Tumescent Liposuction

Our office receives a lot of inquiries as to what types of liposuction Dr. Barlow and his partners perform. The most frequently used method is tumescent liposuction. I have attached a FAQ document from liposuction.com that covers a lot of the questions patients tend to have. Please feel free to call our office if you have questions not covered in this blog.

Thanks,

Laura Dickinson
Patient Coordinator

Tumescent Liposuction

1.) What is the definition of the word tumescent?
The word tumescent means swollen and firm.
2.) What is the tumescent technique?
The tumescent technique for liposuction involves the injection of large volumes of very dilute lidocaine (local anesthetic) and epinephrine (drug that shrinks capillaries) into subcutaneous fat. With the tumescent technique, the volume of dilute lidocaine that is injected into fat is so large that the targeted areas literally become tumescent (swollen and firm). The tumescent technique produces profound and long-lasting local anesthesia of the skin and subcutaneous fat. Tumescent liposuction designates a form of liposuction that uses tumescent local anesthesia.
3.) What is tumescent liposuction?
The word tumescent refers to anything that is swollen and firm. In the tumescent technique for liposuction, a large volume of very dilute solution of local anesthesia (lidocaine and epinephrine) is infiltrated (injected) into the fat beneath the skin, causing the targeted area to become tumescent. The drug epinephrine (adrenaline) provides profound localized vasoconstriction that is virtually eliminates surgical bleeding during tumescent liposuction.
4.) What are the benefits of tumescent liposuction?
As a result of the widespread capillary constriction caused by the epinephrine in the anesthetic solution, there is minimal bleeding during and after surgery.
5.) How much blood is lost during tumescent liposuction?
The tumescent technique is so effective at minimizing blood loss that the jmajority of patients lose approximately 15 to 30 ml (1 to 2 tablespoons) of blood during large volume liposuction. This is the same volume of blood that is taken for routine pre-operative laboratory sutudies. In the days before the advent of the tumescent technique, the biggest risk of liposuction was excessive loss of blood during surgery. In fact, many surgeons required their patients to donate their own blood several weeks before surgery, and the during surgery, the blood would be returned to the patient by transfusion. With the advent of the tumescent technique, blood transfusions are no longer a part of liposuction surgery.
6.) How does the tumescent technique reduce bruising after liposuction?
There are two reasons there is dramatically less bruising with tumescent liposuction than other techniques. First, because there is so little blood loss with the tumescent technique, there is almost no blood that remains beneath the skin to cause bruising after surgery. The second reason for decreased bruising is that with the tumescent technique there is a considerable amount of post-operative drainage of the blood tinged anesthetic solution the first 24 hours following surgery. By allowing this fluid to drain out of the small incision sites, it prevents the build-up under the surface of the skin which could lead to firmness and bruising.

98% of Elective Mastectomy Patients Would have Reconstruction Again, Says ASPS Study

Women who have breast reconstruction after an elective mastictomy are satisfied with their decision, have low complication rates and 98 percent would do it again, reports a study in July's Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons. In addition, breast reconstruction after preventive mastectomy was as safe as or safer than reconstruction in women with breast cancer and had excellent cosmetic results.

"Breast cancer is a terrible diagnosis and decisions regarding treatment are never easy. This study shows that women with cancer in one breast who choose to have their other breast removed as a preventive measure are happy with their decision and a high percentage would do it again," said Scott Spear, MD, study co-author and past ASPS president. "More remarkable is the 100 percent satisfaction level, as well as the 100 percent willingness to have breast reconstruciton again, for the women who chose to have both breasts removed."

The study examined 74 women who had preventive mastectomies and subsequent breast reconstruction between 2000 and 2005. Forty-seven patients had breast cancer in one breast and elected to surgically remove their other breast (unilateral prophylactic mastectomy). Twenty-seven patients did not have breast cancer, but chose to surgically remove both breasts due to a high-risk of developing breast cancer (bilateral prophylactic mastectomy). The cosmetic outcome was scored by 14 surgeons who looked at post-reconstruction photos and evaluated the result on a 1 to 4 scale (4 being an "excellent" result).

The study found that women who had a bilateral prophylactic mastectomy were 100 percent satisfied with their breast reconstruction and 100 percent of them would have the surgery again. Ninety-four percent of women who had unilateral prophylactic mastectomy were satisfied with their reconstruction and 96 percent of them would have reconstruction again.

