As you undergo surgery, you should be aware that there are three types of surgery facilities: an Out Patient Surgery center, a '23-hour stay' facility (which can be at either a free standing surgery facility or a hospital surgery facility), and a hospital. When you learn which facility your surgery will take place, please make any necessary financial arrangements with that facility. If you are coming from out of town and wish special arrangements for nursing care or a hotel, contact our Patient Coordinator.

PRE OPERATIVE VISIT - Your general health and prevention of any post operative problems are the primary concerns before surgery. Factors that determine where your surgery is performed and what type of anesthesia is to be used are: your health history, your personal requests, your level of anxiety, the nature and length of the procedure and recovery period.

Please be sure to inform the Doctor and the staff of any health problems you may have had, especially events of previous surgeries, and all medications and vitamins taken on a routine basis (especially blood pressure medications.) Good results from elective cosmetic surgery are the result of excellent communication and teamwork between patient, staff and physician.

HELP US TO HELP YOU!! *Call the surgical facility the day before your scheduled surgery to find out the time of your arrival.

SMOKING HAS BEEN SHOWN TO DECREASE THE RESULTS OF COSMETIC SURGERY, PLEASE REFRAIN FOR TWO WEEKS BEFORE AND TWO WEEKS AFTER SURGERY. IF YOU HAVE EVER THOUGHT ABOUT QUITTING, NOW IS A GREAT TIME. DO NOT TAKE ASPIRIN PRODUCTS FOR TWO WEEKS PRIOR TO OR DURING RECOVERY PERIOD FROM SURGERY WITHOUT INFORMING THE DOCTOR.

If you have pain and are in need of some kind of medication, please take Tylenol or ask the office for instructions.

The following drugs contain aspirin:

Aspirin Cope Coricidin Empirin Compound Percodan Anacin Coricidin-D Excedrin Robaxisal

APC Daprisal Fiorinal Robaxisal PH Asa Defort-Derfule Liquidprin Tablets Sal-Fayne Ascription Dolor

Measurin Stanback Bufferin Dristan Midol Trigesic CAMA Ecitrain Norgesic Triaminic

Capron Caps Ecotrin Novahistine w/ APC Vanquish Contact Edrisal Pac Zactrin Anesthesia

For those patients who are having GENERAL ANESTHESIA OR STAND-BY ANESTHESIA your name will be given to the Anesthesiologist. The doctor will answer all of your questions. Typically, for those patients undergoing general anesthesia, the anesthesiologist will gently and painlessly place a soft tube in your arm to administer medication and fluids. You will become sleepy and you will undergo your procedure without memory of surgery .

DAY OF SURGERY - Wear loose-fitting clothes. No jewelry. You will be escorted to the surgery suite and made comfortable on a specialized table. The appropriate heart, pulse, and blood pressure monitors will be applied. When you awaken, you will probably become aware of your surroundings about two hours after

GENERAL INSTRUCTIONS
1. FOR FACIAL OR PLASTIC SURGERY: Nasal Surgery/Ear Surgery/Plastic Surgery Cleanse your face with Betadine Skin Cleanser or any other medical soap thoroughly the night before surgery and the morning of surgery. For women this includes all mascara and eye makeup. Shampoo your hair with Betadine Skin Cleanser or Betadine Shampoo. You may apply conditioner. You may use a blow dryer. DO NOT USE HAIR SPRAY.

2. MEDICATIONS: If you are taking any prescription medications or non prescription drugs, INCLUDING ASPIRIN, notify our office. If you have a medical problem, please contact your private medical doctor to obtain an okay for surgery. Have this provided to our office on the pre-op visit or prior to surgery. If you have recently had a cold or cold-like symptoms or an infection, contact our office. Also, call your medical doctor for any special instructions regarding your medications. TAKE REGULAR MEDICATION ON THE DAY OF SURGERY. Birth control pills or other "anti-inflammatory medications" may have an effect on coagulation. They are blood thinners. Let us know what other medications you are on.

3. EATING: NOTHING TO EAT OR DRINK (INCLUDING WATER) AND NO SMOKING AFTER MIDNIGHT THE NIGHT BEFORE SURGERY.

4. CLOTHING: Do not wear any tight fitting clothing. Wear a blouse or shirt with buttons or a zipper down the front. NO PULL-OVERS. (Women, no girdle or pantyhose; bras will be removed for surgery.) Wear only flat-healed shoes.

