Risk of Liposuction Procedure: 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 significant IV sedation is required. A recent study involving over 15,000 patients who had tumescent liposuction without general anesthesia, revealed no serious complications, no serious infections, no hospitalizations, no blood transfusions and no deaths. The greatest risks in liposuction are those associated with general anesthesia. By eliminating general anesthesia, the risks of liposuction are dramatically reduced. Clients can minimize the risk of complications by not taking certain medications or over-the-counter preparations that might adversely affect the procedure. Clients should inform the doctor of any medications being taken either regularly or occasionally, including herbal remedies and dietary supplements.
Risk of irregularities of the skin: Tumescent liposuction using microcannulas is the least likely to cause any significant or noticeable post-procedure 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 and thereby cause irregularities. Thus, the tumescent technique helps to minimize the risk of post-procedure irregularities or rippling of the skin. Liposuction might improve per-existing irregularities of the skin such as dimpling or cellulite, but prospective clients should not assume that there will be significant improvement. It is unrealistic to expect perfectly smooth skin. Clients should expect that their skin will have approximately the same degree of dimpling and irregularities as existed before tumescent liposuction. After tumescent liposuction the skin texture should be within normal limits. A casual observer should not notice any evidence of procedural irregularities of the skin. However, it is possible that a noticeable irregularity of skin may result. If an irregularity occurs, it may require a corrective procedure for which there will be a fee to cover the second procedure expenses. Because skin tends to lose some of its elasticity with increasing age and with cumulative sun exposure, older clients may notice an increase of fine wrinkles in areas such as the upper abdomen after liposuction.
Risk of Scarring of the Skin: Incisions for liposuction may result in scarring. Tiny (1-2 millimeter) round holes in the skin called adits are used for inserting the cannulas through the skin and into the fat. Typically, when adits heal they become virtually invisible. 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 clients may have a genetic predisposition for persistent discoloration at incision sites. Anyone who has previously experienced hyper-pigmentation or hyp-pigmentation (pale or light colored scars) of the skin in the past might expect to also experience it with liposuction adits. 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.
Smoothness of Results: Liposuction can produce some irregularities of the skin which can be visible in certain conditions of lighting. In general, the smoothness of the skin is much improved after microcannula lipsuction. These are usually rather subtle and imperceptible to the casual observer. It is reasonable to expect significant improvement, but the results are rarely perfect.
Obesity & Liposuction: Liposuction is not an appropriate treatment for obesity. Liposuction is not a substitute for a prudent diet, good nutrition, and regular exercise. Obese clients may be good candidates for limited liposuction if their goal is simply to improve the shape of certain limited areas of the body. Obesity is associated with an increased risk of surgical complications.
Post procedure healing: Normal healing after tumescent liposuction involves a limited but definite degree of soreness, swelling, bruising, itching and lumpy firmness. A temporary mild numbness of the skin may persist for 2 to 10 months. Most clients can actually see improvement of their silhouette within a week after Lipo. However, because of the slow resolution of post procedure swelling, the ultimate results following liposuction usually require 12 to 20 weeks to be achieved but improvements can be seen for 6 to 9 months following your procedure.
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. Clients should have realistic expectations. Although clients can usually expect to achieve a significant and noticeable improvement, it is unreasonable to expect 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.
Clients 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 client happy, then it is likely that these expectations will be met. Our clients generally achieve more than a 50% improvement.
Longevity of results: The fat cells that are removed by liposuction do not grow back. If the client later gains or loses weight, the change tends to be distributed proportionally over the entire body. For the best results the client’s post-op weight should be less than the pre-op weight. Although one can expect some changes with aging, provided that the client does not gain large amounts of weight, the client’s new, more pleasing silhouette is relatively permanent.
What to Expect on the Day of Tumescent Liposuction
Arrival: You will check in at the front desk at time of arrival. A nurse will greet you. After you have signed your consent forms, you will be escorted to the bathroom. Your weight will be recorded and a pregnancy test will be done if indicated.
Pre-Op Preparations: In the treatment room pre-operative photographs will be taken and then the areas on your body to be treated with liposuction are marked with a blue felt-tip pen. Additional photos of the markings on the body will be taken, and the client will be asked to initial these photos to confirm agreement with the areas to be treated by liposuction. This process of preoperative documentation typically requires 30 to 45 minutes before beginning the infiltration of the tumescent local anesthesia. Baseline vital signs will be obtained.
