Two to six weeks before every surgery at Southwest Plastic Surgery, a nurse calls the patient and stays on the phone for twenty to forty-five minutes. Dr. Agullo calls it the most underrated appointment in the practice.
Several of those calls were transcribed. What follows is the nursing team in their own words, with staff names and every patient detail removed.
Pre-op nurse: “So your vitamins, I’m gonna explain them to you, but it’s a lot. But we’ll be sending you written instructions for everything.”
That sentence shows up in nearly every call.
Paperwork and Clearance
Pre-op nurse: “The first one is gonna be with the clearance paperwork that you need to take to your PCP for everything that we need before your surgery. And then the second email is gonna be the email with the copy of your consent, pre- and post-op instructions.”
Pre-op nurse: “We need everything that is on file. Just because sometimes you go to the PCP and they tell you, oh no, because of your age we don’t need to do some of the labs that are here. Our Surgical Criteria Center requires everything that is on the clearance. And then for the EKG, if you can just let them know that we need the actual EKG.”
Patients without insurance are not stuck: “Anybody that, you can go to urgent cares or any doctor, they’ll be willing to do it.” Everything is due back at least ten days before surgery.
Fasting and Medications
Pre-op nurse: “You do have to be completely, completely fasting. Nothing to eat or drink since the night before after 12 midnight, as well as both of your index fingers, no gel or acrylic, ’cause that’s the finger where we’re checking your oxygen level while you’re under surgery.”
Pre-op nurse: “It’s just so you don’t have anything in your system when you come into surgery and we intubate. The less stuff you put in your stomach, the less risk of aspiration.”
Home prescriptions are handled case by case:
Pre-op nurse: “It depends, because if it’s for blood pressure, I’d rather you take it than not take it. But if it’s something, vitamins, or if they’re hormone therapy, yes, those kind of stuff can hold off.”
The Night Before
Two Hibiclens packets ship in the pre-op box.
Pre-op nurse: “Tonight I want you to shower, regular shampoo, regular conditioner. You’re going to rinse everything off, and then you’re going to use the first package of Hibiclens to all the areas we will be working with. So specifically, let’s work from the neck down to underneath the booty.”
Pre-op nurse: “I don’t want you to put any lotions, creams, or perfumes. I want that soap to be the last thing to touch your skin before you go to bed tonight.”
One allowance: “You can put a little bit of deodorant just so you’re not stinking during the night and you don’t feel uncomfortable.”
And on what to wear the morning of:
Pre-op nurse: “Most people show up in pajama tops and pajama bottoms. I mean, you’re going straight back home to recovery. It’s not like you’re going to go to Walmart afterwards.”
Supplements, Vitamins and the Bromelain Math
Pre-op nurse: “You’re gonna stop all vitamins, supplements, pre-workouts, or anything that you take that is not prescribed. If you’re taking any prescribed medications, you continue taking them.”
Pre-op nurse: “Our vitamins are called Recovery Support. They help you with the bruising, the swelling, and everything that you need to heal. It’s a month treatment that you start 2 weeks before, then you finish it 2 weeks after.”
The schedule is repeated verbatim on the call because the arithmetic is what patients get wrong:
Pre-op nurse: “The morning formula is gonna be 3 before breakfast. The evening formula, 3 before dinner. Then you’re gonna continue with the Bromelain, which is gonna be 3 days before the surgery. Bromelain is gonna be 2 capsules, 3 times a day. So that means 2 before breakfast, 2 before lunch, 2 before dinner, of course, plus the 3 in the morning and the 3 in the evening. So when you’re taking them all together, it’s a total of 12.”
Pre-op nurse: “Bromelain is what pineapple contains, a natural antibacterial and a natural anti-inflammatory.”
The arnica is labeled by hand before it ships:
Pre-op nurse: “That box is actually opened and taped because I labeled every tablet for you. You’re gonna start with the first tablet that is labeled pre-op, 24 hours before the surgery. Then the post-op, that is gonna be 4 hours after surgery. And then at bedtime the day of the surgery. Day 2, morning, afternoon, evening. Day 3, day 4, and you’re done.”
GLP-1s, Iron and Nicotine
Pre-op nurse: “I’m gonna need for you to stop taking it 2 weeks before the surgery and 2 weeks after. The reason why, they slow down your intestinal motility, as well as the surgery, and we do need for you to have bowel movements right after surgery.”
Iron starts two weeks ahead for body contouring and tummy tuck patients:
Pre-op nurse: “The reason why, we do lose a little bit of blood during surgery. So if you lose a little bit of blood and it’s high, it’ll go to normal levels other than having it normal and dropping to anemia.”
Pre-op nurse (translated from Spanish): “The only difference with the iron we prescribe, we prescribe ferrous gluconate, and usually when you buy over the counter it is ferrous sulfate, and the sulfate causes a little constipation, the gluconate does not, and the gluconate has better absorption.”
Pre-op nurse: “He wants you to stop smoking 2 weeks before the surgery and 2 weeks after. The reason why, nicotine closes our blood vessels. If your blood vessels are blocked, you will not have enough oxygenation to the scars and we can create a problem called necrotic tissue, which means that the skin will die.”
Pre-op nurse: “If you need help, you can just let us know so we can send you some Chantix as medication to help you stop smoking.”
