Q: What does it mean to be board certified in plastic surgery and why is it important?
A: Dr. Nahai is board certified in plastic surgery. That means that he has completed a full residency training program specifically in plastic surgery that is recognized by the national board of medical specialties (www.abms.org). However, the training alone is not enough, the certification process includes verification by means of a written and oral board exam specifically testing competency in plastic surgery. Maintenance of certification also requires that Dr. Nahai fulfill a minimum yearly continuing medical education (CME) requirement and re-test in plastic surgery on a scheduled basis. Board certification in plastic surgery ensures that Dr. Nahai is specifically trained in, tested, and up to date on the current practice of plastic surgery and is recognized by the board of medical specialties.
Q: What services does The Center for Plastic Surgery at MetroDerm (CPSMD) offer?
A: The center offers the full spectrum of plastic surgery of the face, breast, and body and injectables like Botox and fillers. An additional full range of laser, peel, and facial treatment services is offered as well. Medical grade skin care products are available for purchase also.
Q: Who will be responsible for my care?
A: Dr. Nahai takes ultimate responsibility for your care, performs all procedures from beginning to end, and is always available (when in town and even sometimes when he is not). He also relies on the assistance of his physician’s assistant in addition to a patient coordinator, aesthetician, and medical assistants. Dr. Nahai has specifically trained everyone on his team.
Q: What happens during a consultation?
A: Dr. Nahai will meet with you to learn about your goals and desires. He will then examine you, make an assessment, and then provide you with the best options to achieve your goals. You will be provided with a thorough understanding of the procedure and any care that must be taken leading up to and after your surgery. Before and after photos of patients who have had similar procedures will also be reviewed with you in detail. Thereafter you will meet with the Surgical Scheduler who will review fees and possible surgery dates.
Q: Is there a fee for a consultation and why?
A: Yes, Dr. Nahai charges a reasonable fee for a cosmetic consultation. You will be fully examined, evaluated, and an assessment will be made with an individualized solution that makes sense for you. In some cases, digital imaging is also used to help visualize a potential result and plan a procedure. If you have injectables or schedule a procedure, the consultation fee will be applied to that.
Q: Will my insurance be billed?
A: Plastic surgery can be divided into two categories: cosmetic and reconstructive. Insurance companies do not cover cosmetic procedures since they are not medically necessary (eg. face/lift, tummy tuck, liposuction). Procedures that fall under the reconstructive category are typically covered by insurance (eg. breast reduction, hernia repair, breast reconstruction). Some circumstances arise where a procedure may be partially cosmetic and partially covered by insurance, examples are eyelid surgery with work done to improve the field of vision or rhinoplasty with work done to improve breathing (eg. correcting a deviated septum).
Q: What is considered a cosmetic procedure?
A: Anything not done for functional reasons or done for appearance alone would be considered cosmetic and would not be covered by your insurance (i.e. fee for service).
Q: Will I be charged for follow up visits after a cosmetic procedure?
A: No, there is no charge for visits after a cosmetic procedure. Those are all included.
Q: What is a filler?
A: Fillers are substances used for facial rejuvenation, and come in several different forms. They help soften facial wrinkles, replace lost volume, and fill shadows, and change contours of the face. Fillers have many applications and are a very good option to address early signs of ageing in the face. Often the results are immediate and the ‘down time’ is minimal. These treatments are not permanent and must be repeated.
Q: How does Botox work?
A: Botox is an injection used to help reduce facial wrinkles. By interrupting the transmission of nerve signals, it temporarily weakens muscles that make facial lines and wrinkles. The effect is temporary and Botox must be repeated for the effect to be maintained, on average every 3 to 4 months. Botox can be used on almost all parts of the face; most often it used around the frown lines of the brow, the forehead, and the eyes.
Q: Are there any medications that can be taken to help decrease swelling and bruising after surgery?
A: Yes. We recommend that our patients begin taking Arnica and Bromelian one week before surgery. Also, multivitamins such as A and C have been shown to help with healing.
Q: Are there any medications that I should avoid before surgery?
A: We ask that you review all of your medications with us prior to surgery. As a general rule, any pill you are taking that is NOT prescribed by your physician should be stopped at least one week prior to surgery. Common medications to avoid include high dose vitamins, arthritis medications, and NSAIDs such as aspirin, and ibuprofen. These drugs should be avoided 1 week before surgery. If you are on a blood thinner, please notify us.
Q: I usually take ibuprofen if I have a headache, what should I take instead?
A: Tylenol (Acetaminophen) is a safe alternative that will not thin your blood.
Q: Can smoking affect my surgery?
A: Yes. Smoking increases the risk of delayed wound healing, infections, and skin necrosis (dead skin).
Q: In that case, should I stop smoking?
A: Yes. All patients are instructed to stop smoking at least two weeks prior to surgery and two weeks after surgery.
