Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Pre and Post Operative Instructions

Pre-operative Checklist and Post-operative instructions

Our aim is to get you through your surgical experience as safely, as simply and as comfortably as possible.

  1. Pre-operative preparation at home for recovery

After surgery you may be tired and lacking in energy. Ensure that you are well prepared at home. Allow yourself the time and space to recover. Make sure you have everything you will need at home before surgery.

  1. Diet

Eat healthily before and after surgery.
It might be beneficial to take Vitamin C and Zinc supplementation to aid in wound healing.
Avoid Aspirin containing medication, anti-coagulant medication and all supplements (apart from the above) for 2 weeks prior to surgery as these can cause bleeding issues.
Ensure that after surgery you drink sufficient fluid so that you are passing good volumes of pale urine.

  1. Sleep

Sleep aids recovery. Ensure that you get adequate sleep and rest before and after surgery.

If you think you will need sleeping pills before and/or after surgery then please let us know. We usually use Stilnox 10 mg – take half or one tablet before bed.

More information: http://www.sanofi.com.au/products/aus_cmi_stilnox.pdf

  1. Hygiene

Bath or shower the night before and the morning of surgery and wash the area to be operated on well. You can use an anti-bacterial soap and one may be supplied.

  1. Pain

Surgery is never completely pain free, but in general plastic surgery procedures are not that painful and are entirely bearable. We will try to reduce your pain to a level which is easily tolerated. We have a step-wise approach to pain management so as to provide optimal pain relief with minimal side effects. The more steps you go up, the higher the risk of side effects.

It is best to take your medication with meals.

Step 1: Paracetamol 1 tablet plus Stilpane 1 tablet. Take both together every 6 hours.
1 tablet of Paracetamol contains 500 mg of paracetamol.
1 tablet of Stilpane contains 320 mg paracetamol and 8 mg codeine.
The two together optimise the paracetamol dose and the codeine works synergystically with the paracetamol. Codeine can cause gastro-intestinal side effects including constipation.
After a few days, when the pain is less, stop the Stilpane and continue with the Paracetamol only, 1-2 tablets 6 hourly when needed for pain.
Alternative to Stilpane: Mypradol (250 mg paracetamol, 10 mg codeine and 200 mg Ibuprofen).

Step 2: Add Celebrex 200 mg, morning and evening.
Celebrex is an anti-inflammatory (a COX-2 inhibitor) and strong analgesic. Celebrex can also cause gastro-intestinal side effects including heartburn.

Step 3: Oxynorm 5-10 mg, 3-4 times a day as needed. This is a strong analgesic in the same class as morphine (opiate).

More information:
Paracetamol: http://home.intekom.com/pharm/gulf/von-pmol.html
Stilpane: http://home.intekom.com/pharm/lennon/stilpant.html
Mypradol: http://home.intekom.com/pharm/adcock/myprod-c.html
Celebrex: http://home.intekom.com/pharm/searle/celebrex.html
Oxynorm: https://www.drugs.com/uk/oxynorm-10mg-capsules-leaflet.html

  1. Bowel actions

Because constipation can be a problem after some surgery and a side effect of the medication, if you are prone to constipation we can prescribe Movicol.
More information: https://www.drugs.com/uk/movicol-sachets-leaflet.html

  1. Mobility and exercises

To improve circulation and reduce the risk of leg clots it is advisable not to remain totally bed bound during the day, but to move around a bit. Also, while in bed do leg exercises, flexing your toes and ankles, holding them flexed and then extending them and holding the extension. Similarly knee bends are useful. Ten an hour every hour. All patients will receive a full risk assessment prior to surgery.

  1. Compresses

Hot compresses, heat bags and hot water bottles should NOT be applied. After surgery sensation may be diminished the application of heat can cause burns. Similarly ice or cold packs are NOT recommended and can lead to thermal injury and vascular compromise. For facial rejuvantion surgery or eyelid surgery cold can be applied as follows and may be comforting. Combine ice and water in a bowl and circulate two face clothes between the iced water and your face or eye area.

  1. Dressings

Dressings are placed to protect the wound and frequently to keep sutures in place. Unless otherwise instructed, do not remove or disturb your dressing. Do not remove or cut any sutures. If you feel you need a dressing change, please contact the rooms to arrange to come in to have the dressing inspected and changed by us. I usually use a thin, plastic, waterproof dressing. You can shower with this dressing. It is not unusual for some blood to collect beneath the plastic.

  1. Monitoring for complications or problems

The complication that I am most concerned about early after surgery is bleeding. Internal bleeding will be evident as swelling, bruising and pain, usually markedly different from the other side. If this occurs contact me immediately. I will usually ask you to send me a selfie of the area and arrange to see you with a view to a return to theatre to evacuate any blood collection and control the bleeding.

Infection, if it occurs, is a later event, occuring days after surgery. It is characterised by pain, warmth, swelling. Like bleeding, if it occurs it is usually obvious. Again, you should contact me if you are worried.

A painful swollen calf might be indicative of a blood clot. The only way to confirm this would be to send you for a scan.

  1. Check ups

Your first post-operative check up will be 1-3 days after surgery depending on scheduling. Thereafter there will usually be 2 or 3 check ups in the early post-operative period. Further check ups will be arranged accordingly and I have an open door policy in regard to additional check ups. If there is an issue you need to discuss you can either schedule to come in or contact me.

  1. Whom to contact

Dr. Lazarus: 082 656 1961. You can send a Whatsapp picture of the operated area any time.

Danni will call or message you the night before surgery, the evening of surgery and the morning after surgery. Ensure that your phone is on and that you can take her call (private number).

  1. Feedback and rating

If you are satisfied please give me a patient rating on Google or www.realself.com. Thank you for trusting me with your surgery.

 

Testimonials

Dear Anneli, My best wishes to you and Dirk. Thank you for all the excellent care provided. He is a great colleague. Got the compliment that you need to hear. I was told by my office manager yesterday that my face looked much better having removed the beard and moustache while on this March vacation. It was removed over a year ago. Hence, something was different and better but she could not tell what. Sign of an excellent surgical result. You did a great job. Truly impressive facility, …