To help you become better prepared for plastic surgery, the California Surgical Institute has provided a list of answers to the most frequently asked questions about preoperative preparation.

1.  Question:  What medications should I avoid before my surgery?

Answer:  You should avoid aspirin, anti-inflammatory drugs, and herbal supplements especially those containing green tea, ginseng, and ginkgo biloba which are found to increase bleeding during the surgery and recovery.  These medications should be stopped at least two weeks prior to the operation. Just to be on the safe side, you should tell your doctor about all the medications you are currently taking.

2.  Q:  Why is it important to quit smoking well in advance of the surgery?

A:  The nicotine has been found to inhibit the normal circulation of oxygen, thus predisposing patients to higher risk of skin necrosis or death of skin tissue.  If this complication happens, they may experience delayed healing and unnecessary scarring.

If you are a smoker, you should quit the habit at least two weeks before the surgery and avoid this during your recovery period.

3.  Q:  What are the things that I should prepare in order to have a comfortable recovery?

A:  Your doctor will prescribe all the drugs (antibiotic, pain medications, etc.), medical garments, proper clothing, icepacks, and other supplies that you will need during your recovery.

In addition, you should purchase easy-to-prepare foods such as soup, yogurt, oatmeal, frozen dinners, cottage cheese, crackers, and protein shakes.

4.  Q:  What other supplies should I purchase prior to my surgery?

A:  It is important that you prepare antibacterial soaps, thermometer, petroleum jelly or moisturizers for the incisions, loose clothing (ideally button-down shirts and pajamas), and low-sodium foods.

5.  Q:  How long is my work leave should be?

A:  You should take a leave from work so you can have plenty of rest and sleep.  But since the length of recovery will depend on the extensiveness of the procedure and your body’s healing ability, you should ask your doctor on when is the safest time to return work.

And because your recovery may take several weeks, you should also prepare some magazines and books, DVDs, video gaming devices, and other sources of entertainment to fight boredom.

6.  Q:  Should I assign a capable adult who will tend to my needs while I recover?

A: Yes.  Arrange someone to care for you during the first 24 to 72 hours of your recovery since it will be difficult for you to move around while the anesthesia wears off.

7.  Q:  Should I arrange for an overnight stay at a hospital?

A:  While most plastic surgery procedures are performed as an outpatient basis, you may choose to have an overnight stay at a hospital (or sometimes even longer if your surgery is extensive).

8.  Q:  How can I prepare my house in order to have a comfortable recovery?

A:  Have a telephone near your bed (turn off the ringer while you are sleeping) so you can call your doctor or someone in case that you will experience something that is out of ordinary; clean your house prior to the surgery; place all the supplies you will need everyday in accessible areas or at hip level (so you will not bend down or reach your arms too high); and if you have a small child, ask someone to take care of him/her while you are still recovering.

To guide you during your recovery after surgery, the California Surgical Institute has provided a list of answers to the most frequently asked questions about what you should do and expect during the healing time:

1.  Question:  Should I assign someone who will care for me during my recovery?

Answer:  Yes.  Assign a capable adult who will tend to your needs for at least three days following your surgery.  But in case that your procedure is an extensive one, it is best that you opt for an overnight stay at a hospital.

2.  Q:  How long is my recovery?

A:  The length of your recovery will largely depend on the treated area, extensiveness of the procedure, type of plastic surgery, and your body’s healing capability.

These are the most common cosmetic procedures and their estimated recovery time:

• breast augmentation – three to 12 months
• eyelid surgery – eight weeks to seven months
• tummy tuck – eight weeks to nine months
• traditional liposuction – eight weeks to 12 months
• facelift – eight weeks to 10 months

3.  Q:  When can I resume my work and normal activities?

A:  Most patients can return to normal activities (excluding strenuous exercises) and “quiet” work” 10 days after their surgery.  But to be on the safe side, you should always ask your doctors on when you can safely resume your daily life activities.

4.  Q:  Why is it dangerous to remain sedentary or bed-ridden for a long period of time after my surgery?

A:  If you remain in bed for a long period of time, you are at risk of developing blood clots in your legs and lungs and other serious complications.  Ideally, you should take a short, gentle walk as soon as you can in order to promote a good blood circulation.

5.  Q:  What are the most common postoperative symptoms should I expect?

A:  It is most likely that you will experience swelling, bruising, tenderness, soreness, pain and discomfort, temporary numbness in the treated area, and nausea as the anesthesia wears off.

