Are there any PS who will use Exparal and the no-drains technique for a TT?

Doctor Answers 9

Exparel and No Drain Technique for Tummy Tuck

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It is possible to have a tummy tuck or #abdominoplasty without #drains. The #drainage tubes applied during traditional tummy tucks are also used by trained Plastic Surgeons for various operations. The purpose is to drain extra fluid that may otherwise accumulate under the skin, fat or muscle following surgery.  Patients generally find this annoying and uncomfortable and they can impede mobility and therefore slow aspects of #healing. Over the years, surgeons have improved procedures and found ways to eliminate the need for these #drains in a variety of operations; including #tummy #tuck or #abdominoplasty.

In recent years , Exparel , was developed to control #pain.  This is a long acting injectiable medication, (ex. bupivicaine, Marcaine) formulated to last for about three days. This is injected all along the muscle and skin to provide pain relief following the procedure. The healing is not completely pain free but there is definitely much “less-pain” than without the Exparel.

I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty.  I may use drains on a case by case basis for these patients. Also, a newer option now can include the use of tissue #glue to adhere the abdominal #skin to the #muscle; eliminating any space that previously required a drain.

If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate. Your board-certified plastic surgeon will recommend the type best suited for you during a one-on-one in-person consultation. Also, another element to a satisfying result of your procedures are realistic #expectations.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Tubeless Tummy Tuck in Seattle!!

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Yes, we call it a "Tubeless Tummy Tuck", since there are no drains or pain pump tubes used!  Patients do extremely well and recover much more quickly than when we used drains and a pain pump (total of 4 tubes).  There is a faster recovery, and much less anxiety for the patient and their caregivers.  Patients now come in at one week post-op all dressed up with makeup on and appearing well.  In the past, they often came to the office at a week out in their pajamas with a cold compress on their foreheads, appearing quite ill. 

Our complication rate is much lower with this technique and the Exparel seems to work better than the pain pump, probably because of better distribution of the numbing medicine throughout the abdominal wall, instead of being limited to just along the course of the pain pump catheters.  Less post-op pain means less need for narcotics, thus we see less nausea, vomiting and constipation.

When combined with our "No Nausea Protocol" and "Pain Control Protocol", patients seem to do better than they ever did in the past.

Are there any Plastic Surgeon who will use Exparel and the no drain technique for a Tummy Tuck?

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Tummy tucks
have dramatically changed for the better over the past few years. The two reasons that tummy tucks have become easier for patients are one Exparel (a long acting local anesthetic) and the no drain technique called progressive tension sutures. The combination of these to advance have made the recover for patients much easier as they have less pain and it is easier for them to move around after surgery.
The exparel in my patients has created an enhanced experience for several reasons. One I typically do not use any drains with my tummy tuck so with the use of the exparel I don’t have any standard drainage
tubes or the tubes connected to the pain pumps for the patients to deal with after surgery. The second reason is that with exparel is injected at the time of surgery, so there is no concern of the pain pump tubing be removed prematurely, kinking or having any type of problems. Thirdly and most importantly the exparel can be injected directly to the areas where you plastic surgeon wants it. It can be injected along the muscles that are tightened, any areas that liposuction was performed and along your incision.
I rarely ever use drains in my tummy tuck patients as the progressive tension suture technique has eliminated the need for drains.  With this new technique I place sutures on the inside that help eliminate any space for fluid to collect after your tummy tuck. Without a large space for fluid to collect the body can absorb the fluid, as it would normally do on a daily basis. Thus tummy tuck patients can avoid the need for drains with their procedure. The combination of the exparel and no drain technique has made a dramatic difference in the
recovery of patients after their tummy tuck. Please discuss your tummy tuck options with your board certified plastic surgeon.

Tummy Tuck without Drains and Exparel

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Excellent question. This technique does not require the use of drains and by utilizing a long acting local anesthetic (Exparel) it is possible to achieve excellent pain control for 3-4 days without the need for excessive use of narcotics.

 Here in Nashville, I've been using this technique for about 5 years now with excellent results. Using a series of stitches to suture the tummy tuck flap back onto the muscles of the stomach wall, closes off the space where fluid could accumulate and thereby avoids the need for drains which would usually remove this fluid accumulation. Although not every patient is a good candidate for this technique and good judgement needs to be used in determining on whom to do this, I have found that the majority of patients wanting a tummy tuck can benefit from this technique.

