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Offline anget

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Hello-new member
« on: June 08, 2012, 11:28:40 AM »
Hi all.  I a new member.  I'm a 38 year old mother of 2.  I am scheduled to have liposuction on my thighs later this month and I am really starting to have anxiety.  After 4 consultations I have chosen a board certified plastic surgeon am very confident about however he requires that I be under general anesthesia, which I never have been before and I am worried about the added risk.  My first concern is that I do nothing to put myself at significant risk because I want to be here for my children, forever if I could.  On the other hand I have a pretty bad problem with my thighs that cannot be corrected with diet or exercise and has inhibited my life in so many ways over the years since I was a child. 

Offline anget

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Re: Hello-new member
« Reply #1 on: June 08, 2012, 11:29:57 AM »
I guess my question is whether there really is enough added risk from general anesthesia that I should request an alternative or find a different surgeon who is willing to use an alternative.

Offline DrBermant

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Liposuction Forum - Type of Anesthesia
« Reply #2 on: June 08, 2012, 03:08:54 PM »
Hi all.  I a new member.  I'm a 38 year old mother of 2.  I am scheduled to have liposuction on my thighs later this month and I am really starting to have anxiety.  After 4 consultations I have chosen a board certified plastic surgeon am very confident about however he requires that I be under general anesthesia, which I never have been before and I am worried about the added risk.  My first concern is that I do nothing to put myself at significant risk because I want to be here for my children, forever if I could.  On the other hand I have a pretty bad problem with my thighs that cannot be corrected with diet or exercise and has inhibited my life in so many ways over the years since I was a child.

I guess my question is whether there really is enough added risk from general anesthesia that I should request an alternative or find a different surgeon who is willing to use an alternative.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our forum.

Liposuction is a common component of many forms of Plastic Surgery sculpture such as Tummy Tuck, Gynecomastia Male Breast Reduction, Breast Lift, and Breast Reduction.

Plastic Surgery Anesthesia is an art form, each doctor has their own preferences. This should be investigated as a component of selecting any surgeon. I preferred local with sedation for my patients with a lower complication rate. The experiences documented on my site were typically done under sedation as indicated. While in competent hands General Anesthesia should be safe, I preferred how we could have our patients awake, comfortable, and feeling great right after surgery with a lower chance of nausea. That is why I included patient experiences with anesthesia as part of the documentation process of patients learning about what we offered. Have you investigated such issues with the surgeon you chose, or why did you choose that doctor? We have built many resources on How to Pick Your Plastic Surgeon, but also included more specific criteria for certain types of sculpture.

Hope this helps,

Michael Bermant, MD
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Offline anget

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Re: Hello-new member
« Reply #3 on: June 08, 2012, 04:32:37 PM »
Thank you for your expedient reply! I chose this surgeon based on a number of factors including, his procedure photos, the professionalism of his office, his honesty with me and his realistic plan for correction, his credentials, his accredited surgery center and use of board certified anesthesiologist, his explanation and reasons of the method he uses compared to other methods (tumescent with power assisted suction) as well as his reputation in the community.  I saw 3 other surgeons in bigger cities, 2 doing vaser and 1 also doing tumescent with power assisted suction.  The surgeon I chose is experienced in vaser, has used it in the past, and has chosen not to continue using it.  He wasn't negative about it but said one downside was the larger incisions and longer surgery time but that the ultimate safety and result comes down to the skill and knowledge of the surgeon, not the preferred method.  I felt he was the most confident and proficient without being arrogant or unrealistic. I felt like he was providing medical competence as well, not selling me a swanky spa type operation.  When I started the research and consultation process, I felt very sure I would only consider a procedure that didn't require general anesthesia however in the end I wanted to choose who I thought was the best surgeon because I'm also mindful of risks such as clots or embolisms from loosened fat. I'm not sure how much I should be worried about those risk factors compared to general anestesia.  Thanks once again for your reply. I have my pre-op appointment next week.  I called his patient coordinator yesterday to ask if I had other options for anesthesia but she is on vacation and I believe the surgeon is as well.  I could have spoken to someone else in the office but I prefer to direct my questions to the surgeon or his right hand person so I will have to wait until Monday to find out if I have other options.

