Liposuction Consultation


Liposuction Consultation and Physical Exam

We have outlined below what you can expect from your liposuction consultation. Read carefully, as there are many suggestions that will save you time, clear up questions, and help you convey to your plastic surgeon what you want to accomplish.

Health History

All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used but also applies to local anesthesia. Liposuction can be done under either general or local anesthesia. The type of anesthesia depends on how many areas are being liposuctioned and the discomfort tolerance of the patient. Single areas such as abdomen or lateral thighs can be done under a type of local called tumescent anesthesia. Tumescent anesthesia is a local anesthesia mixed with saline and then injected into the subcutaneous fat. This effectively numbs the area. Multiple areas and sensitive areas such as the medial thigh are often done under general anesthesia. Each plastic surgeon has his/her own strategy regarding the type of anesthesia used.

Prior to meeting with Dr. Cruise you will be given a health history questionnaire to fill out in the waiting area. There are five areas of your health you will be asked about. Be sure to answer it with detail so that your surgery and anesthesia can be optimized for you.

General Health

General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are: high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.

What will Dr. Cruise do if I have medical problems?

In short, he will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.

If you have a health problem or are over 50 years of age you can often save yourself time by getting a letter from your private physician prior to your cosmetic consultation stating what the health problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.

If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating you are able to tolerate surgery.

Be sure to let your plastic surgeon know if you have ever had a blood clot.

Past Surgical History

On your questionnaire you will be asked about previous surgeries. Be sure to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries especially if you do not like the result and are interested in revision.

Medications

Be sure to list all medications you take including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin containing products at least 10 days before surgery. Tylenol is a good alternative. Here is a partial list of aspirin containing products and other products to be avoided prior to surgery.

Allergies to Medications

Information about medications that cause allergies is very important so that these medications can be avoided. Of particular importance is the reaction you had, especially if you had trouble breathing. Be sure to include this information. Nausea is not an allergy but it is important to mention as well.

Smoking, Drinking and Drug Use

These there will certainly affect your surgery and MUST be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift smoking must be stopped at least 2-3 weeks before and after surgery. Otherwise, the results could be disastrous leading to non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery and breast augmentation, smoking will hurt the overall result but this may or may not be noticeable. In this case smoking cessation is strongly advised but is not mandatory.

Physical Exam

The key to the liposuction exam is to determine exactly what is causing the problem. Some problems can be treated with liposuction while other require removal of excess skin. Sometimes a combination of the two is best. This section will help you decide what is best for you.

What areas do NOT respond well to liposuction?

This web site is designed to educate you so that your plastic surgery experience achieves yours goals. Part of our responsibility is to make sure that your goals are realistic. With this in mind we will first outline which patients are not good candidates for liposuction.

Not all areas respond well to liposuction. Most people feel that if they have a fatty area it can just be sucked away and the problem will be solved. This is not the case. There are other issues that must be considered.

Redundant Skin

Redundant skin usually is best treated with removal. This is especially true with medial thigh, and arms, and often abdomen. If liposuction is done in these cases then a poor result is likely. When the fat is removed, the loose skin becomes even looser often with waviness because the skin does not have the ability to recoil. This elastic skin contraction is extremely important and is elaborated on throughout this section.

Poor Quality Skin

The entire basis of liposuction depends of skin contraction. Poor quality skin does not have this ability. Poor quality skin is identified by stretch marks, cellulite, scars, age, and a certain thin dermis feel that only your plastic surgeon can determine.

Stretch Marks

Stretch marks show that the skin does not have much elastin, which is necessary for the skin to contract. Therefore, after the skin has been stretched (i.e. pregnancy or weight gain) it cannot recoil back. The skin essentially forms scars that are represented by stretch marks. These scars have no capacity to contract.

Cellulite

Unfortunately, cellulite also responds poorly to liposuction. Ironically, this is why some women want liposuction in the first place. Cellulite is skin that has fat in the subcutaneous areas separated by fibrous septa. These septa break the fat into compartments. Sometimes, when this fat is removed the cellulite can become more prominent. Currently, there are no good answers to this problem but certainly muscle tone and proper diet help.

Scars

Scar tissue is devoid of elastin. It has NO ability to contract. Areas with scars are often best revised. Since a scar is already there a good plastic surgeon can perform a scar revision that will result in a less conspicuous scar. As a bonus, a skin and fat removal can be done at the same time, thus, creating a win-win situation.

Aged Skin

Notice how the title is Aged Skin and not a specific age. This is because different people's skin age differently. Amazingly, even skin on different areas of the same person age differently. The bottom line is that the older the patient is, the more likely is he/she to benefit from skin excision than liposuction. The good news is that older skin forms thinner, less visible scars than younger skin.

Thin Dermis Areas

Once again, skin contraction depends on elastin within the dermis. Areas that have a thin dermis do not have much elastin. Areas that are notorious for thin dermis are the medial thigh, and the inner arms. Pinch these areas and feel for yourself. This is why a medial thigh lift or arm lift is usually a better choice. An exception to this is the young patient with thick, elastic skin in these areas.

Beer Belly

This is almost exclusively a male concern. The problem is that this fat is NOT subcutaneous fat that is amenable to liposuction. This fat is under the muscle within the abdomen itself. It is hard, therefore, pinching it is difficult. Because it is intra-abdominal it is not accessible to liposuction and can only be lost by diet and exercise.

Markedly Overweight

Liposuction is not meant to be a weight loss procedure. In fact, most plastic surgeons will limit the amount of fat removed so that patient safety is maintained. Many will not exceed 5000 cc's (11 lbs. ) in one operation. The fact is, massive liposuction often leads to skin waviness as well as skin sag. Skin excision is often a better way to go.

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