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1. How can I know if surgery is right for me?
My job is to tell you what surgery can do for you and to help you understand the risks. Only you can decide whether the operation is right for you. I think it will help you achieve your aim. Although I cannot give you a guarantee, I believe you will like the result. Still, the decision remains a personal one and you must make it.
2. Can I get the same results without surgery?
I only do surgery when no good alternative exists. Your need falls into this category. Without surgery, I cannot correct your problem as successfully. When I examine you in the office, I assess the possibility of other treatments. I balance the advantages and disadvantages of surgery in your case. I think the advantages of surgery outweigh the disadvantages. If you have concerns or you are not clear about the operation, call me before the operation. Make certain your mind is clear long before the day of surgery. I want you to go into the operation with a clear and confident attitude.
3. How much will the operation cost?
My office manager will give you an estimate of the cost of your surgery. When calculating the cost remember there are several separate charges. First is the surgeon's fee. Second the cost of an operating room and supplies. You will incur additional fees for an anesthesiologist to put you to sleep. The operating room will bill laboratory and X-ray studies and some special supplies, separately. We accept several methods of payment, including checks, cash and credit cards. We participate in several local and national programs to help you finance the cost of surgery. You must make full payment for the surgical fee two weeks before surgery. If you cancel surgery without adequate notice, we charge a cancellation fee.
4. Will my insurance pay for this surgery?
Insurance companies only pay for surgery if it is not considered cosmetic surgery. We will give your insurance company documentation about your condition and I am happy to write a letter to them. Although they may pay something for repair of the abdominal muscles it is more common for your insurance company to pay nothing toward the surgery. The American Society of Plastic & Reconstructive Surgeons has information about plastic surgery and insurance coverage.
5. Am I being vain to have this operation?
Most people at some time before surgery have fears and doubts. A common concern is that they are being vain. My experience has been that most patients who have cosmetic surgery are no more vain than anyone else. What does distinguish them is a desire to get the most out of life. Looking after our appearance is not a fault. After all would you leave your house with broken gutters or peeling paint? Why do less for your body? I think you should feel proud of yourself for having the courage to want to change something that you find unacceptable. I emphasize that you should only have the surgery if it is for you. It is a big mistake to have surgery for somebody else.
6. What do I do to get ready for surgery?
Begin by thinking about what you will need in the house in the days after surgery. Do your shopping ahead of time and relax for a few days afterwards. You might consider getting gas in the car and cash from the bank. Make certain you have filled all your prescriptions and know how to take them. For a few days before surgery you may want to take extra vitamin C, many people feel this can reduce bruising and encourage healing. Make certain you do not take any aspirin or aspirin containing medicine for two weeks before surgery because this can increase your risk of bleeding. Antihistamines and vitamin E may also increase bleeding so you should avoid them. The night before surgery, set an alarm so you know you will not oversleep. This is especially important if you take a sleeping tablet the night before surgery. Do not eat or drink anything after midnight the night before surgery. The only exception to this is if you have regular medicine that you take in the morning. You can take these with a small sip of water. Above all call if you have any questions. The best time to ask questions is a few days before surgery. The worst time is right before your operation when you may be a little sleepy and confused.
7. Do I take my regular medicines before surgery?
Yes. I recommend that you take your regular medicine such as those to control blood pressure, at your usual time. If you use a small sip of water to swallow the pill there is usually no problem. Some medications not to miss around the time of surgery include those for blood pressure, diabetes, heart disease, psychiatric problem, birth control pills, etc.. Let me know what medicine you take so I can advise you. If you have a general anesthetic, it is important that you tell the anesthesiologist about the medicines you take. Also mention that you have taken it with a sip of water the morning of surgery. If you use insulin, do not take it the morning of surgery. If you take blood thinners, such as coumadin, you must stop taking them for several days before surgery. You discuss this with the doctor who prescribes them for you.
8. Are there any medicines I should not take before surgery?
Yes. Do not take aspirin for two weeks before surgery. It may increase the risk of bleeding. Remember, many over-the-counter medicines contain aspirin. So, check the label carefully. Other medicines that may increase your risk of bleeding include vitamin E and antihistamines. Many cold remedies contain antihistamines.
9. What do I eat before surgery?
Do not eat anything for eight hours before surgery. This is a common rule: if your surgery is in the morning do not eat after midnight the night before surgery. This rule applies even if you have a local anesthetic. If you eat or drink even small amounts, I may cancel your surgery. This is for your own safety. If you have food in your stomach and you vomit, some of that food may enter your lungs. This is a very serious complication. So no matter how tempted you are, do not eat or drink before surgery. It is a good idea to eat a nourishing diet for a week or two before surgery. Consider increasing your vitamin C intake. Do not go on a strict diet in the weeks before your operation.
