Surgery Recovery Q & A with Dr Justin Perron

A Facebook Live with Dr Justin Perron, Specialist Plastic Surgeon on Surgery Recovery

(If you’d like to watch the Facebook Live video of Surgery Recovery Q&A, click here)

QUESTION: What is the best tape or cream to use on scars?

So there’s a lot of myths out there about what is best to use and what not to use. Certainly some of the things like bio oil or creams or using vitamin E capsules, that sort of thing, none of that unfortunately has any good evidence that it provides good support or good wound after effect after having surgery. There’s a lot of research and so as a surgeon, we always look at the research that is pertinent to what we do whenever we operate. So what I find to be an excellent resource for scars is to look at what they do in burns.

Now, of course in burn surgery, the patients who have injuries have a really severe injury to their skin, obviously because they’ve been burned. And so if we look at the research that they do for healing, they generally provide some of the best data and some of the best evidence for what we do today. So certainly in burns, the backbone of what they use is silicon and pressure, which is why if you ever see someone who gets a bad burn, they always were those pressure masks or they wear the gloves, those high tension gloves. And I think of the three randomised trials that have looked at silicon, pressure, and vitamin E as what potentially is going to improve the wounds, two showed silicon and pressure were the best and those other two also showed that vitamin E provided nothing. And in the third study, vitamin E was actually shown to be of no benefit and in fact it made some of those scars worse. So the big things from my point of view is again, just to look at that sort of evidence, and silicon and pressure are the backbone.

So the best tapes, there are silicon tapes you can buy over the counter as well as silicon gels. And that’s why whenever I operate on patients in their postoperative pack, I always give them silicon because the earlier time we want to start that the better chance of a good scar outcome. Once scars develop then it becomes a bit of a little bit tougher and we’ve got to work through an algorithm of either using a heavier duty silicon on top of scars or injecting them with a bit of, with a bit of steroid. We generally don’t like to put steroid into the wound because there are risks associated with that as well. The wounds can widen, and they can look a bit ugly for awhile. So we try not to do those.

The other thing that helps is pressure. So again, with my patients, I always get them to wear their pressure suits (compression garments), not because I like to torture them, but it actually helps with their scars as well. And so anything where you have pressure on those scars or even a bit of massage also works really, really well. Most other things past that doesn’t really provide much evidence. Again, the burns data shows us that those are going to be the good things.

There are laser treatments and we can use, those lasers are aimed at reducing the amount of vascularity in the scar. So it doesn’t, there’s no sort of magic that happens with it. They’re trying to get rid of some of the blood supply in the scar so it doesn’t get so thick.

So I was asking when to use the scar cream after surgery. So generally for my patients, I’d wait for the wound to be totally healed, so we want to wait at least one to two weeks before we think about putting any scar treatment on, my patients are generally four weeks, because we know for weeks the wound is totally healed over and there’s no risk of causing any infection or causing any problems with those scars afterwards.

QUESTION: Does taking Arnica help with bruising, recovery, especially after liposuction?

Good question. I actually don’t know much about Arnica. I do know that Arnica is a natural product and it comes in various doses.

Now the issue is a homoeopathic dose, which is what a lot of these things are, won’t actually provide any effect you. It’s just like taking sugar pills really. Some of the topical ointments, people swear by them and I don’t suggest my patients use them, mostly because the evidence isn’t there. So again, I look at any of the scientific studies that take a lot of people with similar sort of problems, they give them either the Arnica or they give them a placebo, and then they look at the outcome. And most of the data that we see with Arnica doesn’t really proport any benefit.

Now, what normally happens with people who take Arnica is they’re also really taking care of themselves in other ways. So they’re careful about their diet. They’re making sure they’re well hydrated, they’re making sure they get good sleep. So there’s a lot of other things that kind of go along with that. And usually it’s all those extra things that go along with taking Arnica that are probably more beneficial than the actual Arnica itself. Again, the data that I’ve read and that I look at from time to time, I just haven’t really seen any new studies that put a lot of evidence behind Arnica. However, if it’s one of those things that you believe help, for me, it doesn’t hinder or cause any bad outcomes.

