Sunday, April 4, 2010

Liposuction Q & A with Dr. Karen Horton

1. How soon will I see liposuction results?

The results of liposuction take at least three months, up to a full year, to be evident.  As with any surgical procedure, you can expect some swelling, bruising, numbness and discomfort that will take a few weeks to resolve.

Postoperative tissue swelling, known as "edema", tends to persist in the tissues that underwent liposuction.  Edema feels like firmness and woody texture to the tissue, sometimes with dimpling of the skin and/or a darker pigmentation.  This is entirely normal; edema is the body' s response to injury! (just like a "goose egg" swelling of the scalp with a bad fall). Initially after liposuction, you may in fact gain weight, despite the removal of a few pounds of fat!  This is again due to edema - the body holds on to extra water as part of its injury response.  

Do not weigh yourself for at least a few weeks after surgery, at least until after the bruising has resolved (2-3 weeks).  When bruising is gone, your healing will be well on its way.  You will notice your clothes begin to fit differently (better) after the first three months, and every single month you will notice subtle but significant changes. The results are permanent!

Remember to be patient after having any Plastic Surgical procedure!  Any type of surgery takes up to a year for every last bit of swelling and tissue edema to go away.  Plastic Surgery is an investment in your body.  You will need to continue your regular exercise regime (beginning at 3-6 weeks postop, or when you receive permission from your Surgeon), a nutritious and balanced diet, and healthy overall lifestyle. 

 2. What anesthesia is used with Tumescent Liposuction?

During liposuction, a fluid mixture commonly called "tumescent solution"containing normal saline (sterile salt water), epinephrine (adrenaline) and a local anesthetic (Lidocaine) is injected into the areas of fat that your surgeon has marked for removal before surgery.  Tumescent solution functions to help "puff up" the fat cells for suctioning, decrease bleeding and limit bruising, and to make the area numb both during and for many hours after surgery. 

After the tumescence is infiltrated, it is allowed to circulate for at least 10 minutes in each area.  This is to maximize the "vaso constriction" effect of the epinephrine (to shrink the blood vessels in the fat and under the skin, to help avoid their injury). 

The local anesthetic will keep you comfortable after surgery, although this is not the only method of anesthesia used during liposuction in most cases .Most of the time, you are also fully asleep under general anesthesia, or at a minimum under intravenous sedation so that you do not feel or remember anything during surgery. 

Next, through tiny "stab incisions" that are placed in natural creases of your body, a thin and blunt-ended wand known as a "cannula" is inserted to permanent suck out fat cells.  These incisions are later closed with sutures(stitches), a dressing is applied over each incision, and you are placed in a postoperative compression garment.  The purpose of the compression garments is to limit swelling and bruising, encourage skin contraction, and to keep you as comfortable as possible. 

3. Who can perform Tumescent Liposuction?

Liposuction is a surgical procedure, and should be performed by a specially trained Plastic Surgeon.  Most Plastic Surgeons have completed at least 5 years of surgical Residency at an accredited University, with an additional year or two of subspecialty training.  At least two years, and up to six of these years should be in Plastic Surgery for a Physician to call themselves a "Plastic Surgeon". 

In the United States, it is important to seek out a Board-Certified Plastic Surgeon who is credentialed by either the American Board of Plastic Surgeryor the Royal College of Physicians and Surgeons of Canada (equivalent licensing Boards).  Unfortunately, not all Physicians are Board-Certified. Another good resource is the American Society of Plastic Surgeons (ASPS)and/or the American Society of  Aesthetic Plastic Surgeons (ASAPS).  Entry to these professional societies is limited to Plastic Surgeons who have been in practice for a minimum number of years, are certified by their respective Boards, and are reviewed and accepted into membership by their peers. 

It is up to you, as the patient, to do your homework not only to learn about your surgical procedure, but about your potential Surgeon!  Board Certification is unfortunately not a requirement to obtain a medical license in the U.S.  In Canada and other countries, Board Certification is a rule; a Doctor cannot obtain a medical license without this certification. 