But a week after your surgery, most of these symptoms will become less pronounced.

In case that there is no improvement within a week, you should immediately visit your plastic surgeon to determine if you are experiencing delayed healing and other complications.

6.  Q:  How can I minimize the swelling?

A:  Swelling is more common after a facelift, eyelid, rhinoplasty or nose surgery, otoplasty or ear tucking, neck lift, and tummy tuck.  To minimize this symptom, you should elevate your head and shoulder with pillows within seven to 10 days following your surgery.

Ice packs can also be helpful in minimizing the swelling and bruising.

7.  Q:  Why should I avoid aspirin and anti-inflammatory medications during my recovery?

A:  These drugs, which are sometimes called as blood-thinners, can increase bleeding during surgery and recovery and can also inhibit the body’s healing ability.  Herbal supplements and vitamins, particularly those containing green tea, vitamin E, ginseng, and ginkgo biloba have also been found to increase bleeding.

Just to be on the safe side, you should tell your surgeon all the current medications you are taking.

8.  Q:  Why is it important that I avoid smoking and second-hand smoke before my surgery and during the recovery period?

A:  The nicotine can inhibit normal blood circulation, thus significantly increasingly your risk of developing skin necrosis or death of skin tissue, a complication that often leads to delayed healing and unnecessary scarring.

9.  Q:  What is the most ideal diet during my recovery after plastic surgery?

A:  Because your body will need to repair itself after a surgical procedure, your diet should be high in protein.  However, you should watch your sodium intake since too much of this may aggravate swelling.

10.  Q:  Why is it important to wear compression garments particularly during the first few days of my surgery?

A: If you undergo breast augmentation, breast lift, breast reduction, liposuction, facelift, body lift, and tummy tuck, your doctor will require you to wear a compression garment for a certain period of time in order to prevent sagging, provide support to the new contour, and minimize swelling.

11.  Q:  What are the tell-tale signs of complications related with surgery?

A:  You should immediately seek medical attention if you experience any of the following: abnormal heart rate, swelling and bruising which do not subside after a week, delayed healing, and other conditions which are “out of ordinary.”

12.  Q:  How can I avoid or at least minimize the appearance of scars?

A:  Never expose the incision sites to direct sunlight for six to 12 months in order to avoid dark pigmentation.  You can also use petroleum jelly or special creams, ointments, and lotions especially those containing vitamin E and C, glycolic acid, onion extract, Retin-A, and emu oil.  However, you should only apply these creams after the surgical wound is completely closed (to be on the safe side, you should ask your doctor).

13.  Q:  Aside from using creams and lotions, what are the other ways to remove or minimize the appearance of scars?

A:  Scar revision procedures may include laser resurfacing, anti-inflammatory agents to flatten and/or soften the scar tissue, and medical tattooing to camouflage the dark pigments.

14.  Q:  Is the result of plastic surgery supposed to last a lifetime?

A:  It will depend on the type of procedure.  For example, the result of tummy tuck, body lift, breast reduction, and liposuction can last a lifetime as long as you will maintain a stable, normal weight and avoid future pregnancy.

Rhinonoplaty or nose-reshaping surgery is also supposed to last a lifetime unless you experience unexpected nasal growth.  For this reason, most doctors require their patients to be at least 15 years old to make sure that their nose is fully developed.

But if you will undergo a breast augmentation, expect that you will have a revision surgery at some point in your life since breast implants are not designed to last forever.

In the traditional breast lift approach, doctors create three separate incisions that resemble an anchor; it travels around the circumference of the areola, another vertical cut starting from the nipple to the breast crease, and a horizontal one that covers the entire crease.

But during donut mastopexy, plastic surgeons only use the incision around the perimeter of the areola, allowing them to remove the excess skin and manipulate the tissue surrounding this area and place the nipple to a higher position.  If necessary, the size of an enlarged areola will be reduced to further improve the breast’s appearance.

Because this plastic surgery procedure only uses one incision site, most patients can expect a relatively faster recovery compared to the traditional breast lift technique.  Additional advantages include unnoticeable scar, less post-operative pain and discomfort, and less risk of complications.

Despite the countless advantages of the donut lift, plastic surgeons do not conduct this to large-busted patients with a severe sagging because it only involves a limited amount of tissue and skin.  In general, only women with small to medium breasts that have a mild to moderate drooping can benefit from this technique.

