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Liposuction Related Medicines – Allowed and Disallowed

Pre Liposuction Related Medication

  • Liposuction and Medicines Used
    • Anti-anxiety Medication: Liposuction and anxiety are often intertwined. Many patients get bouts of nervousness before the surgery. In some cases, the doctors must  prescribe anti-anxiety medicines to calm the patients. These drugs, such as benzodiazepines, must only be taken upon the doctor’s prescription. Usually, one dose is given the night before the operation and one just before the plastic surgery. Caution: Their excess may cause drowsiness or disturbed breathing.
    • Vitamin K Supplements: This vitamin is very helpful in blood clotting. Taking it for 15-30 days prior to the cosmetic surgery is helpful in quick blood clotting during and after liposuction. Vitamin K supplements are especially prescribed to those with a history of anti-inflammatory (analgesic) use. Analgesics act as a type of blood thinner, preventing blood clotting and resulting in excessive blood loss and slow recovery from liposuction. Vitamin K intake helps balance this problem.
    • Liposuction Related Medicines Banned: You must stop taking any medicine (including health supplements, Ayurvedic, Homeopathic, & herbal drugs, etc.), 15 days prior to the liposuction procedure or until every trace of the drug (especially the negatively interfering ones) has vanished from the body. Several drugs delay the lidocaine (liposuction anesthesia) elimination from the body, which can cause toxicity. In addition, many medicines react with lidocaine to either slow the blood clotting process or speed it. Your surgeon will guide you on medication use. Make sure you strictly adhere to the doctor’s prescription and instructions. The two main categories of drugs to be stopped before liposuction are:
      • Lidocaine Metabolism Hampering Drugs:Elimination of lidocaine is a three-step process. After administration, the anesthetic is absorbed in the blood, followed by a liver enzyme Cytochrome P450 3A4 (CYP3A4) metabolizing it. The body then naturally excretes out the resulting metabolites. Normally, the liver can process 250mg of lidocaine per hour. The level of the drug in the blood is high until a few hours after the procedure liposuction. However, sometimes lidocaine is retained either for long in the body or its quantity is in excess of what the liver can normally handle. The concentration of lidocaine in the blood, beyond a certain level, in a definite time span amounts to toxicity. Several medicines affect liver functions, especially drug metabolism (breaking down or modification of toxins). Do not make any changes in your medications without the guidance of your doctors. You need to be on a physician guided medication holiday for at least 15-20 days prior to the liposuction surgery. Otherwise, there is a possibility of slow lidocaine metabolism, as the drugs may hamper the release of CYP3A4. These lidocaine interfering drugs include:
        • Analgesics
        • Anesthetics
        • Anti-Arrhythmia Drug
        • Antidepressants
        • Anti-Fungal Medicines
        • Anti-HistaminesH2 Blockers
        • Anti Seizure Drugs
        • Antiviral (Protease Inhibitors)
        • Anxiolytics (Anti-anxiety Drugs)
        • Benzodiazepines
        • Beta-Blockers
        • Calcium Channel Blockers
        • Cholesterol Lowering Drugs
        • Cimetidine
        • Immunosuppressant
        • Sedatives
  • Bleeding Triggering Drugs: These drugs usually thin the blood and may hamper the body’s blood clotting process, leading to excessive bleeding. Some such drugs are:
    • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or Analgesics: During clotting, these meds (such as ibuprofen and aspirin) combine with blood platelets, thereby hurting their function.
    • Vitamin E
    • Warfarin Sodium: This anti-coagulant counters Vitamin K during blood clotting, consequently, slowing down the process.

