I thought it helpful to list a few things that came to mind to help protect and prevent you from being a victim of this pandemic. This will be a challenge as it is expected to infect 40-70% of our population. I am sure you also have other suggestions I missed. Please share them. These suggestions are ones I am adopting and/or recommending to patients, my staff, family members and friends. Based on emerging data, they may need to be changed but most are common sense suggestions based on my personal knowledge base. They apply to healthy households where no one is ill. See below links for other related issues and advice. The CDC, WHO, and others are great websites for detailed information and recommendations.
Stay home as much as possible unless exercising, or activities away from others. Simply put stay away from other people. If a family unit, keep it that way; “alone together”. Clean surfaces with soap and water, then with usual cleaning sprays as needed especially if anyone has symptoms. Include high touch surfaces are just about everywhere especially kitchen, bathroom, door handles, phones, shared keyboards, etc. When outside stay 6 ft or more away from others. If you develop symptoms wear a mask if you have one, isolate yourself and use extra precautions (see CDC link below). Stay away from those at the highest risk to protect them.
Plan ahead: For those with increased risk factors (and others) consider ordering most items you will need including food on line. Many items will be on backorder, but in many cases, you can order now even though it will be delivered days or weeks from now. Stay ahead of your needs by ordering at regular intervals.
If you live alone or are the only adult in your home – figure out what you will do if you are ill. Find a COVID-buddy to share this burden. Do not wait until you fall ill. Remember most likely at least 50% of the population will be affected with COVID-19
Keep Strict procedure to keep your household safe: Hand Sanitizer in cars and immediately inside by the entrance doors. AS soon as you enter disinfect your hands. Hand washing probably more effective than sanitizer. All items in a sealed bag dip can be dipped in highly diluted but effective bleach solution (1/3 cup or 5 Tablespoons per one gallon of water or 4 teaspoons or 20 cc per quart. Betadine, Iodine, solution can be used but just soap and water should be effective. Clean flat working surfaces often. An alternative is washing the surface with soap and water or a disinfectant wipe. Wash hands after, before/after meals, touching pets, touching nose, mouth especially after sneezing/coughing.
Obtain extended supplies – enough for a few weeks if possible. Buy more food and essentials for daily living than usually needed without hoarding, much can be stored in the freezer for later use to minimize the number of trips outside the home. Use Amazon or other home delivery services – though they may be “currently out of stock”, they usually give you an estimate of when it will be available – e.g. a week from now. Order in advance at regular intervals. Wash all packaging that comes into your home or wipe off as needed. Note that freezing will NOT kill COVID 19, just the opposite, it may allow it to be infective for far longer periods. On the other hand, cooking will. I prefer frozen veggies preferred over fresh during this time, as fewer hands have probably touched it. Frozen vegetables are usually frozen immediately after picking so always fresh and can be stored so you do not have eat it immediately or leave the house often. For those unable to wash your fruits and vegetables easily, I would limit eating salads and other non-peeled, fruit. Wash everything thoroughly, and/or consider other methods (see CDC references) and consider discarding outer most leaves. I am personally favoring cooked veggies instead. Perfect time to stock up on dried beans and grains – crockpot, Instapot or pressure cooker makes this no longer a time-intensive activity. Note, food appears not to be a major vector for COVID thus far.
Young people are not immune: The notion that young people are immune is a myth: and yes, young adults can become very ill. In the USA 20% of hospitalizations of first 4000 confirmed cases of Covid-19 were among those in the 20–40 year age group. For needed road trips and business trips: Try not stop for fast food as it increases the chance of interacting with others, is handled by at least 2 others, etc – bring food with you if feasible. Do NOT shake hands, keep a safe social distance. If you are bringing fast food home, consider microwaving it before consuming.
Stay Healthy: Exercise daily using social distancing, sleep adequately (something I hope to be able finally do ), Vitamin C, and D, home projects, etc.. Do fun things, read a book, catch up on Netflix, and your TO DO list, connect with friends by phone, text, conference calls and social media. Call someone who is isolated and let them know you were thinking about them.
Stay safe, stay healthy. Our family, friends, the world…. are being threatened. Do not take this lightly.
