JACQUELINE BRAMBILA, PA-C TERRY J. DUBROW, M.D. Certified, The American Board of Plastic Surgery

Transcription

1 JACQUELINE BRAMBILA, PA-C TERRY J. DUBROW, M.D. Certified, The American Bard f Plastic Surgery LABIAPLASTY AFTER CARE INSTRUCTIONS PLEASE READ ME BEFORE AND AFTER SURGERY J ABOUT JACKIE: My name is Jackie, and I am a bard-certified and licensed physician assciate (PA-C) wrking alngside Dr. Terry Dubrw. My jb is t ensure that yu heal ptimally in the pstperative perid. As Dr. Dubrw s right-hand gal, I will wrk very clsely with yu during yur pstperative and fllw-up appintments develping diagnstic and therapeutic plans t ensure ptimal recvery. Yu will be seeing me fr all f yur pstperative visits. Thank yu fr trusting me with yur surgical and pstsurgical care. These pstperative instructins will help guide yur recvery prcess; it is imperative that yu and any f yur caretakers carefully read these instructins befre and after surgery. THINGS TO PURCHASE befre surgery: 1. Maxi padsàthese will help t absrb any fluid that may be seeping frm the incisins sites (which is nrmal). a. Sme patients like t freeze their maxi pads and then use them t ice the vaginal area t prvide relief. 2. Stl sftener (Duclax, Miralax, Metamucil, r Peri-Clace) Pain medicatin can cnstipate yu. Peri-Clace is my favrite as it helps sften the feces ( the mush ) and als helps stimulate the bwels ( the push ). These shuld be started the day after surgery. 3. Dial antibacterial bar sap: Yu will use this bar sap the mrning f surgery t wash the surgical areas. Yu d nt need t use this sap in the pstperative perid as it will dry ut yur skin. Yu may resume yur nrmal sap pstperatively. 4. Arnika and Brmelin: These are herbal supplements that aid in bruising and swelling. Yu can purchase these prducts at ur ffice ($30 fr a 1-week supply), Whle Fds r Spruts. Yu can begin these supplements up t ne week befre surgery and use them fr 2 weeks after surgery. 5. Cmpressin stckings: We will prvide yu with 1 pair f cmpressin stckings immediately after surgery. Please plan t purchase an additinal pair at Target in the event that yur scks becme siled r are uncmfrtable. They will need t be wrn fr 5 days pstperatively. 6. Flwy skirts r maxi dresses: This will allw the surgical area t breathe. 7. Bacitracin intment (Overt the cunter) Which will be applied t suture lines daily. Yu will re-apply yur Bacitracin intment after washing the vaginal area after using the restrm. 8. Oral Thermmeter: It is imprtant t mnitr yur temperature after surgery in the event that yu feel feverish r ht. Yu have a fever if yu have a temperature abve Rapid Recvery and Healing Prtcl, IV Therapy with Dr. Tdd Newman: Cnsider this therapy in ur ffice befre and/r after surgery t imprve wund healing, decrease recvery time, decrease scarring, imprve sense f well-being and reduce pain and discmfrt during yur pst-surgical curse. Yu can find additinal infrmatin abut this in the Rapid Recvery and Healing Prtcl, IV Therapy sectin f the pst-perative instructins and als in the separate handut prvided t yu in yur preperative care flder prvided t yu during yur preperative appintment. 10. Read the Preparing fr Surgery dcument enclsed in yur preperative flder. HAVE SOMEONE WITH YOU: After surgery, have an adult available t stay with yu fr the first hurs, as yu will be weak and drwsy. WALKING: It is imprtant t get ut f bed early and ften after yur surgery (with assistance) t prevent pstperative prblems. It is gd t walk fr minutes 6 times per day r get up every hur t walk t the restrm and back. This encurages bld flw thrughut yur legs t reduce the chance f bld clt develpment. IF YOU HAVE SHORTNESS OF BREATH, LEG SWELLING, AND/OR LEG PAIN AT ANY POINT IN YOUR POSTOPERATIVE HEALING, GO TO AN EMERGENCY DEPARTMENT IMMEDIATELY (OR CALL 911) AS THIS COULD SIGNIFY A BLOOD CLOT. COMPRESSION STOCKINGS/TRAVELING/PRECISION DVT PREVENTION DEVICE: Cmpressin Stckings: If cmpressin stckings were prvided, please leave the stckings n fr 5 days after surgery. They may be remved when shwering but must be replaced after yur shwer. Yu can als purchase additinal cmpressin scks at Target if needed if the nes prvided in surgery are t large r t small r becme

