Important Info about Tumescent Liposuction

Important Information about Tumescent Liposuction

Risks of Liposuction Surgery:  Any surgery involves the risk of infection, bleeding, scarring or serious injury, however tumescent liposuction has an amazingly good safety record.  One of the reasons that tumescent liposuction is so safe is that neither general anesthesia nor signification IV sedation is required.  A recent survey involving over 15,000 patients who had tumescent liposuction without general anesthesia revealed no serious complications, no serious infection, no hospitalizations, no blood transfusions, and no deaths. The greatest risks of liposuction are those associated with general anesthesia. By eliminating general anesthesia, the risks of liposuction are dramatically reduced.  Patients can minimize the risk of surgical complications by not taking medications or over-the-counter preparations that might adversely affect the surgery. Patients should inform the surgeon of any medications being taken either regularly, or occasionally, including herbal remedies and dietary supplements.

Risk of Irregularities of the Skin:  Tumescent liposuction using microcannulas is the least likely to cause any significant or noticeable post-surgical irregularities of the skin.  By magnifying the fatty compartment, the tumescent technique permits more accurate removal of fat, with greater assurance that the liposuction cannula will not inadvertently approach too near the undersurface of the skin and thereby cause irregularities.  Thus the tumescent technique helps to minimize the risk of post-surgical irregularities or rippling of the skin.  Liposuction might improve pre-existing irregularities of the skin such as dimpling or cellulite, but prospective patients should not assume that there will be significant improvement. It is unrealistic to expect perfectly smooth skin.  Patients should expect that their skin will have approximately the same degree of dimpling and irregularities as existed before tumescent liposuction surgery.  After tumescent liposuction the skin texture should be within normal limits. A casual observer should not notice any evidence of surgical irregularities of the skin. However, it is possible that a noticeable irregularity of skin may result. If an irregularity occurs, it may require a corrective procedure for which there will be a fee to cover the operating room and nursing staff expenses.  Because skin tends to lose some of its elasticity with increasing age and with cumulative sun exposure, older patients might notice some subtle increase fine wrinkles in areas such as the upper abdomen after liposuction.

Risk of Scarring of the Skin:  Incisions for liposuction may result in scarring.  Tiny (1 to 4 millimeter) round holes in the skin, called adits, are used for inserting the cannulas through the skin and into the fat. Typically, when adits heal they become virtually invisible.  Although you may be able to find them upon close examination, most other people would not be able to see them.  Some patients may experience temporary hyper-pigmentation (darkening) that usually fades after several months.  Some patients may have a genetic predisposition for persistent discoloration at incision sites.  Any one who has previously experienced hyper-pigmentation or hypo-pigmentation (pale or light colored scars) of the skin in the past might expect to also experience it with liposuction adits or incisions.  Certain areas of the body, such as the back or upper flanks, may be more likely to have pigmentation changes.

Cellulite:  Liposuction of the thighs, while improving the silhouette, does not necessarily eliminate the subtle “puckering” of the skin often called “cellulite”. Cellulite results from the pull of fibrous tissue that connects skin to underlying muscle.  While tumescent liposuction may reduce the degree of cellulite, it is unlikely to eliminate it. Liposuction should not worsen cellulite.

Smoothness of Results:  Liposuction some produce some irregularities of the skin, which can be visible in certain conditions of lighting.  In general the smoothness of the skin is much improved after microcannular liposuction.  These are usually rather subtle, and imperceptible to the casual observer.  It reasonable to expect significant improvement, but the results are rarely perfect.

Obesity & Liposuction:  Liposuction is not an appropriate treatment for obesity.  Liposuction is not a substitute for a prudent diet, good nutrition, and regular exercise.  Obese patients may be good candidates for limited liposuction if their goal is simply to improve the shape of certain limited areas of the body.  Obesity is associated with an increased risk of surgical complications.

Postoperative Healing:  Normal healing after tumescent liposuction involves a limited but definite degree of soreness, swelling, bruising, itching and lumpy firmness.  A temporary mild numbness, itching or burning of the skin may persist for 2 to 10 months.  Most patients can actually see some improvement of their silhouette with one week after surgery.  However, because of the slow resolution of post-surgical swelling, the ultimate results following liposuction usually require 12 to 20 weeks to be achieved.

