Tickle Tumescent Liposuction

Transcription

1 Tickle Tumescent Liposuction Liposuction is the removal of fat from various areas of the body. Traditional liposuction involves general anesthesia and the use of cannulas to remove the fat. Certain types of energy can be used to remove the fat in addition to manual labor (no energy used except the surgeon s physical energy) and can involve the use of ultrasound energy (Vaser), lasers (Smart Lipo), water pressure (Aqua) and power assisted energy (nutational vibration: Tickle lipo). What is Tickle Tumescent liposuction? Tickle liposuction gets its name from the vibration of the cannula some patients experience a tickling sensation from the mechanical energy. Tumescent liposuction is liposuction performed with local anesthesia along with sterile saline infused into the fat tissue to be removed. Being awake but relaxed during the procedure improves the results from liposuction because the patient is able to move around which helps with the removal of fat from certain areas. Any surgery involves the risk of infection, bleeding, scarring or serious injury; however, tumescent liposuction has an excellent safety record. The greatest risks of liposuction are those associated with general anesthesia. By eliminating general anesthesia, the risks of liposuction are dramatically reduced. Without general anesthesia, the patient is encouraged to eat a meal prior to the procedure and hydrate before and after the procedure. Dr. Murrmann has performed liposuction with other forms of mechanical energy in the past, and has explored Aqua lipo and ultrasound assisted liposuction. She believes Tickle vibrational energy is far superior to the other forms of liposuction. Dr Murrmann achieves a smoother appearance to the treated area because the vibration helps break down the fat and reduce irregularities. Realistic expectations Tickle liposuction helps reduce areas of fat resistant to weight loss because of genetic issues ( I have had saddle bags all of my life ), post pregnancy, or midlife weight gain resistant to dieting. It is not a cure all. Liposuction is meant to encourage lifestyle changes in eating habits and exercise. Dr. Murrmann believes that a little encouragement can help make patients live a healthier life and take better care of themselves. The sculpting and the reduction in body fat are remarkable with Tickle liposuction. However, skin and body irregularities (cellulite, aging skin, stretch marks, dimples, lumpiness) cannot be changed or removed, and may still present after the liposuction. Although the areas do not look worse and improve over the next 6 months, the overall result of fat reduction and body sculpting is significant. Please do not have the expectation of looking like a supermodel (unless you were a supermodel prior to the procedure!). Larger areas of fat may require two procedures because total lidocaine (numbing medicine) dosage of the tumescent solution is calculated to height and weight. There is a limit of lidocaine dosage per procedure. Some medications may need to be discontinued prior to the procedure in order for the lidocaine dose to provide adequate pain relief. Remember, liposuction is not a substitute for weight loss and living a healthy lifestyle. If you gain weight, you can and will gain weight in other areas of your body that liposuction was not performed. The areas you had liposuction on may look irregular! For your best outcome, we encourage you to keep your follow up appointments.

2 Below is a list of medications that must be stopped before liposuction: Advil Aleve Alcohol Alka Seltzer Amigesic Anacin Anaprox Anaproxin Ansaids APC Argesic Arthra G Arthropan ASA Ascodeen Ascriptin Aspergum Aspirin BC Powder Baby Aspirin Bayer Aspirin Bruder Bufferin Butazolidin Cephalgesic Characol Caps Children s Aspirin Choline Salicylate Clinoril Congesprin Cope Coricidin Corticosteroids Coumadin Darvon ASA Darvon Compound Daypro Depakote Dexamethasone Diclofenac Dipyridamole Disalcid Divalproex Doan s Pills Dolobid Dristan Easpirin Ecotrin Empirin Emprazil Endodan Excedrin Feldene Fenoprofen Feverfew Fiorinal Flurbiprofen Froben 4-Way Cold Tabs Garlic Capsules Gelpirin Genpril Genprin Ginko Biloba Goody s Body Pain Haltran Halfprin Ibuprin Ibuprofen Ibuprohm Indameth Indocin Indomethacin Ketoprofen Ketorolac Lortab ASA Mg salicylate Meclofenamate Meclofen Medipren Mefenamic acid Menadob Midol Mobidin Monogesic Motrin Nabumetone Nalfon Naprosyn Naproxen Norgesic Norwich Extra Strength Nuprin Ocufen Orudis Oruvail Oxyphenbutazone Oxyutazone Oxaprozin Pamprin Pepto-bismol Percodan Persantine Phenaphen Phenylbutazone Piroxicam Ponstel Prednisone Quagesic Relafen Rexolate Robasissal Roxiprin Rufin Saleto Salflex Salsalate Salsitab Sine Off Sine Aid Na Thiosalicylate Soma Sulindac Synalgos DC Tanacetumparthenium (feverfew) Tolectin Tolmetin Toradol Trandate Trendan Trental Trigesic Trilisate Tusal Vanquish Vitamin E Voltarin Warfarin Willow Bark Zactrin Zorprin

