Recovery Guide

PREPARATION FOR TUMMY TUCK SURGERY

These recommendations have a specific purpose such as reducing the risk of bleeding (herbal

supplements, aspirin, Advil, etc.), blood clots (estrogen hormones, smoking), and wound healing complications (smoking, vaping, nicotine use).

1. Continue (or begin) conditioning exercise such as aerobic exercise, yoga, Pilates, swimming, or weight training. Strengthening your body through aerobic exercise will enable you to recover from surgery more quickly.
2. Begin a high-protein diet that includes foods such as lean chicken, fish, eggs, beans, and protein shakes. Protein enables your body to more effectively heal wounds.
3. NO SMOKING for one month before surgery and one month after surgery. There should be NO SMOKING/ VAPING/NICOTINE USE by you or anyone confined with you in any closed environment during this period. Smoking significantly compromises blood flow to incisions and increases the likelihood of complications such as skin death, wound separation and poor scarring.
4. To reduce your risk of lower extremity blood clots, stop birth control pills or hormone replacement therapy, including topical or vaginal estrogen creams, for one month before and one month after surgery.
5. To avoid excessive bleeding during and after surgery, avoid aspirin and other over-the-counter anti-inflammatory medications such as Advil or Aleve (for a full list, contact my office), aspirin, alcohol, and herbal supplements for two weeks before and two weeks after surgery.
6. Avoid contact with ill family members for 2 weeks before surgery.
7. To lessen infection risk, do not shave the pubic area for one week before surgery.
8. To aid in wound healing and lessen bruising and swelling, begin taking the VitaMedica Recovery Support vitamins that are provided to you 2 weeks before surgery.
9. Postoperatively, avoid using any heating pads or warming blankets on the surgical areas in order to avoid potential burns.

ITEMS TO HAVE ON HAND PRIOR TO YOUR SURGERY

1. Loose, soft clothing such as yoga pants or sweatpants
   You’ll temporarily be more swollen than usual, so loose clothing will be most comfortable. Also you’ll want to avoid clothes with a snug waistband that could potentially irritate your incision.
2. Antibacterial soap for your hands, antibacterial body wash and alcohol-based hand sanitizer
   This will be important to help prevent infection of your incision. In addition, use a hand sanitizer regularly between washes.
3. Books, magazines, a laptop
   These are nice to have on hand while you are recuperating and taking it easy.
4. Laxatives such as MiraLAX and Dulcolax
   A side effect of pain medication, constipation is common the first week following surgery.
5. A big water bottle
   You will need to ensure you drink plenty of water and/or fruit juice to help you stay hydrated, at least 8 cups a day or 16 cups if you have liposuction in conjunction with a tummy tuck.
6. Clean linens and towels; absorbent pads for the bed or recliner
7. Step stool
   This will make it easier to get in and out of a high bed and a shower seat.
8. Recliner
   This can provide ideal positioning and ease of getting up and down.

THE DAY BEFORE TUMMY TUCK SURGERY

1. To reduce constipation after surgery, eat a liquid diet, and have a bowel movement, even if a laxative or Fleet’s enema is required.
2. To reduce the risk of infection, thoroughly cleanse with antiseptic soap at least the night before and the morning of surgery. Areas of most concern include the armpits, genitalia, anal areas, and under the fingernails.
3. If you are anxious, take the Xanax prescribed (or sleeping medication) to sleep, before 12 midnight (10 p.m. is best).

SURGERY DAY
1. On the night before surgery, have nothing at all to eat or drink after midnight. Do not chew gum.
2. You may brush your teeth in the morning, but do not swallow any water.
3. Do not wear contacts to the surgery center. Please wear your glasses. If you do accidently wear your contacts, please notify your nurse.
4. If you are on your menstrual cycle, do not wear tampons on the day of your surgery.
5. The clinic will tell you what time to arrive at the surgery center. Please arrive on time and leave all
valuables at home. The only things you will need on the day of surgery will be your filled medications and your clothes. The nurse will verify you have all the medications you need.

Dr. Patronella strongly recommends the use of Exparel, a long acting (approximately 72 hours) local anesthetic injection performed in surgery, to assist in postoperative pain management and a more comfortable experience.

Please ask about this option. In addition, Dr. Patronella employs a technique (Progressive Tension Sutures) for all body contouring procedures that eliminates the need for uncomfortable drains, improving mobility and further reducing pain.

