This is perhaps one of the more embarrassing moments in a plastic surgical patient’s life—and we know it as surgeons. It may get more embarrassing, as I’ll explain, but unfortunately, this is the “price” of beauty, so to speak. The photos, by the way, are very useful for several reasons. Sometimes, if there are unusual or subtle concerns, it can help to look at the photos with your surgeon beforehand to be sure that he or she sees what you see. After the surgery, it’s often helpful to compare and review
especially if there are spots that might need a little secondary attention—a so-called “touch-up” procedure. And of course, we take pictures so that we can share them with future patients, who might be considering a similar procedure.
Back to the day of your surgery and your next opportunity for embarrassment. Before you can go off to sleep for your operation, your surgeon will need to mark the areas to be treated. Generally, this marking looks like a topographic map over the problem spots that are being treated. Some surgeons use colored markers. Some will mark you the day before the surgery, others the morning of the procedure. In any case, you will be standing with minimal or no clothing for the marking. The markings are important, because after you lie down, relationships change and the markings help to keep track of the areas to be addressed.
You will also have to have some sort of skin prep to sterilize the operative site, and in some of my patients, I do this with the patient standing, while I paint them with a sterilizing solution. As I tell my patients, I try to have the operating room warm, I try to have the solution warm, and I try to have as few people in the room during this process as possible. I also like to have the patient get at least a little bit of medication to relax them, though this must be done carefully since he may be standing for a few minutes. There is really no way to go through this part of the process without feeling exposed, to say the least. It’s helpful, however, so that in certain cases, the entire region can be visualized for a more reliable three-dimensional view during the procedure. Many times, the patient just lies down, goes off to sleep, and the prepping process takes place then—with far less awkwardness.
Most liposuction procedures today are done with some sort of injected local anesthetic fluid, or “tumescent anesthesia.” This technique allows for procedures to be done with awake patients, mildly sedated patients, deeply sedated patients, or generally anesthetized patients. The choice is often dictated by the extent of the procedure, and the desire of the patient and his surgeon. Using tumescent anesthesia for liposuction helps to decrease bleeding, as there is epinephrine in the solution to help shrink up the small blood vessels. It also helps to give a more even result by “plumping up” the tissues, essentially increasing the size of the treatment area. Finally, there is some post-operative pain relief until the local anesthetic wears off. Not all of the fluid is necessarily removed, and you may ooze a pink cool-aid like solution for up to 24 hours after the surgery. Don’t worry—you’re not bleeding to death.
Each surgical site is usually approached from several angles through small incisions—about ¼ inch. These are hidden in skin folds when possible, but in any case, they usually heal well without much evidence over time.
After the procedure is completed, you will need to wear a compression garment, usually for four to eight weeks. This helps to minimize swelling, minimize bleeding in the early post-operative period, and to help support your skin and shape the contour afterwards. The garments are worn under your clothes, they’re snug fitting and barely perceptible in most cases. Now that Spanx are available for men, I often recommend these for chest and abdominal procedures to be used after the initial post-operative garments (compressive vest or abdominal binder). There are many other options available through various medical companies, but the “medical” garments tend to be more expensive, though no more functional.
Depending on how extensive the procedure is pain will vary from person to person. Typically, narcotic pain medication is used for most patients, though many of my patients find they need that only for a few days, after which they can use ibuprofen or other comparable agents. Similarly, activities are limited for a period of time. I generally recommend a week of laying low after most major procedures, but just a couple of days for smaller procedures. As most of my patients are fitness enthusiasts, I let them do cardio after a week, and they can do resistance training after two weeks, being careful to protect the operative site for four to six weeks. Resuming work depends on how physical the job is, and many patients are able to have surgery on Friday and go back to work on Monday, unless they have a more physical job.
Results can be obvious right away in most patients, but swelling may be present for weeks afterwards. In patients with only a small amount of fatty excess, where the change isn’t dramatic, the swelling may obscure early results. After six to eight weeks, however, much of the early swelling resolves, and the results become more obvious. Still, skin tightening takes time—up to a year, and other changes occur as the healing progresses. If there are post-operative contour issues, they can usually be addressed with a minor touch-up procedure. I normally wait nine months to a year before doing something like that, as it can take that long to see the final results.
There are risks to the surgery, and I’m not going to list them all here—your surgeon will address those. The one risk I want to talk about is the risk that you may not be happy afterwards. In most cases, this is related to minor contour issues that can be corrected with a minor procedure. In some patients, however, there may not be adequate skin tightening after the surgery, or a more significant contour issue may be present. Sometimes, it becomes apparent that liposuction just wasn’t the right procedure, and something more extensive is required. The most important thing to do if you’re not satisfied is to speak with your surgeon and explain your concerns. As plastic surgeons, it’s our goal to get you a good result. Most surgeons have a policy whereby secondary procedures are done with as little cost as possible. In my practice, as long as secondary work can be done in the office, we only charge a small fee to cover our expenses. If general anesthesia or hospitalization is required, there may be more expense involved. This is something I explain to my patients at their initial consultation, and you should be sure to ask your surgeon about that before you sign on the dotted line.
The process I’ve described here varies from person to person. Some handle it well, others are overwhelmed when they get a splinter. As surgeons, we know that we perform these procedures all the time, and we know you have far less experience as patients—at least most of the time. Even knowing that, however, we may sometimes overlook a detail that concerns you as the patient. You should always speak up and ask about such issues, since a simple question will often resolve something long before it becomes a problem. In the end, with good planning and a good surgeon, you’ll be looking your best on the beach this summer!