QUESTION: What is arginine supplements and how does it prevent wound breakdown?

So arginine is an essential amino acid that you need to have. And it does come in high supplements. There’s a lot of research that’s gone way back in the forties and fifties and sixties that looked at what arginine did, was it some sort of extra magical amino acid that did something special for wounds.

There was a lot of interesting data that came out of it. What they found was, arginine administration can improve wound healing. So it certainly is one of those things that can help. And the best dose of arginine supplementation appears to be about two percent of the [inaudible 00:10:04] you’d normally use. How much is that? I have no idea. I think it’s one of those things, if you wanted to take arginine supplements, I think the important thing in those circumstances is to actually take it well before surgery. So if you want it to start taking arginine supplements who looking at, you know, probably three or four weeks before, only because if you, if you want to take them the day before surgery and then really go crazy afterwards, in some circumstances you can actually cause more problems. So, certainly taking any supplement is important to make sure your body’s used to it before you go into surgery.

And yet was the data that they also showed was that the effects of arginine on both wound healing and infection were better when started preoperatively or before the challenge. Now before challenge are things like injury, injury at work or injury in the gym, that sort of thing. But it, you really need to have the arginine in you before you do it rather than having the injury and then starting afterwards.

Arginine is safe in all patients except when you have an active infection, so it’s best to take it before those sort of events. The other thing that can help as well are omega three fatty acids. The only issue is that omega three fatty acids also thin your blood, so they act like aspirin. So taking that after surgery, bad idea, that increases bruising and potentially increases your risk of hematomas and that sort of problem. So I would always recommend for all my patients to not take fish oil for two weeks prior to surgery and definitely not for up to two weeks afterwards, minimum. The detrimental effects are worse than actually the benefits of something like fish oil. And a lot of the other discussions around arginine and supplements tend to be that they work really well together. But again, you know, fish oil and surgery, not a great idea.

QUESTION: Are there any other supplements that I would suggest to help with healing?

So again, the only sort of major things that are really important are vitamin C and zinc, as well as a well balanced diet. So the important thing for me is to make sure my patients are well fed, they’re well nourished, they’re not losing weight going to surgery, they need to be at a neutral energy or at least a positive energy, or a positive energy balance, which means that they’ve actually maybe even gained a little bit of weight going into surgery.

I think if patients are losing weight or their energy isn’t very good, they can end up with really, really bad effects. Wounds don’t break down or wounds don’t heal. They end up with a lot of breakdowns, that sort of thing.

QUESTION: Vitamin C, magnesium or zinc, will these help with wound healing?

All of them will, zinc and vitamin C are the most important. The reason why they’re important is those are three essential ingredients for the production of collagen. Collagen, so we know that that’s a big deal because scurvy, was as a result of vitamin C deficiency. And so that’s when you get the, the ricketts, the legs that would bend in those sailors didn’t have enough vitamin C, and they would end up with bow legged bones because their collagen was so weak that the weight of their body actually bent their bones. And that’s why they would take limes on board the ships way back when because they could suck on limes and have that vitamin C to make sure they didn’t get their tickets.

QUESTION: how early can I have a tummy tuck after c section?

After pregnancy you really need to let your body calm down because that’s a major physiologic change to your body. So really we’re looking at six to 12 months. You have a lot of changes post-pregnancy that can still occur. And we’d really wait for that time afterwards. So six months at the absolute minimum, but I go more for towards 12 months is what I’d recommend.

QUESTION: Is there anything I can do to help the healing of a fleur de lis and scarring?

So the big thing there is again, make sure you have a good balanced diet and make sure that you have a few extra supplements, vitamin c and zinc are important as well, or even just a multivitamin, but you don’t need to overdo it.