Realistic Expectations:  Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection.  It is impossible to guarantee the precise amount of improvement that will result from liposuction.  Patients should not have unrealistic expectations.  Although patients can usually expect to achieve at least a 50% improvement, it is unreasonable to expect 95% improvement or near perfection.  For the perfectionist, or for liposuction of a very large area, maximum improvement may require a second procedure for which there would be an additional fee.

Patients who would be satisfied with a 50% improvement would be reasonably good candidates for liposuction.  The “50% improvement” is intentionally a vague measure.  It indicates a definite perceptible improvement, but something short of perfection.  If a 50% improvement would make a patient happy, then it is likely that these expectations will be met.  Our patients generally achieve more than a 50% improvement.

Longevity of Results:  The fat cells that are removed by liposuction do not grow back.  If the patient later gains or loses weight, the change tends to be distributed proportionately over the entire body.  For the best results the patient’s post-op weight should be less than the pre-op weight.  Although one can expect some changes with aging, provided that the patient does not gain large amounts of weight, the patient’s new more pleasing silhouette is relatively permanent.

What to Expect on the Day of Tumescent Liposuction

Pre-Op Preparations:  In the operating room pre-operative photographs will be taken and then the areas on your body to be treated with liposuction are marked with a permanent marker.  Additional photos of the markings on the body will be taken, and the patient will be asked to initial these photos to confirm agreement with the areas to be treated by liposuction.  This process of preoperative documentation typically requires 45 to 60 minutes before beginning the infiltration of the tumescent local anesthesia.

Local Anesthesia:  Using the smallest needles available, the doctor or the nurse will anesthetize the skin at sites through which the longer needles or cannulas will be inserted to anesthetize the subcutaneous fat.  Patients usually experience a slight pricking sensation as the skin becomes “numb”.  A large volume of dilute tumescent anesthetic solution is carefully and gently injected into the targeted fat.  Once an area has been well infiltrated with the anesthetic solution, the fat is usually completely numb.  The infiltration of the local anesthetic is a slow careful process that can take as long to complete as the liposuction itself.  After the infiltration of the anesthetic is complete, but before beginning liposuction, you will be escorted to the bathroom one more time.

Sedatives:  Experience has shown that giving a sedative by mouth permits better local anesthesia than when intravenous sedatives are used.  This is because an alert patient is more capable of detecting subtle areas of incomplete anesthesia.  A patient who is too sedated might easily ignore an incompletely anesthetized area, and then feel more discomfort later during liposuction.  Therefore avoiding excessive sedation actually maximizes patient comfort during liposuction.

Liposuction is accomplished through tiny (1 to 4 millimeter) round holes in the skin, called adits.  The adits, which are made in the skin with 1 to 4 mm biopsy punches, are so small that they need not be closed with stitches.  After surgery, adits remain open for 2 to 5 days and facilitate the post-operative drainage of residual blood-tinged anesthetic solution.

After Liposuction:  After completing liposuction, absorbent pads are placed over the adits.  Finally, after the Tumescent Liposuction Compression Garments are pulled on, and you are ready to get up and go home.  Because of residual local anesthesia, it is several hours after completing the liposuction before any significant soreness begins.  The tumescent technique minimizes post-operative discomfort.  Because the residual local anesthesia lasts for over 18 to 24 hours, plain Tylenol is usually sufficient to treat post-operative discomfort.  Post-operative nausea is unusual after tumescent liposuction.  When nausea or vomiting does occur it typically happens 6 to 12 hours after surgery after the patient awakens from a nap.  This type of nausea and vomiting usually last for only one to three hours.

Transportation Home after Liposuction:  Patients are not permitted to drive themselves home after liposuction except in the case of an especially small amount of liposuction where the patient has not received sedation.  Although most patients feel well enough to drive a care immediately after surgery, you must not do so because of the large amounts of local anesthesia may cause some drowsiness.  The person who will be driving you home should have a flexible schedule for the afternoon, although patients are typically discharged in the mid to late afternoon, the exact time cannot be precisely predicted.

