Your Initial Consultation What can you expect to learn about liposuction before you decide to have the surgery? How do you find a qualified, experienced physician? What questions should you ask, and what sort of answers should you anticipate?
FINDING THE BEST DOCTOR FOR YOU
You may have read about liposuction in a newspaper or magazine ad, or a newspaper story. Usually the name of one or more physicians who perform liposuction is listed in the article. When you check the classified phone directory, especially if you live in, or near, a major metropolitan area, you will find that a physician who performs liposuction often will mention the fact in the telephone directory listing for herself or himself or for the group of doctors to which he or she belongs. Sometimes you will have heard about a doctor who performs liposuction from friends or co-workers. At any rate, in the beginning you have a name-or several-and a telephone number to call.
Another way to find a physician who performs liposuction is to contact The Liposuction Institute of America 312-259-6161, the American Society of Liposuction Surgery (213-459-5032), or the American Academy of Cosmetic Surgery (800-221-9808).
When you telephone the surgeon's office, the first person you will talk to is probably a receptionist or switchboard operator, who may refer you to the doctor's secretary or administrative assistant. There are three questions you should ask at this point:
1. Does the doctor or group of physicians perform liposuction?
2. How long has the doctor been doing liposuction surgery?
3. What training and experience in liposuction surgery has the doctor had? On approximately how many patients has he or she performed liposuction?
There are, of course, reasons why you should ask each question. If the doctor or group does not perform liposuction, that fact eliminates them from consideration. You want also to be aware of the doctor's background and training in liposuction, and to learn whether or not the doctor has substantial experience in liposuction surgery.
There is no magic minimum number of operations that "qualifies" a doctor as an expert in doing this operation, but all things considered, my opinion is that you certainly have far more chance of being satisfied with the results of this surgery if you are not one of the doctor's first liposuction patients. It is possible that you may hear of a "good" cosmetic surgeon or plastic surgeon...that is, someone who is well-known and has a fine reputation. When you ask more detailed questions, however, you may find out that the surgeon has not had a great deal of experience with liposuction. It is my strong opinion that you will have the best results from your liposuction if you choose a surgeon with considerable experience in this demanding operation. Liposuction-or body sculpturing-is as much of an art as it is a science. A cosmetic surgeon who is well-known for facial plastic surgery such as nose reshaping may not necessarily have performed many liposuctions of the abdomen or buttocks.
There are other questions you will want to ask the physician, but you should wait until you meet with the doctor for your initial consultation.
THE IMPORTANCE OF GOOD COMMUNICATION
The idea of questioning a doctor may seem strange and a little frightening, especially if you are of a generation that accepted the advice of a physician automatically. I am certainly not suggesting an adversary relationship with your doctor! In today's health care climate, however, many men and women are choosing to be informed patients, taking much more of the responsibility for their own health care choices.
Liposuction is elective cosmetic surgery. No life-threatening emergency condition is forcing you to have it done. Although successful liposuction surgery offers you a great many benefits in appearance and psychological well-being, it is by no means a life-or-death operation. You are choosing liposuction-as you would choose where to spend a vacation, what type of car to buy, whether or not to change jobs.
In most major life decisions, you expect to spend a good deal of time considering your options. You will check out various choices, thinking carefully about the benefits of each. You do your research carefully.
Many men and women today approach health care in the same manner. Their questioning and research helps make them partners-along with their doctors-in the well being of their bodies. Because they take an active role in health care decisions, they feel good about those choices.
What I am saying is this: in my opinion, it is all right to question your physician, to ask for explanations when you do not understand. It is important to feel free to talk frankly to your doctor at all times without embarrassment, hesitation, or fear. In today's health care climate, most doctors will not be surprised or offended when you do; rather, they will welcome the opportunity for fuller communication.