QUESTION: Top tips to prevent infections?

So infections are, again, they can be a little bit nebulous. Some operations are obviously higher risk than others. Obviously doing any work inside in the bowel, doing any work where, it’s a potentially dirty cavity, that sort of stuff. There’s always that risk that there’s going to be an infection. Certainly for this stuff that we do in plastics, probably the biggest risk or things like breast surgery or any work where there’s an active infection or active and irritation to the area.

Again, part of the surgical safety we talked about before and the culture that’s present in Australian surgery is aimed at prevention. So for any plastics procedure, we always give patients a little shot of antibiotics preoperatively and I would usually supplement that with antibiotics postoperatively for high risk surgery. Certainly for things like breast implants, I would always give my patients a bit of antibiotics afterwards, and any major large surgery I would do that as well.

The big things, again, prevention, not doing any high risk activity, so having a surgery and then jumping back into the gym the next day. You get sweaty and potentially that sweat gets into a wound that’s fresh. You can potentially introduce a few bacteria in there. A lot of it is just common sense and just trying to kind of prevent those sorts of things from happening. The other major thing is also the preoperative preparation. So, most patients would have a little wash before surgery, so they get an antibacterial wash that they do from head to toe, and that helps to reduce all that skin bacteria so that it’s potentially less risk of infection. And everyone has a slightly different practise on that. Evidence has shown that that does decrease the risk of infections postoperatively. But again, every surgeon has a different protocol for that.

QUESTION: What can I personally do to prevent wound breakdown?

So in terms of what you should do to prevent wound breakdown, probably the big thing is, there’s a few things that will help. So certainly as we’ve discussed, nutrition is the cornerstone of a good surgical outcome. Want to make sure that you have lots of protein, well balanced diet afterwards and vitamin supplements if you’re having a quite a large surgery. Again, avoiding things that could potentially cause bleeding. So things like fish oil and also doing any major movements afterwards. So having an operation and say, can I go flying on an aeroplane two days later, it might not be a good idea simply because you are going to be actively moving and sitting and getting up and standing and doing all those sorts of things and that could potentially shear those little laceration, the incision point where we’ve got, could potentially open up some of those wounds and then once they’re opened up they’re just going to be a problem to get them back together.

And just the recommendations from your surgeon. But most of that is just, it’s really just common sense. I tell all my patients, the whole important thing about surgery is afterwards you get a little bit of pain. And the pain is actually is your guide. So if it’s sore, it’s telling your body, telling you to stop doing it. It’s not like going to the gym where you know, you get a little bit of pain and everyone wants you to work through it. That’s definitely the opposite in surgery. Any pain you get, are they doing something wrong or you really need to pull back and slow down on your activity. It’s definitely a sign that you’re doing too much. So a lot of it is just to listen to your body. And sometimes it’s just in certain areas the risk of wound breakdown can be high, so high movement areas that can cause problems.

And that’s usually things when I do brachioplasties for example, generally I would see wound breakdowns at the corner just between the arm and the arm pit. And that’s because it’s a high movement area. It’s very difficult to tell patients don’t move your arms, because we need to get dressed, we need to feed ourselves. So we just say, just be gentle and careful and don’t overdo it.

QUESTION: What about a breast lift post-baby?

Same thing. So it’s going to be 12 months or at least three months after you’ve lost breastfed. So if you’re not breastfeeding, again, I’d wait one year, and if you are actively breastfeeding then we have to wait until you stopped, and then we even wait another three months after that. It’s just the risk of course, of doing a breast reduction when you’re actively lactating and the risk of infection is very, very high.

QUESTION: Will the surgeon make the call or not if we require liposuction as well as a tummy tuck?

