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Procedures

 Vaser and SmartLipo (The use of ultrasound and laser to melt fat and tighten skin)

Commonly Asked Questions

 What is SmartLipo?

SmartLipo is a revolutionary new procedure that uses a laser, inserted into the fat layer using a small incision to melt away small localized areas of fat. Ideal candidates have one to one and a half inches of fat in a localized area. In addition, as the laser frequency of the laser is a skin tightening frequency and the laser interacts with the skin causing the skin to shrink or tighten in the treatment area.

 What is Vaser?

Vaser uses ultrasound waves inserted through the skin to liquefy fat while leaving other tissues undisturbed. Dr Johnson makes a small incision and inserts a small cannula into the targeted layer of fat. The ultrasound waves of the Vaser emulsifies/liquefies the fat allowing Dr Johnson to suction the fat out of the body. Vaser works great in conjunction with SmartLipo to get those larger areas of fat (two inches or more). Since Vaser doesn’t get as much skin tightening as the SmartLipo laser, typically Dr Johnson does the SmartLipo first to get as much skin tightening as possible in the entire treatment area and then performs Vaser in the entire treatment area that needs Vaser.

 What is Vibro/Tickle Lipo

Vibro/Tickle lipo is rapidly becoming the best technique available for liposuction in Europe. Tickle lipo uses vibration to help suction the fat, therefore making the procedure more comfortable for the patient.

 Do you suction after melting the fat?

Yes. Dr Johnson always suctions as much fat and tumescent fluid out of the treatment area as he can remove. Dr Johnson uses the SmartLipo laser for skin tightening, and uses either the Tickle lipo or Vaser for fat removal. Both Tickle and Vaser an important part of the procedure is suction.

 How are the procedure(s) performed (SmartLipo, Tickle Lipo, Vaser)?

The SmartLipo Laser, Vaser, and Tickle lipo are introduced through a tiny incision into the treatment area. Most patients find it hard to find their incisions a month out, but do keep in mind that we did make

incisions so you could have tiny little scars. SmartLipo uses a laser to melt relatively small areas of fat, most of the fat evaporates and turns to CO2 gas. The fat that does not turn to gas is suctioned from the body. Vaser uses ultrasound technology to emulsify or liquefy larger areas of fat that are then suctioned from the body. Tickle lipo uses vibration to emulsify the fat. When performing Vaser or Tickle lipo, SmartLipo always precedes it to provide the area with greater skin tightening. The use of both devices allows Dr Johnson to carefully shape and contour a treatment area and gives you the appearance you desire.  How is the Fat Transfer liposuction performed?

Liposuction for Fat Transfer must leave the fat intact, therefore we cannot use instruments like the Vaser and SmartLipo that melt and destroy the fat. Instead of using Vaser/SmartLipo we use a form of standard liposuction that doesn’t require general anesthesia. Lipo leaves the fat intact while still allowing us to remove it gently and easily. You as the patient will notice very little difference between the areas we do Lipo and Vaser/SmartLipo. If you are afraid you will have loose skin after the lipo suction we can do SmartLipo after removing the necessary amount of fat for the fat transplant and SmartLipo right up against your skin. Doing SmartLipo is an additional charge. SmartLipo must be done after lipo as it destroys fat cells and those cells are no longer viable for fat transfer.

 How do you choose what fat to transfer?

The best area to transfer is the inner thigh as it is the least fibrus area. However most people that area doing the Brazilian Butt Lift, or doing breast lifts want a smaller waist so we often lipo the love handles and the sancrum (the area between the dimples in the back).

 What do I need to do after Fat Transfer?

After fat transfer you need to not diet for three (3) months. The fat that we have moved needs a good steady blood flow so that it can adhere in the desired location. At best only 50-70% of the transplanted fat cells will survive, so Dr Johnson will originally over fill the area so that by the time everything settles you will be closer to your desired results. After two (2) weeks you may return to exercise soaking water. Exercise and a healthy diet is essential to keeping the new fat healthy and alive.

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 How do we avoid loose skin?

SmartLipo uses a 1064 nm laser introduced into the subcutaneous fat. The 1064 laser is one of the best tools for skin tightening when used on the surface of the skin. When the laser is introduced into the subcutaneous fat the results are even more impressive. The laser heats the supporting connective tissues resulting in collagen tightening. Over time new collagen is laid down and healthier, thicker skin results. The skin and connective tissue is also tightened as the new collagen is laid down. This tissue tightening results in less loose skin after the procedure which is not available with previous liposuction techniques. The skin tightening is a healing process and takes time, in the average patient the process takes anywhere from 6 to 9 months.

 Can I put fat back in that area?

No once Dr Johnson has destroyed the fat from the area you are doing SmartLipo/Vaser in you cannot put fat back in that area. However if you continue eating the same amount of calories without exercising you will put fat somewhere else, so we recommend a good exercise routine. 40% of women find that after doing SmartLipo they start putting fat in their breast if they do not do something to avoid putting fat in other places.

 Is it safe?

In the 20 years of tumescent liposuction there have been no reported deaths. In the 4 years of Smartlipo suction there have been no major complications reported.

 What makes Dr Johnson different from other doctors?

Dr Johnson uses a two-pass technique while doing your procedure. First the entire treatment area is infused; this infusion process typically takes the longest amount of time. After infusion of the area, Dr Johnson does his first pass which is strictly for skin tightening. Dr Johnson performs a crosshatch pattern right under the skin. After completing the crosshatch pattern Dr Johnson performs a second pass that actually melts the fat. This fat-melting pass will typically take Dr Johnson 20 to 30 minutes per area. Then Dr Johnson will suction all areas making sure the treated areas are even.

 What is a Touch-up and why would I need it?

The goal of liposuction is to contour the body. At times you and Dr Johnson will decide to not remove all the fat in an area because so doing you would not achieve the shape you are looking for. Because

liposuction is about contouring about 12% of patients desire a touchup to better contour their body. Liposuction touchups are $500 per area. Touch-ups are only applicable for patients who are under their original weight or have gained no more than 5 pounds of their original weight.

 What areas can be treated with SmartLipo/Tickle Lipo/Vaser?

SmartLipo/Tickle Lipo/Vaser can treat almost any area of the body. SmartLipo’s ability to perform detailed contouring in small areas make it ideal for treating areas that previously have been difficult or impossible to treat with standard liposuction. Tickle Lipo & Vaser treats larger fatty areas and is excellent in conjunction with SmartLipo to achieve skin tightening. Some commonly treated SmartLipo and Vaser areas are: Chin and Neck, Abdomen, Love Handles, Back, Saddlebags, Inner Thighs, Knees, & Arms.  Will my cellulite be affected?

Liposuction of the thighs, while improving the silhouette, does not necessarily eliminate the subtle “puckering” of the skin often called cellulite. Cellulite results from the pull of the fibrous tissue that connects the skin to the underlying muscle. While SmartLipo/Tickle Lipo/Vaser may reduce the amount of fat in the thighs it is unlikely to eliminate cellulite, as it is removing fat underneath the cellulite layer.  Does SmartLipo/Vaser require anesthesia?

