FAQ Before Surgery

The BMI limit depends on the surgery. Please see the BMI limit for each of the following surgeries:
BMI 35 for tummy tuck
BMI 35 for 360lipo or BBL

BMI 28 for 360lipo or BBL combined with another surgery (such as tummy tuck)
Patients that have had previous 360lipo or BBL cannot undergo a second round BBL with tummy tuck combo at the same time. Such patients have to stage the tummy tuck and second round BBL because all of the scarring from the previous lipo/BBL makes doing these surgeries together harder for the surgeon and patient recovery.

– Comprehensive metabolic panel (CMP)
– Complete blood count (CBC)
– HIV test
– Beta-HCG pregnancy test (for women)
– Medical clearance letter (for patients age > 40 years old or specialty specific medical problem), including height, weight, BMI
– EKG (for patients > 40 years old or cardiac history)
– Mammogram (for patients having breast surgery > 40 years old)
– Breast ultrasound (for patients having breast surgery 30-39 years old)
If you wish to have these tests done at Xiluet, you need to be in Miami 3 days prior to your surgery. The costs of those tests at Xiluet are $100 for blood work, $50 for EKG, $80 for preop clearance by a primary doctor near the clinic, and/or $120 for cardiology clearance by a cardiologist (Dr. Aldo) near the clinic.
A nicotine test and a drug test will be performed on the morning of surgery. If you are nicotine positive or positive for any controlled substances, your surgery will be cancelled. If you are positive on the morning surgery, you will be charged $1500 a cancellation fee.

The prescription medications you need will be provided on the day of surgery. The medications can be picked up by your caregiver so that they are ready once you leave the recovery room. Medications will include pain medication, an antibiotic, and an anti-nausea medication. Lovenox injections will be provided to thin the blood to prevent blood clots in patients that are at high risk due to lack of mobility or personal/family history of blood clots.

Psychiatric medications do not need to be stopped before surgery. Blood pressure medications should be taken the morning of surgery with a sip or water. All blood thinners including aspirin, Plavix, NSAIDS (ibuprofen, naproxen, etc), or Coumadin must be stopped 2 weeks before surgery. You must also stop all herbal medications 4 weeks before surgery because some of these medications thin the blood and can increase bleeding risk.

Patients getting liposuction should take iron supplements 3 times per day (one with each meal) until your surgery date in order to get your hemoglobin level as high as possible. This will help make sure your level is high enough to be eligible for surgery, avoid extra costs of Cellsaver to return your blood to you during surgery, minimize the changes of needing a blood transfusion after surgery, and speed up your recovery. Even without surgery, iron is good for you. Hemoglobin is the oxygen carrying molecule in your blood. Having a high hemoglobin is good for everyday living so that you have more energy and stamina. Many women of childbearing age have low hemoglobin because of menstruation. For gastric bypass patients that cannot absorb iron, iron infusions by the doctor managing your nutrition may be needed.

For any procedure involving 360lipo (including BBL), your hemoglobin level needs to be 13 or above before surgery. Your hemoglobin level should be 13 or greater. If your hemoglobin is 12-13, you will need Cellsaver to return your lost blood to your during surgery, but this increases costs. If your hemoglobin is less than 12 and you are getting liposuction, you will have to postpone your surgery until you have improved your hemoglobin with iron supplements.

You should eat healthy food of any kind. Eating foods high in iron is especially helpful. Foods high in iron include red meat, liver, seafood, spinach, beans, tofu.

Essential items: ABD pads. Bottled water. Iron pills. Adult diapers (for liposuction patients). Protein shakes. Hibiclens soap. Compression stockings. Abdominal binder (for abdominal liposuction or a tummy tuck), and a surgical bra for breast surgery. An abdominal binder will be worn first before a faja, which can be fitted to size later once you know how much swelling you have after surgery.
Optional items: foams, boards, female urinal.
Optional over-the-counter medications: Benadryl for itching, stool softeners

Please let your preoperative coordinator and the doctor know about any past medical problems, previous surgeries, medications you take, any allergies, any smoking or drug use, any history of blood clots, bleeding disorders, or problems with anesthesia in you or your

family. For females, please let the doctor know about prior pregnancies or miscarriages. For patients that had massive weight loss, please let the doctor know. For patients getting breast surgery, please let the doctor know about any family history of breast cancer and the age of any immediate family member at the time of diagnosis. If you have been diagnosed with HIV, please let your preoperative coordinator know prior to arriving at the clinic because additional laboratory tests are required before surgery.

Do not apply deodorant on the morning of surgery. Do not shave body hair with a razor that leaves microscopic cuts on the skin within 3 days of surgery because this increases infection risk; you may use scissors or an electric clipper that does not leave cuts on the skin because this does not increase the risk. Remove any synthetic nails from the index finger of your right hand to allow monitoring of your oxygen via that finger. Do not apply any perfumes or make-up on the morning of surgery. Do not wear any jewelry or bracelets on the morning of surgery. If you have any metal that cannot be removed, please let the person checking you in for surgery know. If you are menstruating on the day or surgery, this is not a problem; just let the nurse when you check in for surgery.