3 Medications and Foods that Potentially Interact with Tumescent Anesthetic Please Inform Dr. Murrmann, Judy or Tara if you are taking any of the following: Anesthetics -propofol (Diprovan) Anti-Arrhythmics -mexiletine (Mexitil) -propafenone (Rythmol) -quinidine (Quinaglute, Quinidex) Anti-Asthmatics -zafirlukast (Accolate) -zileuton (Zyflo) Antibiotics/Anti- Microbials/Anti-Infectives -ciprofloxacin (Cipro) -clarithromycin (Biaxin) -chloramphenicol (Chloromycetin) -enoxacin (Penetrex) -erythromycin -isoniazid -norfloxacin (Noroxin) -troleandomycin (Tao) -tetracycline Anti-Convulsants -acetazolamide (Daimox) also a diuretic -carbamazepine (Tegretol) -divalproex (Depakote) -stiripeentol -valproic acid (Depakene) Anti-Depressants -amitriptyline (Elavil) -clomipramine (Anafranil) -flouxetine (Prozac) -fluvoxamine (Luvox)-nefazodone (Serzone) -paroxetine (Paxil) -sertraline (Zoloft) Anti-Diabetics -triglitazone (Reztilin) Anti-Fungals -fluconazole (Diflucan) -itraconazole (Sporanox) -ketoconazole (Nizoral) -metronidazole (Flagyl) -miconazole (Monistat) Anti-Histamines -astemizole (Hismanol) -terfenadine (Seldane) Anti-Neoplastics -tamoxifen (Nolvadex) Anti-Psychotics -clozapine (Clozaril) -sertiadole -pimozide (Orap) Anti-Secretory -omeprazole (Prilosec) Benzodiazepines -alprozolam (Xanax) -flurazepam (Dalmane) -midazolam (Versed) -triazolam (Halcion) Beta Blockers -propranolol (Inderal) Calcium Channel Blockers -amiodarone (Cordarone) -diltiazam (Cardiazam) -felodipine (Plendil) -nicardipine (Cardene) -nifedipine (Procardia) -verapamil (Calan) Corticosteroids -dexamethazone (Decadron) -methylprednisolone Food/Beverages -naringenin (Grapefruit Juice) Hormones -ethinylestradiol (Estinyl Feminone) -danozol (Danocrine) -thyroxine H2 Blockers -cimetidine (Tagamet) Immunosuppresants -cyclosporine (Neoral, Sandimmune) Miscellaneous -anastrozole (Arimidex) nonsteroidal aromatase inhibitor -caffeine -cannabinoids -cortisporin (Cortisol) -methadone (narcotic) -mibefradil dehydrochloride (Posicor) -pentoxifylline (Trental) -ramacemide -tacrine (Cognex) reversible cholinesterase Protease Inhibitors/Antivirals -diethyidithiocarbamate (Imuthiol) -indinavir (Crixivan) -nevirapine (Viramune) -nelfinavir (Viracept) -ritonavir (Norvir) -saquinavir (Invirase)