BEFORE LIPOSUCTION INSTRUCTIONS

Our office wants to provide you with the very best surgical care.  You can help to minimize the risk of complications by carefully reading and following your preoperative and postoperative instructions.  Ask us to clarify any item about which you have questions.

1.       For seven (7) days before surgery do not take ASPRIN (Anacin, or Bufferin, or Baby asprin) or IBUPROFEN (Advil, Mortin, or Nuprin), or NAPROXEN (Aleve) or any other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) that impair platelet function in the normal blood-clotting process.  It is permissible to take an acetaminophen (Tylenol or Anacin-3).  Please see page 7 for a list of common drugs that contain aspirin.

2.       Do not take decongestants such as Sudafed or Actifed for 5 days before surgery.  Do not take appetite suppressants such as phentermine (Fastin) for at least 2 weeks before surgery.  Do not take Zoloft or other antidepressants and all herbal remedies, unless specifically approved by your surgeon, for two (2) weeks before surgery.  Please see page 6 for list of drugs that might have adverse drug interactions with the local anesthetic lidocaine.

3.       Avoiding alcohol.  We suggest no alcohol during the two days before and two days after surgery) alcohol decreases resistance to infection).  Otherwise drinking a small amount of alcohol (for example no more than a glass of wine or beer per day) is permissible during the other days of the week before or after surgery.  Avoid red wine for 4 days before surgery to minimize bruising.

4.       Do Not Drive Home:  Arrange to have someone drive you home after surgery.  It is the patient’s responsibility to make prior arrangements to have a responsible adult to meet and accompany the patient after surgery.

5.       Do not wear unnecessary jewelry, no perfume (deodorant is OK), and minimize use of cosmetics (survival rations only).

6.       Diet before surgery:  You should eat a light, low fat meal, such as toast and juice, fruit, dry cereal and/or non-fat milk no closer than two hours prior to surgery.  Avoid whole milk, cream, butter, cheese and other foods that are high in fat content as dietary fat slows digestion and delays stomach emptying.  Please minimize caffeine the day of surgery.  You will be give a snack as soon as surgery is completed.

7.       Changing your dressing the morning after surgery is easier if you have someone help you. 

8.       Loose Clothing on the day of surgery:  There is usually quite a lot of drainage of slightly blood-tinged anesthetic solution after surgery.  Since this drainage might stain clothing, we suggest that you choose your clothing with this in mind.  Because we will apply elastic support garments on top of some bulky absorbent gauze padding your clothing should be very loose and comfortable.
Women: Wear a comfortable bra that you would not mind getting stained from the blue ink that is used to mark the surgical areas. Do not wear an exercise sports bra if you are having liposuction on your abdomen or torso.
Men: Speedo-type swim trunks are the easiest type of garment to wear into the operating room for surgery.  Jockey-type underpants are acceptable.  Boxer-type underpants are less convenient during the surgery, and may interfere with the surgeon’s liposuction technique.  Bring extra underpants to wear after surgery.

9.       Bring socks to prevent cold toes during surgery.  If you ten to get cold hands, you are welcome to bring clean mittens (no leather gloves) to wear during the surgery.  The operating room is kept relatively warm, about 72 to 75 degrees.

10.    Do not use moisturizers or soap that contains moisturizers for at least a week before surgery.  Tape and EKG electrodes will not adhere or stick well to moisturized skin.  The ink markers used to outline the areas of your body to be treated by liposuction will rub-off too easily if you have recently used a moisturizer.

11.    Towels & Plastic Sheets. Plan ahead and avoid staining the car seat with blood tinged anesthetic solution: Bring a towel, and a plastic sheet (such as a trash can liner) to cover the seat during your ride home.  Prior to surgery pad your bed at home, and your living room chair with towels and plastic.  Some patients have found it comfortable and convenient to place a felt-backed vinyl tablecloth on the bed, with the felt-side up. Be careful to avoid allowing drainage to stain carpets.

