People Fly WHERE for Cosmetic Surgery?

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis.

Kirstin (00:13):
Hey Dr. Koehler.

Dr. Koehler (00:14):
Hey Kirstin.

Kirstin (00:16):
What do you want to talk about today?

Dr. Koehler (00:18):
I always let you pick, so what you got?

Kirstin (00:20):
Alright. Well, our wonderful surgery coordinator had an idea about people traveling to Fairhope and why you would come here for cosmetic surgery.

Dr. Koehler (00:31):
I mean, why wouldn't you?

Kirstin (00:33):
Exactly. Why wouldn't you?

Dr. Koehler (00:36):
Yeah. This is like the land of unicorns and rainbows, so I think you should come here.

Kirstin (00:41):
Yes, piers and sunsets, that's what we're known for in Fairhope.

Dr. Koehler (00:44):
Piers and sunsets.

Kirstin (00:45):
Piers and sunsets.

Dr. Koehler (00:46):
Alright.

Kirstin (00:46):
Okay. Alright, well let's talk about you first.

Dr. Koehler (00:49):
Okay.

Kirstin (00:50):
When did you move from Tulsa to Fairhope?

Dr. Koehler (00:54):
It's been 11 years now, I think. Something like that.

Kirstin (00:56):
Oh my, okay. Is it true that you still have old patients coming here to see you in Alabama?

Dr. Koehler (01:02):
Yeah. Yeah. Actually when you were in a place for a long time, which I was in Tulsa, I mean, yeah, I had some people that I've already operated on and sometimes even new people that they wanted to come see me and even though I was 12 hours away or 10 hours, it's a 12 hour drive, people were making the trip. So yeah, it's an honor and it is nice to see these people that make the trip to come see me.

Kirstin (01:29):
Yeah, we love that. I think we just had a couple last week or the week before that came. I don't think they were previous patients. I think they were referrals.

Dr. Koehler (01:38):
They weren't previous patients, but they were referred to me by a previous patient and so yeah.

Kirstin (01:43):
Yeah, that's pretty cool.

Dr. Koehler (01:43):
Husband and wife came to visit me, so that was pretty cool.

Kirstin (01:46):
Yeah, I like that. Okay, so what are some reasons that people may travel for surgery instead of staying close to home?

Dr. Koehler (01:53):
Yeah, well of course they're coming to see me, Kirstin, that's why.

Kirstin (01:57):
Exactly.

Dr. Koehler (01:58):
No, I think obviously the obvious reason why people travel outside of their home city is that, for instance, in my case, I have previous patients that trusted me with prior surgery and when you develop that relationship with your doctor that you trust, it's sometimes hard to go to somebody else and they can be very good. It's just that you feel confident in that person. Making the step to have surgery is a big decision. And so the biggest hurdle is first of all, feeling confident with your doctor. So for me, that's one of the reasons that I have people that travel is because they're prior patients and they feel comfortable with me. And then of course there's just the general referral system that we have people here in Fairhope that have family members outside of the state, and so whether that's sons or daughters or mothers, whatever, and they want to have a procedure and their family member's like, I want to take care of you here and there's a good doctor that I really think you'd like. We have a lot of that as well. Those are some of the reasons. Then sometimes you get known for certain procedures that people are like, oh, hey, I hear he does really good with X, Y, or Z. I like his facelift, so I'm going to come see him for a facelift. And so those are some of the reasons people will make the trip.

Kirstin (03:23):
We have a patient that she originally was from Fairhope, moved to Atlanta, she got a nursing job there and wanted to come back to you and so you did her surgery and we schedule her post ops around her schedule when she's going to come back to town to visit. And then now she's become a med spa patient. So whenever she's in Fairhope she shows up at the med spa. We love it. It's a long way to travel for that kind of stuff, but we really appreciate the loyalty really.

Dr. Koehler (03:51):
Yeah, for sure.

Kirstin (03:52):
Also coming here, I think people can kind of be discreet if they don't want to be at home and recovering in their hometown and have to be seen at the grocery store, they can kind of come here and chill and this is a very nice town to kind of take a break and recover discreetly.

Dr. Koehler (04:10):
Yeah, I mean certainly there's the privacy issues. Even if you walk right through the front door, if you're from out of the state, I mean nobody knows who you're, but I think a lot of that, the stigma of that has, that might've been a thing years ago. I still think obviously people want their privacy, but I don't think the stigma of that is nearly what it used to be.

Kirstin (04:30):
Do you offer virtual consultations for people that are coming from out of town?

