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  • Preoperative preparation should include a discussion regarding the procedure; a review of the patient’s history, medications, and allergies; any appropriate physical examination; obtaining informed consent through a process; and answering patient and/or family questions.

  • The preoperative evaluation ultimately serves as a forum to assess probability of overall success and cement the patient–physician relationship.

image Beginner Pearls

  • From the first moment the patient steps into the office, the front office staff has the opportunity to begin collecting information, such as the patient’s mood and degree of anxiety.

  • If capacity is ever in question, simple questions like “where do you live?” or “how did you get here?” are innocuous queries that evaluate mental status without prompting any perceived stigmatization.

image Expert Pearls

  • Outline postoperative restrictions ahead of the procedure so that patients avoid conflicts with athletic events as well as allowing them to make any arrangements they may need for home care, child care, time off from work, or transportation to and from the procedure.

  • Patient preparation and the informed consent process is a critical part of the surgical procedure.

image Don’t Forget!

  • While a written signature is desirable, the real goal of the consent process is effective communication.

  • If an informational packet is provided to help patients prepare, it may include an outline helping them prepare for the pre- and postoperative period.

image Pitfalls and Cautions

  • Patients who have many questions or voice cosmetic concerns when they are scheduling their procedure are self-identifying as individuals who would benefit from an in-office preoperative consultation.

image Patient Education Points

  • Without adequate preparation, even mild and expected outcomes, such as edema and ecchymoses, can be a cause for significant concern.

  • Make the patient your partner, and use partnering language when discussing the surgical plan.

  • Certain subtleties become evident over time, such as personality, forgetfulness, unrealistic expectations, or specific fears that can be noted by the staff and guide the remainder of the visit. These observations can be acted upon early and preemptively, helping to tailor the patient care experience in a positive fashion.

  • Some patients under 18 may look older than they are (and vice versa), so it is important when operating on young adults to check their date of birth.

  • A full discussion of benefits and risks improves mutual trust and respect between the physician and patient, and ultimately improves patient satisfaction.


Evaluating the patient preoperatively, preparing them for surgery, and going through the informed consent process are important prerequisites that must be accomplished prior to initiating dermatologic surgery. This is important from an ethical standpoint, but also ultimately yields significant time savings for the surgeon, as an informed patient ultimately is less likely to make repeated telephone calls or return visits to the office in the postoperative period. Discussing procedural risks and the ...

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