You may visit your surgeon as many times as you wish, to have all of your questions answered. At your preoperative visit (which takes an hour or more), your final questions will be answered and you will confirm that you understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that will be used before surgery, as well as for pain pills and antibiotics, along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 40, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or other laboratory (e.g. Kaiser Hospital, etc.). Smoking constricts blood vessels and hinders normal healing – all smokers will be asked to stop smoking three months prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.

It will be necessary to scrub the chest, abdomen, groin, flank regions, and thighs for ten minutes the evening prior to surgery and a final time the morning of surgery before leaving home. Washing the surgical site these two times with Hibiclens® soap will lower the possibility of an infection occurring after surgery.

Ordinarily, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center, prior to your procedure. You must make arrangements to have someone drive you to and from the Laguna Hills Surgery Center and stay with you at home for the first three or four days afterwards.

Arrangements can also be made to have a registered nurse care for you for the first night or two as well, either at your home or at the Ayers Hotel adjacent to the Surgery Center.

The operation will be performed in an outpatient facility under very deep sedation or light general anesthesia, supplemented by local anesthetics.

An incision is made clear around the lower body (thus the term “body lift” or “belt lipectomy”), beginning above the buttocks and extending, in a curved line over the hip areas and across the lower abdominal wall above the pubic area. The posterior skin is excised as a big wedge, with little undermining unless flaps are desired to enhance the buttocks area. The skin and fat of the abdominal wall are elevated to the rib margins. The navel remains attached to the abdominal wall, but is released from the surrounding skin and fat through a diamond shaped incision around the navel. The abdominal muscles are tightened by suturing them together in the midline. These internal sutures are permanent but all of the remaining sutures used for the skin closure are absorbable. The excess skin and fat from the lower abdomen are trimmed. A tighter abdominal wall can be obtained by excising a vertical wedge as well, resulting in an inverted “T” scar, with the vertical component extending up the abdominal midline from the pubic area to the rib cage – this scar tends to spread and is avoided unless absolutely necessary. On occasion, it may be appropriate to suction some of the excess fat that can not be resected, but there is a limit to how much can be removed without jeopardizing the viability of the skin flaps. A new opening is created in the skin of the abdominal wall to reinsert the navel. Drains and pain pump catheters are inserted prior to suturing the wound closed. The pain pump catheters are connected to a reservoir that contains local anesthetic solution that will automatically infuse into the surgical site for the first few days to minimize your discomfort. The pain pump catheters are optional (strongly recommended) but all patients will have drainage tubes inserted anteriorly (not require from the back side). The drains remove excess blood and serous fluid and will be removed after the drainage has decreased to less than 25-30 cc. (about an ounce) of fluid per day. This usually takes about a week to ten days but can take up to a month.

Adequate pain medication will also be prescribed. All patients, who go home on the day of surgery, will find that an assistant at home is a necessity for the first three days or so. This can be a family member or a trained nurse. High bulk foods are highly encouraged and laxatives may be necessary to prevent straining associated with constipation.

Patients will be encouraged to walk as much as possible at home after surgery as this will reduce the possibility of pneumonia or of clots forming in your calf veins. Wearing Tedd® compression stockings for the first week is advised. It may be helpful to keep the hips gently flexed for the first week to minimize discomfort and to prevent excess tension on the abdominal suture lines but sitting should be avoided as much as possible during the first week as this can increase tension on the suture line across the back. Each patient is allowed to stand up straight, bend or sit when comfortable doing so. Patients will be allowed to shower after the drains have been removed, but soaking in a bathtub is to be avoided for few weeks. Wounds are generally closed with absorbable buried sutures. The incisions are covered with surgical adhesive, which will wash/peel off spontaneously over a few weeks. It is recommended that patients begin applying ScarGuard® (or another suitable scar cream or ointment to optimize healing) as the adhesive begins to peel off about two weeks after surgery. The ScarGuard® should be applied daily as directed until the scar has finished healing (scars flat and soft).

Your first post-operative visit will generally be scheduled three to four days after surgery at which time the pain pump catheters will be removed. The drainage tubes will be removed at a subsequent visit. You should continue taking antibiotics as long as the drainage tubes are in place. You will be required to have someone drive you to the office for your first and second visits. Most patients find that they can gradually increase their activity levels thereafter. You may drive a car with caution, wearing a safety belt, beginning 48 hours after your last pain pill or sedative, if you feel comfortable and physically able to do so.

