SOME INFORMATION FOR OUR PATIENTS ABOUT SUCTION LIPOPLASTY
(Fat Suction, Suction Contouring, Liposuction, Ultrasonic Liposuction)

INTRODUCTION TO SUCTION LIPOPLASTY

SUCTION LIPOPLASTY is a term which describes A TECHNIQUE OF BODY CONTOURING BY REMOVING LOCALIZED FAT DEPOSITS through small incisions using suction. The technique, which began in the mid 1970's, involves small incisions through which tubes or cannulas connected to a suction apparatus are passed. LOCALIZED DEPOSITS of fat are then removed by applying negative pressure and sucking the fat out of the area of involvement. The technique may also be termed SUCTION CONTOURING, ULTRASONICALLY ASSISTED LIPOSUCTION, or simply LIPOSUCTION. In addition to the information contained here, during your consultation and examination, we will review specific factors which pertain to your individual case. (As you review this information, please write questions in the margins that we can address during your consultation.)

SUCTION LIPOPLASTY IS NOT INTENDED FOR OR SUCCESSFUL IN CORRECTING WIDESPREAD OBESITY. THE TECHNIQUE IS NOT A SUBSTITUTE FOR WEIGHT LOSS OR EXERCISE.

THESE TWO CRITERIA MUST BE MET IN ORDER TO ACHIEVE GOOD RESULTS FROM SUCTION ASSISTED LIPECTOMY.

1. The contour defect resulting from excess fat deposits must be WELL LOCALIZED. Diffuse fatty areas do not respond well to this technique.

The skin must have "youthful" qualities in order to be able to contract and recontour following removal of underlying fat. Excessively loose or lax skin, which does not contract and recontour usually precludes a good result. There is no definite age past which this technique cannot be applied. Decisions regarding pliability or contractibility of the skin must be individualized to each patient. If excess or lax skin is present, surgical removal of excess skin may be necessary to achieve a good cosmetic result. Skin elasticity determines the amount of fat removal that can be safety accomplished if skin removal is not planned as part of the operation.

Proper exercise and conditioning are essential ingredients to obtain and preserve body shape, contour and stability. Proper amount of weight loss and maintenance of stable weight are equally important. When deformities persist after proper weight level has been stabilized and an exercise program carried out, then and only then, do surgical procedures play a role in the further correction of deformities.

There has been a revolution in suction lipoplasty over the last several years. Techniques and instrumentation have evolved and improved as new technology has become available. Tumnescent liposuction refers to the introduction of a saline (physiologic saltwater) solution including a local anesthetic for pain control and adrenaline to reduce bruising in the treated tissues. Most procedures use this fluid filling of the tissues to more evenly remove fat with the surgical technique, as well as to deliver medication to the tissues.

ULTRASONIC LIPOSUCTION, also known as ULTRASONICALLY ASSISTED LIPOSUCTION, is a technique of using ultrasonic sound energy created at the tip of a special probe or cannula that melts or emulsifies fat in the tissues, to allow traditional liposuction techniques and cannulas to remove the liquefied fat. This technique allows for more atraumatic fat removal, theoretically reducing bruising, swelling and pain.
Recovery is generally more rapid and there is some ability, when the technique is used more superficially, to stimulate skin tightening. However, whether this improvement in skin elasticity persists long-term is both debatable and unpredictable.

The main risk of ULTRASONIC LIPOSUCTION is skin burns, causing scars and irregularities that can sometimes be permanent without good treatment options. Not all body regions treated with suction contouring need to be treated with the ultrasonic techniques. As with most surgical options, the choice must be customized and individualized.

Areas of contour defects which can be improved by LIPOSUCTION are: Face, chin, neck, breasts, fatty areas above the breast near the arm crease, the waist area, "love handles" in both sexes, the buttocks, the abdomen, thighs "riding britches" deformity, the inner thighs, the knees, calves, ankles and arms. Certain post surgical or posttraumatic deposits may also be contoured by this technique. SUCTION CONTOURING can also be used, and many times is an integral part of many lifting procedures, such as abdominoplasty, arm and thigh lifting.

