In body contouring plastic surgery, breast reduction has one of the highest patient satisfaction rates, as suggested by medical literature. This is not surprising since it can provide immediate relief from painful bra strap grooves, back pain, nerve and disc damage, postural problems, and other symptoms caused by being too “endowed.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who performs breast reduction on a regular basis, says that most complications are minor or “just nuisances,” as opposed to health-threatening problems.
The standard breast reduction incision technique favors women who require large downsizing, i.e., more than 600 gram of tissue per side.
Nonetheless, Dr. Smiley says he requires all his patients to pass lab screening to determine that they are fit for the surgery and its ensuing recovery. A careful preoperative evaluation, he adds, also allows him to identify breast reduction risk factors, many of which can be eliminated or at least controlled to minimize risk of complications.
A 2013 study, which involved more than 500 women who had bilateral breast reduction, has shown that infection at the surgical site (16 percent) and delayed wound healing (10) were the most common complications.
The study, along with other previous findings, was able to identify the risk factors or predictors of complications following breast reduction surgery.
Smokers were twice more likely to experience infection and poor wound healing than non-smokers because of the nicotine’s constricting effect on blood vessels, preventing the efficient delivery of nutrient- and oxygen-rich blood to the wound.
However, complete smoking cessation for a minimum of two weeks prior to surgery and throughout the recovery is enough to reverse most of the detrimental effects of tobacco use.
Diabetic patients have compromised healing and so they face a higher risk of necrosis (death of tissue) of the areola. Hence, prior to surgery it is highly ideal to eliminate or at least control serious medical conditions through medications and/or lifestyle changes.
The risk of poor wound healing and infection is markedly different between a patient having a 500-gram reduction and someone requiring a 1,000-gram excision.
Large breast reduction entails more breast tissue and skin removal, which could lead to increased bleeding and higher risk of comprising the blood supply. Furthermore, a significant downsize could make it extra challenging to achieve a natural breast shape.
The vast majority of liposuction patients will have their scars heal and fade well into the background. This has become possible with the use of microcannula, a straw-like device whose outside diameter is generally defined as 2.2 mm or smaller.
Aside from microcannula and the use of meticulous surgical techniques, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says “how well a scar fades” will also depend on patient commitment. For instance, sun exposure is best avoided for about a year to prevent the scar from turning dark and thus becoming more visible.
Photo Credit: Medscape
Furthermore, prudent patients should not apply any topical treatments (e.g., scar creams and gels) without first consulting their surgeons and avoid submerging their incisions in water (pools and bathtubs) until these are fully sealed, which happens around three weeks.
Nonetheless, liposuction and keloids risk remains an issue among patients with a history of aggressive scarring.
While having a history of keloids is not a contraindication to liposuction, prudent patients should disclose their susceptibility to aggressive scarring to their doctors who can explain the risks and the possible need for aggressive and proactive scar treatments and preventions.
Keloid is a tough scar that grows beyond the injury site (or liposuction incision). It usually appears pink or purple and has an irregular shape that tends to expand progressively.
To prevent visible scars, Dr. Smiley says all efforts are made to position the liposuction incisions within the natural skin fold and beneath the “bikini area.” To further allay the concerns of patients, he says that only certain parts of the body are prone to keloid scarring such as the earlobes, chest, and upper outer arms—places that are generally avoided during the creation of small puncture wounds used in liposuction.
While follow-up consultation is important for all patients after liposuction, this is particularly true of individuals with a previous history of keloids who require closer monitoring so their surgeons can aggressively treat scars that are becoming thick and unsightly.
The use of cortisone injections is arguably the most common treatment for keloids. However, they are only performed a few weeks apart to prevent skin changes such as depression and hypopigmentation (lightening of color).
Male breast reduction and tummy tuck performed at the same time offers advantages such as lower cost compared to having them separately. Furthermore, not everyone has the luxury to have two recovery periods.
