S04E69 Preparing for Plastic Surgery: Top 5 Must-Knows for Success

Ever wondered how much preparation goes into a successful plastic surgery procedure? Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, and Dr. Sam Rhee @bergencosmetic help unveil the cloak of mystery that often shrouds these vital steps. We share from our trove of knowledge the top five things every patient must know before going under the knife.

You'll learn about the absolute necessity of kicking the smoking habit, the paramount importance of pre-surgery instructions, and the role honesty plays in your surgical triumph.

Dive deep with us into the world of body contouring procedures such as BBLs, as we discuss unique considerations and steps to ensure the best possible outcome. We also shed light on the necessity of disclosing all medications, the impact of alcohol, and maintaining a regular exercise and diet routine. Our candid conversation about optimizing nutrition before surgery and mentally preparing for recovery will provide invaluable insights for potential patients.

Lastly, we delve into the universal success factors applicable to every surgery. Learn why preoperative teaching is non-negotiable and why full disclosure of your habits - be it medication, alcohol consumption, nutrition, and mental preparedness, could make or mar your surgical outcome. Remember, knowledge is power, and preparation is the key to a successful plastic surgery experience. So, join us for this enlightening episode and arm yourself with expert advice from three seasoned plastic surgeons.

@3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S04E69 Preparing for Plastic Surgery: Top 5 Must-Knows for Success

[00:00:00] Dr. Salvatore Pacella: All right, good morning, welcome everyone, I'm Dr. Sal Pacella from La Jolla, California. I'm joined by my two esteemed colleagues, Dr. Sam Jejurikar from Dallas, Texas, and Dr. Sam Rhee from Paramus, New Jersey. How are you guys doing this morning?

[00:00:20] Dr. Sam Jejurikar: Doing great!

[00:00:21] Dr. Sam Rhee: Excellent.

[00:00:21] Dr. Salvatore Pacella: All right, well we got a really exciting show today, uh, this is more of an advice show, generalized advice show, how to get ready for plastic surgery.

In fact, we did something very fun. We got together and we decided each of us independently would list five things that we feel are the most important to tell patients before their plastic surgery. So we're gonna compare and contrast notes here. Before we do that, I'm gonna go to a disclaimer.

[00:00:49] Dr. Sam Jejurikar: This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment after appropriate discussion. Always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care, and never disregard professional medical advice or delay seeking advice because of something in this show.

Back to you, Dr. Pacella.

[00:01:14] Dr. Salvatore Pacella: All right, sounds great. So, you know, I think a philosophy of plastic surgery is that, you know, the difficulty in getting through plastic surgery is not just actually recovering from the surgery, it's preparing yourself ahead of time. So, we spend a lot of time, both personally as surgeons and with our nursing staff, to really map out Everything a patient needs to do, what to be prepared for at home, what to be prepared, prepared for during and after the surgery.

So, so this, this really qualifies as preoperative teaching. And so this is a critical, critical component to having successive plastic surgery. So what I thought we'd do is let's start with one of us. We'll have a volunteer and then you go through your list and we'll chime in if that is exactly on our list.

And I'm going to willing, I'm going to bet something here. I bet 90 percent of our lists are exactly the same.

[00:02:02] Dr. Sam Jejurikar: We only have five things each. That means four and a half would match up. Not to be technical.

[00:02:10] Dr. Salvatore Pacella: so

[00:02:12] Dr. Sam Jejurikar: Uh, why don't I go first, seeing how I interrupted you with that completely irrelevant point. Um, first thing I have on my list is to stop smoking anything and discontinue tobacco in all four. Do you guys have that on your

[00:02:24] Dr. Salvatore Pacella: also on my list.

[00:02:26] Dr. Sam Rhee: Not on my list, but good one. I agree.

[00:02:30] Dr. Salvatore Pacella: Okay.

[00:02:30] Dr. Sam Jejurikar: and the reason...

[00:02:31] Dr. Salvatore Pacella: four, four out of five is 80%. I had to, I had to look that up on a calculate.

[00:02:35] Dr. Sam Jejurikar: And the reason for patients, while we're listening to that, is regardless of whatever plastic surgery procedure you are having... Um, not just nicotine, tobacco, benzene, but also carbon monoxide from smoke can all have profound implications on your ability to heal and cause massive wound healing complications.