In general, liposuction surgery is performed under a light general anesthetic. I believe (as do our board certified anesthesia colleagues) that this is a better and safer approach than local anesthesia alone or local anesthesia under sedation with intravenous drugs.

Liposuction can many times be combined with other surgical procedures, usually producing slightly greater, but nevertheless acceptable risks. A decision in this regard must be strictly individualized, depending on the type of other surgical procedures being performed as well as other medical and surgical factors.

The purpose of all types of cosmetic surgery is to improve your appearance as much as possible. This change will hopefully improve your quality of life by improving your self-image in a very positive way. By addressing and improving those specific areas which detract from your appearance, leaving the positive aspects of your appearance undisturbed, this type of surgery results in an overall improvement in your appearance. Cosmetic surgical procedures are not magic. They are detailed procedures designed to improve specific aspects of your appearance. They can do no more than that. Whether you are happy with the results of cosmetic surgery will depend largely on how well you communicate to us which specific aspects of your appearance you are unhappy with and how well we communicate to you what a surgical procedure can and cannot do toward alleviating the problem. Plastic surgery does not perform transforming miracles. A combination of art and science, plastic surgery is not an exact science. Some of the factors involved in producing the result (such as your healing characteristics) are not totally within your or our control, and therefore, it is impossible to warrant or guarantee the results of your surgery.

After talking with you and examining you, I will make every effort to clearly and precisely give an opinion about whether a specific surgical procedure can significantly improve your areas of concern with a high degree of reliability and a minimal level of risk. All cosmetic surgical procedures involve some trade-offs. I will try to outline these clearly for you and answer any questions you might have. The final decision regarding having the surgery is yours, and I encourage you to consider it carefully and deliberately.

AT YOUR INITIAL CONSULTATION VISIT

When I visit with you in the office, I will review your past medical history, as well as your desires regarding liposuction. Age is not a limiting factor in determining who can have liposuction, as long as your general health is good. We will review extensively the information contained here, as well as more specific information with respect to your specific needs. After examining your torso, I can much more precisely define recommendations for you.

In this consultation, I would expect you to be frank in discussing your expectations with me. Do not hesitate to ask any questions that you may have. I will be equally frank with you, explaining the factors that could influence the procedure and the results.

I cannot make the decision for you regarding whether to undergo surgery or not. I can only advise you regarding the surgical options and anticipated outcomes I would expect for you based upon your individual anatomy, desires, and realistic expectations. I will define goals in a surgical plan at this initial consultation. Follow up appointments will include time to ask further questions or review the procedure so that you are comfortable with its nature and implications. I will educate you and define the operative scenarios and choices available to you, but you must make the final decision regarding the surgical procedure.

When a decision is made to proceed with surgery, preoperative photographs will be taken. These photographs are essential to the planning, execution, and follow-up of your procedure. They are taken with you in the standing position (the position in which you are most often seen). You are lying down during the procedure and I refer to these photographs frequently as your tissues appear very differently than when you are standing.

Surgical fees for the procedure will be discussed with you. They depend upon the nature and the extent of the procedure being performed. All fees for cosmetic surgeries are payable in advance and include the cost of surgery as well as all postoperative follow up care. Additional fees are required for the surgical facility and anesthesia care, and will be collected on the day of your preoperative visit at the surgery center.

BEFORE YOUR SUCTION LIPOPLASTY

Our nurse and office manager will make all arrangements regarding scheduling of your surgery and will give you specific instructions as well as reconfirm these with you by telephone and/or letter. Since both of our schedules must be coordinated with the surgical facility and anesthesia schedules, please allow our personnel a reasonable amount of time to make these arrangements. They will make every attempt to accommodate your requests.

