What Is Liposuction?
Liposuction is the most common cosmetic plastic surgery procedure
performed in the United States. Invented in the late 1970’s,
it was introduced in 1982 to the United States, where it is now performed
on more than 400,000 people annually.
Liposuction is also known as “lipoplasty” or “suction-assisted
lipectomy.” All of these refer to the removal of unwanted lumps,
bulges, and areas of fat using a thin suction metal tube or a “cannula.” This instrument is inserted into subcutaneous body fat through small incisions. A strong vacuum is then applied through a hose
attached to the cannula, which draws fat from under the skin.
The
term “liposculpture" refers mostly to the
practice of liposuction where the body parts are contoured and shaped
into a slimmer profile. Because it involves sculpting and contouring,
your plastic surgeon should be one who is blessed with a strong
artistic sense. It is, after all, not the latest liposuction
technique or machine that will give you the ultimate figure. Rather, it
is the skills of the plastic surgeon who uses them!
Three groups of people seek liposuction in order to achieve the ideal
figure:
The first group includes those who are large and wish to reduce
their size, for many reasons, including being able to feel good
in their clothing. These include women who gained much weight after pregnancy,
or who take medications or hormones that cause weight gain. This also
includes people who have gained much weight due to a bodily injury or
disability that prevents them from exercising. And finally, there are
many people who gain weight with aging.
The second group includes those who are generally fit, but who are frustrated
with disproportionate fat buildup in specific areas, such as the abdomen,
hips, thighs, buttocks, knees, upper thighs, cheeks, and neck. The
reason for fat growth in these stubborn areas is genetic and therefore,
cannot be reduced much -- even through exercise or starvation.
The third group includes men who have gynecomastia –
excessive breast growth. Although some of this breast growth is the result
of the actual enlargement of breast glands, there is also extensive growth
of the fatty tissue in the breasts. Breast growth in men is rather prevalent.
In fact, one third of adolescent men grow breasts. One third of this group
actually keeps their breasts into adulthood. This can pose much embarrassment,
loss of self-confidence, and the inability to wear clothes comfortably.
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Who
Is a Good Candidate for Liposuction?
Men and women who have diligently tried diet and exercise to reduce their size, and who have been frustrated time and again because they cannot achieve their ideal size and figure, are good candidates
for liposuction. Often, these are people who have gained disproportionably
large amounts of weight and fat due to pregnancy, or prescribed drugs
such as hormone replacement therapies or cortisone. Also, those who have stubborn areas of localized fat such as “saddlebags,”
“thunder thighs,” “love handles,” and “double chins” are good candidates. These
are areas of the body that, for genetic reasons, are resistant to exercise
and dieting. Patients complain that, rather than losing weight from these
problem areas, they lose it in their face, in their breasts and in parts
of their bodies that they are happy with. This, in turn, makes them feel
as if they appear prematurely older.
 |
As a general rule, the
best candidates for liposuction are those who have maintained
a stable weight for at least six months, whatever their size. |
Who is Not a Good Candidate for Liposuction?
Liposuction is not a “quick fix” that you
can undergo repeatedly as a way of “keeping in shape.” Also,
liposuction is not a solution for correcting unstable or traumatic situations
in your life – such as serious diseases, unhappy marriages or mental
illness. Liposuction cannot make people fall in love with you, or save
your marriage!
Can I Undergo Liposuction If I Have Diabetes, or Other Chronic
Conditions?
Men and women who have chronic health conditions, such as thyroid
disease, diabetes, high blood pressure, and arthritis can still
undergo liposuction – provided that their conditions have been successfully
optimized by their physician. Even as the most commonly performed cosmetic
procedure, liposuction is still major surgery, and must
be treated as such in all cases. A responsible plastic surgeon will perform
blood tests, and take a comprehensive medical history to assure that all
risks of surgery are minimized.
Does Liposuction Have Any Health Benefits?
One of the benefits of liposuction, not commonly discussed by most internists
or family practitioners, is that by reducing your total body fat, liposuction
can help lower your cholesterol, reduce your insulin requirements, and
reduce your risk of heart disease. Also, by removing fatty bulges from
the abdomen, arms and thighs, liposuction enables large people to be able
to exercise more easily and to become more mobile.
One of the greatest joys for me as a plastic surgeon is to see my
patients become thrilled with their new size, look and increased
self-esteem. They are then motivated to maintain a healthier
lifestyle of good eating habits, and exercise. They are determined
that, after the time, effort and cost of surgery, they would never go
back to where they were!
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Does the Fat Removed Through Liposuction Come Back? What Will
Happen If I Gain Weight After Liposuction?
