Liposuction | BOTOX® & Cosmetic Fillers | Photos

Liposuction

Liposuction Information
Liposuction F.A.Q.
  What is tumescent liposuction?
  Is tumescent liposuction safe?
  How long does liposuction surgery take?
  Will I feel anything during the surgery?
  Will there be much pain after surgery?
  How long does it take to recover from the surgery?
  Are there any restrictions on activity after liposuction surgery?
  Will I still look the same if I gain weight?
  Will fat grow in other areas if I have liposuction?
Important Information About Tumescent Liposuction
  Irregularity of the Skin
  Scarring of the Skin
  Cellulite
  Liposuction and Obesity
  Postoperative Healing
  Realistic Expectations
  Longevity of Results
What to Expect on the Day of Tumescent Liposuction
Instructions Before Liposuction
Instructions After Liposuction
Common Side Effects of Tumescent Liposuction

*Consent FORM for Tumescent Liposuction Surgery (*complete before visit)

BOTOX® & Cosmetic Fillers

BOTOX® Cosmetic Information
*Consent FORM for BOTOX® Cosmetic (*complete before visit)

Injectable Cosmetic Fillers Information
*Consent FORM for Injectable Cosmetic Fillers (*complete before visit)

Photos (Before/After)

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Liposuction

Liposuction Information

Liposuction is a surgical procedure designed to remove isolated pockets of excess fat from selected areas of the body. These pockets of excess fat are frequently present only because of a genetic predisposition. Many patients report that several family members have the same distribution of excess fat as they themselves have. People who have these fatty deposits will most often find it impossible to reduce the size of these areas even with diet and vigorous exercise. Besides being personally frustrating for these people, the presence of these fatty deposits often makes it difficult for these patients to fit into clothes off the shelf without significant tailoring. Some women report that they must wear one size above the waist, and a different size below the waist. Liposuction surgery will remove this excess fat, creating a new, more pleasing, body contour.

Liposuction was developed in Europe in the late 1970s and brought to America shortly thereafter. The procedure was originally performed only under general anesthesia, using a very large metal tube, called a cannula, to remove the excess fat. This initial effort was quite traumatic and often resulted in significant blood loss and the need for blood transfusion. Fortunately, the technique of liposuction has evolved. An American, Dr. Jeffery Klein, invented a new way of performing liposuction using only local anesthesia. He also began using smaller and smaller instruments to perform this surgery with excellent results. These innovations produced highly satisfactory results and made liposuction safer. Dr. Klein called his new technique the tumescent technique and his new cannulas microcannulas.

Tumescent liposuction, using only local anesthesia, involves the use of a dilute anesthetic solution which is instilled into the fatty layer of the skin. The instillation of this fluid causes the skin to swell, or become tumescent, hence the name tumescent liposuction. This tumescent anesthetic solution contains a dilute concentration of lidocaine, a common local anesthetic. In high concentrations this anesthetic can be very dangerous. However, Dr. Klein discovered that dilute concentrations of this anesthetic could be used safely to anesthetize the skin and fat enough to allow liposuction to be performed using only this local anesthesia. This breakthrough not only made liposuction safer, since the patient could avoid the dangers of general anesthesia, it also produced improved surgical results with less bruising.

Dr. Klein improved his technique even further by using smaller and smaller cannulas to perform liposuction surgery. These smaller cannulas, or microcannulas, decreased the contour irregularities that are more common after the use of the larger cannulas. While early surgeons used cannulas as large as 10 millimeters, or more, in diameter, Dr. Klein pioneered the use of cannulas of 2 millimeters, or less, in diameter. These smaller cannulas improve the surgical results after liposuction, as bruising and contour irregularities are decreased when compared with surgery using the larger cannulas.

Perhaps the greatest advantage of tumescent liposuction is the fact that it can be performed using only local anesthesia in an office setting. Thus, a patient is able to avoid the added risks of using general anesthesia, and the added costs of admission to a hospital. Tumescent liposuction is very safe. This safety has been documented over the years, as there has never been a surgical death in a patient who underwent tumescent liposuction exclusively, without any other concurrent surgeries and without the use of general anesthesia. This safety is made possible because of a simple rule regarding the maximum dosage of lidocaine that a patient may safely receive in a single day. This dose is based on  the body weight of the patient. Adherence to this safety standard when performing tumescent liposuction prevents the development of lidocaine toxicity.

This safety standard, or safe dose, with the use of lidocaine will limit the number of areas of the body which may be operated upon in a given day. This may present an inconvenience to those patients who wish to have more than 3 body parts operated upon, as these patients may have to have complete their surgery on two separate days. However, strict adherence to this safety standard prevents excessive liposuction of too extensive an area. Thus, this safety requirement makes it nearly impossible for any patient to have too much fat removed in a given day, which could lead to dangerous electrolyte imbalances.