Local Anesthesia: Using the smallest needles available, the doctor or the nurse will anesthetize the skin at sites through which the longer needles or cannulas will be inserted to anesthetize the subcutaneous fat. Clients usually experience a slight pricking sensation as the skin becomes “numb”. A large volume of dilute tumescent anesthetic solution is carefully and gently injected into the targeted fat. Once an area 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 one more time.
Sedatives: Experience has shown that giving a sedative by mouth permits better local anesthesia than when intravenous sedatives are used. This is because an alert client is more capable of detecting subtle areas of incomplete anesthesia. A client who is too sedated might easily ignore an incompletely anesthetized area, and then feel more discomfort later during liposuction. Therefore avoiding excessive sedation actually maximizes client comfort during liposuction.
Liposuction is accomplished through tiny (1 to 2 millimeter) round holes in the skin called adits. The adits, which are made in the skin with 1 to 2 mm biopsy punches, are so small that they need not be closed with stitches. After the procedure, adits remain open for 2 to 5 days and facilitate the post-operative drainage of residual blood-tinged anesthetic solution.
After Liposuction: After completing liposuction, clients are offered a snack and absorbent pads are placed over the adits. Finally, after the tumescent liposuction compression garments are pulled on, your vital signs are normalized, you are ready to get up and go home. Because of residual local anesthesia, it is several hours after completing the liposuction before any significant soreness begins. The tumescent technique minimizes post-procedure discomfort. Because the residual local anesthesia lasts for over 18 to 24 hours, plain Tylenol is usually sufficient to treat post-procedure discomfort. Post-procedure nausea is unusual after tumescent liposuction. When nausea or vomiting does occur, it typically happens 6 to 12 hours following the procedure after the client awakens from a nap. This type of nausea and vomiting usually lasts for only one to three hours.
Transportation Home after Liposuction: Clients are not permitted to drive themselves home after liposuction except in the case of an especially small amount of liposuction where the client has not received sedation. Although most clients feel well enough to drive a car immediately after the procedure, you must not do so because the large amounts of local anesthesia may cause some drowsiness. The person who will be driving you home should have a flexible schedule as the exact time of discharge cannot be precisely predicted. We ask that he/she leave a phone number that we may use to call him/her when you are ready to leave. If the procedure is done after normal business hours, the person picking you up will not be able to wait inside the building for security reasons. We apologize for any inconvenience this may cause.
BEFORE LIPOSUCTION INSTRUCTIONS
Our office wants to provide you with the very best care. You can help to minimize the risk of complications by carefully reading and following your preoperative and postoperative instructions. Ask us to clarify any item about which you have questions.
Two weeks prior to surgery
- You will need to start taking a Multi-Vitamin once per day, starting two weeks prior to procedure and for at least one month after the procedure. The healthier you are, the quicker your recovery will be.
- A normal healthful diet for at least two weeks before procedure is important for a safe procedure and good healing. Aggressive weight-loss diets should be discontinued at least two weeks before procedure.
- 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 liposuction. Please see page 5 for list of drugs that might have adverse drug interactions with the local anesthetic lidocaine.
- If you are on regular medications, please clear these with the doctor.
One week prior to procedure
- For seven (7) days before liposuction do not take ASPIRIN (Anacin, or Bufferin, Exedrin or Baby Aspirin) or IBUPROFEN (Advil, Motrin, or Nuprin), or NAPROXEN (Aleve) or any other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) that impair platelet function in the normal blood-clotting process. It is permissible to take acetaminophen (Tylenol or Anacin-3). Please see below for a list of common drugs that contain aspirin.
- DO NOT take or drink any alcohol for one week prior to procedure and one week after your procedure as these can interfere with anesthesia and affect blood clotting.
- Use an antibacterial soap for bathing, such as Dial, Safeguard, or Lever 2000 for at least one week before your procedure. (You will find a small bar in your procedure kit)
- DO report any signs of cold, infection, boils, or pustules appearing before your procedure.
- DO NOT take any cough or cold medications without notifying DermaHealth.