Mission Plasticos is helping
On a separate note I wanted to let you know what Mission Plasticos is doing: We are mobilizing potentially needed and potentially lifesaving medical items in our Plasticos warehouse to be able to donate as needed in for community emergency needs which are expected in the days to come. e.g. we have 2 anesthesia machines, suction machines, OR equipment, surgical tools, disposables and PPE’s, etc. For more information see: www.missionplasticos.org
How you can help: Hospitals need help and will shortly have a critical need for additional doctors, nurses, medical assistants, surgical techs and non-medical support. For those without increased risk factors (e.g. under 60 years of age without co-morbid conditions) weigh the dangers vs benefits and consider contacting hospitals and urgent care centers for short time hire or volunteer work. Volunteer individually for a neighbor, friend, or with an organization that takes care of the elderly, those with disabilities, socially isolated – to assist with living essentials like food shopping, picking up meds, etc.
Blood will be critically needed by hospitals. Consider donating blood if you are healthy without risk factors for donors or recipients. This also applies to those that, are fully recovered from COVID-19 and given permission from your physician (your serum may be even more helpful to those critically ill). Donate unneeded blankets and clothes for the increasing homeless population and refugee centers. Remember their health may affect yours.
Please stay safe. Our family, friends, coworkers and staff are the only truly valuable asset we have. We desperately need to protect them. Remember both your actions and non-actions will affect others.
These are just some of the items I thought of that might be helpful to you: Let’s share other safety practical tips not mentioned. We are all in this together, let’s “bend the curve”.
Larry Nichter, MD, MS, FACS, FAAP Pacific Center for Plastic surgery and BioSpa Medical Spa Newport Beach, CA 92660 949 720 3888
Dr. Nichter explains the risks and effects of smoking prior to and during recovery after plastic surgery. Smoking — specifically nicotine and carbon monoxide — impedes the body’s ability to deliver oxygen to tissues. As a result, the healing process after plastic surgery is negatively affected. Healing after plastic surgery has a significant effect on the quality of your result.
Since the origin of its peer review survey of Best Plastic Surgeons, Orange County California plastic surgeon Dr. Larry Nichter has been named in the America’s Top Doctors publication, a listing of the top 1% of physicians in the United Statesfor seven years in a row.
The screening process for this highly exclusive honor is conducted by Castle Connolly Top Doctors®. The process first involves a peer nomination stage in which tens of thousands of physicians are recommended by their fellow doctors. Then, a physician-led research team at Castle Connolly conduct a review of candidates’ medical educations, honors, awards, board certifications, and disciplinary history. The result of their work is a listing of the best qualified doctors in the United States.
From Castle Connolly’s CEO, Dr. John Connolly:
Being selected for inclusion in America’s Top Doctors is a very significant achievement given to only 1% of American physicians. The world of American doctors includes incredibly high quality medical professionals, yet some stand out. Each year we evaluate tens of thousands of peer nominations from throughout the medical community. Then our experts go even deeper to evaluate and select Top Doctors based on referred doctors’ exceptional work and outstanding conduct. My congratulations to Dr. Nichter.
Dr Nichter has also been honored in peer selected awards such as Best Doctors, Top Doctors, andSuper Doctors continuously since their start as well as patient selected awards like Compassionate Doctor and Patient Choice Awards , Dr. Larry Nichter continues to be recognized as an exceptional physician and one of the best plastic surgeons working in Orange County, Southern California today.
Dr. Nichter has been named as among the top plastic surgeons in Orange County by the OC Register for 2013.
Orange County Plastic Surgeons, Dr. Jed Horowitz and Dr. Larry Nichter are honored to be voted into the categories of Best Doctors in America, Top Doctors and America’s Top Surgeons for over a decade. The success of their practice, Pacific Center for Plastic Surgery, can be attributed to providing the highest level of patient care while striving to provide an intimate family atmosphere. In addition, they have been at the forefront of pioneering the minimally invasive lower face lift, branded the LiteLift™. Recognizing the demand for facial rejuvenation which is less invasive, safer, and requires less recovery time, the LiteLift™ has proven to be extremely effective. Dr. Horowitz and Dr. Nichter also provide outreach work through their humanitarian foundation Plasticos Foundation. Through volunteer contributions, medical teams are sent across the globe providing reconstructive surgery to those in need. Plasticos Foundation continues to be their passion and opportunity to give back.
Larry Nichter, MD was honored by receiving the Boston University CGS 60th Anniversary Alumni Achievement Award on September 29, 2012.