As with any breast lift technique, the donut lift does not guarantee a lifetime result due to the natural effects of aging and gravity, although majority of small-breasted women can maintain it for many years as long as they will avoid pregnancy and significant weight fluctuation which can weaken the tissue and skin.  It can also be helpful if the patients will always wear a good-fitting bra that provides a great support.

Some plastic surgeons complement this procedure with breast implant surgery particularly for patients who want to increase their bust size and/or achieve a fuller upper pole to create cleavage.  Combining these two plastic surgery procedures may also correct a more pronounced sagging as long as the implants are placed under the muscles (rather than behind the tissue) so that more tissue and skin can support their weight, thus preventing premature sagging.

As with any cosmetic procedure, the donut lift has some risks such as unnecessary scarring, asymmetrical appearance, and infection.  To be on the safe side, patients should choose a board-certified doctor who has an extensive experience with this particular technique.

Breast massage can also make the bust more symmetrical and make its appearance more natural, according to plastic surgery specialists.

It is important to note that each doctor has a slightly different preference when it comes on how and when to perform breast massage.  However, most plastic surgeons believe that patients should start massaging their breast the day after their operation by applying a very gentle but steady pressure in the area using both hands for two minutes.  This is then repeated on the other breast.

The main purpose of breast massage and compression exercise is to push the implants to the outermost corners of the pockets in order to create a more symmetrical appearance.  Most doctors in plastic surgery require their patients to perform these procedures for at least three months, while others even recommend doing these exercises for up to a year.

Patients should perform breast massage a day after breast augmentation, or at least several days after the procedure even though the breasts are still tender at this point.  In this way, the shape, appearance, and feel of the breasts will become more natural.

About a week after performing breast massage, the process becomes more comfortable to most patients.

As the breast tissues become less tense, plastic surgeons may require their patients to decrease the time spent on performing breast massage and compression exercise.  However, most of them would recommend continuing these procedures for at least three months even if the breast feels soft and the implants are moving freely.

While massaging the breasts, patients should not pinch the implants to prevent damaging the shell.  To be on the safe side, they should ask their doctors on how to perform this procedure correctly and should immediately seek medical attention if they experience any sharp pain, burning, flushing, and hardness or tightening of the breast implants.

Meanwhile, not all plastic surgery specialists recommend breast massage particularly if the patients have textured or teardrop implants.  This is because the textured shell may pull the tissue if the breasts are massaged or compressed while the teardrop-shaped implants already look natural as they simulate the contour of a real bosom.

Some doctors in LA plastic surgery recommend breast massage and compression exercises which generally involve displacing the implants to the outermost corners of the breast pockets several times in order to promote a more natural appearance and shape.  Meanwhile, some experts say that doing these massages can also reduce the risk of capsular contracture—a painful condition in which the tissue attaches itself around the implants.

However, not all plastic surgeons require their patients to perform this post-operative care, especially for those with teardrop-shaped and textured implants.  This is because the teardrop implants already simulate the natural curve of the breasts while the textured shell may reap the tissue if this is moved around the pocket.

To be on the safe side, patients should ask their surgeons if performing breasts massage is safe for them.  And if yes, they should follow their doctors’ specific recommendations on how to conduct this post-operative care.

As with any cosmetic surgery, breast augmentation involves risk of scarring, although the incision lines usually fade and become almost unnoticeable several months after the procedure.  However, patients should not expose their incisions under the sunlight for at least six months to prevent these from developing dark pigmentation.

For women with silicone-filled implants, most plastic surgeons will require them to undergo MRI screening every two years in order to detect “silent leak.”  However, this is not necessary for patients with saline implants because a rupture in the shell can provide a visible manifestation (deflated breasts) for as short as four hours after it breaks.

But regardless of which breast implants have been used, most experts in plastic surgery recommend mammograms (or breast X-rays) and breast examinations.  For women in their 20s and 30s, they should have a clinical breast exam at least every three years while women 40 and above should have this annually.

The recommended screening guidelines for patients with breast implant surgery are the same as those for women who do not have the procedure.

To prevent or at least postpone future sagginess, experts in LA plastic surgery recommend the use of a well-fitting bra that can provide a good “support” to the weight of the breast implants.

During the first and second day of recovery, patients will most likely experience a pronounced pain and discomfort, which can be relieved by taking medications prescribed by their doctors.  But after this period, the pain will continuously subside each day until the patients can resume their normal activities.