EVENING AFTER SURGERY

1. Many patients take advantage of an overnight stay in our fully accredited facility for attentive and prompt care during the early post-op period.
2. Sequential Compression Devices (SCDs) will be kept on the legs overnight to reduce the risk of blood clots and to eliminate the need to get out of bed for a walk that evening.
3. To reduce blood clot risk, many patients (if deemed clinically appropriate) will be given an injectable or oral blood thinner beginning the morning after surgery.
4. When staying overnight, dressing and garment change will occur between 5 a.m. – 6 a.m. the morning after surgery. For those who are recovering at home, an experienced ACPS medical provider will assist with dressing and garment change during the home visit the next day.
5. Discharge from our surgery center will occur at about 7 a.m.

DAYS 1-3 AFTER TUMMY TUCK SURGERY

1. During surgery, a long-acting, non-narcotic local anesthetic injection (Exparel) can be performed. This will reduce discomfort, though it will not eliminate it completely. Pain medication will be required, and it is better to take it and get up and around than to lay in bed all day avoiding movement for fear of pain.
2. Getting out of bed and walking with assistance for 10 – 15 minutes every two hours during normal waking hours is critically important to speed recovery and reduce the risk of blood clots.
3. While challenging due to abdominal discomfort, it is important to expand the lungs fully with conscientious deep breathing exercises regularly while awake. Beginning on the second day after surgery, you may shower with assistance using an antiseptic soap such as Dial. As an option, DERMABOND PRINEO® wound-healing glue can be applied to your incision(s) at the time of your surgery. This glue will provide support for your incision’s healing while creating a watertight seal to help prevent infection. Please shower and let the water run over the incision(s), but do not rub or apply any soaps, creams, and/or ointments to the incision(s). Simply blot dry after showering. This will allow the Prineo to stay on for up to a month after surgery.If Prineo is not used, application of Steri-Strips (provided by us) can provide incisional protection as well, and treated the same while showering. Steri-Strips may be changed every 4 – 5 days.The shower should be equipped with a stable plastic sitting stool, and A hand-held shower head if possible. You should NOT be left alone in the shower, as it is common to experience light-headedness and unsteadiness. Bathtub showers are difficult to get in and out of, and should be avoided during your recovery.
4. For those incisions that are not covered with glue or Steri-Strips, simply clean with hydrogen peroxide or mild antiseptic soap and water, apply Bacitracin ointment and a sterile dressing. To avoid straining the incision line, walking in a slightly flexed (stooped) position at the hips is required for 4 to 5 days, gradually becoming more upright each day.
5. Flexion and extension of the feet at the ankles activates the calf muscles and pumps blood out of the legs, reducing the risk of blood clots.This should be done consistently throughout the day while awake.
6. Eating a light diet of foods that are easily digestible (to avoid constipation), high in protein (improves wound healing), and low in salt (reduces swelling) is ideal. Avoid foods in cans or packages (high in salt).
7. An ACPS certified home health care provider will come to your place of stay in Houston on the second and third days after surgery to assist and teach wound care and dressing change.
8. Constipation is common, especially when using pain medication. We advise regular use of laxatives for the first week or so and drinking plenty of water (at least 8 to 12 cups a day). If constipation persists, over the counter Magnesium Citrate is the best treatment.
9. Alternating or adjusting resting positions is helpful to avoid muscle stiffness and tightness. Shifting from side to side with the hips flexed in the bed (with assistance) is recommended. Avoid sitting in hard chairs.

DAYS 3-5 AFTER TUMMY TUCK SURGERY

1. Gradually increasing light activity is recommended. Walking without assistance for 15 minutes every two hours and improving posture should be pursued.
2. A family member should have been trained to assist with dressing changes once daily by now, usually done after a shower.
3. You may still need assistance when showering.
4. It is advisable to shower after bowel movements to reduce infection risk.
5. Avoiding contact with animals reduces the risk of infection.
6. Avoiding contact with ill family members is mandatory.
7. Eat a high-protein diet with limited salt intake.
8. Bending down isn’t advisable. If you must reach down for something, squat/use your thighs.

DAYS 5-7 AFTER TUMMY TUCK SURGERY

1. You will become progressively more mobile with about 30 percent of your time spent up and about in the home engaging in light activities such as walking, sitting, flexing at the knees and hips, and limited household duties.
2. No driving or exercising is allowed.
3. It is normal to have a slight stoop while walking, progressing to a fully upright standing position by 7 days. Standing upright will help to alleviate back pain.
4. Incisions are covered with a waterproof glue (Prineo) or Steri-Strips (special paper tape). Do not apply ointment to areas covered by glue or Steri-Strips.
5. Most sutures (stitches) are dissolvable; only a few suture tags require removal, 7 – 10 days after surgery.

