How Long Is The Recovery Time from Liposuction under Local Anesthesia?
The recovery time for liposuction can vary depending on whether you were under local anesthesia by the tumescent technique or whether you were under general anesthesia. If under local, then you are up and about moving around the next day but you are leaking fluids for 2 days so most patients wait 2 days to go back to work. Liposuction of the chin has an even faster recovery compared to liposuction of the abdomen. Liposuction under general anesthesia the recovery period is considerably longer sometimes a week to two weeks.
Liposuction has become the most commonly performed cosmetic procedure in the United States. Since it was first introduced in the United States in the early 1980s, many refinements have been made. The most significant improvement was the use of a diluted local anesthetic instead of general anesthesia. This improvement is referred to as the tumescent technique. With the tumescent technique, liposuction patients need no general anesthesia, as contrasted with the traditional/standard liposuction methods, which do require general anesthesia with intubation, or deep intravenous sedation.
The tumescent technique is a method that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. The tumescent technique eliminates both the need for general anesthesia and need for IV narcotics and sedatives. The tumescent technique utilizes natural saline solution containing a precise amount of very local anesthetic (lidocaine) and adrenaline which is injected into the fatty tissue. The injected area then becomes anesthetized. Tumescent (local anesthesia) constricts capillaries and prevents surgical blood loss, provides fluid to the body by subcutaneous injection so that no IV fluids are needed and has the best post-op pain control. It is beneficial because it significantly decreases swelling and bruising after the procedure. It also makes the procedure virtually pain free. The vast majority of patients are able to resume their normal activity within 2-3 days with no swelling or bruising. Nearly all current techniques including laser liposuction (Smart Lipo), ultrasonic liposuction (Vaser), power assisted liposuction use tumescent technique as a component of the procedure. These added devices facilitate more rapid removal of fat as well as tightening of the skin in the areas treated. The days when liposuction was performed with large amounts of blood loss and danger are long gone. In fact, I have to encourage most of my patients no to do too much on the second day since they feel remarkably well!
Botox with NO INJECTIONS?
I am writing this blog to clarify my statement from the Aesthetic Plastic Surgery and Anti Aging Medicine conference I attended this past weekend June 10-12 2011 in NYC. I was limited by the number of words I could “Tweet”.
Topical Botox “gel” RT001 has completed phase 2 clinical trials. So it must complete phase 3 and FDA approval before we as clincal doctors can use it.
The results from phase 2 trials were: 88% of people responded and the results lasted up to about 3 months. It was used for the “crow’s feet” (lateral canthus) area.
It was and will be administered only in a doctors office. It will probably be approved for Crow’s feet (on label) and I also can see it used for underarm sweating. This will avoid the multiple needle sticks to the underarm area that’s done presently. – More to follow- Dr M
Worried About Lip Augmentation for Fear of Looking Like a Duck?
Every woman’s dream: Big, Sumptious, Kissable lips? Yes they are beautiful but when it comes to Lip Augmentation with Injectible Fillers…. LESS IS MORE!… Running a busy Cosmetic Medical practice I usually hear most if not all women wanting fuller lips but that comment usually is followed by.. “but I don’t want to look like a duck” or “I see young women walking around with duck lips.” Unfortunately, what these woman are seeing are the extremes of either “over filling” or poor technique by the doctor since as I always state “Dermal Filler Injection is an Art”.
There are usually two parts to lip augmentation…. filling the darker line around the outside of the lip (vermillion border) and injecting the lip itself to plump up the body. Both usually go hand in hand but there are exceptions depending on the amount of volume lost and the look that the patient desires. Pictures are helpful of your “younger lips”… what isn’t helpful are pictures of Angelina Jolie’s lips since while they may look great on her, that look might not be right for you. Symmetry and balance are the key here. .It’s important to match the size of the lips with the overall appearance of the face. Most people notice their lower lip needing augmentation first since there is a 60/40 proportion of lower lip to upper lip, meaning the lower lip should be fuller. I always instruct a first time lip filler patient to start with one syringe… by starting slowly you’ll be accomplishing two things. First, the augmentation will be more subtle, and second the doctor and patient can assess how your body responds to fillers in the lips. There is always time to place more filler after the results of smaller amounts are shown first…. This usually applies to younger women. In older women, once the lip line looks like it’s shrinking backwards towards the mouth, that’s a sign that two syringes of filler will most likely be needed.
I like to use Juvederm or Restylane for lip augmentation since they are “thinner” hyaluronic acids and tend to be softer in this area. Lips are highly vascular meaing a lot of blood vessels are present and bruising is more likely in this area. So if bruising should occur, it will usually resolve in a few days leaving you with fuller lips. Also don’t do lip injections the day before a “hot date” for various reasons! LOL!
