Q: How Dr Arhur make liposuction as safe as possible?
“Patient selection is of utmost importance. I select only the right patients. They have to pass through various stages of screening before they are allowed to come to Medan for liposuction. Besides that, try performing liposuction with just a syringe, without any machine if possible. This will significantly decrease the risk of puncturing important structures, creating dents from over-removal of fat, or burning the skin with ultrasound or laser devices. I always perform liposuction under just local anesthesia (tumescent anesthesia) and light sedation. This way, even if you hit some important structures, the patient will wake up and scream, hence avert a potential disaster. Even if you can’t feel what you are poking because you are using machine, it is impossible to poke the intestines 10 times unless the patient is heavily-sedated or put under general anesthesia! We have also come across surgeons who would perform several sessions of liposuction on patients on a few consecutive days, and even perform such major surgery without getting proper blood tests done. They are just looking for trouble! The only disadvantages of traditional syringe method are it is physically very exhausting and takes much longer time to complete compared to machine-assisted method. This translates into less cases which can be done, hence less revenue. In our case, we can only perform one liposuction surgery per day. Currently, many doctors still misrepresent facts about liposuction suggesting it is safer if performed under general anesthesia rather than local anesthesia when, in fact, the opposite is true. From the pioneering liposuction techniques introduced in Europe in the 1970s through the time it was introduced in the U.S. in the early 1980s, liposuction procedures were performed under general anesthesia. This changed in the mid-1980s when dermatologist, Jeffrey A. Klein, M.D., developed the tumescent technique. The tumescent technique, which involves local anesthesia, revolutionized liposuction and is much safer than liposuction under general anesthesia.
Q: Why blood test is important before you can go for lipo?
Many prospective clients have questioned us about the need for blood test. In countries like Singapore and Indonesia where Dr Arthur has been practicing, getting blood test done is compulsory for a major surgery like liposuction. It is to detect abnormalities which may increase the risk of serious complications which may cause death. There are 3 major things we look out for: 1. Hemoglobin: as there is significant blood loss during liposuction, we must ensure that the person has enough blood to lose. 2. Blood clotting factors: if there is any problem with blood clotting, the person may bleed to death. 3. Liver and kidney function: All methods of liposuction use tumescent anesthesia. Tumescent anesthesia contains high concentration of lidocaine which can cause toxicity especially if given to someone whose liver and kidney function is not normal. Liposuction is NOT a minor procedure as what many surgeons would like their patients to believe. A person needs to be in perfect health before he/she can go for liposuction. We place safety above all. That is why roughly 1/3 of prospective clients could not pass the initial screening process in order to be accepted for liposuction in our clinic. Once we receive all the information and blood test result, we will have Dr Arthur Tjandra review them. Once he agrees to perform liposuction for you, we will notify you, so that you can proceed to book your flight and surgery slot with us.
*Information that you need to know about Fats transfer to breast.
Fat transfer can be done to the breasts for augmentation and reshaping of the breast to create a long-lasting and natural result. There have been debates amongst surgeons on the long-term implication of fat transfer to the breasts, as fat cells may die and get calcified. On mammogram x-ray, this looks exactly the same as an early breast cancer. When faced with many calcifications on x-ray, the physician is faced with dilemma of whether to take out every single lesion for biopsy, or just to leave them alone, assuming that those are just calcified fat. In a 1987 position paper, the American Society of Plastic and Reconstructive Surgery stated: “The committee is unanimous in deploring the use of autologous fat injection in breast augmentation [underlined in position paper]. Much of the injected fat will not survive, and the known physiological response to necrosis of this tissue is scarring and calcification. As a result, detection of early breast carcinoma through xerography and mammography will become difficult and the presence of disease may go undiscovered.” Ironically also in 1987, a retrospective study of the mammographic changes after breast reduction reported that calcifications were detectable in 50 percent of all mammograms more than 2 years from the time of surgery. Despite this documented high incidence of calcifications, there was no discussion of discontinuing reduction mammaplasties because the procedure might interfere with breast cancer detection. It was well recognized by 1987 that with all surgical breast procedures, there is a risk of causing lumps and/or mammographic changes. After discussion with experienced radiologists, we noted that a “confident differentiation between benign postoperative calcifications and carcinoma” could be made in most cases. Discussion had already begun in the literature concerning such problems after breast reduction and augmentation with silicone implants. Currently, radiologists can distinguish with a high level of confidence the calcifications that are a result of fat necrosis from calcifications that are related to breast cancers. In a most recent study published on the Journal of Plastic & Reconstructive Surgery in March 2011, researchers found that there was no statistically significant difference between breast density findings before and after fat injection, whether using the American College of Radiology classification or a personalized rating system. Similarly, no significant difference was observed using the American College of Radiology Breast Imaging Reporting and Data System categorization before and after fat grafting. In conclusion, radiographic follow-up of breasts treated with fat grafting is not problematic and should not be a hindrance to the procedure. Although more than a decade ago the American Society of Plastic Surgeons (ASPS) did not recommend the use of fat grafting for breast augmentation, more recently, the American Society of Plastic Surgeons Fat Graft Task Force has stated that there is no strong evidence for or against autologous breast augmentation. For more information on this topic, you may like to read the following articles:
1. Fat Grafting to the Breast Revisited: Safety and Efficacy http://www.lipostructure.com/_pdf/Breast%20Paper07.pdf
2. Advantages, Disadvantages and Complications of Breast Augmentation with Fat
Common mistakes most patient made
The most common mistakes most patients made were to fly over for surgery while still having menstruation, or failed to stop taking supplements which increase bleeding, such as vitamin E and ginkgo biloba. If you are worried that your menstruation may come anytime, you may get hormone pills from your GP to delay your menstruation, till after surgery. Smoking is definitely a NO NO, which increases the risk of your skin dying off after liposuction. If you have not stopped smoking for at least a month prior to liposuction, and can’t continue to stop for at least a month after, you’d better cancel your surgery.
Should you expect your period to come just before, during, or after liposuction surgery, you can go to see a GP and ask for hormone pills (usually norethisterone) to delay your period. These pills should be started 3 days prior to your expected period, and continued for a few days after surgery. Once you stop taking the pills, your period will come as usual.