Important Information about Tumescent Liposuction
Risks of Liposuction Surgery: Any surgery involves the risk of infection, bleeding, scarring or serious injury, however tumescent liposuction has an amazingly good safety record. One of the reasons that tumescent liposuction is so safe is that neither general anesthesia nor signification IV sedation is required. A recent survey involving over 15,000 patients who had tumescent liposuction without general anesthesia revealed no serious complications, no serious infection, no hospitalizations, no blood transfusions, and no deaths. The greatest risks of liposuction are those associated with general anesthesia. By eliminating general anesthesia, the risks of liposuction are dramatically reduced. Patients can minimize the risk of surgical complications by not taking medications or over-the-counter preparations that might adversely affect the surgery. Patients should inform the surgeon of any medications being taken either regularly, or occasionally, including herbal remedies and dietary supplements.
Risk of Irregularities of the Skin: Tumescent liposuction using microcannulas is the least likely to cause any significant or noticeable post-surgical irregularities of the skin. By magnifying the fatty compartment, the tumescent technique permits more accurate removal of fat, with greater assurance that the liposuction cannula will not inadvertently approach too near the undersurface of the skin and thereby cause irregularities. Thus the tumescent technique helps to minimize the risk of post-surgical irregularities or rippling of the skin. Liposuction might improve pre-existing irregularities of the skin such as dimpling or cellulite, but prospective patients should not assume that there will be significant improvement. It is unrealistic to expect perfectly smooth skin. Patients should expect that their skin will have approximately the same degree of dimpling and irregularities as existed before tumescent liposuction surgery. After tumescent liposuction the skin texture should be within normal limits. A casual observer should not notice any evidence of surgical irregularities of the skin. However, it is possible that a noticeable irregularity of skin may result. If an irregularity occurs, it may require a corrective procedure for which there will be a fee to cover the operating room and nursing staff expenses. Because skin tends to lose some of its elasticity with increasing age and with cumulative sun exposure, older patients might notice some subtle increase fine wrinkles in areas such as the upper abdomen after liposuction.
Risk of Scarring of the Skin: Incisions for liposuction may result in scarring. Tiny (1 to 4 millimeter) round holes in the skin, called adits, are used for inserting the cannulas through the skin and into the fat. Typically, when adits heal they become virtually invisible. Although you may be able to find them upon close examination, most other people would not be able to see them. Some patients may experience temporary hyper-pigmentation (darkening) that usually fades after several months. Some patients may have a genetic predisposition for persistent discoloration at incision sites. Any one who has previously experienced hyper-pigmentation or hypo-pigmentation (pale or light colored scars) of the skin in the past might expect to also experience it with liposuction adits or incisions. Certain areas of the body, such as the back or upper flanks, may be more likely to have pigmentation changes.
Cellulite: Liposuction of the thighs, while improving the silhouette, does not necessarily eliminate the subtle “puckering” of the skin often called “cellulite”. Cellulite results from the pull of fibrous tissue that connects skin to underlying muscle. While tumescent liposuction may reduce the degree of cellulite, it is unlikely to eliminate it. Liposuction should not worsen cellulite.
Smoothness of Results: Liposuction some produce some irregularities of the skin, which can be visible in certain conditions of lighting. In general the smoothness of the skin is much improved after microcannular liposuction. These are usually rather subtle, and imperceptible to the casual observer. It reasonable to expect significant improvement, but the results are rarely perfect.
Obesity & Liposuction: Liposuction is not an appropriate treatment for obesity. Liposuction is not a substitute for a prudent diet, good nutrition, and regular exercise. Obese patients may be good candidates for limited liposuction if their goal is simply to improve the shape of certain limited areas of the body. Obesity is associated with an increased risk of surgical complications.
Postoperative Healing: Normal healing after tumescent liposuction involves a limited but definite degree of soreness, swelling, bruising, itching and lumpy firmness. A temporary mild numbness, itching or burning of the skin may persist for 2 to 10 months. Most patients can actually see some improvement of their silhouette with one week after surgery. However, because of the slow resolution of post-surgical swelling, the ultimate results following liposuction usually require 12 to 20 weeks to be achieved.
Realistic Expectations: Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection. It is impossible to guarantee the precise amount of improvement that will result from liposuction. Patients should not have unrealistic expectations. Although patients can usually expect to achieve at least a 50% improvement, it is unreasonable to expect 95% improvement or near perfection. For the perfectionist, or for liposuction of a very large area, maximum improvement may require a second procedure for which there would be an additional fee.
Patients who would be satisfied with a 50% improvement would be reasonably good candidates for liposuction. The “50% improvement” is intentionally a vague measure. It indicates a definite perceptible improvement, but something short of perfection. If a 50% improvement would make a patient happy, then it is likely that these expectations will be met. Our patients generally achieve more than a 50% improvement.
Longevity of Results: The fat cells that are removed by liposuction do not grow back. If the patient later gains or loses weight, the change tends to be distributed proportionately over the entire body. For the best results the patient’s post-op weight should be less than the pre-op weight. Although one can expect some changes with aging, provided that the patient does not gain large amounts of weight, the patient’s new more pleasing silhouette is relatively permanent.