I will go even farther. In my opinion, if the doctor you are considering for your liposuction surgery is angry about the questions you are asking; or brushes you off giving you the feeling that your questions are insignificant, I believe strongly that you should find another surgeon. For best results, you will work closely with your doctor for many weeks, planning a comprehensive program together and monitoring your progress. You need to feel a mutual warmth and respect for each other.
I feel strongly that the question of fees for liposuction surgery should not be raised during a telephone call. Certainly you will want an indication of what liposuction surgery will cost, but this can be determined by the doctor only after a careful evaluation of your body and your individual needs.
Continuing consultation and long term care are vitally important.
In discussing fees, a receptionist or office assistant cannot usually give you an exact figure. Instead, such a staff member can usually just quote ranges, and these may not be specific enough. You will need to discuss just what the fee involves ... whether it covers surgery only, facility charges, laboratory work, anesthesiology, etc. Some receptionists will answer your telephone questions about fees with an approximate price quotation for surgery alone. Others will quote a comprehensive fee. Your comparison of different doctors' fees, therefore, will almost certainly be misleading.
If you base the choice of a physician for your liposuction surgery primarily on fees, you are doing yourself and your physician a disservice. After all, you are not comparison-shopping for a car or a washing machine. You are planning surgery-a major event-on your body. You want your liposuction to be as successful as possible. Although cost is important, it should not be the primary factor on which you base your choice.
The receptionist, secretary, or office assistant will almost certainly suggest making an appointment for an initial consultation with the physician. This is essential. Only through meeting you, carefully examining you, and discussing your problems can the surgeon evaluate you as a candidate for liposuction. Only through meeting the doctor and talking frankly about your expectations and questions can you decide if liposuction-and liposuction with this particular physician-is the right choice for you.
Because of the special nature of liposuction, you will want the freedom to discuss your individual body problems frankly with the doctor. Of course, the physician will observe the traditional confidentiality of the doctor-patient relationship. Some people prefer to talk over problems and plans with friends, and will already have been discussing the fact that they are considering liposuction for unwanted fat deposits. Others are embarrassed about their appearance, and would prefer to complete surgery and recovery without anyone's knowing about it. Your doctor will assume that you want your condition, and even the fact that you have consulted a physician, kept confidential. Of course, if you want the doctor to explain anything about the surgery or the pre- or post-surgical program, to a spouse or partner, this can also be done.
Your initial visit is a professional consultation, and, consequently, you should expect to be charged appropriate fees, generally ranging from $50 to $100, depending on time taken and services performed. Usually a staff member can tell you in advance what the fee for this initial consultation will be.
AN INITIAL CONSULTATION AT THE LIPOSUCTION INSTITUTE
Although different doctors have procedures that may differ slightly, the following description of an initial consultation is typical. At The Liposuction Institute, where I am founder and medical director, here is what happens during your first visit.
In one of my consulting rooms, the patient and I meet, usually for the first time. Often, the patient will feel slightly nervous and apprehensive. This is normal. You are considering an operation that will change the way you took, and the way you feel about yourself. It is a big step, and one which should be undertaken thoughtfully.
During our conversation, we discuss liposuction surgery in a general way. We talk about what is involved. I use this time also to try to clear up any misconceptions about surgery that the patient may have, based on incomplete information, and to ask the patient what body parts he or she feels could benefit from liposuction.
Surprisingly often, although patients believe they know where liposuction is needed, they may not realize the extent to which liposuction can help them. For instance, it is quite common for a woman to think her thighs are too fat, but not to know that she also could benefit from liposuction on her inner thighs, her knees, or her buttocks. A man may be concerned about unsightly fat deposits in his breasts, but does not realize that liposuction could effectively improve his body's contours in the areas of "love handles" or a double chin.
During this part of the initial consultation, the patient will want to establish whether or not this indeed is the doctor who will perform the liposuction. You will want to ask the doctor about her or his background and training. It is appropriate to ask questions about how much liposuction experience the physician has had with the body parts you are considering for your surgery. While liposuction is performed in accordance with general, medically-accepted principles, you would nevertheless probably not want to be the doctor's first or even fifth patient on whom he had performed liposuction of a particular body part.