Medication Used during Liposuction

  • Liposuction Wetting Solution: A standard per liter composition of liposuction fluid is:
    • Saline Water: This contains 12.5 mmol sodium bicarbonate in the form of a solution. It helps remove the fat easily.
    • Epinephrine: 0.25-1 mg of this vasoconstrictor drug narrows down the blood vessels, only in the surgical area. This reduces the blood loss and tissue bruising.
    • Anesthesia: 500-1000 mg of lidocaine is generally the liposuction anesthesia. It helps numb the treatment area.
    • Anesthesia:Anesthesia is the key drug employed during the liposculpture. It numbs the senses to reduce the body’s response to external stimulus. This helps develop insensitivity to the pain incurred during the operation.
      • Types:Depending upon their influence on the body, anesthesia has four types:
        • Local Anesthesia: Lidocaine is the local anesthesia used in liposuction. An organic compound belonging to the amino amide group, it is injected directly into the treatment area. The major role of lidocaine is to minimize the pain due to liposuction and the risk of any infection or allergy after it. It also helps control the blood pressure and heart beat during the operation. Tumescent liposuction is mostly conducted on local anesthesia.
        • General Anesthesia: Also called Systemic Anesthesia, here, the patient is unconscious and does not get to ‘feel’ the surgery. The anesthetic is infused intravenously through an IV tube. This anesthesia has its sets of high risks and most of the liposuction deaths are associated with it only. Local anesthesia may or may not be given in this. It is administered in three ways:
        • Gas inhalation
        • Local anesthesia + Sedator – Monitored Anesthesia Care (MAC)
  • Regional Anesthesia: This numbs the body below the waist. Epidural anesthesia, administered in the spine, is employed here.
  • Conscious Sedation: Also called twilight sleep, in conscious sedation, semi-narcotics are introduced into the body through IV administration. You are conscious but amnesic. That is, you know the surgery is happening, but do not feel the pain nor will you remember it.

Doctors use local and sometimes general anesthesia to carry out liposuction.

  • Factors Influencing Anesthesia Selection:
    • The quantity of fat to be suctioned
    • Liposuction technique to be used:

Wet Technique: volume of wetting solution < the lipo volume to be extracted à general anesthesia

Super Wet Technique: volume of wetting solution = the lipo volume to be extracted à general anesthesia

Tumescent Technique: volume of wetting solution (twice or thrice) > the lipo volume to be extracted à general anesthesia

  • Patient’s pain tolerance
  • Lidocaine Dosage:The dose of lidocaine varies in males and females. Female dosages are the standard here. In women, the body built type determines the anesthetic’s quantity grade. The following are the three slabs:
    • Thin Frame: 40 mg/kg weight
    • Average/Plump Frame: 45 mg/kg weight
    • Overweight Frame: 50 mg/kg weight

In a male body, fat is approximately 15-20% less than in females. Therefore, the anesthetic’s dose is reduced accordingly. The dose is lowered by approximately 50%, if a patient is taking certain drug(s), which might interact with lidocaine. Overall, healthy, young, and obese bodies are able to handle lidocaine concentrations more easily than the older and thinner ones.

  • Sedatives: Administered orally or intravenously (IV) through IV tube, sedatives help keep the patient relaxed and drowsy.
  • Analgesics: May sometimes be given orally to relieve the body pain due to the surgery.

Post Liposuction Medications

  • Medicines Used: The doctors may prescribe some drugs for a proper and quick recovery of the body. Any medication should strictly be by prescription. If you feel any discomfort after taking these drugs, then immediately report this to the doctor. Here is a list of some of the common ones which might be ordered for you:
    • Anti-Inflammatory Drugs: Also called analgesics, they help reduce tissues redness and swelling. These include aspirin, ibuprofen, etc.
    • Antidepressants: They help alleviate surgery related anxiety.
    • Antibiotics: They reduce the chances of infections and treat the ones that have set in.
    • High Blood Pressure Drugs: The doctors prescribe them after a time gap, post surgery, as they thin the blood and delay blood clotting and healing.
    • Diuretics: Prescribed 7-20 days after liposuction, they help the body get rid of excess fluid through normal urination.
    • Iron Supplements: To be taken once or twice a day, these drugs help compensate for the iron deficit due to blood loss during the surgery.
    • Stool Softeners: Iron intake often leads to constipation. They help soften the stools for a smoother bowel movement.
    • Skin Ointments: Used after the stitches have been removed, they help reduce skin redness.
    • Medicines Banned:They trigger nausea and vomiting if taken just after the surgery. They include:
      • Acetaminophen
      • Anti-anxiety sedatives
      • Narcotic analgesics