You may visit your surgeon as many times as you wish to have all of your questions answered. At your final preoperative visit, which will take at least an hour, your final questions will be answered and you will confirm that you have 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 is used before surgery, as well as for pain pills, antibiotics and instructions for their use.

All patients anticipating an elective surgical procedure are to stop taking any medication containing anti-inflammatory agents (Aspirin®, Advil®, Motrin®, etc.) as these interfere with the body’s clotting mechanism and can result in dangerous blood loss. Suction lipectomy patients are asked to take iron tablets prior to and after surgery (such as ferrous sulfate or ferrous gluconate, approximately 300 mg each, twice daily, beginning two weeks before surgery and continuing for two weeks after the procedure or longer if strength has not yet returned). In order to minimize the possibility of infection, all patients are to wash the areas to be treated with Hibiclens® soap for ten minutes the night before surgery and to repeat the process for ten minutes on the morning of the operation. Certain laboratory tests will also be required within two weeks of surgery.

If you are over the age of 50, you will have to obtain a cardiogram. 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 any state licensed laboratory (e.g. Kaiser Hospital, etc.) All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation. Usually, 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 Laguna Hills Surgery Center, prior to your procedure.

Suction lipectomy is usually performed in an outpatient surgical facility under a deep sedative or a light general anesthetic, supplemented by local anesthesia, although an occasional small area may be suctioned strictly under a local anesthetic alone. Small incisions are made in convenient skin folds wherever available. Large amounts of saline solution containing local anesthetics are infiltrated into the surgical sites prior to suctioning. If you have a large amount of fat to be aspirated, or if your fat is in a generally more fibrous area, your surgeon might recommend first treating the area with an ultrasonic probe or in using the newer power assisted liposuction (PAL) or laser machines. These probes assist by breaking up the fat and, in such situations, allow more to be removed with less blood loss, and minimize surgeon fatigue. A narrow, metal cannula, which is connected by a clear hose to a powerful vacuum machine, is passed back and forth through the area of excess fat, selectively removing the excess fat. It must be understood that only the layer of fat between the skin and the underlying muscle (the amount you can pinch before surgery) can be suctioned. None of the liposuction procedures significantly tighten loose skin! Some surgeons just perform liposuction and others just traditional excisional procedures. It is highly recommended that each patient requesting body contouring be evaluated by a qualified surgeon who can offer both options to a patient, based on each patient’s needs and desires – thus, patient expectations are more likely to be met!

A large variety of liposuction machines are now on the market and are highly touted by the manufacturers of each. We have a variety of machines available at the Laguna Hills Surgery Center, but it is generally accepted in the scientific literature that results are based more on surgeon technique and the size of cannulas (the smaller the cannula, the less bruising and blood loss, allowing more fat to be removed) than on brand or type of machine. The Power Assist, Laser and Ultrasound machines all produce comparable results, the main advantage over the older generation of machines being the decrease in bruising and the decrease in surgeon fatigue!

The tunnels that are created throughout the area of previous fatty excess fill with blood and body fluids, thus creating the bruising and swelling that are seen after the operation. The bruising usually subsides within three to four weeks, but the final swelling will not dissipate before three to four months have passed by (longer for ankles and calves).

The patient’s age, general health and body size determine the amount of fat, which can be removed safely at any one operative sitting. An absolute maximum that can be removed in the ideal young and healthy candidate is limited to 5 liters of aspirate. Suctioning of larger amounts will increase health risks and could necessitate a transfusion. However, every effort is made to stay within the five-liter limit and to avoid the need for a transfusion or for hospitalization. If removing more than a total of five liters of excess fat is anticipated, performing a second operative procedure three to four months later will be recommended as a safer approach. On occasion, the surgeon will remove the entire five liters of fat from one area before another previously discussed area can be treated. Likewise, it will be necessary to return to surgery three to four months later to remove the remaining fat. The patient must understand that fees will be encountered each time another trip to the operating room becomes necessary.

It is estimated that 5% of patients treated will require touch-up procedures, which consist of removing remaining or new accumulations of fat. In instances where the skin droops or sags after removal of the fat, surgical excision of the excess skin may be desired and this could leave scars, which would be permanent. As mentioned, re-operating will result in additional fees, as well as require additional time for recovery. The patient will be responsible for all costs associated with secondary surgical procedures.

Some patients, especially if it is anticipated that larger amounts will be suctioned, may decide to spend the first night with a registered nurse. After an appropriate recovery period, the surgical facility staff will call the pre-arranged person to come and pick you up. It will be imperative that a responsible adult spend the first 24 to 72 hours at home with you after the operation, depending on how much fat was removed. Although you will be given medication for your discomfort, you will initially find it difficult to move by yourself. Because of lowered blood counts, light headedness and pounding headaches are not uncommon initially. The patient will be given prophylactic antibiotics to take after surgery and must also continue taking the iron pills. Patients complain of feeling “wiped out” and tired until their blood counts can be built up again. Most people find that they are comfortable enough to return to a desk job within a week, but vigorous activity will be uncomfortable for at least three weeks.

Every patient will have some bleeding or oozing from their incisions after they go home. This almost always stops by the next day. Please change the dressings as necessary. You will be instructed to purchase a pressure wrap prior to surgery. This wrap will be placed on the treated area upon completion of your procedure, and you should wear it for one to three weeks, depending on the extent of fat removal. Specific instructions will be given for each treated area prior to release from the surgical facility and at the time of follow-up visits. The procedure is performed through approximately one-quarter inch incisions, which will necessitate removal of skin sutures approximately five to seven days after treatment. Drains are rarely required.

Although most patients have very satisfactory results, as with any operation, certain problems can occur and it is important that you be aware of the risks involved.

Permanent problems rarely occur; however, potential complications with this procedure include thickened or unattractive scars at incision sites, irregularities of contour such as waviness or depressions that may require secondary fat grafting surgery or further suctioning. In the event that skin loss occurs, permanent scarring or the necessity for skin grafting may occur. Skin wrinkling or sagging, numbness or increased sensitivity in the area treated, prolonged swelling of the area treated, accumulation of blood or serum under the skin requiring removal, asymmetry between the treated sides (they will not look alike), a change in the skin color, shock requiring transfusions, clots to the lungs, severe infections or even fatalities have been reported in the literature and may occur.

There is a possibility that you may not look better from this operation and it is conceivable that you may even look worse, should your skin sag excessively or complications occur. This information is not provided to frighten or upset you, but rather to acquaint you with the rare risks associated with this procedure so that if you elect to have such an operation it is with an understanding of the benefits as well as the rare but real potential risks.

Of course, it is not possible to advise you of every conceivable complication and other problems can occur that are unexpected. It should be noted that the complications associated with this procedure are frequently related to the amount of fat, which must be removed and the age of the patient.

All fees will be discussed with you in advance by the office staff. The office staff can assist you with financing if desired. The fee will vary with the number of surgical sites treated. In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in 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. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no 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, implant costs 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.

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

Adequate pain medication will also be prescribed. All patients, who go home on the day of surgery or the next morning, will find that an assistant at home is a necessity for the two or three days. High bulk foods are highly encouraged and laxatives may be necessary to prevent straining associated with constipation. The patient will be encouraged to walk as much as possible at home after surgery as this will reduce the possibility of pneumonia or blood clots forming in your calf veins. To minimize swelling and bleeding, activity should be limited at first to simply walking during the first week. Vigorous activity such as playing tennis or racquetball may be resumed when swelling, bruising and discomfort have dissipated.