Whether a mistake or intentional noncompliance, cosmetic surgery patients who don’t follow pre- and post-surgery instructions can create problems for not only themselves, but also for their providers.
Dr. MardirossianVartan Mardirossian, M.D., a facial plastic surgeon in Jupiter, Fla., says post-surgical supervision is a big safety issue that can go awry among patients having IV sedation general anesthesia. Surgeons need to make sure these patients have adult supervision the night they’re sent home or to a hotel.
Having adult supervision for patients who have had surgery with IV sedation general anesthesia is law in Florida and around the Nation, he says.
“But a lot of patients try negotiating this. They say they don’t need anyone. They can do it themselves,” Dr. Mardirossian says. “But we have to be conservative about that because things can happen, and we need to keep the patient safe.”
What patients do before and after having local anesthesia can lead to problems, too.
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Tips for Avoiding Problems
“Sometimes, patients ask for Valium (diazepam) or Ativan (lorazepam) to relax before the procedure. But some of these medications could interfere with patients’ cognitive capabilities, especially if they choose to use other sedatives or even alcohol at home,” he says. “You have to be really careful with anything that gives that extra sedation.”
Having access to the medications could create a perfect storm after in-office procedures, should patients go home and drink alcohol or take more sedatives. The only solution is for cosmetic surgeons to know their patients’ behaviors, Dr. Mardirossian says.
“Take your time to understand your patients’ living situations and, in cases like this, you might still need somebody to watch that patient, even after a local anesthesia. Or maybe it would be easier to just use intravenous sedation and advise them to have somebody overnight,” he says.
The time surgeons spend with patients can reveal another issue that Dr. Mardirossian says threatens good surgical outcomes: medication disclosure.
“Once I remember somebody forgot to tell me they were taking fish oil. Fish oil is a powerful blood thinner,” he says.
Simple tips can keep patients from doing too much or doing the wrong things too soon after surgery, according to Dr. Mardirossian.
The facial plastic surgeon says he would routinely wash patients’ hair after facial cosmetic surgery to prevent them from going home and trying to wash it in the days following their procedures.
“I always recommend not using a hair dryer because, if their sensitivity decreases, they don’t want to burn themselves. I tell them to massage their hair toward the incision, not away from it, so we don’t widen the scar,” he says. “I also tell them not to carry heavy stuff. I had a patient who carried furniture three days out and bled from the incision.”
The best way to prevent patient noncompliance is to spend enough time with patients to not only get to know them but also educate them about what they can and can’t do before and after surgery. The ability to spend time with patients is a luxury cosmetic surgeons actually have, Dr. Mardirossian says.