2 siled. Precisin DVT Preventin Device: If it is determined that yu are a high-risk patient fr develping a bld clt, (a DVT), yu will be prvided with a DVT preventin device t be used n yur legs in the pstperative perid. Yu will need t wear yur device anytime yu are nt ambulating fr the first 30 days after surgery. The device will stay charged fr up t 8-10 hurs. The device will charge in 2 hurs. The device is yurs t keep and can be wrn in the future fr DVT prphylaxis when traveling lng distances. Please plan t bring yur device t yur first 3 pstperative visits s that we can dcument the amunt f time the device has been wrn (t ensure cmpliance). Traveling: If yu are an ut-f-twn patient and will be traveling back hme after yur surgery, please wear yur cmpressin stckings and DVT preventin device n the plane and remve them after landing. If yu d nt have the DVT preventin device, please nly wear the cmpressin stckings and when n the airplane, please be sure t get up every hur t walk arund and encurage bld-flw in yur legs. Als, be sure t wiggle yur ankles when sitting as if pressing a gas pedal t prmte bld flw. It is safe t fly 1 week after surgery if yu have been cleared by Jackie t d s. If yu experience shrtness f breath after a flight r leg pain with extreme leg swelling, please visit an Emergency Department immediately t rule ut a bld clt. PAIN AND PAIN MEDICATION: Take pain medicatin with fd. Yu will be given an anti-anxiety/muscle relaxant medicatin (Valium) that yu may take as well t prevent aggravatin f the pain cycle. When taking Valium, take it 1 2 hurs after the pain medicatin. Perccet (Oxycdn + Acetaminphen) r Vicdin (Hydrcdne + Acetaminphen) shuld be taken as directed: Mild t mderate pain: 1 tablet every 4 6 hurs as needed Severe pain: 2 tablets every 4 6 hurs as needed If yur pain is mild, r if yu d nt like the effects f the narctics, yu can take Tylenl (Acetaminphen) 1000mg every 8 hurs (which wuld be 2 tablets f the Extra Strength Tylenl, purchased ver the cunter). Please d nt exceed 3000mg in a 24-hur perid. We will prvide every patient with 1 refill f the pain medicatin and the Valium if needed ne week after the last prescriptin was filled. N additinal refills will be prvided. If yu require additinal pain medicatin, please reach ut t yur primary care prvider fr pain management r visit an urgent care as we will nt prvide additinal refills after the 1 alltted refill. We cannt call-in/fax/ /mail a refill fr pain medicatin t a pharmacy. If yu are an ut-f-twn patient, visit yur lcal prvider, urgent care, r ER fr pain management. Take a stl sftener with pain medicatin t prevent cnstipatin. DO NOT DRIVE WHILE TAKING PAIN MEDICATION r Valium. These medicatins can result in drwsiness. If yu are pulled-ver while driving under the influence f narctics r scheduled substances, yu will get a DUI! DO NOT DRINK ALCOHOL WHILE TAKING PAIN MEDICATIONS r Valium. This can be a deadly cmbinatin. Only take the pain medicatin if needed. The quicker yu can wean ff f the pain medicatin, the better yu will feel and heal. DO NOT SMOKE. This is very imprtant!!! Smking (tbacc, marijuana, r vapes) can result in a lack f bld supply t tissues and fat causing tissue death r delayed wund healing. Even 0% nictine vapes cntain a trace amunt f nictine that the FDA accepts as 0%. Smking can resume 6 weeks after surgery as lng as n challenges in healing are present. SUPPLEMENTS: D nt take aspirin (r prducts cntaining aspirin) r Ibuprfen (Advil, Mtrin, Midl ) fr 3 weeks after surgery. Als d nt begin herbal supplements until 3 weeks after surgery. Arnika, Brmelin and Vitamin C are kay t take. Phentermine r appetite suppressants shuld nt be taken until 6 weeks after surgery as these supplements increase heart rate and bld pressure and can interfere with yur recvery.