Yes, it is important to stop smoking for 4 weeks before surgery. Nicotine products decrease blood flow. Using nicotine products increases your risks of infection, skin necrosis (nipples for breast lift/reduction, abdominal skin for tummy tuck, face skin for facelift, nasal skin for rhinoplasty), and fat necrosis (for fat transfer).

Yes, you should stop drinking alcohol 2 weeks before surgery.

Liposuction is a procedure that removes fat but does not change the quality of the skin. Liposuction requires good elastic skin so that the skin will shrink down to the new underlying shape after the fat is removed. If the skin is already loose before liposuction, it will not shrink and can actually become more loose.

Tummy tuck is a procedure that removes loose, stretch-marked skin and tightens the abdominal muscles that have been separated from pregnancy or obesity with visceral fat prior to weight loss. Therefore, a tummy tuck is usually the best procedure for women that have had children or people who had massive weight loss. The belly button is also reshaped during a full or extended tummy tuck. For patients with only a mild amount of loose skin limited to below the belly button, especially if a C-scar is present, a mini-tummy tuck with scar similar to the size of the C-section scar may be preferable. The abdominal muscles can be tightened with mini- tummy tuck by floating the belly button.
Some patients may want to avoid the tummy tuck scar; however, having a well-healed, well- hidden bikini scar with a flatter, tighter abdomen with less stretch marks is much more preferable. Liposuction can also be combined with a tummy tuck to remove fat in addition to

the loose skin removed with the tummy tuck for an overall more superior result; however, liposuction should not be considered an alternative to a tummy tuck.

360lipo or lipo360 means liposuction that is performed 360 degrees (all the way around the body). This includes liposuction of the abdomen, flanks, and back. Additional areas such as the arms or thighs can be added but are not included in 360lipo.

The abdomen contains 6 areas: upper abdomen (2), lower abdomen (2), front sides (2). The back contains 6 areas: upper back (2), lower back (2), back sides (2). Therefore, 360lipo includes 12 areas. The areas are designated in pairs such that there is one area on the right and one area on the left for each section of the body. Other common areas include: arms (2), inner thighs (2), outer thighs (2), chin/neck (2), axilla/bra fat (2).

When liposuction is performed alone (with or without fat transfer), the maximium amount of SUPERNATANT (PURE) FAT that can be removed is 4 liters. When liposuction is combined with another procedure (such as breast or tummy tuck), the maximum amount of SUPERNATANT FAT that can be removed is 1 liter.

LIPOASPIRATE includes all of the contents removed during liposuction, so it contains fat and a lot of other material including blood, oil, and wetting fluid (fluid injected into the patient to stop bleeding before liposuction). The pure fat without any of the other stuff is called SUPERNATANT FAT. There is no limit on LIPOASPIRATE because that volume highly depends on how much wetting fluid is put in prior to liposuction to help perform the liposuction.

1 liter of SUPERNATANT FAT weighs about 2.2 pounds, which means it is actually quite a bit of fat in most patients with a healthy BMI. However, it is important to remember that liposuction is a shape-changing procedure and not a weight-reducing procedure.

The amount of fat transferred depends on several factors.
1. The first factor is how much fat can be removed during liposuction. If 4 liters of supernatant fat is removed during a BBL, 2 liters of fat is available for transfer to each buttock. However, each buttock may not be able to receive that much fat.
2. The second factor is how much space is available to receive fat. The amount of fatty tissue already present in each buttock determines how much fat the buttock can receive; the more fatty tissue present, the more transferred fat it can receive. The reason for this is that the transferred fat cells need to have surrounding living fat cells to be intertwined with in order to provide the transferred fat cells with nutrients to survive.
3. The properties of the patient’s skin is also important. Skin that is more loose or stretches easily can receive more fat. Skin that is tight or scarred cannot receive as much fat because the skin resists being pushed out by fat.
Once the transferred fat starts spilling out of the injection openings, that means the body cannot receive any more fat. Sometimes it is helpful to make the analogy to a bucket of water.

Once the bucket is filled to the top and starts spilling water, that means that is all the bucket can hold. Once the buttock starts spilling out fat, that means that is all the buttock can hold. Trying to overfill the buttocks with fat that it does not want to hold can result in complications such as fat necrosis. Safety should always be the top consideration. It is always possible to add more fat in a second round later, and usually more fat can be added in the second round than a first round because there is now more space (more fatty tissue present than the first round), as described in factor 2 above.

In general, 5-10 lymphatic massages are recommended. Many patients find these massages relieve the pressure of swelling and find them comforting. You may desire more or less massages, which you should discuss with your massage therapist at your massages, as she will know best based on how your massages are going. Lymphatic massages are most helpful over liposuction areas. After a drainless tummy tuck, the central abdomen should not be massaged where the progressive tension sutures are placed internally to avoid disrupting them. Massages should not be performed after breast augmentation to avoid moving the implants out of place.

