat lozenges or ice cream can be very soothing. It is normal to have little appetite for a few days following surgery. Fluids, particularly electrolyte balanced drinks such as Gatorade are important at this time to prevent dehydration and decrease constipation. You also might try chicken soup (low salt, if it is available). Immediately after surgery, begin with a clear liquid diet and advance your diet to more regular foods as you can tolerate:
Clear liquid consists of:
- Decaffeinated tea
- Decaffeinated coffee
- Cranberry juice
- Apple juice
- Clear broth
As your appetite increases: Easily digested foods such as 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 had abdominal surgery, you may be given additional dietary instructions. Following facial surgery, you should adhere to a full liquid or a soft diet for one week. In particular: please avoid chewing on firm foods such as apples, pizza, thick steak or breast of chicken as we want your face to heal without too much repeat tension with firm chewing or wide mouth opening.
Full liquid consists of:
- Cream of tomato soup
- Clam chowder soup
- Fruit juice
- Soft ice cream
Soft diet consists of:
- Cream of Wheat
- Cottage cheese
- Soft fish
- Ice cream
- Yogurt (Don't overlook baby food.)
- Soft chicken or fish
If you have undergone surgery inside your mouth, frequently rinse with Peridex. You should be on a liquid diet for 48 hours followed by a soft diet for an additional three days.
- Antibiotics: eat yogurt, drink acidophilus milk, or take lactobacillus capsules daily to decrease the possibility of yeast infection.
- Regular prescriptions: continue as prescribed by your physician.
- Two days following surgery: Take pain medication regularly, such as 1-2 Tylenol pills every four hours. Scientific evidence has proven that following surgery, a low but definite blood level of mild pain medication goes a long way toward controlling discomfort. Stronger pain medicine is available if you need it. Many patients find that their discomfort slightly increases late in the afternoon or evening. 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.
- Menstrual cycle: Women may experience irregular, or even miss a period or two, for a month or two following surgery. This is normal. Your body will soon adjust and return to its regular cycle. Continue with your regular birth control program.
Two to Three Days after Surgery
- Visitors: Family and friends are very important during the recuperation period. However, you may want to be left alone to sleep or rest. It is important to decide how often you will have visitors, and for how long.
- Activity: You will probably feel better and eager to be up and about. Alternate periods of activity with periods of rest throughout the first several days. You can take brief walks, be sure to wear your hat, scarf, and sunglasses.
- Site swelling: 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 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 too warm, as elevated air temperature will increase swelling.
- Oozing: Small capillaries may continue to ooze for 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. 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. Usually, you may shower after two days, and bathe after one week.
- Irritation to intravenous site: apply a warm moist washcloth can help to alleviate it.
Three to Five Days after Surgery
- Fever: You may continue to run a low-grade fever for a few days. It usually signifies that you need to take deeper breaths. If your temperature rises above 101 degrees, call the office.
- Constipation: Mild constipation may occur 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 of Metamucil or a comparable product each morning. A glass of prune juice or an ounce of Milk of Magnesia may also help.
- Swelling: Beginning to resolve at this point. You may notice slight, shooting discomfort. This is a sign that nerves are returning to normal. Some firmness of the operative site is also normal while swelling is present. Remember that your stitches will still be tender.
- Appetite: It may still be decreased. Continue to avoid excess salt, sugar, spices, fatty dairy products, and alcohol.
- Activity: Rest as much as necessary. You may increase your level of activity each day, but stop when you feel tired. If you have had a tummy tuck, you should continue to walk with you back flexed, though every day you may stand gradually more erect.
- Intimacy: Shortly after surgery, many patients desire closeness and intimacy with the one they love. Hugging, embracing, and kissing is 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.
- "The Blues": 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. The depression, which occurs after cosmetic surgery, is often the psychological response to reaching your goal and the time has come to move on to the next phase in life. You CAN get through this period by reminding yourself that what you are going through is perfectly normal. Keep yourself busy and your mind off your temporary appearance. You can probably think of dozens of projects you've been putting off that will fill up your time without tiring you out. Fresh air will make you feel better. Walking can also help to decrease depression, as well as speed up the healing process.
Five to Seven Days after Surgery
- Stitches: During your first few visits, Dr. Sayah will change your dressings and give you helpful hints. Remember that wounds often heal with slight crustiness or swelling. Once your stitches have been removed, you will have regular postoperative follow-up appointments. Also, if after a few weeks you notice a few small absorbable surface stitches still left they are easily removed or often fall out on their own.
- Makeup: If you have had facial surgery, you can use a standard cover-up makeup to hide black and blue areas. DO NOT put any makeup directly on any incision line.
