My BBL journey AFTER Butt Injections! Its happening!
Ok, so I am the fool that fell for the OKEY DOKE!...
Curious to know if you ladies with previous injections are telling the doctors prior to surgery??
Dr. Yily De Santos
I haven't decided who I am going to as of yet but I certainly appreciate them responding and providing very thorough information regarding pricing as well as instructions!
I have attached screenshots of the email...
Happy Mothers Day ladies And God Bless!!
I may have found "THE ONE"... Dr. Zayas, Could it be you???
Research Research Research!!
https://appsmqa.doh.state.fl.us/MQASearchServices/Home (copy and paste link in url)
The reason it is important for me to have surgery done by a board certified plastic surgeon is (1) due to my situation with the silicone (my buttocks is not a simple bbl procedure it is reconstruction) and (2) largely due to the required additional training they must undergo.
Just FYI members of The American Society of Plastic Surgeons (ASPS) are Plastic Surgery trained and ABMS Board certified Plastic surgeons
In order to be approved for and certified with the above credentials the doctors must……..
Thoroughly trained in plastic surgery within an ACGME approved Plastic Surgery program (the doctor is not trained in another medical field then assert they have expertise in plastic surgery)
Pass and become certified by The American Board of Plastic Surgery (The American Board of Medical Examiners (ABMS) is the only board authorized to certify surgeons in Plastic Surgery of the Face and Body)
Every 10 years the doctor must pass examination in plastic surgery to continue being certified.
Board Membership in the American Society of Plastic Surgery is based on recommendation only and must pass a thorough background examination.
The doctor is to abide by the ASPS code of ethics.
The reason this is so important to me is because a lot of doctors such as dermatologist, internists, dentist etc who were not trained to perform only plastic surgery, have decided they should practice plastic surgery because the money’s good. Then in exchange for membership fees and dues they get these certificates to make us “the consumer believe that these accolades are recognitions to their “plastic surgery expertise.
Now I don’t know about you, but I understand that there are instances where experience may trump education and vise versa however, I just want my doctor to be as honest with me as I am with them!
Also, I am not judging anyone who decides to use someone who may not be certified, that is your business and you must do what works for you!
List of Doctors that I have identified as working on people w/injections
Dr. Yily De Santos, Dominican Republic (does not remove)
Dr. Cesar Velilla, MD Miramar, FL (removes)
Dr. Jose Zayas, MD Miramar, FL (removes)
Dr. Raffy Karamanoukian Santa Monica, Ca (removes)
Dr. Pat Pazmino, MD Miami, FL ( I believe so but has never responded to my consult interest)
Dr. Carlos Alberto Rios Garcia Columbia (removes)
Dr. Kenneth B. Hughes, MD Los Angeles (removes)
Dr. Samir Shureih, MD Baltimore, MD ( I believe so but has never replied to consult interest)
Dr. Julian Gordon, MD Atlanta, GA (removes)
Dr. Yager Wholistic Dr New York (supposedly assists with detoxing chemicals)
Dr. Ayman Shahine, MD Manhattan NY (removes)
Dr. Norman Schulman Lenox Hill Hospital in NYC, (removes)
Dr. Andrew Jimerson, MD (Dr. Curves) Atlanta, GA (he requires you to sign waiver)
Dr. Moises Salama in Miami, FL
Dr. Kevin Tehrani in Great Neck NY (removes)
Dr. Alberto S. Gallerani, MD Miami, FL(removes)
Dr. Tansar Naveed Mir NY (removes it and may also take insurance)
Dr. Rafael Salas (I believe awaiting, consult recommendations)
I hope this helps ladies I'll add more as I find out more....
https://asmbs.org/patients/bmi-calculator (copy and paste link in url)
Soooo here's some photos!
DR CLAP BACK!! LOL
Paying For Surgery
With that being said I am paying for my surgery via carecredit (once I decide to have the surgery lol). But during my research I have found some options that may be helpful depending on your credit situation.
Again, I have not personally used any of these people, however I do a little something about credit so if you have any "credit questions" please feel free to ask or send a pm.
