Rhinoplasty

During this surgery, a plastic surgeon sculpts the cartilage and bone of the nose to achieve a patient’s desired look. for men and women who are unhappy with the size and shape of their nose, rhinoplasty or “nose job,” offers a safe, effective cosmetic solution

?Who is a candidate for Rhinoplasty

Your facial growth is complete-
Have a wide nose-
(Have a nose that is too large or too small(sometimes surgery of the nose may require the addition of cartilage grafts-
Have a nose that is off-center-
Have nostrils that are excessively flared-
You don’t smoke-
You don’t drink alcohol-

Procedure
This procedure can frequently be hidden exclusively inside the nose (close procedure); however, sometimes an external incision is needed (open procedure) where an incision is made across the columella, the narrow strip of tissue that separates the nostrils.
Note: If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.
The choices anesthesia include intravenous sedation or general. Your doctor will recommend the best choice for you . Minimal changes will generally take 1 to 1.5 hours. If there are more extensive changes taking place, then the surgery could last up to 3 to 4 hours.
Some rhinoplasty operations are covered by insurance if the procedure is deemed medically necessary.

Pre-op for Rhinoplasty
Get a lab test-
Avoid any asprin for 1-2 weeks prior to and 2 weeks following your surgery-
Do not Smoke and do not drink alcohol for 2 weeks prior and 3 weeks-

Do not eat or drink after midnight the evening before the surgery unless instructed otherwise-

Post-OP and recovery for Rhinoplasty
typically have mild to moderate bruising and swelling around the eyes and over the nose after rhinoplasty-
cold moist compresses are used continuously over the eyes (to minimize swelling and control bruising) During the day and evening of surgery-
(Pain (mild to moderate-
Reduce activity to decrease any chance of bleeding or the incision opening, swelling and nausea-
You will have a gauze drip pad placed under your nose-

Risks of Rhinoplasty
infection-
bleeding-
Anesthesia risks-
Change in skin sensation-
(Hematoma (when blood collects under the skin-
Swelling-

Total Knee Replacement

When you have a knee injury or arthritis, particularly osteoarthritis, the damage, inflammation, and pain can limit your ability to flex and extend your knees
A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, haven’t helped reduce pain or improve mobility
People with severe destruction of the knee joint associated with progressive pain and impaired function maybe candidates for total knee replacement
The main benefits of knee replacement surgery are reduced or no knee pain and being able to move around so that you can undertake normal daily activities, participate in exercise and society

?Who is a candidate for total Knee Replacement surgery
you have severe pain, swelling and stiffness in your knee joint that interferes with your quality of life and sleep-
you cannot work or have a normal social life-
you’re feeling depressed because of the pain and lack of mobility-

Procedure
Knee replacement surgery is usually performed either under general anaesthetic or under spinal or epidural anaesthetic and lasts about two hours
Your surgeon will move your knee cap to the side to access your knee joint. The worn ends of the bones in your knee joint are removed and replaced with metal and plastic parts (prosthesis) which have been precisely measured and shaped to fit. The artificial joint is held into place with special cement or the bone surface is roughened to encourage your bone to fuse onto the prosthesis

Pre- for total Knee Replacement surgery
preadmission testing (PAT) one to two weeks before your procedure-
You should exercise and eat well to control your weight-
complete checkup from your internist or family practitioner-
Give chest x-ray and an EKG-
Do not Smoke and do not drink alcohol-

Post-OP and recovery for total Knee Replacement surgery
After a total knee replacement, you should expect to spend three to five days at the hospital but recovery times can vary depending on the individual and type of surgery being carried out.you might begin weight-bearing therapy immediately after the operation. You have to wear an apron for carrying things around the house
You can start driving after about eight to 12 weeks

Risks of knee replacement surgery-
infection-
bleeding-
stiffness of the knee-
persistent pain-
blood clots-
(deep vein thrombosis (DVT-
Complications of general anaesthesia-

Meniscus Repair

meniscus is a c-shaped piece of cartilage that acts as a shock absorber in the knee. menisci protect your leg bones from rubbing together, which can lead to osteoarthritis and each knee has two menisci, a medial meniscus and lateral meniscus
Meniscus repair is a knee surgery that repairs a torn piece of cartilage inside the joint