Life threatening or other serious complications after a body lift are relatively uncommon. However, healing delays due to a partial disruption of the suture line are common, occurring in about 10% of cases. There will be a long scar (usually, but not always, within the bathing suit line) extending from hip to hip, front and back. The scar may remain itchy, painful, thick, or otherwise unsightly. It is unusual, but possible, for areas of fat to liquefy and drain through the incision for many months, or to cause a tender mass to develop beneath the skin, which may require excision at a later date. As with any surgical procedure, it is also possible for a deep suture to become infected and to erode through the skin years later.

One of the most common problems after an body lift is a persistent collection of serous fluid under the abdominal skin after the drains have been removed. Should this occur, this fluid will be aspirated with a needle during your post-operative visits. Such drainage always stops eventually (but may persist for more than a month) and usually does not affect the final results. If wound problems develop, it may take several weeks or even months for healing to take place, and the patient will be required to wear dressings over the open wound. Rarely, because of the extensive skin and fat undermining, areas of skin may die and slough, or even require surgical debridement or a skin graft. Also rarely, phlebitis may develop in leg veins and even more rarely, blood clots could travel to the lungs, potentially leading to a fatal complication.

Perfect symmetry does not exist before or after any surgery. Scars will never be identical from side to side, the skin may feel or look tighter on one side than the other, and the umbilicus will never be exactly midline.
Secondary procedures may occasionally be desirable to revise scars, to excise more skin, or to thin the abdominal layer above the scar (usually with liposuction). The patient will be responsible for all costs associated with secondary surgical procedures.

It is not possible to list every conceivable complication. As with any operation, there could be potential complications, which could even be fatal. The foregoing is not intended to frighten or upset you but to enable you to make your decision with an understanding of some of the involved risks.

If a significant spreading of the anterior muscles or a hernia is present, or if you have had documented infections beneath your skin folds, your insurance company may, rarely, reimburse you for a portion of the Surgery Center bill and of the professional fees. In some instances, it may be possible to verify the amount covered by your insurance carrier in advance; the office staff can assist you in making this determination, but cannot guarantee a level of payment. The office staff will provide you with the necessary information to submit to your insurance carrier. All fees are due prior to the surgical procedure and, if any portion of your procedure will be covered by your carrier, you will be reimbursed directly by your insurance company. Insurance carriers will not pay for the skin tightening or other portions of the procedure they consider “purely cosmetic”. If desired, the office staff can also help you arrange financing for your procedure.

In compliance with suggestions adopted by the American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for plastic surgery prior to the desired operation. This insures that the patient is sincere in his/her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date when booking your procedure. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but never later than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees and the anesthesiologist. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.

Pre and post-op photos will be taken of the treatment site for record purposes. I understand that these photos/videos will be the property of the attending physician. I do____, do not ___ agree to allow these pictures to be used for publication, teaching purposes or the practice web site. If I agree, I understand that my name will be kept confidential and protected.

IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL THE OFFICE DURING BUSINESS HOURS (949-888-9700) OR AFTER HOURS, CALL YOUR SURGEON – DR BUNKIS CELL PHONE NUMBER IS (949) 500-8856, OR REGISTERED NURSE, TRACEY PRESCOTT’S NUMBER IS (949) 338-6072.

WITH AN EMERGENCY THAT REQUIRES IMMEDIATE ATTENTION, CALL 911 BUT PLEASE HAVE YOUR FAMILY NOTIFY DR. BUNKIS OF ANY PROBLEMS YOU MAY HAVE!

I, _________________________________________________certify that I have read and understand the “Body Lift/Belt Lipectomy/Post Bariatric Surgery Reconstruction” information sheets dated March 2008, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.

Witness_______________________________ Date__________________

I certify that I or a member of my staff has discussed all of the above with the patient and have offered to answer any questions regarding the procedure. We believe that the patient fully understands the explanation and answers.

Surgeon’s Signature_____________________ Date_________________

Initial if copy requested/given to patient____________________________
Copy placed in chart __________________________________________

Copyright 11/87 Last revised 03/08
Juris Bunkis, M.D., F.A.C.S.

Social activity should be limited while the patient is uncomfortable. A good general rule of thumb is that patients should avoid any physical activity that causes discomfort. There is no set time table for resuming strenuous activity – just avoid activities that cause discomfort – but as a general rule of thumb for most patients, it takes approximately six weeks for the muscle repair to heal to a point where strenuous activity does not cause discomfort. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away. Office work can usually be resumed within 1-2 weeks of surgery, but the patient should expect a six-week delay before returning to physical labor or strenuous exercise. It will take longer than a year for scars to fade and the surgical sites to feel relatively normal. The lower abdominal skin may feel numb forever and completely normal feeling is not to be expected.