Good general health is mandatory for a problem free and predictable recovery from any surgical procedure. Wellness and good general health result from proper diet, regular exercise and appropriately timed medical evaluations focused on preventative medicine. Good nutrition, vitamin and herbal supplements, as well as adherence to holistic health principles are important concepts in maintaining wellness. Certain supplements, although generally beneficial, may have adverse effects during surgery. Please advise us about all your medications and supplements, so we may advise you regarding their safety in regard to your surgical procedure.

We believe that good nutrition is an important component to excellent surgical outcomes. Multiple studies show that most Americans aren’t getting the recommended daily intake of necessary vitamins and minerals, much less the optimal amount. These suboptimal levels of nutrients have been linked with major diseases from heart disease to cancer.

We use a three phase healing program involving supplements to help you recover more quickly and with less downtime. We have you start this a week or so ahead of time to ensure that you are boosting your body’s immune system and removing anything that could interfere with anesthesia or increasing bleeding. Immediately following surgery we give you nutrients that help reduce pain and inflammation and detoxify the anesthesia and other medications. The third phase has additional healing nutrients to support your recovery.

Routine laboratory tests including blood counts and blood chemistries, a pregnancy test when applicable, and an electrocardiogram if you are over 50 years old, will be performed prior to surgery. These tests are performed routinely to screen for any abnormalities, which might complicate your anesthesia or surgery.

Do not take any aspirin or any drug containing aspirin for at least two weeks prior to your surgery. Aspirin may retard platelet function, a blood component that is important to normal blood clotting mechanisms. There are many drugs which contain aspirin. Before taking any drug, check the label carefully to assure that it contains no aspirin.

Do not eat or drink anything 8 hours prior to surgery. Safety in the administration of anesthesia or sedation requires that your stomach be absolutely empty for this interval of time before surgery.

Shower or bathe normally the evening prior to surgery.

You should wear loose fitting, comfortable clothing the day of surgery. A loose fitting shirt with buttons in front is preferable to any type of clothing which must be put on over the head. Pleases be sure that you have all of your questions answered prior to going into the surgical facility. I prefer that you make an additional appointment in the office if necessary to answer questions regarding your surgery. On the day of surgery, I will visit with you briefly immediately prior to surgery. Any final questions will be answered at that time.

Arrange for someone to drive you home at the appropriate time following your procedure, and arrange for someone to stay with you the night of surgery.

THE DAY OF SURGERY

I usually prescribe sedation or premedication prior to your being brought to the operating room. In order to minimize total necessary doses of drugs, sedation is best administered through an intravenous line rather than given in shot form into your muscle. It is normal to be slightly excited or apprehensive immediately prior to the surgery, and this will be alleviated quickly once your intravenous line is inserted. Our anesthesiologist will speak with you and answer all of your questions regarding your anesthetic.

Prior to moving to the operating room, I will ask you to sit and stand briefly so that I can mark your surgical site to use as guidelines during your surgery. Once in the operating room, you will then be positioned comfortably, and will have no recall of further events during your surgery.

The operation is performed using a general anesthetic. In addition, the medications have a profound amnesic effect, and you will have no recall of any events during the procedure. Actual surgical time usually ranges from an hour and a half to four hours depending on the number of areas treated.

After anesthesia is induced, the areas which have been previously marked are treated by making very small incisions and passing suction cannulas connected to a vacuum suction apparatus into the areas of localized fat deposit. Fat is removed by suction in small increments until satisfactory contour is achieved. The amount of fat removed varies from patient to patient – from as little as one to two ounces to as much as two to four pounds when multiple areas are treated. Incisions are closed and pressure dressings or garments are placed to provide some compression over the treated areas.

At the completion of your operation, you will be transferred to the appropriate recovery area where you will remain until you awaken. I purposely like for you to remain drowsy, since you will be much more comfortable. After an appropriate interval of observation, usually a few hours, you will be allowed to leave with someone to drive you home and stay with you the evening of the surgery.