Stop all of those at the minimum, you know, three or four weeks before surgery. Um, it's an all or none phenomenal.

[00:03:00] Dr. Sam Rhee: that's almost a given. I didn't even put that on my list because I would assume that everyone should know that one, but you're right. Not everyone does.

[00:03:08] Dr. Salvatore Pacella: You'd be surprised. You'd be surprised. Um, now tell me, Sam, um. What about vaping? What do you tell patients about vaping

[00:03:16] Dr. Sam Jejurikar: vape for you. Vaping is smoke. So my basic rules are basically this. Don't smoke anything, and don't use tobacco or nicotine products in any form. And that's, I keep it simple.

[00:03:31] Dr. Salvatore Pacella: and what is your, what is your criteria for getting them off? How, what, what was the, what would be the bare minimum holiday?

[00:03:37] Dr. Sam Jejurikar: I mean, I think it depends on the operation, right? If I'm doing a facelift on someone, or if I'm doing a rest lift on someone. The consequences of a wound healing complication can be catastrophic. Giant wounds that are, that are sitting in their face or their nipples and areolas are dead. For those patients, bare minimum, four weeks beforehand.

Other operations where the incisions are, you know, a little bit less and you're not quite so worried about it, let's say just a simple liposuction case, you know, we'll tolerate a shorter period of time. Like two weeks. Um, so I think again, we have to tailor it to what the actual procedure is. You know, ideally, um, they're completely off of it for a month.

[00:04:15] Dr. Sam Rhee: I will say this. I used to, when I first started, I would drug test patients and test for nicotine. And at this point, like it's been a long time. I don't do that anymore. I haven't for a long time, but I do counsel patients. Like this is one of those self responsibility things. If you lie to a surgeon and you are doing, you know, you're still smoking, you're still And you don't tell us, like that risk is taken up on you.

Like that's, that's a big one for sure.

[00:04:43] Dr. Sam Jejurikar: Yeah. Right. What's, what's the first one on your list, Dr. Rhee?

[00:04:47] Dr. Sam Rhee: My first one is review everything the surgeon's office gave you and follow it or ask questions about it if you have them.

[00:04:58] Dr. Salvatore Pacella: excellent.

[00:04:59] Dr. Sam Jejurikar: I kind of, I, I kind of have that on my list,

[00:05:01] Dr. Sam Rhee: So, basically, we give our patients a lot of preoperative instruction, right? Like, I try to keep it concise, I try to, you know, put everything on, on the sheet, uh, that sort of outlines the things we want them to do or don't want them to do before surgery. And I will say maybe one out of six or seven people, or ten maybe, might ask questions about that, that sheet that we give them.

And I know those are the ones. That are going to do well in surgery because they actually looked at it and had questions about it. Like, wait, does that mean this as well? Like, I know that's a good patient. 90, unfortunately, I would say 90 percent of patients don't look at the documentation we give them because I talk to them about it and it's, it was already written.

They were, they were already supposed to have reviewed it and they're like, oh, really? We're not supposed to do that? So, I would say, if you get it from the surgeon's office, read it.

[00:05:57] Dr. Sam Jejurikar: You're up next, Dr. Pacella.

[00:05:58] Dr. Salvatore Pacella: Alright, so top of my list was during, and this kind of segues into what you were just talking about, during our pre op appointment. So, uh, the way my practice works is, you know, I'll see patients for a consult and then shortly before the surgery, we'll have them come back and do a pre op appointment.

Appointment, we'll go over all the teaching, their meds, choosing breast implants, etc. So, during your pre op appointment, I highly recommend that you bring someone with you that is going to be helping to take care of you afterwards. And, I think this is really pretty critical because I can't tell you how many times...

I've gone through a procedure on a patient where they show up alone for the pre op appointment, they may or may not have read anything, and they most likely did not communicate any of this to their spouse, okay? So then, We do the surgery, meet the spouse, call them afterwards and say, Hey, um, your, your spouse is heading home, what do, and the common question I have is, Okay, do I need to do anything?

What do I do? What do I do? Right? And all of a sudden you got this big head wrap on, the face looks like this, very swollen, traumatic, traumatic for, for husbands. And so I think it's really critical to bring Your caregiver to you to the appointment.

[00:07:16] Dr. Sam Jejurikar: great advice. My next one is to remember that over the counter supplements and things like aspirin and Motrin are indeed medications that can have profound impact on your surgery and to make sure you stop taking them before your surgery. Again, I try to get everyone to stop all of these medications at least two weeks before.