SmartLipo/Tickle Lipo/Vaser are performed using a type of local anesthesia known as Tumescent

Anesthesia (TA). TA is a saline solution containing Lidocaine and Epinephrine. When using TA a special saline solution is injected into the treatment areas. The fluid contains a local anesthetic (lidocaine) along with other medications to reduce bleeding. Medicine is also added to decrease swelling and pain after the procedure. Some minor discomfort may occur during the infusion process, however the actual

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 Will I be in pain?

During the procedure most people prefer to take a mild sedative and pain medication. However, generally patients say they feel a little tugging, pulling, pressure, or tickling sensation during the procedure. Dr Johnson has to pinch the skin above the area he is working on to determine that he has destroyed all the fat he can or is there still fat there to destroy, the most common complaint we get is about the pinching

feeling. Patients don’t typically say it feels like a pinch it feels like pressure. After the procedure you will be given a mild prescription pain medication. However many patients require only ibuprofen or Tylenol for pain control. Post procedure pain tends to be the worst on the second day after surgery. Most patients experience some soreness, but minimal post procedure pain.

 What are the side effects of SmartLipo/Tickle Lipo/Vaser?

Though the consent forms are going to have a long list of possible side effects, there are a few that are common. The common side effects include soreness, drainage after the procedure, bruising around the incision sites, and swelling. It is quite common for the treatment areas to drain after the procedure. The fluid that drains contains small amounts of fat that did not vaporize during the procedure. In order to allow the drainage and prevent infection (a rare side effect), the tiny incisions used for the procedure are allowed to close on their own. Bruising is another potential side effect. Swelling is common after the procedure and can last 3 to 6 weeks, patients that do multiples areas may swell for up to 8 weeks. When SmartLipo is performed on the chin or neck, it is not uncommon to have some mild slurred speech from the anesthetic. This can also last 3 to 6 weeks, but is usually only 1-3 days. Other side effects are listed on the consent forms and are rare.

 How long does it take?

SmartLipo/Tickle Lipo/Vaser takes approximately 20 to 30 minutes to actively melt the fat per treatment area. However, the prep time for the procedure and TA of the area can take an hour per area. We also need an additional 30 minutes prior to the procedure to mark the treatment area, take pictures, and an additional 15 minutes afterwards to bandage and dress you. Typically, we plan on 60 minutes to 90 minutes per treatment area.

 What are the pre-procedure instructions?

It is recommended that you eat a light meal before your procedure. If the procedure is in the afternoon, a normal breakfast and a light lunch is best. Patients are given an antibiotic to take before the procedure and for five days afterward. In order to avoid excess bruising, it is best to avoid aspirin and other

anti-inflammatory drugs for two week prior to the procedure. When you arrive at the office you may be given a mild sedative or pain medication. Many times patients don’t plan on taking medication but during the course of the treatment for whatever reason they need the medication (nerves, or the TA does hurt a little bit) so we need every patient to have a designated driver to and from the office. Because every patient may receive a mild sedative or pain medication you can not plan on driving yourself home and will need

someone to drive you home from the procedure. If you can not find someone to drive you we can call you a taxi or use our chauffeur service.

 What time should I arrive to the clinic?

You need to arrive at least 30 minutes prior to your scheduled appointment time. We need this time to mark the area, take pictures, measurements, and record your vital signs. This also allows sufficient time to pre-medicate you.

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 What are the post-procedure instructions?

After the procedure you will leave the office with a compression garment to wear in the treatment area 2 to 3 weeks post-procedure. Chin and neck support are worn for 72 hours when that area is treated. You will be asked to return to the office within a week of your procedure to check on your wounds and swelling, and at that time Dr Johnson will determine if the compression garment needs to be worn for 2 weeks or 3 weeks. Rest is recommended and activity can be resumed gradually. Strenuous exercise should be avoided for 2 weeks. Refrain from hot tubs or swimming pools for 2 weeks (showers are fine). Eat a healthy diet to maintain the improved body shape. Instructions for changing and maintaining your dressing are discussed later in this manual. Continue taking your antibiotic for the 5 days following treatment, and any pain medication as needed. If Tylenol or Advil are sufficient take those instead of the pain medication the office staff called in as they are easier on your body.

We will also have you return at 3 months and 6 months to recheck the treatment areas, repeat pictures, and evaluate the treatment areas. At that time it is also possible that “touch-up” treatments will be

recommended ($500 per area) if needed.

 Who can have SmartLipo/Tickle Lipo/Vaser?

While most people can have SmartLipo/Tickle Lipo/Vaser there are a few people who cannot. Persons on anti-coagulants (blood-thinners) such as coumadin should not have the procedure. The procedure should not be done on someone who has an infection in the treatment area. Patients with heart failure or severe kidney or liver disease should not have the procedure. Additionally it is best if you do not loose a lot of weight before the procedure. The extensive weight loss can lead to loose skin and make tightening the skin more difficult. The best candidates for SmartLipo are those with 1 to 1 ½ inches of small to medium localized fatty areas. Larger fatty areas (2 or more inches of fat) are better suited for the Vaser and SmartLipo. These procedures are ideal for those areas like “love handles” or lower tummy that just don’t seem to go away, no matter how hard you work at it.

 How much weight can I plan on loosing per area?

Liposuction is not an appropriate treatment for weight loss. Nor is it is substitute for a prudent diet, good nutrition, and regular exercise. We prefer to look at liposuction as inch loss and not weight loss. As a patient may lose 1 to 3 inches and only 5 pounds, but those 1 to 3 inches helped the pants fit much better.  What are some realistic expectations?

Although the results of liposuction are often quite spectacular, it is not realistic to expect perfection. It is impossible to guarantee the precise amount of improvement that will result from liposuction. Patients should not have unrealistic expectations. Although patients can usually expect to achieve at least 50% improvement, it is unreasonable to expect 95% improvement or near perfection. For the perfectionist, or for liposuction of a large area, maximum improvement may require a second procedure for which there will be an additional fee.

Patients who would be satisfied with a 50% improvement would be reasonably good candidates for liposuction. The “50% improvement” is intentionally a vague measure. It indicates a definite perceptible improvement, but something short of perfection. If a 50% improvement would make a patient happy, then it is likely that these expectations will be met. Our patients generally achieve more than a 50%

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Preparing for Surgery

 We collect a deposit when you schedule. The deposit is non-refundable. However if you need to reschedule the deposit moves to the new date, or if you decide not to do SmartLipo/Vaser you can use the deposit money for any of our other treatments. The balance of the procedure is due the day of the

treatment before you are escorted to the staging area. There is also a charge for all compression garments.  No Smoking – for two (2) weeks prior to and for two (2) weeks after your procedure. Smoking decreases

circulation and slows wound healing time.

 Do not take Vitamin E or K, Aspirin or Aspirin-containing products – for two (2) weeks prior to your procedure and for two (2) weeks after the procedure. See medication sheet (next page). Also, caffeine products (including chocolate) cause mild dehydration, so they should be avoided for three (3) days prior to the procedure and for three (3) days after the procedure. If you must have caffeine products supplement them with plenty of water to re-hydrate your system.

 Take vitamins C and a multivitamin – these promote healing.

