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BEFORE AND AFTER PHOTOS

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WHAT TO EXPECT AFTER SURGERY

 

Dr. Eric Swanson-Liposuction patient satisfaction survey

Discomfort

 

Survey results confirm that liposuction in males is less painful and the recovery is much faster than in females (Swanson E. Prospective outcome study of 360 patients treated with liposuction, lipoabdominoplasty, and abdominoplasty. Plast Reconstr Surg. 2012;129:965–978; discussion 979–980.). We all know this is not because men are more stoic than women (the conventional wisdom is the opposite). Women have more discomfort, on average simply because they typically have more areas treated and greater volumes removed. Women who have the abdomen and flanks treated alone (the areas most commonly treated in men), without the thighs, knees, axillary areas or arms, have recovery experiences similar to males. There is also considerable variability between individuals. The range of pain ratings was 1–10 for both sexes; some patients experienced virtually no pain and for others, it was the worst possible pain. Patient satisfaction was remarkably similar comparing men and women and the vast majority would have their surgery again.

 

Postoperative discomfort depends on the extent of liposuction needed and the number of areas treated. There is usually a generalized soreness and some stiffness due to swelling. Pain is typically well-controlled with medication, which is taken during the first several days after surgery. I have heard stories from patients who have been treated under local anesthetic, telling me how painful the procedure was. Some patients have friends who reported a lot of pain after liposuction. No doubt, liposuction can be a painful procedure. However, there are ways of reducing the pain. One way is by doing the surgery with the patient asleep, which is preferred for all but small touch-up liposuction procedures.

 

Local anesthetic is injected into the tissues as part of the tumescent (“superwet”) technique. This local anesthetic works for several hours, so patients are not in pain waking up after surgery. Also, tissue trauma is minimized using the ultrasonic technique, the less traumatic blunt cannulae, and avoiding overaggressive treatment. These precautions allow for superior results with tolerable pain levels. Most patients report that the pain level was what they thought it would be. It does not surprise them. It is tolerable and controlled by prescription painkillers.

 

There is still a range of patient experiences. Some patients take liposuction in stride, even returning to work the next day. Others give me a somewhat accusatory look (maybe I’m reading too much into it) and tell me, “I feel like I’ve been run over by a truck!” The number of areas treated is relevant. Most men have the abdomen and flanks treated, which is relatively easy to recover from. Some say it is like a tough workout in the gym. Most women also have the thighs treated. This causes more discomfort, particularly when sitting down.

 

Change in Clothing Size

 

Women dropped an average of 1.7 dress sizes (a drop from a 14 to a 10/12 would be 1.5 sizes). Men reported an average reduction of 1.4 inches around the waist.

 

A garment is worn to help reduce swelling for a period of one month. The garment is removed for short periods to bathe and shower and may be worn under regular clothing. Bruising usually disappears within one month. Patients may then wear shorts or a bathing suit. The stitches dissolve on their own.

 

Numbness

 

Numbness in the treated areas is to be expected. The small sensory nerve endings are traumatized by the surgery. There may also be unusually sensitive areas of the skin. This is called “hypersensitivity.” It typically takes about two months for the feeling to return to normal.

 

Swelling

 

Most patients notice a difference immediately after surgery. However, swelling develops during the first few days, which can make the areas temporarily look fuller than they were before surgery, particularly in lean patients. Accordingly, patients are instructed to wear loose-fitting clothing right after surgery. Although swelling is variable from patient to patient, typically two-thirds of the swelling is gone in one month. Full resolution of swelling takes about three months. This is important for patients to know, because they may otherwise be disappointed at their one-month follow-up appointment, thinking that this is their final result, when in fact they still have a significant degree of swelling.

 

Many patients call the office several days or a week after surgery to report that their feet and ankles are swelling. They have a hard time putting on shoes. They wonder if this is normal. It is. The legs below the knees often show increased swelling a week after surgery because of the effects of gravity, even when the calves are not treated with liposuction. Bruising may extend all the way down to the toes. This may be alleviated by elevating your legs on an ottoman when you are sitting. If one leg is swelling conspicuously more than the other, this should be assessed by your surgeon because this could signal a blood clot in a leg vein (“deep venous thrombosis”), which is a serious complication requiring investigation and treatment.

