In my
practice, liposuction is done as an outpatient at an
accredited ambulatory surgical facility under the care of an
anesthesiologist. You'll be given medication through an IV that
will make you sleep. Tiny incisions, which usually require one
stitch, are made in areas giving access to the operative sites.
When possible, I use the belly button, top of the pubic area or
the leg crease. Through this incision, using an instrument about
the size of a pencil, the operative site is wet with a special
solution. Next an external (not internal)
ultrasound wand is rubbed over the outside of each area to be
treated. This is similar to the ultrasound you get when you're
pregnant. The sound waves mix with the wetness and soften the
fat making it easier to extract. With the external ultrasound,
we have less bleeding, bruising and soreness compared to the
other methods previously used in the past. Two other added
benefits are that I can safely remove more fat in one operative
setting and skin recoil seems to be greatly enhanced by the
ultrasound treatment. In fact, in our practice, sometimes we'll
do postoperative ultrasound treatments in the office soon after
the surgery since it seems to reduce swelling faster.
The most common
sites for liposuction are the abdomen, waist, hips, thighs,
knees and chin. Of course, the books tell us the ideal patient
is one who is of average height and weight, with just a little
bulge here or there, who's never carried an extra 30 pounds,
been pregnant and is stretch mark free. However,
this is the real world. Unfortunately, not many of us have the
potential to be Victoria Secret cover girls but,
we all want to look the best we can with what we have to work
with, right? As long as the expectations are realistic, I feel
there is a place for this procedure for those patients who fall
outside that realm of ideal patient selection. Most patients
don't say to us, "I want to look perfect naked or in a
bikini." The average patient says, "I want to tuck in
my shirt, wear a pair of pants with pleats, not look four months
pregnant or improve the shape of my saddle bags or love
handles." Naked perfection is not realistic for most of us.
A change in contour that may make you more comfortable with how
your clothes fit and your general presentation, that's
realistic.
The surgery
center will call a day or two in advance to register you and get
your medical history. They will remind you not to eat or drink
after midnight and tell you what time to arrive. You'll spend
better part of the day at the surgery center. When you wake up
you'll have a girdle or binder on that will be worn, except for
showering and personal times, for 3-6 weeks. This is very
important. If you are advised to wear this garment, please do
so. The girdles have an open crotch. Panties are worn on the
outside so you don't have to pull the girdle up and down every
time you have to use the bathroom. The space from where the fat
was removed needs to stay compressed. The girdle keeps this
space compressed to minimize fluid accumulation and promote
optimal skin recoil. Don't let your skin or the girdle wrinkle.
Keeping everything smooth influences the healing that's going on
inside. If you let tissues crinkle, they may heal that way.
Wear an old
pair of loose fitting, dark colored jogging pants or loose
slacks to the surgery center because you're bound to get a stain
them. The fluid I put in, to interact with the ultrasound waves,
leaks out when you stand up. In the beginning it can be bright
red, bloody tinged and sometimes there's what seems to be quite
a lot the first day. You can place a sanitary pad between the
girdle and your skin over any incision that is leaking to soak
up any drainage. This only last for about a day, sometimes two,
but it can be messy or scary you if you don't know what to
expect. Don't use bleach trying to get any stains out or you
will ruin the elasticity. Biz or Zout work better.
Once you have
met the criteria for release, you will be able to go home. You
will need a driver and help with small children for a day or
two. Keep ice bags on the operative sites moving them around
frequently. You'll be up and about on the first day after
surgery but I like you to take it easy for the first three days.
Sharon or I generally see you in the office within the next
24-48 hours. After this visit, you may remove the girdle and
shower. No tub baths. Put just a skim of Neosporin ointment on
the incision and change the bandaids. Get back in the girdle
after your shower. You might need help the first time or two.
Make sure the fabric placket under the girdle zipper is smoothed
out. Take it easy for the first three days, after this you can
start resuming all normal activity at your level of comfort. If
your job is very physical, plan about 7-14 days off; otherwise,
most women are back to work in 4-7 days. After the healing
process, there are no restrictions. Do whatever sports,
exercise, etc., that you wish, just start gradual and increase
the intensity.