Healthcare financing Options
Cosmetica Plastic Surgery financing http://www.cosmeticapaymentplus.com
Care Credit financing http://www.carecredit.com/apply/
United Medical Credit https://www.unitedmedicalcredit.com/start-an-application/
American Benefit Credit http://www.abfcredit.com
My Medical Loan http://www.mymedicalloan.com/loan-application.cfm?AID=18
Cosmetic Surgery Financing http://www.cosmeticsurgeryfinancing.com/#!apply-for-financing/galleryPage (aka Lending USA)
Medical Loan Finance https://www.medloanfinance.com/creditapp.asp
CosmiCredit http://www.cosmeticredit.com/applynow.html (aka Lending USA)
Prosper Healthcare Lending http://www.prosperhealthcare.com/patients/
Alpaeon Credit https://d.comenity.net/alphaeoncosmetic/public/apply/ApplyIntro.xhtml
This list is not all inclusive just some options I came across. By the way, please do not murder your credit score by trying to "get approved" and fill out all of these hoping to get financed...it will bring your credit score DOWN and the lower the credit score the lesser the chance of you getting approved.
My RANT! I know some feathers may get ruffled but the truth hurts...
Thank You Dr. Eppley for the good read on Silicone Injection Treatment!!
The desire for a larger and more shapely buttocks has led to a surge in the number of buttock augmentation procedures performed today. While fat injections and implants make up the legitimate surgical methods to increase buttock size, there is a significant black market industry of buttock augmentation by a variety of unapproved injectable filler materials. The most commonly uses of these materials is silicone oil of various grades…none of them approved for human use for buttock augmentation.
Injecting silicone oils into subcutaneous tissues is known to potentially cause adverse tissue reactions and problems. These can include hard lumps, cellulitis and abscesses, pigmentation changes in the overlying skin and chronic pain. As a result the black market buttock injection industry has created numerous patients with chronic buttock problems….known as gluteal silicone toxicosis. This can be a very difficult problem to treat since removing the silicone material dispersed throughout the buttocks is impossible without wide excision and major buttock deformity.
In the March 2014 issue of Aesthetic Plastic Surgery, an article addressing the treatment of gluteal toxicosis appeared entitled ‘ Liposuction and Lipofilling for Treatment of Symptomatic Silicone Toxicosis of the Gluteal Region’. In this paper, liposuction was evaluated as a treatment method for this problem to maintain good buttock aesthetics and to limit the risk of complications. Eight patients (seven women and one man with an average age of 36 years old) ) were treated with combined liposuction and fat injections over a three year period. After one year after surgery, the patient’s pain levels were completely eliminated. No patients experienced any further infections or required ER visits or need for hospitalizations.
This study series support that liposuction with immediate fat transfer is a safe treatment that preserves aesthetic appearance and reduces or eliminates pain for patients with gluteal silicone toxicosis. While the liposuction extraction undoubtably does not remove all of the silicone material, it does break up the scar tissue and painful lumps of silicone and fibrosis. It then replaced this with new fat that is interspersed amongst the broken up tissue areas, creating more healthy tissue areas.
One approach that this study did not evaluate and can be considered for treating silicone buttock injection complications is what role does the liposuction play in its treatment. Since it can not remove all of the silicone and may only remove just a fraction of it, its purpose may be nothing more than to break up the scar tissue and granulomas and provide space for the injected fat. Thus, using the liposuction instruments for tunneling and not necessarily extraction may be just as effective and could result in a greater buttock size than before the treatment.
Eppley, B., Dr. (2014, April 13). Silicone buttock injections Archives - Explore Plastic Surgery - Dr. Barry Eppley. Retrieved May 24, 2016, from http://exploreplasticsurgery.com/tag/silicone-buttock-injections/
My Visit to Masri Cosmetics
If you're wondering why I went to someone here in Michigan it's for a few reasons...
1. I want to be evaluated by a board certified plastic surgeon so that I can get an in person opinion. The doctor will be able to touch and feel which is something that obviously a virtual consult cannot achieve.
2. I want to establish a relationship with a PS here so that in the even a complication should arise regardless of whether I went to him or not I'll be able to pick his brain!
3. I would love to be able to get this procedure done at home if the PS meets my many requirements and if not then I've lost nothing I'll still move forward as planned.
Everythingspeachybaby had this plastic surgery simulator and I've been playing around with it AND BABY IVE TAKEN MY SHAPE HERE THERE N EVERYWHERE ON THIS APP! It's kinda cool too!
Certified Plastic Surgeon aren't any better I see!
Well I've moved forward and narrowed it down
No Malpractice Insurance?? WTH
I am always conflicted when I post adverse information about doctors because I don't want to paint anyone in a negative light but on the other hand I want to share what I learn with all of you so please decide for yourselves and make your best decision about how to use the information provided.