“After fighting my
weight my whole life, I had abdominal liposuction. Now, I
no longer have that beer belly that plagued me. The best part
is, having made this investment and gone through surgery, I am motivated
to eat better, and to exercise more often.”
--Mike, age 43 |
We develop all of our fat cells by the time we reach puberty. When fat
cells increase in a part of your body, you gain weight there. Although
the total number of fat cells remains stable in most people, in cases
of extreme obesity the body can actually increase the number of fat cells
in order to be able to store increased fat. Therefore, the common belief
that patients who undergo liposuction will become “fat” in
other parts of their body is to some extent true.
Fat cells that are removed from a body area do not return. Rather, fat
cells in the remaining parts of the body, not treated by liposuction,
will fill up with fat, thus causing one area to become disproportionately
larger! Therefore, patients who have undergone liposuction need to avoid
gaining significant amounts of weight -- thirty or more pounds.
Does Liposuction Remove Stretch Marks?
No. In fact, the stretch marks can possibly become more noticeable after
liposuction. Stretch marks are caused by excessive stretching, breakdown,
and separation of the deep layer of skin, which is indicative of poor
skin elasticity. Therefore, areas that have many stretch marks will not
have the smoothest and tightest look after liposuction.
Does Liposuction Remove Cellulite?
Cellulite refers to the fatty deposits that form uneven,
wrinkled, dimply skin found on the thighs, hips and buttocks of women. Even when fat is lost from other areas, cellulite remains and
will actually be the last fat to disappear, because it
occurs only when damaged fatty tissue accumulates. Cellulite develops
when connective tissues beneath the skin that shape the fat become weak
and deformed. This connective tissue is made up of fibers, and acts as
an anchor between the muscles and the skin. It also forms the chambers
that hold the fat cells. In areas with poor skin elasticity, excessive
removal of superficial fat can potentially worsen the appearance of cellulite.
What Are the Different Techniques and Methods of
Liposuction?
There are three major techniques of liposuction, involving
different kinds of suction equipment.
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Tumescent Liposuction
Developed about 15 years ago, this is the most common, and safest,
method of liposuction. The term “tumescence” refers to the
swelling and firming of fatty tissues by the means of infusing fluid into
the tissue. After tiny incisions are made where the patient’s skin
covers fatty tissue, the area is soaked with a saline solution that contains
an anesthetic (Lidocaine) and adrenaline to reduce blood loss
and bruising. This reduction of blood loss through the shrinking
of capillaries has been a great advance, enabling plastic surgeons to
remove much fat with little blood loss. Tumescent liposuction involves
swelling the areas to be suctioned with a solution that equals two to
three times the amount of the fat and fluid that will be suctioned out.
In the Super-Wet technique of liposuction, however, the
tissues are infused with an amount of fluid that equals the fat and fluids
that will be suctioned. Super-wet involves the use smaller amounts of,
or no, Lidocaine, thereby reducing the risk of Lidocaine toxicity.
Once the area has been sufficiently plumped up, the surgeon removes these
fat cells through the insertion of a cannula, a tiny
wand like instrument that suctions and removes the loosened fat cells
via a high-power suction machine. The fat then glides through transparent
vacuum-like tubes as fat and fluid are suctioned from your body. Because
of the fluid loss, you need to be monitored carefully by an experienced
anesthesiologist who can balance your fluid intake and output throughout
the procedure.
There is nothing arbitrary about this process. A skilled surgeon, like
a sculptor, has to use his sense of sight and touch to assess the areas
of fat buildup and to contour and sculpt these areas into an ideal form.
It also requires a great deal of arm movement and exertion by the surgeon,
as he or she both suctions and sculpts. The tumescent technique has a low complication rate in and of itself, yet is also used as preparation
for other kinds of liposuction techniques.
Power Assisted Liposuction
In essence, this is liposuction hastened by a vibrating suction
cannula. Developed by a German surgeon, this technique employs
an electric-powered cannula, which like a jackhammer sucks out the fat
faster. In my opinion, while it might help the surgeon to do his or her
job faster, it takes away from the surgeon’s ability to feel the
contour and the topography of tissue as this machine vibrates. Also, this
machine might not be safe to be used in delicate or potentially dangerous
areas such as the neck and face.