Liposuction is not for everybody. This surgery should not be utilized as a means of weight loss. In fact, a patient will experience very little weight loss, even after removal of very large volumes of fat. Liposuction is designed to remove isolated areas of fat which are often genetic and unresponsive to diet and exercise. The change for the patient is measured in inches, not pounds. The ideal patient for liposuction surgery is one who is within 20% of their ideal body weight, and who has already begun a healthy diet  and a program of regular aerobic exercise. Heavier people might be candidates for liposuction surgery, but only if their weight has been stable for a long period of time, and with the understanding that the surgical result for patients whose weight is greater than 20% over their ideal weight is not as good as that for better candidates. There is an axiom that says, the less a patient needs a cosmetic procedure the better the eventual result from that procedure. The results of liposuction tend to be best when the patients who have this surgery are good candidates for it, meaning those patients who are within 20% of their ideal body weight with a healthy diet and with an established program of aerobic exercise.

That said, it is not a great idea to perform liposuction on a person who has recently lost a great deal of weight, only after an intense effort at diet and exercise. This person is more likely to gain their weight back when they are unable to maintain such an intense focus on a perfect diet and an intense exercise program. It is best for the liposuction patient to be near, but not at, their ideal weight before having liposuction surgery. If this person is then able to lose weight after liposuction, their result will only improve. Since it will be easier for these patients to remain at their slightly higher body weight, even though it is not their ideal weight, their surgical result will be less likely to change change over time.

There are many factors which determine the best candidates for liposuction surgery. If you have any questions about whether you would be a good candidate for tumescent liposuction, please call our office to schedule a surgical consultation.
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Liposuction Frequently Asked Questions

What is tumescent liposuction?
Tumescent liposuction is an evolved surgical technique for performing liposuction. Liposuction is surgical procedure to remove unwanted fat deposits from selected areas of the body. Liposuction was developed in Europe and was once performed using very large metal tubes, or cannulas, of 10 millimeters diameter or more, and using only general anesthesia. These initial surgeries were very traumatic, with the patient experiencing significant blood loss and electrolyte abnormalities, sometimes resulting in death. Thankfully, liposuction has evolved over the years. This evolution was aided, most notably, by Dr. Jeffrey Klein, who invented tumescent anesthesia and pioneered the use of very small cannulas. These developments improved surgical results and patient satisfaction.

Tumescent liposuction refers to the use of local a anesthetic, which is instilled into the fatty layer of the skin such that this layer swells, or becomes tumescent. Using only this local anesthesia, and some mild sedatives, the patient is able to have liposuction without general anesthesia. General anesthesia is generally safe, but not as safe as local anesthesia. Further, its use requires that surgery be performed in an expensive hospital setting. Because only local anesthesia is used in tumescent liposuction, the patient is able to remain fully conscious during the surgery. Mild sedation may also be used so the patient is less anxious.
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Is tumescent liposuction safe?
Tumescent liposuction, using only local anesthesia, is very safe. There has never been a surgical death when only tumescent anesthesia has been used. During your surgery your pulse, blood pressure and blood oxygenation will be monitored continuously. Many patients who receive mild sedation will actually fall asleep during their surgery. This is good. The use of continuous monitoring of their vital signs ensures they will be safe throughout their surgery, even if they are not awake.
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How long does liposuction surgery take?
Tumescent liposuction surgery, using only local anesthesia, can take a long time. Because patients remain awake for their surgery, it is important to ensure  that local anesthesia is administered completely and evenly throughout the surgical site. This part of the procedure cannot be rushed. The local anesthetic is instilled slowly by Dr. Giarratana because a more rapid instillation may cause a stinging sensation. Depending upon which areas are chosen for surgery, the instillation of the anesthetic solution may take 1 to 2 hours, and may take even longer to complete than the actual surgery.

Of course, the actual length of your surgery will depend upon the number of areas chosen for surgery and the amount of fat present to be removed in each area. For the average patient, it will require about 4 to 5 hours to complete tumescent liposuction in a relaxed manner. So, plan on remaining in the office for about 5 hours.
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Will I feel anything during the surgery?
The main benefit of performing liposuction using the tumescent technique is that it gives the surgeon the ability to perform liposuction safely and painlessly in a patient who is awake, or only mildly sedated. Instillation of the local anesthetic is the most uncomfortable part of the procedure, and this usually causes only a mild stinging sensation. Most of the time, Dr. Giarratana will offer the patient a sedative prior to administration of the anesthetic solution in order to make this portion of the procedure better tolerated. The tumescent fluid contains liodcaine, a common anesthetic, epinephrine, which causes constriction of blood vessels around the surgical site to keep the lidocaine in this site, and bicarbonate, to reduce the stinging sensation that can occur with instillation of this fluid. The epinephrine may also cause a brief increase in heart rate. To make the patient more comfortable during this part of the procedure, Dr. Giarratana will give his patients a mild sedative. Once the tumescent fluid has been instilled and the patient is allowed to rest for a few minutes, there is very little discomfort for the rest of the procedure. 