5. JEWELRY: Do not wear any jewelry. Leave valuables at home. We will not be responsible for your personal valuables! If you wear contact lenses, leave them at home or remove prior to surgery and give them to the person who will be picking you up. 6.

PRESCRIPTIONS AND ALLERGIES Let us know if you are allergic to any pills or medicines. Your surgical medications and instructions will be given to you at the pre-operative visit, and should be taken as directed. The contents and the directions will be labeled. Common Medications we may be prescribing: 1. Steroid (decreases swelling-low dose, short course, is safe) 2. Antibiotic 3. Pain Medication 4. Betadine Soap (Optional)

RECOVERY ROOM A special recovery room nurse will attend to you and give you whatever medication is indicated for your comfort. Certain criteria are necessary prior to your release. The nurse will be checking with the doctor or anesthesiologist prior to your release.

DISCHARGE FROM THE FACILITY - After the proper time, you will be progressively ambulated until all your vital signs are stable and you are ready for escort to your car in a wheelchair by our staff. NO PATIENTS DRIVE THEMSELVES HOME AFTER SURGERY. DRIVER: Make sure you have arranged for transportation home after surgery. Leave the phone number and address of the person who will drive you home with the receptionist.

IMMEDIATELY AFTER SURGERY AND THE FOLLOWING DAYS We will contact you after surgery. PLEASE DO NOT LEAVE YOUR ANSWERING MACHINE ON!! You are requested to call us at any time you have a question. You are invited to see us in the office for any complaint regardless of how small. THERE ARE NO DUMB QUESTIONS.

1. BATHROOM: Have someone help you up the first time. You may become dizzy when you first get up. BE CAREFUL! Some medication may constipate you. Straining can temporarily increase your blood pressure and you may start bleeding in the early phases of surgery. It could be helpful to use a laxative.

2. BED AND ICE: In almost all surgery, elevation helps decrease swelling and we find ice very effective in helping with black and blue discoloration. Keep your head elevated and try to use ice on your face as much as possible. Try to keep the weight of the ice very light.

DISCOMFORT STAGE - THE FIRST FEW DAYS AFTER ANY OPERATION ARE THE MOST ANNOYING. Almost ANY surgery has some discomfort. You may not sleep so well. Depending upon your procedure, different parts of your body will be sore, your eyes may be swollen shut, blood may appear on your bandages, you may not breathe very well through your nose.

Extreme pain is unusual, and YOU MUST COMMUNICATE THIS TO THE OFFICE. A serious problem may be developing! Bruising will occur almost immediately and will change from PRETTY PURPLE to YUCKY YELLOW - this is normal. You may be wondering why you ever had surgery at this point. All areas in and around incisions will be numb for varying periods of time. Numbness is expected for up to 12 weeks after surgery.

FATIGUE PHASE - Ahhhhhhh! All patients feel a little worn-out. This is normal. The effects of general anesthesia tend to linger for several days and even up to two weeks. Relax and rest.

RELIEF - I can see the light! As the bruising fades, when you are sleeping better and are able to move around, you start to see the improvement. This is a time when you are on the road to recovery.

POST-OPERATIVE PROBLEMS - Patients and Patience Please Unlike the sculptor who can chisel his material almost exactly to his desired specifications, a surgeon works on skin, soft tissues, bone, and blood vessels and must rely on the inherent healing properties of the patient.

Please remember:........................ IT TAKES TIME FOR WOUNDS TO HEAL, SCARS TO SOFTEN, BLEMISHES AND DISCOLORATION TO DISAPPEAR. We are concerned about your discomfort and the problems you may develop. The reason we go to great lengths to examine, diagnose, and prescribe medicine is to AVOID post-operative problems.

The doctor-patient team, working together to get the best results, will provide a happy outcome for all. Fortunately, almost all the concerns that patients have about their surgery procedures continue to improve and get better. Sometimes however, dissatisfaction can persist no matter how good the result. This is a good time to SHARE YOUR FEELINGS AND CONCERNS.

RISKS - Surgery is generally a safe, controlled experience. Rarely do emergent or life-threatening conditions occur.

GUARANTEES - We can not guarantee the results of any procedure, nor can we indicate that you may not need one or several procedures to get the expected result. We can only guarantee to do the best we can for you. Keith Wahl, MD and Staff