Tumescent Liposuction

Under Local Anesthesia: Expected Outcomes, Risks & Benefits

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 intravenous 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. (Refer to page 7 for a list of medications that you need to consult the doctor if you are taking any of them).

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 which would 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, 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. Ultimately, after 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 and require a little touch-up liposuction.

Risk of Scarring of the Skin:

Incisions for liposuction may result in scarring. The incisions made for inserting the cannulas are usually less than 2 to 3 mm in length, and are usually virtually invisible once healed. 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. Patients that have experienced hyper-pigmentation, or hypo-pigmentation (pale or light colored scars) in the past might expect to also experience it with these 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.

Liposuction and Obesity:

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.

Postoperative Healing:

Normal healing after tumescent liposuction involves a limited but definite degree of soreness, swelling, bruising, and lumpy firmness. A temporary mild numbness of the skin may persist for up to 4 months. Most patients can actually see some improvement of their silhouette within 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. 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 your Liposuction Procedure

If you arrive during regular office hours, please check-in at the reception desk in the waiting area.

If you arrive before office hours or on a weekend morning, please take a seat in the waiting area until the staff member greets you.

Upon arriving in the Pelosi Medical Center reception area, you will be greeted and asked to sign your surgical consent forms. You will then change into a surgical gown, and be escorted to the operating room. After one last trip to the bathroom, pre-operative photographs will be taken and, finally, the areas on your body that are to be treated with liposuction are marked with a felt-tip pen. Next you will lie down on the surgical table and the physician’s assistant will show you the various positions you will be required to assume during the surgery. Practicing these positions in advance of the surgery helps make the surgery go faster and easier. It usually takes about 30 to 45 minutes after arrival before the surgery begins.

For safety purposes we may place an intravenous (IV) access catheter in your arm; it consists of a small plastic IV tube with a rubber stopper on the outside through which medication can be injected if needed. A blood pressure cuff is placed on your arm and pulse monitor is placed on your finger.

Next, a large volume of anesthetic solution is carefully and gently injected into the targeted fat. Once an area of fat 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 to void.

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 when liposuction is actually done. Therefore minimizing sedation actually improves patient comfort.

After the liposuction procedure is completed, we will offer you a snack. Absorbent pads are placed over the incision. The incisions are so small that no stitches are required. Finally, after the IV-line is discontinued and the post-liposuction compression garment is applied, you are ready to go home. Because some of the local anesthetic remains in the area that was treated, you may not feel any significant soreness until several hours after the procedure is done. Although you will feel well enough after surgery to drive yourself home, you must not do so because large amounts of local anesthetic may cause some drowsiness.

The Tumescent technique that we use minimizes post-operative discomfort. Because the residual local anesthesia lasts for 18 to 36 hours, regular Tylenol is sufficient to treat post-operative discomfort. With the Tumescent technique there is no post-surgical nausea, nor the unpleasant feeling of a "hangover" usually associated with general anesthesia.

Pre–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. Please ask us to clarify anything you don’t understand.

ONE – TWO WEEKS PRIOR TO SURGERY

DO NOT take ASPIRIN (Anacin, Bufferin, or Baby Aspirin) IBUPROFEN (Advil, Motrin, or Nuprin), NAPROXEN (Aleve) or any other non-steroidal anti-Inflammatory drugs (NSAIDS) similar to these medications for 10 days before surgery; these will promote bleeding and bruising. It is permissible to take acetaminophen (Tylenol or Anacin-3). Check the labels of all your medications, even those which you purchase without a doctor's prescription, to be sure you are not taking any aspirin or aspirin-like substances. Remove any products containing aspirin from your medicine chest so that you do not inadvertently take it during the week before your surgery. Consult your physician before you stop taking any prescribed medicines. Please inform us if you are taking any medications to treat arthritis, or any blood-thinning (anti-coagulant) medications. Below is a list of medications that must be stopped.

DO NOT drink alcohol for one week prior to surgery. This might cause excessive bleeding.
DO NOT fast or undergo dramatic weight loss just prior to surgery. You 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 you to cardiac irregularities, surgical complications, or poor wound healing.
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.
DO NOT use moisturizers or soap that contains moisturizers for one week before surgery. The ink markers used to outline the areas on your body to be treated by liposuction will rub-off too easily if you have recently used a moisturizer.
Antibiotics, such as cefadroxil (Duricef), cephalexin (Keftab) relatives of penicillin, doxycycline (Monodox), or ciprofloxacin (Cipro) are to be taken twice daily in order to minimize the risk of a surgical infection. Antibiotics should be taken with food to reduce the risk of gastric upset. Start taking your antibiotic the day before surgery, and continue until the entire supply is completed. If your surgery is scheduled to begin in the early morning (before 9:00 a.m.), taking your antibiotic and eating should be postponed until after surgery.
Lorazepam (Ativan) is a mild sedative and sleeping pill that does not make one feel "drugged." Surgery is more easily tolerated if you are well rested and relaxed. We suggest that you take one lorazepam the night before surgery.
Mephyton (vitamin K) may minimize bleeding and postoperative bruising. Although it is not essential to take vitamin K, we do recommend it. Take one 5 mg tablet daily, beginning two weeks before the surgery.

