Category Archives: General Plastic Surgery

Postoperative Pain Medications and Side Effects : Understand the “Seesaw” for Better Cosmetic Surgery Recovery – Dover, De

After cosmetic surgical procedures, pain medications can be difficult to tolerate and important advise can help recovery. After many plastic surgery operations like tummy tuck, breast enlargement, and liposuction – pain pills are necessary for comfort and to help with recovery. Often this means taking a narcotic pain pill. Some of the most common narcotic pills prescribed are Percocet, Vicodin, and Tylenol with Codeine. The “seesaw” is a visual aid to understand the benefits and side effects of narcotic pills. A patient from Dover, De asked me to review the concepts that are described in detail below.

There is a critical difference between allergies and side effects. Everyone needs to understand this difference. Allergies are not common with pain pills. Allergies cause problems such as swelling and breathing problems. This can be serious, and the medication should be stopped immediately. This is a true allergic reaction like a bee sting reaction.

Side effects of pain pills, in contrast to true allergies, are extremely common. The most commen side effects are nausea and vomiting, itching, constipation, and generalized malaise (feeling poorly). Sides effects in general are not dangerous but need to be managed to minimize the problem.

After a tummy tuck for example, narcotic pain pills can be necessary to help with the pain. A patient will take pain pills to help with the discomfort of the operation. The patient might unfortunately have to suffer thru the side effects. So a key question is: which is worse- the pain or the side effect? Like a “seesaw,” one side might be higher or worse than the other. For example, if pain is really “bad,” than take the pain pills and try and tolerate the side effects. In contrast, if the pain is not that bad, and side effects are horrible, than stop taking the pain pills to lessen the side effects. Think of it like a seesaw. Which end is up – pain or the side effects. How you respond depends on which is worse.

Nausea and Vomiting:

Try taking the pain medication with food. This makes a huge difference. It might be counter intuitive, as with many flu symptoms, keeping the stomach empty helps with vomiting. But with pain pills, food in the stomach makes a tremendous difference. If you can get food down first, it will really help the patient tolerate the pills.

Itching:

This is because the narcotic causes a mast cell release. This leads to the itching. Benedryl can be used to help with this side effect. The benedryl pills can also help with sleep, so you can use this to your advantage before nighttime. Benadryl and Hydrocortisone creams can also be used to help with itching and your plastic surgery recovery.

Constipation:

Pain pills cause constipation by slowing bowel motility. Typical recommendations for constipation is the use of Colace. This helps costipation because it decreases hard bowel movements. However, the better choice is Milk of Magnesia. Take one tablespoon twice a day. This increases bowel motility and should do the trick for most. I also do not mind coffee and prune juice or other natural laxatives, if desired. Enemas (such as Fleets Enema) can be used for those who don’t mind them or for those who need extra help to get the bowels moving.

A final critical piece of information. STOP the medication that’s causing the problem. It’s the pain medicine! So if the side effect of constipation is the problem. Stop the pain pills to get the best result. If pain is still an issue, try and back off the narcotic pills to lessen the constipation and use Tylenol or Motrin instead.

Generalized Malaise:

This is the doctor term for feeling poorly. It’s interesting that pain pills are used by some drug addicts for abuse to feel better. However, for many people the effect is the opposite. This side effect is feeling really poorly and overall bad. It’s called malaise. If you are feeling this way after surgery, try and get off the pain pills. You will probably slowly start to feel better. It will aid your cosmetic surgery recovery

Managing Pain after Cosmetic Surgery and Dealing with the Side Effects – The Seesaw!

I will recommend to patients to think of pain and side effects like a seesaw. Which is worse? Is the pain worse from the surgery? Or are the side effects worse from the medication. If the pain is worse, than you have to deal with the side effects. If the side effects are worse, than you can stop the pain pills and the effects will resolve or go slowly away.

Don’t under estimate how well Tylenol and Motrin work to elevate and reduce pain. These medications don’t cause nausea and vomiting.

I am a board certified plastic surgeon who practices exclusively cosmetic surgery. Please come in for a complimentary consultation. Details of your cosmetic procedure and your surgical plan will be discussed completely. I hope this writing helps with your recovery from cosmetic surgery.

