Facelift Series #8: Prep for Success

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, Summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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This episode in our facelift
series is titled Prep for Success.

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What are we talking about
in this episode, Dr. Bass?

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This episode focuses on a
lot of important steps and

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actions that both patients and
surgeons take before a facelift

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to tee things up for a
smooth, successful course.

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These are things that help
minimize risk of a complication or

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healing problem,

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ensure that your body is ready
for surgery and ready for the

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healing that follows.

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What medical things need to be
taken care of ahead of time?

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The first thing in getting ready
for a facelift or really any

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surgery is understanding overall health,

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the severity of any medical conditions,

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and that's before we start to
think about the aesthetic needs.

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Yeah,

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some patients need to obtain medical
clearance before they can safely undergo

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surgery.

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This is usually required for patients
over a certain age as predetermined by

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their surgeon,

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as well as any patients who
have a significant medical
condition that would need

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a clearance.

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Clearance is usually involved with
seeing your primary care physician and

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gaining a history physical exam,

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and then usually some laboratory testing
or blood work and then an EKG to make

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sure you're set.

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There could be additional testing for
more specific or severe medical problems.

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Your primary care doctor may ask you to
also see a specialist in one of those

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areas to make sure that you're safe for
surgery and if your medical conditions

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need to be optimized before you are
cleared and deemed safe for surgery than

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your primary care doctor will help
you to optimize those with the goal of

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getting you cleared for surgery hopefully.

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And from that point in
this optimized state,

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a go no go decision about whether
it's safe to have surgery can be

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made. So this doesn't
apply to most patients.

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Facelift has low surgical stress.

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Most patients are more
than healthy enough,

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but for older patients or
those with health issues,

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this has to be looked at very
carefully right at the outset.

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This is mostly about cardiovascular risk,

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any lung conditions and metabolic health,

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things like diabetes and
good glucose control.

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Earlier you mentioned that there are
things to help minimize risk of a

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complication. What are some of those?

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The first and foremost is going
to be bleeding before surgery.

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We stop any medications
that might interfere with
blood clotting like aspirin,

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NSAIDs, any other anti-platelet
medications like Warfarin,

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Coumadin, Plavix, Eliquis.
There are a lot of other ones.

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We'll check with your internist and
cardiologist before stopping these

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medications just to make
sure that it's safe to do so.

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There are some conditions where
it's not safe to stop those,

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so we need to make sure we can
actually do that for surgery.

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And then there are many nutritional
supplements that can also inhibit clotting

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and promote bleeding interestingly.

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So we do hold nutritional supplements
before surgery to keep you safe.

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And because bleeding is the most
common risk we also need the

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blood pressure tightly controlled,

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tighter than normal for walking around.

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So as someone who has high
blood pressure over decades,

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that puts them at increased
risk for heart attack, stroke,

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kidney failure, other
kinds of health problems.

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Preventing bleeding during surgery
means the pressure needs to

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be a little bit lower than what we
would consider safe for walking around.

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Although the walking
around anti-hypertensive
standards have gotten a lot

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stricter over the past few
decades. In my practice,

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I notify the primary care doctor.

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I send a note explaining what
kind of blood pressure control is

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necessary,

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and this means sometimes dosing of
an antihypertensive medication is

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adjusted or a new antihypertensive
medication is added

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temporarily around the
time of the surgery,

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there's a long list of nutritional
supplements that promote bleeding.

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So it's probably best just to
stop all of them to be safe

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rather than trying to puzzle through
what's in some of these things.

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But just a few of these,
and there are many,

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many that can potentially
interfere with bleeding,

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include anise or licorice, ginkgo biloba,

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fish oils or omega fatty
acids in high doses,

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high doses of vitamin E and turmeric.

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So those are just a few. I
will mention though vitamin E,

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a typical multivitamin has 200
international units of vitamin E.

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Perfectly okay to stay on
a standard multivitamin,

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but if you're taking
high doses of anything,

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trying to really push that
particular nutritional

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supplement,

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probably a good idea to back off
on around the time of surgery.

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That all makes sense. What other
steps are needed to minimize risk?

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The risk we worry about is skin loss
from skin necrosis or skin deaths,

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and that risk is greatly increased
with nicotine use, either from smoking,

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chewing tobacco, vaping.

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Marijuana also increases the risk
because it's often mixed with tobacco,

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but even pure marijuana also increases
the risk of skin loss independently.

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So you have to make sure that you're not
taking any of those nicotine containing

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products for several weeks before surgery.

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And that's not critical
for every type of surgery,

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but it's a very critical issue
for a surgery like facelift.

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Fortunately for non-smokers or
people that don't use any of these

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products, that's a low risk normally.

