Newsline 2003 February – Better Pain Relief After Tummy Tucks

Welcome to our February email Update.

It’s always nice to recognized by one’s peers, and this month, Dr. Tobin received an award from the American Academy of Cosmetic Surgery for “excellence in cosmetic surgery.” He was a featured speaker at the Academy’s annual meeting where he spoke on the topic of “open body procedures in cosmetic surgery.” His lecture focused on “tips and pitfalls” in operations including tummy tuck, breast lifting and reduction, arm reduction and thigh lifting. Dr Tobin emphasized that while these operating enjoy great popularity, it was essential to counsel patients regarding the limitations and risks of surgery. With more and more patients undergoing bariatric surgery to weight loss, we are seeing increasing numbers of patients who, having lost large amounts of weight, are looking for ways to eliminated the excess skin that often results.

Better pain relief after tummy tucks

While on the subject of tummy tuck, postoperative pain has always been a significant factor related to this surgery. Along with the removal of excess tissue, the tightening of the abdominal muscles often leads to significant pain following surgery. We have recently had experience with a new device that promises to significantly reduce this problem. The system consists of a small catheter that is inserted under the skin at the end of the surgery. It is connected to a reservoir that contains a supply of local anesthetic that is slowly infused into the wound through a computer controlled pump. There is a provision for the patient to increase the dosage, but not beyond a safe limit. We have now used it in two patients, both of whom described much less post operative pain than we were used to seeing following abdominoplasty. While the device adds about three hundred dollars to the cost of the surgery, our patients seem to feel it is money well spent.

Are mini facelifts the wave of the future?

We are hearing more and more about simplified facelifting procedures that are carried out through limited incisions with little or no deep dissection and recovery lasting only a few days. Of course we have long advocated these minilifts as an adjunct to patients who have already undergone facelifting. We recommend the “tuck” as a planned maintenance program to follow a full face lift every couple of years. When performed in this manner, patients can maintain the benefit of their major facelift indefinitely.

As a primary procedure, the benefits are much more doubtful. The success of the “secondary tuck” is based on the fact that a primary facelift leaves an extensive network of scar tissue beneath the skin. This scar tissue is much less elastic than normal tissue. Therefore, when a secondary tuck is performed, there is much better and longer lasting pull than can be achieved in normal skin. Unfortunately, this is not the case when these procedures are carried out as primary operations. Long term experience has confirmed the importance of adequate dissection during an initial facelifting procedure. We feel that patients are best served by having a first facelift properly done with adequate dissection to “set the stage” for subsequent tucks. Initial minilifts, in our opinion, are doomed to lead to mini results.

In addition, the bottom line is that improved techniques have made recovery from facelift surgery much less traumatic than in the past. Even with a full facelift, patients are up and about the next day, and usually back to normal activity within a week or so. We are convinced that patients should not cut corners on their facelift surgery.

Scar Guard remains popular

For the past several months, many of our patients have been using “Scar Guard” both to treat and prevent thickened scars. So far the feedback we have received from our patients has been positive. It does seen to be effective. Of course, it is a bit difficult to evaluate, since most patients do heal with satisfactory scars without any treatment. The ease of use with “Scar Guard” does make it more attractive than former treatment methods. The combination of silicone, cortisone and vitamin E in a solution that can easily be painted on the incision adds to its attractiveness. We are looking for feedback from our patients, so if you have been using it, let us know the results. For those of you who wish to try it, it is available from the Center.

On a more personal note, Dr. Tobin is the proud owner of a new (to him) 2001 Honda Goldwing GL1800 motorcycle. He has been riding for many years but with this new touring bike, it’s going to be hard to keep him close to home.

That’s it for this month. Please keep your questions and comments coming. We want this to be as informative as possible and your input surely helps.

Sincerely,

Howard A. Tobin, M.D., F. A. C. S.
www.newlook.org

For general information: askdena@newlook.org or n41gt@newlook.org