Plastic Surgery Blog


 

Pre and Post-Operative Care - 9/24/2020

I take pre- and post-operative care very seriously.  In fact, measures taken before and after surgery can potentially reduce the risk of complications and improve the overall outcome for the patient.  Patients must be appropriate candidates for the procedures they seek, and they need to be optimized prior to surgery if they have underlying medical conditions.

Every surgery and every patient is unique, so specific instructions are tailored for each individual.  However, there are some basic guidelines that are helpful for patients to hear. 

For example, I ask that patients undergoing surgery with IV sedation or general anesthesia obtain medical clearance from their primary care physician to ensure that it is safe to proceed with surgery.  If patients do not have a primary care doctor, I can make referrals.

Unless patient must be on a prescribed blood thinner for an underlining medical issue, medications that cause bleeding should be avoided for at least 1 week before surgery.  If it is possible for a patient to stop a blood thinner prescribed for an underlying medical issue, I usually ask the prescribing physician for a note stating that it is alright for the patient to stop the medication.  Blood thinners to generally avoid before surgery include aspirin, ibuprofen, Advil, Aleve, naproxen, Midol, garlic, ginko buloba, Vitamin E, and multivitamins.  A full list of medications to avoid is provided at the pre-operative visit. Tylenol is acceptable to take prior to surgery.

Patients should not eat or drink after midnight the night before surgery.  This is applicable to anyone receiving a procedure in the operating room since that is where IV sedation and general anesthesia is administered.  After undergoing anesthesia, patients are not able to drive, and must have a responsible adult driver available. 

After undergoing general anesthesia, it is important to ambulate and stay hydrated. This helps to prevent blood clots from forming in the legs. Patients can continue to wear compression socks for one week after surgery.  They should be adjusted throughout the day so that there is no skin breakdown.

I prescribe a non-narcotic pain control regimen for after surgery. This includes Tylenol, Celebrex, and gabapentin.  Tramadol, a controlled substance, can be added if needed.

Some procedures require the placement of drains.  If there are drains, patients must keep a log of their drain output. This is important because the log tells us when the drains can be removed, or if there is a problem, such as a hematoma (blood fluid collection) or seroma (body fluid collection).  Drains can be emptied twice per day or when half full.  Drains should always be compressed so that they are on suction.  The color will change from a frank red color to fruit punch color to light pink to yellow.  Drains will be removed once output is <30cc/day for 2 consecutive days.  (This is for each drain).

Cases involving large-volume liposuction, as well as some others, require overnight monitoring.  However, many of the procedures I perform are done on an outpatient basis.  We can also recommend a luxury post-op recovery facility for you to go to if you feel you would benefit.

Please keep in mind that this article is not all-inclusive.  My team and I will go over pre- and post-op instructions at multiple timepoints in your surgical journey with us.  We are also happy to discuss this with your caregiver after surgery.  We know it can be overwhelming, and we are always available to help!


What are Neurotoxins? - 9/21/2020

According to the 2018 statistics published by the American Society of Plastic Surgeons, botulinum toxin injections were the most commonly performed cosmetic minimally-invasive procedure. These injections are a non-surgical means of facial rejuvenation. Common botulinum toxin products for injection include Botox, Dysport, Jeuveau, and Xeomin. These injections work by inhibiting the movement of muscles in the face, thereby reducing the appearance of wrinkles.

Common areas from injection include the forehead, crow’s feet, and glabella (the area in between the eyebrows). Patient may also get injected off-label in other areas, including the chin and around the mouth. Injections can be utilized to treat a gummy smile and bruxism (teeth grinding).

While undergoing these injections is relatively safe, there are risks, as with any medical procedure. Risks include bleeding, bruising, swelling, eyelid droop, and asymmetry, among others. Patient should not be pregnant or breastfeeding while undergoing this procedure.