12.    Do not fast or undergo dramatic weight loss just prior to surgery.  All patients should be on a stable, healthy, well balanced diet for at least 2 weeks before surgery.  Liquid diets, extreme low calorie diets, and rapid weight loss diets may predispose to cardiac irregularities, surgical complications, poor wound healing.

13.    Music to Relax/DVD to watch: Patients usually enjoy listening to soothing quite music during surgery or watching a movie on our 50 inch plasma T.V.  If you have any favorite CDs/DVDs which you would like to share with use on the day of surgery, you are welcome to bring them with you.  Please label the plastic case that holds you CD so that we will know to whom it belongs.

AFTER LIPOSUCTION INSTRUCTIONS

1.       Going Home: You should not drive yourself home.  It is recommended that a responsible adult be with you on the day of surgery.
Diet: Resume your usual diet immediately.  Drink adequate amounts of water, fruit juices or soft drinks to prevent dehydration.
DO NOT drink alcohol 48 hours before or after surgery.

2.       Activities:  Quiet rest is recommended immediately after surgery.  After surgery do not drive or operate hazardous machinery the rest of the day.  Do not make any important personal decisions for 24 hours after surgery.  Late in the day or evening you are welcome to take a short walk if desired.  The day after liposuction surgery you should feel well enough to drive your car and engage in light to moderate physical activities.  You may carefully resume exercise and vigorous physical activity 2 to 4 days after surgery.  It is suggested that you begin with 25% of your normal work-out and the increase your activity daily as tolerated.  Most people can return to a desk job within one to two days after surgery, although one must expect to be sore and easily fatigued for several days.

3.       Absorbent Pads are placed over the treated areas to absorb the large volume of drainage of blood-tinged anesthetic solution during the first 24 to 48 hours after surgery.  Beginning the next morning after surgery, change the Pads twice daily.  During the first few hours after surgery, if you discover some drainage leaking around the larger Pads, simply apply a small absorbent ABD/Sanitary Pads pad over the area by sliding it under the garment.

4.       Post-Op Elastic Compression Garments.  After tumescent liposuction post-op garments are word in order to: hold the absorbent pads in place, proved compression to minimize bruising, and maximize the drainage of blood-tinged anesthetic solution.  The morning after surgery, when the garments is first removed in order to take a shower, the patient may experience brief dizziness and lightheadedness similar to what one experiences when standing-up too quickly.  It is the result of rapid decompression of the legs after the elastic garments is removed.  If dizziness occurs, sit or lie down until it passes.  Dizziness is reduced by first removing the outer garment and waiting 5 to 10 minutes before removing the second garment.  Beginning the day after surgery, you must remove the post-op Garments twice daily and take a shower.  You may was the garments at these times.  Some body areas require two garments, other areas only one garment plus elastic binders (belts).
These should be worn day and night until all the drainage has completely stopped plus and additional 24 hours.  Do not be concerned if you drain for several days.  Notify us if the drainage persists for more than 8 days.  Discontinuing the use of the garments and binders too soon may result in more prolonged drainage.  Typically, patients will need to wear the garments for a minimum of 3 to 6 days, although many choose to wear the garments longer because of the comfort they provide.  Wearing the post-op garments for a minimal number of days is of no significant advantage in terms of the ultimate cosmetic results.  After liposuction of Chin, Cheek, & Jowls, first a spandex head garment is placed to provide mild compression and to hold the absorptive pads in place; next a 2 inch-wide elastic band is placed under the chin and over the top of the head and worn for one hour giving extra compression to minimize bruising. Drainage lasts 1 to 2 days.

5.       Managing Post-Op Drainage: One should expect a large volume of blood-tinged anesthetic solution to drain from the small incisions during the firs 24 to 48 hours after liposuction.  In general, the more drainage there is, the less bruising and swelling there will be.  During the first 36 hours, you should sit or lie on towels.  When there is a large amount of drainage, it is advisable to place a plastic sheet beneath the towel.  Super-absorbent dressings are worn under the compression garment for at least the first 36 hours.  When drainage has nearly stopped, patients need only place a thin absorbent gauze dressings or small pads on incision sites that continue to drain.