In addition, many non-Surgeons (Family Doctors, Internists, Dentists) or Doctors with other specialties (Oral Surgeons, Ear, Nose and Throat, OB-GYN)take a weekend course on liposuction and begin offering this treatment at a discounted rate to their patients.  Beware!  Just as you would not go to a foot specialist for open-heart surgery, you should not trust your body and your life to a practitioner who does not have the training and experience in the procedure you are seeking. 

Lastly, be cautious of the terminology "Cosmetic Surgeon", and certification and the like.  Nearly anyone can call themselves a "cosmetic" anything -most of the time, it means very little!  The American Board of Medical Specialties (ABMS) and the Royal College of Physicians and Surgeons of Canada (RCPSC) only recognize University-accredited training programs in Plastic Surgeon for certification. 

 Again, be cautious and take your time to research your Doctor the same way you would research your nanny, a new school for your child or a contractor for your home.  There is only one of you, and you are a very valuable commodity!  Be sure to put yourself in the hands of the best practitioner for the job. 

4. How safe is Liposuction?

Any surgical procedure carries with it potential associated risks, such as the risks of anesthesia, early risks of surgery, and late risks.  Safety is always the number one goal!  Most surgeries are performed in the operating room or an accredited out patient surgical facility with appropriate intraoperative and postoperative monitoring to ensure your procedure goes as safely and smoothly as possible. 

For liposuction specifically, possible early risks include persistent numbness of the surgical area ("anesthesia" of the skin) that can last weeks to months, pins-and-needles or electric shock sensations of the skin as the nerves are waking up ("paresthesias"), or sometimes unpleasant sensations("dysesthesias") as a temporary experience.  Bruising is common for at least 2-3 weeks after surgery, and swelling may persist for 3 months or more.

Potential late complications can include uneven contour of the skin or rippling, darker pigmentation of the treated areas, or asymmetries between sides of the body.  Differences between your right and left sides will likely be pointed out by your Surgeon preoperatively.  Although symmetry is always the goal, you may never be an exact mirror image from one side to the other - no one is! 

As long as the procedure is performed by a Board-Certified, specially trained Plastic Surgeon with a great deal of experience in liposuction, the benefits of liposuction usually far outweigh the risks.  You should also be healthy and physically fit enough to undergo surgery and have clearance from your Primary Care Physician before having any elective surgical procedure. 

 5. What areas are most common body regions treated with Tumescent Liposuction?

 Fat deposition is primarily based on genetics.  Every woman' s body is different, and your area is likely a little different from your best friend' s.
The most common areas of the body that are appropriate for liposuction are the lower abdomen hips, flanks (sides or "spare tire" area), inner and outer thighs, the upper neck beneath the chin , upper arms and the "butttockroll" (the area immediately below the buttocks). These regions are the trouble spots that most women (and some men) deposit fat and are stubborn to diet and exercise.

Areas that are not appropriate for liposuction include the knees, lower legs, ankles, lower arms, or the face (with the exception of the front of the neck).  These areas are not usual areas where fat is stored, and liposuction in these regions is risky for injury to nerves, tendons, blood vessels, and the skin. Liposuction is also not applicable to internal abdominal fat - the fat that is deposited around the internal organs.  It is also not a treatment for obesity or for weight loss.  Liposuction is for body contouring only! 

6. Can I have other operations with Tumescent Liposuction?

 Liposuction is commonly performed together with other procedures - for instance breast augmentation, breast lift or reduction, abdominoplasty, or a face lift.  So long as the total time under anesthesia is not excessively long (I limit my patients to maximum 8 hours of elective surgery). it is safe to have combined procedures with liposuction. 

 7. How does the Tumescent technique reduce risk of infection?

Vasoconstriction of the blood vessels may slightly decrease the risk of infection, as the blood flow to the area to be suctioned is reduced temporarily during the operation.  However, the risk of infection is very low as a baseline risk for liposuction.  Usually, a single dose of intravenous antibiotics is given immediately before surgery in the operatingroom.  Oral antibiotics are often continued for a few days after surgery to also prevent infection.