As always choose a doctor with a lot of experience injecting lips since as always, if you do a lot of something….you’re going to be better at it! The pictures below show what I can do with lip fillers.
Before
After
For more information please see my previous blog: “Lip Augmentation that Passes the Kiss Test:
What is the Non Surgical Face Lift?
A Non Surgical Face lift or “Liquid Face Lift” is rejuvenating the face using either Botox or Dysport in the upper face, (frown lines, forehead lines, and crow’s feet) and using dermal fillers in the mid and lower face to “volumize” areas and “lift” areas over the bony prominences. Suffice it to say your addressing three different areas (upper, middle and lower face) by the Non Surgical lift. Best of all …no down time!.. a day or two of swelling perhaps to avoid a much larger surgical face lift procedure.
Fillers may be used to augment cheek bones, add volume to the cheeks, strengthen the jawline, and fill hollows under the eyes. All of these things can add up to a rejuvenated and fresher face. Filling in the naso-labial folds and marionette lines is usually the first sign somone is “aging” and why most younger patients come in for rejuvenation. One of the early signs of aging is to lose volume in the face. Many of the wrinkles and sagging skin are caused by this loss of volume.
In many ways fillers can give results superior to surgery for rejuvenating the face. If someone wants to take this Non Surgical face lift to the next level…. a nice combination would be to add an IPL (Intense Pulsed Light) or Photofacial if you were a younger patient with dark spots and redness to blend the complexion. If you were older with deep seated brown spots and wrinkles a Fractionated CO2 Resurfacing would be indicated for a “deeper treatment” to blend the complexion and “lift” or “tighten” the skin.
For more information please refer to my other blogs: “Liquid Mini face lift for the holidays”, “What is Laser Skin Resurfacing?.. What is Fraxel?”, “Laser Skin Tightening… Does it Work?” and “What’s New In Eye Rejuvenation? No Knife Techniques Help Patients Bypass Eyelid Surgery”.- Dr Macri
Dermal Fillers- How Much is Enough? General Guidelines
“Doctor how much will I need to fill this area?” I hear this question frequently throughout the week. I will attempt to provide general guidelines as to how much filler is needed to fill certain areas. I will also use as my “typical patient” a female 35- 45 years old. Exceptions will be obviously younger and older than this demographic patient and varying with individuals who have deeper lines, lighter lines, lost weight or have scars. I will also exclude “touch ups” since touch ups vary with the amount of touching up the patient desires.
So my typical 35-45 year old female will come in noting her naso-labial folds are becoming more pronounced. She is probably coming in because she has been watching this area and the line getting deeper or perhaps she read what can be done to prevent this line from getting deeper. Usually one syringe of dermal fillers will fill this patient nicely. Now this is important…. if you needed filler in this area.. chances are you need filler in the area just below this area called the marionette lines as well. The marionette (puppet lines) are just a continuation of the naso-labial folds anyway. So if you need the upper lines filled, chances are you’ll need the lower ones filled as well. There can be exceptions but form usually follows suit!
Also sometimes this same patient may come in wanting to fill her naso-labial folds when in fact her problem is that the cheek has dropped. The fat pad of tissue dropped from the cheek bone to the area just above the naso-labial fold . Patients are amazed when I pinch this area and pull upward on their face and say….a few years ago you used to look like this? Right? The answer unequivocally is YES! Augmenting the cheek area or the area under the eyes (eye hollows, tear troughs) will fix this but in my experience usually requires two syringes (one for each side) to correct. I usually use a long lasting filler in this area so that patients wouldn’t have to repeat this more than once a year.
Sometimes in an older patient the naso-labial folds, marionette lines and cheeks must all be addressed since obviously more volume has been lost due to age. Correcting all areas together will result in a better overall outcome.
One Syringe usually fills one of the following areas:
- Naso-labial folds
- Marionette lines
- Smoker’s lines around the mouth
- Lips- mild correction
- Glabella (frown lines not responsive to Botox or Dysport)
- Ear lobes
- Nose (Non- Surgical Rhinoplasty)
Two Syringes usually fill one of these areas:
- Cheek hollows
- Tear troughs, Eye Hollows
- Lips- full correction- fuller lips
- Hands (both hands)
What is said above about dermal fillers doesn’t apply to fat transfer since more fat volume is required to result in the same correction as compared to using dermal fillers, but you’re not limited by cost per syringe with fat. For more information please see my previous blogs:
- Fat: The Next Big Cure?
- What is the Stem Cell Lift?
- What is Platelet Rich Plasma (PRP) and Vampire Lift? Hype or Fact?