3 REMEMBER THE FIVE W S: The mst cmmn cause f an elevated temperature/fever after surgery is due t cllapse f the lungs (atelectasis). This is a nrmal ccurrence as a result f anesthesia and the physical stress yur bdy is underging. In rder t decrease yur bdy temperature and expand the lungs, it is imprtant t d the fllwing: Wind: Take 10 deep breaths per hur fr the first 72 hurs. Water: Dehydratin can als cause an increase in bdy temperature. It is imprtant that yu remain hydrated since surgery can deplete yur bdy f water. 64 unces f water a day is encuraged. Walk: Get up and walk nce every hur t keep yur bld mving. This is key fr preventing a bld clt. Wnder drugs: Take yur pain medicatin r Tylenl as needed. An increase in pain can cause an increase in bdy temperature. Wund: Observe the wund fr redness, heat, discharge (pus), and penings. DIET: A light diet is best after surgery. Begin by taking liquids slwly and prgress t sups r Jell-O. Yu may start a regular diet the next day. Thugh it is impssible t get rid f gas entirely, there are strategies t reduce it. Eat and drink slwly, chew thrughly and cut dwn n carbnated drinks. Avid sugar-free gums and sugar-free candies that cntain srbitl r zylitl bth sweeteners are prly digested and can result in blating. Stay n a sft diet, high in prtein, fr 2 3 days and avid spicy fd which can cause nausea and gas. Then yu may resume a nrmal, high prtein diet. POSITIONING: It is best avid prlnged sitting as this culd add unnecessary pressure t the surgical site thereby increasing swelling t the area. It is best t lie dwn and remain as flat as much as pssible fr the first 3 days. As much as pssible, allw the area t air ut. Yu can wear maxi dresses r flwy skirts t help the area breathe when yu are at hme, sleeping, r at yur htel. DRESSINGS, CLEANSING AND SHOWERING Ice packs shuld be applied every 4-6 hurs fr the first 24 hurs while awake, placed ver a maxi pad. Ice packs shuld never be applied directly t the skin: Wrap in a paper twel. Use f ice packs will markedly reduce the amunt f pst-perative swelling and discmfrt. The surgical dressings can be remved anytime they are saturated and then replaced with a sanitary napkin r maxipad. Antibitic intment (Bacitracin which can be purchased ver the cunter) shuld be applied t the incisins twice a day fr 14 days (re-apply after using the restrm). Please apply a thin cating nly. Excessive amunts f intment are nt necessary. Yu shuld rinse the area with warm water when ever using the tilet (yu can use a clean cup and rinse the area while n the tilet). After rinsing, pat the area dry with a gauze pad r tilet paper, put antibitic intment alng the incisin lines, and replace yur maxi pad. It is nrmal t have swelling and bruising f the labia. This will reslve ver the next tw weeks. There will be bldy r bld-tinged drainage fr a minimum f 1-2 weeks fllwing yur labiaplasty. Yu may take a cmplete shwer with sap and water 48 hurs after surgery. Be careful nt t pull r tug n the incisin lines r sutures. Use warm water. D nt sak in the bath until 3 weeks after surgery. ACTIVITIES Mst patients will experience relatively minr discmfrt after a labiaplasty. Hwever, sme patients d experience mderate t severe swelling that can cause much discmfrt. Patients wh experience minimal swelling and bleeding shuld be able t resume sedentary wrk activities within a few days, resume light exercise at ne week, and have n restrictins after tw weeks. Patients with mre excessive swelling and discmfrt may want t limit their activities until they feel cmfrtable and gradually prgress t their nrmal activities. Yu may resume sexual activity 6-12 weeks after surgery. This is patient-dependent. N verheating fr the first three weeks (n ht baths, shwers, spas, exercising in the sun, etc). Fr the first 10 days fllwing surgery, raising yur bld pressure (heart rate) will cause bleeding. This includes sexual intercurse and sexual activity. Yu may begin swimming and all exercising 4 weeks pst-peratively, if healing is cmplete. SUTURES: Sutures are disslvable and will nt be remved. Yu may ntice a fishing line r string-like suture alng yur

