PREOPERATIVE CONSULTATION MELVIN A SHIFFMAN M D J

PREOPERATIVE CONSULTATION MELVIN A. SHIFFMAN, M. D. , J. D. TUSTIN, CALIFORNIA

HISTORY n PRESENT COMPLAINT – WHAT SPECIFIC AREA(S) AND PROBLEM(S) DOES THE PATIENT WISH TO HAVE TREATED

PAST HISTORY n PRIOR SURGERY – AT LEAST SPECIFIC TO THE AREA THAT PATIENT WILL HAVE TREATED n n n PRIOR COSMETIC PROCEDURES INCLUDING FILLERS AND SURGERY HISTORY OF EASY BRUISING OR BLEEDING CARDIAC OR PULMONARY DISEASE DIABETES MELLITUS ALLERGIES OTHER SERIOUS MEDICAL DISORDERS

FAMILY HISTORY BLEDING TENDENCIES n THROMBOEMBOLISM n CANCER (BREAST) n

MEDICATIONS ASPIRIN n ANTI-INFLAMMATORY DRUGS n STEROIDS n ANTIHYPERTENSIVES n ANTICOAGULANTS n HERBALS n ESTROGENS n

PHYSICAL EXAMINATION HEART AND LUNGS n AREA(S) OF INTEREST TO BE TREATED n – BE THOROUGH IN EVALUATION – ABDOMEN: CHECK FOR SCARS, HERNIA, DIASTASIS RECTI – DIAGNOSES SHOULD BE CONFIRMED BY THE EXAMINATION

MEDICAL RECORD n ALL INFORMATION SHOULD BE RECORDED IN THE MEDICAL RECORD – HISTORY – PHYSICAL – IMPRESSSION (DIAGNOSIS) – PROPOSED PROCEDURES, DISCUSSIONS OF PROCEDURE AND RISKS AND COMPLICATIONS

OFFICE VISITS n SUBJECTIVE – PATIENT COMPLAINTS n OBJECTIVE – EXAMINATION n ASSESSMENT – DIAGNOSIS(ES) n PLAN

PREOPERATIVE EVALUATION n LABORATORYOVER THE AGE – CBC n CHEST X-RAY – SMOKER? – OVER THE AGE OF 50 n EKG – SYMPTOMATIC? – OVER THE AGE OF 50

PREOPERATIVE INFORMATION n n n DESCRIBE THE PROCEDURE DISCUSS RISKS AND COMPLICATIONS STRETCH MARK CANNOT BE REMOVED NO WEIGHT GAIN BEFORE SURGERY TRANSFUSION ALMOST NEVER NECESSARY VARICOSE VEINS MUST BE STRIPPED BEFORE LIPOSUCTION OF LEGS

RISKS AND COMPLICATIONS n 20% OF PATIENTS – ASYMMETRY – WAVINESS, PITTING, RIPPLING, SAGGING, DEPRESSIONS – INSUFFICIENT FAT REMOVAL ESCESSIVE FAT REMOVAL

n POSTOPERATIVE PROBLEMS – NERVE DAMAGE, SENSORY – SEROMA – HEMATOMA, BRUISING – SCAR: HYPERTROPHIC, WIDENED, KELOID – PAIN: MAY PERSIST FOR MONTHS

ITCHING, BURNING SENSATION n INFECTION, SEPSIS, CELLULITIS, TOXIC SHOCK SYNDROME n INCREASED OR DECREASED PIGMENTATION n SKIN NECROSIS n PROLONGED WOUND DRAINAGE n

THROMBOEMBOLISM n BLISTERS n PERFORATION OF VESSEL OR ORGAN n LIDOCAINE TOXICITY n PERSISTENT EDEMA n DISSATISFACTION WITH RESULTS n

PREOPERATIVE INSTRUCTIONS STOP ALL ASPIRIN OR NON STEROIDAL ANTI-INFLAMMATORY AGENTS AT LEAST 2 WEEKS BEFORE AND 2 WEEKS AFTER SURGERY n NO SMOKING AT LEAST 2 WEEKS BEFORE AND 2 WEEKS AFTER SURGERY n

NO ANTICOAGULANTS n STOP VITAMIN E, HERBALS, AND ESTROGENS n DIABETES MUST BE UNDER CONTROL n

POSTOPERATIVE INSTRUCTIONS REST AT HOME FOR 2 DAYS n AMBULATE AS TOLERATED AT LEAST TO BATHROOM AND FOR MEALS n GARMENT MAY BE REMOVED AND WASHED AT ANY TIME n WEAR THE GARMENT FOR AT LEAST 3 WEEKS n

RESUME NORMAL ACTIVITIES AS TOLERATED AFTER 2 -3 DAYS n PINK DRAINAGE IS EXPECTED n IF BLEEDING IS EXCESSIVE, CALL THE DOCTOR n IF REDNESS OF THE WOUNDS OR PUS DRAINAGE OCCURS, CALL THE DOCTOR n

SHOWERS MAY BE STARTED AFTER 3 DAYS n IF SHORTNESS OF BREATH, CHEST PAIN, MENTAL CONFUSION, FAINTING, OR SEVERE PAIN OCCUR, CALL THE DOCTOR IMMEDIATELY n