However, one must realize that there is a difference between pain and simple sensation. The tumescent anesthetic solution is administered into specific areas of the body. These are the only areas which should become free of painful sensations. The patient will still experience sensations in other parts of the body, such as feelings of pressure and motion, and may experience soreness from lying on the operating table for a long time. Sensation is normal, and most patients will still feel sensations, They should not feel pain. If there is pain, more anesthetic solution will be administered until the patient is comfortable. Sometimes additional sedation is required. The person who is uncomfortable with the thought of feeling some sensation during this type of surgery should instead have liposuction using general anesthesia.
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Will there be much pain after surgery?
The effect of the anesthetic solution is long lasting, so the patient may remain pain free for 18 to 24 hours following liposuction using the tumescent technique. Every patient receives a narcotic prescription, but most patients require only Tylenol® for pain following surgery.
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How long does it take to recover from the surgery?
Recovery following liposuction using the tumescent technique is relatively easy. Surgery is generally performed on a Friday in order to give a patient the entire weekend in which to recover. Most, if not all, patients may return to work on the following Monday or Tuesday. The patient should not require the use of postsurgical garments beyond 48 to 72 hours following the surgery. However, if there is still leakage from one of the operative puncture sites, the patient may have to wear loose fitting clothing over these garments until they no longer require these garments. 
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Are there any restrictions on activity after liposuction surgery?
There are few firm postoperative restrictions for the patient undergoing liposuction surgery using the tumescent technique. The patient is instructed to avoid any running or other similar activity for 2 weeks. The treadmill and elliptical machines, and the stair climber machine, are all acceptable means of exercise even as early as 2 to 3 days following surgery. However, any pounding exercise that requires running will be uncomfortable for the patient and may increase the risk of bleeding or other complications. Also, because the patient who has liposuction has open wounds which require time to heal, the patient may not swim or use hot tubs for 2 weeks following surgery.
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Will I still look the same if I gain weight?
Once tumescent liposuction is performed, and the isolated pockets of fat are removed, a patient will have a new shape, or body contour. This new contour will not change with minor weight gain. However, it is important to remember that liposuction surgery does not remove 100% of the fat in a given area. This would look extremely unnatural. The goal is to create a new shape that is more pleasing to the patient, and which allows that patient to fit better in clothes without extensive tailoring. If the liposuction patient gains a lot of weight after surgery, fat will be deposited all throughout that person’s body, so even the remaining fat cells in the surgical areas will enlarge. However, the number and concentration of fat cells in the surgical sites are markedly decreased, and these sites will not grow as big as before surgery. Thus, even with some weight gain, the pleasing postsurgical body contour will still be present. If the person is able to return to her initial postsurgical weight once again, her size and shape will become the same as it was right after her surgery.
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Will fat grow in other areas if I have liposuction?
This is a subject of some debate. Our bodies do like to maintain some degree of balance, so once fat is removed surgically, one could argue that the body will gain fat elsewhere to reestablish that balance. Ideally, a person having liposuction will already have an established exercise program that allows her to maintain her weight, or even lose weight, after liposuction. If a person works to maintain the same, or lower, weight she had prior to surgery, the surgical result will be maintained. Common areas of increased fatty deposition include the buttocks, thighs, waist and breasts. Weight gain usually shows up in one of these areas whether one has had liposuction surgery or not. Therefore, it is very important to maintain your body weight after liposuction surgery.
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Important Information About Tumescent Liposuction

