General anesthesia worries many patients. Many patients come to see me in the office and want only local and NOT general anesthesia when i know that if they are asleep they will have a better result. Many doctors do liposuction “awake” under “local” with no anesthesia.
Lots of smaller operations can effectively be done with just local anesthesia. That is when you are fully awake and i inject local anesthesia into the area being operating on. This is how i do moles, skin tags, laceration repairs on children, smaller lacerations on the hand, face or body. Fast acting local is used called lidocaine with epinephrine. This will last for around 2-4 hours in the area.
Local with sedation is more for larger operations. Many times i can do small liposuction areas with this type of anesthesia. Liposculpture of small areas like the neck or arms can effectively be done this way in the operating room. The patient is still monitored and an RN helps to monitor the patients vitals. We use an IV and give a patient Versed and sometimes Demerol or Fentynl for the pain and relaxation.
Larger operations that i perform like body contouring, tummy tucks, breast augmentations or lifts require full anesthesia. I am fortunate to work in an office with a fully accredited operating room with Board Certified Anesthesiologists. The patients are safely put under anesthesia with state of the art monitors and anesthesiologists.
Facelifts are done using a specialized technique. We use sedation with propofol. Our patients are not intubated and given a lot of narcotics. Just enough to make them comfortable and relaxed so that the surgeon can perform the surgery. It is a technique that has been used for over 15 years at the Lasky Clinic and has been well established and recognized as safe and effective.
If you are a man and have extra tissue in your chest , removing the tissue is the best option if done correctly and by a Board Certified Plastic Surgeon.
Many younger men I see as well as older men have breast tissue. Some have extra skin as well. Medications and genetics and weight gain all contribute to the problem of gynecomastia which is male breast tissue. If you are unable to lose weight and still have tissue in the chest area, you may be a candidate for cosmetic surgery to remove the tissue.
The best option is surgical excision of the tissue with liposuction. The surgeon will make the patient comfortable in the operating room with local or general anesthesia. We infiltrate the area with local anesthesia which helps with bleeding and pain. We then suction the area with small liposuction cannulas. Then a small incision is made at the areola site to go in and remove the tissue directly. Drains are left in and a surgical garment is worn for 1-2 months. If the nipple is hanging then there are times skin needs to be removed to tailor and shape the chest. It all depends on how elastic the skin is and the position of the nipple is.
The surgery lasts 2-3 hours and the recovery is usually around 1-2 weeks. Most patients return to work after a few days.
1. Always go to a Board Certified Plastic Surgeon who has a lot of experience in body contouring.
2. Check his pictures and make sure you see lots of results.
1. Can this be done awake?
While it is nice to be awake with smaller procedures, having sedation or anesthesia is imperative for excision of gynecomastia. Most of my patients want to be comfortable during their surgery and having anesthesia allow less pain and less bleeding. This will also mean less post operative bruising.
2. Will insurance cover the cost?
Unfortunately, most insurance plans have not reimbursed the cost of excision of male gynecomastia. Most of the time they will not cover this as it is deemed cosmetic. You will have to call your insurance company and ask them if this is a covered procedure.
The CPT code is 19300, and the ICD-9 code is 611.1. Your insurance company will ask for these codes.
3. Will I have drains?
Two small drains are required after the surgery. These will be removed 3-5 days post op. They help prevent any retained fluid.
4. Do I really need to wear a compression garment and for how long?
Compression garments are imperative. These help push down on the skin and help you get a more even appearance to the chest wall. Patients will have them on for 3-6 weeks.
5. Can I go home after surgery?
This is an outpatient procedure and you may go home after the surgery. Some of my out of town patients stay at an aftercare facility here in town for one night. Depends on where you live and if someone is watching you the first night. Your post op visit with me will be on post op day one or two.
Do you have questions about removing unwanted fat from your body?
Have you been reading about laser liposculpture?
Today I will be using the latest in laser liposuction technology the SmoothLipo by the company Eleme. This has recently been approved by the FDA for liposuction. This is a laser that uses a unique combination of 980nm and continuous wave output to provide the ability to quickly and safely deliver the energy required to heat the targeted fat to the proper temperature. The results are consistent and repeatable and is said to provide optimal skin tightening. SmoothLipo target localized fat deposits using a carefully selected 980nm wavelength. The 980nm absorption profile allows for faster more homogenous heating of targeted areas producing a more uniform result. Continuous wave laser energy uniformly raises the temperature of the treatment area to 45-55 degress C, high enough to cause irreversible thermal death to the fat cells. This process is efficient and effective and continues well after the aspiration.
I will be making a video blog for my patients to see this laser liposculpture in action. I feel there may be some advantages to this new technology but patients need to realize that the results of surgery depend on the surgeon NOT a machine. Going to a Board Certified Plastic Surgeon is the best way to ensure that you will have an optimal result. You are paying for the surgeon’s skill and experience…. not a machine to give you the best results.