?Who is a candidate for meniscus Repair surgery
Meniscus tears that are more than 5 mm-
People that wear a brace and some physical therapy did not help them-
(The location of the tear is important(For example, tears toward the outside of the c-shaped meniscus tend to heal better because there are more blood vessels there-

Procedure
Since the meniscus helps protect the knee from wear and tear, surgeons try to repair the meniscus whenever possible. However, most meniscus tears are not considered repairable
The surgery is primarily arthroscopic (minimally invasive) although additional small incisions, or cuts, may be necessary to perform the repair. A variety of devices or sutures can be used to perform a repair
This surgery can be safely performed under general or spinal anesthetic. In addition, local anesthetic is injected into the knee and incision sites

Pre- for Meniscus Repair surgery
Initial Surgical Consultation for one to two weeks before your procedure-
Physical examination for two weeks before your procedure-
Do not eat or drink after midnight-
Your vital signs, such as blood pressure and temperature, will be measured on your surgery day-
An IV will be started to give you fluids and medication during and after the procedure on your surgery day-

Post-OP and recovery for Meniscus Repair surgery
(Begin with clear liquids and light foods (jellos, soups, etc-
For 2 weeks following surgery take one aspirin daily-
Ibuprofen 200-400mg may be taken in between the narcotic pain medication-
Do not place pillows under knees-
Do not engage in activities which increase knee pain/swelling over the first 7-10 days following surgery-
Swelling to some degree is common after surgery-
May return to sedentary work only or school 3-4 days after surgery-
You should not put weight on the surgical leg-

Risks of Meniscus Repair surgery
infection-
bleeding-
Complications of general anaesthesia-
stiffness or instability of the joint-
pain-

Gastric bypass

Weight-loss (bariatric) surgery helps you lose weight and lowers your risk of medical problems associated with obesity. In Roux-en-Y gastric bypass, the surgeon creates a small pouch at the top of the stomach. The pouch is the only part of the stomach that receives food. This greatly limits the amount that you can comfortably eat and drink at one time

?Who is a candidate for Bypass
Your BMI is 35 or more and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea-
Your body mass index (BMI) is 40 or higher-
You’re a teenager who’s gone through puberty, your BMI is 35 or more, and you have serious obesity-related health problems, such as type 2 diabetes or severe sleep apnea-
Efforts to lose weight with diet and exercise have been unsuccessful-

Procedure
:The procedure has two parts
Part One: Making a Small Pouch in the Stomach: The surgeon divides the stomach into a large portion and a much smaller one. Then, in a process sometimes called “stomach stapling,” the small part of the stomach is sewn or stapled together to make a pouch, which can hold only a cup or so of food
Part Two: Bypass: The surgeon disconnects the new, small stomach pouch from the majority of the stomach and first part of the small intestine (the duodenum), and then connects it to a part of the small intestine slightly farther down (the jejunum). This surgical technique is called a Roux-en-Y

Pre-op for Bypass
Do not take any herbal medications for seven days before surgery-
Do not take any aspirin, Advil, Nuprin, Aleve or any other non-steroidal anti-inflammatory medication for seven days before surgery-
Diet 7-day to 14-day before surgery (decrease foods that are high in carbohydrates, such as sugary desserts, pasta, potatoes, bread, and bread products, fatty meat, and fried food and etc-
Do not smoke 30 days prior to surgery-

Post-OP and recovery for Bypass
Most people stay in the hospital 2 to 3 days, and get back to normal activities in 3 to 5 weeks. If the surgery must be “open,” meaning the surgeon has to make a larger cut, healing takes longer. You can usually start eating regular foods about three months after surgery
Day 1 after surgery: No food or drink-
Day 2 after surgery and for rest of the hospital stay: May be progressed to clear liquids and water if no signs of a leak and after approval from surgeon. Then 1-2 ounces every 20 minutes while awake
First week after discharge: Full liquids including 2 high protein drinks daily. Sugar-free pudding and fat free/light yogurt may be consumed during this diet stage. Drink/eat one to two ounces no more  frequently than every 20 minutes while awake