So as I was background checking one of the doctors I have a consultation with tomorrow guess adn I learned... He has a couple violations anddddd the one thats important to me is the one about the woman who he performed lipo on and she experienced loss of consciousness but thats not it, while he was performing her surgery she wasn't connected to any monitors (reported by the paramedics) andddd he didn't follow up with her! Im irritated okay! But wait theres more so I told you all I was considering Salama, but guess what there's a review (its negative) on salama and she mentioned him not having any malpractice insurance, well its true he doesn't by why not though? Ughh
Here are reviews that have gotten lost in translation, somehow I didn't see this before and she was burned so badly she needed a skin graft ....
erTHIS is A Nightmare https://www.realself.com/user/237114
RochellN34 has a bad experience: https://www.realself.com/user/2518708
Now look this is not intended to be a deterrent just useful information because this hasn't changed my mind about him, it just allows me to make an educated decision about my potential doctor. I also get to address these concerns with him. I want him to be aware that I KNOW these things have happened under his care and should I decide to use him, I will tell him to use the same care on me that he would use on his sister or daughter (of applicable).
Consultation w/ Dr. Elhorr
Almost five minutes after she left Dr. Elhorr came in, introduced himself, he's an older gentleman, he eyes makes him look extremely younger than his build suggests. His hair is longer than it was in the photos on his website and he wore a scrub shirt with jeans and casual leather loafers with only added to his down to earth demeanor. After we got the pleasantries out the way he immediately asked about the silicone injections once we got over that, we talked about the actual procedure. Note: he's concerned about possible infection upon doing the fat transfer so he will do it in two procedures, the first is lipo of the full back, then he will add that to the butt and after one month I'll return to have my mid section done and the fat added again.
I am seriously considering him for the above reasons alone. I think that a two part session health wise is a good look not to mention result wise. My Quote is $5,750.00 for Liposuction of full back including flanks and Smart Lipo of the front upper and lower abdomen and BBL. There was $125.00 consultation fee which is added to your balance. I haven't signed on the dotted line but again I am considering it.
THESE SNATCHED TUMMY'S AND BUBBLE BOOTIES GOT ME LIKE..... YASSSSSS!
My interesting day @ the Doctor and Info to understand your blood work.
So Lets move along to my bloodwork ....
1. Vitamin D was @8 and it needs to be @ 29 and above. They prescribed with 50,000IU of vitamin D to take for (1) wk for the next for wks and then it'll taper off to 14,000 per wk.
2. Cholesterol was @210 and it needs to be @199 or below. I need to change my eating habits!
3. Hemoglobin was @ 13 I'd like to see it around 14 so I'll continue taking my vitamins
I'm on Cod liver oil and Blood builder as of last week.
I have to pay close attention to the Differential blood count and Hemoglobin w/ Platelets area of my blood work because her is where this details info related to infections, allergies and viruses. As I mentioned I've had a staph infection (MRSA) before so I need to be especially careful.
MCV was 91.5: measures the average size of the red blood cells. Optimal Range: 81.0-101.0 fl
MCH was 30.3: reflects the average weight of hemoglobin found in the red blood cell......
Optimal Range: 27.9-33.3 PG
MCHC was 33.1: reflects the average amount of hemoglobin in the red blood cell.
Optimal Range: 31.9-35.9 g/dL
RDW was 13.3: which reflects the distribution of the size of the red blood cell population.
Optimal Range: 10.5-14.5%
MPV 8.8: reflects the average volume of platelets. Optimal Range: 5.7-11.7 fl
Platelets 231: Platelets help stop bleeding after an injury by gathering around the injury site, plugging the hole in the bleeding vessel and helping the blood to clot more quickly. optimal range:140-410
Differential Blood Count
There are five different types of white cells that make up the differential blood count. White blood cells (leukocytes) come in several shapes and sizes and can be identified by the laboratory instrument known as a hematology analyzer, or under a microscope.
Neurtrophils 41.4 Optimal Range: 41.4-74.4%
A high neutrophil count may be seen in infections, some cancers, arthritis, and sometimes when the body is under stress (for example after surgery, trauma, or a heart attack). A decreased neurtrophil may indicate liver damage, viral infections, lupus, drug reactions, anaphylactic shock, enlarged spleen, and damage to bone marrow.
Lymphocytes 47.7: Optimal Range: 24.0-44.0% function primarily to produce antibodies associated with immunity. An increased number of lymphocytes may be produced with a viral infection, bacterial infections, acute stress, chronic inflammatory disorders, and leukemia’s. A decreased number of lymphocytes may occur with chemo therapy and HIV.
Monocytes 8.3: Optimal Range: 0.0-10.0%
High levels of monocytes may indicate chronic infections, infections within the heart, collagen vascular diseases (lupus, rheumatoid arthritis), and leukemia’s. Low levels of Monocytes may indicate bone marrow damage, or leukemia.