- DO arrange for a responsible adult to drive you to and from the facility on the day of procedure, since you will not be allowed to leave on your own.
- DO arrange for a responsible individual to spend the first 24 hours with you, since you CAN NOT be left alone.
- Make sure you have all prescribed medications filled and on hand to start accordingly prior to procedure. Bring with you the day of procedure.
- Begin taking Vitamin K (5mg) daily 7 days prior to your procedure and continue taking them for 3 days following your procedure. DermaHealth carries this product for your convenience.
- NO smoking starting 7 days prior to your procedure as nicotine reduces blood flow to the skin, contributing to an increase in skin laxity and can cause significant complications during healing.
Night Before and Morning of Procedure
- Diet before liposuction: You should eat a light, low fat, high protein meal, such as toast and juice, fruit, dry cereal and/or non-fat milk no closer than two hours prior to your procedure. Avoid whole milk, cream, butter, cheese and other foods that are high in fat content as dietary fat slows digestion and delays stomach emptying. Please minimize caffeine the day of surgery. You will be given a snack as soon as surgery is completed.
- DO take your prescribed antibiotic on the morning of your scheduled procedure.
- DO take a thorough shower with your antibacterial soap the night before and the morning of procedure. Shampoo your hair the morning of procedure. This is to decrease the bacteria on the skin and thereby decrease the risk of infection.
- DO NOT apply any of the following to your skin, hair or face the morning of your procedure: makeup, creams, lotions, hair products, sprays, perfumes, powder, or deodorant. Using any of these products will add bacteria to the skin and increase the risk of infection. Tape will not adhere or stick well to moisturized skin. 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.
- Bring warm socks to prevent cold toes during the procedure. If you tend to get cold hands, you are welcome to bring clean mittens (no leather gloves) to wear during the lipo.
- Towels & Plastic Sheets. Plan ahead and 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 liposuction pad your bed at home, and your living room chair with towels and plastic. Some patients have found it comfortable and convenient to place a felt-backed vinyl tablecloth on the bed, with the felt-side up. Be careful to avoid allowing drainage to stain carpets.
- DO NOT wear contact lens to your procedure. If you wear glasses, bring your eyeglass case.
- DO wear comfortable, loose-fitting clothes that do not have to be put on over your head. The best things to wear home are a button-top and pull on pants. You will want easy-to slip-on flat shoes.
- DO NOT bring any valuables or wear any jewelry (no rings, earrings, chains, toe rings, other metal piercing or watches.)
- You must have an adult drive you home from your procedure. Please note that a cab or bus driver will not be allowed to take you home after procedure. On arrival, be sure we know your driver’s name, phone number, and how we will be able to reach him/her.
- If you are not recovering at home, it is very important that we have the number where you can be reached after your procedure.
AFTER LIPOSUCTION INSTRUCTIONS
- Directly after your procedure, start out with fluids. You can resume a regular healthful diet at any time. Some nausea may exist. If you find yourself vomiting more than a few times, please call our office. Drink adequate amounts of water, fruit juices or soft drinks to prevent dehydration. DO NOT drink alcohol for 48 hours after liposuction.
- It is in your best interest to have someone available to be with you for the first 24 to 48 hours after your procedure to assist you.
- Activities: Quiet rest is recommended immediately after your procedure. After lipo do not drive or operate hazardous machinery the rest of the day. Do not make any important personal decisions for 24 hours after lipo. Later in the day or evening you are welcome 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 lipo, although one must expect to be sore and easily fatigued for several days.
- Absorbent Pads are placed over the treated areas to absorb the large volume of drainage of blood-tinged anesthetic solution during the first 24 to 48 hours after lipo. The pads are held in place by elastic garments. Beginning the next morning after lipo, change the pads twice daily. During the first few hours after surgery, if you discover some drainage leaking around the larger pads, simply apply a small absorbent ABD pad over the area by sliding it under the garment.