Risks of Bypass

Wound infections-
Digestive problems-
Ulcers-
Bleeding-

Gastric Balloon

The gastric balloon is becoming a popular weight loss alternative to ‘going under the knife’
A gastric balloon is a non-surgical, short term weight loss option that creates a feeling of fullness quicker after smaller meals. It reduces your hunger allowing you to control your portion sizes and can be used as a stepping stone on the path to weight loss success

?Who is a candidate for Baloon

you should have a BMI greater than 27-
Tried and Failed at Diet and Exercise-
No Bariatric Surgery or Bowel/Stomach Problems-
Want to Avoid or Prepare for Surgery-
No Complicating Medical issues-

Procedure
A gastric balloon is a soft silicon balloon that is inserted into your stomach through your mouth and oesophagus. This is done using a thin, flexible tube that has a light and a camera on one end, called an endoscope. You will be given a mild sedative or a “light” anaesthetic for this procedure
Normally after six months your gastric balloon is deflated and removed as there is an increased risk of balloon deterioration and perforation after this point
The procedure may be uncomfortable, but is generally painless. It takes only 15 minutes and you will go home the same day

Pre-op for Baloon
Don’t eat anything for 12 hours or drink for 6 hours before the procedure-
Order certain tests like an ECG, x-ray, and blood tests-
Beginning 1 week before surgery, DO NOT take any aspirin, vitamin E, herbal medications-
Stop smoking-
Eat more high protein, low fat foods for two weeks before surgery-
DO NOT EAT OR DRINK anything after midnight the evening before surgery-

Post-OP and recovery for Baloon
:In the first 24 hours, you should only drink clear liquids. Your dietitian will probably recommend you drink
Water, Broth (beef, chicken, or vegetable), Ice Chips, Crystal Light and etc
Leave the hospital and return home the same day-
Have fully recovered and are back to work within 3 days-
۱۴-day transition diet-
starts better diet & lifestyle habits-
Do NOT drink carbonated drinks-

Risks of Baloon
In general, this is a very safe procedure. However as it is still a relatively new procedure the long term effects are as yet unknown. Complications are rare but can happen and these are likely to be the following
Leakage or actual bursting of the balloon-
(Ulcers (rare-
A rupture or bleeding in the stomach or windpipe caused by a faulty insertion of the balloon-
Gastric problems such as reflux, abdominal pain, nausea and vomiting-

Gastric Sleeve Surgery

A gastric sleeve surgery (sleeve gastrectomy) is a restrictive procedure to help you with weight loss.this procedure reduces stomach size by 80% and your new stomach size limits the amount of food you can eat
It can be a single procedure for weight loss or it can be the first step before other weight loss surgical procedures, such as gastric bypass

?Who is a candidate for sleeve
BMI ≥ ۴۰, or more than 100 pounds overweight
BMI ≥۳۵ and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease
Patients who have tried supervised dieting programs & dietary education without success
You have high blood pressure

Procedure
The surgery takes about an hour and done under general anesthesia and you may be stay to hospital up to 72 hours or more.Your surgeon will make a few small cuts in your stomach and insert a laparoscope — an instrument with a tiny camera that sends pictures to a monitor. The surgeon will then insert other medical instruments through the additional cuts and remove 3/4 of your stomach. Finally, he’ll reattach the rest of your stomach to form the “sleeve” or tube
The results surgery include: shorter hospital stays, faster recoveries, smaller scars, and less pain than open surgical procedure

Pre-op for sleeve
Get a lab test-
Reduce their calorie intake and eat more protein-
Do not Smoke and do not drink alcohol for 2 weeks prior and 3 weeks-
Begin healthy diet for 3 weeks before surgery-
No food or liquids at midnight-

Post-OP and recovery for sleeve
Immediately following your weight loss procedure, you have to modify diet for the first 4 weeks-
No honey, sugar, syrup for first week after surgery-
Avoid foods that are high in sugar and fat-

