Controlling the amount of plastic surgery bleeding is one of the most critical steps to reduce risk of complications. Aside from the surgeon’s skills and techniques, patient cooperation will also play a crucial role in preventing increased bleeding.
Reducing plastic surgery bleeding is particularly critical in mommy makeover surgeries, body lift after weight loss, and other combo procedures that typically take more than four hours to complete.
Most patients are instructed to avoid or at least cut down on blood thinners for 2-3 weeks prior to surgery. Products with blood thinning properties include aspirin, ibuprofen (and other non-steroidal anti-inflammatory drugs), and anticoagulants (Warfarin). Certain herbal supplements and vitamins such as ginkgo biloba, ginseng, green tea, kava kava, garlic, and vitamin E (in high dose) also have similar effects.
Because the effects of many herbal supplements and remedies are still unknown, discontinuing them at least two weeks before surgery and about a week afterward remains the best course of action.
Smoking can also result in poor healing and increased risk of infection and skin necrosis; hence, all tobacco products are discontinued for a minimum of three weeks prior to surgery.
When doing tummy tuck and mommy makeover surgery, Orange County plastic surgery expert Dr. Tarick Smiley injects epinephrine drug into the surgical site before making incisions. This constricts the blood vessels and so the amount of bleeding is drastically reduced.
To further control the amount of plastic surgery bleeding, the celebrity surgeon uses electrocautery device, which cuts and seals off small blood vessels. This technique not only reduces the amount of bleeding, but also ensures that postop bruising is minimal.
The “before and after” surgery instructions are almost the same: The patient must avoid products with blood thinning properties for 1-2 weeks postop or at least until most of the bruising and swelling have subsided.
Furthermore, the patient must avoid heavy lifting, too much stress (that’s why working part time or telecommuting is preferable in the meantime), and rigorous activities for three to six weeks, depending on the type and extent of surgery.
It is important to note that rushing one’s recovery not just increases the risk of bleeding, but also leads to persistent swelling and bruising, which of course will result in protracted healing.
However, light exercise such as walking (as long as the activity will not result in increased blood pressure and heart rate) is important during the initial healing stage to promote healing. Prolonged bed rest or immobility, meanwhile, must be avoided because of the increased risk of deep vein thrombosis (blood clots), pulmonary embolism, and persistent swelling.
The ideal arm lift techniques will differ from patient to patient, although there are generally agreed upon guidelines known to provide smoother, more natural-looking results. For instance, some doctors almost always incorporate simultaneous liposuction to further contour the upper arm and possibly the armpit area as well.
In essence, arm lift surgery removes the excess skin with an incision that is limited to the armpit fold, or an inner arm scar that extends down to the elbow; the latter is reserved for massive weight loss patients due to the large amounts of their redundant skin.
But to further achieve smoother results, there is also a need to reshape the underlying supportive tissue with internal sutures. This additional step also allows the surgeon to eliminate most of the tension on the skin, thus allowing the scars to heal and fade better.
It is critical to remove most of the superficial tension, which is achieved with proper wound closure techniques, to prevent the scars from spreading and migrating, as suggested by Orange County plastic surgery experts.
A good number of patients also require simultaneous liposuction to further improve their arm contour.
Arm liposuction in general must involve most of its circumference to achieve a smoother, more feminine contour (this is almost an exclusive procedure for women). Nonetheless, there should remain a thin layer of superficial fat (beneath the skin) to prevent deformities and skin irregularities.
Aside from improving the arm circumference, simultaneous liposuction can also improve the appearance of fat pads in front and/or back of the armpit. This “unwanted” fat rolls become prominent with age or after significant weight loss.
It is almost always advisable to use microcannulas, which are narrow flexible tubes that remove the “unwanted” fats, instead of larger cannulas.
Microcannulas provide smoother results because they allow for more accurate fat removal, i.e., they remove fats in smaller bits. Furthermore, they require smaller round incisions (1-1.5 mm) that almost always disappear quickly in light-skinned patients.
It is also critical to move the microcannulas precisely parallel to the skin and in a rather swift manner to prevent removing too much fats and thus leading to “Swiss cheese” skin irregularities.
The right arm lift techniques and the use of ancillary procedures can provide long lasting results provided that the patient maintains a healthy, stable weight.
Tummy tuck swelling comes in various degrees depending on whether the patient has received simultaneous liposuction and muscle repair. Nevertheless, most people can expect noticeable improvement in their abdominal area after 2-3 months when most of the inflammation has subsided.
Tummy tuck swelling is primarily due to the interruption of blood vessels and lymphatic channels that occurs at the time of surgery.
More and prolonged swelling is expected when muscle repair is performed, which has become an integral part of tummy tuck as it “holds” the new contour and minimizes to some extent the impact of unintended pregnancy and weight gain, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.
In addition to the actual swelling in the soft tissue, the postop swelling is also caused by fluid accumulation between the abdominal wall and the skin. For this reason, some surgeons recommend lymphatic drainage massage, which involves gentle pressure techniques to eliminate the waste fluids (seroma and hematoma) from the affected area.