 Do not drink alcohol – for two (2) weeks prior to the procedure (one or two drinks in a weekend is not a problem, a nightly drinker is a problem). Excessive drinking may create complications and increase bleeding and bruising.

 Fill your prescriptions – we will call in some prescriptions to a pharmacy of your choosing. Please pick up the prescriptions before the day of your procedure. You do not need to bring the prescriptions to the procedure. Please take your antibiotic just as you are leaving for the office.

 Showering – Please shower the night before and morning of the procedure with an antibacterial soap.  Eating – You need to eat before the procedure. If your procedure is in the afternoon then you will want

to eat a regular breakfast and a light lunch.

 Clothing – Wear loose fitting clothes to the office. No jewelry. A little make-up is fine. Old sweatshirts and sweatpants are recommended because of possible drainage from your procedure. We also recommend socks as the treatment room can get a little cool.

 What to expect – The procedure itself is relatively pain-free. During the numbing process, reactions vary. You may experience, at times, a stinging and burning sensation from the injections of the tumescent fluid (local anesthetic), some people say they feel a little tickling, and others have been able to just fall asleep through the procedure. Please expect intermittent discomfort similar to a pinching feeling and pressure for the duration for the numbing process. During the suctioning, you may feel pressure in spots, especially in the abdominal area. Most discomfort can be relieved with the injection of more anesthetic, so it is

important to communicate this to Dr Johnson. During the actual fat melting phase most people feel very little, however this is also an important time to communicate with Dr Johnson, we never want you to be in any discomfort. We want this to be a good experience not a bad one.

 Arrival Time – Please arrive 30 minutes before your scheduled appointment time for pictures,

measurements, and vitals. This also gives your pre-medications time to start working before we start the procedure.

 Transportation – always arrange for a ride home. We understand that you may plan on not taking any pre-medication, however unforeseen circumstances may arise and you need pain medication during the procedure and therefore would need a ride home. So we always require our patients to have a ride home or we will call a taxi or chauffeur for you.

 Over night – most patients are fine, however the first 24 hours you could be a little groggy so we would like you to have someone to stay with you. After the first 24 hours most patients are a little sore but generally ok if they need to be on their own. Do have plenty of Tylenol or Ibuprofen on hand along with your prescribed pain medication just in case of pain.

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Medications to Avoid Before and After Procedure

These instructions are to be followed before and after your procedure. If you are on any rheumatoid, anti-arthritic, circulation, or anticoagulant medication (Motrin, Naprosyn, Plavix, Presantine, or Coumadin), please inform us immediately.

1. For a two week (2) period prior to and after the scheduled surgery, please do not take any medications that contain aspirin or aspirin related products.

2. Do not take pain medications other then Tylenol for two (2) weeks prior to the procedure.

3. Aspirin has an effect on your blood’s ability to clot and could increase your tendency to bleed at the time of treatment and during the post-procedure period.

4. Please check the labels (including vitamins) of all medications that you take, even those over available without a prescription to make sure you are not taking any aspirin or aspirin-like substance.

5. Please consult your physician before stopping any prescribed medications.

The following is a list of medications and substances that can increase your tendency to bleed:

Advil Alcohol Adderall Vitamin E Alka Seltzer Anacin Anaprox Anaproxin APC 5 ASA Ascodeen Ascriptin Aspirin Bufferin Cephalgesic Cheracol-Capsules Children’s Aspirin Cinoril Congesprin Cope Coricidin Coumadin Darvon Darvon with ASA Dolobid Dristan Easprin Ecotrin Empirin Excedrin Feldene Fiorinal 4-Way Cold Tabs Ibuprofen Indometjacin Meclomen Medipren Midol Motrin Nalfon Naprosyn Nuprin Percodan Phenaphen Quagesic Robasisal Rufin Sine Off Sine Aid Trandate Trental Trigesic Trilisate Vanquish Voltaren Zactrin Zorprin

If you need minor pain medication, please take acetaminophen (Tylenol) or another non-Aspirin medication. Tylenol or Anacin 3 are available at your local pharmacy without a prescription and have comparable pain relief to that of Aspirin. If you are allergic to Tylenol or are unable to take it for other reasons, please notify us so that we might arrange for a suitable substitute.

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Going to the Office

 Going to the treatment room is not a normal experience for most of us. Dr Johnson and all of our professional staff caring for you recognize the natural anxiety with which most patients approach this step in the process of achieving their goals. We believe a description of the procedure experience will be helpful.  Your procedure will be performed in a specifically designated treatment room set aside just for

liposuction. Specifically trained assistants and staff members will attend you from the moment you walk in the door until you walk out.

 When you arrive at our office you will be taken to our prep-room. You will be asked to change into a robe, while allowing you to keep on your underwear and socks. If you are doing a procedure around your underwear line, the staff will ask you to wear a disposable thong. Dr Johnson will meet with you before the procedure in order to mark your treatment areas. This is a time to get your feedback on if you feel one side is “lumpier” than the other, has more fat then the other, or to just make any final plans. There will be time for any last minute questions. During this period of time you will be given the pre-medication so that it has 20 to 30 minutes to take affect before we actually get started on the procedure.

 Once you enter the treatment room, the staff will do everything they can to make you feel secure. You will be on a nicely padded operating table. For the entire duration of the procedure you will be connected to a monitoring device that checks your blood pressure, pulse, EKG, and blood oxygen levels. Dr Johnson and trained staff will be with you throughout the entire procedure.

 Before you arrive please eat something. A light breakfast for those patients doing lipo in the morning, or a normal breakfast and a light lunch for those patients doing lipo in the afternoon.

 Wear loose fitting clothing. There is usually some a little drainage. Drainage is a slight reddish/pink tinged color fluid. Since this drainage might stain clothing, choose your clothing with this in mind. Because we will apply compression garments on top of some bulky absorbent pads, your clothing should be very loose.

 When the procedure is over and your dressings are in place, most patients are able to leave

immediately. However some patients need a little while to recover and in that case you will be moved to our recovery room. During any needed recovery time a staff member will check on you periodically.  Please arrange for someone to drive you home. Most people like to have a sedative along with the pain

medication as a pre-medication, and therefore you are not able to drive yourself home. Over the next 24 hours we like you to have someone with you to help with the dressing changes on your incisions. You will have drainage for approximately a week, but the first 24 hour is the heaviest. Over the next 3 to 4 days the drainage tapers off and usually you can cover the wounds with a band aid by day 3 to 5 (realize not all patients are the same).

 We ask all patients to take the day of surgery off from work or strenuous actives. As you will have your most drainage the day of surgery and going home and laying around makes this easier to deal with. We recommend if you are lying on the couch put a sheet down so any drainage that may leak through the pads doesn’t get on your furniture. We will also provide you with a special absorbant pad (blue pad) that is good for this problem. The drainage is a red pinky fluid, it is not blood, and the amount varies upon the number of areas treated and each patient. After the first day it gets much lighter and most patients do not need to change their pads more then once a day.