What to Expect on the Day of Tumescent Liposuction
Pre-Op Preparations: In the operating room pre-operative photographs will be taken and then the areas on your body to be treated with liposuction are marked with a permanent marker. Additional photos of the markings on the body will be taken, and the patient will be asked to initial these photos to confirm agreement with the areas to be treated by liposuction. This process of preoperative documentation typically requires 45 to 60 minutes before beginning the infiltration of the tumescent local anesthesia.
Local Anesthesia: Using the smallest needles available, the doctor or the nurse will anesthetize the skin at sites through which the longer needles or cannulas will be inserted to anesthetize the subcutaneous fat. Patients usually experience a slight pricking sensation as the skin becomes “numb”. A large volume of dilute tumescent anesthetic solution is carefully and gently injected into the targeted fat. Once an area has been well infiltrated with the anesthetic solution, the fat is usually completely numb. The infiltration of the local anesthetic is a slow careful process that can take as long to complete as the liposuction itself. After the infiltration of the anesthetic is complete, but before beginning liposuction, you will be escorted to the bathroom one more time.
Sedatives: Experience has shown that giving a sedative by mouth permits better local anesthesia than when intravenous sedatives are used. This is because an alert patient is more capable of detecting subtle areas of incomplete anesthesia. A patient who is too sedated might easily ignore an incompletely anesthetized area, and then feel more discomfort later during liposuction. Therefore avoiding excessive sedation actually maximizes patient comfort during liposuction.
Liposuction is accomplished through tiny (1 to 4 millimeter) round holes in the skin, called adits. The adits, which are made in the skin with 1 to 4 mm biopsy punches, are so small that they need not be closed with stitches. After surgery, adits remain open for 2 to 5 days and facilitate the post-operative drainage of residual blood-tinged anesthetic solution.
After Liposuction: After completing liposuction, absorbent pads are placed over the adits. Finally, after the Tumescent Liposuction Compression Garments are pulled on, and you are ready to get up and go home. Because of residual local anesthesia, it is several hours after completing the liposuction before any significant soreness begins. The tumescent technique minimizes post-operative discomfort. Because the residual local anesthesia lasts for over 18 to 24 hours, plain Tylenol is usually sufficient to treat post-operative discomfort. Post-operative nausea is unusual after tumescent liposuction. When nausea or vomiting does occur it typically happens 6 to 12 hours after surgery after the patient awakens from a nap. This type of nausea and vomiting usually last for only one to three hours.
Transportation Home after Liposuction: Patients are not permitted to drive themselves home after liposuction except in the case of an especially small amount of liposuction where the patient has not received sedation. Although most patients feel well enough to drive a care immediately after surgery, you must not do so because of the large amounts of local anesthesia may cause some drowsiness. The person who will be driving you home should have a flexible schedule for the afternoon, although patients are typically discharged in the mid to late afternoon, the exact time cannot be precisely predicted.
BEFORE LIPOSUCTION INSTRUCTIONS
Our office wants to provide you with the very best surgical care. You can help to minimize the risk of complications by carefully reading and following your preoperative and postoperative instructions. Ask us to clarify any item about which you have questions.
1.For seven (7) days before surgery do not take ASPRIN (Anacin, or Bufferin, or Baby asprin) or IBUPROFEN (Advil, Mortin, or Nuprin), or NAPROXEN (Aleve) or any other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) that impair platelet function in the normal blood-clotting process. It is permissible to take an acetaminophen (Tylenol or Anacin-3). Please see page 7 for a list of common drugs that contain aspirin.
2.Do not take decongestants such as Sudafed or Actifed for 5 days before surgery. Do not take appetite suppressants such as phentermine (Fastin) for at least 2 weeks before surgery. Do not take Zoloft or other antidepressants and all herbal remedies, unless specifically approved by your surgeon, for two (2) weeks before surgery. Please see page 6 for list of drugs that might have adverse drug interactions with the local anesthetic lidocaine.
3.Avoiding alcohol. We suggest no alcohol during the two days before and two days after surgery )alcohol decreases resistance to infection). Otherwise drinking a small amount of alcohol (for example no more than a glass of wine or beer per day) is permissible during the other days of the week before or after surgery. Avoid red wine for 4 days before surgery to minimize bruising.
4.Do Not Drive Home: Arrange to have someone drive you home after surgery. It is the patient’s responsibility to make prior arrangements to have a responsible adult to meet and accompany the patient after surgery.
5.Do not wear unnecessary jewelry, no perfume (deodorant is OK), and minimize use of cosmetics (survival rations only).
6.Diet before surgery: You should eat a light, low fat meal, such as toast and juice, fruit, dry cereal and/or non-fat milk no closer than two hours prior to surgery. Avoid whole milk, cream, butter, cheese and other foods that are high in fat content as dietary fat slows digestion and delays stomach emptying. Please minimize caffeine the day of surgery. You will be give a snack as soon as surgery is completed.
7.Changing your dressing the morning after surgery is easier if you have someone help you. You do not need to purchase dressings or garments as they will be provided by our nursing staff and sent home with you after surgery.