Any surgery involves the risk of infection, bleeding, scarring or serious injury. However, tumescent liposuction has a very good safety record.  When tumescent liposuction is performed without the use of general anesthesia, the risk of a serious complication is rare. The most common risks of tumescent liposuction, and some other important considerations, are discussed below:
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Irregularity of the Skin: Tumescent liposuction using microcannulas is the least likely to cause any significant or noticeable post-surgical irregularities of the skin. Instillation of the tumescent anesthetic solution magnifies the fatty compartment. This tumescent technique with micro-cannulas permits more accurate removal of the fat. It also reduces the chance that the cannula will approach too near the under surface of the skin, thus reducing the chance of skin irregularities or rippling of the skin. Liposuction might improve preexisting irregularities of the skin, such as dimpling, but patients should not assume there will be significant improvement. It is unrealistic to expect perfectly smooth skin after liposuction. Patients should expect that their skin will have approximately the same degree of dimpling and irregularities as existed before tumescent liposuction surgery. Immediately following surgery the skin will show bruising and swelling in response to the surgery. However, in time the texture of the skin should return to normal. The presence of surgical scars and stretch marks will contribute to post-surgical irregularities of the skin.
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Scarring of the Skin: Rather than make incisions in the skin, which can result in scarring, tiny, round holes called adits are made to allow insertion of the cannulas through the skin and into the fat. Typically, as the adits heal they become virtually invisible. Although you may be able to find them under close examination, most other people would not be able to see them. Some people form scars that are thicker than might be considered normal. This is called keloid formation. Some patients may experience temporary hyperpigmentation  (darkening) or hypopigmentation (light or pale skin) that usually returns to normal after several months. Some patients may have a genetic predisposition for persistent discoloration at the incision sites. Patients who have experienced these skin changes in the past should expect to also experience it after their liposuction surgery. Certain areas of the body, such as the back or the upper flanks, may be more predisposed to pigmentation changes and keloid formation.
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Cellulite: Liposuction of the thighs, while improving the silhouette, does not necessarily eliminate the subtle puckering of the skin often called cellulite. Some people think this cellulite results from the pull of fibrous tissue that connects the skin to the underlying fascia, while others believe that an over abundance of fat globules between this fibrous tissue makes the skin bulge, thus creating the dimples referred to as cellulite. While tumescent liposuction is unlikely to eliminate this problem, it should not make it worse.
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Liposuction and Obesity: Liposuction is not an appropriate treatment for obesity. Liposuction is not a substitute for for a good diet, with a focus on good nutrition, and a program of regular exercise. Obese patients may be good candidates for limited liposuction if their goal is simply to improve the shape of certain limited areas of the body.
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Postoperative Healing: Normal healing after liposuction involves a limited but definite degree of soreness, swelling, bruising, and lumpy firmness. A temporary mild numbness of the skin may persist for up to 4 months. Most patients can actually see some improvement of their silhouette within 1 week of their surgery. However, because of the slow resolution of post-surgical swelling, the ultimate results following liposuction usually require 12 to 20 weeks to be achieved.
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Realistic Expectations: Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection. It is impossible to guarantee the precise amount of improvement that will result from liposuction. Patients should not have unrealistic expectations. Although patients can usually expect to achieve at least a fifty percent (50%) improvement, it is unreasonable to expect 95 percent improvement, or near perfection. For the perfectionist, or for liposuction of a very large area, maximum improvement may require a second procedure for which there would be an additional fee.
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*Patients who would be satisfied with a 50 percent improvement would be good candidates for liposuction. This is an intentionally vague measure. It indicates a definite perceptible improvement, but something short of perfection. If a 50 percent  improvement would make a patient happy, then it is likely that these expectations will be met. Our patients generally achieve more than a 50 percent improvement.

What to Expect on the Day of Tumescent Liposuction

When you arrive, you will be asked to sign your surgical consent forms. Then you will be asked to change out of your street clothes and into the older clothes you have brought for the liposuction procedure. Women should wear a soft jog bra, and both men and women should wear clothes which they would not mind discarding if they were stained. A robe will be supplied to you for your comfort.

You will be asked to supply a urine specimen for pregnancy testing if indicated. Then, your weight will be recorded. In the operating room, you will then take the Valium tablets orally to provide for some mild sedation. Photographs will be taken both before and after marking your skin in preparation for the liposuction procedure. These photos serve the dual purposes of guiding the surgical procedure and acting as a record of your body before undergoing liposuction. These are the “before” pictures and will be used for comparison with the “after” pictures taken about 3 months after your procedure.

No intravenous drugs are used during the liposuction procedure. Drugs such as Versed, a Valium-like drug, for sedation, and Demerol, a narcotic, will be available during the case for any anxiety you might feel or to manage the mild pain sensation you might feel during the administration of the tumescent anesthetic. Your blood pressure and blood oxygen level will be monitored throughout the procedure using a self-starting blood pressure cuff and an oxygen measuring device attached to one of your fingers.

The tumescent anesthetic will be administered by injecting if carefully and slowly into the targeted fat. Once an area has been well infiltrated with the anesthetic solution, the fat is usually completely numb. The infiltration of the anesthetic solution is a slow careful process that can take as long to complete as the liposuction itself. After the infiltration of the anesthetic is complete you will be given a period of time to simply relax before starting the actual liposuction procedure. Your body will absorb some of the fluid administered into your fatty area, so you may use the restroom before starting the surgical procedure. 

Liposuction is accomplished through tiny  round holes in the skin, called adits. The adits, which are made in the skin using 1 to 2 millimeter punch biopsy instruments, are so small that they need not be closed with stitches. After surgery, the adits remain open for 2 to 5 days, and facilitate the postoperative drainage of residual blood-tinged anesthetic solution. Absorbent pads are applied at the end of the  procedure for your comfort. These pads contain the drainage and keep you relatively dry.

