The consultation is perhaps the most important aspect of cosmetic surgery. It is very important that you get an honest, informed opinion on whether or not cosmetic surgery can achieve your expectations. You as a patient will have certain expections of what you want to achieve from surgery and you should express your expectations as clearly as possible. I as a surgeon have to identify what I can and cannot achieve with surgery, and I shall try to explain this to you as clearly as possible. Ideally your expectations and my anticipated outcomes will be very similar.
There are several stages to the consultation:
Initially I shall then take a full medical history of your previous health problems, current medication, known allergies, smoking and alcohol intake etc to ensure that it is safe to undertake surgery. This will include discussing exactly why you want surgery and what it is that you wish to achieve.
I shall then undertake a careful examination to identify what needs to be done surgically in order to achieve your goals.
I will then take a series of photographs. The purpose of this is to record the preoperative appearance and also I shall use these photographs for planning purposes.
We will then discuss the operation and the expected recovery period at some length. We will also discuss the possible complications and the risk of developing a complication. Finally I will give you a realistic assessment of the likely results of surgery.
There are two common types of anaesthetic:
A local anaesthetic is an injection which numbs the area. You stay awake but feel no pain. If you have a local anaesthetic, this will be done by Mr Sterne. You will notice a sharp scratch and some stinging during the injection. This may last up to 30 seconds. You may notice a warm tingling feeling as the anaesthetic begins to take effect within a minute or two. Your operation will only go ahead when you and your anaesthetist are sure that the area is numb. You will remain alert and aware of your surroundings. A screen shields the operating site, so you will not see the operation unless you want to. You will have a nurse available at all times to talk to during your operation and are free to talk to your surgeon during your procedure too.
With a general anaesthetic, you go to sleep and feel no pain. If you have a general anaesthetic, this will be done by a Consultant Anaesthetist. An anaesthetist is a doctor with specialist training who is responsible for giving your anaesthetic and for your wellbeing and safety throughout your surgery. They will agree a plan with you for your anaesthetic and pain control afterwards and they aim to make your experience as pleasant and pain free as possible.
Your anaesthetist will meet you on the morning of your operation. They will:
- ask you about your health
- discuss with you which types of anaesthetic can be used
- discuss with you the benefits, risks and your preferences
- decide with you which anaesthetic would be best for you
Nothing will happen to you until you understand and agree with what has been planned for you. When you eventually get to theatre, a needle may be used to start your anaesthetic. If this needle worries you, you can ask to have a local anaesthetic cream put on your arm to numb the skin before you leave the ward. The ward nurses will do this for you if you ask.
Once you have made a decision to proceed with surgery and have booked a date for surgery, you will be sent an information pack by the hospital.
You may need to have blood tests done and possibly a chest Xray or trace of your heart (ECG). You will be given an appointment to attend the hospital for this in the days/weeks leading up to your operation.
The cost of your surgery should be paid in full (and cleared) before the morning of surgery.
You should attend the hospital at the specified time on the day of surgery.
With fixed cost surgery, the price quoted covers all hospital and theatre costs, anaesthetists and surgeons fees and also covers the cost of treating any possible complications which may arise in the first month or so after surgery, so there are no hidden costs. All follow up consultations after surgery are included in this cost. The only additional cost is that of the initial consultation which is £100, and the cost of any further pre-operative consultations you may need, which are again are charged at £100.
You should attend the hospital on the morning of surgery at the time arranged by the hospital.
If you are having a general anaesthetic you should not have anything to eat or drink after the time specified in your admission letter (usually midnight for surgery in the morning; or 6am for surgery scheduled for the afternoon). If you are taking medicines, you should continue to take them as usual, unless Mr Sterne has specifically asked you not to. You may take a small sip of water to help you swallow your tablets if required. If you are having a local anaesthetic you can eat and drink as normal.
Once you arrive on the wards, a nurse will take you to your room. She will measure your blood pressure and pulse, ask you some questions and eventually get you to change into a surgical gown.
You will be seen by Mr Sterne and your anaesthetist whilst on the ward.
When you are called for your operation
- A member of staff will go with you to the theatre
- A parent will normally go to the anaesthetic room with a child.
- You can wear your glasses, hearing aids and dentures until you are in the anaesthetic room. If you are having a local anaesthetic, you may keep them on.
- Jewellery and decorative piercing should ideally be removed. If you cannot remove your jewellery, it can be covered with tape to prevent damage to it or to your skin.
- If you are having a local anaesthetic, you can take a personal tape or CD player with you to listen to music through your headphones.
- Most people go to theatre on a bed or trolley.
- You may be able to walk. If you are walking, you will need your dressing gown and slippers.
The operating department ("theatres")
When you arrive in the operating department, theatre staff will check your identification bracelet, your name and date of birth, and will ask you about other details in your medical records as a final check that you are having the right operation. You will then be taken to the anaesthetic room, where your anaesthetic will be started. The anaesthetist will attach you to several machines which measure your heart rate, blood pressure and oxygen levels. He may ask you to breath through a mask and will then administer an injection.
