Why don't all doctors use Exparel for Mommy makeovers?

Question

The three things I looked for when choosing who to have a consult with were the result photos, price, and pain management. I was specifically looking for doctors who offer Exparel but only 1 in my area uses it. Is there a reason more doctors don't offer Exparel?

Richard Baxter, MD · Answer

Exparel has a proven record of success in reducing pain after mommy makeover surgery. My practice participated in some of the original studies, and we found a reduction in pain scores of 50% and an equal reduction in opioid requirements. We now place it using an ultrasound-guided TAP block in all tummy tuck patients and it is well worth the extra cost.

Daniel Barrett, MD · Answer

Dear myguy_shyguy,
there is no reason not to use it as it can significantly lower pain levels in early postoperative protocol. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Emmanuel De La Cruz, MD · Answer

Exparel is a long-acting local anesthetic that slowly releases pain relief medication over an extended period. It's used to manage post-operative pain after various surgeries, including mommy makeovers. However, not all doctors opt to use Exparel for several reasons:

Cost: Exparel can be relatively expensive, which may influence a surgeon's decision, especially if it's not covered by insurance. Some patients may not want to incur additional costs for this medication.

Efficacy and Suitability: While Exparel can provide effective pain relief, it might not be necessary or suitable for every patient or every procedure. Surgeons evaluate each case individually and may choose different pain management techniques based on the patient's needs, the extent of surgery, and other factors.

Other Pain Management Options: There are various pain management techniques available, including oral medications, nerve blocks, and other local anesthetics, which may be equally effective for some patients.

Preference and Experience: Surgeons often have their preferred methods of pain management based on their experience and what has worked well for their patients in the past.

Patient-Specific Considerations: Factors such as allergies, individual reactions, and medical history might make some patients unsuitable candidates for Exparel.

Ultimately, the decision to use Exparel or any specific pain management technique is based on the surgeon's judgment, the patient's needs, and other individual considerations. If you're considering a mommy makeover and are interested in specific pain management options, discussing this with your surgeon during consultations is essential. They can explain the available options and help you understand which approach might be best suited for you.

Casey Anderson, MD, FACS · Answer

There is no standardization for this type of thing. Not all doctors believe exparel works as well as it reports. It is also very expensive. I am happy to offer it to my patients though.

Brian K. Reedy, MD · Answer

Hi & thanks for your question!
Not sure why a surgeon would not offer Exparel. You should check with him or her for the specific reason. Exparel has been a great help to our patients for controlling pain. Best wishes!

William Bruno, MD · Answer

Exparel is a long acting (72 hour) local anesthetic. It’s commonly used in tummy tucks as well as other plastic surgery procedures. I find that the results are inconsistent- which is why I don’t use it routinely with all tummy tucks. Meaning that some patients get very good pain relief with it and others get very little improvement. This is likely related to how each person’s body metabolizes the product. If you are very concerned about pain relief, it is something your surgeon should be able to add quite easily. The added cost is about $300-350. I hope this helps.

Best wishes,
Dr.Bruno

Best wishes,
Dr.Bruno

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Physician practice for certain procedures will vary widely.  That said most physicians would use Exparel if the patient desires it, many patients elect to forego the additional cost of the medication, however.

Robert M. Tornambe, MD · Answer

I appreciate your concerns and completely understand your point of view while searching for the right board-certified plastic surgeon. 
My assumption is many surgeons do not offer Exparel because it is somewhat expensive, and if not administered correctly, does not work very well. I use it for all my breast augmentation and Tummytuck  procedures and it is administered by my anesthetist utilizing ultrasound technique to allow placement in the exact correct position near the nerves so it will be most effective. It provides total anesthesia and numbness to the areas for at least 24 hours, allowing the hardest part of the recovery to proceed without pain.
 Best of luck with your search, but please remember this should not be the only criteria for selection of your surgeon. He or she needs to be board certified by the American Board of Plastic Surgery. Good luck!

Kenneth Hughes, MD · Answer

Pain control is important. I typically use whatever medication a patient has used in the past that has had success. If the patient has never had surgery or never used pain medication, I use oral narcotic meds of varying strengths. I think that many patients require prescription pain medications for the first week or so with the transition to the use of Tylenol for the next week. Every patient is different so do not compare your pain level to that of someone else. The pain can be managed effectively by following up with your PS. I usually do not use Exparel because I feel that the body tells you when there is a problem through pain. I do not want to mask the pain and find out there is an issue later. Most patients do not want to pay the additional $300 for Exparel.

Camille Cash, MD · Answer

Exparel is helpful in managing pain those first few days after surgery.  However its use varies by surgeon's preference.  The extra expense for it is typically covered by the patient, so if you are interested in it as part of your surgery I encourage you to speak with your surgeon.