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But for smokers or anyone
who's taking nicotine in any

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form, even with cessation
for several weeks,

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there's still increased risk of skin loss.

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How long should people stop
smoking, vaping, et cetera.?

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The longer you stop smoking
before surgery, the better.

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So if you can stop smoking for however
long you can, the longer the better,

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but we typically recommend stopping at
least four to six weeks before surgery.

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That would be the absolute minimum,

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not only for the risk of skin
necrosis like Dr. Bass mentioned,

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but also for overall lung health and
for undergoing anesthesia for surgery.

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There are a couple of important
points about this. Unfortunately,

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even a little bit of
cheating really ruins it.

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Platelets become much more clottable.

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They clump much more easily
with even a single exposure to

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nicotine in the several
weeks before surgery.

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So it's really important
to stop altogether.

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Some surgeons will actually
test to see if you stopped.

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Others don't.

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But the important thing to remember
is you can fool your surgeon,

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but you can't fool mother nature.

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And if mother nature knows
you had some nicotine,

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she's going to punish you for
that. Also important to remember,

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nicotine replacements like
patches and gum also need to be

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stopped because the nicotine still
has the same effect. However,

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oral medicines that
reduce nicotine cravings,

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these are usually selective serotonin
reuptake inhibitors or SSRIs.

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Those medications are okay,

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so sometimes that helps people
with this no smoking period

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leading up to surgery.

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Okay. And you mentioned other
health issues to consider.

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Can we go through some of those?

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Long health is really important.

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We want your lungs to be in their best
condition before you have anesthesia

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during surgery. This includes
controlling and optimizing asthma, COPD,

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and then again, like we mentioned,
stopping with nicotine use,

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smoking vaping and all
marijuana before surgery.

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We mentioned before diabetes
or metabolic health.

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Good glucose control is important.

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Even though facelift is low stress,

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it can still push glucose levels
higher, at least in the short term.

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If you have a glucose
monitor or do finger sticks,

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you should bring that
with you to the surgery.

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And another important thing that's
become very important in the last

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couple of years is if you're
taking a GLP-1 medication like

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Ozempic, Wegovy, Mounjaro, Zepbound,

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it's really important to
stop that prior to surgery.

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The guidelines for how long
you should stop are evolving,

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but basically you typically
omit one weekly dose before the

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surgery.

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Okay. I think this all makes sense,

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but I also noticed these
are all medical things.

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Are there other things patients can
do to be ready for their facelift?

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Well,

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one thing is making sure your nutrition
is good because your body has to do the

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job of healing from the surgery.

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And so some surgeons will
recommend nutritional supplements,

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and common ones include vitamin C.

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Vitamin C is needed to help
with collagen synthesis,

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which your body uses to
heal the incisions and the

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surgery. Another popular
supplement is selenium,

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which is a mineral.

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There are some specialized pre
and post-surgical nutritional

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supplements that some
surgeons use that have a

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combination that the mix of
which vitamins are in there is

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supposedly optimized,

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although it's hard to know
what your body needs the most.

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But for people that want to
ensure that they have everything

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nutritionally they need
on a vitamin basis,

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that's a good way to do it.

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Arnica and bromelain are other
nutritional supplements that help prevent

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bruising and that help
break down bruising as best

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we understand. The degree
of utility of these

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medications is not a hundred percent
clear or supplements because they're not

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actually pharmaceutical medications,

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but they seem to be safe
when used as directed.

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And so some surgeons in some
patients in an effort to minimize

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bruising will recommend these supplements,

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and arnica needs to be started
in advance of the procedure.

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Overall,

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the most important thing in this regard
is to be eating a balanced complete

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diet.

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If you get a little bit of everything
and you have adequate protein in your

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diet,

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then you should be able to heal if
you're healthy enough to have a facelift

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without difficulty after the procedure.

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Yeah. I'll just echo what Dr.
Bass said. In terms of protein,

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we have a lot of literature and data
that reflects that a high protein diet

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before and after surgery, whether that
be plastic surgery, general surgery,

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any surgery promotes wound healing and
overall recovery following surgery.

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So that is something that is easy for
patients to do well in advance of surgery

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and continue afterwards to make sure
that they're in a good place to heal.

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Okay. Got it.

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And then what things can patients
collect or buy to be ready?

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Cool compresses are a great place to
start and something you want to have on

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hand after surgery.

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There's a lot of options from fancy
face straps with built-in ice packs to a

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good old Ziploc baggie
filled with frozen peas.

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So whatever the patient
wants to use is great,

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but there's lots of options on the market.