Scars, Incisions, and Surgical Results for Cosmetic and Plastic Surgery: West Chester, Pennsylvania

How a scar or incision heals depends on factors such as the surgeon, the scar location, the operation, time, and individual human differences. These factors are discussed in this educational writing and it’s importance to cosmetic surgery results and plastic surgery scars.

A patient of mine from West Chester, Pennsylvania came to me and asked, “Get rid of my scars.” You unfortunately can’t. Scars are permanent. If a person has a laceration or an operation, the incision turns into the scar, and this scar is permanent. It will fade, however! It will become less noticeable, but it will always be there. Understanding this process is very important. Plastic surgery incisions eventually turn into scars.

The factors involved in scar fading, incision healing, and surgical results will now be discussed.

1- The Surgeon:

Everyone wants the best doctor or surgeon to sew up their cuts or lacerations. This is true of their cosmetic operations too. Usually this is the plastic surgeon. Plastic surgeons have extensive training focused on the best techniques to maximize the fading and healing of scars. The techniques used include gentle handling of tissue, meticulous hemostasis, small- delicate stitches, and precise approximation or suturing of the tissues. It is normal to want the best doctor to fix your lacerations or to perform your cosmetic operation. This will play a role in your healing. The plastic surgeon will use his extensive training to maximize the healing and the fading of the incision to give the best result.

2- The Location:

In real estate transactions, there is a phrase used often – “Location, Location, Location!!”
This applies to scars and incisions also. If we get accidentally cut or suffer a laceration, we have no choice of the location or where the cut or scar occurs. However, with operations we have a choice. The location is critically important. Certain areas on the body heal better than others. For example, the face tends to heal extremely well. I call it a “privileged” location. Face lifts, eyelifts, and other cosmetic operations on the face use incisions that almost uniformly heal exceptionally well. The incisions in these areas are placed in “privileged” areas and usually are difficult to see after healing. It is a characteristic of these operations that the scars heal extremely well. If they didn’t, these operations would not be so popular.

However, other locations don’t heal as well as the face. The back, for example, doesn’t heal as well as the face. The scars or incisions in this area tend to be thicker and wider than often desired. The knee or shoulder can heal with wider or suboptimal scars. Some areas of the body do not heal as well as others. Location is critical.

The breasts, like the face, tend to heal very well. Cosmetic surgery operations on the breast often have very nice scar fading and results because of this tendency. This is true also for the incision for an abdominoplasty or tummy tuck. These operations tend to have surgical results with nice incisions and scars that fade well with time.

3- The Operation:

Different operations will have different results and scar healing patterns. As discussed above, certain operations use incisions that are not in the best locations. Thigh lifts, body lifts, buttock lifts have incisions that might not heal as well as other operations. A person might have to except a scar that is not as good as desired or thicker or wider than desired. These locations might have a higher incidence or chance of poor healing. Other operative factors can play a role. For example, operations that have complications, infection, or delayed healing will effect the scar or the surgical result. Delayed healing beyond three weeks is often associated with hypertrophic or keloid scars. Therapy is available if this happens, so this can help the fading if it occurs.

4- Time:

Scars or incisions fade with time. It can take much longer than many people realize to see complete fading of the scar. A good rule of thumb is that scars fade over a year. However, it can take longer for some people. Scars sometimes can take 18 months or even longer. It is important to be patient. It most cases the scar will fade with time. The great majority of people will ultimately be happy about the appearance of the scar. The final surgical result awaits complete fading of the incisions.

5- Individual Differences:

Scar fading is not the same for everyone. Personal differences in skin type, quality, and healing abilities can make a big difference in the final appearance. Patients might have genetic differences that lead to better or worse healing. Some patients will be more prone to keloid scarring. If you know this is the case for you, make sure you tell me as things can be done to enhance healing.

Summary:

Cosmetic surgery requires incisions. These incisions turn into the scars. The final result of the cosmetic operation occurs after the scars have faded to the greatest degree. Scars do not go away completely. They usually heal to the point where most people are very happy with the incisions. Factors that are involved in scar healing include but are not limited to: the surgeon, the location, the operation, time after surgery, and individual differences.