Q: In the past after surgery I suffered from constipation. I am afraid of facing this problem again.
A: Constipation is a common problem after surgery. If you are prone to constipation we suggest starting a healthy bowel regiment one week before surgery. Increasing food high in fiber (fresh fruits and vegetables) and taking stool softeners (such as Metamucil) should be very helpful.
Day of Surgery
Q: What happens the day of surgery?
A: You will be notified by the outpatient center as to what time to arrive. Dr. Nahai will spend time with you the day of surgery to review your plan, answer any last minute questions, and do the pre operative markings. Once everything is set, you will receive a mild sedative before going to the operating room and the next thing you know you will be waking up in the recovery area.
Q: How do I get home after surgery?
A: Following a general anesthetic or mild sedation you will need someone to drive you home. You will not be able to drive yourself? We strongly recommend avoiding using a cab service with someone driving you home that you and we do not know. If you need a service to drive you home, Dr. Nahai has a limousine service he uses that is trustworthy and has experience driving patients.
Q: Can I spend the night in the facility after surgery?
A: Yes, the outpatient centers that Dr. Nahai uses all have overnight rooms with 24 hour nursing coverage. This is a great option for after longer procedures as you can rest in a comfortable and caring atmosphere with the ability to treat you with medication through your IV if needed.
Q: Can I continue going to the gym after surgery?
A: You can exercise as much as you would like leading up to your surgery however, you will be asked to refrain from working out for a period of time after your procedure (usually two weeks). The amount of down time can vary and is dependent on the type of procedure that has been done.
Q: What kinds of activities are okay to continue doing after surgery?
A: We would like you to take it easy but do not be afraid of getting up and out of bed. We would like you to move all parts of your body to some degree at least every two hours during the day. This will help keep your blood flowing in turn prevent complications such as blood clots and pneumonia. For certain procedures surgical socks are provided to patients to help prevent swelling and clots. If you have received them, we ask you continue to wear them until your first post-op visit.
Q: What activities should I avoid after surgery?
A: We ask that you refrain from doing anything that causes severe pain, causes you to become short of breath, increases your heart rate, increases your blood pressure, or that you would consider strenuous. This also includes sexual activity. As rule of thumb we ask that you do not lift anything heavier than a laptop computer. Also, we ask that you leave housework for others while recovering.
Q: What can I do to help control pain after surgery?
A: We strive for our patients to have as little pain for the least amount of time after surgery. We do this by providing you with pain medication as well as anti-anxiety medications which can also be very helpful. In addition, we may recommend the use of ice packs, frozen peas, or other cooling methods to assist in reducing pain and swelling. Icing is especially beneficial during the first 48 hours after surgery. We usually recommend icing for 10-15 minutes followed by a 5-10 minute break throughout the day. Do not apply heat to any areas where surgery has been done.
Q: Are there any medications that I have to take after surgery?
A: During your preoperative visit you will receive a prescription that contains a combination of medications for severe pain, moderate pain, antibiotics, eye drops/ointment (for eyelid surgery only), steroids (for most procedures of the face) used to reduce swelling, muscle relaxants and possibly antianxiety medications. Most medications can be renewed over the phone. Certain narcotic pain medications and anti-anxiety medications require a paper prescription that can be picked up at the office. Think ahead, if you anticipate needing more narcotic pain medications or anti-anxiety medications, ask for a prescription when you are in the office.
Q: How do I care for myself after surgery?
A: For many procedures dressings are placed over your incisions to prevent soiling your clothes and protect the incision. In general, most dressings can be removed two days after surgery. Some special situations exist where you will be given specific instructions not to remove your dressings. Dressings that become soiled should be removed as they can harbor bacterial growth. Most incisions do not need a dressing after 48 hours, however if you still have some minor drainage of fluid, continue cycling fresh dressings.
Q: What are some common signs or symptoms I may experience after surgery?
- Changes in skin sensation (decreased or increased sensation)
- Minor oozing from the incision (especially after liposuction)
- Swelling (Usually peaks on the second day after surgery)
- Sore throat (usually from the breathing tube)
- Nausea (especially the first day)
Q: What do I do if something comes up and I need to get in touch with a healthcare provider?
A: If for any reason you are not sure about what to do or what is going on with your body, do not hesitate to call the office at (404) 835-4191. There will always be someone knowledgeable available to answer your question. No question is too small, no question is unreasonable. There is an answering service for after hours.
Several circumstances exist where you should call the office without any delay:
- Rapidly increasing pain and swelling anywhere on your body
- Bleeding that will not stop despite gentle pressure for 15 minutes
- A fever higher than 101 degrees within 10 days of your surgery
- The incision opens up
- Difficulty breathing or the inability to catch your breath
- Severe chest pain
- Redness and severe pain at the surgery site