10. Is there anything I can do to reduce scarring or bruising?
For the first day or two after surgery I recommend that you rest a lot. All surgery is tiring. You can reduce swelling by elevating the site of surgery. Ice will also reduce swelling and pain. Apply it carefully so you do not damage the area. After the first twenty-four hours it will make very little difference. You can sometimes speed up the resolution of bruising by applying heat. Remember that the area around your incision is numb and burning yourself is easy. So be careful. I do not know any way to reduce scarring. Some patients feel that applying vitamin E or aloe vera to the wound may help. If you apply these creams do not rub the scar for about six weeks because you can damage the fragile new tissue. If you have tapes or stitches in place, do not use any cream or lotion unless instructed.
11. Is there anything I need to tell the surgeon before surgery?
The most important thing I need to know before surgery is what you want to achieve. Make certain that you tell me what it is you do not like and what you want corrected. Never hesitate to ask questions. Make certain I answer your questions before the day of surgery. Just before surgery is not a good time to ask questions. You may be sleepy and it is unlikely you will remember the answers. The plan for surgery needs to be clear before you come to the operating room. I need to know about your general health and medical history. When you first came to my office, we asked you questions about your medical history. Please tell me of any changes, I need to know if you have any allergies, especially to antibiotics and pain killers. Telling me about any medicines you regularly take is important, especially heart medicines, blood thinners, insulin, etc. If you have had surgery, I need to know when and what operations you have had. It helps me to know if things went well or if you had complications, such as bleeding or anesthetic problems. Finally, tell me about any previous treatment for the problem we are treating now.
12. Do I need any special tests or X-rays?
If you are in good health and we plan a local anesthetic, you may not need any special tests or X-rays. If you suffer from a serious illness, such as diabetes, I may order tests or suggest you see your treating physician. If you are going to have a general anesthetic, the anesthesiologist may order special tests to prepare for the anesthetic.
13. How early do I need to be at the operating suite before surgery?
I recommend that you are at the operating suite one and a half hours before surgery. Although this seems early, it is necessary to get the best result for you. Often I prescribe medicines before surgery that make you feel comfortable during surgery. If you do not have these medicines on time, they are not as effective. If you need special tests, it often takes an hour for results to return. If you do not arrive at the recommended time, for your own safety, I may cancel or postpone your surgery.
14. Where is the operation done?
I will do your operation in an operating room, often at a day surgery unit. Usually I do surgery in the early morning. Unless you decide to stay in the hospital or unit overnight you can be home within a few hours.
15. How is the operation done?
The principle of the operation is straight forward. The skin of the lower abdomen is stretched and the excess is removed. At the same time the muscles underneath are tightened. Sometimes I may use liposuction to smooth the edges. The navel is not repositioned but may be stretched into a lower position.
16. How long does the operation take?
Your operation usually takes about one to two hours. You should allow two hours to recover in the surgery unit.
17. Where is the scar going to be?
The scar for a mini-abdominoplasty is placed across the lower abdomen and stretches from one side of the pubic to the other and may extend further. Sometimes I use a second incision that goes upwards from the pubic area. All surgery requires a scar and all scars take time to soften and fade. You will not see the final appearance of your scar for a year after surgery. It is usually red and raised for the first month or two after your operation.
18. When will I be able to go home after surgery?
After I finish your operation you will go to the recovery room for about two hours. When the nurses feel you are alert you can go home or be admitted.
19. Can I drive myself home after surgery?
No. this is major surgery. After surgery you will be under the influence of medications. It is dangerous to drive even the day after surgery. If you do not have anyone to drive you home we can call a taxi. Tell the nurses in the surgery unit.
20. What anesthetic is used for the operation?
This operation is performed under a general anesthetic, this means you are asleep. Although small, there is a risk to all anesthetics.