After the absorbent pads are placed, specialized compression garments are pulled on, and then you are ready to go home. The tumescent technique minimizes postoperative discomfort. The residual local anesthesia lasts for about 18 to 24 hours. You will be supplied with prescriptions for both Valium and a narcotic. The Valium may be used for any anxiety you experience in the postoperative period and for sedation. The narcotic may be used for pain control. Frequently, because of residual local anesthesia, all that is necessary for postoperative discomfort is plain Tylenol. Remember that the active drug in Tylenol is contained in the narcotic and excessive use of the narcotic along with the plain Tylenol can lead to over dosage of the acetaminophen in both preparations.

Patients are not permitted to drive themselves home after liposuction except in the event of a very small amount of liposuction when the patient has not received  any sedation. Although most patients feel well enough to drive a car immediately after surgery, you must not do so because the large amounts of local anesthesia may cause some drowsiness. However, you will not feel that unpleasant “hang over” associated with general anesthesia.
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Instructions Before Liposuction

1. Do not take aspirin (Anacin or Bufferin), ibuprofen (Advil or Motrin), naproxen (Aleve) or any other non-steroidal anti-inflammatory drugs similar to these over-the-counter medications for 10 days before surgery. Also, avoid red wine and vitamin-E for 4 days before surgery. These substances impair platelet function in the normal clotting process and thus promote bleeding and bruising. It is permissible to take medications containing acetaminophen, such as Tylenol.

2. Do not take decongestants such as Sudafed or Actifed for 5 days before surgery. Do not take appetite suppressants such as phentermine for at least 2 weeks before surgery. Do not take Zoloft or other antidepressants, or all herbal products, for 2 weeks unless specifically approved by our office.

3. Do not drink alcohol for 4 days prior to your surgery as this might cause excessive bleeding and decrease resistance to infection.

4. Do not drive home. Arrange to have someone drive you home from our office after your surgery.

5. Do not wear unnecessary jewelry, such as belly-button rings, or use perfume (deodorant is okay), cosmetics, body creams or lotions after your morning shower on the day of your surgery.

6. Diet before surgery: Eat a light, low-fat meal, such as toast and juice, fruit, dry cereal and/or nonfat milk, no closer than 2 hours prior to surgery. Avoid whole milk, cream, butter, cheese and other foods that are high in fat content as dietary fat slows digestion and delays stomach emptying. Please minimize caffeine the day of surgery. Bring a light snack with you that you may eat as soon as your surgery is completed.

7. Wear loose clothing on the day of surgery. There is usually quite a lot of drainage of slightly blood-tinged anesthetic solution after surgery. Since this drainage might stain clothing, we suggest that you choose your clothing with this in mind. Because we will apply elastic support garments on top of some bulky absorbent gauze padding, your clothing should be very loose and comfortable. Women should wear a comfortable bra that they would not mind having stained from the dark ink used to outline surgical areas. For men we have paper briefs that are worn during surgery. Both women and men should consider bringing an extra pair of underwear to wear home in case they are needed.

8. Bring warm socks to prevent cold toes during surgery. If you tend to get cold hands, you are welcome to bring clean mittens (no leather gloves) to wear during the surgery. The operating room is kept relatively warm and the temperature can be easily adjusted for your comfort.

9. Do not use moisturizers or soap that contains moisturizers for at least a week before surgery. Tape may not adhere to moisturized skin. Also, the ink markers used to outline the areas on your body to be treated by liposuction will rub off too easily if you have recently used a moisturizer.

10. Plan ahead and avoid staining the car seat with blood-tinged anesthetic solution. Bring a towel and a plastic sheet to cover the car seat during your ride home. Prior to surgery pad your bed at home and your living room chair with towels and plastic. Be careful to avoid allowing drainage to stain carpets.

11. Do not fast or undergo dramatic weight loss just prior to surgery. All patients should be on a stable, well-balanced diet for at least 2 weeks before surgery. Liquid diets, extreme low-calorie diets and rapid-weight-loss diets may predispose to cardiac irregularities, surgical complications and poor wound healing.

12. Music to Relax By: Patients usually enjoy listening to soothing quiet music during surgery. If you have any favorite CDs which you would like to listen to on the day of surgery, you are welcome to bring them with you. Also, you are welcome to bring headphones if you like. If you have no special music, then a radio is available during your surgery.
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Instructions for After Liposuction

Going Home: You should not drive yourself home. Please plan for someone to be available, on-call, to pick you up after your procedure and drive you home. It is recommended, but not essential, that you have a responsible adult stay with you on the day of surgery.

Diet: You may resume your usual diet immediately. Drink adequate amounts of water, fruit juices or sport drinks to prevent dehydration. Avoid drinking alcoholic beverages for one week before and 48 hours after surgery. Of course, never use alcohol when taking narcotics.

