WHAT'S NEW

Pumpkin Patch

The gift that keeps on giving-Luxury Facial, Luxury Micro, & Peel Pkg $ 200

Corn Maze

Belly Dancer performing at Hyde Park Festival

Some of the most common questions I am asked during consultations or pre-op evaluations are regarding post op care and activity.  Someday, I plan to add a Frequently Asked Questions page to the web site to address these concerns in detail.  The problem, however, is that every patient and every post op course is different.  As I like to say, “We do custom work.”  Accordingly, my recommendations are not written in stone.  Also, I change my mind sometimes…

First, post op activity instructions vary greatly with the operation.  All patients, however, should walk as soon and as frequently as possible after their operation to help avoid blood clot problems.  They should also use an incentive spirometer (usually provided before discharge from recovery) to expand the lungs.  This helps avoid post op fevers and pneumonia.

Strenuous activity should be limited post operation to minimize the chances of a wound opening up (dehiscence) or causing bleeding (hematoma).  I’ve seen both happen.  In operations where large spaces are opened up, fluid can collect, even after a drain has been appropriately removed. Early vigorous activity can predispose towards these troublesome fluid collections called seromas.  In the setting of breast implants or expanders, their location can be shifted before they are properly set in place.  I advise a slow return to full exercising between 4 to 6 weeks post operation.  This makes sense when you consider that healed wound strength is 50% at 6 weeks and only reaches a maximum of 80% at 6 months.  Remember, any restrictions are a short term investment in your long term result.  As always with activity, let pain be your guide.

Pain, unfortunately, is a part of surgery.  I try to help patients minimize it by using long acting local anesthetic in addition to general anesthesia during the surgery.  Binders and other support garments also tend to minimize pain.  In abdominoplasties and latissimus flaps, I also use local anesthetic pain pumps which work for about 3 days by dripping local anesthetic into the operative site.  There is no right or wrong ammount of pain medication to take.  You need what you need and will have refills appropriately.  It is the rare patient who requires prolonged medication and they are referred to a pain management specialist.  I like oxycodone as it is an effective oral narcotic with relatively little nausea side effects and the number of pills taken is not limited because it is not combined with Tylenol.  It is okay to take Tylenol and Ibuprofen or Naproxen in addition.  I like to avoid Ibuprofen and Naproxen for about 48 hours post surgery to minimize the chance of hematoma. 

Return to work depends on what you do.  If you work at a desk, most lesser operations require only a few days to a week off of work.  More major abdomen, chest, or large combined operations may need 2 weeks off of work.  If you are a luggage handler at the airport ( I had one ), you might even need 6 weeks off from heavy duties.  We try to be as cooperative as possible with your return to work as we know everyone has to make a living.

Most wounds may be showered post 36 hours after an operation - I usually say the second morning after surgery.  This is because the epithelium (surface layer of skin) is sealed by that time.  Showering removes surface bacteria and just feels good.  It is okay to shower with drains.  Submerging in a bathtub should not be done for at least 2 weeks post op because static water inevitably has more bacteria.  That goes double for hot tubs.  If you have a skin graft with bolster, or are wrapped after a breast implant surgery, you should just sponge bathe around the dressing until you return for follow up.

After the wound is sealed and out of the red inflammatory phase, I recommend using silicone gel strips on wounds.  They are not magic, but have been proven to help improve scar appearance.  No one knows exactly how they work, but it is thought that they decrease surface tension on the wound and help keep it moist.  We have detailed instructions for their use and sell them at the office ( the are not generally available in stores ).  The only other product that is proven to help is Mederma.  It is available in stores, but ends up being more expensive than a reusable strip because it is an ointment that gets used up.  It is also not as effective a the silicone gel strips.  Ultimately, given good operative technique, the quality of the scar varies greatly and is mostly dependent on the individual’s skin type.  Darker types usually do not do as well.

I hope that this general overview is helpful.  As I also like to say, ” If you get 10 plastic surgeons in a room, you’ll get 11 different answers.”  That is, there are lots of right ways to do thing and the advice I give to patient’s is what I believe works best and is easiest to do.  There are definitely some wrong ways to do things, and most surgeons would agree on those. 

Vendor at the Hyde Park Festival

Try our Oxygenating Pumpkin Peel for $ 45

Rainbow over BSU tailgaiting party

Caldwell Night Rodeo - Saddle Bronc Rider

The study in the journal documented injury patterns in a Philidelphia hospital.  The following is a summary of the findings:  62% of bites were to boys; 24% of the bites occurred in June and July; 51% of bites were in 6-12 year olds and 24% in 2-5 year olds; young children had more face bites at 54% while older ones had more extremity ones at 61%; the breed of only 30% of the offending dog was documented, but of these, 51% were pit bulls, 9% rottweilers, and 6% mixed pit/rotty.

So what does this tell us?  There are some demographic patterns, but any child of any age may be bitten anywhere by any dog at any time.  One may also conjecture that dogs seem to attack little kid’s faces because they may be seeing them eye to eye.  As for the breeds, 30% documentation of type is poor, but it is hard to ignore that two thrids of the bites were due to pit bulls, rottweilers, or a mix of the two.  Perhaps because these breed cause more significant injuries, my own experience in 10 years of Plastic Surgery ER call is greater than 90%  pit or rotty- German Shepards and various others make up the rest.  Now, the last thing I want to do is be controversial, start a fight, or be accused of profiling.  These are usually lovely dogs with devoted owners and the offending dogs may have been mistreated or provoked.   Dogs, like people, should be treated as individuals.  Please, no angry mail.

Considering the presented information, I have a few recommendations.  All dogs should be treated with respect and kindness.  Pit bulls and rottweilers deserve love too - with a little extra caution, just in case.  Unfamiliar dogs should be avoided.  Stay away from dogs while they are eating and when they are feeling scared or threatened.  Small children are particularly vulnerable to devastating injuries which will scar them for a lifetime, so a healthy dose of paranoia ( or a little more in my case ) is indicated.  Not every dog bite needs a plastic surgeon and the ED physicians are competent to take care of most.  If they want help, they ask for it.  All bites are at high risk for infection and should be thoroughly washed out and treated with oral antibiotics.  Extremity wounds are often left open, but facial wound are usually closed loosely to allow drainage while still allow some cosmetic improvement ( with about a 5% infection rate). 

You don’t have to send your kids out in full body armour like I do, but encourage your little loved ones to be careful out there.

Caldwell Night Rodeo - Flag at a Gallop