Facial Aesthetic, Cosmetic, and Reconstructive Surgery
A Patient’s Guide Presented by Dr. Fred Fedok
Purpose of the Patient’s Guide
Despite the increasing trend in the overall awareness of cosmetic surgery, most people know little about these types of surgical procedures. The purpose of this booklet is to familiarize those individuals who are considering a change, with some facts about the various surgeries prior to discussing them during a consultation. In addition, this booklet offers a brief explanation of my office policies.
How to Read the Patient’s Guide
I recommend that everyone read the Patient’s Guide. It contains detailed information on office policies. The General Information section will be extremely helpful to you as an introduction to our office. As you review this guide, jot down any questions you may have so that we may discuss them during your consultation.
It is important for you to understand that I speak in terms of the average case when I discuss the various procedures in this guide, as variations do exist.
The goal my office staff and I strive to achieve is to make your surgical experience as comfortable, convenient, and as pleasant as possible, and to achieve results that will appear “natural”.
Cosmetic or aesthetic plastic surgery is surgery to enhance one’s appearance. Procedures which alter one’s own natural feature(s) to a more aesthetically pleasing state, bring one’s own features in a more harmonious balance and eliminate some of the obvious signs of aging, are considered cosmetic plastic surgery.
Reconstructive plastic surgery, on the other hand, is surgery which attempts to restore form or function. This may involve correction of congenital deformities or abnormalities, restoring portions of the face to a state which may have existed prior to an injury, tumor removal, a previous unsuccessful surgery, improving the function of the nasal airway or visual fields, or reanimating the paralyzed face.
Plastic surgery also involves the diagnosis and treatment of many types of skin lesions, cysts, and blemishes.
GOALS AND EXPECTATIONS OF SURGERY
A prerequisite for undergoing any type of plastic surgery is the patient’s level of emotional maturity based on realistic goals and expectations. The following considerations should be acknowledged and accepted in advance of any of the procedures described in this booklet.
A surgeon is a doctor bound by the biological limitations of healing; he cannot perform magic. As such, the degree of success for both the doctor and patient depends not only on the doctor’s skills, but the patient’s age, health, skin texture, bone structure and specific problem area.
Patients should think of surgery as a way to make progress toward achieving their goal.
The goals of any surgical procedures should be improvement, not perfection. A patient who seeks perfection is not being realistic and should not undergo the procedure.
Not every patient is a good candidate for surgery for one reason or another, nor is every patient who requests surgery accepted. It may be that the desired goals of the patient are unattainable surgically or aesthetically inappropriate. During preoperative consultations, these issues will be explored if necessary.
The motivations which brings a person to seek surgical aid should be realistic. Cosmetic surgery is not a cure-all for the problems one might have. The resulting improvement in appearance may well be psychologically beneficial. Increased self-esteem and self-confidence in the individual patient may be a by-product of the surgical experience.
Surgery, however, will not solve one’s problems if one blames his/her lack of success on appearance alone.
Additionally, one must realize that family, friends, and acquaintances will not necessarily give approval after the surgery has been performed.
While there is usually a relative minimum of pain or discomfort and minor incapacity following most cosmetic surgery, a patient needs to be mature enough to accept this situation as temporary.
Every surgical procedure, even a simple tooth extraction, involves some degree of risk. Risk is defined in terms of possible complications or mild disappointment that the results may not match one’s expectations.
Although very rare, some other risks might include reactions to anesthesia or other medications, infection, poor healing, injuries to muscles or nerves, numbness, swelling and discoloration, and scarring, among others.
Each patient should be aware of these possibilities and is encouraged to inquire about the realistic risks of their contemplated surgery. Each patient is also encouraged to discuss any concern or fear with the surgeon before going into surgery.
Every patient should understand that it would be unethical for any physician to guarantee the results of any surgical procedure. The only guarantee that can be made is to do the best job possible to help the patient. All wounds heal by scar formation, a process over which a surgeon has some influence upon, but very little control, once the procedure has been performed.
This accounts for some of the changes, both favorable and unfavorable, that occur as the healing progresses.
Patients should also know that while significant improvement can be seen in the first few weeks after surgery, subtle changes may also occur in the year following surgery and, in some cases, beyond.
In general, it is my practice to use “twilight anesthesia” for most procedures because patients are apt to feel better following surgery. However, with the availability of skilled board-certified anesthetists, the full range of anesthetic services are available, including general anesthesia if it is appropriate for you in order to treat your condition or concern.
