SURGERY INSTRUCTIONS FOR LIPOSUCTION AND/OR LIPOABDOMINOPLASTY

Rev 3/17

First Name Last Name Date of Birth

Our office wants to provide you with the very best surgical care. You can help to minimize the risk of complications by carefully reading and following your Pre-Operative and Post-Operative instructions. Please ask us to clarify any item about which you have questions.

Please review all your consent forms and please have all your questions written down so that we can carefully go over them during your Pre-Op interview.

Preparing for the Day of Your Surgery 1. You must begin to take your antibiotics at least 3 days before your surgery and continue for at least 3 days after your surgery. 2. Medication Schedule a. Continue taking your antibiotic until you finish the bottle. Remember that you must start taking it 3 days before your surgery. i. Amoxicillin , one (1) tablet twice a day, or ii. Clindamycin 300mg , one (1) tablet three times a day with meals and plenty of water. Do not take immediately before going to sleep. You must be upright for at least two (2) hours if you are taking this medication. Notify Dr. Novoa if you begin to have heartburn symptoms while taking this medication. b. Do not take decongestants such as Sudafed or Actifed for 5 days before surgery. Do not take appetite suppressants and all herbal remedies, unless specifically approved by your surgeon, for two (2) weeks before surgery. 3. Do not take ASPIRIN (Anacin, Bufferin, or Baby Aspirin) or IBUPROFEN (Advil, Motrin, or Nuprin) or NAPROXEN (Aleve) or any other Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) similar to these medications, for 2 weeks before surgery: These will promote bleeding and bruising. It is permissible to take acetaminophen (Tylenol or Anacin-3). 4. You must make sure that you are using birth control for at least 30 days before your surgery. Tubal ligation, Depo Provera Injection, Implanon, The IUD, The Patch, Nuva Ring, and oral contraceptive pills are all acceptable forms of birth control with an estimated failure rate of less than 1%. a. Condoms are acceptable but have a failure rate of up to 20%. You must have used condoms during each sexual intercourse for at least 30 days. No Exceptions. b. Withdrawal Method (Pulling Out) and Rhythm Method (Calendar Method) are not acceptable and your surgery will be cancelled and must be rescheduled. Failure to use acceptable birth control will lead to automatic cancellation of your surgery and forfeiture of up to $1,500 of your surgical deposit.

INITIALS c. Remember , if you are pregnant on the day of your surgery, the surgery will be cancelled and you will forfeit at least $1,500 of your deposit. 5. Remember that smoking or any use of nicotine products is contraindicated for at least 4 weeks before and 4 weeks after your surgery because of the increased risks of scarring, delayed wound healing, wound infection.

INSPREOPABD- 1 6. It is recommended that you begin to take your vitamins and herbal medication prior to your surgery and continue until Dr. Novoa tells you to discontinue. 7. Do not drink alcohol for one week prior to surgery, this might cause excessive bleeding. 8. You cannot drive yourself home : Arrange to have someone to drive you home from Novoa MedSpa after the surgery. 9. Do not fast or undergo dramatic weight loss just prior to surgery. All patients should be on a stable, healthy, well balanced diet for at least 2 weeks before surgery. Liquid diets, extreme low calorie diets, and rapid weight loss diets may predispose you to cardiac irregularities, surgical complications, poor wound healing. 10. Eat before your surgery . Please be prepared to eat a balanced meal the night before your surgery and to eat a regular breakfast the morning of your surgery. Unlike other surgeries, you MUST EAT before your surgery. Also, please make sure to drink plenty of fluids (no alcohol). 11. Do not wear unnecessary jewelry, perfume (deodorant is OK), and minimize use of cosmetics (survival rations only). 12. Bring loose clothing because, remember, you will have a bigger breast size. 13. Bring warm socks to prevent cold toes during surgery. If you tend to get cold hands, you are welcome to bring clean mittens (no leather gloves) to wear during the surgery. The operating room is kept relative warm, about 72 to 75 F. Also, bring extra panties. 14. Do not use moisturizers or soap that contains moisturizers for at least a week before surgery. The ink markers used to outline the areas on your body to be treated will rub-off too easily if you have recently used a moisturizer. 15. Changing your dressing the morning after surgery is easier if you have someone to help you.

On the Night Before and Day of Surgery 1. You must arrive on time for your surgery. If you are 15 minutes late arriving, your surgery will automatically be cancelled and you will be charged a $1500 rescheduling fee. 2. Remember to take your medications as directed. 3. Drink plenty of fluids, rest and eat light meals. Do not skip your dinner the night before your surgery or breakfast on the day of your surgery. Unlike other surgeries, it is important that you have a light meal in your stomach before having this type of surgery. Eat a regular meal. Juices with toast and an egg or cereal are good choices. a. You must be well hydrated on the day of your surgery to avoid nausea and vomiting. The best way to tell if you have been drinking enough fluids is to check the color of your urine (pee). The color of your urine must always be light in color or clear. Dark or concentrated urine means that you are not well hydrated and will increase your risk of having nausea and vomiting problems after surgery.

