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• What all do I need to know to be prepared for Liposuction, or Liposculpture?

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What all do I need to know to be prepared for Liposuction, or Liposculpture?

To our patients: The following information has been prepared to enable you to understand what liposuction is, what it can and cannot accomplish, a description of the risks involved, and in general what your experience will be after the surgery. Please read this information carefully, and jot down your questions for further discussion with me. We no longer perform liposuction just to remove "bulges" - rather a circumferential sculpting is performed - now termed liposculpture. Smaller canulas, and, in select patients, the "ultrasound" or "laser" liposuction can be used.

GENERAL INFORMATION
Liposuction surgery has now become the most commonly performed operation in Plastic Surgery. You are considering this procedure for the improvement of your figure in either one specific area, or in several areas. As is true for any surgical procedure, lipoplasty has specific indications, which will influence the applicability of the procedure to your particular situation, and which will also influence the amount of improvement which can be expected following the procedure. Additionally, there are certain potential risks and complications with this procedure, which can be minimized with proper preparation on your part, as well as understanding of the limitations of the procedure.

WHICH PATIENTS WILL BENEFIT FROM THE PROCEDURE
Patients seeking liposuction for improvement of body contour have generally tried multiple diets and exercise programs, to no avail. It is important to realize that suction lipectomy is not a method of weight reduction in itself. The procedure is designed specifically to improve body contour. Therefore, it is important for you to be at or close to the baseline weight. Further weight gain following the procedure may compromise the ultimate results and will result in unhappiness. We do not recommend crash diets before liposuction/liposculpture, as patients will invariably gain weight after surgery.

Suction lipectomy will not change the appearance of the skin. Skin that is loose, dimpled, wrinkled, or having multiple depressions or waves prior to surgery, will not be improved following surgery. Other procedures may be required for improvement of this type of skin. In general, patients with firm elastic skin with minimal wrinkling and redundancy, with well-controlled and stable weight, and with limited areas of fatty tissue excess, can expect the most favorable results. Localized deposits of excess fat in the hips and "saddle bag" areas, as well as inner and outer thigh areas, are usually quite improved following the procedure. In addition, other localized areas in the lower abdomen, ankles, and flanks may be improved by the procedure.

Prior to surgery, as part of your evaluation, photographs will be taken. Photographs are as important to the plastic surgeon as x-rays are to the physician in other medical specialties. These photographs are part of your confidential medical record, and will be used to assess the degree of improvement that has been achieved following surgery.

THE ANESTHESIA
Liposuction is performed under a "light" general anesthetic (patient is asleep). This technique provides excellent operating conditions while affording maximal patient comfort and safety. The anesthetic is administered by a board certified doctor anesthesiologist, who remains in attendance throughout the operation. All of the required monitoring, anesthetic delivery and emergency equipment are present at all times. Further information, including any questions you may have will be explained and discussed fully by our anesthesiologist prior to your surgery.

PRE-OPERATIVE PREPARATIONS
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work will need to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to local doctors in our area. We do not provide these services. It will be required that all this pre-op paperwork be in our office 1-2 weeks prior to surgery.

It is very important that our office is aware of any medical conditions and all medications you are taking.

It is imperative that you not smoke 2 weeks prior to surgery, and 2 weeks after surgery. This would impede your healing greatly. Talk to us about options.

It is a required that someone drive you home upon your discharge. Also arrange for transportation to and from our office for your post-operative appointments until your doctor gives you permission to drive.

DO NOT take aspirin or aspirin-containing products for 2 weeks prior to surgery and for 2 weeks after surgery.

An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.

If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.

Prior to undergoing liposuction, it is important for patients to have reached and to be capable of maintaining a stable weight with the aid of diets and exercise. It is important to realize that it is better to be at one's stable weight rather than an artificially or temporarily low or high weight.

Patients should be well hydrated prior to the procedure.

AFTER CARE- If large volume liposculpture is performed, or if the patient desires, many patients choose to spend the immediate post-operative convalescence in an after care facility. Our staff will describe these facilities to you. These are small, comfortably and elegantly furnished establishments which serve the purpose of giving you personal nursing attention, meals and transportation to and from the office.

THE SURGICAL PROCEDURE
Liposuction is performed in a major hospital or our outpatient-operating suite. The length of the operating time varies between one and four hours; depending upon how much work is to be done in various areas of the body. Incisions for the procedure are generally less than one quarter inch in length and are placed in inconspicuous skin folds with minimal or no shaving of hair. Other procedures may be performed in addition to liposuction, most commonly abdominoplasty, or breast reduction. These procedures will influence the overall length of operating time, as well as the potential for blood loss.

RISKS AND COMPLICATIONS
In any surgical procedure, there are risks involved. Certainly the administration of any medication can have an unpredictable and in extreme cases, a fatal outcome. Every precaution is taken to prevent possible drug sensitivity, and if it should occur, to treat it properly and to avoid any dire consequences. We operate the safest possible private practice. These additional safety measures are in our opinion mandatory, and do add cost to our surgeries compared with other physicians.