Activities: Quiet rest is recommended immediately after surgery. After surgery, do not drive or operate dangerous machinery for at least 24 hours and while taking narcotics. Do not make any important personal decisions for 24 hours after surgery. Later in the evening you may take a short walk, if desired. The day after surgery, you should feel well enough to drive your car and engage in light to moderate physical activities. You may carefully exercise and perform vigorous physical activity 2 to 4 days after surgery. It is recommended that you begin with a 25 percent effort in your normal exercise program and increase your activity daily 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.

Managing Post-Op Drainage: You will  have some drainage from the adit sites for 24 to 48 hours after your surgery. This is normal and should be expected. In general, the more drainage there is the less bruising and swelling there will be after surgery. During the first 36 hours you should sit or lie down on towels in order to protect your furniture. When there is a  large amount of drainage, it is advisable to place a plastic sheet beneath the towel. The drainage is greatest for the first 24 to 36 hours, so super-absorbant dressings are worn under the liposuction garments. When the drainage is nearly stopped, patients need only place thin absorbent gauze dressings or small pads on incision sites that continue to drain.

Elastic Compression Garments: After tumescent liposuction, elastic compression garments are worn in order to hold the absorbent pads in place and to provide compression that encourages the drainage of blood-tinged anesthetic solution. The morning after surgery, when the garments and pads are removed in order that you may take a shower, you might feel a brief sensation of dizziness. This feeling is similar to what you might experience when standing up too quickly. Should dizziness occur, simply sit or lie down until it passes. Dizziness is reduced by first removing the outer garment and waiting 5 to 10 minutes before removing the second garment. Beginning the day after surgery, you must remove the postoperative garments twice daily and take a shower. You may wash the garments at these times. Some body areas only require one garment, while others may require a second garment or an elastic belt. These should be worn day and night until all the drainage has completely stopped, plus an additional 24 hours. Do not be concerned if you drain for several days. Discontinuing the garments and binders too soon may result in more prolonged drainage. Typically, patients will need to wear the garments for as few as 2 days, but perhaps as long as 6 days, although many may choose to wear the garments longer because of the comfort they provide. Wearing the postoperative garments for longer than the minimal number of days is of no significant advantage in terms of the final cosmetic results.

Garment Instructions for Chin/Neck: After liposuction of the neck, a snug elastic bandage will be applied to the neck. This bandage should be left on for 12 hours then removed. There is no need to replace this bandage. The bandage should be removed before you go to sleep in the evening.

Wound Care and Bathing: Keep the incisions clean. Shower once or twice daily. First wash your hands, then wash incisions gently with soap and water. Afterwards, pat the incisions dry with a clean towel. Then apply new absorbent dressings. Incisions that have stopped draining no longer need padding. Be sure to 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 and pain in a treated area. Important recommendations are as follows:
DO NOT apply ice packs or a heating pad to the skin for at least 4 weeks following liposuction.
DO NOT apply hydrogen peroxide or plastic Band Aids to incision sites.
DO NOT soak in a bath, Jacuzzi, swimming pool or a lake for 7 days after the surgery.

Common Side Effects of Tumescent Liposuction Include the Following:
           
Menstrual Irregularities: Premature or delayed onset of monthly menstruation is a common side effect following any significant surgical procedure.

Flushing of the face, neck and upper chest may occur after liposuction surgery and usually lasts for a day or two.

Slight Temperature Elevation: This may occur during the first 48 hours after surgery. This is a natural consequence of the body’s reaction to surgical trauma. A significant elevation of temperature is a temperature over 100.5 degrees.

Discomfort and Soreness: This is worse the second day after surgery, but then improves daily. Two Extra-Strength Tylenol taken every four hours, for the first 48 hours, will reduce the soreness associated with surgery. Do not take aspirin or ibuprofen, or medications that contain these drugs, such as Bufferin and Anacin, or Advil and Nuprin, respectively, for 3 days after the surgery. These can promote bleeding.

Bruising: is minimal with tumescent liposuction. Nevertheless, the more extensive the liposuction, the more bruising one can expect.

Pain and Swelling: This is due to an inflammatory reaction to surgical trauma. It occurs 5 to 10 days after surgery and is treated with antibiotics and anti-inflammatory drugs.

Itching at the operative site: This is part of the normal healing process. Benadryl may help control this symptom. If the surgical incisions are all closed, then soaking in an oatmeal bath preparation may relieve some of the itching. Benadryl and oatmeal preparations, such as Aveeno products, can be purchased over the counter at a grocery store.

BOTOX® & Cosmetic Fillers

BOTOX® Cosmetic Information

BOTOX® Cosmetic, by Allergan, is a purified protein produced by the bacterium Clostridium botulinum. It was first used on humans in 1978 and has been used safely ever since. It is used cosmetically to reduce moderate to severe frown lines (glabellar lines) between the brows. This is the only treatment approved by  the Food and Drug Administration (FDA) for BOTOX® Cosmetic. All other uses of this drug are considered off-label uses. Other common uses of this product are to reduce wrinkles at the corners of the eyes, fine wrinkles on the bridge of the nose and horizontal forehead lines. There are other medical uses for this product. The use of BOTOX® Cosmetic in this office will be restricted to cosmetic treatments.

