LIPOSUCTION AND TUMMY TUCK
ACCREDITED AMBULATORY SURGERY CENTER:
AACS offers a fully certified Ambulatory Surgery Center accredited by: AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities, Inc) with anesthesia services provided only by Doctors of Anesthesiology.
OR Fees: will vary with the number of areas to be addressed, and whether the procedure is done under local anesthesia, or under general at the time of another surgery.
About Sending Photos: Please send multiple views, and any special views that show problems if you are inquiring about revision surgery (see below). The photos should be taken in good lighting, against a dark background. If you send digital photos, please use JPEG (.jpg) format, and simply attach them individually, rather than sending a Zip file. Digital Camera Photos should be 640x480 resolution so that they will not be overwhelmingly large to send, or to view (all digital cameras can be set to this resolution). This may necessitate sending multiple e-mails if your ISP does not allow attachments over 1MB in size. Polaroids or similar types are fine by mail, also, but may delay reply somewhat. For tummy tuck surgery, views should be with undies rolled down to pubic level, and should include frontal views from braline to upper thigh; front view, both sides, and a posterior view to show the hips. Lipo photos should show the areas of concern from multiple views (front/back/sides). A thong may be used for modesty. Mirror-bounced photos will not work as they are generally too distorted to be of use.
]] SURGERY DATE:
]] FULL ADDRESS:
City: State: Zip:
]] Phone Number(s) with Area code:
Home: ( )
Work: ( )
Cell: ( )
Pager: ( )
]] Preferred Stable E-mail Address:
]] Date of Birth:
]] Social Security number (needed for OR posting):
]] Current Bra size: (for breast surgery patients only)
]] Do you sag with nipple at or below the level of the folds beneath your breasts?:
]] What size do you want to achieve?:
]] Do you smoke? How much and how many years?
You will be urged to quit if you smoke, and will not be a candidate for
surgery if a major breast lift, facelift, or abdominoplasty is contemplated due the much higher
complication risk in smokers.
]] Do you have any medical conditions such as: Diabetes, high blood pressure,
or heart disease?
Are you presently under the ongoing care of a physician? Please elaborate:
Do you have a history of previous surgery? Procedures:
]] List any medications you take regularly and dosages and their reason (include aspirin,
vitamins, Birth control, homeopathics):
]] Are you allergic to any medicines?
]] How many pregnancies if any?
FOR BREAST SURGERY PATIENTS: (be sure to send photos from all angles)
]] Have you had any breast surgery in the past? What? Result
]] If you are planning to come for revision of an existing augmentation, when was it done?
Incision Site: Implants over or under the muscle:
What implant type (silicone or saline): Smooth or Textured:
Anatomical or Round: Implant Manufacturer:
Implant size: Fill volume (for saline):
Can you obtain your old operative report(s):
Why do you want/need revision?:
]] Have you ever had a mammogram? Results:
If over 40 and you should have a mammogram within a year before surgery.
]] Is there a family history of breast cancer or breast disease?
FOR LIPOSUCTION AND TUMMY TUCK PATIENTS: (Be sure to send photos of all areas of concern from front, back and sides)
]]Which areas of concern do you think will benefit from liposuction?:
]]Have you had liposuction before?
}}Have you had any abdominal or leg surgery in the past?: What?:
FOR EYELID SURGERY PATIENTS:
]] An eye exam report, including a test for glaucoma and examination of the retina will be needed before surgery. You will need to forward a copy of this report (within the last year) before proceeding.
]]]]Please send these answers back to me, and I will save them for your file.
To cut data, use the cursor to highlight it with the left mouse key depressed, and click Ctrl-C. To paste it, place the cursor on the new document and click Ctrl-V. Answers can now be added to the pasted document.
PRE-OP REQUIREMENTS and RECOMMENDATIONS:
]] Some patients may require lab work or an EKG before surgery, this will need to be coordinated for patients from out of town, especially if they are having surgery in the Office Surgical Suite. Hospital patients will have these tests at the hospital, as warranted.
]] To limit risk of bruising and bleeding: No aspirin, ibuprofen (Advil;Motrin;Nuprin) or other arthritis pill, or any combination medicine (such as cold or flu pill) that contains them for 7 days pre-op.
Vitamin E and Vitamin C should be stopped for 3-4 weeks pre-op due to potential for increased bleeding and impairment of clotting.
]] Stop any homeopathic or herbal medicine (herbal teas; Ginseng, St.John's Wort) for at least 4 weeks pre-op, because they are unregulated regarding side effects, and many may impair clotting, or interfere with serum chemistry pre-op.
]] Do not drink alcohol for 24 hrs. pre-op
]] Do not shave axilla for 10 days (Breast augmentation patients only), or groin hair (lipo patients), until the AM of surgery to limit risk of ingrown hair.
]] Arrive for surgery with an empty stomach and nothing by mouth for 8hrs pre-op (except cardiac meds with a sip of water)
]] Wear a loose garment that buttons in front to the hospital or office the day of surgery (e.g. a sweat suit)
]] Do not wear jewelry to the hospital or office for surgery
]] If you are from out of town bring light snacks, saltines, baggies for ice chips, lifesavers or hard candy, mild soda (e.g. ginger ale) or juice to keep in your hotel room, along with books, or magazines.
]] Be sure that you are not pregnant (if applicable) pre-op. Honest- this happens!
]]For patients who take Birth Control Pills, you will be given an Rx for antibiotics to take after surgery, and be mindful that antibiotics may compromise the effectiveness of the contraceptives in your current cycle. Be sure to take appropriate precautions in this regard.
]] For BA patients, bring or send me photos of the "look" that pleases you, but remember, that the final result will be greatly related to the existing dimensions and shape of your chest and breasts, as well as height, weight, etc. This helps me to communicate what you consider to be a various cup size.
}} For Abdominal Liposuction or Tummy Tuck patients, extra care should be taken to clean the belly button with soap and water and a q-tip with each shower for a week before surgery.
]] Patients who smoke, should obviously quit smoking for several weeks ahead of time to prevent impairment of wound healing, and heightened discomfort associated with Nicotine, Carbon monoxide poison gas in smoke.
revised: December 28, 2012 11:00:34 PM