The vast majority of patients who are undergoing cosmetic surgery have preoperative blood testing which includes a CBC. This test has several components which are critical elements of the preoperative evaluation. These include the platelet count, the white blood cell count, and the hematocrit and hemoglobin levels. Each of these measurements is extremely important. The platelet count measures the patient’s ability to clot blood, an elevated white blood cell count is an indicator of infection, while the red blood cell count, hematocrit, and hemoglobin all measure the body’s oxygen carrying capacity.
Occasionally other blood tests are performed in combination with a CBC based on your physical findings.
If you’re concerned about your preoperative blood testing, it’s appropriate to consult your plastic surgeon. Your surgeon should be able to discuss these lab values in detail.
The vast majority of women who undergo tummy tuck surgery are done having children. Rarely, women who have undergone abdominoplasty change their minds about additional pregnancies or accidentally become pregnant. Under these circumstances, tummy tuck has no negative impact upon the pregnancy. Unfortunately, pregnancy has a negative impact upon the patient’s previous abdminoplasty. Pregnancy recreates many of the patient’s original problems, including loose saggy skin, weakened abdominal muscles, and stretch marks.
Because of the significant investment in time, money, and effort, we strongly recommend that patients be done having children before proceeding with abdominoplasty. Even when women don’t plan on having additional children, their life circumstances change and they become pregnant. Under these circumstances, revision of the original tummy tuck can be undertaken with success.
Flabby upper arm tissue can represent a significant aesthetic deformity that can adversely impact self-esteem and self-image. When this situation arises, several treatment options exist which can improve upper arm aesthetics. These include liposuction, mini brachioplasty and full brachioplasty. The procedure chosen is dependent upon the patient’s aesthetic goals and specific anatomic findings.
In some cases, liposuction may be a viable alternative. When this procedure is utilized, scarring is minimal and results are usually excellent. Unfortunately, this procedure is only effective when fat is present and skin is relatively tight.
When excess skin is confined to the upper arm in the area of the axilla, a mini brachioplasty may be effective. This procedure utilizes an incision in the upper arm which is transversely oriented and well hidden. The procedure is helpful when patients have minimal excess upper arm skin and is associated with excellent results.
Unfortunately, the vast majority of patients who have had significant weight loss require more extensive procedures. In most cases, this involves a full brachioplasty with an incision that extends from elbow to axilla. This procedure addresses excess skin in the vertical and transverse dimensions. In most cases, results are excellent, but occasionally adverse scarring can be a problem.
When significant excess skin is present laser tightening and other non- surgical treatments aren’t effective. For this reason, patients who have significant arm skin sag should consult a board certified plastic surgeon who can formulate an appropriate treatment plan.
Skin tightening following liposuction varies from patient to patient and depends on a variety of factors. It’s not unusual to have skin tightening following liposuction in patients who are younger and have good skin tone. In older patients with poor skin tone, liposuction might result in skin sag because of poor skin contraction.
Skin tightening isn't unique to post-operative liposuction patients, but also occurs following massive weight loss and pregnancy. How individual patients respond to these changes is dependent upon their genetics and biologic behavior. Although multiple liposuction techniques are available that reportedly tighten skin, the patients wound healing biology and genetics are the most important variables.
If you’re considering liposuction and are concerned about skin sag, it’s important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to assess your risk for skin sag.
Whenever possible, patients should be near their ideal body weight before they undergo liposuction. For some patients this just isn’t possible and under these circumstances a stable body weight is acceptable. When patients are actively losing weight, it’s appropriate to delay surgery until a stable weight has been obtained.
It’s important to realize that weight fluctuations after surgery can adversely impact the results of liposuction. For this reason, every effort should be made to reach a stable weight that can be easily maintained before and after surgery.
There are no scientific studies that conclusively demonstrate that massage is helpful following liposuction. Despite this, many plastic surgeons utilize massage as a routine component of postoperative care following this procedure. They believe that massage minimizes internal scarring, decreases edema, and helps remodel soft tissue.
It’s not unusual for patients to complain of swelling, tightness, and stiffness following this procedure. Massage and an early return to physical activity seems to help with these issues. For these reasons, plastic surgeons often recommend gentle massage and stretching exercises after liposuction. These are usually started 7 to 10 days following the procedure. Initially these maneuvers cause mild discomfort which quickly resolves with time.
If you’re planning liposuction, it’s important to discuss this issue with your plastic surgeon. In many cases, massage will be an important part of your postoperative care.
Tumescent liposuction represents a significant advance in the management of localized fat collections. When this techniques is utilized with local anesthesia alone the response varies from patient to patient. The majority of patients appear to do well and have good results especially when smaller amounts of fat are removed. Unfortunately, we frequently see patients who have had significant pain and discomfort during the injection process when local anesthesia is used alone.
For this reason, many surgeons supplement local anesthesia with I.V. sedation or general anesthesia to minimize pain and discomfort during the procedure. When utilizing this approach patients can have more fat removed and avoid multiple procedures. The procedure is more comfortable and avoids break through pain which can occasionally occur with local anesthesia alone.
It’s important to realize that all surgical procedures and anesthetic techniques have risks. This is true whether local anesthesia, I.V. sedation or general anesthesia are utilized. Most surgeons who perform tumescent liposuction agree that the anesthetic technique utilized is less important than the use of a certified operating room and the presence of an anesthesiologist. In other words, you don’t want your surgeon to be your anesthesiologist.
