Advice For Overseas Patients
Advice for overseas patients
As mentioned elsewhere in the website, my primary objective remains patient safety. I have been treating patients from abroad for some time now, and can therefore offer some advice, based on experience, to maximize safety. Obviously, I can only look after you for as long as you remain in Cape Town, so in essence, the longer, the better! You need to plan your trip sensibly, to ensure a minimum of 2 to 3 days pre-operatively in Cape Town, during which time we can have a formal consultation or two, and discuss the specific procedure in considerable detail. Post operative stay requirements will vary with the different procedures; on average 10 days to two weeks is ideal for most surgeries; the exception being breast reductions, facelifts and full tummy tucks, which ideally require a 3 week post op stay.
PRIOR TO LEAVING
- G.P: Visit your GP or local physician to ensure you are in good general health, have your blood pressure checked etc.
- MEDICATION: AVOID all medication that contains any aspirin, NSAID’s (anti-inflammatories) or any other herbal / homeopathic remedies, vitamins, minerals etc. for at least 2 weeks before the surgery. The list is extensive, and includes, but is not limited to, all OMEGA OILS, GARLIC CAPSULES, EVENING PRIMROSE OIL, FLAXSEED OIL, ARNICA, GINKO BILOBA, ST JOHNS WORT etc. All of these medicines interfere with blood clotting, putting you at greater risk for bleeding during and after the surgery. I will need to know about any medicines that you are taking on a regular basis. Paracetamol / Tylenol can be taken without any problems. Please remember that many “cold & flu” remedies contain aspirin – PLEASE CHECK WITH ME IF THERE IS ANY DOUBT.
- IN SHORT – YOU MAY TAKE NO MEDICATION WHATSOEVER (unless cleared by me), WHETHER HERBAL OR HOMEOPATHIC, FOR A FULL 2 WEEKS BEFORE ANY PLANNED SURGERY. Failure to follow this may well result in your surgery being cancelled.
- SMOKING: I do not perform certain surgeries on active smokers – notably facelifts tummy tucks and labiaplasty. Smoking interferes with wound healing, and increases the risk of all surgical complications. For these and all other procedures, one should stop smoking for 4 weeks pre-operatively and 4 weeks post operatively to minimize your risk of complications.
- WEIGHT: Being significantly overweight is a risk factor for surgery – one should be as close as possible to one’s ideal weight before surgery of any kind is undertaken. A BMI of below 30 is acceptable. If your BMI is much over 30, it is unlikely that I will be able to offer you surgery.
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- BREASTS: If you are planning any aesthetic breast surgery, and are close to, or over the age of 40, it is strongly advised that you have a mammogram and breast ultrasound before the surgery, or at least within the preceding year. This can be arranged via my office given adequate notice.
- Try to organise a seat with extra leg room.
- Ensure that you drink plenty of non-alcoholic drinks – keep well hydrated.
- Do the in-flight leg exercises as advised by the cabin crew.
- Ideally, purchase medical grade anti-embolism stockings (T.E.D stockings) which should be worn for the duration of the flight.
- Walk up and down the aisles when possible.
- Wear comfortable, loose fitting clothing on the flight.
- Do NOT take aspirin on the flight!
ON ARRIVAL / PRE-OPERATIVELY
- Go for short walks – get some exercise!
- Purchase an anti-septic body wash / shampoo (eg Betadine or Bioscrub – if you are not allergic to iodine) and use for 2 or more days pre-operatively.
- Avoid alcohol the week before surgery.
- You may need to purchase a pressure garment (for liposuction) or a sports bra (for breast augmentation) – I will advise you about this during the consult. FYI, the bra I most often recommend after sub-glandular breast enlargement (pre-pectoral / in front of the chest muscle) is the Triumph Tri-Action Sports Bra, which is available locally from either Total Sports, or Edgars at the Waterfront shopping mall – 5 minutes by car from my office.
- Avoid sun tanning in the days pre-op. The sun in South Africa is particularly strong, and severe sunburn is likely, especially if you are from abroad. Severe sunburn may result in your surgery being cancelled or deferred.
- You will need to rest for a few days. That said, moderate exercise e.g. short walks, are beneficial in improving circulation and accelerating the resolution of swelling.
- Expect to be a bit bruised and swollen for a few days – it may be several months before the final result can be seen.
- Analgesics will be prescribed once you leave hospital – keep yourself as close to pain free as possible for the first 24 hours, by taking these regularly.
- Eat sensibly post operatively – you need to provide your body with the “building blocks” to begin the healing process. I encourage the use of vitamin supplements post op, and usually recommend Berocca.
- On the return flight, do as mentioned above under “flights”. If you have had body contouring surgery, do not wear the pressure garment on the flight, and use the T.E.D anti-embolism stockings.
- Keep in touch via email when you get home, so that I can follow your progress.
SCAR MANAGEMENT POST OPERATIVELY
- All surgical incisions result in scars which are permanent. The concept behind post operative scar management is to modulate this process to try to ensure your get the best possible scar that your body will produce. Remember that the ultimate scar quality depends more on your genetics than it does on the surgeon – some patients make beautiful, barely visible scars whilst others make thick, unsightly scars, but everyone can make the effort the maximize their “scarring potential” by following a simple post operative regimen.
Please note that scars take about a year to become quiescent / mature, and often look their worst between 3 and 6 months post op, as the body lays down a lot of new scar tissue which it later withdraws and remodels. A useful guide is that at 1 month after any surgery, your scar will look well healed, but is only about 25% of its final strength. During the period of scar “activity” (approximately 1 year, but most active during the first 3-6 months), you can influence the final product by the following:
General factors, such as good nutrition, avoidance of smoking, and avoidance of direct sun exposure will go a along way to improve overall scar quality.
As regards local care, I usually recommend the following:
Either – micropore tape (made by 3M) to be applied (where practical) along the length of the scar. This is left in place and changed for a new piece of tape at approximately 2 weekly intervals, for the first 3 months post operatively. Most body contouring surgeries in my practice will have micropore placed on the incision at the end of the surgery, and left in place for the first 2 weeks post op, to support the wound. Please note that a small number of people may be allergic or “react” to this tape.
If you want the “best that is available”, I usually recommend a silicone based gel, called kelocote (www.kelocote.com) or Dermatix (same product, different trade name), although cicacare is another silicone gel product that can be purchased in sheets, rather than gel form. (My experience is that most patients favour a gel, rather then gel sheeting, as it is less fuss to apply)
Kelocote is usually applied twice daily, in very small amounts, to the incision once it is completely healed (usually start at about a month post op) and although we are not 100% certain how the silicone gels work, there is a good body of scientific evidence to verify their efficacy. Kelokote is available for purchase at my office. It is used in place of micropore, not together with it, and typically for about 3 months, or longer if there is significant scar redness / activity.
I strongly advise that either micropore or kelocote be used for the first few months after any surgery.