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Aftercare after Liposuction

INSTRUCTIONS Going Home You should not plan to drive yourself home. It is recommended that you have a responsible adult at home with you on the day of surgery.

Diet If you have had liposuction totally by local anesthesia, you may resume your usual diet immediately. Drink adequate amounts of water, fruit juices or soft drinks to prevent dehydration. Avoid drinking alcoholic beverages for 48 hours before surgery and 48 hours after surgery.

Physical Activity Quiet rest is recommended for the first few hours immediately after liposuction surgery. Do not drive or operate hazardous machinery for 18 hours after surgery. Do not make any important personal decisions for 24 hours after surgery. Later in the day or evening of surgery you may take a short walk if desired. The day after liposuction surgery you should feel well enough to drive your car and engage in light to moderate physical activities. You may carefully resume exercise and vigorous physical activity 2 to 4 days after surgery. It is suggested that you begin with 25% of your normal workout and then increase your daily activity as tolerated. Most people can return to a desk job within one to two days after surgery, although one must expect to be sore and easily fatigued for several days.

Elastic Compression Garments HK Post-Op Garments are designed specifically for tumescent liposuction. Two HK Over-All garments are worn after tumescent liposuction of the thighs or hips. One HK Torso garment plus an adjustable elastic binder is used after tumescent liposuction of the abdomen, hips, waist, flanks, back, or breasts. These garments are specifically designed to be used with super-absorbent pads and to provide firm compression to encourage maximum drainage of residual blood-tinged anesthetic solution. Beginning the day after surgery, the post-op garments are to be removed daily to permit you to shower and to wash the garments. Two Over-All garments or one Torso garment plus binders should be worn day and night until 24 hours beyond the time when all the drainage has completely stopped. Do not be concerned if you have drainage for several days. Discontinuing the use of the garments and binders too early may result in more prolonged drainage. Typically, patients will need to wear the garments for 3 to 6 days. Some patients, especially after a large amount of liposuction, will have drainage for more than a week. Many patients choose to wear the garments for a greater duration simply because of the comfort the garments provide. Wearing the post-op garment for more than the minimal number of days provides no significant advantage in terms of the ultimate cosmetic results.

Dizziness and Fainting Patients may experience a brief sensation of dizziness the morning after surgery, when the garments are first removed in order to take a shower. Feeling lightheaded is similar to what you might experience when standing-up too quickly. It is the result of rapid decompression of the legs after the post-op garments are removed. Should dizziness occur, simply sit or lie down until it passes. Dizziness may be prevented be removing the outer compression garment 10 minutes before removing the second garment.

Fainting at the Sight of Blood Some people have a tendency to faint upon the sight of blood. Such persons should anticipate such a problem when removing blood-tinged absorbent pads when changing dressing after liposuction.

Fainting after Urination On the morning after childbirth a woman has an increased risk of fainting if she stands up too fast immediately after urinating. This is known as post-micturation syncope. A similar situation occurs the morning after liposuction. A liposuction patient should stand up slowly after urinating. In order to avoid a serious injury from a fall, if dizziness does occur, the patient should sit or lie down on the floor immediately. It is recommended that patients not lock their bathroom door so that someone can come to assist if necessary.

Managing Post-Op Drainage One should expect a large volume of blood-tinged anesthetic solution to drain from the small incisions during the first 24 to 48 hours following tumescent liposuction. In general, the more drainage there is, the less bruising and swelling there will be. For the first 24 to 48 hours, bulky super-absorbent pads are worn overlying the treated areas, and under the compression garments. After most of the drainage has stopped, patients need only place absorbent pads over the incision sites that continue to drain.

Leaks Are Possible When the super-absorbent HK Pads are properly applied they should absorb all of the drainage. However, leaks beyond the pads can occur. During the first 36 hours, when sitting or lying down, you should place absorbent terrycloth towels beneath you in order to protect your furniture from any unexpected leak of blood-tinged drainage. When there is a large amount of drainage, it is advisable to place a plastic sheet beneath the towel.