Lastly, splitting a syringe in more than one place usually only works out for someone who has done fillers before and has sufficient filler remaining in all areas. I call this technique ”Layering” but it amounts to more of a ”touch up”.
Bad Botox? Is there such a thing?
If done correctly …very unlikely but it can be operator dependent.
I have seen multiple times in my office patients from other doctors that went for treatments and have waited about two weeks and still no result!
There are multiple reasons for this. Again, in this blog what I say about Botox applies to Dysport as well.
Let’s first assume the provider or doctor is ordering either Botox from Allergan or Dysport from Medicis so it’s “real Botox”.
There are other problems that can arise. Let’s also assume it was transported and stored via refrigerated means. Initially Botox stated it must be used in 1-2 weeks… multiple studies have came out since showing once mixed it lasts about 4-6 weeks refrigerated. If it was mixed for 6 weeks or longer for example a provider who only uses small amounts on limited patients in his practice it may have gone bad. .. so yes bad Botox! I always tell patients to wait ten days to two weeks for full effect especially for Botox. Dysport tends to act quicker so waiting a week to ten days would be appropriate.
So assume you’ve waiting the prerequisite time and you are having a decrease in the muscle movement .. but you still have a wrinkle you may need more units injected. Some patients like to cut back on or say I can only afford this much.. can you spread it out?.. I always say it’s better to treat one area completely than to “spread out” the dose to hit all the areas desiring correction. The next important consideration is “user dependant” Did they mix the concentration properly? Since it doesn’t come pre mixed… the provider has to mix it and there are different regimens to accomplish this. For the purposes of learning let’s also assume the doctor is giving you exactly what he says he is. The next and equally important point is placing Botox into the muscles that are causing the wrinkle….Many times I have patients tell me can you inject it… here and here…. Botox only works if it is injected correctly into the muscle that is pulling at a right angle to the wrinkle. So the answer is …no it can’t effectively treat all lines but it depends on how the muscle is moving. I spend extra time to determine how a person wrinkles their forehead and have them make funny faces to determine this movement. The frown lines (glabella) move by primarily three muscles that require 5 injections to all parts of the muscle to achieve relaxation. I have been at conferences and believe it or not many doctors inject it in a “V” like the product flyer describes but doesn’t describe the musculature. If its not placed precisely … your not going to get the best result that can be obtained.
There is such a thing as developing antibodies to Botox. I have only seen a case or two in 6 years but it is reported albeit rare. Also sometimes if someone doesn’t respond to Botox the provider can try Dysport.
Will Botox remove all wrinkles…no.. if after treatment you still have a line and the muscle that causes the line still has movement ..you still have the option of placing more Botox.. If there is no more movment a viable option would be injection of dermal filler. For more information you may refer to my blog: Dermal Fillers: Restylane vs Juvederm What’s Best?
Lastly, as always, go to someone who does alot of injections .. like anything else if you do alot of something you”ll become very good at it and you’ll constantly have a fresh supply of product because of sheer volume! -Dr Macri
Do you always look sad or angry when you’re not?
With active frown lines and a down turned mouth, you may appear angry or sad. Botox/Dysport is the perfect treatment to reduce the muscle activity that creates the frown lines and down turned mouth. However the “angry look” may come from more than just the frown lines. Do not neglect the slight downturn some people get at the corners of their mouth, which is caused by a muscle called the depressor anguli oris pulling down on the corners of the mouth. Botox/Dysport can be injected on the sides of the chin to relax the muscles that pull the corners of the mouth down. Dermal fillers can also be used to correct the creases along the sides of the chin (marionette lines). In addition to these treatments giving you a more youthful look, some of my patients have shared that they appeared happier and more approachable to others!
Will Botox/Dysport Prevent Wrinkles?
This is an outstanding question! It usually gets asked 5 times a week, usually in conjunction with: Is it too early to start Botox?.. to prevent wrinkles? In fact, I treated a 22 year old last week that was getting married and didn’t want to be photographed with frown lines. Can you blame her? The muscles of facial expression (frowning), genetics and aging contribute to wrinkles. There are two schools of thought. I will use the term Botox in this blog but what is said for Botox would apply to Dysport.
Prevent Wrinkles.. Agressive Approach:
It is best to start Botox before the wrinkles develop. The reasoning is that continued stress leads to dermal atrophy and breakdown of the structural integrity of the dermis (wrinkles). If you start Botox early, then you are decreasing the stress on the skin and, thus, helping to prevent wrinkles. In general, Botox works best in younger patients because it reverses the trend to frown unnecessarily. Over time, you can actually re-train those over-active muscles and prevent wrinkles. Often, I have seen patients put off Botox and fillers too long, and then these simple procedures don’t have the same effect as if they were started before the wrinkles became more permanent. Permanent wrinkles are harder to remove.