Patients receive medicine in the preoperative period, before their arrival in the surgical suite, that will make them very sleepy. Then, in the surgical suite, they receive intravenous medications which help them “go to sleep”. A local anesthetic is used to supplement the “twilight anesthesia” to make a specific area of the patient’s body numb, so that there will be no pain.
Most patients are usually alert soon after the procedure is complete, although most patients will experience a degree of loss of memory regarding the surgical experience.
PRIOR TO CONSULTATION
Prior to your consultation, it is important for you to have read the previous section, General Information, and the section which follows, Consultation, because of their impact on your total care.
Patients should realize that the consultation provides them with much of the information about the condition or problem for which they have concern. A great deal of training has been acquired by the surgeon to form an expert opinion as to whether or not a plastic surgery procedure should or should not be performed. Should it be determined that surgery is not recommended, patients should realize this decision is made in their best interest.
To help you become familiar with the techniques, the surgeon will use pictures to determine how to proceed in your case; you can analyze your facial features in the following manner. Leonardo da Vinci has shown that facial aesthetics can be divided into equal one-thirds in a vertical dimension over the face. These are demonstrated by lines drawn horizontally across the forehead, brows, base of the nose, and chin. Ideally, the middle segment, which contains the nose, should be equal to the lower segment from the base of the nose to the chin. Horizontally, the face should be five eyes wide (five times the width of an eye). When looking at the profile, the chin should approximate a vertical line drawn from the lower lip. If the nose or chin is out of proportion to the other facial features, correction of this can provide an improved facial harmony.
Consultation fees are due at the time of the initial visit. Personal check, Master Card and Visa are acceptable forms of payment. Surgical fees are quoted at the end of each individual consultation. If surgery is scheduled, our policy requires all cosmetic surgery fees to be paid in full approximately three weeks prior to the surgery date, or on the day of your preoperative visit. It is customary and appropriate for surgical fees to be paid in advance of elective cosmetic surgery. The surgeon is then assured the patient is not undertaking elective surgery he/she cannot afford, and that the patient is sincere about proceeding with this treatment. Also, studies indicate this financial arrangement assures a better doctor-patient relationship. If you are interested, personal loans for financing the operation may be arranged with outside sources.
If the surgery involves reconstructive, functional, or skin lesion, cyst or blemish removal, nearly all or a portion of the surgical fee may be paid for by your insurance. In this case, you may not need to pay any amount in advance, except that which is estimated to be your deductible and co-insurance. If there is a percentage of the procedure that is cosmetic, it will be quoted separately and that portion will need to be paid three weeks prior to the date of surgery.
Any surgery which requires the removal of tissue (for example, moles, cysts, or any skin from a scar revision), must be sent to the pathologist for identification. This is a separate fee and is billed directly to the patient from the pathology laboratory.
Some procedures may be performed the day of your appointment, such as a mole or cyst removal, a collagen augmentation injection, or steroid injection. We request that cosmetic procedures, such as collagen augmentation injection, be paid in full when services are rendered. If the procedure is to be paid by your insurance carrier, it is absolutely mandatory for us to have your current insurance information, including a copy of your insurance card. Failure to provide us with the correct insurance information will result in the entire bill being your responsibility.
One must remember that all expenses, including a separate fee for the use of an operating room, the anesthesiologists’ services, the cost of prescriptions, and the cost of preoperative laboratory tests, are your responsibility as well.
The expenses connected with cosmetic surgery (surgeon’s fees, operating room expenses, medications, laboratory tests include EKG’s, etc.) probably will not be covered by medical insurance. Only if some of the surgery performed improves function, eliminates a medical problem, or is reconstructive, will insurance cover these fees and costs. For example, saggy upper eyelids may also impair vision. The correction of this condition may eliminate the visual problem and then only with proper preoperative written documentation by an eye doctor will this procedure be covered by one’s insurance.
Insurance companies’ policies vary, and we cannot predict how your company will handle your individual case. There are many different policies with variable allowances and coverage amounts. The staff will assist patients in getting their insurance company’s reimbursement by filling out required forms and submitted reports of the operation. However, my office cannot ethically, and will not, fill out forms in such a way as to make a procedure not appear to be done for cosmetic reasons when, in fact, it is. The patient must remember that health insurance policies are contracts between the insurance company and the patient. You, the patient, not the company, are responsible for charges incurred.
