Dr. Dirk Lazarus, Plastic Surgeon, Cape Town, South Africa

Planning your trip: Duration of stay
Surgery always entails some downtime necessary for recovery. You should allow for this when planning your trip. Guidelines for minimum duration of stay are presented below. Longer is always better, especially if you know you are a slow healer. Check with me before finalising travel arrangements.

single consultation: Botox, fillers (Restylane, Perlane)
8-10 days: eyelids, ears, tip rhinoplasty, liposuction, breast augmentation, brow lift
2-3 weeks: facelift, breast reduction, tummy tuck, rhinoplasty

If problems or complications arise, you may have to delay your return home. This is highly unlikely, but the possibility should be taken into account.

What to do before you leave home
1. Ensure that you are healthy - go to your GP for a check up, including blood pressure, haemoglobin.
2. Eat sensibly to achieve your ideal weight.
3. Do moderate exercise, involve a personal trainer.
4. Live a healthy lifestyle.
5. Avoid smoking especially 2 weeks prior to and after surgery.
6. Avoid aspirin-containing medication for 2 weeks prior to surgery. Aspirin can increase bleeding.
7. Avoid the oral contraceptive pill as this increases the risk of leg clots.
8. Avoid any medication or substance, including vitamins (vit E) and homeopathic treatments, which can affect the clotting of your blood.
9. Avoid arnica until about 2 days post-operatively.
10. Bring sunglasses and a scarf for face surgery; loose fitting clothes for body surgery.

What to do on the flight
1. Use graduated pressure stockings for your legs, such as TED stockings or flight socks, when you fly, intra-op and post-op
2. Drink plenty of water on your flight over. Avoid alcohol.
3. Exercise on the airplane - follow the instructions in the in-flight magazine.

What to do after you arrive in Cape Town
1. Go for a good walk soon after arrival to improve the circulation in your legs.
2. Wash well the night before surgery and the morning of surgery. If possible use an antiseptic soap such as Betadine and shower rather than bath.
3. At the pre-op consultation ensure that all your questions are answered and that you are confident that you understand your procedure, the risks, possible complications and the likely post-op course. The better prepared you are, the easier it will be. If you are unsure about something, ask me.

What to do after surgery
1. Allow yourself the time to recover. Do not plan too busy a schedule.
2. Follow any specific post-op instructions diligently.
3. Do not expect to see the result immediately. Your body takes time to heal and to recover. Swelling and bruising take on average 2-3 weeks to settle.
4. Allow for the routine post-op consultations. I will see you a number of times after surgery and before you leave for home.
4. Follow the same precautions for your flight home as you did on your flight to Cape Town.
5. Once home, keep in touch and keep me informed of your progress via e-mail.

What if a complication occurs after you return home?
Complications, if they occur, can be problematic for any patient - even more so if you are a traveler away from home, or if you have already returned home. Although rare, complications can occur with any surgery - even the healthiest patient and the best surgeon! Fortunately most complications are minor and resolve without the need for further surgery. Most complications occur soon after surgery, hence the recommended duration of stay.

Complications which occur once you are back home will have to be dealt with by a doctor/plastic surgeon in your home country. I can keep in touch and give advice, but obviously cannot treat a problem from some distance away. I do have plastic surgery colleagues, mainly in the UK, who will be available to see problems on a fee for service basis.

To avoid complications I try to operate with an awareness of the potential for problems and my surgical philosophy is one of conservatism. On the whole, plastic surgery is safer than many other types of surgery because procedures are relatively minor and superficial and surgery is being performed on a fit individual. Safety is my primary concern. I do not take on unsuitable or high risk cases. Having plastic surgery in another country should really be restricted to the routine case rather than the extraordinary. Careful patient selection is important so that the great majority of patients can undergo uneventful surgery and return home fit, healthy and happy.

Standard Health Precautions for the Traveler
Fortunately South Africa, and Cape Town in particular, has an extremely good and reputable health care system. Nevertheless you should take the standard precautions:

Ensure that you are healthy when you travel. Have a dental check up prior to your departure. Bring a spare pair of spectacles.
Ensure that required immunisations and vaccinations are up to date.
If in doubt, check with your doctor or travel clinic at home before you leave.
If you are on routine medication, bring it with you in the original packaging.
Take out travel health insurance.

Cape Town is not a malaria area, although parts of the north of the country and other parts of Southern Africa are. If you are considering going to these areas, ensure that you have anti-malaria prophylaxis.

For patients traveling from the UK, please obtain the Health advice for Travelers booklet (phone: 0800 555 777) or go to www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/en

Deep Vein Thrombosis
Deep Vein Thrombosis (DVT) is the formation of a blood clot in the deep veins of the legs. The blood clot can break off and travel in the blood stream to the lungs as a pulmonary embolism (PE). Pulmonary embolism can cause problems with breathing, blood flow in the lungs and can even be fatal. Prior to undergoing surgery, it is appropriate to have perspective on DVT, its causes and risk factors and what you can do to minimise the chance of its occurrence.

The risk factors are
~ Long haul flights
~ Surgery: major surgery, abdominal surgery
~ Previous DVT or PE
~ Patient age (increase risk with increased age)
~ Obesity
~ Disease (diabetes mellitus, cardiac disease, respiratory disease, polycythemia)
~ Medication: oral contraceptive pill
~ Pregnancy
~ Cancer

Preventative measures
~ Avoid risk factors such as the oral contraceptive pill, etc. If you are on the pill, I recommend stopping it one month prior to surgery. Don't forget to take other contraceptive measures!
~ Stop smoking: Not only does smoking increase the risk of DVT, but it also increases the risk of other complications.
~ Graduated compression stockings such as TED stockings can be obtained prior to your departure from home, used on the airplane coming over and during and after surgery. This is well worth doing and I would urge all patients traveling from abroad for surgery to do this.
~ Exercise routinely post op and on the flights here and home: Every hour on the hour: knee bends, ankle movements, wiggle toes. Walk around. Follow the guidelines in the in-flight magazine.
~ Avoid sleeping pills and alcohol on the flight.
~ Drink plenty of fluids, water in particular.
~ High risk patients will also receive treatment in theatre and other preventative measures.

PLAN WELL AND HAVE A SAFE TRIP!

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