4 Before Surgery Our office wants to provide you with the very best surgical care. You can help to minimize the risk of complications by carefully reading and following your preoperative and postoperative instructions. Please ask us to clarify anything you do not understand. If you have any questions for Dr. Murrmann or Tara Polson, RN, please do not hesitate to call (901) One month prior to surgery Discontinue any statins such as Lipitor, Zocor, or Crestor as these medications work in the liver and may cause lidocaine to wear off or break down too quickly. Two weeks prior to surgery Payment. The balance for surgery is due two (2) weeks before your surgery. Balance is paid to McDonald Murrmann Center for Skin, Laser (MMSL), 7205 Wolf River Boulevard, Germantown, TN Our phone number is: Hours of operation are Monday thru Friday 9 a.m. to 5 p.m. Credit card payments may be called in to MMSL and checks payable to MMSL may be mailed. Cash transactions must be paid on site at MMSL. If you are paying with a Care Credit Finance Plan please know that Care Credit levies an 8% fee to MMSL. Therefore, a 5% increase is added to your surgery fee at the time of payment. Do not fast or undergo dramatic weight loss just prior to surgery. You should be on a stable, healthy, well-balanced diet for two (2) weeks before surgery. Liquid diets, extreme low calorie diets, and rapid weight loss diets may predispose you to cardiac irregularities, surgical complications, or poor wound healing. Do not take appetite suppressants such as phentermine (Fastin) for at least two weeks before surgery. If you take an anti-depressant you need to wean off of it completely two weeks before surgery unless Dr. Murrmann states otherwise. Do not take herbal remedies such as Herbalife, Metabolife, Advocare, etc. as these may contain herbal supplements that could interact with tumescent anesthesia and/or cause excessive bleeding and bruising. Two (2) prescriptions(diazepam and Levaquin or Doxycycline) are called into your pharmacy several days before surgery. Cost for prescriptions is the responsibility of the patient. Your insurance may cover the cost of these medications. Vitamin K. Begin taking Vitamin K fourteen (14) days before the date of your surgery. This minimizes bruising, swelling and promotes healing. Please calendar this date as this will be your responsibility to start the medication two (2) weeks before surgery. Bromelain 500 mg (Pineapple Extract). Dr. Murrmann suggests the use of Bromelain once daily one week prior to surgery. Bromelain is a natural product which promotes healing. After surgery discontinue the use of Bromelain as this enzyme can interact with certain prescribed medications. Levaquin/Levofloxacin. (antibiotic prescribed for patients who are not allergic to Penicillin) As directed on the bottle, begin Levaquin two (2) days before surgery. Please take this medication in its entirety.

5 Or Doxycycline. (antibiotic prescribed for patients who are allergic to Penicillin) As directed on the bottle, begin Doxycycline two (2) days before surgery. Please take this medication in its entirety. Diazepam/Valium. Diazepam is a sedative prescribed for anxiety. As directed on bottle, bring Diazepam to the office the day of surgery. Dr. Murrmann s surgical nurse administers this medication at the time of your arrival. Do not drive and/or operate machinery while taking Diazepam/Valium. Hydrocodone/Lortab. Hydrocodone can be taken every 4-6 hours as needed for pain. Please bring this medication to the office the day of surgery. If you live some distance from our office there is a possibility you may need to take the Hydrocodone with food during your return trip after your surgery. Patients usually take Hydrocodone for the first two days after surgery and then change to Extra Strength Tylenol to manage pain and discomfort Extra Strength Tylenol (Acetaminophen). 500mg capsule or tablet does not require a prescription. You may take two tablets, three to four times a day for minor post-surgery discomfort. Do not take Tylenol in addition to Hydrocodone/Lortab as each Lortab contains 500mg of Acetaminophen. Do not take more than eight (8) Tylenol within a 24 hour period. Avoid blood-thinning medications such as aspirin, vitamins, herbal remedies, anti-depressants, alcohol for three (3) days after surgery. Routine daily medications prescribed by another physician. Please refer to the two (2) lists of medications located in the Medications section. Before discontinuing your routine daily medications, please consult with the prescribing physician. Your goal for surgery should be to discontinue most medications and all supplements two weeks prior to surgery. One Week Prior to Surgery Do not take ASPIRIN (Anacin, Bufferin, Baby Aspirin), IBUPROFEN (Advil, Motrin, or Nuprin), NAPROXEN (Aleve) or any non-steroidal anti-inflammatory drugs (NSAIDS) similar to these medications for 7 days before surgery. These medications promote bleeding and bruising. You may take acetaminophen (Tylenol or Anacin-3). Check the labels of all your medications, even those you purchase without prescription, to be sure you are not taking any aspirin or aspirin-like substances. Remove any products containing aspirin from your medicine chest so that you do not inadvertently take it during the week before your surgery. Consult your physician before you stop taking any prescribed medicines. Please inform us if you are taking any medications to treat arthritis, or any blood-thinning (anti-coagulant) medications. Do not drink alcohol (especially red wine), Green Tea, Gingko, or consume vitamins especially Vitamin E, as regular consumption may cause excessive bleeding and /or bruising. 4-5 days prior to surgery Blood work. Blood is drawn 4-5 days prior to surgery at the McDonald Murrmann Women s Clinic next door to the MMSL. Results are electronically forwarded to Dr. Murrmann for her review prior to your surgery.