Before undergoing neurotoxin injection, it is advisable that patients avoid aspirin, vitamin E, fish oil, and non-steroidal anti-inflammatory (NSAID) medications for one week prior to the appointment in order to minimize bruising. Arnica can be used before and after the procedure to also alleviate swelling and bruising. Patients should avoid working out for 24 hours after the injections, and should remain upright for 4 hours after the procedure (i.e. no lying down or getting a massage).

The effects of the injections can be seen within 3-4 days, but it can take up to 2 weeks to see the final result. The injections typically last 3-4 months, but this may vary.

Whenever I evaluate a patient for toxin injections, I review the patient’s medical history, perform a pertinent physical exam, and review
the risks, benefits, and alternatives of treatment. I greatly value patient safety.

 

What to Expect During a Surgical Consultation - 9/11/2020

By Kristen Aliano Messina, MD

The surgical consultation is an extremely important visit for a patient seeking surgery. This visit gives the patient the opportunity to meet the team and surgeon, and it gives the patient and physician a chance to establish a relationship and rapport. I believe that good two-way
communication is vital to patient care.

Prior to being seen, I have my patients complete a very thorough medical history form. This enables my team and me to appropriately develop a care plan that is unique and tailored to each patient. It also helps me to understand how risky it might be for a patient to undergo elective surgery and pre-existing conditions that might need to be addressed prior to surgery. This helps with patient safety.

During the appointment, the patient has the opportunity to discuss his or her concerns and desires with me. A pertinent physical exam is performed, and I discuss whether or not the patient would be a suitable candidate for the desired procedure. A plan is formulated. If an
intervention is reasonable, I discuss what the treatment will entail, as well as what the post-operative recovery would be like. I also discuss the risks, benefits, and alternatives of the procedure. In the case of a surgery involving breast implants, I give the patient the chance to examine different types of implants and be sized. Photos are taken for the medical record, and the patient care coordinator discusses scheduling and pricing of surgery. We try to ensure that all questions are answered at the time of consultation, but are, of course, happy to answer questions after the visit has ended.

All patients undergoing surgery with general anesthesia are required to undergo pre-operative clearance approximately 2-2.5 weeks prior to surgery. Patients are generally seen back at 2 weeks (barring some exceptions) before surgery to review the surgical plan, confirm implants if applicable, and go through the informed consent process.

I strive to ensure that my patients feel heard and have a good understanding of the process.

 

What is the Profound? - 9/3/2020

By Kristen Aliano Messina, MD

The Profound is a temperature-controlled radiofrequency/microneedling device produced by Candela.  The device inserts pairs of tiny electrode needles into the skin, and radiofrquency energy is delivered to the skin, heating up the collegen.

It is a non-surgical device for the treatment of facial/neck aging.  It can also be used for the treatment of cellulite. Candela reports that the device can increase elastin 5x in the skin and collagen 2x in the skin.  Collagen and elastin are important molecules in the skin.  As humans age, the elasticity of the skin decreases.  Skin becomes more wrinkled and collagen bundles atrophy.

Profound treatments for both skin tightening and cellulite can be performed in the office under topical and local anesthesia.  In general, patients usually only require one treatment with this device.  There is less downtime with this device compared to surgical options to treat the aging face.  Patients typically see results in approximately 6 months, but this can vary.

As with any procedure, there are risks.  Risks of the procedure include, but are not limited to bleeding at the needle insertion sites, pain, swelling, redness, bruising, pigmentation change, itchiness, and tingling sensations.

Among other conditions, this procedure is not applicable for anyone with a pacemaker, active skin infection, collagen vascular disease, active psoriasis, eczema, and rash in the treatment area, history of keloid and hypertrophic scarring, facial laser resurfacing or deep chemical peels in the last 3 months, any surgical procedure in the past 3 month in the treatment area, and Accutane use in the past 12 months.

For a full discussion of the risks, benefits, and alternatives, as well as suitability for the procedure, consultation is required. 

 

Getting to Know Dr. Aliano Messina - 8/27/2020

Check out Kristen Aliano Messina, M.D.'s biography page on the McGuiness Dermatology website to read more about her education, training, and accomplishments!

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