I am a board certified plastic surgeon who practices exclusively cosmetic surgery. Please come in for a complimentary consultation. Details of your cosmetic procedure and your surgical plan will be discussed completely.

Funny Plastic and Cosmetic Surgery Quotes and Phrases:

Funny plastic and cosmetic surgery quotes, phrases, and expressions are reviewed in this educational writing. The writing is more for “fun” and “enjoyment” than any other reason. Doctors have their own language. It’s not just anatomy terms that might be unfamiliar, but doctors use expressions to convey concepts. These terms are sometimes funny or even peculiar. They are reviewed here for your amusement. Doctors can use words or terms that are difficult to understand. These expressions are meant to put concepts into easy to understand words. I hope you laugh and enjoy them!

1:   “Spitting Stitches”

Surgical incisions are sutured by the plastic surgeon or cosmetic surgeon with advanced skill and technique. This includes gentle tissue handling, meticulous control of bleeding, and fine delicate sutures. Many procedures have buried or “internal” stitches that absorb or dissolve with time. This allows for an incision with no visible stitches and can minimize the scarring. Expectations are nice healing and fading of the scar. This is called scar maturation or scar fading with time.

During this healing process, one might find that the incision “spits” or things come out of the incision. This is very common. Most sutures used are absorbable and placed in the skin. As the skin heals and turns over, the suture works it’s way to the surface. This can come out and is called a “spitting stitch.” It doesn’t hurt at all! But, it can be scary to some people. The stitch won’t affect the cosmetic result, so there is no reason to worry.

Other aspects of a healing incision can lead to the incision spitting. During the repair of the skin, sweat glands, oil glands, and hairs can get blocked. This can lead to minor infections. These usually are no more concerning than a pimple. So don’t worry. You usually see redness, swelling, and minor pain in a small part of the incision. Some pus drainage is not uncommon. Treatment is usual just Neosporin and band aides. This will not affect the cosmetic outcome.

2:   “Are You Eating, Drinking, Peeing, and Pooping?”

After surgery, patients are given specific and thorough instructions. A frequent question asked is, “What should I look for that might go wrong after surgery?” The standard answer is to look for high fevers (above 101.5 degrees), excessive bleeding, or excessive pain. My patients are given my personal cell phone for questions or concerns. However, if we check basic body functions and find they are well, we can then have a better assurance that all is well. Basic body functions are things like eating, drinking, urinating (peeing), and having bowel movements (pooping). If we are doing all these things, than we can often know that we are healing well after surgery.

This is not a guarantee that everything is perfect. It just means things appear to be going well, if they are all being done. It’s a good sign of progressing recovery.

3:   “Be the Turtle!”  and  “Slow and Steady Wins the Race!”

Everyone who has cosmetic surgery or any type of surgery must allow appropriate time to heal and recover. We have busy lives, and many patients want their surgery and be healed instantaneously. This doesn’t happen!

If we don’t take time to heal, we can cause problems, increase risks, and delay healing. “Be the Turtle” is an expression referring to the fable of the tortoise and the haire (rabbit). In this story, the rabbit rushes ahead and then because he falls asleep, he loses the race. The expression refers to the idea that you need to go slow after surgery and take time to heal. Otherwise, you can actually cause problems and “lose” the race. The “race” is healing after surgery as quickly as possible, with no problems.

The expression “Slow and Steady Wins the Race” refers to the exact same concept. Follow the instructions given. Go slow and heal properly. Be wise. Don’t try and rush things or you will be the rabbit and lose.

4:   “Circle the Wagon”

This is an expression used by surgeons. To my knowledge it is mainly used by a limited number of plastic surgeons. I learned it from Dr. Thomas Whetzel, a professor at the University of California. It refers to surgical dissection. When dissecting anatomy, you have to avoid working in just “one spot” and instead dissect around the entire area to more safely expose the anatomy.

If you are trying to isolate a particular nerve or vessel at surgery, dissection in one location might lead you into a hole with limited visibility. If you dissect above, below, and around this spot (circle the wagon) you will more safely identify the surgical anatomy. Circling the wagon is the best way to dissect safely for surgery.