So I’ve got a bit of a different philosophy on this for me and abdominoplasty is a contouring procedure because we’re obviously contouring your abdominal wall. We’re contouring your flanks and doing a little bit of work there. For me it’s all part and parcel so I don’t try and separate the liposuction out from the abdominoplasty. For me it’s actually just the same thing. So I generally for an abdominoplasty, if you need liposuction I’ll do at the same time, only because that’s the procedure. The procedure is a contour procedure. So that’s sort of my approach to it. Other doctors may have slightly different idea, but for me, that’s how I would look at that.

QUESTION: Will it extend the healing time significantly for women who will be taking time off work?

You certainly do get a lot of swelling after liposuction and it’s one of those things that will take time to heal. It’s probably a little bit of extra time to heal depending of course on the extent of the liposuction and where it’s done. Certainly for abdominoplasty, it will increase the swelling, but liposuction swelling doesn’t last as long as necessarily a body lift swelling or an abdominoplasty swelling. So will it extend it, it probably will a little bit. How much, I don’t know, how long is a piece of string. It certainly will add a little bit more effort for your body to heal.

QUESTION: What’s best to do with a small opening of the wound.

So the best thing to do is to pay attention and sort of trying to understand what’s happening with that small thing. And it really depends on the size. So is anything coming out of that, what does the surrounding area look like? So is the skin around it very red or getting redder? What’s the kind of stuff that’s coming out? Is it clear? Is it cloudy? Is it milky? Is it blood? Is it something else? Those are all clues that I would normally ask my patients to say, it gives us an idea of is there an infection? Maybe there’s a little bit of fluid that’s been left behind that’s coming out, or maybe it’s something like a lymphatic leak or a little seroma that may be starting to form. Not all seroma drain or they cause a little opening on the surface. But with those small opening wounds, we really have to take notice and see what’s going on.

So the best thing to do is if you do have a small opening, give your surgeon a call and say, I’m a bit worried because this just happened, and they’ll do the same thing I did. They’ll probably ask a whole bunch of questions and then say, come on in, let’s have a little look at it. So that’s the best thing to do. The other thing that probably is important, just to keep it covered, keep it clean. And definitely don’t stick anything in it. It’s not the wisest thing to do.

QUESTION: What about Bromelain supplements?

Bromelain, again, it’s one of those things that doesn’t have any evidence, up to date. The current theory is that it’s an enzyme that helps break down various things and helps to increase inflammation. The issue is that when you take anything orally, it all gets broken down in your stomach. So enzymes are proteins. And your stomach is a really good mechanism for breaking down proteins. So if you take an active enzyme and swallow, it generally just gets chewed up and turned into proteins, so they generally don’t do anything. And so any data on that will generally show that it doesn’t have much effect.

QUESTION: Will having surgery in the summer with the humidity increase my chance of infection?

Generally not. It’s mostly just the discomfort of the heat, so generally, if you have a bigger operation, so if in your hospital for anywhere from five to seven days, because a hospital is generally air conditioned, you’re not sweating and doing anything too crazy, that risk is certainly lower. If you have any wounds that opened up after surgery and you are outside, there is that slightly higher risk. However, I don’t really find that I get an increased risk of infection or increased infection rate with patients in summertime. I think it’s just one of those things that happens and we certainly don’t stop operating during summertime. Certainly, most people will decrease their operating around December because it’s Christmas time and they usually take a little bit of a break in January. So that might reflect that lack of availability of operating. But certainly I haven’t seen those issues at all.

QUESTION: I’m having a fleur des lis and arms done – How long should I have to wait after that surgery until I get breasts and back done?

Good question. I would generally wait at least three months between those surgeries. You need time for your body to heal from your first surgery and you need to be ready for the second one. I have shortened that time in very specific circumstances, but as a general rule, three months is the safe time. As I say, I’ll do two operations in one sitting. So I’ll generally do things like a circumferential plus arms, circumferential plus breasts or circumferential plus thighs. But that’s generally it. I don’t like doing the other two or adding a third one unless again, there are circumstances where I will do that. So those circumstances would be, for example, patient’s lost a lot of weight and it’s not going to be a long operation.