BOTOX® Cosmetic is administered by injection directly into the tiny muscles that produce wrinkles on the skin when contracted. It acts by interfering with nerve stimulation, blocking the release of the neuro-transmitter acetylcholine, thus reducing the activity of the muscles which cause wrinkles. The response is not immediate. The effect should be evident within 3 to 7 days, but may take a month to develop fully. It may last from 3 to 4 months, sometimes longer. If a patient decides to discontinue treatments, the previously treated facial muscles will gradually regain normal function and the facial wrinkles will return just as they were prior to beginning treatments.

BOTOX® Cosmetic is contraindicated in the presence of any of the following:

• Allergy to any of the components of the preparation, including an egg or albumin allergy
• Active infection of the facial skin
• Pregnancy, plans for pregnancy(Category C) and lactation
• Neuromuscular diseases associated with muscle weakness, such as myasthenia gravis, multiple sclerosis and Eaton-Lambert syndrome
• Current or planned use of the antibiotics gentamicin, tobramycin, clindamycin and lincomycin
• Current use of medicines to treat heart rhythm problems, such as quinidine
• Current use of anticholinesterases (these drugs may adversely increase the action of botulinum toxin)
• Plans to donate blood. Blood may not be donated for a variable period after BOTOX® use

It is your responsibility as a patient to inform Dr. Giarratana if you have any of the above contraindications. You will be required to sign a comprehensive consent form prior to receiving BOTOX® Cosmetic. This consent form must be filled out and signed prior to all subsequent administration of this product. For your safety, please consider all possible contraindications to BOTOX® Cosmetic prior to giving your consent.

Polaroid® photographs will be taken after using alcohol to remove all cosmetics from the planned administration sites. These photographs will not be shown to anyone without your prior consent. They are taken in order to document your features prior to treatment so that you may be better able to determine the results of treatment upon comparison. Follow-up photos will only be necessary if you are dissatisfied with your results. Since the full effect of treatment is usually evident within a week, follow-up photos should not be planned for at least 10 days to 2 weeks after treatment.

After treatment with BOTOX® Cosmetic, the patient should not massage or scratch the treated areas as this will disperse the toxin. This could both decrease the effectiveness of treatment and spread the toxin into other muscles causing a less than favorable result. The patient should also contract the treated muscles for 1 to 2 hours to expedite the uptake of the toxin.
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Injectable Cosmetic Fillers Information

Injectable cosmetic fillers may be either permanent, semi-permanent or temporary. Dr. Giarratana uses only temporary cosmetic fillers. Temporary cosmetic fillers are available as purified hyaluronic acid derived from bacterial culture. Since they are of non-animal origin, no allergy testing is required prior to their use. They are safe for use in all individuals, regardless of skin type or ethnic origin. Each product is approved for use in America by the Food and Drug Administration (FDA)  for the treatment of moderate to severe  facial wrinkles and skin folds, such as nasolabial folds. Synthetic fillers approved by the FDA include Captique, Juvederm and Restylane. The safety of these products for use in treating other areas of the face or body, such as in the lips, has not been proven clinically. There have been numerous reports on the safe use of these products to treat other areas of the face besides the nasolabial folds, including the lips. However, the patient must realize that all uses of hyaluronic acid other than to treat nasolabial folds are off-label uses.

Hyaluronic acid was first developed as a dermal filler in 1989. When injected into the skin of a patient, the hyaluronic acid draws water into itself, causing the tissue to swell and become more smooth. This alters the appearance of wrinkles, causing them to become less noticeable. The amount of hyaluronic acid needed to treat wrinkles will vary from one individual to another, depending upon the size of the wrinkles and the number of facial areas treated.  The goal of treatment is not perfection, but an improvement in the appearance of wrinkles. The correction achieved with the first treatment will often be improved with subsequent treatments when the hyaluronic acid is already present. The effect of injections of hyaluronic acid will be present for 3 to 6 months, and sometimes even longer. However, retreatment will be necessary if a patient wishes to retain the benefit of the initial treatment.

In contrast to BOTOX® Cosmetic, which is used to treat wrinkles formed with certain facial expressions during muscle contraction, cosmetic fillers may be used to treat static wrinkles, or those wrinkles that are present even in repose. These static wrinkles are created when the skin’s natural collagen layer thins during the course of aging as the result of sun exposure, skin injury, lifestyle activities and heredity.

