Yes you can, but is this safer or just marketing? Matter of fact, all my breast augmentations I do with tumescent anesthesia just like for liposuction. This makes the postoperative recovery less uncomfortable and makes the surgery bloodless. I also use intravenous sedation administered by an anesthetist for the patient's comfort. Submuscular dissection can be quite uncomfortable under local anesthesia only. You will find that a lot of the non plastic surgeons advocate "awake" breast augmentation and scare the patient that the other methods are unsafe. There's nothing further from the truth in this scare approach. Local becomes unsafe if the surgeon has to inject large quantities of lidocaine just to keep the patient pain free. Also, surgeons who promote "local" anesthesia only, often use an intercostal nerve block (small potential for puncturing the lung) or supplement narcotics into the IV fluids. See a board certified plastic surgeon for a consultation to get the best results.

Breast Augmentation

Dear Jamie,

Thank you for your question. A mommy makeover is a major operation, even though most surgeons including myself, do this as outpatient surgery. It is imperative that your surgeon use an anti- DVT method. It is rare to get a DVT and even more rare to get a pulmonary embolus. I do not use chemoprophylaxis like Lovenox, but use sequential compression garment during surgery and have the patient take the device home for 24 hours. After that, I expect that my patients be up and ambulate every two hours during the day. I've been in practice for over 20 years and I can recall only two patients who experienced a PE. One was overweight and the other one had a normally higher coagulable state. She never had surgery before. Both patients did well and recovered without sequelae. Good luck with your urgery.

Tummy Tuck

Dear Diana,

Liposuction in large BMI patients is rewarding for the patient and can improve their self image. There's a limit how much fat can be removed safely in a clinic setting. The American Society of Plastic Surgeons set a safe limit to be about 5,000cc (about 6 quarts) in one surgery. You might need further surgery to improve your results. If you are healthy, otherwise, it is best to make an in person consultation with a board certified plastic surgeon experienced in large volume liposuction.

Tummy Tuck

Traditional liposuction is tumescent liposuction which is still the most common technique of body contouring. Since the introduction of liposuction in this country over 30 years ago, there were a lot of changes in technique. This involved using smaller canulae for the fat extraction and introducing the superwet and tumescent techniques. With these improvements, the procedure became practically bloodless, more fat could be removed and better contours could be achieved. Later on, internal and external ultrasounds were introduced to help melt or extract difficult, fibrous fat (usually in men, people who had scarring from previous liposuction). The PAL or power assist system was introduced, and lately lasers were introduced as adjuncts to the "traditional" liposuction. Smart lipo is a laser which helps tighten the skin right after the liposuction. It is very inefficient in removing large fat volumes. Remember, these are tools used by plastic surgeons to improve or deliver the best results. Unfortunately, the Smartlipo laser was acquired by many unqualified surgeons or non surgeons as well, capitalizing on the tremendous marketing success of Cynosure who makes the laser. I had a patient last year who was treated with Smartlipo by a neurologist friend of hers and completely destroyed her lower abdominal wall. I see one Smartlipo complication per month (by the way, I use the VASER, Smartlipo and Ticklle lipo in my practice). Remember, the best tool is between the surgeon's ears. Seek a board certified plastic surgeon who has good judgement and experience in body contouring.

Liposuction

Thank you for your question. It seems that you have a functional problem and a cosmetic imbalance with the nose. Obviously, it is hard for me to analyze your condition without any photographs or a personal consultation. It appears that you need your septum reconstructed to straighten the nose and alter the other nasal cartilages to recontour the nose. With such extensive surgery, my personal preference would be an open septorhinoplasty. Some insurance companies might cover the septal part of the procedure (normally the surgeon has to request preauthorization before he/she can proceed with surgery). This technique allows one to expose the underlying cartilages without deforming them and trim, suture, or graft certain areas to give a long lasting result.

Nose Reshaping