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General Surgical Risks

 The goal of liposuction, as in any other cosmetic procedure, is improvement of appearance; NOT PERFECTION. Liposuction procedures do not guarantee the reduction of any measurements, including the neck, waist, thighs, or any other areas. As the skin continues to tighten you will continue to see size loss in the treated areas but this is not guaranteed. There are times that a patient needs or wants a touch-up to achieve their desired results, this is to tweak the results from their first surgery. Most touch-ups are for patients that are pleased with their first procedure but feel they could be a little smaller or a little tighter so they want to “tweak” that area, we do this for the patient at only $500 an area. Again realize that we do need to leave a little fat against the skin for protection, so some people doing a touch-up to achieve tighter skin may be recommended Thermage instead, however we will always recommend the cheaper treatment that will achieve the best result.

 The final results will not be apparent for 3-6 months post procedure. There is

no guarantee

that the expected or anticipated results will be achieved.

o Swelling should go down within 3 to 6 weeks, so you will see the size difference. However the ultimate goal is the skin tightening which makes the entire area appear smaller and tighter. You should wait at least 3 months and we prefer you to wait the entire 6 months before you determine if you need a touch-up. Most patients may not see much collagen building in months 1-4 but months 5 and 6 they build their most collagen, so therefore being patient and waiting the entire 6 months is beneficial to you.

 In order to achieve the best possible liposuction results a “touch-up” may be required. There will be an additional cost for this of

$500 per liposuction area.

Touch-ups should be looked at as your way to tweak your results, so if there is one little thing about your results you don’t like do a touch-up. Or if you lost 3 inches from the first liposuction treatment and think (with Dr Johnson’s agreement) that you can loose an inch or 2 more then do a touch-up. This is your opportunity to be picky now that you see your body looking better then it has in years. (touch-ups not applicable with fat transfer/grafting)

 Areas of “cottage cheese” texture (cellulite) will have little change after liposuction, since the procedure is removing fat below the cellulite layer. Cellulite is really caused by connective tissue bands in the layer of skin above where we are taking out the fat. Some people say they see some improvement in their cellulite but that would only be because of the skin’s original looseness was tightened by the SmartLipo, DO NOT plan on any cellulite improvement. Tri-Active, AWT, and Powerplate (the

combination of which is call TriFecta) are very good treatments for cellulite and can be added a month after liposuction to help reduce the appearance of cellulite.

 Strict adherence to the post-procedure (pages 20 and 21) regiment discussed by Dr Johnson (wearing the compression garment 2-3 weeks, exercise, diet, and all other regimens discussed).

This is necessary to achieve the best possible result. Patients who do not have an exercise regiment may benefit from adding Powerplate 2 to 3 times a week (a month post procedure). This exercise regiment helps burn calories and increase muscle tone. It will also help you keep from putting fat in other areas that you didn’t originally have fat. (40% to 50% of women that don’t cut calories and/or exercise after

SmartLipo/Vaser gain fat in their breast.) Or develop an exercise plan that work for their current lifestyle. We have destroyed the fat cells in the areas done by SmartLipo/Vaser and therefore you can not gain new fat cells in that area; however if you continue eating the same caloric content without burning it off then you will put on weight somewhere else.

 We collect a deposit when you schedule. The deposit is non-refundable, however if you need to reschedule the deposit moves to the new date or if you decide not to do SmartLipo/Vaser you can use deposit money for different treatments. The balance for the procedure is due the day of the treatment before you are escorted to the staging area. There is also a charge for all compression garments.

 Bruising is a common result of treatment. Bruising is a common result of treatment. Any bruising that occurs should resolve within 2 to 3 weeks. Most bruising is localized to the incision site, but some patients do bruise over the entire treatment area. Bruising can extend below the treatment area.

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 Post operative pain can be controlled in the majority of patients with Tylenol or Ibuprofen. However some patients require more aggressive pain management. For this reason you will receive a prescription for a narcotic pain reliever to take as necessary, please pick this up before the surgery along with your antibiotic, but you do not need to bring it with you the day of your procedure.

 Bleeding is rare, and in rare cases could require hospitalization and blood transfusion. It is possible that blood clots may form under the skin and require subsequent surgical drainage. A collection of lymph fluid (Seromas) may develop which will require drainage. The drainage of these is an in office procedure and takes much less time then the SmartLipo/Vaser, the doctor just uses a needle and drains the fluid.  Skin irregularities, lumpiness, hardness, and dimpling may appear post operatively. Most of these

problems disappear with time, but localized skin firmness, lumpiness, and or irregularities may be permanent. In dark skinned patients, hyperpigmented scars (dark or black scars) can occur and be permanent. Other objectionable scarring such as keloids are possible. Other complications such as hematomas (collections of blood under the skin) can occur. If loose skin is present in the treated area, it may or may not shrink to conform to the new desired contour. When loose skin is still present 6 months post-treatment, thermage may be an option to tighten the remainder of the skin in the area.

 Infection is rare, but should it occur, treatment with antibiotics and/or surgical drainage may be required. You will be called in an antibiotic to take the day of and for five (5) days after your procedure. Please pick this up before your procedure along with your pain medication. You do not need to bring this with you to the office.

 Numbness or increased sensitivity of the skin over the treatment area may persist for months. It is possible that localized areas of numbness or increased sensitivity could be permanent. On average the numbness goes away within a few days to a week post procedure. Patients that do their chins/neck it is not uncommon for them to have numbness in their lips and have some slurred speech. This also goes away, usually with in a few days to a week, but can last longer. Always remember all patients are different and not everyone responds the same. When it comes to numbness part of what is causing it is the remaining anesthetic that we were not able to suction out, wearing the compression garment will help push the anesthetic out of the body and decrease the amount of time you are numb.

 Objectionable scarring is rare because of the small size of the incisions used in liposuction, but scar formation is possible. In this case there are treatments we can do (at additional cost) in 6 months. Some patients have found that old scars (such as stretch marks) have actually gotten better while doing SmartLipo/Vaser. This is because of two reasons 1) we are decreasing the size of the areas so the skin is no longer stretched over as large of an area and 2) we are building collagen under the skin and pushing the scar(s) out.

 Skin necrosis (dead skin) rarely occurs as a result of liposuction. If this occurs it may require skin grafting which will leave significant scarring.

 Dizziness may occur during the first weeks following the liposuction procedure, particularly upon arising from a laying or sitting position. If this occurs, extreme caution must be exercised while walking. Do not attempt to drive a car if dizziness is present.

 Allergic or toxic responses to anesthetic are rare, but possible.

You will have a staff member follow-up phone call the day after treatment. You will have an appointment with Dr Johnson 1-2 weeks following treatment. We prefer to do follow-up visits, 3 and 6 months post-treatment. Feel free to call during this time if you have any questions or comments.

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Tumescent Anesthesia

 SmartLipo/Vaser are performed using a type of local anesthesia known as Tumescent Anesthesia (TA). When using TA a special fluid is injected into the treatment area. The fluid contains a local anesthetic along with other medicines to decrease bleeding. Medicine is also added to decrease swelling and pain after the procedure. Some minor pain does occur during the infusion process. The SmartLipo/Vaser process has little or no pain.

 The TA is mainly saline. It is mixed with lidocaine to help numb the area, epinephrine to reduce bleeding, and sodium bicarbonate to reduce swelling and stinging.

