Patient Instructions

Table of Contents

Aspirin or Aspirin Related Drugs

These instructions are to be followed before and after your surgery.

For a two-week period prior to and after the scheduled date of your surgery, please do not take any medication that contains aspirin or aspirin-related products, such as ibuprofen (Motrin, Advil) as an ingredient. Aspirin has an effect on your bloodís ability to clot and could increase your tendency to bleed at the time of surgery and during the postoperative period.

Please check the labels of all medications that you take, even those available without a prescription, to make sure you are not taking any aspirin or aspirin-like substances.

Please consult your physician before stopping any prescribed medication.

The following list is of the more common medications and substances that can increase your tendency to bleed.

If you are on any anti-rheumatoid, anti-arthritic, circulation, or anticoagulant medication (e.g., Motrin, Naprosyn, Persantine, or Coumadin), please inform us.

If you need minor pain medication, please take acetaminophen (Tylenol) or another non-aspirin medication. Tylenol or Anacin-3 are available at your local pharmacy without a prescription and have comparable pain relief potential to that of aspirin. If you are allergic to acetaminophen, (Tylenol) or unable to take it for other reasons, please notify us so that we might arrange a suitable substitute.

Botox® Treatment

1. It is recommended that you maintain an upright posture for at least 2 hours
2. Aerobic exercise is prohibited for 2 hours
3. Forward bending and laying down is prohibited during this period
4. The treated area should not be rubbed vigorously or massaged
5. Do use the muscles that were treated; that is, try to frown, squint, or raise your eyebrows. This may help to increase the response to the Botox-targeted muscles
6. Bruising, usually at or near the injection site, may be increased with the use of aspirin or aspirin-like products, including vitamin E. This effect generally clears within 7-10 days. No treatment is necessary
7. Headache and pain at injection site, related to the actual injections, is usually mild and transient, lasting less than 24 hours. This may be relieved with Tylenol and/or ice

If you have any questions regarding your treatment, please do not hesitate to call: (617) 472-6764.

Burow’s Solution Soaks

Domeboro (tablets, packets)

1 package dissolved in 1 pint of water.

Cool solution applied with dampened, thin cloths (thin facecloth, handkerchief, etc.) and applied to involved area. Compresses applied 2 to 4 times daily and allowed to air dry over approximately 15 minutes for bubbling or weeping areas. Compresses can be covered with dry towels.

Rinse treated area with tap water, pat dry and then apply any cream or lotion (if suggested).

A hand or foot may be soaked directly in the solution by using a flat basin (e.g., soaking for 15 minutes in the solution before rinsing).

If you have any questions, please do not hesitate to call: (617) 472-6764.

Laser Skin Resurfacing

PRECAUTIONS TO TAKE BEFORE YOUR COBLATION TREATMENT

1. A sunscreen of SPF 15 or greater should be applied to the area being treated whenever exposed to the sun, and throughout your course of treatment. The sunscreen should be continued following the treatment for at least three months to prevent hyperpigmentation.
2. Do not use aspirin, or medications containing aspirin, for one week prior to resurfacing. Acetaminophen (Tylenol) may be taken. Also, anticoagulants (blood thinning medications), such as Coumadin, must be discontinued at three days prior to skin resurfacing.
3. Please let the physician know if you have a history of herpes simplex infection (cold sores) on your lips or other areas of your face.

PRECAUTIONS TO TAKE FOLLOWING YOUR COBLATION TREATMENT

1. Following treatment, the area can be cleansed by soaking with lukewarm water approximately every two hours for ten minutes. Gently pat dry, then apply Aquaphor ointment to the entire treated surface. DO NOT SKIP ANY AREA. On subsequent days, soak the face four times a day. Continue this regimen for at least 7 days or until fully healed.
2. Immediately after skin resurfacing surgery, there may be swelling of the skin, especially if the cheek, nose, or eyelids have been treated. The swelling subsides in 3 to 7 days. Frequent applications of ice packs on the swollen area(s) may be used to reduce the swelling. The ice pack should be wrapped in a soft cloth and applied to the treated area for 30 minutes every hour. The head should be elevated on several pillows while sleeping. DO NOT LIE FLAT.
3. Avoid strenuous exercise, heavy lifting, intense sunlight, and extreme heat and wind. After the crusting resolves, a sunscreen must be used when going outside for at least six months following the procedure. NO SUNBATHING DURING THIS PERIOD.
4. Makeup may be applied after the crusting resolves. Be careful in applying the makeup, and remove the makeup gently.
5. Showers are permitted, but gently pat the area dry. Do not rub with a towel or washcloth, as the area may be extremely delicate.
6. Any discomfort experienced can be treated with Tylenol. A stronger pain reliever may be prescribed if required.
7. Notify us at once if any new sores or erosions develop, fever, or new areas of tenderness occur.

If you have any questions regarding your treatment, please do not hesitate to call: (617) 472-6764.

Liquid Nitrogen Treatment

Liquid nitrogen is a liquefied gas that is very cold: 321 degrees below zero Fahrenheit (minus 196° C). It is used to destroy superficial skin growths such as warts and keratoses.

The sensation of stinging and burning usually lasts less than 30 minutes, although on the palms and soles it may be sore for several days. Tylenol, aspirin, or ibuprofen may help if the area is too uncomfortable.

At first, the area will be red and puffy, and may even blister. Bleeding may occur within a blister, causing the lesion to appear red, blue, or black. This is normal. Over the course of 1-2 weeks, the lesion will become a hard, scabby crust and slough off. By 3 weeks, the area should be flat and smooth; if not, a return appointment may be needed.