Even though I have always used a long acting local anesthetic to help our patients with post surgical discomfort, Exparel has extended the duration of  pain relief by several days - in most cases past the point where narcotic based pain medications would be needed. the tremendous benefit here is two-fold. First pain is suppressed continuously for several days. No up and down in pain levels as with taking pills. Secondly because patients are not taking systemic narcotic pain pills, there is not the groggy, nauseated and overall "wiped out" feeling that many people get while taking narcotic based pain medications. Overall a win-win situation.

I have been very pleased with the results of these improvements over traditional tummy tucks.

Alexander G. Nein, MD, MS, FACS
Nashville Plastic Surgeon

Are there any PS who will use Exparal and the no-drains technique for a TT?

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I have been doing this for years for over 300 patients and have published papers on it. See link below for details. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Are there any surgeons who will......

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Your question is a classic example of something that can be a big problem to patients in the age of the Internet. While it's great to have all this information available for patients, too much information to an untrained person can actually be confusing and lead to perceptions that are not completey factual. If I were to read on the Internet that one type of brain surgery is better than another, based on what I know about surgery,  I can assure you I woukd not try to find the brain surgeon to fit the procedure. I would find the best brain surgeon I could and let him do what he does best. As plastic surgeons we now more often  see patients who after reading for a few weeks think that they somehow know better than most of the surgeons and so they choose a procedure and then try to fit a surgeon to the procedure. This is completely backwards and almost as bad as shopping surgeons for the cheapest price. Neither of those are in the patient's best interest.
Your final goal should be 1.Safety, 2. Great results, 3. Rapid recovery, 4. Being treated with outstanding patient care. While all 4 are absolutely necessary, if you take #3 and make it the holy grail and seek the surgeon secondarily you might miss out on the others as I am sure somene will "do it your way" just to get the case. 
I assure you that if you choose your surgeon well making that your priority, you will have all 4 of the goals above and you will be glad you picked a surgeon first rather than a procedure. 
And in regards to exparel and the "no drain technique" I once had a mentor in plastic surgery tell me , "if you invent something and no one else uses it very much, then it wasn't all that great ."  
I hope you understand my honesty is in your best interest and not intended to be critical as I am sure you have put a lot of time and effort into this. However , I hope this post will not only help you, but also others who may come across it. 
I wish you all the best. 

Grady B. Core, MD
Birmingham Plastic Surgeon
4.6 out of 5 stars 13 reviews

No drain tummy tuck with exparel

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Thank you for your question. I routinely use Exparel in my lateral tension abdominoplasty tummy tuck procedures. And selected patients may benefit from not having drains, in which I would recommend and not use drains with quilting sutures. I have found that it prolongs the swelling and recovery of some patients however, that's why I don't routinely recommend this technique for all patients. You would need to have a consultation for precise  you would need to have a consultation for recommendations. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

No-drains technique for a TT.

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We have performed tummy tuck without drains for 10 years now, and published peer reviewed papers have shown the techniques work. It is not really fad at all. In your search you are sure to find a surgeon who has adopted the method you are looking for.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

What technique is best for your Tummy Tuck?

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There is a significant amount of expertise and technique that goes into getting a great result with a tummy tuck.  What is more important- the latest fad in technique or the end result?  A qualified board certified plastic surgeon will want you to have the best result in the safest fashion possible.  If it requires drains or a specific medication it is important to discuss these trade-offs.  It is also important to recognize that not all trendy techniques may provide any more benefit than years of experience and great outcomes from a seasoned plastic surgeon who stands behind their work.  

The data on Exparal that claims it can provide up to 72 hours is misleading and is very weak regarding any true benefit beyond 12 hours.  I see many patients who obtain better pain control with oral medication than one intraoperative dose of Exparal which is quite expensive at about $275 for one dose which I'm sure is passed along to the patient.   

No drain tummy tuck technique is a different story altogether though.  There is significant data with over 30 years of experience that shows many patients can benefit from tummy tuck without the need for drains.  Not all patients are the same and not all techniques for tummy tuck are the same and you should discuss this with your surgeon during your consultation.  It is best to bring all your questions to the attention of your surgeon and to see their before and after results and make a judgement on the results, experience and rapport rather than just the specific techniques.  Best of luck!

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 33 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.