Only two such awards were given. Dr. Nichter also was inducted to the Boston University Collegium of Distinguished Alumni for the College and Graduate School of Liberal Arts. This is the highest university alumni accolade and was presented to Dr. Nichter by the American Ambassador to China, also a BU graduate.
Dr. Lawrence Nichter (CGS ’71, CAS ’73, MED ’78) is from a BU family. Besides his mother receiving her Doctorate of Education, his sister, Susan, received degrees from the College of Fine Arts. Larry attended CGS, CLA and BUSM. Currently he is a Clinical Professor of Plastic Surgery at USC and UCI, Chairman, Department of Plastic Surgery at one of the largest hospital departments in the world, and President and Founder of Plasticos Foundation. The latter is a Non-profit institution that trains surgeons while repairing children’s deformities worldwide. He has been on 60 oversees missions thus far and a documentary about one of his trips won an Academy Award. Every institution that Lawrence Nichter has received a degree from has distinguished him with special honors including University of Virginia presenting an annual research award in his name, UCLA giving him an outstanding resident award, and BU College and Graduate School of Liberal Arts presenting him with an outstanding alumni award in 2009.
Use Clonidine Patches as directed by your doctor. Check the label on the medicine for exact dosing instructions.
You will apply the patch to a hairless area on the upper outer arm as directed by our office.
If your blood pressure is normal, it is usually applied two days prior to surgery and left on for one week. If directed to use one prior to that, it should be changed in 7 days if applicable. The area chosen should be free of cuts, scrapes, irritation, scars, and calluses. Do not place the patch on skin folds or under tight undergarments because it may come loose. If more than one patch is prescribed then the new patch should be placed on a different skin site from the previous site.
Wash your hands with soap and water and dry them completely before applying Clonidine Patches.
Clean the chosen application area with soap and water. Rinse the area and wipe it with a clean, dry tissue.
Remove the patch from the pouch. Remove the clear plastic protective backing from the pouch by gently peeling off one half of the backing at a time. Avoid touching the sticky side of the patch.
Place the patch on the skin site (sticky side down) by applying firm pressure on top of the patch. The adhesive overlay does not contain any medicine and should not be used alone.
Wash your hands with soap and water to remove any medication that may be on your hands.
If the patch does not stick firmly or begins to come loose, apply the adhesive overlay on top of the patch. The adhesive overlay does not contain any medicine and should not be used alone.
After removing the used patch, fold it in half with the sticky sides together. Discard the patch out of the reach of children and away from pets. Even after it has been used, the patch contains active medicine, which may be harmful if accidentally applied or ingested.
Continue to use Clonidine Patches even if you feel well.
Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar. This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected. Occasionally if indicated you may need a topical steroid preparation or even a series of injections (5-FU and/or Steroids) or laser treatments to treat or prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.
The most critical decision to be made in achieving the best plastic surgical result is picking the most experienced and talented, that is the best, plastic surgeon possible. Too often, patients choose a physician based on a catchy ad, the brand name of a technique, the basis of one or two before and after photos, or their web site’s search engine ranking. These criteria will not find the most experienced and talented plastic surgeon.
I have been a practicing plastic surgeon for more than 25 years, having trained scores of plastic surgeons as a tenured professor of plastic surgery at USC, and I have had a private practice in Orange County since 1993. Speaking from all this experience, here is my advice and the criteria I would use to find the best plastic surgeon in Orange County, Los Angeles, California, or anywhere in the United States. These are the criteria I would use to select a plastic surgeon for my friends, my family, or myself.
First, I want to stress some general observations I have found to be true over the years.
Caveat Emptor: Buyer Beware
The longer a surgeon trains at his craft, the finer his skills and the better his judgment become. Board certification in Plastic Surgery (see below) is a bare minimum. Board certification in an additional surgical field recognized by the American Board of Medical Specialties, or for that matter “triple-board certified,” attests to a doctor’s advanced training and skill and judgment. It also means that they have attained Chief Resident Status in more than one field during their training which means they essentially ran a large departmental service and had senior decision-making and independent operating responsibilities. It is this step that is most maturing for a surgeon.
The institution where the surgeon trained is also important. More renowned schools usually attract the best faculty.
You can use the internet to research the background of a prospective plastic surgeon quickly. Please do this prior to making an appointment. “Just because you wear a baseball cap it doesn’t mean you are a good ball player.” The same applies to anyone wearing a white coat—it doesn’t make you a plastic surgeon, much less a great one.