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You want to make sure you're going
to have your medications ready,

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so anything that your surgeon asks
you to have for after surgery,

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you want to pick up from your pharmacy,

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any recommended skin products
and bandages, supplies,

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anything you're going to use that
your surgeon is asking you to have,

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it's better to get it beforehand.

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You're also going to want a gentle skin
cleanser and a shampoo and conditioner.

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People often use baby shampoo,

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but anything that's not irritating and
safe for your skin and incisions will be

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great. You're also going to want to
invest in a good pair of sunglasses,

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scarves. I've even had patients
use fake reading glasses.

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If they don't wear prescription glasses,

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you'll be shocked with those camouflage,

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especially when you're making it
to your first pre-op appointments,

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going to the grocery
store, things like that.

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And then speaking of grocery store,

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you're going to want to stock
up on groceries beforehand
so that you don't have

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to make frequent grocery store
trips after your surgery.

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It's also helpful to have food
prepared ahead of time too.

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Patients will often cook meals,

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things like that that they can
easily heat up after surgery,

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and then your pillowcases and your towels
are going to get a little dirty after

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surgery. Just put the drainage,
the ointments, things like that.

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So consider buying ones that you're
not going to miss afterwards,

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that you won't mind throwing
away if they get dirty.

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And then invest in some extra pillows too
that will help you sleep upright after

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surgery,

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even when you're just resting so that
you're not laying flat and all that

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swelling is going to your head. There
are wedges. They make those two,

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but a couple of extra pillows is
a nice easy way to achieve that.

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Usually your surgeon will tell you
what you need or someone from the

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surgeon's staff and go
over these things with you.

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Some surgeons furnish some of these
items so that they know you have

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exactly what the surgeon wants rather
than whatever you happen to run into at

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the store.

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So that makes it a little easier and
takes a little bit of the worry and wonder

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out of it.

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And finally, what else can
patients do ahead of time?

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You're going to want to color your hair
because you're not going to be able to

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do it for about four to
six weeks afterwards.

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So doing it ahead of time will
help make you less sad afterwards.

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And then you can also do
some skin conditioning.

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You can either start some skin products
to get your skin ready to heal from

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surgery and then stop using certain
products like potentially retinols or

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glycolics in anticipation of surgery.

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And this is a controversial thing
because there are some surgeons who feel

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very strongly that being on
retinoids or glycolics can create big

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healing difficulties,

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big skin reaction in an unpredictable way.

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And other surgeons,

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and I'm more in this group feel
that patients that are on a growth

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factor skin product or
a retinoid skin product

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actually have their skin
is a little ramped up.

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It's all prepped and at a higher
metabolic state and ready to jump in and

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heal after the surgery.
So best thing is to,

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with your surgeon,

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understand your surgeon's
perspective on this and follow

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the process that they know
gets them great results.

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Okay, great.

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Can you summarize all of this information
about preparation with some takeaways,

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Dr. Bass?

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Absolutely. Getting a
facelift is fun and exciting,

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but it's still medical care and
taking the appropriate steps to

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crap in advance optimizes the
procedure and subsequent healing.

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It helps keep things on schedule
and helps you get the best possible

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result.

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So start early to get any
medical issues sorted and medical

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conditions optimized if you have them.

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This will avoid postponing
your surgery at the last minute

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because something showed up on clearance
that didn't come in until a few

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days before the surgery.

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Go shopping and collect all the
things you'll need for recovery, food,

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skin and hair care,
pillows or wedge towels,

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pillow cases, and cool
compresses just to name a few.

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There are some more activist options
if you feel so inclined or if your

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surgeon feels it's very important
with nutritional supplements,

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if you want to pursue them.

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It's essential to stop
medications that can promote

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bleeding and to stop all
smoking vaping and similar

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activities as directed by
your surgeon. Remember,

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you can't fool mother nature,

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and this is a procedure in
particular where you get punished for

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not following that rule.
With these simple steps,

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you'll be prepared and
optimized for faceless success.

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Thank you,

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Dr. Edinger and Dr. Bass for providing
all of these useful tips for how to

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prepare for your facelift.

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The next episode in our facelift series
will discuss instructions for taking

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care of your facelift during
recovery from the procedure,

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which is vital information for anyone
considering or about to undergo a

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facelift.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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Follow us on Apple Podcasts,

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00:17:05,420 --> 00:17:07,640
write a review and share
the show with your friends.

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00:17:07,820 --> 00:17:11,330
Be sure to join us next time to avoid
missing all the great content that is

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coming your way. If you want to
contact us with comments or questions,

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we'd love to hear from you,

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send us an email at podcast@drbass.net or

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DM us on Instagram @drbassnyc.