How To Go From “Oww” to “Wow!”

Camille G. Cash, M.D. Aesthetic Plastic Surgery

Mommy makeover and tummy tuck surgery yield some of the most dramatic results as well as the highest patient satisfaction rates.  The inevitable drawbacks of these popular procedures, namely post-operative scarring and pain during healing, are now being significantly minimized with the help of ongoing advancements in the medical field.

Most find a scar to be an easy tradeoff for their newly flat and contoured abdomen, and in fact, most are pleased to find that after about a year of healing the scar fades to white or silver and is much less noticeable.  Better yet?  Now, with Embrace® active scar defense, we are able to proactively minimize the appearance of scars before they even form by relieving tension along the incisions during the healing process.  Tension is the #1 root cause of scarring so incorporating embrace® scar therapy has really been a game changer in the medical field.   As a plastic surgeon, it has been incredibly rewarding to be at the forefront of scar reduction and to be able to help patients further enjoy the benefits of their newly sculpted and restored figures!

While primarily elective, Plastic surgery is still surgery so it should come as no surprise that some pain will be involved during the first few days of healing.  Amongst the surgeries I perform, Tummy Tucks rank high in terms of post-operative pain.  In the past, this pain has been managed quite well by a pain pump. The pain pump is a device that disperses an anesthetic to the surgical area by way of a couple of tubes, positioned by the surgeon at the end of surgery, through the skin of the upper abdomen. The anesthetic solution is stored in a bulb about the size of a tennis ball and is automatically dispersed over a period of about three days. The system has worked quite well in keeping the patient comfortable, however, the device which is in a bag worn by the patient with a strap going around the neck, proved to be somewhat cumbersome and restricted the patient’s movement.

In keeping up to date with the latest innovations, starting in 2012 I began using Exparel® to manage pain after tummy tuck and mommy makeover surgery. Exparel® is a slow release numbing agent that is a onetime injection I perform at the end of surgery. This injectable lasts for about 72 hours, which is the duration of the worst part of the post-surgical discomfort. Exparel® allows the patient the freedom of not having the pain pump tethered to them.

When the brain receives signals of pain, Exparel® will block the nerve impulses, providing relief to the patient. The anesthetic used in Exparel® is bupivacaine, more commonly known as Marcaine, which is suspended in liposomes that slowly release the drug.

Most patients tolerate Exparel® very well.  Exparael® may not be recommended if you have any of the following conditions so it is important to discuss your health history with your surgeon.  Health factors to discuss include any past problems with anesthesia, any history of kidney or liver problems, any history of seizures, heart rhythm disorders or heart disease.

While it is not unusual for patients to seek some sort of additional pain relief in addition to the Exparel®, studies show that patients that had the Exparel® injections took about a third less pain relievers than the non-Exparel® patient.  The same study found that Exparel® patients had a faster recovery time with less discomfort[1].

Exparel® is comparable in cost to a pain pump, so it is mostly used in extensive surgeries such as Tummy Tucks and Mommy Makeovers.  However, patients with a low pain threshold or those who are anxious about an upcoming surgery and the initial post-operative phase, it is worthwhile to discuss this pain management option with Dr. Camille Cash during your consultation and pre-operative visits.

[1] Finical, Stephan, M.D., F.A.C.S. “Exparel Controls Postop Pain.” (n.d.): n. pag. Cosmetic Surgery Times. 27 Aug. 2013. Web. 07 Aug. 2016.

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