Large Volume Liposuction @ Dr. Brian Evans Plastic Surgery

1. Large Volume Liposuction @ Dr. Brian Evans Plastic Surgery America is facing an obesity crisis. Over 50% of the adult population is overweight with a significant portion of that percentage being obese. Recent studies linking truncal obesity to increased insulin resistance are part of the reason for the increased demand for liposuction surgery. While a healthy diet and exercise remain crucial components for overall health, the benefits of decreasing truncal mass, which both decreases insulin requirements and makes exercising easier, has led to an increased demand for large volume liposuction in particular. Small volume liposuction usually involves up to five liters of fat removed, and large volume liposuction refers to cases where 5 or more liters of fat are removed. Large volume liposuction does have a considerable amount of risk attached to it, but as long as the patient meets all of the criteria listed below, the risks associated with the surgery should be minimal. One of the main factors that differentiate large volume liposuction from the more traditional methods is that the patient loses more liquid and therefore requires solid cardiovascular and pulmonary health to keep the body safe during surgery. For this reason and others, doctors and potential patients need to be aware of some of the critical factors:

2. ● Patients are advised to seek surgeons with experience and training in this specific procedure; as opposed to cosmetic surgery in general. ● The doctor must choose an anesthesiologist carefully. As detailed below, the surgeon and anesthesiologist will communicate constantly and make adjustments during the procedure. ● Large volume liposuction should only take place in an accredited facility. ● Make sure any staff working during the surgery know the ins and outs of the procedure and are prepared to handle anything that may arise. ● Large volume liposuction is not appropriate for everyone who wants to lose weight. Doctors need to use a specific set of criteria to determine whether a candidate can safely benefit from this surgery. Choosing the Right Candidates for Large Volume Liposuction with Preoperative Evaluations It is imperative that any candidate for large volume liposuction meet certain criteria before they go into surgery. Preoperative evaluations can be highly beneficial in determining which patients are and are not potential candidates for the surgery. Candidates should be both physically and mentally healthy with no untreated medical problems. Undetected issues like cardiovascular problems, thyroid disease and sleep apnea can be potentially fatal in the operative and post-operative stages of surgery. Doctors should also evaluate a patient’s mental state and expectations. Anyone aspiring to perfection will be disappointed in their results. It’s a surgeon’s job to make sure a candidate’s expectations are realistic. In addition to a healthy body and mind, candidates should also have a stable weight or be in the process of losing weight through diet and exercise. For those that are compliant, any diet medications should be discontinued no less than two weeks before surgery. During the preoperative evaluation, patients should be given a thorough physical exam as well as asked to complete a detailed family history. The preoperative evaluation will determine if a candidate has a normal blood volume and if the lungs are healthy. It is also imperative that candidates be non-smokers with no previous abdominal surgery and within 30-35 lbs of their target weight. The risk of complications is lower for those closer to their target weight.

3. Prime candidates must also: Maintain a stable pre-operative weight. Crash dieting depletes volume and is hazardous. Respond well to a “snap back” skin test for elasticity. Intra-Operative Decisions The Tumescent or Superwet technique has become a standard in recent years because the larger amounts of anesthetics used have several benefits. These include less post-operative pain, less bleeding, less swelling and fewer skin irregularities. However, attention to anesthetics is still essential. General endotracheal anesthesia is the preferred method of anesthesia for large volume liposuction. It is a balanced anesthetic containing narcotic, propofol, midazolam, and an inhalational agent. Intra-operative monitoring during the procedure includes ECG, blood pressure monitoring, pulse, temperature, carbon dioxide measurements, and urine output. Communication between the surgeon and anesthesiologist is essential for a successful surgery. Constant monitoring of the patient’s fluid balance is also necessary. The anesthesiologist must be constantly aware of how much wetting infusion is given in relation to fat and saline aspirated, and urine and blood loss. This is necessary to determine the patient’s fluid balance and to avoid any fluid overload, or the chance that the patient doesn’t have enough fluid to sustain them. Pneumatic compression cuffs are used for all patients undergoing large volume liposuction and are placed on prior to the start of surgery in order to prevent pulmonary emboli. The surgery should also take no longer than 3.5 hours in order to help keep too much trauma and stress from adversely affecting the body. If the surgery is to take longer than 3.5 hours, the surgeon can schedule it in stages. If large amounts of fat are to be removed from the lower back and flanks, the patient should be placed in the prone position in order to allow maximum access to those areas as well as helping to prevent over suctioning that can lead to skin damage. Attention to body temperature also plays a crucial role in a successful procedure. Patients are at a higher risk of developing hypothermia due to the exposure of large