Prevent Wrinkles: Moderate Approach
Worrying about aging will only contribute to aging!…Receiving Botox when you have detected the first signs of wrinkling would be a more reasonable strategy than Botox as a preventive measure. You should wait until you at least start to show a little “crinkle” (much smaller that a wrinkle) in your forehead.
I tend to agree more with the moderate strategy (at the first sign of wrinkles… to treat)….and it seems most of my patients do too! My demographic is largely women ages 25-50 years old. The bulk of this age group the 25-40 year olds know usually by extensive reading and online research that it’s easier to treat a wrinkle before it becomes permanent. So at the first sign of a wrinkle they’re starting Botox treatment and the same would hold true to begin fillers …. before wrinkle lines become established… That’s the reason why almost all my patients are always looking so good!……… Dr Macri
Laser Skin Tightening… Does it Work?
The short answer is yes but patient selection and certain conditions are extremely important.
Any non invasive Skin Tightening technology, Near Infrared Light, Laser Technology, Accent, Thermage, Titan and Refirm are all trying to do the same thing: Heat up the Dermis to remodel and stimulate collagen production. There are primarily three technologies: electrical, light, and ultrasound that do this. The important piece of info is that none of these technologies replace surgery with regards to lifting or tightening. They are meant for patients generally younger that have a small amount of skin laxity. They are not meant for patients with a sagging face or neck that would need a surgical lift or possibly liposuction of the neck. This is the type of technology that one would seek if they need a mild to moderate correction that doesn’t want to undergo surgery and potential surgical complications.
Anyone who expects dramatic skin tightening is going to be disappointed. However, there are laser technologies that will tighten and “lift” the skin over the face…. for example .. a Fractionated CO2 Resurfacing, but you wouldn’t do this procedure as a stand alone treatment for skin tightening. You do Fractionated CO2 Resurfacing to correct: Brown spots, mottling of the skin, sun damage, fines lines and acne scarring. Skin Tightening is as a byproduct of this procedure by remodeling of collagen. This could also be done for the areas around the eye (periorbital area). See my blog on Eye Rejuvenation …no knife techniques for more info.
We’ve tried multiple technologies in our office and have been “under whelmed” by different company reps that tout “their machine is the best” mentality but what it comes down to is: choose the proper patient scenario and the patient wanting mild to moderate correction without undergoing surgery.
Will a Photofacial or Intense Pulsed Light (IPL) Treatment Remove my Red & Brown Spots?
The short answer is Yes! … but there are a few things you should know. A Photofacial, Intense Pulse Light treatment (IPL) is used to remove superficial brown spots (dyschromias), sun damage, red spots, red hue and Rosacea. This treatment specifically treats the superficial or epidermal layer and is considered a “lunch time” procedure with no down time. It typically lasts 8- 12 months or longer, however, since being superficial the damage that is in the deeper layer “Dermis” is not addressed and will gradually come to the surface in that 8-12 month period. At that point the treatment may have to be repeated. A full examination before treatment is warranted by a qualified physician since not all brown spots are benign and its possible that an IPL could delay the diagnosis of a melanoma or basal cell cancer, if unrecognized.
Red spots, red hue….. along with Rosacea are typically a “home run” when it comes to IPL since the red is targeted by the Laser and destroyed. The problem with Rosacea is the skin is too thin and your visualizing the red blood vessels below the skin surface. Again this may need re treatment in about 8-12 months due to the superficial nature of treatment. Additional benefits of IPL whether used for red or brown spots is softer skin, some shrinkage of pores and importantly …. stimulation of collagen making the skin thicker and healthier.
After care for IPL consists of using a gentle cleanser, a gentle moisturizer and SUN BLOCK… every day!
A question I am frequently asked is: Would a Fractionated CO2 resurfacing be better to remove the brown spots?….. The answer is yes, however, a resurfacing requires about 2 days of downtime and is slightly more invasive since your treating the surface ( epidermis) and deeper layer (dermis). It permanently removes the brown spots, highly stimulates collagen, removes fine lines and wrinkles, sun spots and lasts for 5-7 years if you take good care of your skin. This procedure is more technically demanding so it’s more expensive from a cost standpoint. The results are outstanding. A C02 resurfacing isn’t done for Rosacea or red spots since this will ,in fact, make your skin more red or more inflamed. IPL is the treatment of choice for red spots and Rosacea.
For more information.
Please refer to my blog on: What is Laser Skin Resurfacing? What is Fraxel?
Ask the Doctor page: Can facial laser rejuvenation cause skin cancers or other growths to appear in the future?