- Post-Op Elastic Compression Garments. After tumescent liposuction post-op garments are worn in order to: hold the absorbent pads in place, provide compression to minimize bruising, and maximize the drainage of blood-tinged anesthetic solution. The morning after lipo, when the garments are first removed in order to take a shower, the client may experience brief dizziness and lightheadedness similar to what one experiences when standing-up too quickly. It is the result of rapid decompression of the legs after the elastic garments are removed. To minimize this, first sit up on the edge of the bed and slowly remove your compression garment. Give yourself at least 5 minutes after removing the garment before standing. Have someone available to walk you to the shower. It is recommended to pace a stool in the shower for you to sit on. If dizziness occurs, sit or lie down until it passes. Beginning the day after your procedure, you may remove the post-op garment twice daily and take a shower. These 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. Notify us if the drainage persists for more than 8 days. Discontinuing the use of the garment too soon may result in more prolonged drainage. Typically, patients will need to wear the garment for a minimum of 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 is of no significant advantage in terms of the ultimate cosmetic results.
- Managing Post-Op Drainage: One should expect a large volume of blood-tinged anesthetic solution to drain from the small incisions during the first 24-48 hours after 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, it is advisable to place a plastic sheet beneath the towel. Absorbent dressings are worn under the compression garment for at least the first 36 hours. When drainage has nearly stopped, clients need only place thin absorbent gauze dressings or small pads on incision sites that continue to drain.
- Wound Care & Bathing: Keep adits (tiny round incision holes) clean. Shower once or twice daily. First wash your hands, then wash adits gently with soap and water; afterwards gently pat adits dry with a clean towel. Apply new absorbent dressings. Adits that have stopped draining no longer need padding. Call our office if you notice signs of infection such as fever, foul smelling drainage, or focal redness, swelling, and pain in a treated area; if you cannot contact someone from our office, go to an emergency room. If you believe you have a severe emergency call 911.
DO NOT apply ice-packs or a heating pad to the skin of liposuction areas for at least 4 weeks following 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 possible 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 the procedure is a natural consequence of the body’s reaction to trauma. Discomfort and soreness is worse the second day after lipo, then improves daily. Two extra-strength Tylenol taken every 4 hours, while awake, for the first 48 hours, will reduce the inflammation, swelling, and soreness associated with the procedure. Do not take aspirin or ibuprofen or medications that contain these drugs, for 3 days post procedure; these can promote bleeding. Bruising is minimal with tumescent liposuction. Nevertheless, the more extensive the liposuction, the more bruising one can expect. Pain and swelling due to an inflammatory reaction to trauma may occur and increase 5 to 10 days after lipo; this is treated with anti-inflammatory drugs. Itching of the treated areas several days after lipo may occur as part of the normal healing process. To help relieve the itching, you may try taking Benadryl as directed on the packaging. Be aware that Benadryl causes drowsiness. Provided all incisions are closed, soaking in an Oatmeal bath preparation may relieve some of the itching. Benadryl and Oatmeal products may be purchased without prescription at most drugstores.
- You will be contacted by DermaHealth within the first 24 hours post procedure.
- Please do not hesitate to call DermaHealth Laser & Skin Care Clinic at any time if you have questions or concerns. We want to facilitate your healing process, and we are here to help.
- Schedule Follow-up Appointment at our office for approximately 6 to 8 weeks after surgery. You are welcome to return to our office for follow-up visits at no charge as often as you like. Please contact us by telephone if you have any urgent questions.