Although most women can return to their work a week or two after their breast augmentation, plastic surgery experts generally prohibit rigorous exercises, bending over, and heavy lifting for at least three weeks.  To be on the safe side, patients should ask their doctors on when they can perform physically demanding tasks without predisposing themselves to complications.

During the first few weeks of recovery, some patients may feel anxiety and depression since their breasts may not appear as natural as they would expect.  However, they should remember that it usually takes several months (about six months or so) before the breast implants to “settle” and “drop” into their proper place.

To make the implants “drop,” some plastic surgery specialists recommend breast massage and compression exercises which can displace and push the synthetic materials to the outermost corners of the breast pockets.  However, these exercises are not recommended for patients with textured implants and teardrop-shaped implants.

In some cases, the skin appears “shiny” and there is some redness during the recovery period.  These symptoms are usually normal since the tissue and skin are being stretched to accommodate the implants; to address these problems, patients can use moisturizer, particularly those containing shea butter, to make the skin more elastic.

Aside from breast massage, plastic surgeons will also likely recommend the use of elastic garments around the breasts that will help the implants to drop and settle to their proper location.

Because of the post-operative swelling and bruising, the breasts are unnaturally firm for several weeks, especially if the saline and textured implants are used.  But after the swelling completely subsides, —which may take three to six months—the breast tissue will become softer and more natural.

To prevent unnecessary scarring, most doctors in LA plastic surgery advise patients to avoid exposing their incision lines under the direct sunlight for at least six months to a year since it may darken the area.

As with any plastic surgery, breast augmentation requires recovery that largely depends on the implant placement, incision site, implant size, and other surgical approach that have been utilized.  However, majority of patients will experience a post-surgical recovery that is associated with pronounced pain and discomfort which will subside a day or two.

To prevent complications and promote faster healing, patients should avoid strenuous activities and heavy lifting for several weeks.  Nonetheless, they should start walking as soon as possible to promote better blood flow that will result to faster healing, prevent blood clots, and minimize swelling.

According to plastic surgeons, lying in bed most of the time may retard the healing process, slow down the metabolism, result to blood clots in the legs and lungs, and prolong the swelling which may even lead to more serious complications.

It is very important for patients to follow all the post-operative instructions of their plastic surgeons especially in terms of medications (they must avoid aspirin, supplements, and certain anti-inflammatory drugs), proper hygiene and care to prevent infection, use of surgical garments and supports, and avoidance of alcohol and tobacco.

In some cases, plastic surgery specialists require their patients to perform breast massage so the implants can “settle” properly and minimize the risk of capsular contracture, a complication in which the surrounding tissue squeezes the implants, resulting to painful, distorted breasts.  However, the massage should not be done aggressively to prevent damaging the implants and injuring the surgical site.

During the first few days of recovery, patients should have someone by their side to take care of them and help them move around.  Ideally, they should also take some time off from work to have enough rest and sleep, which can lead to faster recovery.

After their plastic surgery, patients are required to visit their doctors periodically to check if there is any complication.  But if a person experiences shortness of breath, unusual heart beat, bleeding in the surgical site, and chest pain, they should not wait for the next visit and immediately seek medical attention.

Meanwhile, patients should remember that following their plastic surgeon’s instruction is the key to a successful surgery.

According to plastic surgeons, “bottoming out” is one of the most common reasons for revision breast implant.  This condition happens when the synthetic material travels south and results to unsightly, drooping breasts.  (See picture below.)

There are certain factors that can increase a patient’s risk to this complication, including over-dissection of the implant pocket during the initial surgery.  This pocket, in which the implant is placed, should be not be too big to the extent that the material can travel freely.

Bottoming out also happens if the implants are too big and heavy for the skin and breast tissue to accommodate.  With this consideration, plastic surgeons do not recommend larger sizes for petite women who usually have limited skin and tissue in their bust.

Some plastic surgery experts also attributed this complication with the use of above-the-muscle implant placement on thinner women or those who have limited skin and tissue.  To minimize such risk, the under-the-muscle placement is the most recommended so there will be more breast tissue and skin to support the implants and serve as a padding that will cover the synthetic materials.

Currently, there are different techniques to address implant bottoming out including the use of internal sutures to reduce the size of the breast pockets and push the implants to a higher place and reposition the areola in the center of the breast mound.  But instead of using sutures, some plastic surgeons use a flap of tissue derived from the inside of the pocket to reduce the capsule.