Dr. Tarick Smiley, one of the leading Beverly Hills plastic surgeons, says that patient safety is the most important aspect of multiple-surgeries operations. Theoretically, the longer operative time under general anesthesia and the more incisions and cutting are made, the higher the risk of complication is.
The first and most critical step to make combo surgery reasonably safe is to conduct strict patient selection. In this respect, Dr. Smiley requires all his patients to pass lab screening to ensure that they can handle the “rigors” of any operation.
Lab screening typically includes blood work and EKG and cardiopulmonary tests.
After passing lab screening, the patients are instructed to “prepare” weeks or even months prior to surgery. The idea is to help them achieve their optimal health through superb diet and regular exercise.
Preparation for surgery also involves complete cessation from tobacco and smoking cessation products and discontinuation of all drugs and supplements with blood thinning properties. For clarity, Dr. Smiley provides his patients written materials that let them know all the things and activities they need to avoid before surgery and afterwards.
To further ensure patient safety, Dr. Smiley says in his recent Snapchat post that he only works with a board-certified anesthesiologist who requires a separate lab screening. Also, this specialist monitors the patient’s vital signs at the time of surgery.
Moreover, all efforts are made to complete the surgery in less than six hours to control the amount of surgical trauma and bleeding.
While combo procedures have a perceived higher risk of complications, Dr. Smiley says having separate surgeries also has problems—e.g., multiple recovery periods, higher cost, and “multiple” risks.
Because bleeding has a large effect on the recovery period and the risk of complications, Dr. Smiley uses different modalities to reduce blood loss. For instance, he injects epinephrine before making incisions.
Epinephrine is a drug that constricts the blood vessels, ultimately reducing the amount of bleeding. Furthermore, it “spreads” the effects of local anesthesia and so the patients rely less on oral narcotics to control their postop discomfort.
Preventing or at least minimizing the risk of rhinoplasty infection should be one of the most important goals of any prudent surgeon performing nose-reshaping surgery, according to California Surgical Institute website.
The list below shows the basic guidelines on how to minimize risk of rhinoplasty infection.
Anyone with uncontrolled medical condition linked to higher risk of infection and poor healing is discouraged to undergo any elective plastic surgery.
Prior to rhinoplasty, judicious surgeons require all their patients to pass lab screening to ensure that they can handle the surgery and the ensuing recovery.
- Achieve one’s optimal health
Achieving one’s optimal health generally includes eating healthy, avoiding smoking and too much alcohol and caffeine, and discontinuing aspirin and aspirin-like products for at least 2-3 weeks.
- Accredited surgical facility or hospital
This is the safest surgical venue. Being accredited means the surgical facility adheres to the highest patient safety standard.
Moreover, an accredited surgical facility has the necessary equipment, building design that promotes sterilized environment, and highly trained staff to reduce risk of infection and contamination.
Many surgeons today recommend prophylactic (preventive) antibiotics to help ward off infection, which must be taken on time and their full course completed.
The patient must be informed of the telltale signs of infection such as elevated temperature, unusual skin changes, and poor healing.
If the patient notices anything unusual, he must notify his surgeon right away than wait for his next scheduled appointment. Some individuals might be apprehensive contacting their surgeon thinking that they might bother them over some trivial thing.
Furthermore, the patient must understand that his full commitment is necessary to minimize risk of complications. For instance, smoking even just a single stick a few weeks leading up to the surgery or during the initial healing stage is enough to drastically increase one’s risk of poor healing, infection, and less than optimal results.
It is important to leave the nose alone to heal. No picking at the incisions, blowing hard, wearing eyeglasses, or anything that might compromise healing.
Liposuction blood loss is often minimal thanks to the introduction of tumescent technique. This involves injecting tumescent fluids, which contain epinephrine that constricts the blood vessels during surgery and prolongs the numbing effects of lidocaine (i.e., local anesthesia).