Fillers are contraindicated in the presence of current skin infection, depressions with sharp edges, a history of allergic reactions and/ or anaphylactic reactions to medications, allergy to anesthetics, active lupus and current or recent use of Accutane. The patient should be off Accutane for 6 months prior to treatment. It may be used with caution in patients with asthma, hay fever, eczema and multiple allergies. Side effects include stimulation of recurrent facial herpes, swelling and bruising, pain during and after treatment, tenderness of the treated area (usually resolves in 1 to 3 days), allergic reaction and an imperfect response to treatment. Special considerations include the following:

Herpes: Patients with a history of herpes should inform Dr. Giarratana about any recent outbreaks. Treatment will be withheld until any recent outbreaks are completely healed. Also, all patients with a history of oral herpes will receive Valtrex 500 milligrams both prior to and 12 hours after treatment. It is very important that the patient inform Dr. Giarratana about their medical history to avoid any avoidable complications of treatment.

Swelling and bruising: this is common and self-limited. This may be minimized by avoiding pretreatment use of aspirin or non-steroidal anti-inflammatory products, and by the use of an ice pack (for less than 15 minutes) after treatment. Patients should also avoid the use of products such as gingko biloba, St. John’s Wort and doses of vitamin E greater than 400 IU daily for 7 to 10 days before treatment.

Nodules: Nodules and irregularities may be more common in those patients who have received earlier treatment with semi-permanent and permanent fillers which may still be present under their skin. It is important that all patients who have received prior treatments with such fillers inform Dr. Giarratana of this before being treated. In all other patients, nodules may be minimized by facial massage after treatment. However, this treatment will be given by Dr. Giarratana, and is not to be done by patients themselves.

General posttreatment recommendations include the following: avoiding strenuous physical activity for 6 hours, avoid facial massage, or any rubbing of the face, for 6 hours, avoid sun and cold until redness and swelling disappears, sleep with your head elevated for one night, use Tylenol® for any mild pain and withhold the use of any skin care products until the day after treatment. Makeup may be used without concern.

After treatment the patient should understand that swelling and bruising are common and to be expected. These problems may be minimized by the use of ice packs frequently for the remainder of the day you receive your treatment. If the patient is planning a social engagement, he or she should allow about 1 to 2 weeks to pass between their treatment and the social event because of this potential for swelling and bruising. Older patients with thin skin and dermal atrophy  should understand that overcorrection of wrinkles may lead to a lumpy appearance or of bluish skin if the injections are too superficial. Patients of ethnic origin should not see hyperpigmentation problems, but overcorrection in these patients may result in the appearance of contour irregularities resulting from how light reflects off of the darker skin. So, not all patients will receive full correction during treatment.

The cost of treatment will vary depending upon how  much hyaluronic acid is required to treat a given patient. The various products on the market come in 0.5, 0.6, 0.7, 0.8 and 1.0 milliliter syringes. A given patient may require anywhere from 0.4 to 2.0 milliliters, or more, to treat their skin. These syringes are meant for use in only one patient and may not be shared by friends coming for treatment at the same time. Any unused product should be discarded, so partially empty syringes will not be kept in the office for an extended period of time. Any touch-up treatment desired by the patient may be done at an interval of 2 weeks. After this single opportunity for a touch-up, the syringe will be discarded. The patient pays for the entire syringe, even if only a portion of the syringe is used during their treatment.

The hyaluronic acid products are temporary, but may last for 3 to 6 months, or more. Even though complete correction is not indefinite, even the partial improvement that is present as the effect wanes will usually be satisfactory to a patient for the full 6 months. Retreatment may be given as early as 2 months or after 6 months, depending upon the wishes of a given patient. Because it is often hard to recall the appearance of one’s features weeks to months later, photographs will be taken both before and immediately after treatment in order to document results and guide future treatments. These photographs may be used to educate other patients on the possible benefits of treatment, but only with the permission of each patient.
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Photographs (All photos are unretouched Polaroid® photographs.)

Chin
This patient is a 34 year old woman weighing 131 pounds at the time of surgery. Dr. Giarratana removed 100 cubic centimeters (cc) of fat from her neck and chin. The follow-up photograph was taken three (3) months after the procedure.
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Before / After  
 

Abdomen and Hips
This patient is a 39 year old woman weighing 131 pounds at the time of surgery. Dr. Giarratana removed 800 cc of fat from her abdomen and a total of 550 cc of fat from her hips. The follow-up photograph was taken four (4) months after the procedure.
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Before / After  
 

Hips and Thighs
This patient is a 24 year old woman weighing 136 pounds at the time of surgery. Dr. Giarratana removed 500 cc of fat from her hips, 1250 cc of fat from her lateral and posterior thighs and 250 cc of fat from her knees. The follow-up photograph was taken two (2) months after the procedure.
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Before / After  
 

Male Abdomen and Flanks
This patient is a 40 year old man weighing 240 pounds. Dr. Giarratana removed 700 cc of fat from his abdomen and a total of 1000 cc of fat from his flanks. The follow-up photograph was taken eight (8) months after the procedure.
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Before / After