Because of the many changes occurring with insurance plans, it is very important for you to find out if your policy requires a second opinion or pre-authorization for the procedure and/or an overnight hospital stay. Failure to find out this information will result in a markedly reduced insurance payment.
Ultimately, you, the patient, are the only one who can effectively work out any disagreements with reimbursement with your insurance company. You will be billed and expected to pay the portion of the total bill your insurance company does not pay. The only exceptions are those situations where the particular type of insurance plan has an agreement with the surgeon and/or the facility to accept their predetermined usual and customary allowance.
Because you have read the General Information section of this booklet, you are aware of the general concerns of facial plastic surgery and how the business office of my practice operates. Your personal consultation will now be addressed.
Many of the important questions about your contemplated procedure, the degree of expected improvement, and the anticipated length of recovery will be discussed in this section.
YOUR FIRST VISIT
Prior to our consultation visit, my office may ask you to complete a medical history questionnaire and to mail or bring it with you. Be sure to list and describe any medical condition(s) and all surgeries you have had in the past or presently have. Please list all allergies, reactions to medicines, soaps, ointments, surgical tape adhesives, etc. In addition, carefully list any and all medications, vitamins, aspirins, or antihistamine decongestants that you take. Be sure to include all dosages of each medication and how often you take them. During your first visit, we will discuss your desires and the conditions that you wish to have corrected or improved. This is followed by an examination and analysis of each condition. I will give you an idea of what I believe can be accomplished in your particular situation. If it is appropriate, we may be able to use video imaging to illustrate what results I think you may expect in your individual case. This is especially helpful for nasal, chin, and neck surgery candidates who can actually visualize what they may look like following the procedure. The expected improvements of each procedure will be discussed, along with the limitations, risks, and alternatives. Please ask any questions that may concern you about the proposed surgical procedure.
Additionally, during the visit, I will take a set of medical photographs to accurately record the existing condition or problem. These photographs are very helpful to me, as I can study them prior to your surgery. Also, they provide us with a mechanism for comparison once the surgery is complete.
Patients who have time schedules to meet, such as returning to school or work, vacation, or other family commitments, etc., should advise the scheduling staff. If you are interested in surgery as soon as possible, we need to know so that a time can be reserved in the surgery schedule.
In most cases, certain preliminary tests are required, such as blood counts and other laboratory tests. Depending on certain medical disorders, special X-rays, electrocardiograms (EKG’s) or consultations with other medical specialists may also be necessary prior to elective surgery.
SUBSEQUENT PRE-SURGERY VISITS
Occasionally, I may ask you to return to the office at least one or more times prior to surgery to discuss the proposed surgical improvements. This may be particularly true if I have asked you to see another physician or obtain other medical consultations. An additional visit may also be helpful by allowing you to better understand the surgery you are going to have.
Also, if surgery is scheduled long after our initial consultation, I may ask you to return to the office prior to surgery and conduct the aforementioned steps so as to review and refresh your memory and answer any new questions that you may have.
Most of the facial cosmetic and reconstructive surgical procedures can be performed on an outpatient basis at the Fedok Plastic Surgery or at South Baldwin Regional Medical Center. I will give you my opinion as to whether the surgical procedure should be completed at these facilities or as a hospital inpatient if your particular insurance dictates such. In either case, you should be prepared to remain in the surgical facility until I believe it is safe for you to return home or to a clinic villa. If you are returning to your home, you must arrange to have someone accompany you home upon discharge, stay with you through the first night and bring you back to the office in the morning. Our staff is able to assist you with arranging villa stays and nursing care.
HOSPITALIZATION OR OUTPATIENT SURGERY AT A HOSPITAL
Certain procedures may be considered by the surgeon to be best performed as an inpatient or hospital outpatient. Patients are hospitalized at South Baldwin Regional Medical Center or at the University of South Alabama Medical Center. The cost generally depends on the type of surgical procedure being completed and the amount of time in the operating room. Costs usually include the operating and recovery room expenses, medications and supplies.
Check with your insurance company to see if your policy will cover any of the above-mentioned incurred expenses at that particular facility.