Please leave any blisters alone, or protect them with a bandage. A painful or obtrusive blister can be broken from the side of the blister with a flamed and cooled needle, cleaned with alcohol. Do not try to remove the blister; just allow it to drain. In the event that the blister breaks or is opened intentionally, the area can be soaked for 10 minutes, 2 to 3 times a day, in a solution of one Domeboro (tablet or powder, obtained from your drug store) mixed with 1 pint of water.

If pain, redness, swelling, or oozing persists or increases after 2 days, call the office.

Treatment on the forehead and nose or around the eyes can result in painless swelling of the eyelid(s), especially noted in the morning. This will subside in 2-7 days.

DO NOT pick off the scabs/blisters. This will only traumatize the healing skin, and can cause scarring. Application of Aquaphor Healing Ointment (found in any pharmacy) or clean Vaseline will soften and speed healing of crusted areas. After the scab comes off, the area will be pink, and there may be an increase or decrease in pigment relative to untreated skin. This will gradually return to normal color.

If you have any questions regarding your treatment, please do not hesitate to call: (617) 472-6764.

Non-Sutured Wound Care

1. Keep area dry for 24 hours
2. Change the dressing once a day
3. Wash your hands before and after dressing change
4. Remove the dressing
5. Wash area with soap and water
6. Rinse and dry
7. If wound is on your ear, rinse with a solution of white vinegar diluted with an equal amount of water
8. Apply Aquaphor Healing Ointment or Bacitracin ointment
9. Apply Telfa dressing, cut slightly larger than the wound
10. Apply paper tape to hold Telfa in place

Continue wound care daily until area is healed. It is important not to allow a scab to form. Keeping the ointment and Telfa in place until wound is healed will prevent scab formation.

Watch for signs of marked swelling, redness, tenderness, and/or discharge. If these occur, or if you have any questions, please call the office at (617) 472-6764.

Retin-A (Tretinoin), Differin (Adalpaline), or Tazorac (tazarotene)

1. These creams/gels should only be used at night, since they are inactivated by sunlight, and can cause your skin to become sensitive to the sun while they are on your skin. The best thing to do is apply it to your skin before you go to bed, then wash it off in the morning. Here's how to apply it...
2. Before you go to bed, wash your hands and face. Wait 20-30 minutes after washing your face to apply the medicine. Then, take just a pea-sized amount of the cream (or gel) and put it on the end of your index finger. Take that pea-sized amount, and dot it evenly all over your face (even to places where you do not have acne), concentrating more on the problem areas. Then, go back and rub all the little dots into your skin. After you have done this, if there is still some cream/gel showing on your face, then you have used too much! Using more than a pea-sized amount for your entire face can actually make your acne worse, not better.
3. If your back and chest also break out in acne, you can apply one pea-sized amount to your chest, and another pea-sized amount to your back. Follow the same application directions as above.
4. In the beginning, your skin may actually become more irritated from this nighttime cream/gel because your skin is not used to it. That's O.K. If this happens, then instead of using it every night, try every-other-night, or even every-third-night. Gradually, over the course of a month or two, you can try building back up to every night, as your skin starts to get used to it. If by the time of your next visit your skin is still irritated, we can change your medicine to a different one.
5. If you experience some dryness on your skin during your course of using these medicines, you can certainly use some over-the-counter moisturizers that are "non-comedogenic" (i.e., "non-acne forming"). Examples are: Cetaphil, Aveeno, and Eucerin, among others.
6. It usually takes about 6-8 weeks of using these medicines regularly until you start to see improvement. Be patient!
7. These medications should NOT be used during pregnancy.

Sclerotherapy

1. Immediately after the injection session, you will be asked to put on your compression hose
2. Maintain normal activities immediately after procedure. You are encouraged to walk as much as possible and avoid standing in a single position for prolonged periods of time
3. Avoid strenuous activity, such as running, high-impact aerobics, and weight lifting for 72 hours after sclerotherapy
4. Compression hose is recommended for up to 7 days after procedure. The hosiery does not have to be worn while sleeping
5. Avoid blood-thinning medications such as aspirin, Advil, and Coumadin for 24 hours after therapy. Consult internist prior to stoppage of medication
6. If any unusual post-procedure symptoms occur, such as persistent pain, unusual diffuse burning, or skin breakdown, or shortness of breath, call the office immediately

If you have any questions regarding your treatment, please do not hesitate to call: (617) 472-6764.

Sutured Wound Care

1. Keep area dry for 24-48 hours
2. Change the dressing once a day unless you have been instructed otherwise
3. Wash your hands before and after changing the dressing
4. Remove the bandage
5. Clean the area with soap and water over the sink or in the shower
6. Rinse and dry
7. Apply Aquaphor Healing Ointment or Bacitracin ointment unless you have a known allergy to these products
8. Apply a non-stick bandage (Telfa) or bandaid

Continue wound care until stitches are removed (or in the case of no stitches, until area is healed). In the event of minor pain or discomfort, take one or two Tylenol tablets every 4 hours. You should avoid aspirin, ibuprofen, or naproxen products.

If the wound starts to bleed, apply continuous pressure to area for 15 minutes.

Strenuous activity or exercise should be avoided while the stitches are in place. Swelling at the surgical site is a common occurrence. It usually peaks at 48 hours, then gradually improves.

If the swelling reappears or worsens, if the drainage from the wound changes or is foul-smelling, or if the wound becomes red, painful, and/or hot, please contact the office.

After the wound has healed, the area will have increased sensitivity to the sun, and we recommend covering the scar using a sunscreen of SPF 15 or higher for at least 3 months.

If you have any questions or problems, please do not hesitate to call: (617) 472-6764.