Risks of sleeve
infection-
bleeding-
Anesthesia risks-
Hematoma-
Pain-

PCNL

Percutaneous NephroLithotomy (PCNL) is the preferred technique for treating larger kidney stones (over 2cm in diameter) located within the kidney. It involves keyhole surgery that is performed through a 1cm incision in the skin

?Who is a NOT candidate for PCNL
Stone less than 10 mm-
(Morbid obesity (patients who weigh more than 450 pounds-
Patients on blood thinners-

Procedure
PCNL is typically performed with the patient under general anaesthesia and lasts approximately 2 to 3 hours
The procedure is accomplished with the assistance of x-ray imaging or ultrasound to guide the entry of a hollow tube into the kidney. This provides access into the kidney drainage system allowing telescopes, laser fibres, and stone grasping instruments to visualize, fragment and remove kidney stones. A drainage catheter (nephrostomy tube) which exits through the skin maybe left in the kidney at the end of the procedure

Pre-op for PCNL
You will be required to have specific imaging-
you should have nothing to eat or drink for 6 hours prior to treatment-
A mid-stream urine (MSU) test is required to ensure the urine is sterile before treatment-
Done other tests required may include EKG, blood chemistry profile-

Note: It is very important that you bring all of your X-ray films and reports to the initial consultation with your surgeon

Post-OP and recovery for PCNL
The length of hospital stay for most patients is approximately one to two days
On the day after your surgery it is very important to get out of bed and begin walking to help prevent blood clots from forming in your legs
You may shower at home. Your wound site can get wet but must be padded dry afterwards. Tub baths can soak your incision and therefore are not recommended in the first two weeks after surgery
Taking daily walks is advised
You may experience sluggish bowels for several days or several weeks following surgery
Try to drink enough fluids: 1.5 litres daily for the first week after surgery

Risks of PCNL

Pain after surgery-
A mild burning feeling when urinating-
Small amounts of blood in the urine-
Mild discomfort in the bladder area or kidney area when urinating-
Need to urinate more frequently or urgently-

(Abdominoplasty (Tummy Tuck

Abdominoplasty often called a “tummy tuck”, is defined as the correction of anterior abdominal wall skin redundancy with undermining of flaps to allow repositioning of the umbilicus and plication of the rectus abdominus muscles where indicated

?Who is a candidate for Abdominoplasty
People who have loose skin and fat that is located in the abdomen can benefit from this procedure. This condition is either inherited or acquired, such as after pregnancy or substantial weight loss. Abdominoplasty can also tighten the rectus (or “six-pack”) muscles that have separated. Stretch marks or striae can also be improved, especially if they are located beneath the navel. A decision to become pregnant in the future or lose more weight, as well as previous abdominal surgery, may preclude you from this procedure

Procedure
Tummy tucks take approximately two to five hours and are performed under general or local anesthesia
An incision is made just above the pubic area. Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen
The vertical muscles in the abdomen are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline

Pre-op for Abdominoplasty
You must quit smoking at least 3 weeks prior to surgery
۵٫NO aspirin, Aleve or Motrin (can interfere with normal clotting) — use only plain Tylenol (will not interfere with normal clotting) or pain medication prescribed by your regular provider for 2 weeks prior to surgery
The week of surgery, wash daily with an antimicrobial soap to decrease your chances of infection
Do not drink or eat anything after midnight the day prior to surgery
To reduce infection, do not wear makeup, lotions, or deodorant on the operative area to day of surgery

Post-OP and recovery for Abdominoplasty
After surgery, compression garments are worn and a temporary tube may be inserted under the skin to drain excess fluid from the surgical site. Recovery time ranges from two weeks to a few months. You should limit strenuous activities for at least six weeks, and may need to take off from work for several weeks
Note: With a balanced diet and regular exercise, results are long-lasting

Risks of Abdominoplasty
Significant complications during a mini or full abdominoplasty procedure are rarePain after surgery. Some of the potential complications that will be mentioned during your consultation include
Bleeding-
infection-
tissue loss-
scars-
(swelling and bruising (dissipate over the course of several weeks-