When the anaesthetic has started and you are fast asleep, you will be taken through to the operating theatre for your operation. Your anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised. As soon as the operation is finished, the drugs will be stopped or reversed so that you wake up.
After the operation, you will be taken to the recovery room. Recovery staff will be with you at all times. When they are satisfied that you have recovered safely from your anaesthetic you will be taken back to the ward.
Pain Relief Afterwards
After your operation you will be given painkillers on a regular basis to keep you comfortable. Good Pain relief is important and some people need more pain relief than others. It is much easier to relieve pain if it is dealt with before it gets bad. Pain relief can be increased, given more often, or given in different combinations. Occasionally, pain is a warning sign that all is not well, so you should ask for help when you feel pain.
ADVICE ? GET FIT, STOP SMOKING, IDEAL WEIGHT, ASPIRIN
TIME OFF WORK FOR EACH PROCEDURE
SEE DAI'S INFO SHEETS
After the consultation I shall write a detailed letter, to both you and your family doctor, explaining what was discussed at consultation. You will also receive an information pack via email, which contains further information about your procedure of choice, a consent form and a quotation for the proposed surgical procedure.
There must be an initial "cooling off" period of 2 weeks from the date of consultation before you can undergo surgery. This period is important to allow you to consider what was said and to change your mind if necessary. Also, if you think of other questions which you would like to ask before making up your mind, you are encouraged to arrange a second consultation.
In order to book a date for your operation, you need to read the consent form carefully and then initial each page to confirm your consent and sign and date the last page of the form. You must return this signed consent form before you can book a date for surgery. This completed consent form can be scanned, and returned by email to firstname.lastname@example.org or posted to Mr Sterne, c/o West Midlands Hospital, Colman Hill, Halesowen, B63 2AH. Once this completed consent form has been returned, Jude will be in contact to confirm the theatre date and to take a non-refundable deposit to secure this date.
If you wish to 'pencil' a date into Mr Sterne's theatre diary, this can be done either at consultation with Mr Sterne, or with Jude over the phone (on 0212 361 8008), but this date is only confirmed once the consent form and deposit have been received.
If you would like to arrange a consultation with me please call Jude on 0121 361 8008
There are several things which you can do to prepare for your forthcoming surgery.
- Stop smoking; cigarette smoke contains many different chemicals which can interfere with blood supply and narrow your blood vessels. The operated area needs a very good blood supply to heal and every cigarette smoked reduces the blood supply to the operated area and increases the risk of you developing a complication. Complications can be as much as 60 times higher in smokers than non-smokers. The longer you can give up for before surgery the better and the longer you can abstain for after surgery the better.
- Lose weight; fat tends to have a poorer blood supply than other tissue. The more fat there is, the less the blood supply and the greater the chance of a complication. Thus getting your weight down to, or close to, your ideal weight reduces your risks of developing a complication. However, it is a bad idea to ?crash diet? before surgery as your body will need a healthy diet to heal properly afterwards.
- Get fit; the body sees any surgical procedure as a stressful event. The fitter you are, the more able your body is to cope with this stress, and the more likely you are to sail through your operation without problems. Furthermore, if you are undergoing certain procedures such as a tummy tuck or TRAM flap breast reconstruction, working to build up certain muscles before surgery can speed up your recovery time. This will be discussed at consultation.
- Avoid aspirin; aspirin is an extremely useful medicine, but it does tend to increase the risk of bleeding, which is not a good thing during surgery. Therefore, you should avoid or stop taking aspirin for 10 days before surgery.
- Avoid or certainly limit alcohol on the night before surgery.
- Do not have anything to eat or drink after midnight on the night before surgery: if you are having a general anaesthetic, it is important that your stomach is empty by the time you go to theatre. It usually takes about six hours after eating food for your stomach to be empty. If you know you are going to be going to theatre in the afternoon, then it is OK to have a light breakfast at 6:30 am. If you are having your operation done under a local anaesthetic (with you awake) then you do not need to fast and can eat and drink normally right up to your operation.
- Do not wear makeup: If you are attending for any facial surgery, it is a good idea not to wear makeup on the day of surgery.
- If you develop a bad cold or chesty cough before surgery it is very unlikely that I would proceed with your operation.This is cosmetic surgery and having a cough or cold could increase your risk of complications and detract from the final outcome. If you do develop a cough/cold before surgery, you should contact my secretary directly who will either arrange for me to see you before your operation or make alternative arrangements.
- If you have a long-standing medical problem such as diabetes, asthma, thyroid problems, epilepsy or high blood pressure (hypertension) you should go to your GP for a checkup
- Arnica: many people like to take Arnica before surgery and swear that it reduces bruising and swelling. There is however, no good evidence to support this claim. I do not feel strongly either way, and have no objections if you wish to take arnica prior to surgery.
- Vitamin E cream: again, many people swear by the power of vitamin E to improve wound healing. In fact though, there is good evidence that vitamin E actually impairs wound healing and I strongly recommend that you do not supplement vitamin E before surgery and do not apply vitamin E cream to your wounds for at least 6 weeks after surgery. After this time if you wish to apply vitamin E cream I have no objection.