After care from surgery abroad

Hi Panda,

Here's how I handle aftercare of my out of town patients:

Before Surgery
We  try and get Cosmetassure insurance, which covers most problems that occur within a month after surgery.

We check the patent's insurance to see if it covers "complications of cosmetic surgery." Simple process and it helps patients plan accordingly.

Problem is developing issues while still overseas.  You may be asked for your credit card in those cases.

I call and speak with the doctor back home or  try and get a PS I know locally to agree to care.  I have reciprocal arrangements with other docs.

Patient and my office agree on line of communication, (email, phone, contact info) so that photos via email can be sent to us in case of issues.  We have a protocol to get photos to me the same day for evaluation and response.

Right After Surgery
We call patient every day until drains are out.  A lot goes into the decision to remove  them and I won't let anybody else decide on this.

We use no sutures on the outside (except 2 for the drains) just Dermabond (glue), so there should be no stitch removal issues unless a deep stitch works it's way out months later, which does happen now and then.

Longer After Surgery
Several issue are not uncommon after surgery that require my input and treatment including swelling, fluid collections, healing problems, scar problems, implant position issues, recurrent skin laxity, and a myriad of other "Q+A" type issues like activity level and nutrition.

Touch-ups and revisions are usually planned by phone, email, and/or photos so we can do them "same day" upon patent's next visit, or at a stage 2 procedure.

Hopefully this helps you understand some of the things you can do to make the experience more predictable and safe.
 

Hi Robin. Sorry for your issues. 

Well, as I mentioned, certain types of permanent stitches are used for the deep layers (in my case, I use 4 or 5 in the front 2 in the hips and none in the arms or inner thighs). They can work their way to the surface however.

Permanent stitches just below the skin would be a problem, and depending on the type, may require removal.

Can you ask your doc the type of sutures used ??....this would give a clue as to whether or not they may eventually dissolve.

Dr. L, what kind of material are these permanent stitches made of?  And what is the purpose of these permanent stitches?  Would the body not heal correctly otherwise?

Hey DrL,

Robin and I had the same surgeon. He used a thick blue non-absorbable suture (with a waxy coating, reminds me of dental floss). I have had over a dozen of mine reject and migrate to the surface, some took months to migrate to the surface and left terrible scars. I had to fish some of the sutures and cut them out myself just to get the holes to close up.

These sutures are all along our incision lines.. it would be unrealistic to think that we could have all of them removed. I can count 8-9 of them on my right arm alone (They are visible under the skin and poke up/create blue bumps in a lot of areas).

Wow.  I haven't heard of a stitch like that.  The only blue one we have here in the states is called prolene, and looks like fishing line. 

Do the peices come out whole, or in fragments?  That would tell me if they are absorbable or not.

It's been 1 year since my plastics and they still come out in full pieces. complete with the 4-5 knots he'd put in a single stich which seriously irritated the surrounding tissues. I'm sorry, I wish I had of taken a picture, I really do.

I did have some sutures that were thin and clear like fishing line and they did absorb. He did a poor job of putting those in too, though (in my opinion) because I'd have LOOPS sticking out of some spots along my incision line that I had to snip so that they wouldn't come out any further.

I emailed Quiroz's office to find out what exactly the thick blue suture material is but it's been a day and still no word

I have a big article, well researched, on the topic.  It will be in a national magazine soon, and then I'll get it on my "Patient Resources" page.