6.       Wound Care & Bathing:  Keep adits (tiny round incision holes) clean.  Shower once or twice daily.  First wash your hands, then wash adits gently with soap and water; afterwards gently pat adits dry with a clean towel.  Apply new absorbent dressings.  Adits that have stopped draining no longer need padding.  Take antibiotics as directed until the prescription is finished.  Take antibiotics with food.  Call our office if you notice signs of infection such as fever, foul smelling drainage, or focal redness, swelling, and pain in a treated area. DO NOT apply ice-packs or a heating pad to the skin of liposuction areas for at least 4 weeks following liposuction. DO NOT apply hydrogen peroxide or plastic Band-Aids to incision sites. DO NOT soak in a bath, Jacuzzi, swimming pool, or ocean for 7 days after surgery.

7.       Common side-effects of tumescent liposuction: Menstrual irregularities with premature or delayed onset of monthly menstruation are a common side effect of any significant surgery.  Flushing of the face, neck and upper chest may occur after liposuction surgery and usually lasts for a day or two.  Slight temperature elevation during the first 48 hours after surgery is a natural consequence of the body’s reaction to surgical trauma.  Discomfort and soreness is worse the second day after surgery, then improves daily.  Two extra-strength Tylenol taken every 4 hours, while awake, for the first 48 hours, will reduce the inflammation, swelling, and soreness associated with surgery.  Do not take aspirin or ibuprofen or medications that contain these drugs, such as Bufferin and Anacin, or Advil or Nuprin for 3 days after surgery; these can promote bleeding.  Bruising is minimal with tumescent liposuction.  Nevertheless, the more extensive the liposuction surgery, the more bruising one can expect.  Pain and swelling due to an inflammatory reaction to surgical trauma may occur and increase 5 to 10 days after surgery; this is treated with antibiotics and anti-inflammatory drugs.  Itching of the treated areas several days after surgery may occur as part of the normal healing process.  To help relieve the itching, you may try taking Benadryl as directed on the packaging.  Be aware that Benadryl causes drowsiness.  Provided all incisions are closed, soaking in an Oatmeal bath preparation may relieve some of the itching. Benadryl and Oatmeal products may be purchased without prescription at most drugstores.

8.       Schedule Follow-up Appointment at our office for approximately 6 to 12 weeks after surgery.  You are welcome to return to our office for follow-up visits at no charge as often as you like.  Please contact us by telephone if you have any urgent questions, (815) 937-4500.

Patient Signature ________________________Staff Signature ______________________Date: ________

Medications and Foods that POTENTIALLY Interact with Tumescent Anesthetic

Consult Dr. Sarat Yalamanchili/Dr. Saroja Yalamanchili if you are taking any of the following:

Anesthetics

                Propofol (Diprovan)

Anti-Arrhithymics

                Mexiletine (Mexitil)

                Propafenone (Rythmol)

                Quinidine (Quinaglute, Quinidex)

Anti-Asthmatics

                Zafirlukast (Accolate)

                Zileuton (Zyflo)

Antibiotics/Anti-Microbials/Anti-Infectives

                Ciprofloxacin (Cipro)

                Clarithromycin (Biaxin)

                Chloramphenicol (Chloromycetin)

                Enoxacin (Penetrex)

                Erythromycin

                Isoniazid

                Norfloxacin (Noroxin)

                Tetracycline

                Telithromycin (Ketek)

                Troleandomycin (Tao)

Anti-Convulsants

                Acetazolamide (Daimox) (also a diuretic)

                Carbamazepine (Tegretol)

                Divalproex (Depakote)

                Stiripeentol

                Valproic acid (Depakene)

Anti-Depressants

                Amitriptyline (Elavil)

                Clomipramine (Anafranil)

                Flouxetine (Prozac)

                Fluvoxamine (Luvox)

                Nefazodone (Serzone)

                Paroxetine (Paxil)

Sertraline (Zoloft)

Anti-Diabetics

Troglitazone (Rezulin)

Anti-Fungal Medications

Fluconazole (Diflucan)

Itraconazole (Sporanox)

Ketoconazole (Nizoral)

Metronidazole (Flagyl)

Miconazole (Monistat)