DAYS 7-10 AFTER TUMMY TUCK SURGERY

1. Fully upright walking is expected, though it may be slightly tight and uncomfortable initially.
2. Leaving the home to attend indoor activities is encouraged. Riding in a car is acceptable but should be limited to no more than 30 minutes at a time. Lengthy rides in a car or on a plane can predispose a postoperative patient to blood clots and should be avoided.
3. Walking for 2 to 4 blocks (15 – 30 minutes) at a slow pace twice a day in cool temperatures is encouraged.

DAYS 10-14 DAYS AFTER TUMMY TUCK SURGERY

1. Increasing walks to half a mile twice a day (30 – 45 minutes) in cool temperatures improves mobility and prepares you for your return to work.
2. Usually a minimum of 10 full days of recovery is required before you can return to work with light duty restrictions: no lifting, stooping, prolonged standing (two hours or more), physical exertion, or strenuous activity.
3. If you did not elect to use Prineo wound glue, continue incisional care with twice weekly application of new Steri-Strips as long as there is no skin irritation.
4. Applying a soothing moisturizer (vitamin E, aloe, etc.) to your skin after showers helps relieve dryness that is common after surgery.
5. Driving is allowed at the 12 – 14 day point if you are fully mobile, have good torso turning ability, and do not require pain medication.

WEEKS 2 – 4 AFTER TUMMY TUCK SURGERY

1. Exercise is limited to brisk walking or a stationary bicycle for 45 – 60 minutes. Be careful to avoid straining or lifting.
2. Travel should be limited to short trips of no more than one hour in a plane or car. Advise your doctor regarding travel plans for additional recommendations. (Anti-coagulation medication)
3. Second-stage garments are often started to reduce swelling after surgery.
4. Do not alarmed by noticeable dimpling in surgical areas; this is caused by internal dissolvable sutures, destined to disappear over several months.
5. A belly button-shaping foam plug (swim ear plug) will be used for 6 – 8 weeks after surgery.

WEEKS 4-6 AFTER TUMMY TUCK SURGERY

1. Patients are beginning to feel pretty good by now, so the tendency is to push harder with physical activity. The key to avoiding a setback is to progress slowly and cautiously. Keeping the exercise routine to about 50 – 75 percent of what you feel you are capable of is prudent at this juncture.
2. While increasing aerobic exercise with walking, stationary bicycle, or elliptical trainer, proceed with caution, avoiding abdominal straining at all times. Light upper body weights for toning is acceptable as long as there is minimal abdominal work required.
3. Swimming may begin as long as you have no wound healing issues.
4. Travel in a plane or car should be limited to two hours, with a short walk at the midway point to ensure good venous circulation in the legs. Use of blood thinning, anticoagulation medication (Eliquis) is advised for travel.
5. Dr. Patronella’s medical assistants will remove your Prineo tape.
6. Begin Dr. Patronella’s Scar Therapy Program. Several products are used to optimize the appearance of the scar. Treatment is required for at least 6 – 12 months depending on scar responsiveness. Consistent use and patience is essential.

WEEKS 6-12 AFTER TUMMY TUCK SURGERY

1. Progressively increasing exercise tolerance to full capacity is acceptable as long as it is reached gradually. You may begin incorporating more strenuous exercises such as aerobic exercise, jogging, Pilates and yoga. Isolated abdominal exercise (sit-ups, crunches, etc.) are not allowed until a full 12 weeks from the date of surgery has been reached. Light weight lifting can proceed with caution, avoiding any abdominal straining until the full 12-week mark.
2. Travelling more than two hours in a plane or car is acceptable, as long as a short walk is taken every hour during the trip. An aisle seat for plane travel is advised. Long flights over 4 hours are not advisable until 3 months after surgery. Dr. Patronella will prescribe anti-coagulation medication during any travel within 3 months of surgery.

THE TUMMY TUCK SCAR

In a tummy tuck procedure, an incision is most commonly made from one hip to the other. To diminish the appearance of the scar, Dr. Patronella incorporates a Scar Therapy Program into the postoperative care of his tummy tuck patients. The products in this regimen are designed to provide an optimal healing environment for the scar in order to soften its appearance.

The tummy tuck scar will continue to fade over a period of one to two years, sometimes longer. To prevent darkening of the scar, avoid sun exposure for one year, or liberally apply sunscreen to the exposed scar.