The complication rate for reconstruction in women who had bilateral prophylactic mastectomy was 3 percent and 10 percent for those who had unilateral prophylactic mastectomy. Additionally, the study noted the cosmetic assessment for all patients was a score or 3 of 4.

"These women look and feel the same or better and their risk of cancer has been taken off the table," said Dr. Spear. "For women who know they are at risk, this option gives them the opportunity to be active about their health and appearance rather than reactive. They can have excellent cosmetic results, low surgical risk and a high level of satisfaction with their breast reconstruction. This is empowering for women."

According to ASPS statistics, more than 57,000 breast reconstructions were performed in 2007, up 2 percent since 2006.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

Mommy Makeovers-More Women are Opting for Cosmetic Surgery after Pregnancy, Childbirth and Nursing

Becoming a mother is a magical experience that is filled with many emotional journeys. One of the aspects of that journey is the major changes a woman’s body experiences. Pregnancy, childbirth and nursing can place great strain on a woman’s core, breasts, hips and legs. Many women feel unsatisfied with their bodies after pregnancy and will try improving their exercise and diet which are effective at reducing fat but have no effect on the skin. Not seeing results from their hard work often leads to frustration.

But there is a solution that many women are beginning to embrace. Cosmetic surgery packages, known as “Mommy Makeovers” are becoming more and more popular as women seek to regain their more youthful pre-maternal shape.

“Our patients usually come in with a very clear goal of what they would like to achieve”, says Sheila Londeck, RN. “And Dr. Barlow works with each patient to achieve the desired results in each area.”

Pregnancy can add extra layers of fat to the body and stretches the skin, resulting in trouble spots that no amount of Pilates, PowerYoga and crunches can reduce. The most popular procedures for women who want to regain their natural shape before they became moms are abdominoplasty (tummy tuck) and breast augmentation, sometimes with a breast lift.

During pregnancy the skin and muscles of a woman’s core become stretched and weakened. Tummy tucks can be performed in 3 different gradations: mini-tucks, full tummy tucks and extended tummy tucks. Dr. Barlow will examine your core carefully to determine which tummy tuck is appropriate for you and your goals. Further, if you have had a C-section, Dr. Barlow can work from that scar, eliminating additional scarring in many cases.

In addition, nursing and pregnancy add extra weight to the breasts and after nursing, many women find their breasts to lack volume and appear less appealing in shape. To reshape the breasts and give them a more youthful appearance, Dr. Barlow will often lift the breasts. Sometimes this surgery is combined with the addition of a breast implant to achieve the exact desired shape.

Liposculpting of the hips and thighs is also a popularly requested procedure. These procedures can remove those unwanted extra fatty deposits and create a smoother, shapely appearance. It is often recommended that a tummy tuck be combined with liposculpting, as Dr. Barlow can reshape the entire trunk and recreate a slimmer silhouette.

Many patients hesitate to come in for a consultation because they are concerned they will not be able to incur the financial burden. “Our office has two companies that specialize in surgical loans that we work with to coordinate payment schedules,” advises Laura Dickinson, Patient Coordinator, “giving a patient up to two years to pay for their surgery.”

Recovery is another concern many patients voice. “Many of these procedures can be performed at the same time”, says Sheila. “Most patients find they are back to work in two weeks and feel completely back to themselves within a month to six weeks. And it is worth it!” Indeed, the return to their pre-maternal shape is what motivates all of these women to seek cosmetic surgery as a solution.

“Our patient’s goals are very specific to those parts of their body that have been affected by pregnancy, childbirth and nursing,” says Katherine Grimes, Clinical Aesthetician. “They want to feel comfortable and confident in their own skin again, and these procedures will very often help them to achieve their goals.

To learn more about Mommy Makeovers and the packages that Dr. Haven Barlow provides, please visit http://www.barlowmd.com/Mommy-Makeovers.htm.

Debunking Common Plastic Surgery Myths

There are many misconceptions that patients have when it comes to plastic surgery. These misconceptions have lead to a plethora of myths that are increasingly working their way into our societies understanding of the topic. Whether it is who having plastic surgery, who is performing procedures, where procedures are being performed, or how to go about finding a surgeon that is right for you, patients are hungry for a better understanding of the process. According to the American Society of Plastic Surgeons, the largest and most respected plastic surgery specialty organization in the world, the following have been found to be some of the most common myths regarding plastic surgery.