Eosinophils 2.0: Optimal Range: 0.0-4.7%
A high eosinophil count often indicates allergies, skin diseases, drug reactions, inflammatory disorder (celiac disease, inflammatory bowel disease), parasitic infections, and some cancers, lymphomas, and leukemia’s. Low levels of eosinophils are usually not medically significant. Low levels may indicate stress or acute inflammatory states.
Basophils 0.6: Optimal Range: 0.0-1.6%
A high basophil may indicate rare allergic reactions, inflammation (rheumatoid arthritis, ulcerative colitis), and some leukemia’s. Low levels of basophils are usually not medically significant. Low levels may indicate stress or acute inflammatory states.
White Blood Cell Count (WBC)
White blood count 6.4 Optimal Range: 3.7-10.7 K/mm3
WBC's are your body’s protectors. White blood cells are larger than red blood cells, but there are fewer of them.When you have an infection, an increased number of white blood cells are sent form the bone marrow to attack the bacteria or virus that is causing the infection. An increased number of white blood cells may occur with mild infections, appendicitis, pregnancy, leukemia, hemorrhage, and hemolysis. Strenuous exercise, emotional distress, and anxiety can also cause an increase in WBC. A low white blood cell count makes it harder for your body to fight off an infection. People with a low WBC are more likely to catch colds or other infectious diseases.
Red blood cells are the most common type of cell in the blood. Your body contains millions upon millions of these disc-shaped cells. Red blood cells are continuously produced by the bone marrow in healthy adults. The cells contain hemoglobin, which carries oxygen and carbon dioxide throughout the body.
Red blood Cells 4.28 Optimal Range: 3.95- 5.35 M/mm3
The RBC determines if the number of red blood cells in your body is low (called anemia) or high (called polycythemia). Common causes of an abnormal RBC are iron deficiency anemia due to chronic blood loss (i.e.: menstruation, small amounts of bleeding due to colon cancer), acute blood loss (i.e.: acute bleeding ulcer, trauma), and hereditary disorders (i.e.: sickle cell anemia). Polycythemia is relatively uncommon.
Info obtained from, hopes this helps others understand it certainly helped me. http://www.cchwyo.org/Services/Wellness/Need_Help_Understanding_Your_Results.aspx
FMLA, Vacation or Short term Disability
Understanding Tumescent Liposuction!
METHODS OF LIPOSUCTION
Microcannular tumescent liposuction
The word “tumescent” means swollen and firm.[8,9] This technique involves subcutaneous infiltration of large volumes of crystalloid fluid called Klein’s solution, which contains low concentrations of lignocaine and epinephrine, followed by suction-assisted aspiration of fat by using small aspiration cannulae called microcannuale.
The procedure of microcannular tumescent liposuction consists of two steps:
A. Induction of anaesthesia by tumescent anaesthesia:
Making 4–8 small incisions called adits (1–3 mm in size)
Introduction of a large amount (1–4 L) of Klein’s solution into the fat. Klein’s solution contains lignocaine, epinephrine, and large amounts of saline. The saline balloons the fat tissue, epinephrine causes vasoconstriction, thus, decreasing bleeding, and lignocaine induces local anaesthesia. This procedure usually lasts 45–60 minutes.
Allowing the fluid to percolate uniformly through all layers, a process called detumescence, lasts 30 minutes.
B. Aspiration of fat by microcannular liposuction:
Sucking the fat out through microcannuale which are 1.5–3 mm in diameter. This is a slow process lasting 1–1½ hours.
Leaving the incision wounds of cannulae open to drain out fluid. A small amount of fluid is left back in the tissue and is allowed to drain slowly over two days. This residual fluid provides analgesia in the immediate postoperative period.
Applying compression bandages and sending the patient home without any hospital admission.
The procedure has the advantages of safety, lack of need for hospital admission, and rapid postoperative recovery time. However, the procedure is also slow, taking 3–4 hours to perform and also, the amount of fat that can be extracted is usually limited to about 4–5 litres.
Conventional liposuction using large cannulae under general anaesthesia, largely practised by plastic surgeons, is performed as follows:
General anaesthesia is used.
Introduction of a small amount of fluid into the fat.
Making large incisions (1–1.5 cm) to introduce cannulae.
Sucking out large amounts of fat, often 8–10 litres (called megaliposuctions), quickly in 1–2 h, through large cannulae (6 mm-1 cm in diameter).
Suturing the incision wounds of cannulae.
The whole procedure lasts 2–3 hours. Thus, this method is quick, can remove large amounts of fat, and saves time for the surgeon. However, it has the following disadvantages:
As the method is under general anaesthesia, the patient has to be hospitalized, which adds significantly to the cost and the possibility of hospital-acquired infections.
