Pre-Surgery Instructions

Pre-Surgery Instructions

These instructions are intended for patients of Advanced Dermatology & Skin Surgery only. They are not meant to be comprehensive instructions; if you have questions or concerns, please call our office at 828-210-7989.

If you have a surgical procedure scheduled with Daniel Zivony, MD, Todd Wilkinson, MD, Stephanie Myracle, MD, Elise Rackoff, MD, Alexandra Bourgeois, MD, or Jeffrey Aldridge, MD, please follow these instructions to minimize the risk of complications during and after your procedure.

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Bleeding Complications:

There are a few medications that have been shown to increase bleeding during surgical procedures:

  • Anticoagulants (blood thinners): Aspirin or aspirin-containing products: This includes many cold preparations; please read the label prior to taking any over-the-counter medications. The generic name for aspirin is acetylsalicylic acid. If you are taking aspirin for preventative measures only, these products should be discontinued 10-14 days prior to your procedure.
  • Plavix (clopidogrel), coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban) and Eliquis (apixaban) are other commonly used anticoagulants that may cause bleeding. If you are taking aspirin as recommended by your physician due to a past history of heart attack, stroke, or any other medical condition, please continue your aspirin as usual unless we advise you to stop.  If another surgeon is planning to perform a repair after Mohs surgery, please check with your surgeon before discontinuing these medications.  Tylenol or acetaminophen may be taken if pain medication is needed during this time period.  You may resume taking aspirin 72 hours after the procedure.
  • Ibuprofen, Nuprin, Advil, Motrin, Aleve, Celebrex, and other non-steroidal anti-inflammatory agents include many prescription pain medications and arthritis pain medications.  If you are unsure if a medication you are taking falls into this category, please ask us.  If possible, these medications should be discontinued 3 days prior to the procedure.
  • Vitamin E, Multivitamin, Fish Oil may increase bleeding. If you take any of these supplements, please stop the medication 3 days prior to the procedure.  You may resume the medication the day after the procedure.
  • Alcohol may increase bleeding during procedures. If you drink alcohol, please do not drink any beverages or take any medications containing alcohol for 3 days prior to the procedure.  You may resume any alcohol use the day after the procedure.

If you are taking these medications as recommended by your physician, please continue taking them as usual unless we advise you to stop.


This is a possible complication whenever the skin barrier is disrupted.

These are a few things you can do to decrease your chance of developing a wound infection:

  • If you have a history of wound infections after surgical procedures, please tell your doctor, as he or she may wish to prescribe oral antibiotics for you to take prior to the procedure.
  • Cleanse the skin the morning of the procedure with soap and water.  Use an antibacterial soap if you have one such as Lever 2000 or Dial.
  • Do not apply cosmetics to this area if the surgical site is in an area where you would normally wear make-up.
  • Do not shave the area the morning prior to the procedure.  This has been shown to increase the risk of infection.  If the surgical site is in a hair-bearing area, we may elect to shave the site and a very small surrounding area immediately prior to the procedure.

Post-Operative Activity Restrictions:

Be sure to follow these items to avoid complications after surgery:

  • Plan to limit your activity for 24-48 hours after the procedure.
  • No lifting of more than 10 pounds for the week after surgery.
  • Any activity that increases blood pressure can cause post-operative bleeding. After this time period, specific limitations in activity will depend on the surgical site, the type of activity, and whether or not there are stitches present.

Ask your doctor for specific limitations.  If this is an elective procedure, and you have a planned activity that you feel may interfere with healing, you may choose to schedule your procedure after this planned event.

Please call the office with any questions:  828-274-4880