Offline DrBermant

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Re: Hello-new member
« Reply #4 on: June 08, 2012, 05:14:54 PM »
Thank you for your expedient reply! I chose this surgeon based on a number of factors including, his procedure photos, the professionalism of his office, his honesty with me and his realistic plan for correction, his credentials, his accredited surgery center and use of board certified anesthesiologist, his explanation and reasons of the method he uses compared to other methods (tumescent with power assisted suction) as well as his reputation in the community.  I saw 3 other surgeons in bigger cities, 2 doing vaser and 1 also doing tumescent with power assisted suction.  The surgeon I chose is experienced in vaser, has used it in the past, and has chosen not to continue using it.  He wasn't negative about it but said one downside was the larger incisions and longer surgery time but that the ultimate safety and result comes down to the skill and knowledge of the surgeon, not the preferred method.  I felt he was the most confident and proficient without being arrogant or unrealistic. I felt like he was providing medical competence as well, not selling me a swanky spa type operation.  When I started the research and consultation process, I felt very sure I would only consider a procedure that didn't require general anesthesia however in the end I wanted to choose who I thought was the best surgeon because I'm also mindful of risks such as clots or embolisms from loosened fat. I'm not sure how much I should be worried about those risk factors compared to general anestesia.  Thanks once again for your reply. I have my pre-op appointment next week.  I called his patient coordinator yesterday to ask if I had other options for anesthesia but she is on vacation and I believe the surgeon is as well.  I could have spoken to someone else in the office but I prefer to direct my questions to the surgeon or his right hand person so I will have to wait until Monday to find out if I have other options.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Evaluating pictures is important, but when I was evolving my various Standard Pictures for Tummy Tuck and other body contouring operations, I found that how tissues moved were even more critical such that I then started using Tummy Tuck Videos to show how tissues moved. One of the advantages was to be able to document the emotional component. In my questions asked during these sessions, I typically included about the anesthesia experience. There are many such videos on my site, but listening to them can help better understand why we featured our anesthetic technique as part of our patient education.

We found the power of local with sedation so valuable, that we moved our Tummy Tucks from general to this method which we then called my Tumescent Tummy Tuck well before it was published in the literature by others. But each surgeon to his / her own.

Good luck on your surgery.

Hope this helps,

Michael Bermant, MD
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Michael Bermant, MD
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Offline anget

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Re: Hello-new member
« Reply #5 on: June 10, 2012, 12:33:24 PM »
Thanks again for your reply.  One further question if you don't mind.  One of the other risks I've read about, as I mentioned is if some fat breaks loose and gets lodged somewhere it shouldn't causing an embolism.  It seems as if this is a rather remote risk however I was wondering techniques that use either laser or ultrasound to first liquify the fat further reduce this risk?  Thanks again.  Trying to be prepared with all the questions I want to ask my surgeon between now and my surgery.

Offline DrBermant

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Re: Hello-new member
« Reply #6 on: June 10, 2012, 07:46:15 PM »
Thanks again for your reply.  One further question if you don't mind.  One of the other risks I've read about, as I mentioned is if some fat breaks loose and gets lodged somewhere it shouldn't causing an embolism.  It seems as if this is a rather remote risk however I was wondering techniques that use either laser or ultrasound to first liquify the fat further reduce this risk?  Thanks again.  Trying to be prepared with all the questions I want to ask my surgeon between now and my surgery.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Liposuction is a component of many different types of Plastic Surgery such as Abdominoplasty. Deep venous thrombosis or DVTs are real and we always stressed the factor not only in a discussion of not just Risks of Tummy Tuck Surgery, but also during all of our Liposuction Consultations.

Plastic Surgery Anesthesia is one factor in that equation. One of the features why I like my movement towards local anesthesia with sedation such as for my Tumescent Tummy Tuck, was to be able to get a patient up and walking around straight from the operating table. Of course we used sequential compression devices during our operations. However, the best way to prevent DVT beyond the surgery technique, is using the leg muscles. Up and walking about means much less risk than in pain in bed. That is why we concentrated so much on our Comfort after Tummy Tuck so we could not just help our patients with less pain, but also lower their risks of complications. This was true for also Recovery After Liposuction alone.

I never liked any of the fat destruction techniques, and there have been many over the years. They certainly make the surgeon's work easier and that might mean shorter operating room times. But my analysis was that the doctors using such methods had much more swelling and bruising. We carefully monitored the path our patients took from the before to after surgery such as in Swelling and Bruising After Tummy Tuck or Swelling and Bruising After Gynecomastia Male Breast Reduction. In my opinion, it is the doctor advocating that ultrasonic or vasor, or "smart" or whatever liposuction technique to show the in between path to be as good or better. Unfortunately most do not, and one needs to look for their patients' recovery on forums posted by the patients themselves or see them in my office for a revision operation and hear their comments comparing my more complex revision surgery to their first surgeon's methods. You can read more about this on

Revision Gynecomastia Forum - Unhappy: VASER Liposuction Did Not Remove Gland which was also had an element of those devices not working on gland of the male breast, but also reflects the issues of recovery path taken.

Liposuction Forum - Why do some people gain weight from lipo? discusses documentation of bruising and swelling path taken by a technique.

It is an issue of the destroyed fat not being completely removed and the body's process in dealing with that and damage to remaining tissues left behind. If a method is better, then someone advocating it should demonstrate it with documentation such as sequential standard pictures and movies how patients were up and about after surgery. To date, I have yet to find any coming close to what we were achieving. But that day will come as someone takes off beyond what I had been able to evolve. Hand waving with words alone is not sufficient, look, see how an individual moves with video at that point in time is why we took the added effort to take the pictures and movies. You can find many such videos on my Plastic Surgery Encyclopedia.

The above details were why I did things my way. The method evolved following a critical analysis of what we and others were doing. But then again, each surgeon has his / her methods. It is nice when someone takes the time to develop their documentation to help set their patients at ease as to why they do something.

Wish you luck on your surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Liposuction Body Contouring
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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