Dr. Koehler (04:34):
I mean, I think our patient care coordinators will do a lot of the work virtually, but when it really kind of comes down to it and they're like, yeah, no, I'm ready to have surgery. We really want to have a one-on-one. I don't want to be seeing this person for the first time face-to-face, morning of surgery. I mean, yeah, you can look at pictures and you can talk to somebody, but when you see somebody face to face, sometimes there's little things that you pick up on. You're like, oh, hey, this could be an issue, and you just don't want to have that showing up at the day of surgery. So yeah, when we're really ready to go forward, we like to have a face-to-face, but we can do a lot of the work ahead of time very much so virtually.

Kirstin (05:18):
For patients that need medical clearances or labs, do you require that they get those done locally or can they be from out of town and do that in their hometown?

Dr. Koehler (05:27):
Oh yeah, they can get that all done anywhere as long as, especially for clearances, a lot of times, I mean they have a doctor and we want it from their doctor. We don't want it from somebody that's never met them before, so. So they can get their labs done wherever and most of the time, obviously this is elective surgery, so most of the patients we're treating are healthy people. They might have some mild things, but there are some circumstances and obviously we do have, I have privileges at local hospital here, so if somebody is in a little worse health, we might do it at the hospital.

Kirstin (06:00):
Is there a timeframe or how far out in advance should patients be booking surgery if they don't live locally?

Dr. Koehler (06:07):
Well really need to be looking months in advance. First of all, we're booked out for a while, so it's not like you can just say, I'd like to go next week, you really need to plan this. But when you're planning surgery, especially surgery where you're going to be out of state, there's a lot of things to prepare for. Like we talked about getting the labs ahead of time and then just taking care of your life if you have pets, making sure those are taken care of, who's going to take care of you, where are you going to stay, all these things that you kind of got to plan for. I think it's also good to just make sure you have a contingency plan too. So let's say we go, oh, well, we want you to stay here a week before you go home, but what if we had to keep you for a few more days? Do you have the ability to do that even if you were having surgery at home? I mean, those things can happen if we said, oh, you should be able to go back to work in a week, but what happens if it turns to two weeks?

Kirstin (07:00):
So you mentioned staying in town for a week post op. Is that your general recommendation that you want people to stay around for about a week?

Dr. Koehler (07:08):
For a lot of things, yes, but sometimes if it's a bigger procedure, we might want to stay 10 to 14 days a little bit longer. It depends on whether or not they're going to have drains. It can depend on a lot of things. So I don't want to just say a blanket statement, Hey, a week for minor stuff, like you could probably go in a couple of days and if it's something that doesn't have sutures that require removal and things like that. But if we have stitches that we need to take out, that's typically going to be at a week. Drains are usually at a week. It's somewhere between one and two weeks typically that we'd like you to stay.

Kirstin (07:43):
We call in our patients antibiotics and medications and stuff ahead of time. So other than medications for out of town patients, what sorts of things do they need to bring with them if they're traveling for surgery?

Dr. Koehler (07:56):
We're going to give you a list of sort of items that we recommend post-surgically, like whether it's antibiotic ointment or gauze or whatever. We're going to give you that list. Probably easiest just to come the day before, go to the pharmacy and get your things like your Chlorhexidine soap that you're going to wash with beforehand. I mean, you can bring those things in your travel bag, but a lot of times just easier to get it when you're here, but we're going to give you that list. Other than that, I mean, have a good book to read, get your Netflix ready. I mean, you want to just have some things to do while you're chilling.

Kirstin (08:31):
It is a small town, but we do have a target and a Walmart and a Walgreens.

Dr. Koehler (08:35):
It's not that small.

Kirstin (08:36):
No, not anymore. Why is it not safe to travel too soon after surgery?

Dr. Koehler (08:42):
Well, I mean, I think the biggest reasons for not wanting to travel too soon would be maybe risk of a hematoma. Most of the time, hematomas, whether it be with a facelift or a breast aug or anything, most of these are going to happen within the first 24 to 48 hours. So if you were to leave the next day, I mean, a lot of times for simple things like a breast augmentation, you're probably fine. I mean, if you didn't get a hematoma overnight, you're probably going to be fine. But if you overdo it, you strain, you travel, all of a sudden now you get a hematoma, and this is not like an emergency from the standpoint of life-threatening, these things are usually self-limited. So let's say with a breast augmentation, you got a hematoma, well, your breast would swell, it would get very uncomfortable and it would swell up quite a bit.

(09:27):
The pressure would build up and it would stop bleeding, but you'd have one breast that's significantly larger than the other, it'd be very uncomfortable, and it typically requires surgery to go back, evacuate all that blood that's in there and figure out what started bleeding. So you want to be nearby for those first few days to make sure if something like that was to happen, that you could get medical care that you needed. So that'd be one reason. The other reason I guess, issue for travel is if you have drains, like I said, we typically like to take those out ourselves, but then the risk of blood clots. So there's a risk of getting a blood clot in your legs, even if you haven't had surgery. For long periods of time, if you're immobile, I mean like sitting in a car, sitting on a plane, that puts you at risk for a blood clot.

