Prior to surgery you should not take aspirin for one week before surgery and you should stop any nicotine products which include cigarettes, vaping, gum, and patches for at least 4 weeks prior to surgery. If you have a history of medical problems, we may have you undergo clearance by your primary care physician or any pertinent specialists. You should plan to take 1-2 weeks off after surgery depending on the activity level of your job. Your follow-up and post-operative instructions will be discussed with you at your pre-operative appointment.
On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.
During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.
Before the Day of Surgery
Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.
Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.
Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.
Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.
You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.
The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.
Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.
Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.
Do not eat or drink anything after midnight the night before your surgery.
Please call our office if you have an infection of any kind prior to your surgery.
Day of Surgery
On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon will make some preoperative markings and perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.
On the day of surgery do not take the following blood pressure medications with generic names that end in “-pril”, “-sartan” before your surgery. If you are on metformin, you will be asked to not take it on the day of surgery.
During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.
After surgery you will be placed in an elastic bandage or compression garment for several weeks. You will have drains in place to remove extra fluid. You will have to limit activity for 6 weeks after surgery. Initially, you will have swelling around the legs that will decrease over time. It may take several months to see the final results of your arm lift.
In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:
- Prepare a sleeping area that is easy to get to for the first night. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
- You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
- If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
- Review your post-surgery instructions given to you at your pre-operative appointment
If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.
When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.
After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.
You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.
Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.
You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.
If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.
You may be prescribed an antibiotic which you should start the evening of the day of surgery. Take all antibiotics to completion or until your surgeon tells you to stop.
Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.
We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.
Surgical Site Care:
You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery.
Immediately after surgery you will be placed in elastic bandages. After the first day, you can start wearing the compression garment. The compression garment may lose elasticity after being worn for a while or become loose as your swelling diminishes and you will need to get a new garment for your new size.
We typically place a drain on each arm. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.
Please Call Immediately if:
Please call if you have the following signs/symptoms:
- temperature greater than 100.5 F
- bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
- increasing pain that is not controlled on oral pain medications
- increasing redness or size at the surgical site
- your drain is not holding suction
- if your wounds come apart
- Any other concerns
For non-emergency questions:
During business hours (8 AM – 4:30 PM): call (210) 658-3555.
After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.
If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.
No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move. You will be allowed to return to normal activities 6 weeks after surgery.
Follow-up Clinic appointment:
Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.
Risks and Safety
Arm lifts are best for removing extra loose skin on the arms. It is not meant for reduction of a large amount of excess fat. If you have a lot of excess fat, you may benefit from a weight loss program, weight loss surgery, or liposuction prior to undergoing an arm lift.
The scar from a standard or extended brachioplasty is a long visible scar on the arm. In patients with darker skin, you may have a dark scar which may not lighten.
Risks include poor wound healing, bleeding, infection, fluid collections, wound separation, asymmetry, damage to lymphatics in the arm resulting in long term swelling, damage to nearby nerves, deep fatty tissue may die (fat necrosis), skin discoloration and/or swelling, spitting sutures, poor appearance of scars, numbness or changes to sensation on the skin, and need for additional operations.
If you have swelling in one leg, pain in the legs, shortness of breath, chest pain, or abnormal beating of the heart, you should immediately go to the emergency room.
The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.