So just last Friday for example, I did a circumferential plus breasts and thighs. Patient was very, very thin and I knew it wasn’t going to be an extensive surgery so we could do that. And we did the whole thing and in a little over six hours, which is certainly within safe operating time. Once we get into sort of the seven and eight hours, really have a hard time justifying it, you know, a cosmetic procedure that’s going to take longer than that. And so I generally try and keep them under that time. So that’s my general kind of rule of thumb for that. Certainly risks of breakdown, infection, et cetera, they all happen the longer we operate, potentially. So, longer you’re asleep, all those risks go up. So that’s, again, part of that surgical safety is doing a safe operation for patients.

QUESTION: What would be the recovery with a BBL.

So I think with the breasts, it really just depends on you. So there’s a lot of factors that happen with that. Generally it’s about two weeks before you can go back to work. I generally would say to patients and other couple of months before getting into the gym and usually three months before you start doing high impact activity. Some patients heal faster, some patients heal a little bit slower. It’s really just a variability that we’ve got to have a good open discussion whenever I see patients, and I see my patients regularly afterwards, during that three month period to make sure that there’s no issues happening.

QUESTION: What’s the difference between a mini tummy tuck and a normal tummy tuck?

So normal tummy tuck is one where it involves a placating the abdominal muscles, so that’s where we do a rectus placation, repair the muscles and also created a large flap above that, above the belly button. A mini tummy tuck is generally just involves skin, a tiny little bit that hangs over, usually post pregnancy and those are just a little excision of that skin on the lower part of the abdomen. Generally if you’ve got a little bit of that skin, you generally have enough laxity for a full abdominoplasty. You should usually get your rectus sheath repaired. But again, individually, and it’s usually a call that you have to make when I see patients.

QUESTION: When do breasts “drop and fluff” (settle into their final position) after the breast augmentation.

It takes time. Unfortunately, it’s not something that happens overnight. That’s usually anywhere from four to eight weeks. Everyone’s slightly different in terms of their soft tissues and how things work, but it’s usually about that four to eight weeks.

QUESTION: Do I (Dr Justin Perron) use local anaesthetic to manage post operative pain?

So I do. One of the things I do use, particularly for circumferential or abdominoplasties, I use something called a pain buster. So what a pain buster is, is a little elastomer ball that we fill with local anaesthetic. That local anaesthetic goes through two little catheters that sit just under your rectus sheath and over usually two or three days, they just secrete a little bit of local anaesthetic, makes the abdominal wall numb. So the biggest pain after having abdominoplasty is having that rectus sheath repaired. And so that little bit of local anaesthetic helps to really take that sting away for the first three days when the pain is usually at the worst. It also means you use less analgesia, meaning you’re using your pain button a lot less, or your pca. And because you’re using fewer opiates, you get less constipated, less constipation means you’re not straining afterwards, and so you feel much better. So I generally use those as much as I can. I also use as much local anaesthetic as I can that’s safe in order to make sure that patients again, are comfortable when they wake up.

QUESTION: Are there any recommendations for supplements or diets to take pre post op to aid in wound healing?

So it’s a good question about diets. Is there any specific diet, and there is no specific diet, just a well rounded, well balanced diet. Proteins are good. A little bit of fat and a little bit of good fibre. There’s nothing specific. I think making sure you’re not losing weight, going to surgery. In fact, even if you want to start gaining a little bit is fine because once you have surgery, there’s a couple of days where you’re not really eating that much because you’re generally recovering from a big operation. And afterwards, again, same thing. You just want to make sure you’re supplementing yourself with some extra protein, some multivitamins, vitamin C and zinc. And those are the things that really help quite a bit.

QUESTION: Do seromas in the legs post thigh lift eventually drain naturally despite having it drained a few times?

