How high are the risks associated with liposuction on an area impacted by nerve irritation?

Question

I had coolsculpting to outer thighs in April 2022 and struggled with severe nerve pain for 8 weeks after. Since then, there are fluctuations with nerve irritation causing discomfort and itchiness, but never enough to require medication. The coolsculpting did nothing, so I am exploring liposuction on the same area. All of the surgeons I have spoke to have recommended VASER lipo. (Im BMI 20 with bulges of fat on thighs) How high is the risk of exacerbating the existing nerve issues?

J. Timothy Katzen, MD, FACS · Answer

Hi Jenna. Thank you for your question regarding how high are the risks associated with liposuction on an area impacted by nerve irritation secondary to failed Cool Sculpting. Thank you for your history. There are many reasons why your nerve may be irritated after Cool Sculpting. The nerve may have been damaged from the freezing process, scar tissue may be pressing on the nerve, or scar tissue can be wrapped around the nerve. Many conservative modalities can be used to minimize nerve pain. This includes deep tissue massage, magnetic or radio frequency modulation, electrical stimulation, steroid injection, and injection of 5-FU. If you do not want conservative treatments for your nerve pain, liposuction is an option but is high-risk.  If you still are considering liposuction, I would definitely use the VASER liposuction technique.  The VASER utilizes ultrasonic frequency to break up scar tissue and also melt fat. It is the best machine to treat areas that have been previously treated with liposuction or Cool Sculpting. In my opinion, I think the risk is quite high of exacerbating pre-existing nerve issues. It is highly possible that the VASER could further damage the nerve and make it worse.  Even though the VASER can eliminate fat and scar tissue, the VASER may damage the nerve in the process of scar removal. In my opinion, if you were concerned about nerve injury, I would not have any kind of liposuction, even if its VASER. However, if you are set on liposuction, use the VASER. I hope that I have answered your question regarding the risk associated with VASER liposuction on an area already impacted by nerve damage, secondary to Cool Sculpting.  Good luck.

Emmanuel De La Cruz, MD · Answer

Liposuction, like any surgical procedure, carries certain risks, and these risks may be heightened when the procedure is performed on an area impacted by nerve irritation. Some of the potential risks associated with liposuction in such areas include:

Numbness or altered sensation: Liposuction can sometimes cause temporary or permanent numbness or altered sensation in the treated area. If nerves are already irritated or compromised in that area, there may be an increased risk of nerve damage leading to sensory changes.
Increased pain or discomfort: Nerve irritation can amplify pain or discomfort during the liposuction procedure and during the recovery period. This can make the recovery process more challenging and may require additional pain management strategies.
Delayed healing: Nerve irritation can potentially interfere with the healing process, leading to prolonged recovery times or increased risk of complications such as infection or poor wound healing.
Worsening of nerve symptoms: In some cases, liposuction in areas with pre-existing nerve irritation may exacerbate nerve symptoms, leading to increased pain, tingling, or other sensory disturbances.
To minimize these risks, it's essential to work with a qualified and experienced plastic surgeon who can carefully assess your individual situation and discuss the potential risks and benefits of the procedure. They can also take steps to minimize the risk of nerve damage during the surgery and provide appropriate post-operative care to support healing and minimize complications. Additionally, open communication with your surgeon about any pre-existing nerve issues or concerns is crucial for ensuring the safest possible outcome.

Anuj Purbey, MBBS · Answer

I'm sorry to hear about your experience with CoolSculpting and the subsequent nerve pain. It's understandable that you're cautious about proceeding with another procedure. Here are some points to consider:Consultation with Surgeons: It's positive that you've consulted with surgeons to discuss your concerns. Their recommendations for VASER liposuction might be based on its precision and ability to target specific areas effectively.Risk Assessment: During your consultation, discuss your existing nerve issues in detail with the surgeon. They will assess the potential risk of exacerbating the nerve problems and provide insights into how VASER liposuction may impact your specific situation.Experience of the Surgeon: Choose a board-certified and experienced surgeon, preferably one with a history of successful procedures and a thorough understanding of nerve-related issues. They can tailor the procedure to minimize risks.Alternative Treatments: Explore alternative treatments or non-invasive options that may be suitable for targeting the fat on your thighs without involving surgery. Your surgeon can guide you on the most appropriate approach based on your unique circumstances.Clear Communication: Open communication with your surgeon is crucial. Share any concerns, discomfort levels, or changes in symptoms during the recovery process, allowing for prompt adjustments if needed.Ultimately, the decision to proceed with VASER liposuction should be made collaboratively with your surgeon, taking into account your specific health history and concerns. If you have any reservations, seeking a second opinion can provide additional insights.

Mats Hagstrom, MD (license on probation) · Answer

I suggest you get an assessment and some type of working diagnosis. Do you want to have a better understanding of your current symptoms including if Liposuction could make things worse. What you described is fairly a typical. Patient often had changes in skin sensation after liposuction. Patient often experience partial numbness “ghost itching”. Normal sensations typically return within 2 to 3 months.
I suggest you ask each provider during consultations. Delivering consistent quality liposuction results is more difficult than most people realize. The number of plastic surgeons who truly mastered this procedure are in a small minority. The type of equipment isn’t particularly important in comparison to the scale and experience of the provider. I suggest patients have multiple inperson consultations. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patient with similar body characteristics to your own. And experienced plastic surgeon that should have no difficulty showing you the before and after pictures of at least 50 previous patience. Being shown a handful of preselected images, representing the best results. Other providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they’ve actually performed.
The ability to deliver consistent quality results with the ability of making accurate assessments and having predictable outcomes, consistent with quality before, and after pictures requires years of dedication. Liposuction skills very dramatically from provider to provider. Being board-certified and plastic surgery with years of experience and overall good reputation does not mean somebody has a mastered any one single procedure especially procedures like Liposuction. Patient should be more selective and they think necessary when it comes to choosing providers for permanent your reversible body contouring procedures that can potentially lead people disfigured.
Best,
Mats Hagstrom, MD

How high are the risks associated with liposuction on an area impacted by nerve irritation?

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