Wound Care & Bathing Keep incisions clean. Shower once or twice daily. First wash your hands, then wash incisions gently with soap and water; afterwards gently pat incisions dry with a clean towel. Apply new absorbent pads. When an incision has ceased draining for more than 24 hours, it no longer needs to covered by pads.

Take Antibiotics Take Antibiotics as directed until the prescription is finished. Take antibiotics with food. Call our office if you notice signs of infection such as fever, foul smelling drainage, or focal redness, swelling, or pain in a treated area.

Nausea Nausea and vomiting are among the side effects that may be associated with liposuction. Nausea can be caused by antibiotics, lorazepam, or local anesthesia.

Menstrual Irregularities Menstrual irregularities may occur for a month or so after liposuction. Premature or delayed onset of monthly menstruation is a possible side effect of any significant surgery.

Temperature Elevation Slight temperature elevation during the first 48 hours after surgery is a natural consequence of the body's reaction to surgical trauma.

Inflammation, Swelling Inflammation, swelling, and soreness are expected consequences of liposuction. Two extra-strength Tylenol should be taken every 4 hours while awake for the first 48 hours to reduce postoperative soreness and inflammation. Discomfort and soreness is worse the second day after surgery, then improves daily.

Avoid Aspirin and Ibuprofen For 3 days after surgery do not take aspirin or ibuprofen or similar NSAIDS (non-steroidal anti-inflammatory drugs) such as Bufferin, Anacin, Advil or Nuprin. NSAIDS can promote bleeding by impairing platelet function. NSAIDS also depress the immune response to infection by impairing white blood cell function.

Bruising Bruising is minimal with tumescent liposuction. Nevertheless, the more extensive the liposuction surgery, the more bruising one can expect. Some patients have more of a tendency to bruise

than others.

Pain and Swelling Pain and swelling due to an inflammatory reaction to surgical trauma may occur and increase 5 to 10 days after surgery. Notify your surgeon if there is a dramatic increase in pain or


Itching Itching of the treated areas several days after surgery may occur as part of the normal healing process. To help relieve the itching, you may try taking Benadryl as directed on the packaging. Be aware that Benadryl causes drowsiness. You may also try using oatmeal soap. After the 7th postoperative day, provided that the incisions are well healed, you may soak in a bath with an oatmeal bath preparation. Benadryl and oatmeal products may be purchased at most drugstores.

Post Operative Care

The Tumescent Technique The tumescent technique for liposuction uses a large volume of a dilute solution of lidocaine and epinephrine. The tumescent technique for liposuction has become the worldwide standard of care for liposuction because it has eliminated the common problem of surgical bleeding associated with older techniques. The dilute tumescent fluid contains both lidocaine for local anesthesia and dilute epinephrine that shrinks capillaries. After liposuction, a large volume of blood-tinged tumescent anesthetic solution remaining trapped under the skin may slow postoperative recovery.

Open Drainage and Bimodal Compression This is a new method for post-liposuction care. It provides improved patient comfort, shortens the healing time, and decreases the number of postoperative visits to the surgeon. Open-drainage with bimodal compression is a modern technique that greatly reduces the degree of pain, swelling, bruising and convalescence time. Nevertheless, many surgeons and nurses continue to use antiquated post-liposuction care techniques that were used before the invention of the tumescent liposuction. This chapter will introduce you, and perhaps your surgeon to the newer technique for accelerating post-liposuction recovery known as Open-Drainage and Bimodal Compression.

Traditional After-Liposuction Care Methods Traditional After-Liposuction Care Methods rely on 1) the closure of incisions with sutures and 2) the prolonged use of high compression elastic garments for two weeks or more. Most liposuction surgeons would agree that these traditional methods of caring for patients after liposuction leave much room for improvement. The common undesirable characteristics of the healing phase after liposuction include protracted swelling, bruising, tenderness, as well as time-consuming post-operative follow-up visits with the surgeon.