Some waviness and/or rippling and dimpling of the skin may be noticed in certain areas following liposuction. This may occur to a small extent in even the most ideal circumstances, but it is more likely to occur if there were any pre-existing waves or dimples in the skin due to laxity of the skin. There may be relative contour excesses due to post-operative fluid accumulation of incomplete removal of fat in certain areas. This may result in a somewhat asymmetric appearance of the body when comparing one side to the other; however this situation can usually be rectified by an additional minor liposuction surgery done at a later time. A small number of patients develop pigmentation of the skin in the treated area and may develop scar tissue in the overlying skin. These usually disappear spontaneously after several months, however in a very few patients this discoloration of the skin has been permanent. Abnormal firmness in the tissues beneath the skin may require treatments with ultrasound, massage, or hydrotherapy in the post-operative period if it does not show signs or spontaneous resolution. In addition, there are other potential complications including venous thrombosis and pulmonary thromboembolism, fat embolism and fat embolic syndrome, tenderness and swelling which may persist for up to three to six months, inflammation and infection, and seroma and hematoma accumulation. In extremely rare cases, excessive blood loss or dehydration, leading to hypotension, shock, and other cardiovascular problems may occur. In cases of liposuction performed in the face and neck area, there may be temporary or permanent weakness of the muscles of facial expression due to injury of the nerves. Liposuction is real surgery and we do not skimp on safety.

It is important to realize that although these complications are extremely rare, there are risks involved in the procedure which must be acknowledged as a possibility. For this reason it is extremely important that patients provide full details of their medical history including pre-existing medical conditions, any and all medications taken, and history of smoking or hematological problems.

WHAT TO EXPECT AFTER SURGERY
Generally following the procedure, a pressure garment will be placed over the areas that have been suctioned. This is done for your comfort and to minimize the amount of fluid accumulation beneath the skin. Some bruising of the skin is to be expected following this procedure. The bruising will generally resolve within three weeks of surgery, and often times will appear to spread to lower areas of the body as you become more active. This is a normal function of gravity. You will be seen in the office within 72 hours of the procedure, and at that time small dressings which have been applied after surgery may be changed. Generally, your pressure garment will be left in place and should be worn at all times for a minimum of one week. After pressure garments are removed, a "support type" of panty hose is usually suggested for at least the first month following surgery.

Following liposuction, the initial one-week is the period during which any discomfort, swelling and bruising appear to be at their maximum. Between week one and week two, it is not uncommon to feel somewhat fatigued and during approximately the third week even mildly depressed. This is normal following any type of cosmetic surgery, but excessively prolonged periods of depression should be brought to my attention. Usually between three and six weeks there is a feeling of relief and you will generally be able to begin resumption of your normal activities. Remodeling of the tissues may continue to take place for the first three to six months following the procedure, except for liposuction of the ankle areas which may require six to nine months for complete resolution and healing. This is a function of the remodeling of the tissues beneath the skin, as well as some shrinkage of the skin due to its own elasticity. It is important to note that occasionally "touch up" procedures may be required at six months after surgery and must be delayed until that point to allow the healing process to take place. These subsequent procedures may or may not be necessary, depending upon the results of the surgery and your satisfaction with these results. If these procedures are required, we ask only that the patient cover the cost of the surgery. "Touch up" procedures are not designed to remove more fat, just to achieve symmetry. It is always our intention to remove the most amount of fat within safety and aesthetic guidelines. Liposculpture is not designed to remove all the fat.

It is not unusual for a patient to experience a period of the "blues" during the convalescence. This is temporary. It's helpful to remember that it is impossible to judge the final result of your surgery until all of the swelling has subsided and the operative area has smoothed out.

POST-OPERATIVE CARE
Activity: Post-operatively the patient is encouraged to ambulate soon after surgery, with frequent periods of resting.

Optimal sleep position is elevated on your back with 2 pillows. A pillow under each arm, and a pillow under your knees

FIRST SHOWER; on your third post op day you may remove your garment, discard all sponge padding (leave steri-strips alone), and shower. We strongly recommend that you remove the garment, lay down for 10-15 minutes, and then shower. This will prevent you from becoming light-headed, and fainting. Someone should be with you to help you the first day. Your garment can be hand washed and air dry at this time, and continue wearing the garment for about 2 more weeks.

Arnica gel is highly recommended and at this time can be applied to all bruised areas after every shower.

After 2-3 weeks, or when all scabs have fallen off:

Begin using Scarease gel (apply lightly every night), and Vitamin C & E serum (apply lightly- every morning) directly to incisions for several weeks. These products can be purchased in our office, and can be mailed to out of town patients.

RESUMPTION OF PHYSICAL ACTIVITIES
GENERAL RULES OF THUMB

TWO, FOUR, SIX RULE
FIRST WEEK: TAKE IT EASY!!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!

At two weeks: take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.

At four weeks: light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.

At six weeks: resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyper-pigmented scar.

 

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