You will have been given prescriptions for pain medication and antibiotics with instructions for each at your preoperative visit.

AFTER YOUR SUCTION LIPOPLASTY

Since I want you to remain drowsy and comfortable the evening of your surgery, fill your prescription for pain medication before surgery and take one immediately on arrival at home. Pain medication is best taken with a small amount of food and not on an empty stomach since nausea may occasionally occur. Make yourself comfortable, not necessarily in bed; a couch or comfortable chair is fine. You will continue to be drowsy and will awaken intermittently during the evening. Use the pain medication as directed to remain comfortable. Intermittent cold compresses for the first 48 hours after surgery may help with swelling and discomfort.

Do not try to eat any heavy foods the evening of surgery. Liquids or light foods are preferable. You may resume a normal diet the next morning. Should you experience any nausea the evening of surgery, drink small amounts of liquids only: no food until morning. Antinausea medications are generally not needed; any nausea experienced from the medications used in surgery will usually be gone the next morning. If you have a history of nausea after anesthesia, please inform your anesthesiologist the morning of surgery and you will be given anti-nausea medications during the procedure that will help minimize this occurrence after surgery.

Dressings or a pressure garment must be kept in place for 3-5 days depending upon the size of the areas treated. I ask you to maintain some type of support dressing for 6-8 weeks.

Massage activities will begin approximately one week following surgery, and consist of massages over the areas needed to assist in obtaining a smoother contour.

Bruising with some discoloration of the skin in "black and blue" areas as well as texture irregularities will be present and may last up to two weeks or more.

If you are given a prescription for antibiotics following surgery, take the prescription until ALL of the antibiotics are completed.

Resume normal tasks of daily living as rapidly as possible. The pain from the procedure decreases to about half of its intensity each 24 hours following surgery. Postoperative discomfort is most marked only during the first 24 hours and regresses rapidly thereafter. Resumption of normal activities, for example, lifting the arms to comb the hair and lifting objects of normal weight, speeds the recovery process and reduces the pain more rapidly. Immobility tends to cause continued discomfort and increased muscle spasms. The only limitation to activity is if you feel significant pain. Discomfort is normal with motion initially, and there is nothing that can be harmed by normal activity. Most patients are back at work in 5-7 days. Call the office for an appointment to be seen as directed following surgery.

You may resume light exercise at 3 weeks following surgery. This includes low impact activities at 1/3 duration of exercise, repetitions, amount of weight, and pulse rate. Your exercise tolerance should gradually increase to 2/3 intensity at 6 weeks, and be at full intensity by 8 weeks. This includes high impact activities such as running, horseback riding, and high impact aerobics.

POSTOPERATIVE HEALING

Postoperative healing requires some mandatory down time as part of the surgical recovery process. Post surgical healing requires the body to repair the surgical wound (whether in the skin, fat, muscle or bone) with scar tissue. The bruise and tissue fluid in the wound are gradually replaced by stronger scar or fibrous tissue over a period of 6-8 weeks. Until the time that the healing area is strong enough to maintain tissue integrity, the wound is held together by the sutures (stitches) placed at the time of surgery. Too much wound tension (stress) before the strength of the healing tissue is satisfactory, can cause disruption of the incision. I place sutures very precisely to account for these healing characteristics to maximize your postoperative activity, comfort, and safety. However, your inherent healing characteristics significantly dictate these parameters. Stretching, movement, massage, and return to normal activities of daily living in the early postoperative recovery allow for the optimal return to your full normal life style.

After the initial burst of high energy healing and the “bulking up” of scar tissue, the wound enters a maturation phase, and the scar tissue becomes thinner, less red, and stronger. The maturing and stabilization of scar tissue occurs over a period of 6 to12 months. Long-term changes tend to be more subtle, slower, and less evident than short-term changes that occur in the first 6 to 8 weeks.