Just like
any other surgery, you can expect postop pain to be more
intense for the first few days. Prescriptions for pain
medication and antibiotics are called to your pharmacy in
advance to avoid the need to stop on the way home. Take your
medication as directed. You can also take Extra Strength Tylenol
(not aspirin) in between the pain medication if you need to.
Bruising is very individual. Some patients hardly bruise at all,
others bruise badly. You may have bruises in areas we didn't
touch (like the pubic area) because your body's like a sponge
inside.
The results are
immediate in that, while you're on the operating room table,
it's like taking the stuffing out of a pillow. However, by the
time you get a look, the bruising and swelling, that's a part of
the normal healing process, has set in. You may be disappointed
and wonder if I really did much. Be patient! You'll see changes
in the first few weeks but it really takes several months before
the subtle residual swelling, that's not very obvious, simmers
down and you really get to the final result.
This surgery is
at a level deep to the skin so don't expect improvement in
cellulite. Any rippling and dimpling you have before surgery
will probably persist, to some degree, after. I've seen a few
people develop a few waves they didn't have before surgery. The
ultrasound seems to have helped with this to some extent.
I always hope
that I can meet your expectations but sometimes patients wish I
had done more… or less… or now that they have this they want
that……
I can usually
do all areas of concern in one surgery. Occasionally, a heavier
patient will have more than what can be done safely in one
surgical setting. For instance, we might do the abdomen and hips
in our first session and plan a second session to do the legs at
a later date.
This is
real surgery. Just because this procedure is a want
and not a need doesn’t mean it doesn’t have the same
potential complications and consequences (like pain) of any
surgery you might have-whether it’s a C-section or an
appendectomy. Despite the fact that, in the hands of those
properly trained in plastic surgery, complications with this
procedure are very few and far between and generally not severe,
you should be aware of a few things. Bodies are not symmetrical
(even) before surgery and they won't be afterwards. However, you
may be overly critical after you've spent several thousand
dollars and gone through a couple days of discomfort. In fact,
you may notice things you never did before. You may be
disappointed that no one seems to notice much of a change but
you. Co-workers, friends and family really don't care if you
wear your shirt in or out, that you have to pin the extra fabric
in the waist of the size 14 pants because you can't get your
hips in the 10 or 12 or that you have a little pooch sitting in
your lap when you sit down. If you think this is important
to anyone but you, pass, because it won't change anything in
your life except how you feel about you. The primary
potential consequences of liposuction are fluid imbalance,
hematoma (collection of blood or fluid under the skin), tissue
loss, bruise, fat shift, sensation change, localization of a
residual pocket of fat (more common around the umbilicus)
inadequate skin recoil, prolonged bruise discoloration and under
or over correction. The nicer the skin quality is to start with
the better….. but it doesn't mean the patient who gains a
flatter abdomen, but has a little crinkle in the skin, will look
at this as any less of a success when she zips up her jeans than
the guy or gal who bears themselves on the cover of Victoria
Secret or G.Q. Everything in life is relative.
The horror
stories you hear about on the talk shows are real, unfortunate
and, for the most part, avoidable. Problems caused by poor
patient selection, unqualified surgeons with lack of proper
medical and plastic surgical training, operating in an
inappropriate facility, upsetting the body's fluid and
electrolyte balance by removing too much fat and fluid at one
time are situations that can be avoided. This is not a surgery
for someone who has significant heart or lung disease, it
shouldn't be done in an office unless it is properly set up for
surgery and any possible resulting emergency, it
shouldn't be done by a physician of another specialty who's just
doing a little plastic surgery on the side. Liposuction is
designed to change contour by reducing fat volume. Although it
can be used as an adjunct, or beginning step, to other
procedures such as abdominoplasty, it cannot take the place of
procedures to tighten muscle or remove skin.
My surgeon’s
fee includes a 24-48 hour postop visit, suture removal at 7-10
days and routine office visits as necessary, usually one between
3-6 weeks and one in 3-6 months.
The typical
expense my patients incur is approximately $5,000 to 6,000. This
is inclusive of my surgical fee and routine followup and
facility and anesthesia fees, which are based on time and
paid to the surgery center separately from my fee.
All fees for
elective cosmetic surgery are payable in advance of the
procedure. My staff will be happy to discuss the details and
payment options including Mastercard, Visa and Discover and
offer advice on financing options you may want to consider.
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