Ultrasonic Assisted Liposuction (UAL)
This method was first used in the 1990’s, and was considered an
advance in treating especially fibrous areas, such as the male chests,
back, and flanks. It uses cannulas that bombard subcutaneous fatty
tissues with waves of ultrasound, thereby liquefying them through ultrasound energy and heat. An external method also delivers
this energy by applying a paddle-shaped instrument to the skin. The higher
general complication rate of this technique as compared to other conventional
techniques has recently drawn surgeons away from this fad. Specifically,
ultrasonic assisted lipoplasty (UAL) carries an increased risk of skin
and tissue burns, permanent tissue damage and scarring, nerve damage causing
lasting skin irritation or pain, and fluid buildup or formation of seroma
– cavities of fluid beneath the skin. Because there is insufficient
proof of the safety of UAL devices, the Food & Drug Administration
(FDA) has never approved the marketing and advertising of UAL devices
to be specifically used for liposuction.
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What is Large Volume Liposuction?
“I have already been
laughed out of the offices of a few plastic surgeons, so what you
do seems amazing to me. I have lost 130 pounds in the past
two years. No matter what I do, I can’t get past this
plateau. I’ve tried and tried, but my legs and butt
are never reduced. My arms are huge and make me so self-conscious.
I would love to meet with you as soon as possible. I hope
that you can get me on the right track!”
--Cheryl, age 45 |
What person today has not heard of gastric bypass surgery,
more commonly known as “stomach stapling?” The news stories about musicians, new anchors and other celebrities
who have undergone this procedure are frequent. Yet, only twenty years
ago, the mere mention of gastric bypass would have elicited a declaration
of “that would be malpractice!” In much the same way, our
assessments about the safety of Large Volume Liposuction are progressing.
Notions of what is attractive are constantly evolving. The voluptuous
actresses of the 1950’s would today be considered overweight. However,
while we can’t really define what an “ideal” weight
is, it is widely accepted that a significant portion of Americans today
are overweight. This is both a health issue, and a self-esteem
issue. More than half of American women wear a size 10
or more, and are unhappy with their size.
Just as the safety of gastric bypass surgery was once questioned, so
is the acceptability of Large Volume Liposuction. However,
in the hands of a skilled and experienced plastic surgeon who takes all
of the usual precautions that are observed during any major surgery, a
patient can successfully and safely have large amounts of fat removed.
When approximately two liters of fat (about the size
of a Coca-Cola bottle) are removed, this is considered Small Volume
Liposuction. This is successful when smaller localized “problem”
areas of the body are being contoured. However, the removal of this quantity
of fat will not make a difference in a large person whose goal is significant
size reduction. In the latter case, large volumes of fat, five
or more liters are removed, with the dramatic outcomes- 2 to
5 size reduction in cloth size. The surgeon removes the fat with an eye
towards contouring the area as well. In Large Volume Liposuction, it is
a good practice to combine the Tumescent with the Super-Wet Technique,
as the latter does not use Lidocaine (or uses less), thereby avoiding
the risk of Lidocaine toxicity.
If you are considering Large Volume Liposuction, you
should seek a plastic surgeon who has very extensive experience in performing
this procedure in an optimal surgical facility. A minority of qualified
plastic surgeons specializes in this.
Who Is Qualified to Perform Liposuction?
You would not select an auto mechanic to perform root canal. Similarly,
you should not jeopardize the outcome of your liposuction procedure, or
your well being, by choosing anyone less than the most qualified plastic surgeon.
While many states allow any licensed physician to perform cosmetic surgery,
that does not mean all physicians are competent to do so. In some states,
even dentists are lobbying to perform cosmetic procedures. Because liposuction
is major surgery, you should place your life in the hands
of the most qualified and skilled plastic surgeon. You should also choose
a surgeon who will show you solid “Before and After” examples of his or her work, and whose artistic sense is in sync with the results that you are seeking.
In choosing a surgeon to perform liposuction, you should first choose
one who has been certified by the American
Board of Plastic Surgery (ABPS).
This assures that surgeon has endured the most rigorous training possible,
including three to five years of training in general surgery and two years
of training in plastic surgery. Beware of those physicians who claim to
be “board certified” cosmetic surgeons. This may mean that
they have taken a brief weekend course in a procedure, but does not guarantee
the competence that the American Board of Plastic Surgery ensures. Ideally, you will choose a surgeon who has extensive liposuction
surgery experience, not only experience in plastic surgery in general.
Liposuction, like sculpturing, is an art that is learned through experience,
but can only be perfected by the plastic surgeon who has an eye and feel
for body proportions and contour. This ultimate expert in liposuction
can perceive your body contours and the thickness of fat just by feel.
In essence, you should choose a physician who is also a sculptor.