Good question. So, thigh lifts are a really interesting discussion because there’s a few different ways to do that operation. The method that I use is something called an avulsion technique. So what that means is I do some very aggressive liposuction in the area that we need to treat, we excise or incise through the skin to the area that want to do and then I actually avulse all that skin off. It would be an interesting video, I’m sure if Trish wanted to see it at any point, we can certainly post a video of how that operation works.

But the whole philosophy behind that operation was that it preserves all the lymphatics, all the veins and all of the structures that we don’t want to damage. So if we actually cut that tissue out using a scalpel and diathermy we actually injured all those structures. So things like lymphatics and things, etc. And as a result, they leak into the wound and they cost seromas.

QUESTION: How long will seromas last?

It’s really tough. Every doctor hates seromas, every patient hates seromas because they can potentially come back. More importantly, they can also potentially get infected. And so we generally don’t like seeing seromas and that’s why we generally drain them when we do see them, So will they eventually stop, fingers crossed, really. The only way to treat them is to continue to drain them until they hopefully get a bit smaller. If you’re having these things drained several times a week or even up to a month later, they can be a real pain. And sometimes we actually need to operate again to try and find the point that’s draining, try and clamp them off. But usually they just go away. And that’s usually the only thing we worry about.

QUESTION: Can the skin that you’ve removed be donated to other patients for burn victims, et cetera?

It’s a good question. Generally not. Most of the stuff that we use or that have been used for burns victims, they do use, particularly at the Royal Brisbane Hospital, they use a cadaveric skin. So what that means is they actually have people who donate bodies to science. One of the things that they do is they’ll strip the skin off and then process them in a way that gets rid of things like infectious components or components can potentially caused cross-reactivity and issues. But they use those as temporary burns dressings, they use those temporary biological dressings while people are healing.

Unfortunately you can’t donate it, as much as they’d love to get their hand on big swaths of someone’s tummy, it would be, and it’s very, very nice to offer. But we’ve asked before. I asked before as well, the best thing we can do is just use it for medical students to just train for how to do lesions or do some suturing training. But generally it’s a pretty rare time for that to happen. We usually just give it to the hospital cat. I’m kidding. We actually just throw in the bin. There’s nothing fancy that we do with it.

QUESTION: Is there any correlation with infection and nutrition?

Absolutely. And we do see people who… if you’re not well fed, as a general rule, your infection rate is higher. So we see people who are, if they’ve come from overseas. Sometimes they’ll organise people to come across, and various other non profit or charity groups will bring patients in. As a general, we would actually bring patients in if they’re planning for a big operation from overseas and we’ll fatten them up for a bit. So we get them sit down with nutritionists and the nutritionists, dieticians will actually let these kids and people, will actually, first thing we do is assess the nutrition and actually give them a really good diet for a couple of weeks leading up to it.

Surgery takes a massive toll on your body. Anyone who’s had it will know that. And particularly in big procedure, we really need to be careful. It’s one of the most important things that we need to remember is energy is required to heal. And if we’re not giving you food or if you’re not eating, you won’t heal. And so if you’re not healing, your body wants to repair itself. And of course if it’s being distracted with repairing, it’s not doing its normal job which is defending against infection. And so then of course everyone says your defences are down and that’s when you really need to worry. So absolutely. Will nutrition cause any problems with it? Yes, it will. It will absolutely cause an increased risk of infection.

QUESTION: How does smoking affect surgery? Everyone in Europe smokes, but they don’t appear to get as many infections as us here? What’s that about?

Good question. What is that about? So everything seems to go better in Europe, that’s not really the truth. People do smoke in Europe, but their infection rates will be higher if they do smoke. Any problems I have with patients, and I’ve got one gentleman who I did a circumferential for him. Unfortunately he was smoking leading up to that operation. And sure enough, ended up with a massive wound breakdown, pretty much from hip to hip all the way around. Everything broke down, here there, left and right, and it’s taken us about nearly six weeks to get him back healed up. He required a couple of small operations to get him healed up again and get everything back together. Disastrous when it happens, and he realised pretty soon leading into it, and he wasn’t even smoking after surgery or the day before. We’re talking a couple of weeks before surgery and he still had problems healing. And he wasn’t a particularly big guy. He was actually very, very small.