I think many patients when they're filling out their list of medications will say that they're not taking any medications at all and you start asking them about these questions and it turns out they are indeed taking them and they, and they don't realize the implications they can have on their surgery.

[00:07:50] Dr. Sam Rhee: That's on my list. I, I said, uh, disclose all medications and supplements and stop taking them if directed. So many people take all sorts of supplements, you know, CBD oil, you name it. Like, just all sorts of stuff which can interact with your healing process, can interact with anesthesia, can interact with, you know, your outcomes.

And you're right, people forget, oh, you know, I've been taking a ton of Advil lately because... My knee's been hurting. Oh, that's a medication? Yes, it's a medication. Like, all of these things. Oh, I forgot, I'm taking, uh, allergy medication. Like, you know, but I don't take it all the time, just sometimes. Well, you know, you gotta disclose those, those things.

So, so I think, um, we literally have a list of about 20 things that we think people always forget, and we ask them. And I would say at least two or three of them, most patients will say, Oh yeah, I do take that sometimes. Like, when was the last time? Oh, two days ago. So these are the kind of things that, it's not easy, listen, when I go to the doctor, I forget half the crap I take myself, but if you're gonna go see someone and you're planning surgery, think about it, write it all down, even the stuff you take once in a while, and, and let your doctor know about it.

[00:09:04] Dr. Salvatore Pacella: definitely on my list. I couldn't set it, couldn't have said it better.

[00:09:09] Dr. Sam Jejurikar: What do you got next, Sam?

[00:09:11] Dr. Sam Rhee: Uh, I got, um, stopped drinking before surgery, so I have a fair number of patients who will say they have a glass of wine or two after dinner, but that glass of wine is usually like, Two or three glasses of wine. Like, I always talk about alcohol because a lot of people drink a lot more alcohol than they think they do.

And again, that may affect their outcomes. It certainly affects their anesthesia. I feel like I do a fair amount of stuff in office too. And I just feel like their outcomes and, and their experience are so much better if we can get them to sort of lay off the sauce for a couple of weeks beforehand. Maybe not the easiest thing to do for some people, but I think it makes a big difference for surgery.

[00:09:55] Dr. Salvatore Pacella: That's an excellent point, which was not on my list, but should be

[00:09:58] Dr. Sam Jejurikar: Not on my list either, but I think it's a really good point.

[00:10:01] Dr. Salvatore Pacella: for the listeners out there, why is this important for surgery? Well, a couple different reasons. So, uh, Sam alluded to anesthesia. So, routinely, if you, uh, you, if you drink a lot of alcohol, It means you, oftentimes during surgery, you're very much resistant to the total amount of anesthesia that you can be given.

So, what I mean is, our anesthesiologists, if somebody is drinking, oftentimes have to really put them fairly deeply to sleep, and that can affect your recovery, obviously. Second issue is bleeding. So, the pathways for alcohol to be removed from your body are through the liver. And the liver is, uh, is one of the organs responsible for creating proteins that are responsible for clotting, okay?

And so when you use a lot of alcohol... What can happen is that liver is going to concentrate on processing the alcohol and not process, processing the proteins you need for clotting. Can lead to hematomas, can lead to excessive bruising, uh, and other sorts of problems.

[00:11:07] Dr. Sam Jejurikar: Excellent.

[00:11:09] Dr. Sam Rhee: Sal, you got one?

[00:11:10] Dr. Sam Jejurikar: yeah, what do you got next?

[00:11:11] Dr. Salvatore Pacella: Okay, so, um, so I got two here. So, uh, we covered three that were on my list here. So, number one is, kind of goes along with what you're saying about alcohol, but I would say, what I tell my patients is, I would like you to keep the same exercise and diet routine. That you are doing now, going up into surgery.

So, if you don't do anything, just stay healthy and keep doing what you're doing, okay? If you're continuing to work out, this is not a time to stop working out, okay? And why is that important? Very important to me in body contouring procedures like abdominoplasty, liposuction. Why that is, is because if you lose a dramatic amount of weight prior to your surgery, and you are in exceptional fit shape, nine times out of ten what happens is after you're done with surgery you go back to those same habits that you had before.