(10:14):
And surgery is another thing that puts you at risk for a blood clot. So when you go to sleep for surgery, the muscles in your legs and they're not moving the blood. Typically it would when you're, even if you're sleeping, you've got tone to your muscles and you're moving a little bit and it's moving the blood. When you're under anesthesia, we put compression stockings on. We put compression pumps on in certain surgeries, we give you a shot of blood thinner to prevent blood clots. Even if you left a week or two weeks afterwards, those risks still apply. So it doesn't mean you're out of the woods after a week because really the risk for blood clots is for several weeks after the surgery. So if you're at a higher risk, we're going to put you on some medications to help thin your blood. But if you're driving, we kind of recommend, oh, get up, walk around every few hours, like stop at a gas station. You don't have to do much. Walk around a little bit, get back in the car. If you're flying, most of the flights here within the US are kind of shorter flights unless you're traveling, let's say all the way coast to coast type of a thing. So you should be fine, but you can get up, stand up, go to the bathroom once during the flight, probably be fine to get up and just move a little bit.

Kirstin (11:23):
Can patients come alone or do they need to bring support or a travel buddy?

Dr. Koehler (11:29):
Yeah, no, absolutely don't come by yourself. You've got to have somebody with you. I mean, we won't discharge you from our facility by yourself. You can't throw you in an Uber and go, Hey, good luck. So you need to have somebody responsible that can take care of you, and you might only need that closer care for the first 24 hours just to make sure if you need some assistance getting up, if you feel a little lightheaded after anesthesia, make sure that you get your medications when you're supposed to get 'em. And because you might not be, the effects of anesthesia, you might lose track of time and not be totally cognizant. But usually after the next day, people are fine. They may not need that close care, but there's somebody there if you need to get something from the store, somebody can go run an errand for you. So you do need to have somebody.

Kirstin (12:16):
What have we asked our team to do to help make things easier for people that travel from out of town?

Dr. Koehler (12:23):
Well, I mean, I think the things we've done is, we mentioned a little bit already is that we have all the post-op instructions. So we go through that ahead of time, make sure they have all the supplies, that they can get themselves prepared for all the supplies, and then we can kind of help give people guidance of where places to stay and around Fairhope, and there's a lot of great places to stay here. They've got access to our patient care coordinators. They are really responsive so they can talk to them prior to getting here. Then once they've had the surgery, patients have multiple ways to communicate with us through texting, through calling. So those are the things we do to help people get prepared.

Kirstin (13:04):
Let's talk about what airports to use when people fly in here.

Dr. Koehler (13:08):
Yeah, state of Alabama's not going to like this, but I fly out of Pensacola. That airport is, in my experience, been much more convenient in terms of, I haven't had as many issues with canceled or delayed flights. Security has been generally pretty good experience for me compared to flying out of Mobile, but it's a little bit longer, but actual travel time ends up typically being less. It's a straight shot on I-10. So go from Pensacola and you're here in an hour. It's an hour drive from the airport to here.

Kirstin (13:41):
And Mobile, you've kind of got to fight traffic a little bit to get over here, so it takes a little bit longer. But Pensacola is, like you said, just straight interstate.

Dr. Koehler (13:49):
Yeah, the distance is shorter to the Mobile airport, but I've had plenty of times where it's taken me well over an hour to get across the bay. So yeah, I mean, that's where I would recommend flying in and out of is Pensacola.

Kirstin (14:02):
Do we have any specific hotels around here that you prefer patients stay at, or do we have partners or anything?

Dr. Koehler (14:10):
Let me ask you that. I mean, what are you guys recommending? I know kind of my favorites, but what are you recommending to patients?

Kirstin (14:15):
Well, yeah, of course, we want everybody, if you are coming here, very nice, luxurious place to stay is the Grand Hotel in Point Clear. It's what, 10 or 15 minutes down the road. But then we also have some smaller hotels. There's a Hampton Inn in downtown Fairhope and downtown Fairhope is charming and beautiful. So if you're coming for surgery and you want to stay come a couple of days early, I would definitely recommend staying at the Hampton Inn in downtown Fairhope, or there's a couple more budget friendly hotels closer to the interstate as well.

Dr. Koehler (14:49):
Yeah, I think there's plenty of locations. Definitely the Grand Hotel, it's beautiful. That's where all the weddings and everything, all the big functions are going to be at the Grand. It's right on the bay. It's pretty, and I definitely like downtown. Downtown's nice, cuz you can go walking around and lots of nice stores and places to eat, so I think that's a really convenient place too.