 Most patients feel a little tugging, pulling, pressure, or tickling during this process. Areas around the bones or old scars are always the worst.

 Dr Johnson asks for your feedback. You do need to realize that if you are going to feel discomfort during the procedure it is going to be during the numbing process, however if you are hurting then you need to let us know. We can go slower or give you more medication. Our goal is always to make this a good

experience for you.

Applicable Health Factors

 We may draw blood work before your SmartLipo/Vaser procedure. We draw the labs to ensure you are in optimal health before your procedure.

 In the case we draw blood it is common for us to do an HIV and/or Hepatitis C panel.  If either of these panels are positive we WILL tell both you and required government agencies.

Other Risks

 Please understand that we can’t foresee everything that could happen with your body. Nor is everything that happens within the week(s) after your procedure due to the procedure. We have done our best to outline the foreseeable risks but each person is different and reacts differently

 Though extremely unlikely Vaser and SmartLipo could burn the skin. This is typically a burn like you could get off the oven and will go away after a few days.

 Allergic reactions to anesthetic can happen, but are very uncommon, and is part of the reason you are monitored during the entire treatment.

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Liposuction Pre-procedure Consent

1) No smoking for two (2) weeks prior to and for two (2) weeks after your procedure. Smoking decreases circulation and slows wound healing time.

2) Do not take vitamin E or K, Aspirin, or Aspirin containing products for two (2) weeks prior to treatment and for two (2) weeks after treatment. See medication sheet (page 7). Also caffeine containing products (including chocolate) cause mild dehydration, so they should be avoided for three (3) days prior to treatment and for three (3) days after treatment.

3) Do not drink alcohol for two (2) weeks prior to your procedure. Excessive drinking may create complications and increase bleeding and bruising.

4) Please shower using antibacterial soap the day before and the morning of your procedure

5) Eat: a moderate meal for breakfast and/or lunch the day of your treatment

6) Please arrive 30 minutes before your scheduled appointment time. This allows us to pre-medicate, mark the treatment areas, take pictures, measurements, and vital signs. Bring to the office the following items: 1) sports bra (women) 2) slippers or socks 3) dark loose clothes and 4) wool cap

7) You will need a prescription for an antibiotic. The antibiotic should be taken the morning of the procedure and for 5 days after. If you have any questions about your medication please call our office.

8) Wear loose fitting dark clothes to our office. No jewelry. A little make-up is fine. Old sweatshirts and sweatpants are recommended because of possible drainage from your procedure.

9) Please make arrangements for a friend or family member to bring you to the office and also drive you home after the procedure. Expect to be in the office 3 to 6 hours.

10)The procedure itself is relatively pain free. During the numbing process, reactions vary. You may experience, at times, a stinging and burning sensation from the injection of the tumescent fluid (local

anesthetic). Please expect intermittent discomfort similar to a pinching feeling and pressure for the duration of the numbing process. During the suctioning, you may feel pressure in spots, especially in the abdominal area. Most discomfort can be relieved with the injection of more anesthetic, so it is important to

communicate with Dr Johnson.

11) Please arrive 30 minutes before your scheduled appointment time for pictures, measurements, body fat analysis, and vitals

*Please have available at your home sanitary pads that will be used to cover your incisions. We recommend the old-fashioned hospital type that can be found at CVS or Walgreens.

If you have any questions or concerns, please call our office: Grapevine 817.410.7970 Dallas 214.420.7970 If you should have questions after business hours these numbers will forward you to the answering service.

I have read the Pre-Procedure instructions and fully understand what is contained therein:

___________________________________________________________ _________________________

Patient Date

__________________________________________________________ _________________________

Witness Date

Day of Procedure things to Bring

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Medication Precautions

These instructions are to be followed before and after your procedure. If you are on any rheumatoid, anti-arthritic, circulation, or anticoagulation medication (Motrin, Naprosyn, Plavix, Presantine, or Coumadin), please inform us immediately.

1) For two (2) weeks prior to and after the scheduled procedure, please do not take any medications that contain Aspirin or Aspirin related products

2) Do not take any pain medications other then Tylenol for two (2) weeks prior to the procedure

3) Aspirin has an effect on your blood’s ability to clot and could increase your tendency to bleed at the time of treatment and during the post-treatment period.

4) Please check the labels of all medications that you take, even those available without a prescription to make sure you are not taking any aspirin or aspiring-like substances

5) Please consult your physician before stopping any prescribed medications

The following is a list of medications and substances that can increase your tendencies to bleed:

Advil Alcohol Adderall Vitamin E Alka Seltzer Anacin Anaprox Anaproxin APC 5 ASA Ascodeen Ascriptin Aspirin Bufferin Cephalgesic Cheracol-Capsules Children’s Aspirin Cinoril Congesprin Cope Coricidin Coumadin Darvon Darvon with ASA Dolobid Dristan Easprin Ecotrin Empirin Excedrin Feldene Fiorinal 4-Way Cold Tabs Ibuprofen Indomethanic Meclomen Medipren Midol Motrin Nalfon Naprosyn Nuprin Percodan Phenaphen Quagesic Robasisal Rufin Sine Off Sine Aid Trandate Trental Trigesic Trilisate Vanquish Voltaren Zactrin Zorprin

If you need minor pain medication, please take acetaminophen (Tylenol) or another non-Aspirin medication. Tylenol or Anacin 3 are available at your local pharmacy without a prescription and have comparable pain relief to that of Aspirin. If you are allergic to Tylenol or are unable to take it for other reasons, please notify us so that we might arrange for a suitable substitute.

I have read the medication precautions for liposuction and fully understand its contents.

______________________________________________ ___________________________

Patient Date

_____________________________________________ __________________________

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Liposuction Procedure Operative Consent Form

I have had the opportunity to ask questions about the treatment, its limitations and possible

complications. By placing my initials next to the following item, I express that I clearly understand and accept the following myself or through my legal guardian.

_____ 1) The goal of liposuction, as in any other cosmetic procedure, is the improvement of appearance; NOT

PERFECTION. It does not guarantee the reduction of any measurements, including the neck, waist, and all other areas. _____ 2) The final results will not be apparent for 3-6 months post-treatment. There is NO GUARANTEE that the expected or anticipated results will be achieved.

_____ 3) In order to achieve the best possible results, a “touch-up” treatment may be required. There will be a supply cost charge to you of $500 an area.(liposuction only, not applicable on fat transfer/grafting)

_____ 4) Areas of “cottage cheese” texture (cellulite) will have little change after liposuction

_____ 5) Liposuction is a body contouring procedure and is not performed for purposes of weight reduction.

_____ 6) Strict adherence to the post-operative regiment discussed by Dr Johnson (wearing the elastic garment for at least 2-3 weeks, exercise, diet and all other regimens discussed) is necessary in order to achieve the best possible results.

_____ 7) There is a deposit the day you schedule, and the remainder of the balance is due the day of your treatment before the treatment is performed.

Although complications following liposuction are infrequent, by placing my initials next to the following, I understand that they may occur.

_____ 8) Bruising is a common result of the treatment. Any bruising that occurs should resolve within 2 to 3 weeks. _____ 9) Swelling occurs commonly in the treatment area. The swelling usually resolves in 3-6 weeks, but can last several months.