Pain Medication and the Pharmacy Coupon
Pre-op nurse: “For pain medication, we prescribe Journavx. Journavx is a new pain medication, and it’s as strong as an oxycodone, but it doesn’t have the narcotics. So you avoid the constipation, the drowsiness, everything that comes when we take narcotics.”
Pre-op nurse: “You’re gonna take 2 pills 30 minutes before your surgery, because what Journavx does, it blocks the pain receptors.”
Pre-op nurse: “Sometimes they tell you that it is not covered by insurance or that the cost is $400. We don’t want you to purchase it. In the email I’m going to send you, I’m going to send you a copy of the coupon. So it’s only $30. If they still tell you that they don’t accept the coupon, don’t purchase them. Once you get here to El Paso, we’ll go ahead and guide you to a pharmacy where they know how to run it with the coupon.”
Traveling In, and Who Stays With You
A large share of the practice comes from out of town.
Pre-op nurse: “If you’re able to arrive here the day before, that will be good so you can come into the office and we can have you sign your original consents and take your before photos. But if it’s unable, we understand, as long as you arrive at 7:30 in the morning.”
Pre-op nurse: “For this one, we need you seven days minimum. Some people stay two weeks, but seven days is the usual.”
Somebody has to stay with the patient for forty-eight hours. When nobody can:
Pre-op nurse: “You will need to stay in our office, you will need to pay for the overnight stay, and then the next day we can arrange for a driver to take you to the hotel or the Airbnb. Because we cannot release you right after surgery because you’re still loopy and drowsy.”
Pre-op nurse: “In recovery we go over all the medications and all the post-op instructions with your husband. You’re not going to remember any of it because you just had anesthesia. However, the nurse will be going to your house or your Airbnb or your hotel the next day, and she’ll pretty much reiterate all of the discharge instructions to you.”
Pre-op nurse: “She just goes to the hotel and stays with you for a couple of hours, and she checks all your vital signs. She checks to see if you’re not anemic, and if she sees that you’re really low, she’ll give you a little bit more of IV fluids.”
Garments, Movement and Massage
Pre-op nurse: “Your package comes with two full body suit garments, but the garments, we don’t put them right after surgery. We’ll put them on at your first massage. The reason why, there’s some circulation compromised during surgery, so we want to let circulation start working again in order for us to constrict you.”
Pre-op nurse: “Once we put the garments on, you’re gonna wear them 24/7 for 4 weeks. The only time you’re gonna take it off is to shower, which you have to shower right the next day after surgery. And it’s only showers, no baths. Nothing you can submerge, no hot tubs.”
Pre-op nurse: “He wants you to be up and walking right the next day, every hour for 5 to 10 minutes. And that’s to help prevent DVTs as well as, the more active you are, the better you’re gonna start feeling sooner.”
Pre-op nurse: “It’s gonna be no lifting, carrying, pulling, or pushing objects greater than 15 pounds for 4 weeks after surgery, as well as nothing that is gonna make your breasts bounce. If your breast is bouncing, that means you’re doing too much for the recovery.”
Pre-op nurse: “Dr. Agullo strongly, strongly recommends lymphatic draining massages. The lymphatic massages help break the scar tissue that the liposuction creates, the fluid retention, and for the drains to come out faster. He wants you to get at least 2 a week, a total of 8 the first month.”
Pre-op nurse: “The person that comes with you can go in there and see the massages so they can see how they do them and help you when you’re back at your hometown. Remember, they have to be lymphatic massages done by hand.”
Skin Care During Recovery
Pre-op nurse: “Every time you go under anesthesia, and especially after lipo, your body becomes very dry and itchy. We don’t want you scratching because scratching creates stretch marks, so we want you to use the body moisturizer at least twice a day. But not on the incision.”
Pre-op nurse: “The Skinuva and the scar tape, they’re for you to start 3 to 4 weeks after surgery, once we’re completely sure that all the incisions are completely closed. The Skinuva is silicone-based, it contains hyaluronic acid, growth factors, aloe vera, vitamin C.”
Longer-term skin work, once everything has healed, is handled through the med spa.
The Part About the Face
The most quoted passage on any of these calls is not clinical at all.
Pre-op nurse: “For the face procedure recovery, that one is more like a psychological healing. The reason why, because the face is something that we can’t hide. When we do our body, we just put the garment and loose clothes and nobody notices. The face we can’t. So the majority of our patients, around week 3 to 4, they’re regretting what they did. I like to let you know, because once you remember what I tell you when you’re healing, you’re like, okay, she did tell me.”
Pre-op nurse: “You might be one of the lucky ones that don’t swell up a lot, you might be one of the not so lucky that swell up a lot. It varies per patient. Just remember, if you’re very, very swollen, you’re not gonna stay like that.”
Why a Nurse Makes This Call
Dr. Agullo’s reasoning is that by the time a patient reaches this conversation the decision is already made. What they need next is someone with unlimited patience who will repeat the bromelain math three times and mail the written version anyway. The nurses are also the people answering the phone at week two when something looks strange.
Dr. Agullo is a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor of plastic surgery at Texas Tech University Health Sciences Center.
Ready to Talk?
Call Southwest Plastic Surgery at (915) 590-7900, text the consult line at 1-866-814-0038, or book a consultation at swplasticsurgery.com.
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