In a “Practice Advisory on Liposuction- Executive Summary”
published on March 15, 2003, The American Society of Plastic Surgery states the following regarding Training and Qualifications for liposuction:
1) Physicians performing liposuction must be trained as surgeons. A surgeon’s
scope of practice is defined by one of the 10 surgical boards recognized
by the American Board of Medical Specialties (ABMS);
2) Surgeons performing procedures outside of his/her area of training,
defined by the surgeon’s specialty, must obtain additional education,
certification and experience. The ABMS surgeon must have liposuction and
body contouring training as well as operate in his/her area of anatomic
expertise.
The physician who performs liposuction in any surgical setting must meet
all of the following minimal formal training requirements:
a. Basic Education: M.D. or D.O.
b. Be qualified for examination or be certified by a surgical board recognized
by the ABMS: and
i. Complete training in liposuction/body contouring during an accredited
residency or fellowship; or
ii. Complete an eight-hour liposuction/body contouring training course
approved for Category I CME credit with at least three hours of hands-on
bio-skills cadaver training and a comprehensive instructional program
on fluid replacement. Observation by a proctor with liposuction privileges
for the first three clinical procedures is recommended.
c. Operate within his/her area of training and area of anatomic expertise,
which is defined by his/her ABMS Surgical Specialty Board.
3) A physician should have the primary responsibility for providing and/or
supervising anesthesia. A physician should order all anesthesias. Anesthetics
may be administered by a qualified physician, a CRNA under physician supervision,
or by another qualified health care provider under the supervision of
a qualified physician as required by law. The responsible physician must
be physically present in the operating room throughout the conduct of
the anesthetic.
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In Addition to Education, Training, and Experience, What Should
You Seek in a Plastic Surgeon?
A plastic surgeon should be nonjudgmental – accepting
the patient “as is” and with sensitivity toward the patient’s
concerns. At the same time, you should seek a surgeon who will project
realistic results, and not make false promises. Your expectations, and
what the surgeon can achieve for you, should mesh.
What Are the Preferred Facilities for the Performance of Lipsuction?
There been incidents when liposuction deaths or mishaps occurred when patients had liposuction performed in garages, dentist chairs,
or even in doctor’s examination rooms. You should pay special attention
to the facility where the plastic surgeon operates. To
be safe, the surgery must be performed at an accredited ambulatory surgery center, or at a hospital, and the surgeon should have
privileges to perform liposuction at that hospital, wherever the surgery
takes place. If it takes place at a freestanding ambulatory facility,
consider the following:
1. It is certified by the American Association for Accreditation of Ambulatory
Surgery Facilities (AAAASF) or;
2. It is certified by the Accreditation Association for Ambulatory Health
Care (AAAHC) or;
3. It is certified by Medicare or;
4. It is certified by the Joint Commission on the Accreditation of Healthcare
Organizations (JCAHO) and;
5. The facility has a transfer agreement with a local hospital.
To investigate the status of local physicians, visit www.medbd.ca.gov.
You should also discuss who the plastic surgeon employs to administer anesthesia during liposuction, as your life depends on
his or her skills, as well as those of your surgeon. While many surgeons
use nurse-trained anesthetists, you should choose one
who employs a physician who is trained in the specialty of anesthesiology.
A physician is the most skilled and qualified to administer anesthesia
safely, and to address any complications that may arise.
What Is the Difference Between Liposuction
and a Tummy Tuck?
Basically, liposuction is designed to remove excess fat from beneath the skin. Abdominoplasty, or a “tummy
tuck,” is designed to remove excess skin and to tighten
the abdominal wall and skin. While liposuction can significantly reduce
the clothing size in a person who is generally obese, a tummy tuck may
not change clothing size at all. On the other hand, a person who has lost
much weight and has loose, hanging skin that makes everyday
tasks and wearing clothing difficult, a tummy tuck is more effective.
What Are the Major Risks and Potential Complications of Liposuction?
Like any non-cosmetic major surgery, liposuction has potential risks
and complications. Therefore, you should consider it as seriously as you
would any major surgery.
What Are the Common Minor Complications,
or Consequences of Liposuction?
Changes in Skin Sensation. This is a normal consequence
of liposuction that occurs in everyone to a different extent. You may
experience "paresthesias," which is an altered sensation at
the site of the liposuction. This may either be in the form of an increased
sensitivity (pain) in the area, or the loss of any feeling (numbness)
in the area. This sensation is permanent in very rare cases. However,
in almost all patients it goes away within the first two to four months
after surgery. Massaging the area of liposuction helps increase circulation,
and facilitate return of normal skin sensation.
Swelling. This is also a normal occurrence that occurs
in every patient. Compression garments and post-operative massage help
to minimize this, as well as reducing its duration to less than two months.
Bruising: There will be bruising in many areas that are
liposuctioned, as well as in adjacent or dependent areas. For example,
people who have abdominal liposuction experience swelling and bruising
in their genitalia. This is not because these areas are actually liposuctioned.
