Planning Your Surgery

We will examine and measure the area/areas of interest and will photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) We will discuss the variables that may affect the procedure-such as your age, and the condition of your skin and underlying structures as well as general health. You should be very clear what the goals of the procedure are for you.

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We will describe the procedure in detail, explaining its risks and limitations and making sure you understand the incisions that will required to perform the surgery. Often pictures of prior patients who have had the procedure you are considering are used to help understand all the issues related to surgery and healing.

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We will also explain the anesthesia we will use, the facility where the surgery will be performed, and the costs. Some procedures are covered by insurance if they are deemed “reconstructive or related to cancer” others are strictly cosmetic/self-pay.  We will help clarify all these specifics.

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An important part of the consultation is to establish realistic expectations. Once it is certain that the patient is prepared for surgery, has realistic expectations, and all his/her questions have been answered, then surgery is scheduled.

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Choosing a Doctor/Surgeon

If you are on this website, you are most probably looking to explore a treatment or surgery related to a variety of conditions dealt with by plastic surgeons.  Plastic Surgeons truly operate on the whole body from the scalp to the feet.  Most plastic surgeons have specialized in a variety of surgeries and do not do other surgeries although they have been trained to do a multitude of procedures.  For instance, we do not do rhinoplasty, cleft lip and palette nor craniofacial surgeries.  We have focused and specialized in the procedures listed on this web site.  If you are unsure whether we can address your special needs, please call the office and we can help you determine.

 

When deciding on a plastic surgeon, it is important to note that the surgeon is Board Certified or Board-Eligible by the American Board of Plastic Surgery.  Certification by the ABPS ensures that provider has trained at an Accredited surgical training program, has met all standards for care both technical and academic and continues to participate in an ongoing, continuous educational program called Maintenance of Certification.  This assures that the specific surgeon is educated on the latest techniques and information relevant to providing optimum and safe patient care. Dr. Sasmor is board certified by the American Board of Plastic Surgery.

 

 

What is Reconstructive Surgery?

It's estimated that more than one million reconstructive procedures are performed by plastic surgeons every year. Reconstructive surgery helps patients of all ages and types—whether it's a child with a birth defect, a young adult injured in an accident, or an older adult with a problem caused by aging.

 

The goals of reconstructive surgery differ from those of cosmetic surgery. Reconstructive surgery is performed on abnormal structures of the body, caused by birth defects, developmental abnormalities, trauma or injury, infection, tumors, or disease. It is generally performed to improve function but may also be done to approximate a normal appearance.

 

Although no amount of surgery can achieve "perfection," modern treatment options allow plastic surgeons to achieve improvements in form and function thought to be impossible 10-20 years ago. This will give you a basic understanding of some commonly used techniques in reconstructive surgery. It won't answer all of your questions, since each problem is unique, and a great deal depends on your individual circumstances. Please be sure to ask your doctor to explain anything you don't understand. Also, ask for information that specifically details the procedure you are considering for yourself or your child.

 

 

Who has Reconstructive Surgery?

There are two basic categories of patients: those who have congenital deformities, otherwise known as birth defects, and those with developmental deformities, acquired as a result of accident, infection, disease, surgery or in some cases, aging.

 

Some common examples of congenital abnormalities are birthmarks; cleft-lip and palate deformities; hand deformities such as syndactyly (webbed fingers), or extra or absent fingers; and abnormal breast development.

 

Burn wounds, lacerations, and some aging problems are considered acquired deformities. In some cases, patients may find that a procedure commonly thought to be aesthetic in nature may be performed to achieve a reconstructive goal. For example, some older adults with redundant or drooping eyelid skin blocking their field of vision might have eyelid surgery to improve their vision. Or an adult whose face has an asymmetrical look because of paralysis might have a balancing facelift. Although appearance is enhanced, the main goal of the surgery is to restore function.

 

The treatment of and removal of Skin cancer and other skin lesions are generally considered medical necessary and “reconstructive” in nature and are usually covered by insurance.

 

Large, sagging breasts are one example of a deformity that develops as a result of genetics, hormonal changes particularly related to pregnancy. Breast reduction, or reduction mammaplasty, is the reconstructive procedure designed to give a woman smaller, more comfortable breasts in proportion with the rest of her body.