Some doctors-always with their patients' prior permission-may give you the names of former patients on whom they have performed successful liposuction surgery. If your doctor offers such information, by all means do call and talk to the persons. Ask them what they liked and didn't like about the procedure. Ask them whether, knowing what they now know, they would have liposuction performed by the same physician. Sometimes, satisfied patients who have seen what a difference liposuction has made in their lives will offer to show you photographs of themselves, before and after surgery. Many times, they are so pleased with what has happened that they will share details of their lives with you.
Do not be embarrassed or afraid to make such a call, if you have the opportunity. The information you get is all part of the decision-making process you are going through about the surgery, and will help you be a more "aware" patient.
YOUR DOCTOR'S CREDENTIALS
The doctor you choose for your liposuction will probably be a member of one or more professional groups involved with liposuction, such as the American Society of Liposuction Surgery, the American Academy of Cosmetic Surgery, or the American Society of Plastic and Reconstructive Surgery. There is no medical or legal requirement that your doctor should belong to any or all of these groups in order to perform liposuction surgery. Nevertheless, the doctor's membership in one or more of these professional groups indicates the physician's interest in being aware of the latest medical advances in the field, and her or his commitment to continued professional growth.
WHAT TO TELL YOUR DOCTOR
During the first phase of a patient's initial consultation at The Liposuction Institute, I ask a number of detailed questions about the patient's medical history and that of her or his family, especially in relationship to eating behavior, fat deposit patterns, and similar topics. I will ask about ethnic eating patterns that may have affected the way you think and behave about food and fat.
We will talk about such things as holiday meals or special family celebrations. We will discuss your lifestyle in detail, including your occupation, eating history, weight gain and loss experiences, exercise and activity patterns, and other factors. If the patient is a woman, I talk with her about her eating habits and fat deposit patterns during menstruation, pregnancy and menopause.
You should be completely frank with your doctor, even though these may be-and probably are-extremely sensitive subjects for you. You may be reluctant to talk about them. You may have denied your own behavior to others, and perhaps even to yourself You may need to examine your thought and behavior patterns carefully and concentrate more seriously and thoughtfully on the subject than you have before. It is not easy to confess to food binges, to bulemia (the eat-to-excess-and-vomit syndrome), to compulsive overeating and midnight refi-igerator-raiding, to lethargic behavior, inactivity, or lack of exercise. Nevertheless, the more your physician knows about these factors, the more easily he or she can assess your total situation. And the more likely it is that your eventual liposuction will be successful, with this comprehensive approach.
Since many fat deposit patterns have a strong genetic component, it is also possible that you may have been eating "normally" and even exercising regularly, but still have unsightly bulges.
THE IMPORTANCE OF HONESTY AND CONFIDENTIALITY
Do not be embarrassed to discuss these topics. Your doctor will keep what you say in strictest confidence, and you can be completely honest, without fears. Rest assured that the physician who is experienced in liposuction and who believes in a truly comprehensive approach to solving your problems will not lecture you, ridicule your past experiences, or make you feel ashamed about your lifestyle or anything you have done, or any goals you have failed to achieve in dealing with your problem previously.
I cannot stress enough the importance of your complete honesty throughout your medical treatment, beginning with this initial consultation. It is extremely important for the success of your surgery, and for your continuing relationship with your physician before, during, and after the operation, that your doctor know and understand your condition.
If you do not feel during the initial consultation that your doctor respects you and your situation, or if you feel hostility or resentment towards the doctor; then, no matter how well-qualified medically that physician is, you may want to choose another with whom you feel a closer, more trusting relationship. The fee you will pay a second physician for a similar consultation will be well spent if that is what it takes to find the right doctor for you.