6 Do not take decongestants such as Sudafed or Actifed for five (5) days before surgery. Compression Garment. A compression garment is put on you immediately after surgery. You are given a second compression garment for your convenience. No air travel for 72 hours after surgery. To reduce risk of thrombosis (blood clotting), please refrain from air travel or long road trips prohibiting you from moving around for 72 hours after surgery. Please be rested before surgery and plan to take it easy after surgery No shaving for 24 hours before surgery. Please do not shave in or around areas where Dr. Murrmann may be performing your surgery. Shaving below the knee is permissible. Menstruating at the time of your surgery. Tampon use with a kotex pad is suggested for surgery. Driver and Adult Caregiver. Arrange to have someone drive you home from surgery. When you arrive for surgery, Judy Miller, RN requires your driver s cell phone number so that they can be contacted thirty (30) minutes before the completion of your procedure. Please also arrange to have a caregiver/spouse to stay with you for 24 hours after surgery to observe your condition, assist you with dispensing medications and also to assist with changing drainage pads. If you have small children at home you will need assistance for the first hours. Diet. Dr. Murrmann asks that you eat before surgery to avoid taking Valium on an empty stomach. Eat a well-balanced meal prior to surgery avoiding spicy or greasy foods. Take antibiotic with food at least two hours before surgery to avoid gastric upset. Minimize caffeine intake day of surgery. The surgical nurse administers Valium after the completion of your paperwork. Day of Surgery Do not wear perfume, lotion, moisturizer or soap that contain oil and minimize the use of cosmetics. Leave valuables such as jewelry at home. Wear loose clothing that can easily be removed and put on. Do not wear a sports bra as these tend to compress the upper body during surgery. Do not wear your best lingerie and socks due to drainage that can stain. Wear shoes that can be washed or bleached (crocs, tennis shoes, flip flops). Socks are recommended for warmth. Plan ahead to avoid staining the car seat with blood-tinged anesthetic solution. Bring a towel and a plastic sheet (such as a trash can liner) to cover the seat on your ride home. Prior to surgery prepare your bed, chair, and couch with towels and plastic. Change your drainage pads on a tile surface to avoid staining carpet. Home Aftercare Shopping List You will need the following items: Extra Strength Tylenol (Acetaminophen) You may take Extra Strength Tylenol in place of Hydrocodone. Many patients take Hydrocodone during the first 2-3 days of their recovery. Patients discontinue the Hydrocodone and begin taking Extra Strength Tylenol to manage pain or discomfort. Kotex Pads are needed at home for covering incisions and collecting drainage. Judy Miller (Dr. Murrmann s Surgical Nurse) will provide pads after surgery, but you will need your own pads for home aftercare.

