Nutritional Counseling And Preparation For Surgery
Dr. Amron strongly believes in creating proper balance and proportion to a patient's body. Every patient is evaluated from their neck to their ankles to determine the areas of disproportion and locate where the diseased fat is concentrated to target with liposuction. Patients who suffer from Lipedema tend to have very disproportionate figures, and the goal of liposuction surgery in any patient - especially with Lipedema patients - is to create a balance and proper proportion to the patient's body.
Dr. Amron treats patients from all over the world, and the majority of patients come from outside of the Los Angeles area. Dr. Amron offers a unique phone consultation process, or alternatively an online video consultation using Skype. This process allows Dr. Amron to see patient photographs, review previous medical records and create a personalized surgical treatment plan without requiring the patient to fly to Los Angeles for the consultation. After a treatment plan is created, Dr. Amron asks his patients to arrive one day prior to their first surgery for an in-person pre-operative visit to confirm all aspects of the treatment plan.
Typically, the first surgery is done the day after the face-to-face consultation. Patients are typically able to fly back/return to their homes as early as three to four days after their last surgery.
Having your body in optimal state is important for any surgery. As part of the Advanced Lipedema Treatment Program at The Roxbury Institute, we encourage every Lipedema patient to receive a nutritional consultation with our naturopathic doctor, Sara Whitney. During the consultation, Dr. Whitney will review your medical history and nutritional and lifestyle goals and customize a pre-and post-surgical plan for you. You will also be able to discuss obtaining additional bloodwork to evaluate hormonal issues or the possibility of further treatments to help in your recovery, such as stem cell therapy.
Depending on the severity of the disease, a patient may only need one surgery if just one area is affected. On average, Dr. Amron will perform two separate surgeries to remove all the diseased fat. The first surgery is typically comprised of the calves, ankles and arms. The second surgery typically involves the circumferential thighs, and possibly buttocks.
The length of time between surgeries depends on the stage of Lipedema and the complexity of surgery, but typically is four weeks apart. Rarely, a third surgery may be necessary for very advanced patients. For patients who are not local, you should plan to stay in the area for at least five days.
Dr. Amron has devised a specific postoperative care plan for each patient who undergoes surgery at The Roxbury Institute. Directly after the operation, patients are drained by massage on the table to remove excess fluid. After this, patients are placed in compression garments, which they are advised to wear 24 hours a day for four weeks after their surgery, followed by an additional four weeks wearing the garments, but for 12 hours a day. Depending on various circumstances, post-surgery IV therapy may be utilized.
Patients with stage three or four Lipedema may have their feet and legs bandaged immediately after surgery. The next step in the recovery process is to schedule Manual Lymphatic Drainage (MLD) therapy for the patient twice a week for four to six weeks post-surgery.
Directly following surgery, patients will be up and walking within 15-30 minutes, and will leave the surgical center in the care of a family member or nurse. For patients with complicated medical histories we will recommend an aftercare facility. Patients are instructed to take it easy on the day of surgery, and are encouraged to resume a normal diet, and drink one glass of water every hour on the day of their surgery.
The day following surgery, Dr. Amron recommends patients take a walk up to one mile the following day as tolerated to help drain out any fluid remaining in the muscles. This also helps mobilize fluid from the tissues.
Stage one and two Lipedema require no bandaging; however, patients with stages three or four Lipedema may have their feet and legs bandaged after surgery.
Depending on the nutritional consultation, post-surgery IV therapy may be utilized in-office by Dr. Sara Whitney.
The next step in the recovery process is to schedule Manual Lymphatic Drainage (MLD) therapy for the patient once or twice a week, with possible additional bandaging. MLD is a specialized type of massage which helps to reduce swelling for lipedema patients. The first one or two sessions are done in Los Angeles. For out of town patients we will help coordinate treatment in your hometown.
Lipedema patients experience a significant amount of discomfort, pain and numbness prior to surgery, and are relieved to hear liposuction almost always greatly improve s their pain or eliminates it completely. A vast majority of testimonials from Dr. Amron's patients state the pain they endured prior to surgery is almost completely gone the following day, or within a week after surgery.
During the liposuction procedure, Dr. Amron uses water-assisted liposuction (WAL) to infuse the fluid into the fat to anesthetize it. The majority of surgeries are performed with only mild sedation and patients typically only experience a slight discomfort and pinching feeling as the fluid is being placed into the fatty tissue. However, it is a quick process to complete, and this period of discomfort only lasts for approximately 30-45 minutes.
During the extraction part of the surgery, most patients feel a slight pressure, but usually do not have any significant pain.
After surgery, patients are given prescription pain medications. However, in Dr. Amron's experience, only 10-15 percent of patients have needed to take them on the evening of their surgery. Many of Dr. Amron's Lipedema patients experience little to no pain the day after surgery. However, the degree of discomfort in subsequent days is entirely dependent on the amount of bruising and swelling after surgery.
Patients tend to experience swelling after the surgery because many times it's the lower part of the legs, like the calves and ankle areas, where swelling generally takes longer to subside. Most patients note significant reduction in size within the first week and this slowly continues up to 12-18 months for final reduction.
The majority of patients have mild bruising. Approximately 10-15 percent of Dr. Amron's patients experience moderate to extensive bruising. It should be noted, these patients tend to be sorer and experience more swelling after the procedure until the bruising has subsided, which occurs within two to three weeks.
For liposuction in general, the recovery time is about a year to see the final results, and this is also true for Lipedema patients, in particular. Patients will immediately start to see results after surgery, and a reduction of fullness in their bodies due to the amount of fat removed during surgery.
As the body continues to heal, patients will experience a remodeling and restructuring of body tissue, as it develops new connective tissue to tighten up areas of looseness. Most patients begin to see an improvement within four weeks after the initial swelling subsides.
This remodeling process takes a significant amount of time to heal, and many patients won't see final results until approximately 12-18 months after surgery.
A majority of patients start to see a significant improvement with in the two to four weeks of surgery, but results vary from person to person. At the three-month mark, most patients see between 50-70 percent of final improvements. At the six-month mark, this normally increases to about 80-90 percent, but final results will not be seen until 12 - 18 months post-surgery.