There are no absolute parameters regarding return to postoperative activities and one must adjust for variation in pain tolerance, invasiveness of surgery and healing variations.

In general, you cannot speed up the healing process, only slow it down by too much activity too soon. Overexertion can lengthen the period of time for pain to decrease, swelling and bruising to resolve, and the final surgical results to be evident. Healing occurs for up to one (1) year, sometimes longer. The latter changes tend to be subtle and gradual, and therefore not nearly as dramatic as in the initial 6 to 8 weeks.

Please be patient with your own healing. Any change in your appearance affects your perception of self-image and requires an adjustment period of days to weeks. It is normal to have mild feelings of doubt or a low mood during this period in the first 1 to 3 weeks following surgery. These feelings are then rapidly replaced by positive feelings as healing progresses and you adjust to your improved appearance. Since discomfort from this procedure diminishes rapidly, pain medication should be necessary for a maximum of three to five days. Most patients usually require pain medications for only 24 to 48 hours.

Should you develop any of the following symptoms, please call our office: a) elevation of temperature to or above 101 degrees, b) extreme swelling or tenderness, c) any prolonged or significant bleeding from incision lines (slight drainage for 24 hours is normal), d) redness along the incision lines or elevation of temperature.

If you should have any other questions or problems, please contact our office at
(303) 443-2277.

LIMITATIONS, RISKS, AND POSSIBLE COMPLICATIONS OF SUCTION LIPOPLASTY

With any surgical procedure, a very small percentage of untoward complications can occur. These complications are rare, and I mention them not to alarm you, but only to inform you.

It is possible to have untoward side effects to any drug which is administered during surgery. Severe side effects are extremely rare, but can be life threatening. It is for this reason that I insist on performing your surgery in an optimal setting where all conceivable equipment and medical backup are available should you have an unexpected reaction. Anesthetic or sedation risks are extremely minimal. The media has vastly over publicized many cases, and most have occurred in settings where less than optimal facilities, equipment and personnel are present.

Collections of blood or serum: In the areas which have been suctioned, small amounts of blood or serum are always present beneath the skin, but occasionally a significant collection will occur which may require drainage of the area as a secondary procedure.

Infection: Infection following this procedure is rare, and you will receive pre and post- operative antibiotics as preventative measures.

Skin rippling: Some degree of waviness or rippling of the skin occurs occasionally after suction lipectomy. It normally resolves or improves greatly by six months, but some residual irregularity may persist.

Numbness in the areas treated by liposuction and numbness of the overlying skin occurs, is usually transient and disappears by three to four months. Some areas of localized numbness may persist.

Pain: In certain areas, specifically the lateral thighs and ankle areas, residual pain may persist several months after surgery. All of this discomfort usually disappears in time.

Swelling: Irregular areas of swelling may last as long as six months following this procedure before final resolution and contour occur. Most of this type of swelling tends to occur in the ankles and feet following liposuction of the knees, calves or ankles.

Change in skin color: Very rarely collection of blood and fluid beneath the skin in treated areas may stain the skin for extended periods beyond the normal bruising mentioned above.

Though not well documented, it may be possible for particles of fat to enter the bloodstream and/or other organs.

All of the above-mentioned complications of suction lipoplasty are unusual, but occur occasionally despite the most vigorous standards of surgical practice. They are listed not to alarm, but simply to adequately inform you prior to your surgery.

CONCLUSION:

Suction lipoplasty is a technique which is extremely effective in improving contour defects resulting from LOCALIZED fat deposits. Success with the procedure depends on careful selection, evaluating skin characteristics and the location and extent of fat deposits. The procedure has limitations, it may have complications, but in properly selected cases, produces significant improvement with minimal scarring to areas of localized fat deposits.

During your office consultation, additional and more detailed information regarding all of the areas mentioned in this information sheet will be provided you as well as an opportunity for you to ask in-depth questions. Please review this sheet carefully, and write down any questions you may have.