However, bruises usually move downward due to gravity, and can thus temporarily
accumulate in the genitalia. Some bruising can last a long time or even
lead to permanent skin pigmentation. Sun tanning immediately after surgery
can cause these bruises to become permanent skin stains.
Skin Irregularities or Wrinkles: The extent of this depends
on the elasticity of the suctioned skin areas. People who have many stretch
marks, cellulite, or skin dimples have poor elasticity and therefore will
have more skin irregularities or wrinkles. Usually, post-operative massage
helps to smooth these areas.
Asymmetry: No two halves of the body are identical. Therefore,
following liposuction, there may appear to be very slight differences
between the contour and size of the two sides. Scoliosis or other spine
derangements can magnify body asymmetry.
Muscle Spasm: It is very common to get temporary muscle
spasm or cramps in the areas that were liposuctioned. This usually resolves
quickly by itself or can be helped by gentle heat and massage.
Pain and Discomfort: You should expect to have pain or
discomfort similar to a feeling of having worked out too hard. Some of
this may feel like a stabbing pain in the liposuctioned areas, and in
adjacent areas. This can usually be managed by pain medications, and it
generally lasts for a few weeks. Rarely, and in people with Fibromyalgia,
or other forms of chronic pain syndrome, there can be a worsening of the
patient’s baseline pain.
Depression, emotional, or sexual changes: There have been reported
incidents of post-liposuction depression similar to postpartum depression.
While this is usually temporary, patients need to address it with their
physician.
Seroma or fluid collection: After liposuction, there
may be a pooling of serum, the straw colored liquid from your blood, in
areas where tissue has been removed. While this can be a common problem
with Ultrasound Assisted Liposuction (UAL), it rarely occurs with standard
Tumescent Liposuction. Your surgeon can alleviate these by draining them
with a small needle in an office procedure.
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Rare and Severe Complications:
Infections. Infections may happen after any surgery and
may rarely occur after liposuction. Because we routinely prescribe an
antibiotic to all patients undergoing liposuction we have never yet seen
a patient who has developed post-operative infection after liposuction.
Extremely rarely, infections may be serious or life threatening such as
in cases of necrotizing fasciitis (bacteria that eat away at the tissue)
or with toxic shock syndrome, a serious, sometimes fatal infection caused
by a bacteria, that is associated with surgery (such as is sometime caused
by the use of tampons).
Embolism. This is also extremely rare and is lessened
by early postoperative mobility so that blood does not have time to become
stagnant in calf muscles. Fat embolism may occur when fat is loosened
and enters the blood through blood vessels ruptured (broken) during liposuction.
Pieces of fat get trapped in the blood vessels, gather in the lungs, or
travel to the brain. The signs of pulmonary emboli (fat clots in the lungs)
may be shortness of breath or difficulty breathing. If you have the signs
or symptoms of fat emboli after liposuction, it is important for you to
seek emergency medical care at once. Fat emboli may cause permanent disability
or, in some cases, be fatal.
Visceral Perforations (puncture wounds in the organs). During liposuction, the physician is unable to see where the cannula,
or probe, is. It is possible to puncture or damage internal organs during
liposuction. This may happen, for instance, if the intestines are punctured
during abdominal liposuction. When organs are damaged, surgery may be
required to repair them. Visceral perforations may also be fatal.
Skin Necrosis (skin death). The skin above the liposuction
area or at the site of stab wound incisions may become necrotic
or “die.” This is more prevalent with Ultasound Assistant
Liposuction. When this happens, skin may change color and be sloughed
(fall) off. Large areas of skin necrosis may become infected with bacteria
or microorganisms.
Burns. During Ultrasound Assisted Liposuction, the ultrasound
probe may become very hot and can cause burns.
Fluid Imbalance. Fat tissue, which contains a lot of
liquid, is removed during liposuction. Also, physicians may inject large
amounts of fluids during liposuction. This may result in a fluid imbalance.
While you are in the physician's office, surgical center or hospital,
the staff will be monitoring you for signs of fluid imbalance.
However, this may happen after you go home and can result in serious conditions
such as heart problems, excess fluid collecting in the lungs, or kidney
problems as your kidneys try to maintain fluid balance.
Toxicity from Anesthesia. Lidocaine, a drug that numbs
the skin, is frequently used as a local anesthetic during liposuction.