However, some patients bleed more than others due to some underlying medical condition. Also, large volume liposuction—i.e., removing more than 4 liters of fluids in one day—is also linked to increased bleeding and possibly longer recovery.
Reducing liposuction blood loss is the first and most crucial step to make the surgery safer, says leading Los Angeles plastic surgeon Dr. Tarick Smiley who has performed over 9,000 liposuctions.
He explains how me reduces the amount of bleeding with the techniques shown below:
He requires all his patients to pass a rigorous set of physical exam to ensure that they can handle the surgery. Furthermore, any medical condition that could lead to increased bleeding and poor healing such as anemia is treated ahead of the operation.
Moreover, Dr. Smiley’s board-certified anesthesiologist requires his patients to pass another lab screening.
Once the patients have passed the lab screening, they are instructed to discontinue all blood thinning medications and supplements (aspirin, ibuprofen, fish oil, ginko biloba, etc.) 1-2 weeks before surgery to reduce bleeding and postop bruising.
Furthermore, the patients are required to discontinue smoking and smoking cessation products a few weeks prior to surgery. It is also helpful when they avoid or at least cut back on caffeine and alcohol.
- Tumescent liposuction technique
Dr. Smiley always injects the fatty area with tumescent solution, which contains epinephrine to constrict the blood vessels and ultimately minimize the amount of bleeding.
Despite all efforts, small capillaries are slightly injured during surgery and thus bleeding still occurs, although oftentimes this is just minimal.
Some patients require large volume liposuction to achieve their desired results. However, it comes with one caveat: more bleeding.
To prevent significant liposuction blood loss, Dr. Smiley uses Cell Saver, a piece of equipment that can filter out and collect the red blood cells that have been removed during surgery. These cells are then re-infused into the patients as if no blood loss has occurred.
- Never rush one’s recovery
All patients are instructed to avoid over-exertion for at least three weeks after surgery to prevent postop bleeding and persistent bruising and swelling.
The guidelines involving liposuction safety are primarily aimed to control the amount of bleeding and surgical trauma, as suggested by world-renowned plastic surgeon Dr. Tarick Smiley who oversees accredited surgical facilities in Los Angeles, Dubai, and Lebanon.
A good number of doctors avoid large volume liposuction whose definition greatly varies. For instance, some interpret it as removing more than 4 liters of fluids (fats, blood, and anesthetics or wetting solution injected into the fatty area); others use the patient’s body weight to “establish” the maximum safety limit.
One way to avoid large volume liposuction in patients who need “extensive correction” is to conduct two procedures performed months apart. The goal is to give the body sufficient time to recover from the surgical trauma caused by the initial surgery.
However, the aforementioned approach can lead to additional expenses—i.e., the patient has to pay for two anesthesia and surgical facility fees. Moreover, it entails two recovery periods, which can be a rather inconvenient for someone with a hectic schedule.
Despite the caveat of large volume liposuction, Dr. Smiley still offers the procedure provided that the patient is healthy enough to handle the surgery and the recovery it entails; hence, lab screening and blood work is a critical component of his strict patient selection process.
To further ensure large volume liposuction safety, the celebrity plastic surgeon uses a new technology called Cell Saver, which can process the fluids collected during surgery. It works by collecting the red blood cells, which are then re-infused into the patient as if no blood loss has occurred.
Dr. Smiley has recently demonstrated large volume liposuction on his Snapchat account. He was able to collect more than 4 liters of fluids in the patient’s frontal abdomen alone.
The female patient required 360 degree liposuction (i.e., the entire waistline) to achieve a more hourglass silhouette.
While the use of Cell Saver enables the renowned surgeon to perform large volume liposuction without resulting in significant bleeding, trauma, and fluid imbalance, he does not always perform this type of aggressive fat removal, particularly in patients whose skin lacks a good amount of elasticity.
It is important to note that the skin must shrink-wrap to the new contour to achieve smooth results.