There are different grades of breast droopiness/sagginess known as ptosis in medical terms. The best way to assess for the need for a breast lift is to evaluate the breast from the side to see if the nipple is located at the level of the breast fold or below. If that is the case, the patient would benefit from a breast lift. If there is a lot of lower pole breast tissue below the fold even if the nipple is above the fold (called pseudoptosis), the patient would also benefit from a lift to tighten the lower pole tissue. The best way to achieve that is with an inverted-T scar that goes around the areola, a vertical scar from the areola to the fold (to

tighten the tissue below the nipple), and often a small horizontal incision hidden in the fold under the breast (not visible in most positions). A circumareolar technique (scar all the way around the areola) can be used to tighten breast tissue to a lesser extent, lift the areola to a lesser extent, shrink the areola size, and correct previous irregular scarring around the areola; however, it is limited in its lifting ability and not very effective at tightening hanging lower pole skin. It also tends to flatten the breast. It is beneficial in a constricted/tuberous breast. The crescent technique (half way around the upper areola) is effective at moving just the areola upward without substantially changing its size to correct minor asymmetries or positioning of a normal sized area.

This is often a personal decision and not a mandatory decision. The advantage of implants with a lift is that the implant will create a more rounded appearance to the breast, will add volume, and will increase upper pole fullness. A breast lift without implants will not obtain these advantages, but a nice shape can be achieved by placing internal parenchymal sutures that helps reshape the breast internally to achieve a more rounded, lifted appearance. If the patient’s areola is very large, a large amount of skin has to be removed so that no darker pigmented areola skin is left behind, and those patients may not be able to receive an implant until a second stage.

Silicone implants look and feel more natural. Saline breast implants are made of salt water, which means they feel similar to a water balloon and have a high chance of visible rippling. Gummy bear implants are a type of silicone that is more cohesive, which means it holds its shape compared to the older, more liquidy silicone that could spill out.

You will be given your exact surgery time the day before surgery at the end of the day. You will receive a phone call and text letting you know the time to arrive for your surgery the following day. Larger combinations surgeries and patients with certain medical conditions (e.g. diabetes) are typically put earlier in the morning because they require greater care during the day for safety reasons.

You will return to the clinic on the first day after surgery to see doctor medical assistant. She will help change your dressings and make sure that everything appears normal after surgery. The doctor will be available in case of any concerns. If you are a traveling patient, you must follow-up with doctor on the day prior to leaving Miami, which will be at approximately 1 week postop in most situations. It is important that you follow-up twice in the clinic before leaving Miami. If you live within several hours driving from the clinic, you may leave when considered safe based on your surgery type and medical condition and return to the clinic for your second follow-up visit at 1- week postop.

The timing to travel home after surgery depends on the type of surgery you had. We recommend that you stay for at least 5 days following breast surgery, 7 days following Brazilian Butt Lift (BBL), 7 days following tummy tuck, and 7-10 days following combination surgery (e.g. mommy makeover, BBL + tummy tuck, etc). If you are driving a far distance, we recommend that you take a break every hour on the road to get out of the car to stretch your legs to improve circulation to avoid getting blood clots. If you are flying home, we recommend that you get up and walk up and down the aisle of the plane every hour to avoid getting blood clots. Therefore, we recommend getting a first-class or aisle seat for your plane ride home. There are no risks to breast implants from pressure changes while flying, which is a common myth. Before going to the airport, please call your airline to check about their policies regarding flying following surgery so that you do not experience any unexpected delays at the airport. If you need a letter to fly home, please let one of the medical assistants know so that they can prepare that for you.

A woman must wait 6 months after giving birth to have a tummy tuck. A woman must wait 6 weeks after milk production has stopped to have breast surgery.

If the plastic surgery procedure is performed on the same area of the body as the previous surgery (i.e. tummy tuck following hysterectomy), it is best to wait at least 6 months for the swelling to resolve and the tissues to heal. If the plastic surgery procedure is performed on a different area of the body (i.e. breast lift following hysterectomy), it is best to wait about 6 weeks when the patient has recovered from a health standpoint since operating in another body area will not interfere with the previously operated area. If you underwent weight loss surgery (gastric sleeve or bypass), you should wait until you have lost all of the weight that you want to lose and your weight has stabilized prior to getting body contouring plastic surgery.

All payments for surgery must be received in full 2 weeks prior to the surgery date. You can reschedule your surgery without a penalty up to 2 weeks prior to the day of surgery. If you reschedule within 2 weeks of the date of surgery, there is a $500 fee to reschedule. Rescheduling should also take into account the time frame of the duration of the promotion you received.

If you decided to cancel surgery before 2 weeks prior to the day of surgery, there is no penalty, but you will forgo the deposit, which is non-refundable. If you decide to cancel surgery within 2 weeks of the date of surgery, there is a $1500 fee to cancel in addition to forgoing the deposit.

Remember if you do not find your answer in our FAQ, contact your coordinator or your pre-op.