5:   “Exposure, Exposure, Exposure!”

This can be thought of like a realitor’s phrase of location, location, location. With surgery, proper exposure of the anatomy is critical to safely find and dissect nerves and blood vessels. It the surgeon has proper exposure, then he can see what anatomy to protect. This leads to less chance of injury to the surrounding anatomy.

The concept of exposure is similar to “circle the wagon.” The expressions are both related to ways the surgeon should operate or dissect. The surgeon must have all important vessels and nerves safely identified. This will minimize the chance of injury to the surrounding anatomy.

6:   “Twinkle in the Eye”

Clinical experience can be more important than lab values and X-rays. When recovering from surgery, it’s important to be able to tell if the patient is recovering well. Recovery has its ups and downs, but the trend should be gradual improvement and healing. Patients often want to know if they are doing well and how to tell if they are not. The doctor can often look at a patient and tell if things are ok or not. A famous surgeon, Dr. F. William Blaisdell, called it “the twinkle in the eye.” If the patient was doing better or healing, you could tell from experience. Better than a blood level or X-ray, often just “seeing” the patient could help the doctor tell everything was ok.

This experience comes from years of taking care of patients. That’s why I tell my patients it’s important to keep their follow up appointments. By seeing them, I can get a better handle on their healing and what needs to be done to recover the best. If there is any question or concern, I tell my patients, “Just come into the office.” By seeing them, I can tell if they have a twinkle in the eye. It also helps to see what is really happening and if there is a problem or not.

Dr Blaisdell was one of my mentors at the University of California. He was a surgical pioneer, expert, and Professor and Chairman of the department of surgery. He invented the extra-anatomical bypass and started the first surgical ICU in California. He also started the first trauma center in California. He was a major influence on my training and a hard work ethic.

7:   “Tincture of Time”

Sometimes during the healing process, a doctor can not tell for certain if there is a problem or not. An infection can sometimes take a while to manifest and with time it will be self evident. Treatment might be delayed to see if it was indeed a problem or not. This waiting peroiod can be called a “tincture of time.” A tincture is a word that in pharmacy means a medicine that is often alcohol based or containing a chemical. It can also mean a small dose, trace or tinge. A tincture of time means we are going to give it a small dose of time to see if it improves or not. Usually with time, the healing will be self evident or not. With a waiting period, the doctor will be able to better assess what is best. Typically no harm comes from a small wait. It is often a wise thing to do to minimize risks of unnecessary treatments.


I hope you enjoyed these funny plastic, cosmetic surgery expressions, phrases, and quotes!

Will Insurance Cover My Cosmetic Surgery? Philadelphia, Media, Delaware Valley PA

This educational writing discusses insurance coverage of cosmetic and plastic surgery. Who will pay? What will be the cost? Is it going to be covered? Will insurance pay for my plastic surgery? These are fantastic questions that are normal, and they should be addressed for anyone considering these procedures. For the interested reader, please see my book – “A Woman’s Guide to the Real-Reality of Cosmetic Surgery.” The book reviews and discusses major concepts about cosmetic surgery, results, recovery, and expectations.


It is very common for people to come into my office and state, “My insurance company has told me that my tummy tuck operation will be covered.” Or they might have been told their eye lift or eye tuck operation will be covered because of blocked vision. The unfortunate truth is that the great majority of these cases are not covered by insurance companies, and the company is misrepresenting the truth. This article will cover some of the truths and facts about cosmetic surgery, plastic surgery, and insurance companies.

I am a Board Certified Plastic Surgeon, and I (like most plastic surgeons) want insurance to work for my patients. It helps pay your expenses and is a great thing when covered! The plastic surgeon is on the side of the patient. It is very important to understand that the surgeon is on “your side.” We want the insurance to work or pay for the cosmetic surgery. My staff assists patients with all the paper work necessary for insurance claims. This includes appropriate codes, documents, and forms. Common requests are for tummy tuck surgery, eye lift or eye tuck surgery, and breast reduction surgery. Also, insurance coverage for a nose job or rhinoplasty is often desired. I want the procedures covered, but it is critical to know that it is not that simple, and most of the time it will not be covered.

