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Outpatient Surgery (Excision) – Patient Instructions

Please notify our office before the day of surgery (preferably at least one week in advance) if any of the following apply:
If you have taken Accutane in the previous 6 to 12 months, history of keloids or thick scarring.
If you are taking blood-thinners (see attached list), aspirin, ibuprofen, or any other anti-inflammatory medications (commonly found in headache preparations, arthritis medications, and menstrual cramp relievers) call us. If your doctor has recommended that you take aspirin, you need to contact your doctor to ensure that it is O.K. to stop. It is recommended that one stop aspirin for 10 days before the procedure. For other non-steroidal anti-inflammatories (i.e. ibuprofen), it is recommended that one stop them at least 3 days before the procedure. It is recommended that one stop taking Vitamin E for at least one week and refrain from consuming alcoholic beverages for 3 days before the procedure.
If you are taking Coumadin (although in most cases it is not necessary to discontinue this medication) we need to be advised at least one week prior to surgery.
If you need to take antibiotics before surgery or when you get your teeth cleaned, if you have a heart murmur, or have an artificial joint please call our office so that we can prescribe an antibiotic for you. The antibiotic that we use is NOT the same as the one prescribed for teeth cleaning. Please notify us if you are already taking an antibiotic for any other reason.
In many cases, stitches are used that do not dissolve. In these circumstances you must return to have your sutures removed, which is usually 7-21 days after surgery. If this is a problem, call our office!

Two Days Before Treatment (for lesions that are below neck)
Purchase HIBICLENS from a local pharmacy. Twice daily on the day before surgery and on the morning of surgery, scrub with solution
from the neck down, leave on for 5 minutes and then rinse off with water only. Pat dry with a clean towel and put on clean clothes. Do not
apply any other soaps, lotions, powders or perfumes to the cleansed areas. If time does not permit on the morning of surgery, cleanse the surgery site only. DO NOT USE IN GROIN OR ABOVE THE NECK.

Before the Day of Treatment
You may want to buy supplies to care for the surgery site.
For sites on the face, antibiotic ointment (i.e. PolysporinÒ ointment, unless you are allergic), hydrogen peroxide, and cotton swabs are usually all that is needed. Some patients prefer to cover the surgical site with a bandage. If a bandage is desired, TelfaÒ gauze and paper tape is recommended and is available at any pharmacy.
For sites that are not on the face, care may not be required. Some patients choose to keep the surgery site covered, especially if it is in an area that can become irritated by clothing. In this case, we recommend purchasing an antibiotic ointment (i.e. PolysporinÒ ointment, unless you are allergic), hydrogen peroxide, cotton swabs, TelfaÒ gauze and paper tape, all of which are available at any pharmacy.
Some patients may wish to apply ice to the area (for sites on the lip or around the eyes) A bag of frozen peas applied 20 minutes every hour is recommended.
Although most patients have minimal discomfort that rarely requires any medication, TylenolÒ is the only recommended medication.
If prescribed, do not forget to take your antibiotics on the day of the procedure. Put it in a place where you will remember to take it. Your surgery may be cancelled or postponed if it is not taken.
Plan ahead. You may not be allowed to shower or bathe for 24 hours after surgery. In some cases, you may be required to keep the surgical site dry for one week (which is not uncommon for some sites on the lower nose, ear, or eyelid). Therefore, plan on showering on the day of surgery or the night before.
You are responsible for locating the site of the cancer. If you have a caregiver or significant other that has cared for the biopsy site and is unable to come in on the day of surgery, have him or her circle the biopsy site. In some cases that biopsy heals up extremely well with little evidence of site. For this reason, it is recommended that the site be checked daily and marked with a regular ballpoint pen if necessary.
Get a good night’s rest before the procedure.

Day of Treatment
Do not consume any Caffeine!!!
Please do not apply any make-up, powder, sunscreens, moisturizers, lotions, or creams to the area to be treated.
Wear clothing that is easy to put on and take off. For sites on the face, it is recommended that one wear a button down shirt.
Take all of your regular medications (i.e. blood pressure medications) except those which you were specifically informed not to take (i.e. aspirin for some patients). Don’t forget to take your antibiotics, if prescribed
Unless arranged with the staff in advance, no other problems will be addressed on the day of surgery unless it is urgent. For this reason we kindly ask that you reserve any questions not pertaining to the surgery for another day or at the time of suture removal or wound check.
Eat a good breakfast.

What to expect after surgery
For sites on the face, bending and lifting should be avoided for one week.
One should discontinue exercise or other strenuous activities, including golf and tennis, for at least one week unless otherwise instructed.
For sites on the trunk, arms, or legs, avoidance of strenuous activities, including bending or stretching may be necessary for more than two weeks.
The treatment of sites around the eyes, including the forehead, may result in a black eye.
Patients should not take aspirin, non-steroidal anti-inflammatories (i.e. ibuprofen), Vitamin E, or consume alcoholic beverages for at least 48 hours unless otherwise instructed.
Usually there is no discomfort felt after the procedure. If there is any mild discomfort, only Tylenol should be taken.

Herbal preparations and supplements should be avoided as these contain natural blood thinners.