4 incisin lines. These will eventually disslve ver time and shuld be left alne. If the sutures becme uncmfrtable and have nt disslved by 7 days, yu may have them remved by a medical prvider in yur hmetwn. If yu are a lcal patient, Jackie will remve them fr yu. WHAT TO EXPECT: The skin f the labia may be partially numb fr several mnths (abut 9 mnths) while the wunds are healing. Permanent numbness is very rare. Swelling and bruising are a nrmal expectatin fllwing surgery. This will reslve ver the next tw weeks. There will be bldy r bld-tinged drainage fr a minimum f 1-2 weeks fllwing yur labiaplasty. It is nrmal t have an itching sensatin. Asymmetry t the labia is als t be expected in the immediate healing perid since ne labia may be mre swllen than the ther. This will imprve and be crrected as the swelling subsides. It takes 6 MONTHS FOR FINAL RESULTS t appear. In the interim, yu may ntice incisin asymmetry and swelling that changes frm day-t-day. Be patient please and try nt t fcus n these issues befre the 6-mnth perid. A burning sensatin (raw, sensitive) r sharp shting pains alng the abdmen and incisin line is nrmal and indicative f nerve regeneratin. These neuralgias will burn ut by 9 mnths. EMOTIONAL EXEPECTATIONS FOLLOWING SURGERY: It is nt unusual fr patients t underg significant emtinal ups and dwns after any type f surgery. Factrs such as underlying stress, medicatins, and/r psychlgical tendencies can result in patients experiencing a pst perative depressin that generally reslves after a few weeks. Having a partner, family member, r friend wh is supprtive can help with this prcess. Understanding the stages f emtinal ups and dwns can help patients stay calm and recver frm this emtinal prcess faster: Phase 1: Being Out f It Swelling and discmfrt is mst severe ver the first few days after surgery. Pain medicatins als can make yu disriented and emtinal. Phase 2: Md Swings Having just had surgery, patients are adjusting t a sudden change in their appearance with much anticipatin. The presence f bruising, swelling, and asymmetries will distrt a patient s results thereby cncealing the final utcme. Md swings (especially sadness), wrry and depressin are cmmn emtins as a result. Patients may even ask, "What have I dne?" r think that "I never shuld have dne it." Phase 3: Being ver critical During the secnd week, patients will prbably be feeling a lt better. The swelling and muscle cramping/spasms will be decreasing and sutures will be ut. Because f anticipatin, it is natural fr patients t lk critically at their new bdy wrrying abut symmetry, scars, and s n. At this pint, it's nrmal t wnder if they have achieved their gal and what they paid fr. This is t sn t tell and mst cncerns are reslved with time. Phase 4: Happy at last Finally, abut 3 6 mnths ut f surgery, patients will prbably start liking hw they lk and are feeling much better. They may be in the md t check ut sme bathing suits r utfits t shw ff their new figure. RAPID RECOVERY AND HEALING PROTOCOL, IV THERAPY PACKAGE: There are numerus benefits t receiving the Rapid Recvery and Healing Prtcl, IV therapy package. Thse benefits include, but are nt limited t, imprved wund healing, decreased recvery time, decreased scarring, imprved sense f well-being and reduced pain and discmfrt during yur pst-surgical curse. Our single (pre-perative) IV package is typically given ne t tw days