General anaesthesia always has its risks.
The use of large cannulae causes greater damage to tissue and hence, increases the bleeding. This technique is associated with significant blood loss,[10,11] often needing blood transfusions.
There is a risk of side effects such as fat embolism, which can be potentially fatal.
Large cannulae need large incisions which have to be sutured and which heal with significant scars.
Recovery time is slow, as after any procedure under general anaesthesia.
Other methods of liposuction
Power-assisted liposuction with a reciprocating cannula is a new technology for liposuction and has some advantages. In powered liposuction, the reciprocating motion of the cannulae mimics the to-and-fro action of the surgeon’s cannula movement, decreasing the work of the procedure and is therefore, less tiring for the physician. In addition, it allows the surgeon to remove fat more completely in “tight” areas where forceful cannula movements are difficult because of physical space constraints (e.g., per umbilical and waist areas). While powered liposuction can help to remove fat quickly, it can do so only if large cannulae are used. Usually power-assisted liposuction also needs concomitant IM or IV narcotics and sedatives, as well as sometimes using nitrous oxide. These features therefore, negate the above mentioned advantages of tumescent liposuction (safety because it is done under local anaesthesia, and finesse because of the use of microcannuale).
Ultrasound-assisted liposuction (UAL) was introduced to damage the fat cells and thereby, facilitate the removal of fat. However, the method had significant side effects such as burns of the skin. The damaged fat also lead to small cysts containing fluid called seromas. Ultrasound-assisted liposuction is associated with significant bruising and prolonged postoperative swelling. Most importantly, the ultrasound machines are expensive, increasing the cost of the procedure.
PRINCIPLE OF TUMESCENT ANAESTHESIA
The most important aspect of tumescent liposuction is that a local anaesthetic is used over a wide area to provide anaesthesia and analgesia, using a sufficient quantity of lignocaine far in excess of the conventional dosage. Conventional teaching has widely regarded, without adequate pharmacological proof, that the safe upper limit for lignocaine administration is 6 mg/kg body weight. In a radical departure from this conventionally accepted fact, Klein showed that in tumescent anaesthesia, much higher doses, even up to 45–55 mg/kg weight can safely be administered.[16–20] This is because in tumescent anaesthesia, the rate of absorption of lignocaine is slow, leading to smaller peak values and hence, lesser toxicity. The reasons for the slow absorption of lignocaine are:
Subcutaneous fat has a low volume of blood flow.
Lignocaine is lipophillic and is easily sequestered in fat.
Diluted epinephrine in saline solution ensures vasoconstriction, thus, minimizing systemic absorption and bleeding.
The large volume of tumescent solution itself compresses blood vessels by hydrostatic pressure.
The very low dilution of lignocaine in Klein’s solution does not achieve the gradient required for systemic absorption.
Most of the solution is removed during aspiration, minimizing the duration for absorption.
This slow absorption from subcutaneous fat has been likened to a slow release capsule, with the fat itself acting as the capsule!!
PROCEDURE OF TUMESCENT LIPOSUCTION
Proper patient selection is highly important—the ideal candidates are patients with localized deposits of fat, who are not grossly obese, without significant medical problems, and have realistic expectations.[1,2,5,17,21] Many patients seek consultation in the mistaken assumption that liposuction is a treatment for weight reduction. It should be clarified to them that liposuction is only for improvement of shape and any weight loss (which will be about 4–5 kg) is only incidental. There is no definite age or weight limit for patients to undergo liposuction.
The maximum amount of fat that can be removed safely by tumescent liposuction is probably about 4–5 litres. Generally, it is advisable to avoid the so-called megaliposuctions as they are associated with complications.[1,2] The risk of side effects increases with removal of larger amounts of fat. Different areas such as the abdomen and the thigh or buttock are not generally combined in one session. However, it is possible to treat both buttocks or both thighs in one session. If patient desires more than one area or needs more than 4–5 litres of fat removal, the procedure may be repeated any time after two weeks.
A thorough medical history with particular reference to history of bleeding diathesis, emboli, thrombophlebitis, infectious diseases, poor wound healing, and diabetes mellitus should be always taken. Patients with a medical history of these conditions need to be examined and cleared by a physician before undergoing liposuction. Liposuction is contraindicated in patients with severe cardiovascular disease, severe coagulation disorders including thrombophilia, and during pregnancy. The patient’s history should also include noting prior abdominal surgeries such as caesarean sections which produce scarring. A detailed drug history is essential. As lignocaine is metabolized by the liver, drugs that compete with it for metabolism by the cytochrome P450 enzyme system or displace lignocaine from plasma proteins can increase lignocaine blood levels and cause lignocaine toxicity.
