Liposculpture Procedure
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 write down any questions for further discussion when we meet.
We no longer perform liposuction just to remove "bulges". Instead, we do circumferential sculpting, which is 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. This procedure can be considered for the improvement of your figure in either one, or several, specific areas. You must clearly understand the limitations of the procedure, as well as how it is applied according to each specific situation. As is true of any surgical procedure, how familiar you are with lipoplasty will also influence the amount of improvement that can be expected. Additionally, there are certain potential risks and complications with this procedure that can be minimized with proper preparation on your part.
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 consequently unhappiness on your part. Just as important, 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 to correct these issues. In general, patients with firm elastic skin, minimal wrinkling and redundancy, stable and controlled weight and 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 most improved following this procedure. In addition, other areas that can improve with suction lipectomy are the lower abdomen, ankles and flanks.
As part of your evaluation, photographs will be taken prior to surgery. 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 anesthesiologist, who remains in attendance throughout the operation. Prior to surgery, our anesthesiologist will provide additional information and answer any questions you may have. Required monitoring, anesthetic delivery and emergency equipment are present at all times.
Pre-Operative Preparations
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work needs to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to a local one in your area; we do not provide these services. It will be required that all pre-op paperwork be in our office 1-2 weeks prior to surgery.
It is very important that our office be aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior or 2 weeks after surgery. This would greatly impede your healing. Talk to us about your options.
It is a required that someone drive you home upon discharge. Also arrange for transportation to and from our office for your post-operative appointments until we give you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior or 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.
It is important that prior to undergoing liposuction patients be capable of maintaining a stable weight with the aid of diets and exercise. One’s stable weight is better than an artificial or temporary low, or high, weight.
Patients should be well hydrated prior to the procedure.
After Care
If extensive liposculpture is performed or if the patient desires, post-operative convalescence time can be spent in an after-care facility. These small, comfortable and elegantly furnished establishments are designed to provide personal nursing attention, meals and transportation to-and-from the office. Our staff can provide more information about these facilities.
The Surgical Procedure
Liposuction is performed either in a major hospital or in our outpatient-operating suite. Operating time can vary between one and four hours, depending upon how much work is to be done. 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 conjunction to liposuction, the most common being abdominoplasty, and/or breast reduction. Additional procedures can, and will most likely, increase operating time, as well as the potential for blood loss.
Risks and Complications
All surgical procedures involve risk. The administration of any medication can have an unpredictable, and in extreme cases, fatal outcome. Every precaution is taken to prevent such an occurrence, but are prepared to control, manage and resolve any situation, if necessary. We operate the safest private practice possible taking any additional safety measures, which in our opinion, are mandatory; and unlike other physicians, at no additional cost to you.Some waviness, rippling and dimpling of the skin may appear in certain areas following liposuction. This may occur to a small extent even in the most ideal of circumstances. However, it is more likely to occur if there were pre-existing waves or dimples in the skin due to laxity of the skin. There may also be an excess of contouring due to post-operative fluid accumulation or incomplete removal of fat, resulting in a somewhat asymmetric appearance of the body when comparing one side to the other. This situation can usually be rectified by an additional minor liposuction surgery performed 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, and in very rare occasions, become permanent. Abnormal firmness in the tissue beneath the skin may require treatments with ultrasound, massage, or hydrotherapy. In addition to the aforementioned, there are other potential complications such as: venous thrombosis, pulmonary thromboembolism, fat embolism, fat embolic syndrome, three to six months persistent tenderness and swelling, inflammation, 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 to the face and neck area, injury to the nerves may occur resulting in temporary or permanent weakness of the muscles that control facial expressions.
It is important to understand that this type of procedure involves a great deal of risk, and although complications are extremely rare, they do exist. 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.
Liposuction is a serious procedure and we take the most critical of measures to ensure your safety and protection.
What to Expect After Surgery
Generally following the procedure, a pressure garment is 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. Often times the bruising will appear to spread to lower areas of the body as you become more active. This is normal and the bruising will generally resolve itself within three weeks. 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 continuously be worn, at all times, for a minimum of one week. It is suggested that after the pressure garments are removed, a ‘support type’ pant hose be worn for at least one month following the surgery.
During the first week following liposuction expect discomfort, swelling and bruising to be at its highest. Between week one and week two, it is not uncommon to feel somewhat fatigued; and at 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 our attention. Between the third and sixth week after surgery you will get a sense of relief and you will be able to resume normal activities.
Remodeling of the tissues continues to take place for the first three to six months following the procedure, except for liposuction of the ankles area which may require six to nine months for complete resolution and healing. This is a remodeling function of the tissues beneath the skin, as well as some shrinkage of the skin due to its own elasticity. Once you’ve allowed the healing process to take place (approximately 6 months after surgery), a "touch up" procedure may be required; liposculpture is not designed to remove all the fat. These subsequent procedures may or may not be necessary. It depends upon the results of the surgery and your level of satisfaction. If these procedures are required, we ask the patient cover only the cost of the surgery. "Touch up" procedures are designed to achieve symmetry and not to remove more fat. It is always our intention to remove the most amount of fat possible, however, safety is our number one concern and we only operate by strict aesthetic guidelines.
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: The patient is encouraged to ambulate soon after surgery, with frequent periods of resting.
Optimal sleep position is on your back, elevated with 2 pillows, a pillow under each arm, and a pillow under your knees.
First Shower:
Three days after surgery 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 the first time you shower. Your garment can be hand-washed and air-dried at this time. Continue wearing the garment for about 2 more weeks.We highly recommend you apply Arnica gel to all bruised areas after every shower.
After 2-3 weeks, or when all scabs have fallen off: Begin applying Scarease gel (lightly every night), and Vitamin C & E serum (lightly every morning) directly to incisions. Do this 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 of your 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 hyperpigmented scar.