Anti-Histamines

Astemizole (Hismanol)

Anti-Neoplastics

Tamoxifen (Nolvadex)

Letrozole (Femara)

Anti-Psychotics

                Clozapine (Clozaril)

        Sertiadole

        Pimozide (Orap)  

Anti-Secretory

        Omeprazole (Prilosec)

Benzodiazepines

        Alprazolam (Xanax)

        Flurazepam (Dalmane)

        Midazolam (Versed)

        Triazolam (Halcion)

Beta Blockers

        Propranolol (Inderol)

Calcium Channel Blockers

        Amiodarone (Cardarone)

        Diltiazam (Cardiazam)

        Felodipine (Cardene)

        Nicardipine (Procardia)

        Verapamil (Calan)

Corticosteroids

        Dexmethazone (Decadron)

        Methylprednisolone

Hormones

        Ethinylestradiol (Estinyl Feminone)

        Danozol (Danocrine)

        Thyroxine

H2 Blockers

        Cimetidine (Tagamet)

Immunosuppresants

        Cyclosporine (Neoral, Sandimmune)

Miscellaneous

        Anastrozole (Arimidex)

        (nonsteroidal aromatase inhibitor)

        Caffeine

        Cannabinoids

        Cortisporin (Cortisol)

        Methadone (Narcotic)

        Mibefradil dihydrocholride (Posicor)

        Pentoxifylline (Trental)

        Ramacemide

        Tacrine (Cognex)

 (Reversible cholinesterase)

Protease inhibitors/Antivirals

        Diethyldithiocarbamate (Imuthiol)

        Indinavir (Crixivan)

        Nevirapine (Viramune)

        Nelfinavir (Viracept)

        Ritonavir (Norvir)

        Saquinavir (Invirase)

MAO inhibitors may interact with certain sedatives and are relatively contraindicated.

Information about Prescriptions & Medications

1. Antibiotics, such as cephalexin (Keflex) relatives of penicillin, doxycycline a relative of tetracycline, or Levaquin are to be taken twice daily in order to minimize the risk of a surgical infection.  Antibiotics should be taken with food to reduce the risk of gastric upset.  Please start taking your antibiotic the day before surgery, and continue until the entire supply is completed.  If your surgery is scheduled to begin in the early morning (before 9:00 a.m.), taking your antibiotic and eating should be postponed until after surgery.
2. Lorazepam (Ativan) is a mild sedative, and a mild sleeping pill, that does not make one feel “drugged”.  Surgery is more easily tolerated if the patient is well rested and relaxed.  We suggest that you take one lorazepam (1 mg) the night before surgery.
3. Mephytone (Vitamin K) will theoretically minimize bleeding and postoperative bruising.  Although it is not essential to take vitamin K, we do recommend it.  Take one 5 mg tablet daily, beginning two weeks before the surgery.
4. Acetaminophen (Tylenol Extra Strength), 500 mg capsules or tablets, does not require a prescription.  Taking two tablets, three to four times daily, beginning after surgery, should help minimize postoperative swelling.  To treat any minor pains before surgery take 2 Extra Strength Tylenol (500 mg), as needed.  If Tylenol is not acceptable, notify us so that we can arrange a suitable substitute.
5. Diphenhydramine (Benadryl) 25 mg capsules or tablets, doe not require a prescription.  Taking as directed can help to reduce postoperative itching.  Be aware that Benadryl may cause drowsiness.

Medication Precautions for Surgery Patients

1. Do Not Take ASPIRIN (Anacin, or Bufferin or IBUPROFEN (Advil, Motrin, or Nuprin), or NAPROXEN (Aleve), or any medications that contain these drugs or any similar anti-inflammatory medications, for seven (7) days before and 3 days after surgery.  These drugs will promote bleeding and bruising.  Check the labels of all your medications, even those which you purchase without a doctor’s prescription, to be sure you are not taking any aspirin or aspirin-like substances.  Remove any products containing aspirin from your medicine chest so that you do not inadvertently take it during the week before surgery.  Consult your physician before you stop taking any prescribed medicines.  Please inform us if you are taking any medications to treat arthritis, or any blood-thinning anti-coagulant medications.  Below is a list of medications that must be stopped sever (7) days before surgery.