Caveat Emptor in Latin means “Buyer Beware.” In most states, including California, any physician with a medical school diploma and state license is viewed as a doctor and a surgeon—even without any formal surgical training. In some cases even doctors who have completed only the minimal requirements (medical school, licensing examination, and a one-year internship that need not include surgical training) are touting themselves as “cosmetic surgical experts.” They make these claims of expertise despite the fact that they are only formally trained as family practitioners, OB/Gyns, emergency physicians, dermatologists, or ear-nose-throat specialists. Even physician assistants and nurses have made such claims.
7-Step Process for Finding the Best Plastic Surgeon
The following are my screening guidelines and criteria for picking the best plastic/cosmetic surgeon.
1. Board Certified Plastic Surgeon by the American Board of Plastic Surgery
To become a plastic surgeon certified by the American Board of Plastic Surgery requires a minimum of five years of surgical training with a minimum of two years of training specifically in plastic surgery. Then the applicant must also pass a comprehensive written board exam. If successful, the candidate must present his/her clinical cases for critical review by board examiners (I was one such board examiner) and if accepted will take a series of oral examinations.
Since the 1990s, the American Board of Plastic Surgery Certification is only valid for ten years. To retain your board certified status, a plastic surgeon must complete a Maintenance of Certification including written testing and case review. This means that all who pass are trained and experienced in all plastic surgery procedures including facial procedures, breast, and body; essentially all cosmetic and reconstructive procedures.
If a Plastic Surgeon is additionally board certified by another surgical specialty recognized the American Board of Medical Specialties, then this also marks additional expertise and training at the highest level. The American Board of Facial Plastic Surgery (ABFRS) is not a licensing body nor an educational institution and the certificates it issues are not legal licenses to practice facial plastic and reconstructive surgery. The ABFRS is not recognized by the American Board of Medical Specialties (although it does note additional specialty training/interest in facial aesthetic surgery).
Likewise, beware of physicians armed only with certification from other non-ABMS recognized boards or special society memberships other than those I have recommended (eg. “Cosmetic Surgery Board,” “Lipoplasty Society of North America,” etc.).
2. Fellow of the American College of Surgeons: FACS
The American College of Surgeons is dedicated to improving the care of the patient and to safeguarding standards of care in an optimal and ethical practice environment. Members of the American College of Surgeons are referred to as “Fellows.” The letters FACS (Fellow, American College of Surgeons) after a surgeon’s name mean that the surgeon’s education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.
To be a member you have to:
be board certified in a surgical specialty recognized by the American Board of Medical Specialties
be in practice in one location for a number of years, with a background check, nomination, and interviews which verify that you are an ethical and safe surgeon among other criteria.
Hint: Look for the “FACS” (or “FRCS,” see below) after the “MD” in a doctor’s title or in his/her Curriculum Vitae to see if he/she is a “real surgeon.”
Note for patients in Canada: The equivalent of FACS in Canada is the Royal College of Physicians and Surgeons of Canada, FRCS.
3. Member of the American Society of Plastic Surgeons (ASPS)
The American Society of Plastic Surgeons is the largest organization of plastic surgeons in the United States and one of the largest in the world. ASPS members are uniquely qualified because of the society’s membership requirements:
Members of the American Society of Plastic Surgeons must be Board Certified by The American Board of Plastic Surgery complete at least 5 years of surgical training with a minimum of 2 years of training specifically in plastic surgery. The more years of Plastic Surgical Training the better – this includes fellowships in a plastic surgical field.
American Society of Plastic Surgeons members are required to adhere to a strict code of ethics and must fulfill rigorous Continuing Medical Education (CME) requirements including patient safety issues.
Beware of physicians without this membership but belonging only to similar-sounding societies as their claim to excellence eg. “American Society of Cosmetic Surgery,” “Lipoplasty Society of North America,” etc.
4. Member of the American Society for Aesthetic Plastic Surgery (ASAPS)
This is the most elite society in the United States and perhaps the world for Aesthetic Plastic Surgery. To be a member means that your career is focused in cosmetic surgery at the highest level. Among the requirements for invitation and election to ASAPS membership, a plastic surgeon must:
Be certified by the American Board of Plastic Surgery (or in plastic surgery by the Royal College of Physicians and Surgeons of Canada);
Be in at least the third year of active practice following board certification;
Participate in accredited Continuing Medical Education (CME) to stay current with developments in the field of cosmetic plastic surgery and patient safety;
Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate wide experience;
Be sponsored by two ASAPS-member plastic surgeons to help ensure that the applicant’s professional reputation meets the high standards required by ASAPS;
Adhere to current ethical standards for professional conduct as outlined in the Code of Ethics observed by all ASAPS-member surgeons;
Operate in accredited surgical facilities; and
Be elected by at least 80% of the Active Membership.