• Myth 1: Only plastic surgeons can legally perform plastic surgery.
• Myth 2: Plastic surgery procedures cost the same no matter who performs them or where they are performed.
• Myth 3: It is disrespectful to ask your plastic surgeon tough questions.
• Myth 4: It is inappropriate to ask surgeons to speak with their previous patients.
• Myth 5: All plastic surgeries are performed in accredited facilities.
• Myth 6: Plastic surgeons only perform reconstructive surgery.
• Myth 7: "Extreme makeovers" are routine in plastic surgery practices.
• Myth 8: Science still has not proven the safety of silicone breast implants.
• Myth 9: Plastic surgery is only for the rich and famous.
• Myth 10: All board certifications are the same.

Myth 1

Only plastic surgeons can legally perform plastic surgery.

No regulations govern what type of medical practitioner can perform plastic surgery procedures. So the best way to know your surgeon is qualified is to choose an ASPS Member Surgeon.

ASPS Member Surgeons:
• Are certified by the American Board of Plastic Surgery to perform plastic surgery of the face and all areas of the body
• Have at least six years of surgical training and experience, with a minimum of three years of plastic surgery
• Operate only in accredited facilities
• Fulfill continuing medical education requirements

Myth 2

Plastic surgery procedures cost the same no matter who performs them or where they are performed.

There are many variables involved in the pricing of plastic surgery procedures - including geographic location, surgeon expertise and demand, and the time and effort your procedure requires. Other factors include the costs of anesthesia, surgical facility fee, labs, and more. Be sure to ask your surgeon about all costs involved.

When choosing a plastic surgeon, remember that the surgeon’s qualifications and experience as well as your comfort with him or her are just as important as the final cost of the surgery. Many plastic surgeons offer patient financing plans.

Myth 3

It is disrespectful to ask your plastic surgeon tough questions.

Asking tough questions is the best way to get to know your surgeon. It gives you the opportunity to learn about their qualifications, experience, and demeanor. Your questions let them know you’ve done your homework, want to be educated about your procedure, and will be an active partner throughout the process.

Myth 4

It is inappropriate to ask surgeons to speak with their previous patients.

Reputable surgeons will have no problem supplying you with contact information for some of their recent patients. Speaking with patients about their experience and results is an excellent way to learn more about your surgeon.

Myth 5

All plastic surgeries are performed in accredited facilities.

Some practitioners perform plastic surgery procedures in non accredited facilities. Making sure that your procedure can be performed in an accredited facility will significantly reduce safety risks and increase your comfort level. ASPS Member Surgeons perform surgeries only in accredited facilities.

Myth 6

Plastic surgeons only perform reconstructive surgery.

Plastic surgery encompasses both cosmetic and reconstructive surgery. ASPS Member Surgeons are trained, experienced, and qualified to perform both cosmetic and reconstructive procedures on the face and all areas of the body. Because many cosmetic procedures are rooted in reconstructive plastic surgery, ASPS Member Surgeons are uniquely qualified to handle your cosmetic needs.

Myth 7

“Extreme makeovers” are routine in plastic surgery practices.

Contrary to what reality shows portray, extreme makeovers are far from routine or common in plastic surgery. Most patients inquire about one particular area of the body that they would like to improve.

During your consultation, your surgeon will ask you a series of questions to gain an understanding of your goals for plastic surgery and discuss them with you on a realistic basis.

Myth 8

Science still has not proven the safety of silicone breast implants.

In November 2006, the FDA reversed its 14-year ban on silicone breast implants, allowing patients in the United States access to the same implants that women in 60 countries around the world already have.

You can find a wealth of scientific information on the safety of silicone breast implants at www.breastimplantsafety.org.

Myth 9

Plastic surgery is only for the rich and famous.

A 2005 study found that almost 60 percent of people who had recently had plastic surgery or were seriously considering plastic surgery had a household income of $30,000–$90,000 a year. In fact, 40 percent of that 60 percent reported an annual income of $60,000 or less. Just 10 percent of respondents reported a household income of more than $90,000.