Day of Surgery When you arrive on the day of your surgery, please check in at the front desk. Once you have checked in, you will be taken to one of our offices to sign your Surgical Consent Forms and take a pregnancy test.

Once we have confirmed that you are not pregnant with a negative urine pregnancy test, you will then be asked to change into a surgical gown and be led to the operating room.

INSPREOPABD- 2 In the procedure room, Dr. Novoa will then mark you. After marking all of the treated area, Dr. Novoa will take pre-operative photographs, at different angles.

Next, you will lie down on the surgical table and the nurse will explain to you the various positions the physician may require you to assume during the procedure. It usually takes about 30-45 minutes after arrival before the surgery begins, so it may be a good idea to take this time to practice the positions beforehand which will help the surgery run much smoother.

For safety reasons, you will also have a blood pressure cuff placed on your arm and a pulse oximeter will be placed on your finger. An IV site will also be determined and started. Please be aware that at least one of your fingers must have a short fingernail without fingernail polish in order for the pulse oximeter to read properly. If your nails are long and polished and the pulse oximeter is unable to obtain a proper reading, you will be asked to cut at least one of your nails and remove the fingernail polish before surgery will begin. Failure to assist us in properly monitoring your vital signs will terminate this agreement and surgery will not be performed.

Next, you are ready to be injected with lidocaine in the areas to be treated, numbing you, and allowing the filtration of the tumescent anesthetic solution. After you have been numbed, a large volume of dilute Tumescent Anesthetic solution is carefully injected into the targeted fat tissue. As soon as the area has been infiltrated with the anesthetic solution, the tissue should be completely numb. Infiltration of the anesthetic solution takes time and can often take as long as the procedure itself.

When a sedative is given to the patient, the local anesthesia tends to be more effective, versus when an intravenous sedative is used. A patient, who is too sedated, sometimes will not realize that an area is not anesthetized and may end up feeling more pain when the procedure is actually done. In short, minimal sedation actually will help maximize your level of comfort.

Before, during and after the procedure, you will be offered a snack and something to drink.

After the procedure, pads are placed over your incisions to absorb any drainage. The incisions are then stitched as required. After placing the pads, a support garment is then put on. After the garment is placed, you are ready to go home. You should not feel any soreness for several hours, due to the affects of the Tumescent Local Anesthesia. Even if you feel well after surgery, you cannot drive yourself home. The anesthetic causes drowsiness, therefore you cannot drive.

The effects of the Tumescent Local Anesthesia should last anywhere from 18 to 36 hours. Maximal blood and tissue levels may be as soon as 6-12 hours. If you are at all concerned with any side- effects, please contact Dr. Novoa at 915-595-9944. If you feel pain, please take your pain medication, as prescribed. If, for any reason, you feel that your pain medication is not enough, please contact Dr. Novoa at 915-595-9944.

Please note that there will be a minimal amount of spotting at your incision site. Excessive bleeding is considered abnormal and if this occurs, please contact Dr. Novoa immediately. However, you are expected to have a significant, if not gross amount of fluid discharge. This discharge is considered to be normal following either liposuction and/or lipoabdominoplasty. Light spotting or bleeding mixed with gross clear discharge is considered to be normal. If you notice anything other than fluid mixed with a light amount of blood, please call Dr. Novoa immediately at 915-595-9944.

Post-Operative Dressing & Garment Application represents a critical aspect to the your recovery. Post-Operative care is a very controversial issue as well.