Advil                      Bufferin                             Doan’s Pills                   Haltran                      Nalfon                       Rexolate                    Trental

Aleve                      Butazolidin                       Dolobid                          Halfprin                     Naprosyn                  Robasissal                 Trigesic

Alcohol                  Cephalgesic                      Dristan                           Ibuprin                       Naproxen                  Roxiprin                    Trilisate

Alka Seltzer          Cheracol Caps                 Easprin                          Ibuprofen                  Norgesic                     Rufin                          Tusal

Amigesic                Children’s Asprin             Ecotrin                           Ibuprohm                  Norwich Ex. Str.       Saleto                         Vanquish

Anacin                   Choline Salicylate           Empirin                          Indameth                  Nuprin                        Salflex                       Vitamin E

Anaprox                Clinoril                               Emprazil                        Indocin                      Ocufen                       Salsalate                    Voltaren

Anaproxin             Congesprin                        Endodan                       Indomethacin          Orudis                        Salsitab                      Warfarin

Ansaid                   Cope                                  Excedrin                        Ketoprofen               Oruvail                       Sine Off                     Willow Bark

APC                        Coricidin                            Feldene                          Ketorolac                  Oxyphenbutazon    Sine Aid                     Zactrin

Argesic                   Corticosteroid                   Fenoprofen                   Lortab ASA              Oxybutazone           Thiosalicylate           Zorprin

Arthra G                Coumadin                         Feverfew                       Magan                       Oxaprozin                 Soma-Compund

Arthropan             Darvon ASA                     Fiorinal                          Mg Sallicylate          Pamprin                     sulindac

A.S.A.                     Darvon                              Flurbiprofen                  Meclofen                   Pepto-bismal            Synalgos DC

Ascodeen              Compund                          Froben                           Medipren                   Percodan                   Tanacetum

Ascriptin                Daypro                              4-Way-Cold Tabs        Mefenamic               Persantine                 parthenium

Aspergum              Depakote                          Garlic Capsules            Menadob                  Phenylbutazone       (feverfew)

Aspirin                   Dexamethasone              Gelpirin                          Midol                         Piroxicam                  Tolectin

BC Powder            Diclofenac                        Genpril                           Mobidin                     Ponstel                       tolmetin

Baby Aspirin        dipyridamole                    Genprin                          Monogesic                Prednisone                Toradol

Bayer                     Disalcid                              Ginko Biloba                Motrin                        Quagesic                    Trandate

Brufen                   Divalproex                        Goody’sBody Pain      Nabumetone            Relafen                      Trendan

2. Do not take decongestant medication containing pseudoephedrine (Sudafed, Actifed) for 5 days prior to surgery.  These can cause the heart rate to be too rapidly.
3. Appetite suppressant drugs phentermine (Fastin), should not be taken for at least 14 days before surgery.  Do not stop appetite suppressants abruptly as you may have side effects.  To avoid side effects such as depression, it is better to begin decreasing the dose gradually two weeks before surgery.  Maintain a healthy diet and stop aggressive weight loss diets for a safe surgery and good healing.
4. Do not take antidepressants, such as Zoloft or tricyclics for 14 days before surgery.  Please consult you prescribing physician before discontinuing any of your prescribed medications.

Liposuction Preoperative Check-List.  Please initial each item to confirm your agreement.  Print “NO” if you disagree.

____ Circle the following locations where we can telephone you (Cross-out if NO):                     Home     Work     Cell

____ Circle the following locations where we can leave a message (Cross-out if NO): Home     Work     Cell

           Please provide the telephone number(s) where we can call you.

          (____ )________________            (______)________________          (______)___________________

            Home Telephone                             Work Telephone                                 Other Telephone

____ I permit visiting physicians or nurses to observe my surgery.

____ I permit Dr. Yalamanchili to show my pre-op & post-op photos to prospective patients, (no name will identify the photo).