5. Hospital privileges to perform the same type of surgery
Hospitals often examine qualifications of doctors applying for hospital staff privileges and restrict privileges to only surgeons best trained and qualified to do certain procedures. For example, in order for surgeons to be granted plastic surgery privileges in most hospitals in Orange County, California, that surgeon must have completed plastic surgery residency training and must be board-eligible or -certified in plastic surgery to be allowed to perform plastic surgical operations in that hospital.
Non-surgeons and other physicians that are not plastic surgeons circumvent this process by performing surgery in their offices or in outpatient surgery centers where the credentialing process is less rigorous or nonexistent. In these settings non-plastic surgeons perform procedures in which they have no formal residency training.
I am not warning against use of outpatient surgery centers or in-office procedures. I am only recommending that you check that your physician has hospital privileges for these same procedures.
6. Surgical Experience in the procedure you are having
Few patients ask how long doctors have been doing a certain procedure or how many they have performed. When you consult with a plastic surgeon:
Ask to see typical “before and after” photos;
discuss the details of the procedure in a manner that is clear to you;
review benefits and potential complications;
get full answers to your questions.
7. Evidence of Excellence, Experience and Commitment to the field of Plastic Surgery
Here are some additional criteria to look for in your plastic surgeon.
Surgical Board Certification in more than one field
Plastic Surgical Fellowships in addition to Plastic Surgical Residency.
Number of years practicing.
Peer Review Honors in their own board certification from groups such as Best Doctors, Top Doctors, Super Doctors.
Current or Prior position denoting excellence in the field or high regard by their peers such as:
Prior or present Professor or Faculty affiliation with a University Plastic surgical program (the higher the rank the better)
Chairman of a Department of plastic surgery at a regional hospital
Honors from surgical societies of which they are members such as Board Examiner, etc.
Published Plastic Surgical papers in peer review journals are also a good sign that they are committed to being on top of their field.
Feel Comfortable with your choice
It is very important that after you have done this screening and met with your potential surgeon that you feel confident in your choice.
Complications are not common in cosmetic surgery, but if one did occur are you confident that this surgeon would take charge and handle just about any problem?
Do you feel that he listens to you and communicates well by answering your questions completely, doesn’t rush you in to a decision but rather makes you part of the decision-making process? You should truly feel that it is a combined effort.
Does the surgeon’s office run smoothly? Do the staff take good care of you? If you answered in the affirmative and have gotten this far in your screening guidelines then I think you have found your “Dr. Right.”
A compression garment is required and beneficial after liposuction because:
It restricts the amount of edema that forms and hastens its resolution by mechanical pressure.
It decreases the amount of bruising.
It assists the loose skin in retracting or shrinking.
It is common to have weight gain due to edema, serum that collects in the area, and the tumescent fluid that was injected. This will resolve over time. The more you wear the garment initially, the quicker this fluid resolves.
Edema: a condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body.
The length of time that the garment should be worn varies depending on the amount of fat removed, the elastic nature of your skin, how much loose skin remains, and other factors. Your surgeon would give you the best advice, however this is the general routine for my patients.
The first garment should be fitted for you in the office prior to surgery and applied in the operating room. Often it will become loose as the edema is mobilized, and then it will need to be replaced. Spanx is a reasonable compression garment if it gives enough support and is the right size. I have my patents bring them in so I can confirm that it fits well.
Most important advice is to listen to your surgeon, as he or she knows how much fat was removed, the elasticity that remains in your skin, and amount of skin redundancy.
I recommend that my patients wear their garments for a minimum of three weeks full time then for twelve hours at a time (day or night). If there is not a lot of redundant skin, this continues to a maximum of six weeks.
To be effective, the garment needs to fit snugly—but not too tight as that can make it difficult to sleep or cause pressure problems (inspect your skin when it is exposed if you are uncomfortable). As the edema resolves it is common for patients to switch to a smaller garment that fits. A Spanx-type garment would work fine, rather than ordering one or paying more at your doctor’s office.