Minimizing Swelling, Bruising, & Tenderness Swelling, bruising, tenderness are the result of 1) persistent blood-tinged tumescent anesthetic solution trapped under the skin after liposuction, and 2) injury to subcutaneous lymphatic capillaries caused by the liposuction procedure. Lymphatic capillaries are small vessels that drain fluid away from injured body tissues. Temporary injury to lymphatic capillaries as a result of liposuction cannot be avoided. However the persistence of blood-tinged tumescent solution trapped under the skin can be prevented. Older techniques for post-liposuction care do not facilitate rapid drainage of this blood-tinged anesthetic solution. The newer technique known as "open drainage" diminishes the swelling and speeds recovery after tumescent liposuction.

Prolonged High-Compression In the Old Days Prolonged High-Compression in the old days was necessary. Before the tumescent technique for liposuction, bleeding was the major problem associated with liposuction. After a liposuction had been completed, patients had to wear a high compression garment for many weeks in order to minimize the problems caused by so much bleeding. Immediately after surgery the high compression garments were required to compress the bleeding vessels and stem the loss of blood. Patients continued to wear high compression garments for up to six weeks in order to decrease the swelling caused by the blood trapped beneath the skin.

Prolonged Compression Now Makes Matters Worse Now that tumescent technique has become the standard of care, the traditional post-liposuction techniques, established before the invention of the tumescent technique, may now contribute to delayed healing and prolonged swelling. With tumescent liposuction there is no need for prolonged high compression because there is no significant bleeding during surgery, and virtually no blood remains trapped beneath the skin. After tumescent liposuction, closing incisions with sutures will prevent drainage of residual blood-tinged anesthetic solution, and encourage swelling. In addition, the prolonged use of excessive compression after tumescent liposuction will compress the subcutaneous lymphatic capillaries and impair the lymphatic drainage system that is responsible for removing fluid from injured tissues. After tumescent liposuction, the goal is to maximize the rate of drainage of residual blood-tinged tumescent anesthetic solution.

Preventing Swelling Preventing swelling, bruising and inflammation before they occur by removing the subcutaneous blood-tinged fluids and encouraging lymphatic drainage is the ideal method for post-liposuction care. The method known as Open-Drainage achieves these results by 1) encouraging open drainage by not closing incisions with sutures, 2) the use of special pads that both absorb the messy blood-tinged drainage and reduces bruising by uniformly distributing the compression of elastic garments, and 3) using special elastic compression garments designed for optimal drainage as well as patient convenience and comfort.

Open-Drainage Open-Drainage after tumescent liposuction refers to the technique for maximizing the drainage of blood-tinged tumescent solution by 1) using small adits which are tiny round holes (1 mm, 1.5 mm or 2 mm in diameter) made by skin-biopsy punch to facilitate postoperative drainage, 2) placing adits in strategic locations in order to maximize gravity-assisted drainage, 3) allowing the adits to remain open instead of being closed with sutures.

Fewer Postoperative Visits Fewer postoperative visits to the surgeon's office can save time and hassle for the patient and the patient's family. Because there are no sutures to be removed, the patient can eliminate the need to return to the surgeon to have the sutures removed. Because there is less swelling, and pain with Open-Drainage, there is less need for the patient to return to see the surgeon in the early postoperative period for time-consuming follow-up examinations. Patients should feel free to return to see the surgeon if there is any concern about the healing process. On the other hand, if everything is healing well and the patient has no significant concerns then the first follow-up visit is often not until six weeks after surgery.

Super-Absorbent Pads These prevent staining clothes and furniture, and to avoid the "sight of blood" that would otherwise accompany the drainage of blood-tinged tumescent fluid. For example, the HK Pads that measure 12 x 20 inches weigh just 6 ounces and have the capacity to absorb more than a liter (two pounds= 32 ounces) of water, or more than 5.5 times their own weight. In practice, the absorbent pads have two distinct functions. First, they absorb the large volume of tumescent drainage to improve patient comfort and hygiene, and secondly the pads distribute the elastic garment's compressive force more uniformly. This uniform compression narrows the gaps between interstitial collagen bundles in the dermis and prevents red blood cells from moving toward the skin surface where it appears as a bruise. HK Pads (US Patent 6,162,960) are the only commercially available pads of this type.

Adhesive Foam Pads Adhesive foam pads such