THE COMPREHENSIVE PHYSICAL EXAMINATION
1. During the comprehensive examination, the doctor will identify all areas that will benefit from liposuction.
2. Fat deposits will be evaluated.
At The Liposuction Institute, the second part of your initial consultation consists of a thorough physical examination. Height and weight are recorded, of course. You will be asked to undress in an examining room, and to put on a disposable gown. Although your genital areas will be covered, I will ask you to stand otherwise nude in front of a full-length mirror so that together we can observe and discuss the fat deposits on the parts of your body you are concerned about.
1.Types of fat deposits in various areas will be examined.
2. Overall body fat will be taken into consideration.
Usually a patient starts at the top-with face, chin, neck, etc., and moves downward. While he or she is pointing to the fat deposits, I also examine them. I touch the area, feel the area, and in general evaluate whether or not I think you are a good candidate for liposuction surgery. I will also use the pinch test for skin elasticity of certain parts of your body. In addition, based upon my professional experience and assessment, I classify your body fat distribution as primarily endomorphic, mesomorphic, or ectomorphic.
During the physical examination, I pay particular attention to skin elasticity and texture. For instance, I may note numerous stretch marks covering a particular area. These stretch marks, incidentally, often occur whether or not you have ever been pregnant. They frequently show up in men, as well as women.
Their presence (or absence) may tell me a good deal about your skin elasticity and the underlying collagen structure. The pinch test also helps. In general, a skin which is fairly tightly attached to the body and does not pull easily has a better prospect of healing quickly and more attractively after liposuction.
The texture of your skin also helps me to predict how you will heal and how you will look after surgery. Some patients have skin, especially in the buttocks or hip area, which is bumpy or dimpled with fatty deposits-a condition commonly referred to as "cellulite." Your chances for an attractive appearance after liposuction are better if you do not have too much cellulite. Liposuction can improve your appearance and get rid of a good deal of the cellulite. However, liposuction is not a "cure-all" or panacea. All the cellulite will not vanish, and you will not return again to having the skin of a 14-year-old.
I want to emphasize, however, that even though you have stretch marks...even though you have cellulite ...you can still be a candidate for liposuction. Even if you are obese-more than 20 percent overweight by medical standards-you can usually still have the surgery if you are otherwise in good physical condition. Even if a person is overweight, he or she may still benefit from specific treatments such as the tummy tuck, or liposuction of enlarged male breasts, sagging buttocks, or "thunder thighs."
Likewise, there are no arbitrary age requirements or limitations for liposuction.
Most experienced physicians would not perform liposuction surgery on an adolescent who is not full-grown. It is also true that the best candidates for liposuction are 55 years old or younger. However, patients in good general physical health can almost always have the surgery. I myself have performed liposuction surgery on patients as young as 14 years old (a patient with enlarged male breasts) and as old as 82 years.
While a patient looks in the mirror, it is usual for me to point to the areas in which I think they can benefit from liposuction, and to discuss them.
One question I always ask patients at this time is, "Do you want to look good in clothes?"
1. The pinch test will be used to determine skin elasticity also.
2. Skin texture is examined, and can reveal much about under- lying collagen structure.
The older patient, or patient with a previous history of frequent weight loss and gain, usually answers "yes," and this helps me to understand their expectations of what "Posuction will mean to their appearance. A patient with many stretch marks, with substantial loose folds of hanging skin, or large areas of dimpled skin, however, who says she expects to look good in a string bikini after the operation is apt to be disappointed in her expectations. In such a case, it is especially important to discuss the benefits of liposuction frankly, so that such a patient makes a decision about the surgery fully aware of the probable outcome.
WHAT ABOUT SCARS?
At this time, patients often have questions about the placement of incisions, and the possibility of scar formations. I will show them where I propose to place the incisions, doing everything possible to camouflage them in natural body creases. Although I try to make incisions as inconspicuous as possible, I still must reserve the right medically to do during surgery what seems best for you, even if there is a change in plans. Most doctors, I am sure, feel the same way. Although we try to anticipate and plan for various situations, nevertheless if it becomes apparent during surgery that a different way of doing things is better for you, we need the freedom to use our best professional judgment.