 

Breast Reconstruction is preformed to restore the natural anatomy of the breast after mastectomy for breast cancer, or prophylactic mastectomy in those women with a high risk of developing breast cancer due to specific genetic risk factors.

 

A young child might have reconstructive otoplasty (outer-ear surgery) to correct overly large or deformed ears. Usually, health insurance policies will consider the cost of reconstructive surgery a covered expense. Check with your carrier to make sure you're covered and to see if there are any limitations on the type of surgery you're planning. Work with your doctor to get pre-authorization from the insurer for the procedure.

 

 

What is Cosmetic Surgery?

Cosmetic Surgery and Esthetic Treatments are performed to reshape normal structures of the face and body to improve the patient's appearance and self-esteem.

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Time and aging are constant, physical changes occur to everyone’s body no matter how hard you work to maintain the status quo.  Everyone ages differently and everyone has different stresses in their life and different genetics. Weight gain, pregnancies can cause changes to the abdominal wall and to the abdominal tissues, skin and fat overlying that, in addition changes in the breast can be related. Abdominoplasty, liposuction and breast lift, augmentation or reduction are all approaches to “fixing” the contour issues and optimizing the appearance of the body. Changes occur in the arms, upper back, thighs to name a few.

Facial/neck changes related to skin changes, lines and wrinkles, sagging/drooping tissue, pigment changes are a combination of time, genetics, sun exposure, nutrition, general health and smoking.

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A multitude of procedures are available to address these issues; ranging from advanced skin care and non surgical treatment to surgical face and neck lifting.  You sill find all these options discussed on our web site.

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PLANNING YOUR SURGERY

 

Preparing For Your Surgery

Preparation for each different type of surgery is slightly different.  Minor procedures such as removal of a small skin cancer may need no specific testing or X-rays.  However, medications called anticoagulants such as Aspirin and Coumadin (a blood thinner) may need to be stopped before the procedure to prevent bleeding problems. These meds will generally be restarted 24 hours after your procedure.

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For breast surgery your surgeon may require you to have a mammogram (breast x-ray) before surgery. Other major surgeries may not require any X-rays at all.

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Patients having larger/longer procedures, or patient with other medical conditions, may need lab testing and those over a certain age or with high blood pressure may need an electrocardiogram. The requirements of each patient given their specific procedure, age, medical condition and current medications will be explained in detail and ordered for you.

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You’ll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, stopping smoking, and taking or avoiding certain vitamins and medications.

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Major operations will require preoperative showering with antibacterial soap. This process will be explained in detail and you will be provided the appropriate antibacterial soap.

 

Very few of the surgeries performed by ur doctors require a blood transfusion. If a transfusion should be needed, your own blood can be used. This takes prior planning and will be discussed at length with you. The office will organize all the lab procedures that you will need.

 

 

Locations and Anesthesia Requirements

We operate in 3 different locations:

• Very small cases that can be done under local anesthesia (commonly known as Novocain) are often done in the office setting.

• Larger cases that take more time but can be done under local anesthesia, may be done in the outpatient surgery at Anna Jaques Hospital. This is called APR (Ambulatory Surgery Center).

• Cases that may require sedation, (twilight sleep) may be performed in the outpatient surgery at Anna Jaques Hospital. This is called APR (Ambulatory Surgery Center).

 

Monitored Anesthesia Care (MAC), is provided by anesthesia in cases where deeper sedation is required, or the patient has a variety of medical problems and is not a candidate for sedation by our doctors.  Our goal is your comfort and safety.  All options will be discussed with you at your consult.

 

Major cases that take more time and require extra sterile conditions and require the services of an Anesthesiologist will be done in the Operating Rooms at Anna Jaques Hospital.  Special preoperative instructions will be given to you in the office and we will make sure you have all supplies and appropriate lab work before the surgery.

 

You will have a consultation with the preoperative nursing staff and with an anesthesiologist, who will explain general anesthesia benefits, risks and possible complications. Overall, anesthesia is extremely safe and has minimal complications.