____  I agree to avoid aspirin and ibuprofen for 7 days prior to surgery, and to avoid decongestants for 5 days prior to surgery, and not to take Fastin (phentermine), Zoloft and all herbal remedies (unless specifically approved by my surgeon) two (2) days before surgery.  I understand it is recommended that you remove all aspirin and ibuprofen products from my medicine chest.

____ If, before surgery, another physician prescribes new medications for me, then I will notify the nursing staff as soon as possible.

____ I agree to leave valuables at home or in the care of a responsible “family member”. Dr. Yalamanchili is not responsible for lost valuables.

____ I agree: it is my responsibility to have a responsible adult to accompany me after surgery, to not drive myself home after surgery, and to not drive an automobile until the day after surgery.

____ If I develop a rash, skin infection, open wound or illness anytime prior to surgery, then I will notify my surgeon.

____ If your pre-op exam and labs are done out of town by your own primary care doctor, then you guarantee that the results will arrive at our office at least one month prior to surgery.

____ If my surgeon requires a clearance-letter from my primary care physician or a specialist to verify liposuction will be a safe procedure fro me, I understand this letter must arrive at least 3-4 weeks before surgery.  My surgery date cannot be finalized until this letter is received.  If this letter is not received two weeks before surgery, then my liposuction surgery may have to be rescheduled to a later date. I authorize the disclosure/exchange of protected health information for the purpose of treatment and obtaining medical clearance.

Cosmetic Surgery Policies

____ Payment Schedule:  It is our office policy to ask patients to pay half of the total surgery fee as a down payment at the time the surgery is scheduled.  The balance of the fee is to be paid 14 days before the surgery.  Final payment may be made with either Visa, MasterCard, or cashier’s check.  Please make checks payable to Dr. Sarat Yalamanchili M.D. S. C.  If final payment is now received by 14 days before surgery, your surgery date will be automatically cancelled and your deposit, minus $500 for expenses, will be returned.

____ Rescheduling Charges:  If it is necessary to change or cancel the date of the surgical procedure, then at least two week notice is required.  A $400 rescheduling fee will be charged for any schedule change requested by the patient with less than two weeks notice.  A $300 additional rescheduling fee will be charged if your surgery date is rescheduled more than a total of two times for your convenience or by manner.  If all preoperative laboratory results and any necessary medical clearance letters are not obtained a required letter of medical clearance in a timely manner.  If all preoperative laboratory and any necessary medical clearance letter are not received by 14 days prior to surgery, your date will be forfeited and rescheduled.  Last minute cancellations due to illness must be well documented in writing by a physician including a copy of the physician’s physical examination and diagnosis.  It is the patient’s responsibility to document the date and time, as well as the name of our office staff member who received the notice of cancellation or change in schedule surgery date.  If you would like to revise the plan of body areas designated for liposuction, you should notify us at leas one week before surgery.

____ Cancellation Charges:

          With more than two weeks notice, $500 cancellation fee will be charged if surgery is cancelled for any reason after the pre-operative physical examination and laboratory studies have been completed.  This includes a cancellation by you for any reason or a cancellation by us for medical reasons discovered from results of your preoperative medical examination or laboratory tests.

          With less than two weeks notice, if you cancel for any reason, or if the surgeon must cancel the surgery because you have not complied with explicit instructions, then half of the total surgical fee will be forfeited.  If, with less than two weeks notice, you first reschedule the surgery and later cancel the surgery altogether, then half of the total surgical fee will be forfeited.  If a surgery is cancelled with less than two weeks notice, it is usually impossible to arrange for another patient to fill that surgical time-slot.  Thank you for your understanding in this matter.  Cancellation within less than 48 hours of scheduled time of surgery for any reason will result in forfeiture of the entire surgical fee.

____ Pre-Op Telephone Calls:  Our staff routinely telephones patients for confirmation two to four days before surgery.  If we are unable to reach you, please telephone us 48 hours before the surgery to confirm the exact date and time of arrival.

I have read the above policy and consent to the routine pre-operative laboratory studies including Hepatitis C and HIV tests.  The results of these tests will be placed in the patient’s chart and will remain strictly confidential as required by law.

____________________________________                                                                                    _____________________

                    Patient’s Signature                                                                                                                                  Date

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