You may have had a similar drug, Novocaine, to numb your mouth at the
dentist. Large volumes of liquid with lidocaine may be injected during
liposuction. This may result in very high doses of lidocaine. We try to
minimize the potential for Lidocaine toxicity by greatly limiting the
extent of Lidocaine used during general anesthesia. The symptoms of this
toxicity are lightheadedness, restlessness, drowsiness, tinnitis (a ringing
in the ears), slurred speech, metallic taste in the mouth, numbness of
the lips and tongue, shivering, muscle twitching and convulsions. Lidocaine
toxicity may cause the heart to stop, resulting in death. In general,
any type of anesthesia may cause complications and is always considered
a risk during any surgery.
Fatalities Related to Liposuction. There are numerous
reports of deaths related to the liposuction procedure. Studies conducted
to date have not been definitive, so it is difficult to be sure how often
death from liposuction occurs.
Some studies indicate that the risk of death due to liposuction is as
low as three deaths for every 100,000 liposuction operations. However,
other studies indicate that the risk of death is between 20 and 100 deaths
per 100,000 liposuction procedures. One study suggests that the death
rate is higher in liposuction surgeries in which other surgical procedures
are performed simultaneously. In order to understand the extent of the
risk, one study compares the deaths from liposuction to that for deaths
from car accidents (16 per 100,000). It is important to remember that
liposuction is a surgical procedure and that there may be serious complications,
including death.
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Prior to Surgery
The surgeon will provide very specific instructions prior to surgery so you will have an optimal and safe experience. These
includes what medications to avoid to prevent excessive bleeding and bruising,
required medical exams, what to eat and drink prior to surgery, and the
prescription of an anti-nausea pill to take on the morning of the surgery.
In all cases, you will be asked to have a reliable friend or family member
take you home after the surgery, as you will not be allowed to drive.
Also, take care of all your chores and to do things before your surgery
so you don’t have to worry about taking care of things early during
your recuperation. This means if you usually clean the house do it in
advance of our surgery. Also have your hair cut and colored, wax your
legs, pay your bills, and take your dog to the vet ahead of your surgery.
Pre-operative Instructions From the Office of Dr. Sean Younai:
1. If you are older than 45 years, or have heart disease,
we require a pre-operative EKG, which would either be
done by your internist, cardiologist, or at our facility. Heart disease
and all other medical illnesses need to be monitored first by an internist
or specialist.
2. If you are anemic, or have a low blood count, please notify our office well in advance of surgery so that we
can start you on Iron supplement. You cannot have liposuction if you are
anemic.
3. Pre-operative laboratory blood and urine tests are
done usually within 10 days of your surgery date. If you do have health
insurance this might be covered, otherwise, the laboratory will charge
you.
4. If you have specific medical illnesses, allergies,
or physical handicaps, please notify our staff during your pre-operative
visit.
5. Please refrain from taking any Aspirin, Aleve, Advil, Motrin or other
NSAID for ten days before your surgery. These drugs can increase the incidence
of bleeding and bruising.
6. Do not drink or eat after midnight, the night before your surgery.
This means no coffee or breakfast in the morning of your surgery. You
should take all your medications with a little water.
7. Please remove and leave behind all jewelry, watches, and body rings
before you come in for your surgery. Please do not wear any makeup or
perfume.
8. Before leaving home for your surgery, take one “nausea pill”-
COMPAZINE - with a little water.
9. Please wear comfortable and loose clothing the day of surgery. It would
be helpful if you wear front open tops and loose sweat pants.
10. We ask you to check the fit of your compression garment in advance
and to bring it with you to surgery.
11. You should make arrangements for a responsible adult friend or family
member to take you home after surgery. You are not allowed to drive yourself
home or take a taxi. After surgery, this caregiver is required to stay
with you and to monitor and assist you for at least the first 24 hours
after surgery. If you don’t have such a person please let us know
in advance so that we can help you make arrangements for a stay at an
after-care facility or hospital.
Having a support system of family, friends or a professional caregiver
in the days following surgery is of the utmost importance, as the patient
will need assistance with everyday tasks, such as going to the bathroom.
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What Should You Expect During the Recovery Process?
When patients leave the surgery facility to go home, they are usually
groggy for about 12 hours -- or overnight. That is why it is very important
to have someone who can assist you with getting around and taking your
medications for at least the first 24 hours.
Make sure that you have all your medications, cold drinks, and towels
at your bedside.
Most people are nauseated during the first 24-48 hours. To reduce this,
we suggest that you take your nausea pill one hour before taking your
pain pills or antibiotics. While it is good to drink plenty of liquids,
please refrain from drinking plain water or acidic fruit juices because
they will make you more nauseated.
Do not be alarmed when blood-tinged tumescent fluid oozes from your incision sites. This is a normal result of liposuction
and usually stops within half a day. The surgeon leaves these tiny incisions
exposed so that the liquid spills out, thereby minimizing bruising. You
should cover your bed to avoid staining from this fluid.