Day of Surgery

DO NOT wear unnecessary jewelry, perfume, and minimize use of cosmetics. You may use deodorant.
DO NOT drive home. Arrange to have someone drive you home from the Pelosi Medical Center after the surgery.
Diet: You should eat a light, low fat meal, such as toast and juice, fruit, dry cereal and/or non-fat milk no less 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. Minimize caffeine intake the day of surgery. You will be given a snack as soon as surgery is completed.
Wear loose clothing. There is usually quite a lot of drainage of slightly blood-tinged anesthetic solution after surgery. Since this drainage might stain clothing, 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, and may prevent optimal results. Bring extra underpants to wear after surgery.
Bring warm socks to help keep your feet warm during surgery. If you tend 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 at 71 - 74¡ F.
Towels & Plastic Sheets. Plan ahead to 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 car seat during your ride home. Prior to surgery pad your bed at home and your living room chair with towels and plastic. Be careful to avoid allowing drainage to stain carpets.
Music to relax by: Patients usually enjoy listening to soothing quiet music during surgery. If you have any favorite CDs which you would like to share with us on the day of surgery, you are welcome to bring them with you. Please label the plastic case that holds your CD so that we will know to whom it belongs.

Post–Liposuction Instructions

Going Home: You should not plan to drive yourself home. We recommend that you have a responsible adult be with you on the day of surgery.

Diet: Resume your usual diet immediately, but eat light meals in the first 48 hours. Drink adequate amounts of water, fruit juices or soft drinks to prevent dehydration. Avoid drinking alcoholic beverages for one week before surgery and 48 hours after surgery.

Activities: Rest quietly 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. Later in the day or evening you may 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 then 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.

Tylenol Extra Strength (Acetaminophen) 500 mg capsule or tablet does not require a prescription. You may take two tablets, three to four times daily as needed beginning after surgery, to help minimize postoperative swelling and treat any minor post surgery discomfort. If for some reason Tylenol is not acceptable, then notify us at 201-858-1800 so that we can arrange for a suitable substitute.

Post-Op Garment: After tumescent liposuction a post-op garment is worn in order to hold the absorbent pads in place and to provide mild compression that encourages the drainage of the blood-tinged anesthetic solution. The morning after surgery, when you remove the garment to take a shower, you may experience a brief sensation of dizziness. Feeling lightheaded is similar to what you might experience when standing up too quickly. It is the result of rapid decompression of the legs as the post-op garment is initially removed. Should you feel dizzy, simply sit or lie down until it passes.

Beginning the day after surgery, remove the post-op garment daily prior to showering and to wash the garment. The first morning after surgery it is easier if you have someone to help you. The post-op garment and binder (if applicable) should be worn day and night until all the drainage has completely stopped plus an additional 24 hours. Do not be concerned if you drain for several days. Discontinuing the use of the garment and binder early may result in more prolonged drainage. Typically, patients need to wear the garment for 3 to 6 days, although many choose to wear the garment longer because of the comfort it provides. Wearing the post-op garment for more than the minimal number of days provides no significant advantage in terms of the ultimate cosmetic results.

Managing Post-Op Drainage: You should expect a large volume of blood-tinged anesthetic solution to drain from the small incisions during the first 24 to 48 hours following liposuction. In general, the more drainage there is, the less bruising and swelling there will be. During the first 36 hours, you should sit, or lie, on towels. When there is a large amount of drainage, you may want to place a plastic sheet beneath the towel. For the first 24 to 36 hours, bulky super-absorbent pads are worn under the garment. After most of the drainage has stopped, you need only place thin absorbent gauze dressings over the incision sites that continue to drain.

Wound Care & Bathing: Keep the incisions clean. Do not allow scabs to form in the first 72 hours. Shower once or twice daily. Avoid very hot water during the first 48 hours following surgery. First wash your hands, then wash incisions gently with soap and water; afterwards gently pat incisions dry with a clean towel. Apply new absorbent dressings. Incisions that have stopped draining no longer need padding but should be covered with Vaseline or Aquaphor in the first six weeks. Apply sunblock to any exposed incisions in the first twelve (12) months after surgery to prevent hyperpigmentation. Take antibiotics as directed until the prescription is finished. Take antibiotics with food. Call our office if you notice signs of infection such as fever, foul smelling drainage, or local redness, swelling, and pain in a treated area.

DO NOT apply ice-packs or a heating pad to skin overlying the areas treated by liposuction.

DO NOT apply hydrogen peroxide or plastic Band-Aids to incision sites.

DO NOT soak in a bath, Jacuzzi, swimming pool, or the ocean for 7 days after surgery.

Common side-effects of tumescent liposuction: Menstrual irregularities with premature or delayed onset of monthly menstruation is a common side effect of any significant surgery. Flushing of the face, neck and upper chest may occur after liposuction and usually lasts for a day or two. Slight temperature elevation during the first 48 hours after surgery is a natural consequence of the body's reaction to surgical trauma. Discomfort and soreness is worse the second day after surgery, then improves daily. Two extra-strength Tylenol every 4 hours, while awake, for the first 48 hours will reduce the inflammation, swelling, and soreness associated with surgery. Do not take aspirin, ibuprofen or medications that contain these drugs, such as Bufferin, Anacin, Advil or Nuprin for 3 days after surgery; these can promote bleeding. Bruising is minimal with tumescent liposuction. Nevertheless, the more extensive the liposuction surgery, the more bruising you can expect. Pain and swelling due to an inflammatory reaction to surgical trauma may occur and increase 5 to 10 days after surgery; this is treated with antibiotics and anti-inflammatory drugs. Itching of the treated areas several days after surgery may occur as part of the normal healing process. To help relieve the itching, you may try taking Benadryl 25mg capsules/tablets as directed on the packaging. Be aware that Benadryl causes drowsiness. You may also try using oatmeal soap. After 7 days (as long as the incisions are closed), you may soak in a bath with an Oatmeal bath preparation. Benadryl and Oatmeal products may be purchased at most drugstores.

Schedule a follow-up appointment at our office.