 

 

Going Home After Your Procedure

If your procedure is done under local anesthesia, you should be able to drive yourself home. If you are concerned, then it is advisable to have someone to drive you home.

 

Cases done under sedation, MAC or general anesthesia require that you have someone to drive you home. This is for your safety as anesthesia can make you groggy and unable to fully concentrate for 12-24 hours. After that, if you are not taking narcotics, you may drive.

 

Some major operations and combined cases may require you to stay in the hospital overnight.  We will explain the specifics to you if you fall into this category. Overnight observation is for your safety and to make sure you are medically stable.  You should plan on a ride to drive you home once released from the hospital.  In these cases, discomfort and inability to move well can impede your ability to drive safely.  With some major operations, it may take 5-10 days to get to the point that you can drive.

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Pain Control After Surgery

We optimize the type of pain control needed based on your surgery and your own specific pain tolerance.  In general, patients having surgery under local anesthesia need very little medication.  We suggest ice to the area and use of acetaminophen (Tylenol) and/or non-steroidal anti-inflammatories (Ibuprofen, Advil, Aleve) as needed. Procedures done on the arms and legs sometimes will have compression placed (Ace wrap) to prevent swelling and help keep the area pain free.

 

More complex procedures may require use of acetaminophen (Tylenol) and/or non-steroidal anti-inflammatories (Ibuprofen, Advil, Aleve) on a schedule.  Using these medications on a set schedule, around the clock for a few days provides significant relief and is the pain treatment needed.  However, occasionally you will require the addition of a mild narcotic medication, also used around the clock initially to help keep pain to a minimum.  We work with each patient on an individual basis to optimize your care and minimize narcotic use.

 

If you are using non-narcotic medications, you may drive. Patients who are on narcotic medications should not drive until they have been off the medications for at least 48 hours.

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All Surgery Carries Some Uncertainty and Risk

When surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. However, individuals vary greatly in their anatomy and healing ability and the outcome is never completely predictable.

 

As with any surgery, complications can occur. These may include infection; excessive bleeding, such as hematomas (pooling of blood beneath the skin); significant bruising and wound-healing difficulties; and problems related to anesthesia and surgery.

 

There are several factors that may increase the risk of complications in healing. In general, a patient is considered to be a higher risk if he or she is a smoker; has a connective-tissue disease; has areas of damaged skin from radiation therapy; has decreased circulation to the surgical area; has HIV or an impaired immune system; or has poor nutrition. If you regularly take aspirin or some other medication that affects blood clotting, it's likely that you'll be asked to stop a week or two before surgery.

 

We will evaluate your complete medical history and medications at the time of your consult.  Any potential issues will be addressed before undergoing any surgery. In addition, we will discuss potential complications related to the specific surgery you are considering and address how to prevent, minimize and address any of those complications.

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After Your Surgery

Getting back to “normal” activity after your surgery is based on the procedure you undergo. In general, Dr. Sasmor wants to get you back to your baseline activities as soon as possible. We will discuss with you the specifics of your surgery and post op limitations before your procedure.

 

Procedures under local anesthesia, depending on what body site is involved, may not require any significant alterations in activity.  Procedures on your arms or legs may require compression wraps (Ace bandage) to help prevent swelling and you may be asked to limit vigorous physical activity for a week to two weeks. Generally, you are back to regular activity in 1-2 weeks or less.

 

Larger procedures may require compression garments, like a special bra or full body girdle. Again, the limitation of activity is different based on different procedures.  We will discuss and explain the limitations and activity schedule that she suggests for each specific procedure at the time of your consultation and again at your preoperative visit.

 

Time to return to driving is also variable, based on the procedure that you are contemplating. We will discuss and explain driving limitations and return to driving schedule that she suggests for each specific procedure at the time of your consultation and again at your preoperative visit.

 

Questions or Concerns

At any time, if you have any questions or concerns, please do not hesitate to call the office. Our doctors or one of our staff is always available to answer any questions at (978) 462-8300. If you have questions outside of office hours, the answering service will contact our doctors who will call you back. Our goal is to support you through your procedure and recovery in every way that we can to optimize your procedure.