Non narcotic post op pain magement after BBL?

Question

I want to have a BBL performed without ant post op narcotic pain meds. Is it too painful that I will absolutely need them? Or is there something else that can be effective?

Semih Yildiz, MD, FEBOPRAS · Answer

Narcotics are not always absolutely required after a BBL, but the discomfort can be significant because most of the pain usually comes from the liposuction areas, swelling, and tightness rather than the fat transfer itself. Some patients do well with a planned non-opioid regimen, while others need a small rescue prescription for the first few days.

This is best discussed before surgery with your surgeon and anesthesia team. A multimodal plan may include acetaminophen, an anti-inflammatory if it is safe for you, long-acting local anesthetic, compression guidance, careful positioning, and nausea prevention. Avoiding opioids is a reasonable goal, but it should be paired with a backup plan so pain does not prevent walking, breathing deeply, hydration, and early recovery.

Ryan Rebowe, MD · Answer

Most women will need opioid pain medication for at least the first 72hrs following surgery. However, medications like tramadol, which are opioid like in their action without having the full opioid effect, can be utilized in some patients with a high pain tolerance. It really is up to the comfort of you and your physician. It is worth noting that if you are diligent about not taking opioids unless absolutely needed and discontinue them soon after surgery, your risk for tolerance and addiction is low.

Alan Gonzalez, MD, FACS · Answer

Hello @Tlh1221, thank you for your question. While the amount of pain experienced may differ between individuals, most people will experience some degree of discomfort in the days after their procedure. Fortunately your doctor can provide over-the-counter medications to help manage any associated soreness – such as ibuprofen and naproxen or acetaminophen. Best wishes! Alan Gonzalez. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Daniel Barrett, MD · Answer

Dear Tlh1221,
I understand your concern. It is best that you consult your plastic surgeon regarding post operative care and management (i.e including massage techniques and timing) specific to your case. Your surgeon knows your condition well and has preferences on when and what to use for faster healing and recovery. Post operative care and management depends on the type of surgery performed and the technique used during surgery among other factors.It is best, however, that you follow your plastic surgeon's advice on post operative care management for a smooth and faster healing and recovery.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

It’s possible to recover from a BBL using only ibuprofen. 
It helps if the procedure is done awake.
The reason is this. As an awake procedure ALL areas must be injected with numbing solution which keeps patients comfortable for 12 hrs after surgery. When general anesthesia is used surgeons will still inject numbing solution but they never know if all areas are covered bc pt is under general anesthesia. If awake patients will not tolerate the procedure unless it’s numb.
Immediately after surgery after general anesthesia patients I could become a given narcotic pain medication in the recovery area. that is probably enough to them transition onto ibuprofen the first six hours may be more uncomfortable.
When done as an awake procedure because all areas have to be covered with local anesthesia or be numb or the procedure cannot be performed The initial recovery is less painful.
Typically narcotics will be required during the procedure whether you are awake or under general anesthesia. It’s possible to use only ibuprofen after surgery but you may be sore. 
High doses of ibuprofen have been sufficient for all my patients for the last 10 years. Once a year or so somebody needs something stronger.. 
Personally I do all my procedures with patients awake using local anesthesia with mild sedation. Because of proper use of local anesthesia recovery is not that difficult during the first 12 hours. Recovery from these procedures is mostly tenderness and soreness rather than pain. In other words laying still most patients are reasonably comfortable but it’s uncomfortable to move or perform activities. 
Patient often described as sensation as having severely overdone exercise.
Muscle pain and stiffness that slowly dissipates after three days. Patient will continue to have some soreness for a few weeks but after the third day pain becomes much more tolerable. Avoidance of narcotic pain medication may be necessary for a multitude of reasons and there are many alternative medication that can be considered depending on what the apprehension is based on.
Some providers no longer prescribe narcotics pain after liposuction or fat transfer procedures.
Individuals with a history of issues with my colleagues should communicate openly with all medical providers so everybody’s on the same page. this is especially true for those in recovery.
Sometimes having a consultation with a anesthesiologist prior to surgery can be useful if patients have unusual circumstances like being on buprenorphine.
 Best,
Mats Hagstrom MD

Non narcotic post op pain magement after BBL?

Answers (5)

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