The physician must perform a detailed physical examination to determine that the areas of planned for surgery are amenable to liposuction. In particular, any evidence of keloids, scars, or hernia should be looked into.
Counseling should include:
Discussion on different management options, including the role of diet and exercise.
Detailed explanation about the surgical procedure, including possible postoperative complications.
Specific instructions that full results would be seen after 6–12 weeks.
Instruction that although the fat removed by liposuction does not normally come back, there may be recurrence of the problem if the patient puts on excessive weight. The importance of continued exercise and diet regulation should be stressed.
Any allergies or medical condition that the patient may have should be recorded.
As in any cosmetic procedure, the patient should not expect to achieve perfection.
Patients should be told not to expect to lose any dramatic amount of weight loss with liposuction. Weight lost is equal only to the amount of fat removed, about 3–5 kg.
Patients should also understand that liposuction does not improve cellulite or the striae. Patients can also be assured that there is no likelihood of loose skin hanging in the operative area due to the elasticity of skin. Abdominoplasty is usually not necessary for abdominal contouring but is only necessary if a large amount of excess skin or muscle laxity is present.[22,23] The recent introduction of skin tightening machines has also helped in the management of any mild laxity.
These are routine and include:
Routine blood investigations such as blood counts, bleeding and clotting time, prothrombin time, blood sugar, liver function tests, HbS Ag, HIV-ELISA, and ECG.
Advice to stop smoking and oral NSAIDs as smoking increases intraoperative bleeding.
Preoperative tranquillizers such as diazepam or lorazepam on the night before surgery to relieve any anxiety.
Injection Vitamin K to minimize postoperative bruising.
On arrival on the day of the surgery, patients are administered preoperative antibiotics such as cephalexin, and a tranquillizer such as oral lorazepam 1 mg. Oral Clonidine 0.1 mg is also administered to prevent epinephrine-induced tachycardia and as an adjuvant anxiolytic drug. The area for liposuction is topographically marked with marker ink to delineate the bulges and asymmetry [Figure 2]. Preoperative photography is vital.
Baseline vital signs including blood pressure and heart rate, are to be recorded preoperatively and monitored intraoperatively. Pulse oximeter monitoring is essential. Medical personnel trained in resuscitation, preferably an anaesthetist, should be available on the premises.
This is a very important and vital step. Proper tumescence will ensure painless and smooth aspiration.
Adits are small holes made for insertion of infiltration cannulae. These are done with 1.5–2 mm dermal punches in different locations of the area under infiltration anaesthesia with 1 mL of 2% lignocaine. The number of adits needed depends on the area involved. About 6–8 adits are normally needed for the abdomen.
Tumescent fluid is prepared as follows: The usual tumescent solution concentration used is 0.05–0.1% lignocaine and the concentration of epinephrine is at 1:1,000,000–1.5:1,000,000. As the lignocaine solution is acidic, 10 meq of sodium bicarbonate solution is added to one litre of tumescent solution to raise its pH and to prevent stinging. The acceptable maximum dose of lignocaine is 55 mg/kg for most patients, although we have used dosages up to 57 mg/kg in our patients. If higher concentrations are needed, small amounts of fluid can be reintroduced after partial aspiration to avoid excessive dosing. The recommended concentration of epinephrine in tumescent solutions is 0.25–1.5 mg/L. The total dosage of epinephrine should not exceed 50 µg/kg.
Infiltration of tumescent fluid: The delivery system for tumescent solution consists of infusion bags, infiltration pressure cuffs, an infiltration pump to hasten delivery of the fluid, and infiltration cannulae 0.5–1 mm in size. About 2–3 litres of fluid are infiltrated gradually in different directions, first into deeper layers of fat and then, into the superficial layers. The end point is a firm feel of the skin which makes the skin swollen, and difficult to grasp [Figure 3]. It is important to be slow and to avoid jerky, sudden movements to avoid pain. Normally it takes about 1 to 2 h for proper anesthesia.
Infiltration of tumescent fluid
Detumescence: It is important to wait for about 30 min after tumescence for the infiltration fluid to percolate properly and its full pharmacological effects to take effect. This is indicated by a slight decrease in firmness and the ability to grasp the skin.