INSPREOPABD- 3 POST-OPERATIVE INSTRUCTIONS 1. Going home: The medication prescribed may impair your driving. Make arrangements for someone to drive you home. 2. Immediately after surgery, start out with clear fluids. You can resume a regular diet anytime. 3. You must have someone present with you for the first 24 hours after surgery. 4. You must keep the garments on around the clock for the first 24 hours. 5. Activities : You will want to rest immediately following your surgery. You must get up and walk after surgery. The distance does not have to be great, but at least get up and move. Begin arm exercises the following day. You may resume normal activities such as exercise 1-2 weeks following the surgery. 6. Return to our office the next day for follow-up and photos. 7. Wound care and bathing : Keep incisions clean and dry. Replace your Steri-strips only if they become dirty. You may apply a topical antibiotic daily. Avoid very hot water during the first seven days following surgery. You can take a luke-warm shower the next day as well. Be sure not to take a bath or get into a Jacuzzi for at least six weeks. Shower prep: Sit on the edge of the bed to remove the garment. Wait five minutes before standing. It is recommended to have someone present to assist you with the bathing process. While showering, use regular soap and wash the incision sites well. While washing, your compression garment can be placed in the washer on gentle cycle. 8. Take antibiotics as directed until your prescription is finished. Take your medication with food to avoid nausea. 9. It is important for you to keep your compression garment on at all times, until you see Dr. Novoa on your follow-up visits. Your compliance in wearing this garment is important for a desired cosmetic outcome. 10. Alcohol : Alcoholic beverages should be avoided for one (1) week after the surgery. 12. Common side effects : Menstrual irregularities with premature or delayed onset of monthly menstruation are a common side effect of any significant surgery. A slight temperature elevation during the first 48 hours after surgery is normal. Call Dr. Novoa if your temperature is higher than 100.4 F. Soreness will persist for the first several days and the second day will be the worst. Each day will improve. Bruising is usually minimal and is only temporary. Pain and swelling due to inflammatory reaction to surgical trauma may occur and increase 5 to 10 days after surgery. This is treated with anti-inflammatory medication. Itching may occur on the incision sites several days after surgery as part of the normal healing process. 13. Call our office : If you notice signs of infection, fever, foul smelling drainage, focal redness, or swelling, you may call 915-595-9944. You may leave a message and the doctor will return your call.

INSPREOPABD- 4 POSTOP MEDICATION INSTRUCTIONS 1. Dr. Novoa is available by telephone (915-595-9944) for emergencies or questions related to your surgery. 2. Medication Schedule a. Continue taking your antibiotic until you finish the bottle. i. Amoxicillin , one (1) tablet twice a day, or ii. Clindamycin 300mg , one (1) tablet three times a day with meals and plenty of water. Do not take immediately before going to sleep. You must be upright for at least two (2) hours if you are taking this medication. Notify Dr. Novoa is you begin to have heartburn symptoms while taking this medication. b. Phenergan ( Promethazine ) 25mg. Take one (1) tablet every 4 hours for nausea. Remember to always take a Promethazine tablet before taking Tylenol-3 to reduce the chances of vomiting up your medications. c. Wait 20 minutes, then take Tylenol-3, one (1) tablet every 4 hours for pain. If your pain is severe , you may take up to two (2) Tylenol-3 tablets every 4-6 hours. i. You may repeat this cycle every 4 hours. However , someone must watch you closely for the first 24 hours. d. Motrin ( Ibuprofen ) 800mg. Take one (1) tablet every 8 hours for pain. You can take Phenergan, Tylenol-3 and Motrin together as long as you do not exceed the recommended number of tablets during the time allowed. i. Do not take Motrin every four (4) hours only every (8) hours. ii. If your pain level is not severe , you may take only Motrin if you wish. However , few people are able to take only Motrin . Your pain level is expected to be severe , so do not suffer. Take the medication schedule as directed. 3. Keep your incisions clean and dry. 4. Keep your compression garments on for the next 24 hours. 5. If you develop a fever of greater than 100.4 F or have a foul smelling discharge coming from your incision site, call Dr. Novoa as soon as possible at 915-595-9944. 6. Light bleeding onto your steri-strips is normal, but if you are concerned about increased bleeding or bruising, call Dr. Novoa. 7. Continue to drink plenty of fluids. Remember to keep the color of your urine (pee) light in color. 8. The medications from your surgery and Tylenol-3 will constipate you, so consider adding prunes or prune juice to your diet. Increase the amount of grain cereals, fruits and vegetables to your diet to decrease the chances of constipation.

MEDICATIONS 1. Phenergan 25mg. Take one (1) tablet every 4 hours. 2. Wait 20 minutes. 3. Then take Tylenol-3 one (1) tablet every 4 hours. You may take up to two (2) Tylenol- 3 tablets every 4 hours.

INSPREOPABD- 5 • Repeat the cycle of pain control using Phenergan and Tylenol-3 every 4 hours • Please follow the interval of use as prescribed. Do not take Phenergan and Tylenol-3 more often than every 8 hours without discussing it with Dr. Novoa. 4. Ibuprofen (Motrin) 800mg. Take one (1) tablet every 8 hours for pain. • You may take Motrin with Phenergan and Tylenol-3 . There is no expected drug interaction and the combined medications may improve pain control. • Please follow the interval of use as prescribed. Do not take Motrin more often than every 8 hours without discussing it with Dr. Novoa. 5. Continue taking Amoxicillin 875mg twice a day as directed. 6. Continue taking Milk of Thistle , Vitamin E and Omega 3 as directed. 7. Drink plenty of fluids, rest and eat light meals. 8. Keep incisions clean and dry. 9. Keep compression dressings on for the next 24 hours. 10. If you have a fever greater than 100.4° F or have a foul smell from your incision sites or feel you have an emergency, please call Dr. Novoa at 915-595-9944.

Patient’s Signature Date

INSPREOPABD- 6