1. The experienced liposuction surgeon will use very small incisions.
2. Whenever possible, incisions are placed within natural skin folds on the body.
YOUR DECISION FOR SURGERY
At The Liposuction Institute, after the physical examination, you dress and return to the consulting room. Now is the time we will talk about the findings and their implications for you.
1. The doctor will dicuss the patient's needs and expectations, the recommended procedures and the likely short- and long- term results.
By this time, the patient has almost certainly decided to have liposuction surgery. The physical examination, the careful taking of the medical (and eating behavior) history, and the introductory discussion have reinforced the patient's desire to undergo the operation and to benefit from surgery. The patient has had the opportunity to decide if he or she feels comfortable with the doctor, and to ask questions about the surgery itself.
This third phase of the initial consultation, might be summarized as "Where do we go from here?"
Although you may have come to the office, assuming you would have liposuction on a certain body part, it is possible that during the physical examination, you have decided to undergo surgery on additional areas of your body. If so, then we will talk about the order in which we will do the procedures. Some procedures can be combined satisfactorily-that is, it is usually possible to perform liposuction of a double chin at the same time as surgery on the abdomen, if that is what the patient needs and wishes. Other procedures, however, will need to be done separately because of such factors as the location of body parts, the complexity of the surgery, or the length of time under anesthesia.
WHERE SURGERY IS PERFORMED
You will want to discuss the location where your surgery will take place. This will vary according to the individual physician. In almost all instances, however, liposuction is done as an outpatient procedure, either in a surgical suite in the doctor's office, a free-standing medical center, or an ambulatory surgical area of a hospital with which the doctor is affiliated.
HOW MUCH WILL LIPOSUCTION COST?
At this time, it is most certainly appropriate for you and the doctor to talk frankly about fees, related costs, and payment. You should expect your doctor to answer your questions in detail about the surgical fees, about costs for the location in which the surgery will take place, the anesthesia and medical supplies, the services of an anesthetist or anesthesiologist, the special bandaging or surgical garment which (depending upon the body parts being operated upon) you will wear during your recovery period, and any other anticipated costs. Such costs, for instance, can be expected for any additional required visits to the office prior to surgery, for laboratory tests and other medical procedures, and for follow-up care.
At The Liposuction Institute, I also talk with my patients about a long-range plan for their comprehensive care. Such a plan may include, but is not necessarily limited to, referrals to nutritional counseling and services, the development of an appropriate exercise/physical activity program, psychological counseling if advisable, and similar topics.
In my opinion, a physician who merely performs liposuction surgery is much less likely to have pleasing, lasting results with patients than a doctor who looks upon the operation as part of a comprehensive, thorough plan to improve the patient's appearance and state of health.
BEFORE SURGERY TAKES PLACE
It is my custom to schedule another visit for patients before surgery. This visit (for a thorough medical assessment) is more fully described in Chapter 7.
The method of payment is also discussed during the initial consultation. Liposuction is considered elective cosmetic surgery, and so is generally not covered by health insurance plans. In the United States, it is customary to pay for surgery and all related costs in advance of the operation, so you should not be surprised if your physician asks you to do so. A few doctors will accept charge card billing.
During your initial consultation, you should feel free to ask your doctor any questions you have about liposuction, or about surgery in general. The psychological rapport you have with the physician you trust to perform this intimate operation should be strong enough that you can ask her or him any questions without embarrassment.
At The Liposuction Institute, (assuming that you intend to have liposuction), we can tentatively schedule your surgery for a mutually convenient date, and make those arrangements while you are completing your initial consultation. We will be able to confirm the date of the operation after your next pre-surgical visit: an extremely thorough examination and assessment of your general state of health.
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