General Questions

• How do I reach my doctor in an emergency?
  Dr. Wittenberg or Dr. McBride are available for emergencies 24 hours a day. The doctors can be reached per pager in cases of emergencies.

• Should I stop smoking before the surgery?
  Yes, we would prefer you to stop smoking at least 4 weeks before the surgery. Studies showed delayed healing and lost of tissue after cosmetic surgeries in smokers.

• How long does it take to heal?
  Every patient's healing process is different, and the final results after surgery are usually not fully seen until 3 months afterward. In cases of nose surgery, it takes up to 12 months before the final result is seen. Because of the delayed healing in most cosmetic surgery procedures, we usually don¹t perform revision surgeries if necessary before 6-12 months.

• When can I shower after the surgery?
  You can shower the day after the surgery. Please don¹t get your dressings wet. You can also wash your hair with cold water the day after the surgery with the help of an assistant.

• Do I have to sleep in any special position?
  We like to have you sleep with a slightly elevated head(2-3 pillows) for the first 2-3 days to decrease the swelling.

• How will I feel emotionally after surgery?
  After the surgery most patients are emotionally unchanged, but we see some patient getting depressed for the first few days after the procedure. This is usually related to the dressing and the swelling and bruising of the face. If necessary we occasionally treat the patient for this condition. Please keep in mind depression is very uncommon and only temporary.

• Can I have the operation again?
  Yes, if necessary most of the surgeries can be repeated. We usually wait 6-12 months if possible before we re-operate Especially neck-lifts in male patients with a heavy neck need occasionally a second surgery in around one year after their original surgery.

• When can I go to the beautician after the surgery?
  You can see your beautician after the incisions are healed, which is usually 5-7 days after the surgery.

Before the Surgery

• How can I know if surgery will be right for me?
  The questions is very personal and can only be answered by yourself. During the consultation process Dr. Wittenberg will explain to you the changes which can be expected after the surgery. Also the risks and benefits will be discussed with you. It is important to understand that cosmetic surgery is elective surgery and usually helps to improve your self-esteem. It is important that you want to have the surgery done for yourself, and not to please other people or use it to solve a current personal life crisis. To have the right motivation is essential for a good success in your treatment.

• Can I get the same results without surgery?
  This questions can only be answered during the consultation process. For the early stages of aging process surgery is usually not indicated. In some patient only skin care is necessary.

• Can I slow down the aging process with other methods than surgery?
  The aging process of the skin can be slowed down by the appropriate precautions. The worst factors for the aging process of the face are extensive sun exposure and smoking. We recommend not to smoke and to wear a sun block of at least PSF 15 or more, whenever your are in the sun. Skin care is another essential part of delaying or slowing down the aging process. The use of
  Retin-A, glycolic peel, moisturizer, topical Vitamin C and other skin products can be of great help. We usually pre-treat our patient before surgery and keep them on an regular follow-up program to maintain the results of the surgery for a longer time. As you can see, the appropriate skin care is essential for the success of any surgery.

• Will my insurance pay for the surgery?
  Insurance's are not covering cosmetic surgery. Only in cases of nasal surgery (deviated septum
  or hypertrophy of the turbinates) insurance might cover the surgery. This kind of nose surgery is
  not cosmetic surgery, because it repairs a functional problem.

• How much time should I take off from work/school?
  We usually recommend to take 2 weeks off from work or school. Often you can go back sooner, but most of the bruising and swelling takes at least 2 weeks before it subsides. After most of
  the surgeries you are able to place make-up on day 7. At this time most of the sutures will be removed. It is important to keep in mind that the healing process can be quite different, we had patient going back to work and being in public 3 days after a facelift, and other stayed home for
  up to 4 weeks. It is important for you to ask Dr. Wittenberg about the possible recovery time.

• What medicines should I or shouldn't take before the surgery?
  You are supposed to take your regular medications if not different told to you by the doctor. We
  like you to stop two weeks before the surgery any Vitamin E supplements in excess of 200 IU (causes more bleeding problems), Gingko bilboa (prolongs bleeding), Garlic supplements (prolongs bleeding) and Woodruff an Chinese herb. You should also stop any Aspirin ,Ibuprofen or similar products after you discussed it with your doctor. We usually start you on pineapple juice 1 glass three times a day 2 weeks before the surgery and at the same time we recommend 3000mg of Vitamin C per day (decreases swelling and improves healing). Shortly before the surgery we start you on Bromeliad and Arnica tablets to decrease the swelling and bruising and the night of the surgery you will start an antibiotic. Detailed instructions are part of our preoperative package given to you before the surgery.