You were planning and that could lead to excessive weight gain, it can lead to fat swelling, and it could lead to a suboptimal result. So you just want to be consistent and remove as many variables as you can going into surgery.

[00:12:14] Dr. Sam Jejurikar: I love that advice. Not

[00:12:15] Dr. Sam Rhee: that on my, I got that on my list. Slightly different, I said get, get healthier if directed weight management nutrition for body contouring. Um, there are some patients where, uh, like you said, if they're in fit shape and they're doing great, just keep doing it. Don't stop just because you're having... Um, there are some body contouring patients that kind of push a little bit in terms of if I, if I ask them, they're not happy where they're sitting in terms of their health. Well, I want them to get there before surgery because. Like you said, they're going to revert back to wherever they were, sort of, post surgery, pre surgery.

So, get the pre surgery set up right for yourself, uh, like you said, and, and generally speaking, uh, that will hold after, after your procedure.

[00:13:02] Dr. Salvatore Pacella: Now that leads me to a question for, uh, both of you guys who do, uh, tremendous amount of BBLs. How is your, how is your advice different for the BBL patient?

[00:13:16] Dr. Sam Jejurikar: Um, I tell them to, slightly differently, I tell them that I don't want them to lose weight after their BBL. And I don't want them to artificially gain weight. There's many surgeons that will tell patients, Oh, you know, you don't have enough fat, put on some fat, and then we're gonna harvest that and graft that.

But, as you guys know, I mean, the way fat works is by storing triglycerides. Fat cells store triglycerides, so if you, if you have a BBL, you gain weight for it. And then you lose that weight after surgery, well, by definition, those fat cells that you transplant will shrink. So, I'd rather have to work very, very, very hard to get that fat, and then them be at their lowest weight going into it.

Because then, you know, typically, if patients are going to gain weight after surgery, their butt will get a little bigger as opposed to smaller. Bottom line is, I do not have people artificially gain weight for

[00:14:08] Dr. Sam Rhee: agree. There's something that's wrong to me about making people unhealthy or, or asking them to become unhealthy before surgery. That just smacks of, I don't know, it's just wrong, you know, philosophically for me. So, I will say, listen, if you want to gain weight before surgery, that's fine, but you can't do it eating Krispy Kremes.

Like, trust me, nobody gains weight by eating more grilled chicken and, and broccoli. Like that's really hard. So if you want to, if you want to keep eating more, fine, but stick to the healthy stuff. And trust me, like most patients are going to find that excessively difficult to do.

[00:14:44] Dr. Sam Jejurikar: Yeah. Um. Along those lines, something I have on my list, which I don't know if you guys have on yours, but you would agree with, is to optimize your nutrition ahead of time. Where we've been talking about body contouring and one of the things that I think both you guys will agree with is that protein optimization prior to surgery goes a long way in helping to prevent wound healing complications.

So I'll have my patients if they're getting particularly body contouring procedures, but I think this applies to any surgery for at least... Um, for at least a month ahead of time, I want them to augment their traditional diet by at least 60 to 80 grams of protein a day. Um, there's, there's data out there that shows that can make a profound impact in preventing wound healing complications. Some of the most frequent complications we can see after big body contouring operations.

[00:15:26] Dr. Sam Rhee: Do you, uh, recommend a particular supplement or just adding more food with protein to their diet?

[00:15:32] Dr. Sam Jejurikar: I, I typically tell them that it's going to be easiest to do that by adding protein shakes, and we'll talk about a variety of protein shakes, like Premier Protein is everywhere in every grocery store on Amazon. 30 grams of protein and 160 calories in every, in every bottle. Um, so I think that's, you know, that that's a very effective and easy thing for patients to do.

There's, there's particular, you know, protein shakes that are formulated for surgery, but those tend to be pretty expensive and they're more defined. Um, feel in the general surgery space. I don't feel that strongly about that. Um, but yeah, I mean, I think protein shakes through whatever form are, are very,

[00:16:07] Dr. Sam Rhee: Great point.

[00:16:10] Dr. Sam Jejurikar: um, what else does anyone else have anything that hasn't been said? I have one more, but I don't want to

[00:16:14] Dr. Salvatore Pacella: Uh, I have, I have one more. Um, so, uh, you know, one thing I tell patients, particularly in the. Uh, patients in the breast cancer world, but it, uh, it applies to really everyone, which is you have to mentally prepare yourself for recovery after surgery. You cannot go into surgery stressed out about getting all your work done at your job.