Two issues that he had. He wasn’t eating properly, and he was smoking a little too close to surgery. Smoking is probably the worst thing you can do to your body in terms of healing. It saps the energy. It prevents blood supply from getting to where we need it. And particularly in plastic surgery, one of the things that we need are all those tiny little blood vessels that we rely on for healing. If you’re smoking, all that nicotine just clamps off those vessels and that’s when we see things like skin death, we see things like increased wound breakdown and of course that’s just an entry point for bacteria causing infection. So absolutely, it’s a major issue. Anybody who does smoke will tell you that it was a bad idea and you know, they don’t heal very well. So everyone in Europe smokes. They do. There’s also a lot of smokers here in Australia, and we get infections, but the Europeans will get infections as well.

And it’s definitely not advisable to smoke. Any of my patients who come in, I always tell them the same thing. I’m not the nicotine police, so I’m not going to test to see if you actually are smoking before surgery. But I also know you’re a responsible adult and I’m going to tell you that if you do smoke, there’ll be problems and life will be, you know, the seven depths of hell after surgery when you get these wound breaks down, because we get to see each other on a regular basis to change your wounds and it’s just not a very, very nice thing.

QUESTION: Are Compression Garments really necessary after surgery?

Couple of last questions here. Melissa, Melissa is another one of my patients from up north. She had a little seroma in her arm and she’s been having a real problem with that. We’ll have to talk to Melissa afterwards to fix that up. I think one of the things that does help is certainly compression. Compression helps to keep that wound area down. There are a couple other little tricks we can sometimes try and I’d be more than happy to talk to Melissa about it afterwards and we can see if we can arrange a time afterwards.

QUESTION: What are some of the complications of undergoing surgery whilst overweight?

So, the big thing about being overweight is blood supply. Blood supply and that risk of poor wound healing. When there’s a lot of weight behind scars or there’s a lot of weight behind the wounds, there’s only so much that sutures can hold and only so much blood supply that can be provided. And so I generally, again, the evidence that we look at when we look at complications postoperatively, two major factors are smoking and what the current weight is.

So anyone’s got a bmi of 32 or greater is an absolute indicator that we really shouldn’t be doing any elective surgery unless we absolutely need to. So I generally would get my patients below about 30. 30 is a much safer number. Ideally I’d like to get my patients down to even healthier than that, but really 30 is the absolute minimum for me. If I were to come and talk to patients as we know, once we hit 32 and higher, wound breakdowns and problems, complications, infections, that sort of thing, just increase.

QUESTION: Are Cheezels a good source of nutrition post op?

Funnily enough, cheezels aren’t bad because they do provide a lot of calories. And your body needs that energy. Sure, too many cheezels not a great idea, but a few cheezels as a supplement, I would say that’s fine. That’s actually one of those things that, in fact in kid’s hospitals, they actually encouraged kids to eat some of the fatty foods like fries and deep fried stuff because they need the energy to repair. So it’s probably the only time that I would say if cheezels are your favourite snack food then that’s actually not too bad.

QUESTION: Can you lift weights and do strength training right up until surgery? Will it increase your rate of recovery?

It will because it means your rate in nutrition is obviously going up and when you’re working out, your caloric intake is, is quite high. So when you stop, you’re still eating. And that’s why people, when they stop working out they gain weight because the brain, still thinks you need to eat. So lifting strength training right up to surgery, absolutely. I wouldn’t go on a big weight lift binge the night before surgery, but certainly doing all that stuff beforehand, absolutely. Your blood to all your tissues is increased and your rate of healing is much butter. I do find patients who are active leading up to surgery always have better outcomes. Their blood supply is better and their cardiovascular fitness is much better so they have a much better outcome.

QUESTION: Do I need to lose muscle pre op?