befre yur surgery. This easy t administer, 30 t 40-minute, infusin can be given at ur Newprt Beach ffice r in the cmfrt f yur htel rm. A pwerful mixture f fluids, vitamins, minerals and cfactrs (glutathine), it is designed t ptimize yur nutritinal status prir t surgery. Our infusins will give yu everything yu need t prepare yur bdy fr the stress f surgery, maximize yur ability t heal and help yu feel energized. Additinal therapy sessins are undertaken n the first three days after surgery and beynd, as needed. During thse days we will deliver additinal fluids, vitamins, muscle relaxants, anti-nausea agents and nn-narctic pain relievers under the care f ur M.D. wellness physician, Dr. Newman. Additinal ptins t imprve yur surgical experience include pre-perative nutritinal guidance as well as 4, 8 and 12-week pst-perative nutritin and supplement prgrams. Finally, we can deliver delicius custm designed meals, snacks and beverages, t yur hme r htel. These packages are nt nly delicius, but help t reduce inflammatin,

5 curb sugar craving, supprt healthy intestinal flra, and frm a framewrk fr a healthy eating habits lng beynd yur time in ur care. FOLLOW UP APPOINTMENTS: It is imprtant t be seen by Jackie at yur initial pst-p checks. Jackie will see yu in fllw-up appintments: Day ne, 1 week, 2 r 3 weeks, 6 weeks, 3 mnths, 6 mnths and 1 year pst-p. These appintments are patient-specific and may vary depending n yur wn individual healing. If yu are frm ut-f-twn and cannt see Jackie at the recmmended frequency, then it is strngly advised that yu establish a relatinship with a prvider in yur hmetwn wh can fllw yur prgress r evaluate yu in case f infectin, wund separatin, r serma. Jackie and Dr. Dubrw cannt evaluate yu r treat yu ver the phne, via , r frm a distance. If yu have a csmetic r functinal cmplicatin, please plan t visit ur ffice fr a pstperative visit r seek care frm yur lcal prvider r lcal plastic surgen. We cannt prvide referrals and cannt manage cmplicatins frm a distance. Call t schedule yur appintments at (949) between the hurs f 9:00 AM and 5:00 PM, Mnday Thursday and between 9:00 AM and 2:00 PM n Fridays. The ffice clsed n Saturday and Sunday. PLEASE JACKIE (PA-C) AT JACQUELINE@DRDUBROW.COM IF: Yu have general questins regarding yur pstperative care r aesthetic cncerns. Keep in mind that Jackie is seeing patients thrughut the day and may nt respnd immediately. She checks her at 9 am and at 5 pm and will respnd accrdingly. Keep in mind that a discussin f aesthetic cncerns requires a physical pstperative visit. If yu need t schedule an appintment, please call the ffice at D nt Jackie t schedule appintments as she des nt have access t the schedule. Please include yur name, surgery, date f surgery, and questin in !!! PLEASE CALL THE OFFICE AT IF: Yu have redness, increased pain at surgical incisin sites, sudden increase in swelling, warmth, drainage (pus), r ral temperature greater than F Yu have nausea and vmiting despite Zfran use, rash, shrtness f breath, leg pain with swelling, r diarrhea after taking yur medicatin PLEASE VISIT AN EMERGENCY ROOM OR CALL 911 IF: At any pint yu experience shrtness f breath r leg pain with swelling as this culd indicate a pulmnary emblism (bld clt in lung) r dvt (bld clt in legs) and culd be deadly if untreated. PLEASE VISIT AN URGENT CARE ON THE WEEKENDS OR WHEN THE OFFICE IS CLOSED IF: Yu have redness, sudden increase in swelling, warmth, drainage (pus), r ral temperature greater than F Any questins in regards t scheduling, rescheduling, preperative cncerns, r cnfirming appintments shuld be cmmunicated with the ffice staff (nt Jackie) at If it is the weekend and yu have scheduling questins, please cntact yur surgical crdinatr (Maryam r Kim) with thse questins.