DR. P’S SCAR THERAPY PROGRAM

Careful attention to early incisional treatment and the resulting scar can make a dramatic difference in its appearance. The Exofin or Prineo glue applied to your incision during surgery provides good protection and support for the early incision. Once the Exofin/Prineo is removed (usually 3 – 4 weeks after surgery), you will begin the Scar Therapy Program.

1. Retinol or Retin-A
Applied nightly to cleansed skin on the scar, a retinol product such as SkinMedica’s Retinol Complex is an exfoliant for the scar surface, reducing thickness and unwanted pigmentation. Retinol should not be used until 5 – 6 weeks after surgery to reduce the chance of irritation. This product will often cause dryness with flaking and mild redness, requiring moisturizers such as Vitamin E or Aloe.

HOW TO USE: Apply this product first, using a thin layer. This is to be used in the evening only.

2. Sientra Biocorneum Silicone Ointment Biocorneum
This advanced scar treatment with FDA-Cleared Silishield Technology interlinks silicone and SPF 30 to support your skin inside and out. This product will help your incision line get softer, thinner, and lighter more quickly.

HOW TO USE: Twice per day, apply this last in a thin layer.

3. Neocutis BIO CREAM
This potent cream contains growth factors, antioxidants and matrix proteins, including collagen to boost the skin’s firmness, elasticity and brightness.

HOW TO USE: Apply a thin layer twice per day.

ADDITIONAL PRODUCTS MAY INCLUDE:

Vitamin C/E in silicone carrier – A skin care product containing vitamins C and E, such as SkinMedica’s Vitamin C+E Complex is a good alternative for those intolerant of retinol, or as a substitute. Vitamin C acts as an exfoliant, reducing surface scar and pigmentation, while vitamin E is a conditioner/moisturizer.

Hydroquinone 4% – 6% – A strong bleaching agent, this product may be required in those patients who have a greater tendency to hyperpigment. This is commonly seen in darker skinned people (Black, Hispanic, Asian, Indian, Middle Eastern, etc.) and requires early attention to prevent hyperpigmentation.

Scar Recovery Gel with Centelline – A blend of patented therapeutic ingredients clinically-proven to reduce scar visibility.

RECOVERY SUPPORT

Home Health Visit

As part of this exclusive service, patients recovering in the Houston area are offered a private visit to their homes or hotel accommodations a day or two after their surgery from one of Dr. Patronella’s nurses or medical assistants. This experienced care provider will change your bandages, educate your caregiver in providing appropriate care techniques, and provide Dr. Patronella with an update on your recovery.

NuERA® TIGHT POST SURGERY TREATMENT

The NuEra® Tight procedure is our favorite post-surgical procedure. NuEra Tight uses radiofrequency technology to non-invasively heat the skin to a targeted temperature causing gradual softening of scar tissue and increase drainage for enhanced post-surgical results. Many patients describe the treatment as resembling a “hot-stone massage”. Treatments are performed 2 weeks apart and
as soon as 3 weeks post-op depending on your surgery.
Please Note: NuEra Tight cannot be treated on areas that have not regained sensation post surgery. This most frequently applies to patients who have received a tummy tuck or any “lift” procedure, like a thigh lift. Dr. Patronella will let you know when you can begin NuEra Tight treatments.

VitaMedica’s Recovery Support Program

Taken for two weeks prior to surgery and two weeks after, VitaMedica’s Recovery Support program is formulated to speed wound healing, support the immune system, prevent infection, minimize inflammation, and reduce bruising. Recognized for their beneficial role in the healing process, the program’s nutrients include vitamin A, vitamin C, copper, selenium, bioflavonoids,

bromelain, quercetin, and homeopathic Arnica Montana.

RECOVERY TIPS FROM A PATIENT’S PERSPECTIVE

“During the first week of my recovery after tummy tuck surgery, I was wondering if I had done the right thing. But after the first week, I turned a corner—it got better and better.”

– A., Missouri City, TX

For at least 1 – 2 weeks following your tummy tuck procedure, it will be important for you to pamper and care for yourself and to allow others to as well. If you’re a busy mom who is used to caring for others and running a busy household, it can be tough to switch gears to be on the receiving end of care. However, as one tummy tuck patient and mother of grown children advised, “Be kind to yourself and rest.” Doing so will speed your recovery and help you to return to your normal daily routine feeling more refreshed and renewed.

1. If you have young children, you will want to arrange for help to care for them for at least 7 – 10 days.
2. Some patients plan to have a cleaning service come to their homes prior to their surgery and/or while they are recuperating.
3. Consider preparing or purchasing meals ahead of time that can be frozen and reheated.