Some doctors allow their patients to start their lymphatic drainage massage one week postop, while others feel that waiting at least 2-3 weeks is more ideal.
Furthermore, the use of medical-grade compression garments is believed to control tummy tuck swelling. Some proponents even suggest wearing them round the clock for the first two weeks postop.
The goal of compression garments is to prevent seromas or fluid accumulations and ultimately encourage the skin to heal smoothly and evenly.
As previously stated, most of the swelling will resolve after 2-3 weeks. But if it remains persistent beyond this period, it might be caused by the unintended separation of the sutures that hold the abdominal muscle in place. To prevent this complication that warrants a revision surgery, Dr. Smiley says he prefers making “individual stitches,” as opposed to “one long running suturing” technique, when performing muscle repair.
With the use of individual permanent stitches, the risk of muscle separation is almost eliminated, explains the celebrity plastic surgeon.
Another possible cause of persistent tummy tuck swelling is the presence of fat, which can be diagnosed on physical examination. Again, this can be avoided with proper surgical execution and possibly the use of simultaneous liposuction, says Dr. Smiley.
Breast implant sizers kit is one of the most effective methods to help patients select the “right” size based on their personal preference, body frame, and chest/breast dimension. Along with good patient-doctor communications, it can further provide results that will satisfy both parties.
Breast implant sizers are cup-like devices filled with soft but solid silicone gel; they are inserted in a bra to help patients during the implant selection process.
Patients are asked to try on different sizers (based on the amount or cubic centimeter), which can be as small as 125 cc or as big as 800 cc. Anecdotal reports show that the most popular size range is 300-500 cc.
Orange County plastic surgery expert Dr. Tarick Smiley says that while breast implant sizers kit can help patients describe their goals, it does not provide 100 percent accuracy since the implant placement, implant profile or forward projection, and chest/breast dimension (which to some extent can change by weight fluctuations) also have their effects.
For instance, a 300 cc high profile implant can appear rounder and fuller than a low profile implant of the same size.
High profile implants offer the most forward projection based on their base diameter, while low profile implants have the least amount of projection, says Dr. Smiley.
When trying on different types of breast implant sizers, most patients are encouraged to bring along their favorite or usual clothing, from casual outfit to cocktail dress.
With breast implant sizers kit, the patients can assess the ideal size range that will fit their body frame, particularly in terms of their weight, height, waist-to-hip ration, chest dimension, shoulder width, and so on. For this reason, petite women who are after the natural look are often encouraged to choose smaller implants, while taller ones with broad shoulders are more suitable for bigger implants.
To further help patients during the implant selection process, some doctors offer 3D imaging technology (e.g., VECTRA), which basically takes 3D photos of the patient, loads these into the system, and allows the surgeons to “morph” the images to reflect the most possible results of a certain implant size.
However, some doctors feel that 3D imaging technology is not as helpful as breast implant sizers kit because the altered image is not really a “photo,” but more like a diagram or “avatar” of the patient’s body.
Poor neck lift results are generally caused by over-resection of skin and/or fat. Hence, the goal is not about removing optimal amounts of tissue, but more importantly, leaving behind enough to ensure that the results look natural and the scar will not spread or migrate.
Leading Orange County plastic surgery expert Dr. Tarick Smiley explains how he prevents poor neck lift results:
- Use the right incision pattern based on the underlying problems and anatomy.
In an attempt to minimize scarring, inexperienced surgeons use shorter or fewer incisions despite the presence of large amounts of hanging skin. It is important to note that for most neck lift patients with loose skin, a small incision behind the ear, specifically within the natural folds of skin, is used.
To further create a smooth and youthful angle between the chin and neck, a small incision is placed underneath the chin.
Interestingly, the use of correct incision pattern based on the underlying anatomies (even though the incisions seem long and extensive) results in favorable scars as they remain hidden within the natural skin folds.
- Over-resection of skin and fat must be avoided at all cost.
Poor neck lift results due to over-correction—i.e., removing too much skin and/or fat—is remarkably difficult to improve with a revision surgery. In fact, the patient might be advised to just wait for the skin to relax and “settle.”
However, qualified surgeons (i.e., they are board certified and are performing facelift and neck lift on a regular basis) know how to avoid the signs of over-corrected neck lift—e.g., skin asymmetries, gaunt appearance, and visible platysma muscle.
Skilled surgeons know that there should be at least 5 mm of fat beneath the skin to prevent surface irregularities and visible platysma muscle; hence, they will avoid over-aggressive liposuction.
- Tighten the weak platysma muscle.
In young people the platysma muscle is tight but with aging it becomes weak and splayed, leading to the appearance of vertical neck bands. This “cosmetic” problem can also be a result of massive weight loss.
To create a smooth, youthful angle between the chin and neck, the platysma muscle needs to be tightened in the midline with the use of internal sutures. This is possible by placing a small incision underneath the chin.
Aside from correct scar placement, proper wound closure will also play a critical role to prevent surgical stigmata. The goal is to eliminate tension on the skin to preclude the scars from migrating or “pulling.”