Bmi is huge, but fat percentage is low. How do we lose muscle? Well, I think it’s a personal thing. So it depends on what sort of operation you’re having. I would generally say that despite weight, as long as any excess on the outside is relatively low. It’s something that is a little bit qualitative. So it’s not something that necessarily there’s a number that you can put behind it. But again, if you go and talk to any surgeon about ant operation, absolute weight, that number is actually important. It’s more of an overall sort of feel. So bmi is important. Weight is a factor, but it’s more just having a word with patients and seeing where they’re at with their body.

QUESTION: Do I (Dr Justin Perron) see interstate patients?

Absolutely. It’s just a matter of booking and making sure that it works within your schedule. There’s no specific day that I see them. I usually, I’m happy to accommodate if you’re up here for work or for doing something else. I’d be more than happy to see you at any point.

QUESTION: What is the best way to improve or eliminate swelling post op?

Great question. So one of the things that I generally recommend for most patients postoperative swelling, and one of the big things is salt. So anytime we eat anything salty, so this will come back to Emmy, even though I had told you that cheeses were okay. The big issue with cheeses, they contain lots of salt. Salt’s delicious. We all love salty food. The problem is postoperatively after a surgery, all your blood vessels get a bit leaky because they’re injured. And so as a result of inflammation and inflammatory process, we swell. And the issue is if you have a high salt content in your body, that salt leaks out through those vessels, gets into your tissues and attracts more water so it actually causes more inflammation.

So any patients I do a facelift on, for example, the face is very sensitive to swelling. So I would tell all my patients who have a face lift or even even body lifts, keep the salt down. So if you can go on a low or a no salt diet during your recovery period, your swelling level is almost nothing. And you get amazing scar results. You get amazing early postop results in your recovery and because swelling causes pain, again your pain levels are also very, very low. So again diet, very important, low salt, no salt diets are a huge benefit in those circumstances.

QUESTION: If you do lift weights and work out regularly and your body is used to caloric intake after surgery can this be offset by using an appetite suppressant?

So appetite suppressants are okay. I generally wouldn’t recommend them. I think mostly because there’s always that rebound effect once you come off them. So any patients who have things like dex-amphetamines or any really aggressive appetite suppressants, there’s always a rebound in the weight. So it’s a temporary sort of thing. I think a lot of those things is rather than having your regular diet that you normally would, if you’re working out is just to stick to something that’s going to cause a lot of space in your stomach without adding a whole lot of calories. And those are things like vegetables and some fruits. I think both of those are really nice, they don’t really fuel your body, but they just sort of help to make you feel a little bit more full without actually having to do something like dietary supplements.

QUESTION: Would there be any problems if I want to dose up on vitamins, proteins before surgery and have a break one week before a few days postop vitamins?

Sounds great. I think that sounds like a really good plan. Reason for that is that sometimes the vitamins will contain things that thin your blood. Again, getting back to that fish oil idea where fish oils can potentially thin your blood. I generally recommend all my patients stay off oils in general, so anything oily, vitamin a, vitamin E and fish oils, krill oils, all that sort of stuff. They generally will cause a little bit more bleeding. The way to think about some of them will actually act like aspirin, so they affect the platelets. And if you don’t have platelets that work, you bleed more, hematomas, et cetera, et cetera.

QUESTION: Is there any way of doing a breast lift without having a nipple relocation? Concerned about scarring.

Good question. So it’s a really tough one to move the nipple without having a scar. I think anyone who invents that operation is going to be a multigazillionaire because it’s going to be really tough to do that. I think the scarring itself, generally people don’t like the scarring initially. I’ve seen patients who have breast lifts 10, 15 years down the road and you can’t even see the scars. So they’re actually a scar that heals very, very, very well. Particularly the one that goes from the nipple down to the fold. The one in the fold can hang around for a bit, but if you’re worried about those sorts of scars, I can reassure you that they’re generally not too bad.