While the said approach can correct bottoming out, most doctors stay away from this since the stitches may cause additional scarring.

Fortunately, there is another option to treat this problem.  By using tissue substitutes such as Strattice and Alloderm, there will be a structural brace to hold the breasts up and support the implants.  This approach is ideal for patients who do not have enough tissue in their breasts.

Certain cases of bottoming out can be addressed by breast lift (or mastopexy) combined with skin removal along the breast crease.  And if the problem is also caused by implants that are too large, plastic surgery specialists will most likely replace them with a smaller size to prevent this complication from happening again.

As with any plastic surgery, breast lift involves incisions which means permanent scars.  However, these surgical marks will fade and improve over time until they become less noticeable.

How breast lift surgery is performed:

1.  Anesthesia is administered.  In most cases, plastic surgeons use general anesthesia that will make their patients asleep throughout the operation, although some prefer to administer local anesthesia combined with intravenous sedation.

2.  Incisions are placed.  Once the anesthesia has taken effect, plastic surgeons create an incision directly on the bust; its length and placement will depend on the extensiveness of the sagginess, shape and size of the breasts, and desired result of each patient.

For large-busted women with severe sagginess, the most recommended technique is the anchor lift which uses an incision around the areola, another one that begins at the areola down to the crease, and one more that horizontally covers the entire breast fold.

In some cases, plastic surgery specialists remove the horizontal incision in treating small- to medium-busted patients with              minimal to moderate sagginess.

3.  Incisions are closed.  Once the necessary changes have been made, the remaining tissues are tightened using deep sutures                that will act as a support to the newly shaped breasts.  Meanwhile, plastic surgeons also use surgical tape and/or skin                      adhesives to close the incisions in the skin.

Meanwhile, some surgeons place small tubes in the breasts that will help drain any excess fluids which in turn promote                    faster recovery.

4.  Recovery.  In most cases, breast lift is performed as an outpatient basis, although some women can ask to have an                              overnight stay at the hospital where they can be monitored by surgical staff.

During the recovery period, patients should wear an elastic bandage or surgical bra that will support the new contour,                        prevent swelling, and promote faster healing.

To further promote faster recovery, doctors require their patients to start walking as soon as possible instead of lying in bed              most of the time.  According to several studies, walking can also lower the risk of blood clotting and minimize swelling                      and bruising.

Meanwhile, the result of breast lift surgery generally lasts a lifetime, although this can be affected by weight fluctuations.                  For this reason, it is important to maintain a stable and normal weight after the procedure.

Many patients who had this plastic surgery said that the recovery period is the most challenging for them rather than the procedure itself.  This is because they had to endure pain and discomfort, nausea, swelling, and bruising especially within the first few days of their operation.

Despite the discomfort, most plastic surgeons require their patients to start walking as soon as possible to promote better blood flow and faster healing, and prevent excessive swelling and blood clotting.  Meanwhile, people should not lie down all the time as doing so can aggravate swelling, slow down their metabolism, and predispose them to risk of blood clotting in the legs, lungs, and other vital organs.  (See picture below.)

In some cases, plastic surgeons also require their patients to perform breast massage and compression exercises that involve pushing the implants to the outermost corners of the pockets.  If performed correctly, this post-operative care can provide a more natural appearance by promoting the synthetic materials to “settle” down to their proper position.

Aside from providing a better result, breast massage has also been said to reduce the risk of capsular contracture, a painful condition in which the scar tissue attaches itself around the implants, resulting to a ball-shaped bust.

However, not all plastic surgery specialists recommend this exercise especially for women with textured or teardrop-shaped implants.  To be on the safe side, patients should ask their doctors if it is safe to perform breast massage and what is the proper way to do this procedure.

Meanwhile, mammograms (breast X-rays) and examinations are also an important part of implant maintenance program.  According to plastic surgeons, women with silicone-filled implants should undergo MRI screening three years following their plastic surgery and then every two years to detect if there is any leak or rupture in the shell.

For women with saline-filled implants, MRI screening is not a requirement since an implant leak will always have “visible manifestations” such as asymmetrical or deflated-looking breasts.

But to be on the safe side, women older than 40 should undergo an annual clinical breast exam while those who are in their 20s and 30s should at least have this procedure every three years.

Women with implants should also inform their doctors, including their dentists, that they had breast augmentation procedure.  In this way, they may be advised to pre-medicate with antibiotics before they will have surgery or dental work.