- Bruising: Your soreness and swelling are resolving, and your bruises are changing color as they, too, resolve. If the healing process seems to "plateau" for a few days, don't worry. Soon you'll notice your bruises fading again.
- Activity: Your energy reserves may be very limited, and you may find that you still need to rest a great deal. Many patients go through a period of frustration because they don't look as good or feel as well as they would like. Be patient! Your body needs good 4-6 weeks to recover from the trauma of surgery. Gradually, you will feel better and require fewer and shorter rest periods.
- Diet: Continue drinking plenty of juices. There is evidence that pineapple juice and tomatoes decrease bruising at this stage, so you might want to include these when planning your daily meals.
- Constipation: If it continues, a daily ounce of Milk of Magnesia should help. If you are taking vitamins, particularly those with added iron, your stools may be dark.
- Driving: Go out for a test-drive with a friend before setting out on your own. If you've had facial surgery, continue to use a sunblock on any exposed incision site.
- Returning to work: Be careful not to overdo it. Your body will let you know if you try to do too much. If possible, begin by scheduling a shorter workday than usual, or take more breaks during the day. Try to postpone any meetings or projects that may be especially stressful.
Two Weeks after Surgery
- Diet: You may resume Vitamin E supplements, Asian foods, papaya juice, meat tenderizers, and any other food associated with increased bruising. You may also take aspirin or aspirin-related products. As long as you are not taking any medications, you may drink light alcoholic beverages. You should still avoid excess salt and spices, as these cause your body to retain fluids and prevent the resolution of swelling.
- Activity: Light exercise. Moderate to fast walking, stretching, and light lower extremity exercises should be started slowly. Do a bit more each day. Don't be discouraged if you are stiff and somewhat slow at first. The increase of body fluids during the past two weeks may result in temporary weakness and some muscle stiffness. If you have had a tummy tuck, you may walk perfectly erect at this point. Avoid rotation of your torso as this may stir up bleeding or oozing.
- You will be instructed on self-breast massage if you have had a breast augmentation.
- You should switch to warm compress at this point to minimize any further swelling or bruising.
Three Weeks after Surgery
- Appearance: You are probably back to work now or, if you are a student, back in the swing of things at school. You may find yourself at a plateau stage where most of the swelling is resolved, and now you see little difference from day to day. You will be happier with your appearance every day.
Six Weeks to Six Months after Surgery
- Activity: Jogging, nautilus training, light aerobics and swimming in a pool is permitted. Continue to protect your skin from the sun by wearing hats, scarves, sunglasses or sunblocks. Avoid electrolysis or waxing around your operative sites for at least 10-12 weeks.
- Emotionally: Patients feel they are back to normal–emotionally as well as physically. Whatever soreness remains at your surgical site is rapidly resolving and should be minor at this point. Keep in mind that it will take three months or longer before all swelling and asymmetry resolve.
- Office Appointments: Dr. Sayah will closely check your progress throughout this period.
Personal Incision Care Program
- A scar is part of the healing process, the idea of scarring is frightening to the patient. 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 are very inconspicuous. Your incision lines heal in four phases, as follows:
- This program will improve the contour and final appearance of your incision lines.
- Please DO NOT independently use any creams, treatments or vitamins on your incision lines without first checking with our office. Many of these treatments may actually worsen your scars.
- Day 1-14: Characterized by slight oozing and crusting; bruising and soreness resolve in seven to ten days; ice compresses are helpful. See care instructions below.
- You may shower after 48 hours when your incision line is sealed and bandages and surgical tape are removed.
- Apply prescribed cream or ointment lightly twice daily until the area is completely healed.
- Six weeks to six months: scars lose their redness, itchiness and tenderness gradually subside; areas flatten and begin to blend.
- For six months, your incision line must be totally protected from sun exposure. Brown camouflage Micropore tape (available at our office) can be used over the area as protection while improving scar thickness.
- Always test new products on a small area of your incision line overnight to ensure that you don't develop a rash or irritation.
If you have a genetic tendency toward hypertrophic scarring or keloids,
the following treatments may be instituted:
- Silicone sheeting over your incisions (available at our office)
- Topical cortisone, such as hydrocortisone 2'/2%, applied twice per day for 2-4 weeks.
- Small injections of Kenalog, two to four treatments, two to four weeks apart.
- In rare cases where permanent excessive scarring is still present after one year, surgical revision and/or radiation treatments can be used.
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 your telling us if you had a good experience. We also want to know if your experience was less than you expected. Dr. Sayah wants you to continue looking great your whole life. In addition to successful plastic surgery, many factors contribute to an attractive, youthful appearance.
If there is anything we can do, please contact our office.