• Do I need any special lab tests or x-rays?
  Depending on the extend of the surgery we usually require some blood tests and depending on your age an chest X-ray and an EKG. In most of the cases your primary care physician can order these test.

• Do I need to have somebody stay with me after the surgery?
  Yes, you will need someone to stay with you for the first 24 hours after surgery and it is important that somebody picks you up after the surgery.

• Are there any medical condition which would make me not a good candidate for the surgery?
  Yes, patients with chronic diseases like a bad heart conditions, severe diabetes or lung problems are usually not good candidate for cosmetic surgery. It is important to realize, that cosmetic surgery is elective surgery and it would not be appropriate to endanger your life by the surgery. If you have any concerns regarding your medical history, please talk to Dr. Wittenberg about it.

• Do I take my regular medication before the surgery?
  Yes, you take your regular medication if not told differently to you by the doctor. We usually also have you take your morning medication of the day of surgery with a sip of water.

During the Surgery

• Where is the surgery done?
  Our facility is accredited as an ambulatory care center by the State of California. We performing
  the majority of our surgery in our operation room. In special cases we are using the operating room of Hazel Hawkins Hospital of Hollister. Please ask to see our operating room on your consultation visit.

• What anesthesia is used?
  For the facial cosmetic procedure we using a combination of intravenous sedation with local anesthetic. The combination of these two techniques causes the least risks and is very safe. On special request a general anesthesia can be performed.

• How long does the operation take?
  It is very difficult to give a general time estimate for the different procedure, a face -or neck-lift
  takes around 4 hours, the nose surgery 3 hours, the lifting of the brows 1.5 hours, the fat injection 40 minutes and the skin resurfacing with the laser 2 hours. Please ask at your consultation about the approximately time for your surgery.

• Will I be able to go home after the surgery?
  You will be able to leave our office approximately 1 hour after the surgery is finished. You must
  have a person with you, who is driving you home and stays with you for the following 24 hours.

• Where are the scars going to be?
  The placement of the scars is different for each patient. For the facelift it starts in the temporal
  area is following a line in your ear and curves behind your ear into your hair. The neck-lift incisions are below your chin(3cm) and another incision is extending from above the earlobe in front of the
  ear and curves behind the ear into the hair. The brow-lift has usually a incision in the hairline our in your hair. For the nose surgery we occasionally place a small incision in the skin between the nostrils. Most of these scars are invisible and are rarely of concerns. Please keep in mind that the scar looks red in the first few months , before it starts to fade. If the scars seems to be not aesthetically pleasing we usually treat it with different ointments and injections, before we perform
  a small surgery to revise the scar. ( diagram of incisions for surgeries)

After the Surgery

• Can I drive myself home after surgery?
  No, somebody has to drive you home and stay with you for the following 24 hours.

• Do I hurt after surgery?
  Facial cosmetic surgery is surprisingly painless. You will have some pain medication but often regular or extra strength Tylenol is enough to help with the pain. Please don¹t hesitate to call us if you feel that your pain is more then nomad, because this can be related to a postoperative problem, like a enlarging hematoma.

• When can I exercise?
  In general we like to see you back walking and doing light work at home the day after the surgery. You should not perform any strenuous work like lifting weights for at least 4 weeks. As you can see, we want you getting back to your regular lifestyle as soon as possible.

• Will I need to change my bandages?
  The dressing placed after neck-,face- and brow-lifts is usually removed after 1-2 days by us. Occasionally we are placing another bandage or garment for a few days. The splint and dressing from nasal surgery stays on your nose for 10 days. The dressing after laser skin resurfacing is
  very extensive and has to be done for up to 1 months. Most of the other procedures usually don¹t require a dressing.

• Will I have any drains?
  Drains are occasionally placed in patients with face-neck-lifts and for surgery on the brows. The drains are usually removed after 2-3 days, depending on the amount of collected fluids.

• How do I look after my incisions?
  The best is to keep the incisions clean with hydrogen peroxide and Q-tips. You can place some Bacitracin or Neosporin ointment over the incisions. Special wound care instructions are given to you with your post- operative instructions.

For more information schedule your free consultation with Dr. Wittenberg to discuss this procedure in full. Our experienced and professional office staff members are here to help you with all your questions. Call our offices at (831) 636-9808.