Kirstin (15:13):
There's cottages and Air bnb's and stuff downtown on the bay, so if you'd rather have a home to stay in, there's lots of Air bnbs and places like that right on the water. So

Dr. Koehler (15:23):
Yeah,

Kirstin (15:24):
It makes it nice. Okay. Well, how difficult is it to get around Fairhope if somebody flies in here, do they need to rent a car? Do we have Ubers? How's that work?

Dr. Koehler (15:32):
Well, I think there's Ubers, but I don't know that you're going to get the kind of Uber service that you get in some of the big cities. I'd say you probably are going to want to rent a car. I mean, you could get an Uber from the airport probably to Fairhope. I would probably rent a car. But once you're here, if you're in downtown Fairhope, it's very easy to get around in Fairhope with or without a car. And really, like I said, if you stay in downtown Fairhope, I don't really know that you need a car except for to get to and from the airport, because everything you need is kind of right around there. There's a pharmacy and there's stuff close by that. Yeah, you can get an Uber. It's just you might not have it like pronto like you would in some bigger cities.

Kirstin (16:16):
Right. Also, downtown Fairhope, they've started a free shuttle service. So there's a limousine golf cart that drives you around, takes you from end to end and restaurants and

Dr. Koehler (16:27):
A limousine golf cart.

Kirstin (16:29):
It's just like a long golf cart that can fit people on it, but it's free. It's like retired people drive people around.

Dr. Koehler (16:35):
Well, I like the idea. No, that's great. I just never heard of a limousine golf cart.

Kirstin (16:39):
Yeah,

Dr. Koehler (16:40):
I might want one for next time day I go golfing.

Kirstin (16:42):
Oh, there you go. Okay. That's just the city of Fairhope trying to throw something nice in there for us. Can we get DoorDash and Uber Eats and things like that here?

Dr. Koehler (16:52):
Yes, yes, yes.

Kirstin (16:53):
Yeah. Fairhope has amazing restaurants. Are there some mistakes to avoid when traveling for cosmetic surgery, like booking your return flights too soon? Should they have their return flight to go home when they plan this, or should they wait to book that until they're fully ready to go?

Dr. Koehler (17:12):
No, I think it's great to go ahead and book the return flight, but you want to maybe pay that extra money so that if you have to do change your flight that you're not getting charged or not able to change your flight. So I think that's just an important thing. I mean, it costs you a little more to do that with the airlines, but you want to be able to change your return flight if you had to. But I think preparing for once we've had a discussion and we feel pretty good about how long we'd like you to stay and we tell you that and say, okay, yeah, I think you could fly back in a week or eight days. Yeah, go ahead and make your travel plans, but just make sure you have that contingency plan in place.

Kirstin (17:45):
What about not staying close enough to the practice? Would you prefer people don't go stay in Mobile?

Dr. Koehler (17:51):
I mean, I think if you're traveling out of state to have the procedure done, it's kind of nice to be closer because we're going to need to see, we always see everybody for these out of state people. We're going to be seeing you postoperatively before you go. So I mean, you don't have to be right nearby. I mean, if you're a mobile, that's fine. We have lots of people that come from mobile every day for surgery, so it's really up to you. But I think if you're traveling from out of state, being within the Fairhope area is good. The likelihood of needing to go back to surgery is rare. But if it did, I mean, you'd want to be reasonably close by.

Kirstin (18:31):
And Fairhope's a destination. It's fun to just come stay and enjoy the bay and the shopping and everything anyways, but we don't want people to go out the day after their surgery and enjoy the downtown. If you want to come, this is not a vacation. If you want to come enjoy the town, come a couple days ahead of time.

Dr. Koehler (18:49):
You cant come binge drink before the surgery and go out from martinis the day after surgery. Those are in your booklet. You got to stay away from alcohol and yeah.

Kirstin (18:59):
Yes. And we don't want you to walk clear around town after you've just had surgery. Do you have any other things to talk about to avoid?

Dr. Koehler (19:10):
Not to avoid. No. I mean, the things to avoid are going to be in that preoperative booklet, like medications. We'll go through all that. Medications we want you to avoid, but things like alcohol, and obviously for surgery, nicotine is a big thing. We talk about it at consult and pre-op. But yeah, there are things that you do need to potentially avoid, and we'll go over that.

Kirstin (19:30):
Okay. Do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at Alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Koehler.

Dr. Koehler (19:42):
Thanks, Kirstin.

Kirstin (19:43):
Go back to making Alabama beautiful.

Dr. Koehler (19:45):
I'm on it.

Announcer (19:49):
Got a question for Dr. Koehler? Leave us a voicemail at Alabamathebeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.