Myth 10

All board certifications are the same.

Any group of medical professionals can create its own “certification” board. ASPS Member Surgeons are certified by the American Board of Plastic Surgery - a group designated by the American Board of Medical Specialties to oversee credentialing in plastic surgery of the face and all areas of the body. Their certification requires passing rigorous oral and written exams.


Dr. Haven Barlow has been specializing in plastic surgery for 20 years and is currently the Chief of Plastic Surgery at INOVA Fairfax Hospital. He is consistently named one of the best plastic surgeons in the DC Metropolitan area by Washingtonian Magazine since 1992, and is a member of the American Society of Plastic Surgeons, as well as a Diplomate of the American Board of Plastic Surgeons.

Dr. Barlow’s warm and personal approach ensures that each patient will approach surgery with a full understanding of their procedure and a realistic expectation of their surgical results. Complimentary consultations are scheduled so Dr. Barlow can give patients the time they need to voice all their concerns. Consultations are designed to be individual and patient-centered, focused on each patient’s individual needs and goals. To schedule a complimentary consultation contact our office at 703-560-8844.

Please visit www.barlowmd.com for additional information on our practice and the procedures our surgeons perform.

A primer for men and cosmetic surgery: Three things you should discuss with your plastic surgeon

More men are opting for cosmetic surgery; from calf implants to Botox injections

While cosmetic surgery has been popular with women for at least two decades, it is only recently that Dr. Haven Barlow, a well-respected plastic surgeon in Fairfax, Virginia, has noticed an increase in the number of men who visit his practice. Most common procedures men are interested in are Botox, microdermabrasion and liposuction.

Botox® is a botulinum toxin used to temporarily paralyze nerves within one’s facial appearance. Men may choose to have this safe, non-invasive procedure done to reduce the lines that may furrow their brows, or forehead. Microdermabrasion is another common procedure used to improve the appearance of one’s skin by removing areas of damaged or wrinkled skin. Liposuction, a surgical procedure used to removed unwanted fat from the hips, legs, arms or backs can create a more youthful and athletic physique for men.

“Men are feeling more comfortable with being invested in their appearance,” says Dr. Barlow. “They notice how great their wives look, or they wish they looked differently, and aren’t afraid to ask how to gain back their younger-looking selves.”

As the population ages, many successful, vibrant men are re-thinking their attitudes to dieting, face-care products and cosmetic surgery. Wanting to look youthful and appear dynamic well into one’s 40s, 50s and 60s means that some men will turn to a trusted and experienced plastic surgeon like Dr. Barlow for advice on how to regain a youthful appearance.

From 2000 to 2005, there was a 44 percent increase in minimally invasive cosmetic procedures among men, according to the American Society of Plastic Surgeons. Minimally invasive cosmetic procedures are those that do not require surgery and therefore mean a quicker return to the office and everyday life.

“Men are seeking out those treatments that will affect the way they look with the least possible fuss,” says Dr. Barlow. “They want to try something that is not a huge investment in time, like Botox. But they are also seeking out information on male breast reduction surgery, also known as gynecomastia, calf-implants and liposuction. Most of the time, they come in knowing what they want. But after spending some time discussing their goals, I can suggest some other procedures that may fit better with their expectations.”

For most men, discussing these procedures may at first feel uncomfortable. Dr. Barlow has three suggestions for men when discussing what their goals are for plastic surgery:

1. Identify exactly which physical attributes are making you uncomfortable. Do you wish you looked slimmer, more youthful or would you like to change the shape of your ears, nose or chest? Do you have a clear goal in mind? These will help your plastic surgeon determine the best plan of action.

2. Bring in a picture of yourself when you were younger, or a celebrity whose looks and physique you admire. This will help guide both you and your plastic surgeon toward your ultimate goal.

3. Keep an open mind about the procedures and techniques you are willing to try. Dr. Barlow’s number one goal with all his patients is to be sure they understand the benefits of each procedure, so they can make an informed decision about how to proceed.

Looking to the future, Dr. Barlow says he expects tummy tucks and body lifts to become even more popular among men. Men are also electing to have liposuction under the chin, to minimize any unattractive bulges that may occur when wearing a tie.