 

The Garment

 

At the end of the operation, while patients are still asleep, a “compression garment” is applied. This is either a simple Velcro binder that goes around the abdomen and flanks (commonly used in men), or a girdle that goes from the level of the upper abdomen down to the thighs, either above or, more commonly, just below, the knees. The purpose of the garment is not to even out the fat layer. The remaining fat cells do not move around, which is why technical expertise in evenly removing the fat cells is important. The garment is not used to smooth contours. Rather, it is used to limit swelling, and help the swelling to go down sooner. Most patients also find it more comfortable to wear the garment. They feel that they need the support. It is removed for bathing, and may be washed, although it should be dried in a no-heat cycle to avoid shrinking. It is difficult for women to put on the girdle at first; they need help. But after changing it a few times, it becomes easier. One trick is to leave the bottom end of the garment at the knees zipped for several inches so that it does not become tangled when it goes in the wash.

 

I usually recommend wearing the garment for one month. It is concealed under clothing, except during the summer when Capri pants may be necessary to conceal the knee-length girdle (when the knees are treated). However, two weeks after surgery, patients may wear spandex instead, such as cycling shorts or an aerobics outfit. You can alternate wearing the garment and wearing spandex. The principle is gentle compression. Some patients are never comfortable with the garment and make the switch to spandex earlier. It is important to realize that too loose is better than too tight. If you don’t wear the garment at all, your result will be the same, but your swelling will take longer to go down. I recommend wearing slightly compressive athletic garments when exercising, even after a month. This helps reduce swelling.

 

Time Off Work

 

Time off work depends on the areas treated, how physical requirements of the job, and your own pain tolerance. Most women take one week off work, or two weeks if they have a job that requires significant physical activity. Men usually recover quickly because fewer areas are treated and are often back to an office job in three or four days. Some return to work the day after surgery. For more physical jobs, such as a plumber or construction worker, one week off is recommended. If the job is very physical, such as going up and down ladders, two weeks off is better. For women, who usually have the lower body treated (thighs included), one week off is recommended for office jobs. However, plenty of my patients return to work sooner. If you have a job that involves standing for long periods (pharmacist, for example), a week off is recommended. Otherwise, you will swell more and be uncomfortable at the end of the day. Sitting is uncomfortable after having the thighs treated and you will want to get up frequently and move around.

 

Exercising

 

Most patients want to know when they can get back to exercising. Many work out on a regular basis, some every day. The most difficult aspect of the surgery may be interruption of their exercise routine. I tell them, no exercising for two weeks, and they give me the look that says, “maybe for other patients, doctor, but not me.” I then explain that they will be sore after surgery and if they do work out, they will have more swelling and will hurt more afterward (not while they are working out, but later). It is possible to get some nonvigorous exercise, by walking for example, but any vigorous exercising that raises the blood pressure will exacerbate swelling. Using an elliptical trainer or exercise bike should wait about three weeks after surgery. All exercises may be resumed four weeks after surgery. When resuming exercise, it is important to let your body tell you when you are ready. First do a light workout, maybe 50% of what you would ordinarily do, and then see how you feel the evening after exercising. If there is no problem, increase your exercise routine gradually. If you do it all at once, you will swell and hurt more, and will need to take more time off before resuming exercising, but fortunately, this will not jeopardize your result.

 

Back to Normal

 

Another common question is, “When can I go on a cruise?” I’ve had patients go on Caribbean holidays days after surgery, but most people want to look and feel their best. One month after surgery, the bruising and most of the swelling is gone. There are no restrictions at this point, so a minimum of one month of recovery time is recommended.

 

Liposuction of Arms

 

There is no garment that is applied to the arms. However, some patients will wear a snug athletic shirt that has sleeves to provide some gentle compression. Swelling and bruising are to be expected. The bruising may extend down the forearm due to gravity. There are areas of numbness that can take a few months to return to normal. The arms are sore, but the pain is tolerable. Often a caretaker may grab the arm to help, not realizing that it is sore. Because the arm is at a higher level than the heart, arm swelling tends to go down more quickly after liposuction than the legs. Liposuction of the arms does not seem to add much to the amount of postoperative discomfort, and improves an area that is more visible and responds favorably, so it is common for women to have the arms treated simultaneously with their lower body.

 

 

 

Dr. Eric Swanson-Liposuction patient satisfaction survey