There will be some swelling and some minimal bruising which dissipates five to eight weeks following surgery. Despite this swelling,
you will be smaller than your original size. However, you should wait
to buy new clothing until your size has stabilized.
Following
liposuction surgery, you are placed in a support garment that covers all
liposuctioned areas. Do not remove this until your doctor instructs you
to do so. We usually have the patient remove their garment and to take
a shower after 2 days. The first time that you remove your garment you
will feel faint, which is normal. Have someone with you at that time.
After your first shower you need to apply Vaseline or heavy lotion all
over liposuctioned areas to elevate the itchiness that is caused by the
skin-drying effects of liposuction. This is a good time for you to start
massaging the liposuctioned areas. You should massage these areas deeply
about three times a days for about six weeks. Sometimes, patients whose
skin was not firm and elastic will experience dimpling or wrinkling of the skin. These can be eliminated or
minimized by massaging and early exercise.
All liposuctioned areas stay numb for four to eight weeks. Massage will
help to desensitize your skin in order to avoid hypersensitivity or skin
irritation.
The most important way that a person can contribute to having a great
result is by being meticulous about conducting massage.
Most patients will have ¼ inch incisions that
will heal and become for the most part unnoticeable.
Patients will also feel a bruise-like or muscle cramp-like pain,
particularly in the areas where fat was removed, and which will be addressed
through a prescription from your surgeon.
Antibiotics are prescribed to reduce the risk of infection.
“After I had liposuction
on my love handles and on my hips, I felt really sore – a
burning feeling as if I had worked exercised too much. My
back especially would feel that way. But massaging the area
a lot with oils and creams and applying heat was very helpful.”
- Renee, age 35 |
Patients can hasten their recovery by moving as much as they can, to
increase their circulation. Many will find this difficult, but should
push themselves to take at least small steps. The walking will reduce
your risk of blood clots. It is helpful to elevate the
areas where you had liposuction, by placing pillows under those areas.
Support garments should be worn 24 hours a day for three
weeks, and then during the daytime for the next three weeks. This will
help to reduce swelling, and to help shrink the skin.
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When Can I Resume Work and Exercise?
Most patients can resume normal activities three to seven days following
liposuction. You can even resume exercising within that time frame. However,
you should resume activity only as is comfortable for you. You will probably
be restricted as to lifting, pushing and pulling because your muscles
will be bruised. Most patients return to work within a week, or less.
How Painful Is Liposuction?
Because liposuction only involves the fat beneath the skin, and not entry
into the abdominal cavity or cutting or tightening of muscles, most people
describe it as feeling like a bad bruise. Others say
that you might feel like you do after a heavy workout. For the majority of patients, liposuction is less painful than a C-section,
hernia surgery, breast surgery, abdominal surgery or a hysterectomy.
“I decided to
have liposuction after a relentless cycle of losing and gaining
weight. I couldn’t bend over and touch my toes because
my stomach was in the way. Stretching to reach for things
at my job was difficult too. But my husband didn’t want
me to have the surgery – he said he loved me the way I was.
It’s been a month since I had abdominal, hip and neck liposuction.
I’m already much smaller and I’m motivated to stay on
my diet and exercise. My husband is still reluctant to give
me compliments or say that he’s glad that I did this.
But he sees that I feel better about myself and he’s starting
to come around.”
--Janet, age 29 |
When Can I Resume Sexual Relations?
Liposuction does not hinder your ability to have sexual relations. However,
you should resume sexual activity only as you feel comfortable
in doing so. The desire to resume having sex varies from patient
to patient.
How Will Liposuction Affect My Stamina?
As with any major surgery, liposuction will have an impact on your energy
level. While you can resume normal activities within a week, you will
experience variations in your stamina, sometimes from
day to day. While there will be days when you feel as you did prior to
surgery, you will not feel 100 percent yourself consistently in the four
to six weeks following surgery. Sometimes you will feel a burst
of energy, and sometimes you will feel exhausted,
possibly without any warning. You should feel prepared for this ebb
and flow in your stamina.
Will Having Liposuction Affect Me Emotionally?
Liposuction is a transformation that not only alters your body, but it
also changes your image of yourself, as well. It will also alter the way
that others perceive you. You can make the best-- or worst of this --
as with any life-altering experience.
While achieving their desired figure is exciting for most people, there
can also be a difficult adjustment period for patients,
significant others and friends.