Dr. Haven Barlow has been specializing in plastic and cosmetic surgery for 20 years in Virginia, Maryland and the DC Metro area. He is currently the Chief of Plastic Surgery at INOVA Fairfax Hospital, and is a member of the American Society of Plastic Surgeons, as well as a Diplomate of the American Board of Plastic Surgeons. Visit the Barlow Cosmetic Plastic Surgery website to learn more about Dr. Barlow’s cosmetic and plastic surgery procedures.

How pesky problem areas such as the upper arms, beneath the chin, and above the knees can be addressed

I can’t tell you how many patients have come to us because no matter how much they exercise or how much weight they lose they can’t get rid of pesky problem areas like their double chin, extra upper arm fat, and extra fat above the knees. Now through minimally-invasive surgical options we can bring about quite a transformation for ideal patients.

For instance, chin and neck liposuction procedures are a unique form of facial rejuvenation that do not take a long time in the operating room or have a prolonged recovery period. Despite its minimally invasive nature, this surgical procedure can make a dramatic change in a person’s appearance. In the past, patients would need a facelift or neck lift to correct the problem of excess fat under the chin and in the neck. But, for appropriate candidates, this procedure is effective, less expensive, affords minimal recovery time, and successfully addresses the problem of the annoying "double chin" or overly full-looking neck. This procedure, which is ideal for both men and women, can dramatically improve a person’s appearance with minimal downtime and less risk of scarring.

In the case of upper arm liposuction, ideal patients can benefit from the area between the elbow and the underarm being reshaped to result in a more toned and proportionate appearance. This is can be a particularly troublesome spot for many patients to tackle. Candidates with the appropriate skin elasticity are able to enjoy smoother skin and contours without having to undergo a full Brachioplasty (Arm Lift) procedure which is more invasive and can cause rather unsightly scarring in a highly visible location due to the large incisions necessary. Similarly, addressing excess pockets of fat above the knee with liposuction is often a quick and relatively easy resolution to a pesky problem area.

The fact that any of these procedures can be performed individually or can be added on to surgery that you may already have planned is rather advantageous. Some patients may be concerned with just one of these areas, other patients may see them as a way to compliment different procedures they are having done. Adding any one of these areas to other surgical plans helps to minimize surgical costs to the patient as well as time taken off of work for recovery purposes. For additional information or to schedule a complimentary consultation, please contact our office at 703-560-8844.

How Smoking Affects Your Surgical Results

Many of us realize that quitting smoking at any point is one of the best things that patients can do to increase their overall health and longevity. However, in the case of cosmetic surgery, it is a necessary step in working toward a patient’s ideal final outcome. Some board-certified plastic surgeons limit the cosmetic surgery procedures they perform on smokers because smoking increases the risk of pulmonary complications and can impede wound healing, which may decrease the quality of surgical results.

In a survey by the University of Texas Southwestern Medical Center, 955 board-certified plastic surgeons were asked about their standards regarding treatment of patients who smoke. While ninety percent of the board-certified plastic surgeons surveyed said they perform elective plastic surgery on smokers, approximately fifty percent of this group stated that they limit the type of procedure they perform on smokers.

With many patients looking to their surgeon for superior skill and mastery of the most advances techniques and technology, patients who smoke are not always able to take advantage of these assets. Two thirds of the surgeons surveyed said they "usually" or "always" perform a less invasive technique on smokers. While a third of respondents said they "sometimes" change their technique.

Of the countless substances contained within tobacco smoke, nicotine and carbon monoxide are two of the most detrimental to wound healing and may cause pulmonary complications. These substances have a harmful effect on tissue oxygenation, which impairs the reparative processes of wound healing and by delaying the formation of healing tissue, the stage is set for increased scarring at the edges of the wound. It is this tendency to hinder our bodies wound healing response that may dramatically decrease the final cosmetic outcome. At the same time, smoking is associated with an increased risk of wound infections due to the weakening of neutrophil defense against pathogens.

In order to aid smokers reduce the risk of complications, Dr. Barlow asks patients to quit smoking prior to surgery. It has been shown that four weeks of abstinence from smoking reduces risk levels to those of non-smoking patients, regardless of the use of nicotine patches. When considering plastic surgery, it is important to remember that a successful surgical outcome relies upon the patient and surgeon working together.