Knowing that you're going to take two weeks off, or six months off, or whatever, okay? Um, this is also not the time where, after a blepharoplasty, the next day you're going to be catching up on emails at work, okay? You're going to give yourself headaches, you're going to give yourself eye strain, you're going to give yourself migraines, okay?

So, you need to take the time to prepare yourself ahead of time and prepare yourself for relaxation and recovery. This should be your full time job for the appropriate amount of time that your surgeon tells you. And, you know, believe it or not, this is very difficult for people to do. I mean, certainly difficult for me to do, uh, but you have to get yourself in this kind of this Zen space that gets you.

I'm going to concentrate on my surgery kind of thing, you know?

[00:17:30] Dr. Sam Rhee: I, I have

[00:17:30] Dr. Sam Jejurikar: that was my last one. Yeah, that was my last

[00:17:32] Dr. Salvatore Pacella: Oh, well,

[00:17:33] Dr. Sam Jejurikar: yeah, that's, that's exactly, I couldn't agree more with that. People just don't give themselves the time that they need to recover. And then they're trying to make swelling go away or pain go away in an artificial constraint that is just not realistic.

And then that tends to make the recovery much worse. It makes them much more emotional, contributes to post operative depression. And so, um, couldn't have said that any better than you did, I agree.

[00:17:59] Dr. Sam Rhee: I, that was my last one too. I said. Like, I get patients all the time. They're like, I need this surgery now. In, in eight weeks, I'm going, I'm getting married, or I'm going on a big family reunion trip, and I, I need to look good by then. And, those are the patients that will inevitably run into some sort of complication or difficulty.

Like, you know, avoid the deadline mentality when it comes to

[00:18:23] Dr. Sam Jejurikar: Well, at least you have that option that, that we don't have for them. And that is you can get them into your CrossFit gym and start training them. Like, you know, like, at least that's how they're going to get ready in eight weeks. Cause surgery

[00:18:32] Dr. Sam Rhee: I wish I

[00:18:33] Dr. Sam Jejurikar: hell is not going to do that.

[00:18:34] Dr. Sam Rhee: I wish I could. I will, I will tell you. Um. Anyone who comes in with a deadline or like Sal says, says, I have to get to work right away or I have to do this, that's a setup for like you said, that stress will delay, delay, delay your outcome. And so

[00:18:53] Dr. Sam Jejurikar: I mean, I think deadlines are okay. They just have to be realistic deadlines, right? If they say I have a wedding in nine months, that's a deadline I'm excited about. If they tell me that I have a deadline in three weeks, it's going to, let's look at the Spanx catalog together, you know, lunch. But yeah, there's, that's just not gonna work.

[00:19:13] Dr. Sam Rhee: Absolutely.

[00:19:14] Dr. Salvatore Pacella: I had a patient come to me a couple months ago who, you know, it was a facelift, she was ready to have surgery. She's like, how quick can you do it? How quick do you need? My son's getting married next month. You know, like, it's not gonna, it's not gonna happen. Heh, heh, heh. So.

[00:19:35] Dr. Sam Jejurikar: Well, I think this was really, uh, kind of a neat way to do things. I, I like this topic. Hopefully, yeah, hopefully patients got something out of this. Um, I know I, I, it's, it's reassuring to hear that we all sort of think the same way on these things. Um, and, you know, I think together we came up with a list of 8 to 10 things that patients can actually, uh, can use to, to succeed after surgery.

[00:19:57] Dr. Salvatore Pacella: A real shocker, right? That we all said about the same thing. We're all, 80 per, it was an 80 percent overlap, okay? 4 out of 5.

[00:20:07] Dr. Sam Jejurikar: Yeah.

[00:20:07] Dr. Sam Rhee: 80%. It's really surprising to me. I mean, again. We are all in different locations around the country. Our practices, setups are totally different in a lot of ways, but we are all sort of honing in on what makes people successful before surgery. And it's universal. It's, it's, it really is kind of universal.

[00:20:28] Dr. Sam Jejurikar: All

[00:20:28] Dr. Salvatore Pacella: right. With that, well, let's sign off. Gents, it's been a pleasure. We'll see you for the next one.

[00:20:33] Dr. Sam Jejurikar: then.

[00:20:33] Dr. Sam Rhee: Take care.