_____ 10) Post operative pain can be controlled in the majority of patients with Tylenol or Ibuprofen. However some patients require more aggressive pain management. For this reason you will receive a prescription for a narcotic pain reliever to take as necessary.

_____ 11) Bleeding is rare, and in rare cases could require hospitalization and blood transfusion. It is possible that blood clots may form under the skin and require subsequent surgical drainage. A collection of lymph fluid (Seromas) may develop and will require drainage.

_____ 12) Skin irregularities, lumpiness, hardness, and dimpling may appear post-treatment. Most of these problems

disappear with time, but localized skin firmness, lumpiness, and/or irregularities may be permanent. In dark-skinned patients, hyperpigmented scars (dark to black scars) can occur and be permanent. Other objectionable scarring such as keloids are possible. Other complications such as hematomas (collections of blood under the skin) can occur. If loose skin is present in the treated areas, it may not shrink to conform to the new contour.

_____ 13) Infection is rare, but should it occur, treatment with antibiotics and/or surgical drainage may be required. _____ 14) Numbness or increased sensitivity of the skin over the treated area may persist for months. It is possible that localized areas of numbness or increased sensitivity could be permanent.

_____ 15) Objectionable scarring is rare because of the small size of the incisions used in liposuction, but scar formation is possible.

_____ 16) Skin necrosis (dead skin) may occur as a result of liposuction and may require skin grafting which will leave significant scarring.

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_____ 17) Dizziness may occur during the first weeks following liposuction, particularly upon arising from a lying or sitting position. If this occurs, extreme caution must be exercised while walking. Do not attempt to drive a car if dizziness is present. _____ 18) I have been informed about the new Vaser (3rd_{Generation Ultrasound) procedure and have been informed by Dr}

Johnson that burns of the skin could occur, although every effort will be made to prevent this.

_____ 19) I have been informed about the new Smartlipo (Laser) procedure and have been informed by Dr Johnson that burns of the skin could occur, although every effort will be made to prevent this

_____ 20) Allergic or toxic responses to anesthetic are extremely rare, but possible

_____ 21) In addition to these possible complications, I am aware of the general risks inherent in all cosmetic procedures and anesthetic administrations.

_____ 22) I understand that if I do not have a ride available one will be provided for me at my expense.

You will have a staff member follow-up phone call the day after treatment. You will have an appointment with Dr Johnson 1-2 weeks following treatment. We prefer to do follow-up visits at 3 and 6months post-procedure. Feel free to call during this time if you have any questions or comments

My Signature certifies that I have discussed the above materials with Dr. Bill J. Johnson, and I understand the goals, limitations and possible complications of liposuction procedures, and I wish to proceed with the operation.

I hereby request, authorize and give my consent to Bill J. Johnson, M.D., to perform upon my liposuction procedure and whatever operations, treatments or technical procedures which may be deemed necessary or advisable in the diagnosis or treatment of my case. I also give my permission to have such anesthetics administered as are deemed necessary or advisable. This particular procedure, which I, __________________________________ am about to undergo has been explained to me in detail and I understand in general what is to be done, that there are calculated risks, and that Dr. Johnson has not made any guarantee whatsoever.

___________________________________________ _________________________ Patient Date

___________________________________________ _________________________ Witness Date

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Fat Transfer Procedure Operative Consent Form

I have had the opportunity to ask questions about the treatment, its limitations and possible

complications. By placing my initials next to the following item, I express that I clearly understand and accept the following myself or through my legal guardian.

 The goal of fat transfer, as in any other cosmetic procedure, is the improvement of appearance; NOT

PERFECTION. It does not guarantee the change of any measurements, including the buttock, breast, and all other areas.

 I have read the Liposuction booklet handed to me and clearly understand what is expected of me.

 The final results will not be apparent for 3-6 months post-treatment. There is NO GUARANTEE that the expected or anticipated results will be achieved.

 Strict adherence to the post-operative regiment discussed by Dr Johnson (wearing the elastic garment for at least 2-3 weeks, exercise, diet and all other regimens discussed) is necessary in order to achieve the best possible results.  There is a deposit the day you schedule, and the remainder of the balance is due the day of your treatment before the

treatment is performed.

Although complications following liposuction are infrequent, by placing my initials next to the following, I understand that they may occur.

 Bruising is a common result of the treatment. Any bruising that occurs should resolve within 2 to 3 weeks.  Swelling occurs commonly in the treatment area. The swelling usually resolves in 3-6 weeks, but can last several

months.

 Post operative pain can be controlled in the majority of patients with Tylenol or Ibuprofen. However some patients require more aggressive pain management. For this reason you will receive a prescription for a narcotic pain reliever to take as necessary.

 Bleeding is rare, and in rare cases could require hospitalization and blood transfusion. It is possible that blood clots may form under the skin and require subsequent surgical drainage. A collection of lymph fluid (Seromas) may develop and will require drainage.

 Skin irregularities, lumpiness, hardness, and dimpling may appear post-treatment. Most of these problems disappear with time, but localized skin firmness, lumpiness, and/or irregularities may be permanent. In dark-skinned patients, hyperpigmented scars (dark to black scars) can occur and be permanent. Other objectionable scarring such as keloids are possible. Other complications such as hematomas (collections of blood under the skin) can occur. If loose skin is present in the treated areas, it may not shrink to conform to the new contour.

 Infection is rare, but should it occur, treatment with antibiotics and/or surgical drainage may be required.  Numbness or increased sensitivity of the skin over the treated area may persist for months. It is possible that

localized areas of numbness or increased sensitivity could be permanent.

 Objectionable scarring is rare because of the small size of the incisions used in liposuction, but scar formation is possible.

 Skin necrosis (dead skin) may occur as a result of liposuction and may require skin grafting which will leave significant scarring.

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 Dizziness may occur during the first weeks following liposuction, particularly upon arising from a lying or sitting position. If this occurs, extreme caution must be exercised while walking. Do not attempt to drive a car if dizziness is present.

 Allergic or toxic responses to anesthetic are extremely rare, but possible

 In addition to these possible complications, I am aware of the general risks inherent in all cosmetic procedures and anesthetic administrations.

 I understand that for the 3 months following fat transfer I can NOT diet as the transferred fat cells need the best blood supply possible. Exercise after two (2) weeks is fine and recommended, but dieting will cut off blood supply to the new fat cells and reduce how many survive.

 I understand that at best only 50% to 70% of the transplanted fat cells will survive, so Dr Johnson will originally over fill the area so by the time everything settles we will be closer to my desired results.

You will have a staff member follow-up phone call the day after treatment. You will have an appointment with Dr Johnson 1-2 weeks following treatment. We prefer to do follow-up visits at 3 and 6months post-procedure. Feel free to call during this time if you have any questions or comments

My Signature certifies that I have discussed the above materials with Dr. Bill J. Johnson, and I understand the goals, limitations and possible complications of the fat transfer procedures, and I wish to proceed with the procedure.