4. areas of the body to an infusion of wetting solutions and the long procedure. It is most important to prevent hypothermia as it is difficult to correct once it sets in. Careful monitoring of the patient, as well as the room temperature, can help prevent this complication. The ultrasonic technique has become very popular in recent years for a number of reasons. By using ultrasonic technology to blast apart fat deposits prior to removal surgeons find that patients experience: Less blood loss Less fluid loss Less bruising and Better post-operative contraction or tightening of the skin In order to qualify for this technique patients must have good normal heart health, good skin elasticity (not loose or with stretch marks), and have normal blood volume. The last point may be a matter of concern for menstruating women. Post-operative Care After surgery, patients should be admitted to post-operative care for approximately two hours after surgery for close monitoring of their vital signs. It is necessary to have a well-trained staff of registered nurses in the recovery room area in order to provide the maximum amount of care to a patient who has just undergone large volume liposuction. Usually 24 hours after the operation, the patient is seen in the doctor’s office in order to receive instructions about support garments, which are generally given 3-5 days after surgery, depending on how much edema is present. If there is a significant amount of edema present, the patient is given 25mg of maxide which helps to eliminate excess water. They are also encouraged to get up and walk 24 hours after surgery to increase circulation. After the first 7-10 days patients are then encouraged to start lymphatic massage twice a week for four weeks. Heating pads and ice packs are not recommended during the post-operative care procedure because they can lead to further injury. After two weeks, the patient is usually advised to return to the gym and resume workouts 2-3 times a week. They are also given specific dietary instructions that

5. often include a menu that stresses glycemic control in order to minimize insulin resistance. The diet should be high in omega-3 fatty acids, vitamin C, and should be free of trans fat. Multiple small meals a day are recommended with snacks in between. The patient is then weighed every two weeks to ensure that there is no weight gain. Surgical garments during this time are recommended to be worn for 4-6 months after the procedure. Perhaps one of the most important aspects of post-operative care after large volume liposuction is the support team involved with the aftercare. After the procedure, the patient is released under the care of a trusted, competent after care facility for 24 to 48 hours or a specialty nurse who will manage their immediate aftercare their primary objective is to watch over the patient and determine if any additional medical action needs to be taken after the procedure due to complications in breathing, swelling, etc. Successful Large Volume Liposuction Large volume liposuction can be a safe procedure for those who qualify and are under the care of a trained profession who is an expert at the procedure. The qualifications of the surgeon and staff, evaluation of the candidate and communication between all involved parties are all essential to a successful outcome. The final factor of success is the patient’s ability to maintain a healthy post-operative lifestyle. Liposuction can be used alone or in conjunction with other cosmetic procedures at Dr. Brian Evans Plastic Surgery West Hills Hosptial & Medical center practice, including a tummy tuck, body lift, buttock enhancement, Face Lift, or Breast Augmentation. Because there is a limited amount of fat that can safely be removed from the body, the most dramatic liposuction results come at the hands of surgeons like ours with the experience necessary to maximize your results. Visit our West Hills Hosptial & Medical center practice to see how liposuction can transform your body. Contact Brian Evans MD today to schedule your liposuction consultation in West Hills Hosptial & Medical center For more info please visit: http://www.drbrianevansplasticsurgery.com