The truth is the insurance company is not giving the patient the whole picture when they say a procedure is covered. They should tell you that most of the time these procedures are denied and are only approved infrequently. It can really disappoint a person, because they are told this by the insurance company, and then they don’t get approved. The patient then feels they were “robbed.” Insurance companies are in the business of making money. They do this by “denying” surgery which makes more company profit by saving the expense of surgery. It can not be over emphasized that they make money by denying your surgery! It might be listed as a covered procedure, but this rarely is the case. It disappoints the doctor too, because he then uses valuable consultation time talking about insurance issues, instead of your medical needs and surgery.

Family doctors or other physicians will often tell a patient that the surgery is covered. Patients come in saying, “My doc told me my surgery will be covered.” Unfortunately, the doctor who said this isn’t the one trying to get the insurance coverage. This can lead to disappointment when the surgery is ultimately denied.

Some examples will help with this discussion. These are true stories. The first is a women who had lost 70 pounds from diet and exercise. She was interested in a tummy tuck. She was concerned about hanging skin and rashing at the folded over skin. She called her insurance company as was told that this is a “covered benefit.” Photographs were submitted with all appropriate codes. Her case was unfortunately denied. The insurance company deemed it a cosmetic abdominoplasty. They said the skin would have to hang down half way to the knees to be covered. Fortunately, the patient was able to have the surgery on a cosmetic basis. She healed well and was extremely happy with her results.

Another example was a women who wanted her breasts lifted and reduced. She complained of breast pain, neck and back pain, and shoulder grooving from her bra. She wore a 40 DDD. She was 5′ 6″ tall and weighed 155 pounds. Photos were submitted and codes given for a breast reduction. Unfortunately, she was denied by her insurance company who said it was cosmetic breast surgery. They said she had to be close to ideal body weight (within 10%) and should lose 20 pounds and resubmit. Also, they said one pound of tissue would have to be removed per breast, if she was successful in the weight lose. This would leave her as a B cup and she wanted a C cup. She also proceeded with cosmetic breast surgery, without insurance. She wanted to pick her own size and not be forced to go too small. She ended up extremely happy with her new breasts, which were C cup and “perky!”

It is intereting to understand how insurance companies really will fight to deny surgery. Patients might find it incredible that the companies considered cleft lip deformities in babies a cosmetic issue! Yes, this is true. We can thank our federal government who created a law stating cleft lip surgery is not cosmetic and mandated coverage. They forced the companies to accept that plastic surgery for cleft lip surgery is not cosmetic! If they were fighting this, you can bet they will fight tummy tuck or breast lift, or breast reduction surgery!


There are a few exceptions about cosmetic surgery and insurance coverage. If a person has had a gastric bypass then insurance coverage of the tummy tuck is easier, but it is not a guarantee. Also, rhinoplasty or nose job surgery and insurance companies can be a more positive experience. The septum or breathing aspect of the surgery can be covered. This is called a septoplasty. This is not the cosmetic aspect. However, the septum being approved can really offset the expenses of the surgery. Finally, eye lift surgery or blepharolasty surgery can be covered if a person fails the visual field test. This is a test that demonstrates major blocking of vision by hooding.This usually has to be severe however.

It also is extremely difficult to get thigh lift surgery, buttock lift surgery, or lower body lift surgery covered, even after gastric bypass surgery and/or extreme weight loose. My office will try and fight for you, but you must remember it is difficult to win. They make money by denying surgery!!

I am a board certified plastic surgeon who practices exclusively cosmetic surgery. Please check out the before and after photos on our web site. Also, please come in for a complimentary consultation to learn about your choices and options!


Cosmetic Surgery Nutrition Delaware : Cosmetic Surgery Nutrition Pennsylvania – Part One

Many patients have questions after that focus on diet and cosmetic surgery nutrition. How do I best lose weight? What is the best diet?