I hereby request, authorize and give my consent to Bill J. Johnson, M.D., to perform upon my fat transfer procedure and whatever operations, treatments or technical procedures which may be deemed necessary or advisable in the diagnosis or treatment of my case. I also give my permission to have such anesthetics administered as are deemed necessary or advisable. This particular procedure, which I, __________________________________ am about to undergo has been explained to me in detail and I understand in general what is to be done, that there are calculated risks, and that Dr. Johnson has not made any guarantee whatsoever.

___________________________________________ _________________________ Patient Date

___________________________________________ _________________________ Witness Date

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Consent for Blood Work

Patient Name: ___________________________________________ Date: _______________________ Consent and understand the following:

 I understand that Innovations Medical may draw blood test before my SmartLipo/Vaser procedure can be scheduled.

 I understand that the blood tests Innovations Medical may draw may include an HIV and/or Hepatitis C panel.

 I understand that if either the HIV or Hepatitis C is positive Innovations Medical WILL inform me of these results.

 I understand that by law Innovations Medical is required to report any positive HIV and Hepatitis C results to the Health Department.

 I understand the blood work is to ensure that I am in optimal health before surgery.

***I AGREE THAT THIS CONSTITUTES FULL DISCLOSURE AND THAT IT SUPERSEDES ANY PREVIOUS VERBAL OR WRITTEN DISCLOSURES. I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE CONTENTS OF THIS PERMISSION FORM.

_________________________________________________ Patient Signature

________________________________________________ Witness

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Authorization to Release and Disclose Photographs

This photographic release pertains to photographs taken during the following:

SmartLipo and Vaser

I, _____________________________________(Print name), voluntarily consent to the

Copyright, publication, and use of my picture and likeness by Innovations Medical, PA affiliates, successors, and assignees.

By signing this form, I am allowing Innovations Medical, affiliates, successors and assignees To disclose photographs taken of me before, during and after treatment of the study. (Please initial either yes or no on each line)

For research, educational informational purposes: Yes___ No___ For publications in a medical journal and /or textbook: Yes___ No___ For general advertising, publicity, or promotional purposes: Yes___ No___

I hereby release Innovations Medical from any claim demand, cause, action, or proceeding of whatever nature arising out of publication and distribution of the said photographs in accordance with the terms of this release. This release also includes affiliates, successors, and assignees of Innovations Medical. I also understand that I can revoke or take away my permission to allow Innovations Medical to disclose

photographs of me at any time by sending a letter to Innovations Medical telling him or her not to disclose photographs of me to affiliates, successors, or assignees of Innovations Medical. If I send a letter saying that I revoke my authorization, Innovations Medical will not disclose any more photographs of me after he or she receives the letter. However Innovations Medical will not retrieve any photographs disclosed prior to his or her receipt of the letter.

I understand that once my photographs have been disclosed to Innovations Medical, affiliates, successors and assignees the photographs will no longer be protected by federal privacy laws. However, Innovations Medical, affiliates, successors, and assignees will not use the photographs except as permitted on this authorization form. I understand that I will be given a signed copy of this form.

I hereby release Innovations Medical, its affiliates, successors and assignees, from any claim demand, cause, action, or proceeding of whatever nature arising out of publication and distribution of the said photographs in accordance with the terms of this authorization.

___________________________ __________________________ ___________ Printed Name of Participant Signature of Participant Date

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SmartLipo/Vaser Post-Procedure Instructions

1) Post procedure drainage may occur following the procedure and your garment may develop blood stains around the incisions. Abdomens especially tend to ooze a blood-tinged drainage for several hours (up to 48 hours) after the procedure. Even though this fluid is red, it is only about 1% blood with the remained being injected local anesthetic and tissue fluid. Draining for each patient will vary from mild to excessive. You may have to change you dressings the night of the procedure and periodically for 1 to 4 days. Sanitary pads are recommended. Bandages should be changed at least daily to prevent infection.

Very important: If you have excessive drainage (first 24 hours: have to change the pads more then once every couple of hours, after the first 24 hours: have to change the pads more then 2 to 3 times a day) call the office at:

Fort Worth: 817.744.7901 Dallas: 214.420.7970

2) If you experience nausea and/or vomiting it is probably due to the antibiotic or pain medication.

Please try to take this with food. If it persists, please call our office at: Fort Worth: 817.744.7901

Dallas: 214.420.7970

3) Please have someone stay with you the day of the procedure. This is very important. We want you to take the day of the procedure off. A family member or friend needs to drive you home as you will be given a sedative and pain reliever. Even if you plan on not taking the pre-medication there are times that

unforeseen circumstances occur and therefore we need you to plan on someone taking you home or us calling you a chauffer or taxi. You also need to have a family member or friend stay overnight with you, this night you may be a little groggy and they can help with bandage changes.

4) Please leave compression garments on at all times, except during dressing changes and showers for the first two (2) weeks. Neck patients should wear their garment for 48 hours continuously, and then at night for the following two (2) weeks. Take only a sponge bath for the first 24 hours. You may shower after the first 24 hours and for the first two (2) weeks. After two (2) weeks, you may take a tub bath and swim. You will wear your garment for 2 weeks after the procedure continuously. Some patients benefit from wearing the garment for longer periods to help decrease swelling.

5) A prescription for antibiotic will be given to the patient. Please take the entire prescription as directed.

6) Do not take vitamins E or K, Aspirin or Aspirin containing products, Motrin, or alcoholic beverages for two (2) week prior to the procedure and two (2) weeks after the procedure.

7) Diet notes: Meals are not restricted. Drink plenty of clear fluids. We recommend 6-7 10oz glasses of water a day. Avoid caffeine and alcohol containing beverages for two weeks, no exceptions.

8) Post-procedure discomfort usually consists of deep muscle soreness and improves over the following 2-7 days. A prescription for pain will be given to you to be taken as needed, however take 1-2 Advil tablets every 6-8 hours as needed for discomfort.

9) Clean the incision sites with peroxide and water. You may apply antibiotic ointment (polysporin) and cover the incision site with band-aids once drainage has stopped.

10)Rest for the first 12 hours. Take it easy for the first 2-3 days. You may resume your normal activities as tolerated. If you experience more then mild swelling or discomfort you may be over doing it. This will not affect the results of your procedure. If you have your knees or arms done, elevated them for the first 24

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hours to decrease swelling in the ankles, feet, forearms, and hands. Males and females experience significant swelling in the pubic region after lower abdomen procedures.

11) Do not exercise for two weeks following the procedure. Exercise can increase swelling and pain.

12)Therapeutic massage is very helpful to speed the healing process. Massages may be done as often as every other day. Whirlpools and hot tubs are permitted (2) weeks after the procedure to increase circulation.

13)You may experience mild depression the first week after the procedure. After this time your mood will improve as you see swelling and bruising fade.

14)Avoid sun-tanning until bruising has faded. Remember the goal is improvement not perfection

I have read the pre-procedure instructions and understand what is contained therein: _____________________________________________ _______________________

Patient Date

____________________________________________ _______________________

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Medications

 The doctor and the office staff have called in some prescriptions for your comfort and care. It is important that you use the medications as directed unless you experience abnormal symptoms that might be related to medication usage.