Sometimes a feeling of guilt accompanies achieving the
desired results. Some patients, especially those who have devoted themselves
to the needs of others before fulfilling their own needs, feel undeserving,
or conflicted about investing in themselves. Many patients
suffer due to the puritanical heritage of the United
States. Taking steps to improve our looks is often seen as a selfish thing
and is thus frowned upon. Issues also stem from our culture’s negative
attitude towards aging. While other cultures revere the
elderly, and the wisdom that accompanies age, our culture maligns the
aging process, and any acknowledgement that we are getting older. Therefore,
we face the pressure of having to look young in order to remain competitive
among our peers.
Unlike women, men who have liposuction are more likely to keep their
cosmetic surgery a secret because they are afraid to be perceived as being
somehow “unmanly” to care about their appearance.
Liposuction results can also pose a dilemma for spouses and significant
others. Sometimes even those who love you will feel threatened by your new attractiveness. Others may feel jealousy.
“After I had liposuction,
I returned to work within one week. There were times that
I couldn’t stop crying, for no reason at all. My doctor
prescribed an anti-depressant, and that helped me to get through
it. Today, I feel like myself again, only better!
--Cathy, age 25 |
Other significant emotional changes include depression and mood swings. These can result, both from the feelings
described above, as well as chemical imbalances that may accompany the
healing process following surgery. These emotions, while normal, should
not be ignored and should be shared with your physician.
Some patients benefit from having an anti-depressant prescription to ease
them through this process.
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Post-Operative Instructions from the
Offices of Dr. Sean Younai:
1. You should make arrangements for a responsible adult friend or family
member to take you home after surgery. You are not allowed to drive yourself
home or take a taxi. After surgery, this cargiver is required to stay
with you and to monitor and assist you for at least the first 24 hours
after surgery. If you don’t have such a person, please let us know
in advance so that we can help you make arrangements to stay at an after-care
facility or hospital.
2. Rest as needed the day of and the day after surgery. You do not have
to stay in bed. Gentle walking at home will help your circulation.
3. Make sure that you drink adequate amount of fluids so that you do not
get dehydrated. You should also monitor your level of hydration by making
sure that you are urinating “light-color” urine at least every
four to six hours.
4. There are no dietary restrictions; however, you should refrain from
eating greasy or acidic foods so that you will not get nauseated.
5. If you are diabetic, make sure to monitor your blood sugar level with
a finger-stick or other usual means, three times per day, for the first
2 days.
6. For the first 24 hours after surgery you might have some blood-tinged
drainage from surgical sites. This is expected.
7. After surgery you will be placed in a garment, which will be covering
the areas liposuctioned. Do not remove garment until the first post-op
visit. Keep the garment straight, in order to lessen dimpling of suctioned
areas.
8. After your first visit with doctor, leave the garment on 24 hours a
day for 3 weeks, removing it only to shower. Avoid hot showers, but warm
water is acceptable. You can replace your garment at this time, as needed.
9. Start gentle fingertip massage (light kneading motion) to operated
areas for 10-20 min., three times daily, for three to six weeks.
10. The fourth week after surgery, wear the garment during the day and
remove it at nights to sleep. At this time you may purchase another garment
at your local department store (i.e. J.C. Penny’s, Sears, Target).
Make sure that the garment is not too constricting but tight enough to
give you support.
11. Refrain from extraneous activities or exercising for the first two
weeks. Although you can do gentle walking during this period, unless it
is not a challenge for you.
12. After two weeks you can resume your exercise routine if you feel comfortable
and strong enough.
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What
Are the Most Common Reasons for Patient Dissatisfaction?
Less than desired results are a common complaint among patients who have
had liposuction on multiple areas on the same day. This
is because there is a limit to how much fat can be removed safely at one time. Surgeons who attempt to treat too many body areas on a single
day are obliged to remove less fat from each individual area. Therefore,
it is best to limit liposuction to one or two body areas during the same surgery.
Skin irregularities or lack of smoothness can be a complaint.
Smooth results that look natural are of great importance. Cannulas (the
metal wands that are used to suction fat from beneath the skin) that have
a relatively large diameter tend to produce results with more irregularities
than do smaller cannulas. Smooth results also depend on patient’s
skin elasticity, the body area, and how meticulously patients massage
the suctioned area following surgery.
Seven Steps to Achieving Satisfaction With Your Surgery
1.
Do your research;
2. Ask questions;
3. Check the credentials of your doctor, and of the surgery facility;
4. Know your goals;
5. Have realistic expectations – no human being can attain “perfection;”
6. Follow your doctor’s instructions thoroughly;
7. Be patient during the healing process. You just had major surgery;
and you didn’t buy a new body off the rack!
Links:
www.Beautifulfigure.com
www.Extremeliposuction.com
www.Plasticsurgery.org
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