8.Loose Clothing on the day of surgery: There is usually quite a lot of drainage of slightly blood-tinged anesthetic solution after surgery. Since this drainage might stain clothing, we suggest that you choose your clothing with this in mind. Because we will apply elastic support garments on top of some bulky absorbent gauze padding your clothing should be very loose and comfortable.
Women: Wear a comfortable bra that you would not mind getting stained from the blue ink that is used to mark the surgical areas. Do not wear an exercise sports bra if you are having liposuction on your abdomen or torso.
Men: Speedo-type swim trunks are the easiest type of garment to wear into the operating room for surgery. Jockey-type underpants are acceptable. Boxer-type underpants are less convenient during the surgery, and may interfere with the surgeon’s liposuction technique. Bring extra underpants to wear after surgery.
9.Bring socks to prevent cold toes during surgery. If you ten to get cold hands, you are welcome to bring clean mittens (no leather gloves) to wear during the surgery. The operating room is kept relatively warm, about 72 to 75 degrees.
10.Do not use moisturizers or soap that contains moisturizers for at least a week before surgery. Tape and EKG electrodes will not adhere or stick well to moisturized skin. The ink markers used to outline the areas of your body to be treated by liposuction will rub-off too easily if you have recently used a moisturizer.
11.Towels & Plastic Sheets. Plan ahead and avoid staining the car seat with blood tinged anesthetic solution: Bring a towel, and a plastic sheet (such as a trash can liner) to cover the seat during your ride home. Prior to surgery pad your bed at home, and your living room chair with towels and plastic. Some patients have found it comfortable and convenient to place a felt-backed vinyl tablecloth on the bed, with the felt-side up. Be careful to avoid allowing drainage to stain carpets.
12.Do not fast or undergo dramatic weight loss just prior to surgery. All patients should be on a stable, healthy, well balanced diet for at least 2 weeks before surgery. Liquid diets, extreme low calorie diets, and rapid weight loss diets may predispose to cardiac irregularities, surgical complications, poor wound healing.
13.Music to Relax By/DVD to watch: Patients usually enjoy listening to soothing quite music during surgery or watching a movie on our 50 inch plasma T.V. If you have any favorite CDs/DVDs which you would like to share with use on the day of surgery, you are welcome to bring them with you. Please label the plastic case that holds you CD so that we will know to whom it belongs.
AFTER LIPOSUCTION INSTRUCTIONS
1.Going Home: You should not drive yourself home. It is recommended that a responsible adult be with you on the day of surgery.
Diet: Resume your usual diet immediately. Drink adequate amounts of water, fruit juices or soft drinks to prevent dehydration.
DO NOT drink alcohol 48 hours before or after surgery.
2.Activities: Quiet rest is recommended immediately after surgery. After surgery do not drive or operate hazardous machinery the rest of the day. Do not make any important personal decisions for 24 hours after surgery. Late in the day or evening you are welcome to take a short walk if desired. The day after liposuction surgery you should feel well enough to drive your car and engage in light to moderate physical activities. You may carefully resume exercise and vigorous physical activity 2 to 4 days after surgery. It is suggested that you begin with 25% of your normal work-out and the increase your activity daily as tolerated. Most people can return to a desk job within one to two days after surgery, although one must expect to be sore and easily fatigued for several days.
3.Absorbent Pads are placed over the treated areas to absorb the large volume of drainage of blood-tinged anesthetic solution during the first 24 to 48 hours after surgery. Beginning the next morning after surgery, change the Pads twice daily. During the first few hours after surgery, if you discover some drainage leaking around the larger Pads, simply apply a small absorbent ABD/Sanitary Pads pad over the area by sliding it under the garment.
4.Post-Op Elastic Compression Garments. After tumescent liposuction post-op garments are word in order to: hold the absorbent pads in place, proved compression to minimize bruising, and maximize the drainage of blood-tinged anesthetic solution. The morning after surgery, when the garments is first removed in order to take a shower, the patient may experience brief dizziness and lightheadedness similar to what one experiences when standing-up too quickly. It is the result of rapid decompression of the legs after the elastic garments is removed. If dizziness occurs, sit or lie down until it passes. Dizziness is reduced by first removing the outer garment and waiting 5 to 10 minutes before removing the second garment. Beginning the day after surgery, you must remove the post-op Garments twice daily and take a shower. You may was the garments at these times. Some body areas require two garments, other areas only one garment plus elastic binders (belts).
These should be worn day and night until all the drainage has completely stopped plus and additional 24 hours. Do not be concerned if you drain for several days. Notify us if the drainage persists for more than 8 days. Discontinuing the use of the garments and binders too soon may result in more prolonged drainage. Typically, patients will need to wear the garments for a minimum of 3 to 6 days, although many choose to wear the garments longer because of the comfort they provide. Wearing the post-op garments for a minimal number of days is of no significant advantage in terms of the ultimate cosmetic results. After liposuction of Chin, Cheek, & Jowls, first a spandex head garment is placed to provide mild compression and to hold the absorptive pads in place; next a 2 inch-wide elastic band is placed under the chin and over the top of the head and worn for one hour giving extra compression to minimize bruising. Drainage lasts 1 to 2 days.