The most important aspect of proper aspiration is the slow, repeated, to-and-fro movement of the cannulae.[24,25] The cannulae are of different sizes, varying in diameter from 1 to 2.5 mm. Cannulae larger than 4.5 mm in diameter are not used as they cause more tissue damage and are associated with the risk of embolism and bleeding. A smaller cannula (1 mm) is first used to create tunnels in the fat. Cannulae of gradually increasing diameter are then employed to aspirate fat. Deeper layers of fat are aspirated first and then the superficial layers. The direction of the handles is always parallel to the skin and is never vertical [Figure 4]. The nonoperating hand is used as a guide to push the fat in the direction of aspiration and also, to feel the tip of the cannula to prevent damage to the overlying skin or underlying structures. It is also important to avoid skin trauma at the adit to ensure proper healing of the adits. Care should be exercised to ensure uniform aspiration in all areas and to avoid excessive aspiration from a given area to avoid dimpling and asymmetry. Different areas are aspirated and then compared for symmetry and regularity. One great advantage of tumescent anaesthesia is that because the patient is conscious, (s) he will feel the pain and warn the surgeon if the cannula is moved deep into the muscle or into the surrounding unanaesthetized area. Also, the patient is in a position to sit or stand so that the surgeon can compare the two sides for symmetry. The process of aspiration normally takes between 90 minutes to two hours and about 3–5 litres of fat are aspirated. Blood loss is minimal and does not exceed 30–50 mL if the tumescence is proper [Figure 5]. It is important to keep the patient engaged by having a television or music in the theatre during the entire procedure.
Postoperative dressing and follow-up
Postoperative dressing is a very important step in tumescent liposuction. An important feature of the tumescent procedure is that some amount of the fluid is still left behind at the end of the procedure, which ensures anaesthesia in the immediate postoperative period, minimizing the need for potent oral analgesics. This fluid drains out in 3–5 days to facilitate which the adits are not sutured and are allowed to heal by secondary intention. Tight pressure bandages are essential to ensure proper drainage of the tumescent fluid [Figure 6]. Two layers of pressure dressing (called bimodal compression) are put in place to ensure tight compression in the first two days.[26,27] Dressings are removed on the first postoperative day and the adits are opened again, if necessary, to ensure proper drainage. Improper drainage increases the possibility of panniculitis, secondary infection, and irregularity. Postoperative analgesics and antibiotics are continued. The pressure in the dressing is decreased after three days and continued for a minimum of two weeks. The patient is advised to come for follow-up for daily dressing for three days. It is important to note that while the patient can return to normal sedentary work in 1–2 days, exercise and undue exertion should be avoided for at least ten days
Tumescent anaesthesia is a remarkably safe procedure if all the essential steps are adhered to.[17,28–30] In the author’s experience of nearly 200 cases, side effects have been rare.
Postoperative pain: This is minimal in the first two days because of the persistent anaesthetic fluid in the tissue. Mild oral analgesics such as paracetamol are all that are required. Mild tenderness at the site of adits may be felt over 3–5 days. An antibiotic cream (such as fucidic acid or mupirocin) may be prescribed for application at the sites of the adits.
Postoperative oedema over dependent parts (such as legs and genitals) may occur and is due to the inflammation caused by the aspiration movements. It is minimized by using small cannulae and proper postoperative dressings.
Postoperative syncope is common and is vasovagal in origin due to the sudden release of pressure while removing the tight bandages. It is easily avoided by releasing the bandage in the supine position and asking the patient to get up gradually. Mild tenderness is also expected over the adit sites.
Postoperative ecchymoses may occur which usually disappears spontaneously over a week. This is common in hypertensive patients and hence, proper blood pressure control is essential.
Diffuse tenderness and induration can occur if the drainage is improper.
Panniculitis and fat necrosis are rare, but they may occur in diabetics. Hence, it is important to ensure proper diabetic control.
Postoperative infection is rare if proper aseptic precautions are followed.
Seroma formation: Seromas are cystic swellings which occur due to aggressive superficial fat aspiration. They are more common in ultrasound-assisted aspiration but were seen in only two patients encountered by the author.
Irregularity and asymmetry can occur if the amounts of fat aspirated are different in different areas and if pressure garments are not worn properly. This is common over the chest and upper abdomen. It is also common in men treated for gynaecomastia and in patients in whom large cannulae have been used to remove fat quickly.
Pigmentation is common in Indian patients over the adit scars, although none of our patients experienced any keloids.
SAFETY OF TUMESCENT LIPOSUCTION
Several serious complications have been reported with conventional liposuction done under general anaesthesia. These include pulmonary embolism, excessive blood loss, hemorrhagic necrosis of fat, and even, death.[28,29] These complications have been reported mostly in patients in whom liposuction is combined with other procedures such as abdominoplasty, or more than one area have been treated, and in megaliposuctions.
