Tumescent liposuction. Are there any contradictions with the tumescent fluid and patient taking antidepressants?

Question

Are there any contradictions with the tumescent fluid (lidocaine,epinephrine) and patient taking antidepressants such as remeron 15mg and klonopin 0.5. I am interested in a bbl procedure for self improvement I'm 41 years old and In pretty good health and my depression has been stable for 6 years. I been delaying getting the bbl 360 lipo because I've been afraid of the drug interaction with the mental health medication I'm on... Thanks for insight!

Jason Emer, MD · Answer

tumescent doesnt interfere with medications.

my whole practice is doing lipoabdominoplasty, or at least liposuction with internal heating (which is not the gold standard for skin tightening with body contouring).

the smaller you are before liposuction the more contouring you can get from the procedure. most of my liposuction patients get pre and post surgical optimization with hormonal therapy (see link to help boost their weight loss before surgery and help them heal after).

You need a formal evaluation by an expert in body shaping and contouring to determine what is best.  Traditional liposuction awake and smart liposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radio-frequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well . trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a Brazilian butt lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting.  Dr. Emer.

Connie Hiers, MD, FACS · Answer

As fat s I know, no, your medications should be fine with liposuction. However, please ask your psychiatrist to be certain.

Robert W. DeConti, MD · Answer

There are no contraindications for using tumescent infiltration with liposuction in a person on antidepressants. As long as you are in a good frame of mind, which you say you are you should not be at any increased risks from the solution.
 I hope this helps.Best wishes,Dr. D.

Mats Hagstrom, MD (license on probation) · Answer

Certain medications can compete with the degradation of lidocaine in the liver through something called a P450 enzyme system.  That enzyme can have a bottleneck affect when competing drugs are added giving one, or the other or both drugs and potentially longer half-life.  some plastic surgeons take this into consideration when doing liposuction as an awake procedure when calculating the safe dose of lidocaine to be used.

Other than this potential lengthened half-life of lidocaine because of P4 50 enzyme inhibition I don’t know of any other potential issues.

Many many different types of drugs are broken down through that enzymatic pathway in the liver.

I personally do not differentiate on how much lidocaine I use when doing liposuction as an a week procedure for patients to take medications similar to around.  I routinely use up to 50 mg per kilogram in tumescent solution.

If the procedure is done under general anesthesia and the need for large volumes of lidocaine is a non-issue.

I certainly wouldn’t let that stop you from having a liposuction. Have a few in person consultations to see if you’re a good candidate for the procedure. This really only is the potential issue when the procedure is done as an awake procedure.

Even then this is more theoretical than it is a real problem.  Going up to 50 mg per kilogram of lidocaine even on patients who take antidepressants has never once cost me to have patience report lidocaine toxicity symptoms.  as one of my anesthesiology friends once noted there is a long distance between having the first signs of lidocaine toxicity and having a serious negative outcome.

Best,

Mats Hagstrom MD

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