DermaHealth Nursing Directors:
Cheryl Briggs, RN, BSN, CPCP
Marcy Mayes, RN
During Office Hours: (417) 447-7777
After Hours: Cell (417) 818-0404 / Cell (417) 848-5045
Home: (417) 889-1114
Medications and Foods that POTENTIALLY Interact with Tumescent Anesthetic
Consult your physician if you are taking any of the following:
- propofol (Diprovan)
- mexiletine (Mexitil)
- propafenone (Rythmol)
- quinidine (Quinaglute, Quinidex)
- zafirlukast (Accolate)
- zileuton (Zyflo)
- ciprofloxacin (Cipro)
- clarithromycin (Biaxin)
- chloramphenicol (Chloromycetin)
- enoxacin (Penetrex)
- norfloxacin (Noroxin)
- telithromycin (Ketek)
- troleandomycin (Tao)
- acetazolamide (Daimox) (also a diuretic)
- carbamazepine (Tegretol)
- divalproex (Depakote)
- valproic acid (Depakene)
- amitriptyline (Elavil)
- clomipramine (Anafranil)
- duloxetine (Cymbalta)
- flouxetine (Prozac)
- fluvoxamine (Luvox)
- nefazodone (Serzone)
- paroxetine (Paxil)
- sertraline (Zoloft)
- troglitazone (Rezulin)
- fluconazole (Diflucan)
- itraconazole (Sporanox)
- ketoconazole (Nizoral)
- metronidazole (Flagyl)
- miconazole (Monistat)
- astemizole (Hismanol)
- tamoxifen (Nolvadex)
- letrozole (Femara)
- clozapine (Clozaril)
- pimozide (Orap)
- omeprazole (Prilosec)
- alprazolam (Xanax)
- flurazepam (Dalmane)
- midazolam (Versed)
- triazolam (Halcion)
- propranolol (Inderol)
Calcium Channel Blockers
- amiodarone (Cordarone)
- diltiazam (Cardiazam)
- felodipine (Plendil)
- nicardipine (Cardene)
- nifedipine (Procardia)
- verapamil (Calan)
- dexamethazone (Decadron)
- ethinylestradiol (Estinyl Feminone)
- danozol (Danocrine)
- cimetidine (Tagamet)
- cyclosporine (Neoral, Sandimmune)
- anastrozole (Arimidex)
(nonsteroidal aromatase inhibitor)
- cortisporin (Cortisol)
- methadone (narcotic)
- mibefradil dihydrocholride (Posicor)
- pentoxifylline (Trental)
- tacrine (Cognex) (reversible cholinesterase)
- diethyldithiocarbamate (Imuthiol)
- indinavir (Crixivan)
- nevirapine (Viramune)
- nelfinavir (Viracept)
- ritonavir (Norvir)
- saquinavir (Invirase)
MAO Inhibitors may interact with certain sedatives and are relatively contraindicated.
Information About Prescriptions & Medications
- Antibiotics, such as cephalexin (Keflex™) relatives of penicillin, or doxycycline a relative of tetracycline, are to be taken in order to minimize the risk of a post-procedure infection. Antibiotics should be taken with food to reduce the risk of gastric upset. Please take your antibiotic the morning of your procedure.
- Lorazepam (Ativan™) is a mild sedative and a mild sleeping pill that does not make one feel “drugged”. Surgery is more easily tolerated if the patient is well rested and relaxed.
- Vitamin K will theoretically 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 one week before the surgery.
- Acetaminophen (Tylenol™ Extra Strength), 500 mg capsules or tablets, does not require a prescription. Taking two tablets, 3 to 4 times daily, beginning after surgery, should help minimize postoperative swelling. To treat any minor pain before surgery take 2 Extra Strength Tylenol (500 mg), every 4 hours as needed. If Tylenol is not acceptable, notify us so that we can arrange a suitable substitute.
- Diphenhydramine (Benadryl™) 25mg capsules or tablets, does not require a prescription. Taking as directed can help to reduce post-operative itching. Be aware that Benadryl™ may cause drowsiness.
Medication Precautions for Liposuction Patients
- Do Not Take ASPIRIN (Anacin, or Bufferin) or IBUPROFEN (Advil, Motrin, or Nuprin), or NAPROXEN (Aleve), or any medications that contain these drugs or any similar anti-inflammatory medications, for seven (7) days before and 3 days after liposuction. These drugs will promote bleeding and bruising. 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 procedure. 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 seven (7) days before liposuction.
4-Way-Cold Tabs Garlic CapsulesGelpirin
Dipyridamole (Permole, Persantine)
- Do not take decongestant medication containing pseudoephedrine (Sudafed™, Actifed™) for 5 days prior to surgery. These can cause the heart rate to beat too rapidly.
- Appetite suppressant drugs phentermine (Fastin), should not be taken for at least 14 days before liposuction. Do not stop appetite suppressants abruptly as you may have side effects. To avoid side effects such as depression, it is better to begin decreasing the dose gradually two weeks before lipo. Maintain a healthy diet and stop aggressive weight loss diets for a safe procedure and good healing.
- Do not take antidepressants, such as Zoloft or tricyclics for 14 days before liposuction. Please consult you prescribing physician before discontinuing any of your prescribed medications.