What exercise program is recommended? Cosmetic surgery patients often ask for information on nutrition after tummy tuck or post tummy tuck diet. Similar questions from Delaware or Pennsylvania patients arise for nutrition after liposuction or a liposuction diet plan. This educational writing focuses on diet and nutrition in relation to cosmetic surgery. Part One focuses on general concepts,Part Two focuses on more specific issues, and Part Three will give food, calorie, and fat diet advice. These plans can really work! Please see tummy tuck Delaware or tummy tuck Pennsylvania before and after photos.

“Fat is the enemy!”

The goal of many cosmetic surgery operations is to be made smaller and thinner. Liposuction, tummy tuck, and many operations target fat and fat cells. The operations try to achieve significant reductions in fat cells and volume. However, the best results are when the patient understands there are limitations to what surgery can do. Diet, exercise and nutrition should start where surgery stops and make the results even better. It is extremely important to understand that diet and exercise are “part of” the best cosmetic surgery results. Some call this cosmetic surgery nutrition or cosmetic surgery diet plans. It is also called common sense.

“Exercise regularly and don’t eat crap!”

Many people are looking for the easy way out. The diet that “tricks” the body and leads to weight loss without hard work. Diets are hard for most people. There are no tricks! You can not eat “crap food” and be sedentary and maintain significant weight loss. Many scientific studies have shown that “fad” diets don’t last, and I do not recommend them.

Exercise regularly and don’t eat crap!! This is the diet after cosmetic surgery that will wrok for most people. This is the liposuction diet plan and nutrition after tummy tuck that has been shown to work. It’s not easy. It’s hard! But it is often extremely successful.

“Outside fat is the tip of the iceberg!”

People interested in nutrition after liposuction, tummy tuck diet, or cosmetic surgery nutrition often ask how much weight are they going to lose after liposuction of the stomach or how much weight will be lost after a tummy tuck. Many people will be surprised by the answer. They might love the way they look after their cosmetic operation but be surprised about the weight loss. Most of our weight is inside us and not outside. Liposuction patients might lose only a pound or so. Tummy tuck patients can also be surprised by this.

The knowledge that most of our weight is inside us underscores the importance of nutrition after liposuction or post tummy tuck diet. Significant weight loss after surgery usually leads to much more dramatic results. Right after surgery is often the best time to get the weight off and “go for it!”

People have heard that all weight loss before a tummy tuck should be “before” the operation. This is not the whole story. Yes, weight loss before the operation is recommended but “after” is also highly successful too. Weight loss before surgery is thought to be the best because all the extra skin will be present at the operation. However, the problem with this approach is that many people can’t lose the weight and that is why they want cosmetic surgery.

For people who are having problems losing the weight before hand, losing it after the operation usually works fantastic. Many people get motivated after the tummy tuck. They have spent money, recovered, and see the benefit of the operation. They don’t want to ruin it! Many people feel more comfortable in their workout cloths after surgery and now succeed in weight loss.

For most people, any weight loss after surgery only makes things even better! For most who loose 5-20 pounds after the operation, they are just going to look even better and more sculpted. It in general doesn’t create excess skin and ruin the results. It usually just makes the person thinner and enhances the results. In extreme case, such as 50- 100 pounds loss after surgery, this might make extra skin; but this usually doesn’t happen.

Weight loss after liposuction is the same situation. Liposuction diet and proper nutrition after liposuction can help a person lose weight after the liposuction. This in most situations leads to improved results. It gets rid of extra fat that wasn’t removed. It leads to enhanced results and increased satisfaction with the operation. The answer usually is lose weight- it helps!! Proper diet after cosmetic surgery, tummy tuck diet, liposuction nutrition- these are the ways we enhance results after cosmetic surgery.

Part Two will be the next educational writing.

This will cover more specifics to help you!

People interested in tummy tuck, liposuction, nutrition after tummy tuck, post tummy tuck diet, liposuction diet plan, cosmetic surgery nutrition or other topics about cosmetic surgery in Delaware or Pennsylvania should please call the office for an appointment.

Dr. Saunders is a board certified plastic surgeon who practices exclusively cosmetic surgery. Please check out the liposuction before and after photos on our web site. Also, please come in for a complimentary consultation to learn about your choices and options!