PREPARING FOR SURGERY
There are certain medications, vitamins, etc., that I ask you not to take for at least two weeks prior to your surgery. These include Vitamin E (over and above what is already in a multi-vitamin); aspirin and any drugs containing aspirin or aspirin-like ingredients; and most anti-arthritic medicines. These medicines and this vitamin seem to prolong bleeding and increase postoperative bruising. However, medicines that contain acetaminophen can be used safely in place of aspirin for pain. They are available without prescription. Depending on your procedure, you may be able to take any of the non-steroidal anti-inflammatory medicines, such as ibuprofen, up to forty-eight hours prior to surgery. Ask Dr. Fedok or his staff if you have to take such medicines.
I recommend that patients take 500 milligrams of Vitamin C twice a day and one extra-strength multi-vitamin one week prior to surgery, as well as for a minimum of two weeks during the postoperative healing period. While a multi-vitamin may contain Vitamin E, the amount is not so significant as to cause an increase in bleeding.
THE DAY OF SURGERY
At the time your surgery is scheduled, you will be given a sheet of instructions outlining exactly what to do the morning of your surgery. Plan to check-in at least one-and-one-half to two hours prior to your surgery time or as instructed, in order to be properly prepared and sedated.
It is very important that patients follow my instructions. Smoking is not allowed after midnight. I highly suggest that you do not smoke for at least two to three weeks prior to surgery. If you are having a facelift, do not smoke at all until healing has progressed satisfactorily. Smoking has a direct adverse effect on healing because the nicotine diminishes blood blow to the tissues. Also, most patients will not be allowed to eat or drink anything after midnight.
I do require that men shave closely the morning of surgery. Men with beards or mustaches do not have to shave these areas unless they are having a facelift or chin augmentation.
Upon your arrival at the surgery facility, you will receive medications which will make you very sleepy and help relieve any anxieties. Normally, once you arrive in the operating room, you will have an intravenous line in place so that further medicines can be given to assure that you will be “asleep”. Then, a local anesthetic will be given to the area to be operated on which will provide complete anesthesia. Patients who undergo this type of anesthesia may have amnesia regarding the entire surgical experience. This type of anesthesia is used for your comfort and safety. Please, do not worry, you will not “know” what is going on during the course of your surgery, nor will you experience any pain.
THE POSTOPERATIVE COURSE
Following your surgery, you may go to a specially-designed relaxing chair or to the recovery room until you become alert enough to be discharged with someone to take you home. The medications you have received will allow you to be comfortable and relaxed for several hours following completion of the surgical procedure. Additional medications can be ordered afterwards to insure your comfort.
If you are hospitalized for your surgery, you can expect to be discharged the morning after your surgery. The same situation applies if you are staying in the clinic hotel. You will be discharged after a visit to the office the morning after surgery.
During the first morning check, you will be given instructions on how to take care of the surgical area, as well as instructions on taking any medication during the healing period. A return appointment will also be scheduled at that time, usually one full week after surgery. Occasionally, it is necessary to examine some patients more often during the first week, and those appointments will be scheduled accordingly. Appointments will be scheduled during regular office hours.
Subsequent appointments will be scheduled at one to two months, four months, and one year, until the healing process is complete. It is important for you to keep these appointments, since they are vital to insuring the best possible results from your surgery. It is your responsibility to assist us in monitoring the healing process. Should a problem arise, I may ask you to come in more often, and I want you to feel free to contact me if you experience any problems or concerns.
It is my policy that patients are not charged for visits during the first year, unless there is a new concern that we are focusing on, when they have paid their full surgical fee in advance. Thereafter, the charges are determined on a case-by-case basis.
My goal is to make your entire surgical experience a pleasant and convenient one while striving to achieve a natural appearance for you. As it is very important to me that you thoroughly understand your potential surgery and the policies of my office, please read all the materials and ask any questions you have regarding the procedure you are contemplating during our visits. I believe that an informed, prepared patient has a much better surgical experience than one who is not well-prepared or still has misconceptions about the surgery. Please remember all the information presented in the materials as general, and that there may be exceptions depending on your particular case. I will do my best to inform you about your surgery and its postoperative course, which will often require several visits so that I may monitor the healing process and your progress. These follow-up visits are essential for obtaining the best possible result. Again, please feel free to discuss any special problems with me or the office staff, and we will do our best to help solve them.
I look forward to meeting with you during your upcoming visit. I trust the online brochure will assist you in making the most of your valuable time.
WHY CHOOSE DR. FEDOK?
- Past President of the American Academy of Facial Plastic and Reconstructive Surgery
- 30+ Years of Experience
- Facial Plastic Surgery Specialist
- High Expertise
- Individualized Care