7 Pedialyte is an oral electrolyte solution that restores vital minerals and nutrients. Drink plenty of water and Pedialyte to avoid dehydration that is caused by lidocaine. Pedialyte versus Gatorade Pedialyte is the better choice as Gatorade is higher in sodium and may cause retention of fluid. Pedialyte is typically located in the pediatric/infant section at your local store or market. Hydrogen Peroxide should be applied to incision sites after your surgery. Peroxide not only cleans the incisions but helps to dry them as well. Please do not use Neosporin which can lead to scarring. No ointments such as Vaseline or Aquaphor while incisions are drying up. Dermaka Cream will be provided by the Skin & Laser Center after your surgery. Massage Dermaka Cream into affected areas but away from open incisions. Hand held massager to use with the Dermaka beginning one week after surgery. Twice daily massage is recommended for areas that feel firm or lumpy. What to Expect on the Day of Your Liposuction Procedure Arrive for your surgery at the scheduled time (not one hour prior). Your surgery will take place at McDonald Murrmann Women s Clinic at 7205 Wolf River Parkway, Suite 150, Germantown, TN If you arrive during regular office hours (9:00 5:00 p.m. Monday thru Friday), please check-in at McDonald Murrmann Skin and Laser and ask them to inform Judy Miller, RN. If you arrive after office hours or on a Saturday morning, please take a seat in the waiting area. If doors are locked for security after or before office hours, please call Judy at If you are scheduled for a Saturday surgery, record Judy s cell number in your phone at this time. All questions and concerns are to be directed to your contact person/tara Polston, RN at (901) Please do not call Judy after hours unless directed otherwise. After the liposuction procedure is completed, absorbent pads are placed over the incision sites. The incision sites allow drainage of any excess fat and fluid that was not removed by the cannula during the procedure. Significant drainage may flow from these incisions sites. Judy will help you into your compression garment. Your driver will be contacted at this time. Judy will continue to observe your condition after surgery and will review aftercare instructions. You will be given printed post-op instructions to refer to at home. Because some of the local anesthetic remains in the area that was treated, you may not feel any significant soreness until several hours after the procedure is done. Post procedure You will be given an appointment date and time for 2-3 days after surgery. Dr. Murrmann or Tara will check you at MMSL. This is a mandatory appointment to confirm that the compression garment and binder (if applicable) are compressing targeted areas. Tickle liposuction is performed with local anesthesia which reduces the complications associated with general anesthesia. Your safety is our biggest priority. There is drainage from your small incisions after the procedure for the next 48 hours. The drainage decreases and the incisions close in 2-4 days. You are sore after the procedure. You are given a prescription for pain medication; some patients do not require pain meds. Bruising is minimal in most patients; we encourage the use of Dermaka cream after the procedure to help minimize soreness and bruising. Although you are given antibiotics to take after the procedure, redness or infection in the

8 skin can occur. It does not happen often. Call if you are experiencing increasing discomfort, redness, or fever. After hours call Garments. After your procedure, you are fitted in a compression garment to wear without removing or showering for 48 hours. Keep the compression garment on for 48 hours to help minimize fluid buildup in the areas of fat removal, irregular skin texture, and the chance for infection to develop. You may be given an additional binder or compression pad to wear depending on the type of procedure. Change drainage pads regularly. The garment should be worn for 2-4 weeks post procedure to help with the contouring and compression of the remaining fat. Best results are achieved by the appropriate wearing of compression garments post procedure. Fat is very impressionable and any wrinkling of the skin or abnormal compression might be permanent. Incisions. Small incisions are made in strategic (hidden) areas to remove the fat and achieve optimal results. The incisions heal spontaneously. However, scars may be more visible if you have a tendency to heal poorly or have a tendency to keloid. Irregular skin, stretch marks, or aging sagging skin. Initially after surgery, you may experience excessive wrinkling of the skin that improves as you heal. Some wrinkling can remain. Wrinkling of the skin is related to elasticity determined by several factors such as condition of the skin before surgery and to what degree the skin was stretched due to weight gain, pregnancy or obesity. Although we cannot change the appearance of your skin prior to the procedure we can recommend massage tools, laser treatment, or radiofrequency therapy to aid in the postoperative appearance of your skin. Dr. Murrmann believes that whether you have liposuction or not, continuous aggressive massage of your body and skin can improve circulation, minimize spider veins, aid in fat loss and the appearance of irregular skin and cellulite. This is very important as you age. We now have the privilege of offering ThermiSmooth to our patients postoperatively, incorporating monopolar energy to reduce swelling, pain, and irregular appearance of the skin postoperatively. The ThermiSmooth also helps with skin laxity that comes with age and the appearance of stretch marks. The treatments are an additional cost but we believe in this technology, and endorse and encourage the use of ThermiSmooth for follow up. Cellulite: Cellulite results from the pull of fibrous tissue that connects skin to underlying muscle. Liposuction, while improving the silhouette, does not necessarily eliminate the subtle puckering of the skin often called cellulite. While tumescent liposuction may reduce the degree of cellulite, it is unlikely to eliminate it completely. Liposuction should not worsen cellulite. Other technology such as ThermiTight and ThermiSmooth can help with the appearance of cellulite. Please ask the MMSL staff about the use of this technology. This unique and ground breaking precise energy driven technology is quickly taking the place of laser for skin smoothing in cosmetics!