21. What are the complications?
After all operations there is bruising and swelling. This lasts about two weeks but can continue for a month or more. Remember that the human body is asymmetrical and that even after surgery both sides of the body will look different. All surgery requires an incision and therefore will leave a scar. In most patients the scar heals well, but in a small number of people the scar remains thick and heavy At the time of surgery the small nerves that supply feeling to the skin are damaged. This may cause changes in sensation including numbness. Although uncommon, bleeding and infection are risks and can be serious. You will have pain and discomfort after this surgery. The pain usually only lasts for a few days. One per cent of all operations lead to major complications. Weigh up the pros and cons, it is for you to decide. This is a surgical procedure and as such potentially serious complications such as a blood clot or embolus or an unexpected response to drugs or anesthetics can occur. Beside the complications that can develop after any surgery, there are problems that are special for your surgery. These include: the scar may be slow to heal, it is not unusual to have scabbing along the scar for a week or two, fluid(either blood or serum) can collect under the skin flap, the scar is not a fine line like a cesarean section scar and if liposuction is performed there are risks such as surface irregularity and the need for secondary surgery. Make certain you understand all consent forms: check out this page from the American College of Surgeons about surgical permits.
22. Will I need to take any special medicines?
I usually prescribe a pain killer and a mild sleeping tablet for you to use after surgery. In most cases I will also prescribe an antibiotic and something in case you feel nauseated. If I prescribe an antibiotic it is important that you take it as prescribed on the bottle. The other medicine you can take at your discretion. If you think you may be allergic to any of the medicines I prescribe please call my office immediately. Remember that all medicines have side effects. One of the most common is gastrointestinal upset. This means you can have an upset stomach or diarrhea. If this becomes severe call my office. As soon as possible stop taking narcotics and sleeping tablets. Many patients are surprised that they can obtain good pain relief with simple over-the-counter medicines like Tylenol and Advil. Do not take aspirin because this can increase the risks of bleeding. Narcotics and sleeping tablets will interact with alcohol so do not drink at the same time as you take them. They will also make you drowsy so do not drive while you are taking them.
23. How do I look after myself after surgery?
You can follow some simple rules to make your surgical experience more pleasant. First acknowledge that you have had surgery and it takes time to heal. Be patient. For the first twenty-four hours take it easy and rest a lot. this is a good time to read all those books or watch the videos that you have been promising yourself you would read over the last few months. After the first day or two you will start to feel more comfortable but you are still not ready to begin vigorous activity. Keep the area of surgery elevated and apply ice as directed. I will give you specific instructions if needed. Take plenty of fluids and eat a balanced nourishing diet. I suggest additional vitamin C for about six weeks. Do not take extra vitamin E at this point because it can increase bleeding. It is very important that if you have any questions you call the office. You should not drive yourself for a week after surgery.
24. Do I need somebody with me after surgery?
Most patients feel more comfortable if they have somebody with them for the first few days after surgery. If this is impossible for you then I suggest you consider staying in the hospital.
25. Does it hurt after surgery?
All surgery is associated with pain and discomfort. For this reason I will give you a prescription for pain killers. Remember you can often get good pain relief with simple over-the-counter medicines like Tylenol and Advil. Do not take aspirin because this can increase the risks of bleeding. By the end of the first week the pain is usually much less.
26. What will I look like after surgery?
All surgery is associated with bruising and swelling, so you should expect this for one to two weeks after your operation. Some patients remain bruised longer and in rare cases up to a month. You may start to see the results quickly but you will not see the final benefits of your surgery for many months. I do not consider you fully healed for a full year.
27. Will I like the results?
You satisfaction with the results is very important to me. Most patients are happy with the outcome and serious complications are unusual.
28. What happens I do if I do not like the results?
No surgeon can give a guarantee about the outcome but I can say that I will work with you to achieve the result you want. If this means additional surgery I will usually do this for you without a surgical fee, if I think it is medically safe.
29. When can I return to work?
After any operation it is necessary to rest completely for a day or two. During the first week you will begin to feel more like yourself. By the end of a week you may be able to perform light duties such as using a telephone or computer. You should not do any heavy lifting for at least a month. This is a big operation and you will feel tired for about a month.
30. When can I exercise?
I encourage you to begin gentle short walks at the end of the first week after surgery. A serious complication of any surgery is the development of blood clots in the legs as a result of inactivity. The risk of this is reduced by early movement. Begin to walk around as soon as possible after your operation. After two weeks you can begin more vigorous activity but you should not do any heavy lifting or vigorous jogging for at least a four to six weeks. Sometimes there are exceptions to these rules. If you have any special needs, please ask me.
31. Do I have to eat a special diet?
I recommend that you eat a balanced diet and drink plenty of fluids. I like my patients to have additional vitamin C for about six weeks after surgery. Do not take extra vitamin E at this point because it can increase bleeding. After two weeks additional vitamin E by mouth may reduce the risks of thickening of the scar.
32. Afterwards do I need to wear any special clothing or garment?
At surgery I will apply a compression garment this needs to be worn for several weeks until the swelling and bruising has gone.