Symptoms such as itching, development of a rash, wheezing, and tightness in the throat would probably be due to an allergy. Should these occur, discontinue all medications and call the office for instructions.  Pain: Hydrocondone is the most common. It is a pain reliever that is used for relief of moderate or

moderately severe post-operative pain. This medicate may cause stomach irritation if taken on an empty stomach. If you are allergic to codine then we will call in a different but equal pain reliever.

 Antibiotic: Duracef this is an antibiotic used to prevent infection following your procedure. You are to take one dose the morning of the procedure and each morning for five (5) days after the procedure. If you are allergic to Penicillin please contact our office and we will call in an equal antibiotic.

 Nausea: We seldom have a patient need a medication for nausea so therefore we do not pre-call-in medication for nausea however if you are nauseated then we will call you in Phenergan. Phenergan is a suppository that helps with nausea and vomiting. If pain medication creates nausea or vomiting, use one Phenergan suppository 15-20 minutes prior to taking it.

Blood Work

 We may perform blood work prior to the procedure. We do this for your protection. We want to make sure you are healthy.

 The blood work will be billable to your insurance. If you don’t have insurance then we will charge you our cost not the patient cost from the lab. This cost depends on the results of the labs, but you can ask your consultant for a price range.

 We will draw a CBC (complete blood panel) – this checks if you have any blood infections.  We will draw a PT and PTT (prothombin and partial prothombin) - these check the existing

coagulation levels in the blood.

 We will draw an HIV – this will check to make sure you aren’t HIV positive. If you are HIV positive we

WILL inform you and are required by law to inform the health department.

 We will draw an Hepatitis C panel – this will check to make sure you aren’t Hepatitis C positive. If you are Hepatitis C positive we WILL inform you and are required by law to inform the health department.

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General Post-Procedure Care

 Very important: If you have excessive drainage (first 24 hours: have to change the pads more then once every couple of hours, after the first 24 hours: have to change the pads more then 2-3 times a day) or pain, call the office at

Fort Worth: 817.744.7901 Dallas: 214.420.7970

Day or night

 Your first 24 hours: We want you to take the day of the procedure off. A family member or friend needs to drive you home as you will have been given a sedative and pain reliever. Even if you have planned on not taking the pre-medication there are times that unforeseen circumstances occur and therefore we need you to plan on someone taking you home or us calling a chauffer or taxi for you. You also need to have a family member or friend stay overnight with you, this night you may be a little groggy and they can help with bandage changes.

 Dressings: Dressings are sanitary pads cut in half and placed over the wounds. We prefer you to not change them more then once every 24 hours. However the first day the drainage tends to be fairly heavy and if you need to change the dressings more frequently cut a sanitary pad in half, double the two half up, and tape across the body. Make sure the time or two you change your dressings some one is there to help you find your incisions and to center them on the dressing. The incisions may be difficult to locate because of their small size. Be sure you do not put the tape directly on top of the incision.

 Activity: Take it easy and pamper yourself. Try to avoid straining. You may return to normal daily activity after 24 hours. However we don’t want you to lift anything more then 5 pounds for two (2) weeks. Do not take any tub baths, get in a hot tub or swimming pool (anything with soaking water) for two (2) weeks. Showers are fine after 24 hours. Avoid exercise for two (2) weeks and then build up slowly back to tolerance.

 Diet: There are no diet restrictions. If you have any post procedure nausea, carbonated sodas and dry crackers may settle the stomach. If nausea is severe, use the suppository. If you feel normal, start with soups and bland foods, and if those are tolerated, progress to a regular diet.

 Smoking: Smoking reduces capillary flow in your skin and can cause bleeding. We advice you not to smoke at all during the two (2) weeks after the procedure.

 Do not take Vitamin E or K, Aspirin or Aspirin containing products: for two (2) weeks after the procedure. These products can cause the blood to not clot and therefore cause you to bleed.

 Alcohol: Alcohol dilates the blood vessels and could increase post-procedure bleeding. Please do not drink for two (2) weeks after the procedure.

 Caffeine: Do not drink caffeine (cokes, tea, coffee, hot chocolate) or eat chocolate in excess. One or two cups when supplemented with nothing else but water all day long is fine. If all you drink is coffee and soda all day then you need to go three (3) days without caffeine.

 Driving: We do not want you to drive yourself home from the procedure. The day of the procedure you will have the sedative in your system do not drive. The day after, be careful driving if taking the pain medication.

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 Post operative appointments: it is very important you follow the schedule of appointment we establish after the procedure. Typically you will come in 1-2 weeks post-surgery to check on the wounds and then not need to come in again until 1, 3, and 6 months for pictures and to check on how your skin is tightening.

Specific Post-Operative Instructions

 Drainage: You will have post-procedure drainage. This drainage is a red-pinky fluid, it is not blood. Right after the surgery a little blood may, or drainage, may get on your compression garment right around the incisions, do not worry about this. Drainage varies for each person. Usually it last 3-5 days. The more areas a patient does the longer the drainage last, so if your drainage lasts for out to a week, do not worry this is common. Sanitary pads are used to cover the incisions and control drainage, they should be changed at least daily.

 Nausea: Though nausea is uncommon it can happen. It is usually due to the antibiotic or pain medications. One thing that helps prevent nausea/vomiting is taking any medications with food. If you have persistent nausea/vomiting please call our office

Fort Worth: 817.744.7901

Dallas: 214.420.7970

 Compression Garments: You will have a compression garment. This garment is good for several reasons. It helps with reducing swelling, it reduces bruising, it helps the skin and muscle heal more tightly together so there is less sag, and helps you feel less sore. Please leave the garment on at all times except for garment changes, showers, or to wash it for the first two (2) weeks. Neck/chin patients should wear their garment for 72 hours continuously, and then at night for the following two (2) weeks. Some patients benefit from wearing the garment longer then two (2) weeks.

 Discomfort: Post-procedure discomfort is usually compared to that of a deep muscle soreness and

improves over the following 2-7 days. A prescription will be given for you to take as needed, however take 1-2 Advil tablets ever 6-8 hours as needed for discomfort.

 Incision Cleaning: It is fine to clean your incisions with peroxide and water. Once any drainage has stopped you can apply an antibiotic ointment (polysporin) and cover the incision sites with band-aids.  Diet: Fat grafting, fat transfer patients MUST NOT diet for 3 months post treatment. You must stay on

the same diet plan you were on before lipo/transfer. As a healthy blood flow to the new fat cells is essential to keeping those fat cells alive.

 Elevation: For patients that have their arms or knees done, elevate them for the first 24 hours to decrease swelling in the forearm, hands, ankles, and feet.

 Swelling: Males and females experience significant swelling in the pubic region after lower abdominal procedures. Ice packs or frozen peas can help reduce the swelling. If you are experiencing more then mild swelling or discomfort you may be over doing it. This will not affect your results.

 Massage: Therapeutic massage is very helpful to speed the heeling process. Massages may be done as often as every other day. Whirlpools and hot tubs are permitted two (2) weeks after the procedure to increase circulation.

 Depression: Some people experience mild depression right after the procedure as they were hoping for instant results no matter how much they knew in their heads they were going to be swollen. It is not

Appointment Date: Appointment Time:

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