However, these complications are extremely rare in tumescent liposuction and the safety of tumescent liposuction has been well documented in literature. In our experience of 200 cases, no patient had any serious side effect and all patients recovered without any untoward incident. Extensive reviews have been carried out to establish the safety of the procedure and different parameters such as the amount of fat aspirated, type of anaesthesia, facility for surgery, and speciality of operating surgeon have all been studied in large reviews. It is important to note that while mortality has been reported with conventional liposuction, not a single death has been recorded after tumescent liposuction.[1,2,17,30–32] These studies are discussed in detail below.
In a survey of 9478 liposuction cases performed by dermatologic surgeons, the risk of systemic complication was found to be as low as 0.07%. Five patients had “excessive” intra- or postoperative blood loss, and two patients had infection. There were no reported cases of disseminated intravascular coagulation, fat emboli, perforated viscus, thrombophlebitis, or death. The risk of local complications was also small. Of these, the most common were postoperative contour irregularities (2.1%), hematoma (0.47%), and persistent postoperative oedema (46%). A later (1995), more extensive survey of data on 15,336 patients undergoing tumescent liposuction also did not find any serious complications.
In 1999, a study by Coleman determined whether the specialty of the physician had an effect on the incidence of malpractice claims. The study showed that < 1% of the defendants were dermatologic surgeons, even though dermatologic surgeons performed about 33% of liposuctions in the US. In 2002, in a national survey of over 66,000 liposuction cases performed using the tumescent anesthesia technique, no deaths were reported and the rate of serious adverse events was 0.68 per 1000 cases. A review of the State of Florida adverse event data revealed that there were no tumescent anesthesia-related liposuction deaths. In contrast, there were two deaths related to liposuction under general anaesthesia. Safety of office-based liposuction as opposed to hospital-based liposuction too has been well documented. It was found that hospital-based liposuction had three times the rate of malpractice settlements when compared with office-based liposuction surgery.[35–37]
Thus, these data have conclusively established the safety of this procedure, particularly when performed by dermatologic surgeons and as an office-based surgery. Hence, tumescent liposuction is now regarded as the gold standard method for liposuction.
Tumescent liposuction is a safe and effective procedure when performed in trained hands in a proper setting. Experience and training of surgeon, proper selection of cases, and proper technique in anaesthesia and aspiration are all important to get optimal results. It is important to keep in mind that, as in any cosmetic procedure including liposuction, a final safe and satisfactory result is far more important than quick results.
Venkataram, J. (2008). Tumescent Liposuction: A Review. Journal of Cutaneous and Aesthetic Surgery, 1(2), 49–57. http://doi.org/10.4103/0974-2077.44159
Its happening. I am getting my BBL!
Well well well smdh Ladies I got some tea for ya'll..Im hurt Relieved MAd all at the same damn time
Postponing BBL no longer going to Dr. Elhorr
Dr. E said I understand you wanted to talk with me, I said yes there are photos on fb, he cut me off and said fb always reports his pics because of the before and afters. I told him that wasn't the issue, the problem lies with posting photos as your work when they aren't. He said yes they are and I showed him the 2 pics as well as the doctors, to which he replied oh those aren't mine then states that the rest are. I told him I had another pic which is not his work, and I showed him; he's upset now and the office manager chimes in to say we don't post to fb someone does it for us. I said most doctors don't post to their social sites, however the content being shared is theirs and when I spoke to ya'll on the phone I told you I found you through fb so regardless to whether another person is posting on your behalf you should always be aware of whats going on.
I came in here and gave you my life story because I wanted to be honest with you and allow you to make a medical decision to perform this surgery on me or not. Me on the other hand, that choice was taken from me and I no longer want to proceed with surgery. I have to trust the person working on me and I don't.
He said he was going to call the guy, picked up the phone as if he was going to do it at that moment and then tells me ...well we do many BBLs here and they look beautiful. I will talk to him but we're not going to spend too much more time on this. You either do the procedure or not. You have to feel comfortable and we're not going to force you to work with us if you don't want to thats fine. I knew by their body language at the start of the conversation that I would be getting my money back so I wasn't surprised with their tone. They were patronizing and both were unwilling to take responsibility for what happened. Seriously, she(OM) had this look on her face like who cares, bye!
The photos of course have since been removed from all social media and I will review their service on various sites. I got my deposit back minus consultation fee of course and I will be holding off because I am just drained. I went from sx being scheduled for this upcoming Monday to not have it at all. But honestly, I'm glad, something in my spirit wasn't allowing me to feel rested and secure but I just thought it was jitters HAHAHa...NO it was a deceitful damn doctor!!