33. Will I need to change any bandages?
If you need to change your bandage either I or one of the nurses will give you instructions.
34. Will I have drains?
Drains are always used after this operation. I use drains for two reasons. One is to remove fluid such as serum or blood that would otherwise collect under the skin. The other reason is to pull the skin against the underlying tissue to allow it to stick in place. If you have drains when you leave the surgery unit you will be given instructions on their care before you go home.
35. How do I look after my stitches?
You do not need to do anything special with your stitches. If I need you to clean the area I will tell you. You may have paper tapes or steristrips over the stitches do not remove these tapes. They are an important part of the repair. You may get them wet but do not rub soap into them. I almost always use stitches that dissolve. This mean your stitches do not have to be removed.
36. How long does it take to heal?
Healing is a slow process and varies dramatically from person to person but this graph may help you understand the process. It takes almost six weeks for any scar to begin to soften and a full year to be complete.
7. Will I need a catheter?
I often recommend a catheter after surgery because it is difficult for you to go to the bathroom. This is removed before you leave.
38. When can I bathe or shower?
You can bathe twenty-four hours after your drains are removed. If stitches are exposed or you have paper tapes it is fine to get them wet, but do not massage the area of the incision or rub soap into the tapes.
39. Do I have to sleep in any special position?
You may sleep in any comfortable position but try to keep your hips and knees flexed at all times to avoid putting tension on the incision line. A recliner is a good way to position yourself. Try to avoid pressure on the area of surgery and follow any special instructions you may have been given after surgery.
40. Do I need to use ice on the surgical site?
If you apply ice carefully for the first twenty-four to forty-eight hours you may have less pain and swelling. I recommend that you apply the ice for about fifteen minutes every hour while you are awake. There should always be something between the ice and the skin so that you do not damage the skin. After the first two days ice will probably make no difference but if you find it makes you feel more comfortable then continue for a few more days.
41. When can I have sex?
You can resume sexual activity as soon as you feel comfortable. For two weeks avoid pressure at the site of surgery and do not massage the area.
42. Should I stop smoking around the time of surgery?
Yes. Smoking delays healing and can cause your skin to die leaving bad scars. I like my patients to stop smoking for two weeks before and after their operation. If you need help to stop, contact the American Lung Association 212/315 8700 .
3. May I drink alcohol around the time of surgery?
Narcotics and sleeping tablets will interact with alcohol so do not drink at the same time as you take them. They will also make you drowsy so do not drive while you are taking them. After the first few days when you are not taking pain killers you can drink a small amount of alcohol.
44. Can I combine the operation with other procedures?
A major trend in the last few years is for patients to have more than one operation at the same time. This reduces cost and means you only have one period of recovery and pain. In my experience this does not significantly increase the risks of surgery.
45. How will I feel emotionally after surgery?
Some patients feel emotional after surgery. Some even become depressed. If this happens to you do not feel you are alone or frightened. It will almost certainly pass. Talk to me about it. If it becomes persistent or serious I can help you find a counselor.
46. How long will the results of surgery last?
This depends a great deal on the individual patient and the type of skin but unless you gain weight the results are very long lasting.
47. Can I have the operation again?
Almost all surgery can be repeated. Still for most patients this is not needed. As time passes we may find that we need to modify or "update" something that we had done several years ago. This is usually not a problem. Secondary liposuction can sometimes help if you gain a small amount of weight.
48. Do I tell people I have had cosmetic surgery?
Cosmetic surgery is a very personal matter. Only you can decide who should and should not know you have had surgery. I recommend that you talk about surgery with at least one other person you know well. Your spouse or a good friend are obvious examples. You could also discuss surgery with a therapist or your family doctor. Unfortunately, even today many professional people are not well informed about cosmetic surgery. If you let those close to you know about the operation then you can ask for help afterwards without being embarrassed or shy.
49. When can I go to the gym after surgery?
Gentle exercise can begin after two or three weeks but vigorous exercise or strengthening of the abdominal muscles should not begin for six weeks. Even then you should begin gradually.
50. How do I reach Dr. Hudson if I have an emergency?
Serious emergencies are rare after this surgery. The quickest way to reach me is through my office number. The office is open between 9:00 AM. and 5:00 P.M. Monday through Friday. During these hours call 505/242 0070. The office staff will call me for you. Please stay by your telephone and I will either call or relay a message to you. If your emergency is life threatening go to your nearest emergency room. They will begin treatment and contact me for you.
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