General Information

Cellulite is a depression of any shape or size with defined edges seen on the surface of the skin, typically on the buttocks or thighs. A major underlying cause of cellulite are the fibrous bands that tether your skin to the structures below. These bands are called septa. Some septa are good (and you want them as connective tethers), but others stiffen or shrink over time and lead to the dimples we see on the surface and call cellulite.

Am I a good candidate for Avéli™ Long Term Cellulite Reduction?

The best candidates for Avéli™ are individuals of relatively normal weight who have areas of well-defined cellulite on their buttocks and/or back of their thighs and have firm, elastic skin.  It is important to understand the difference between cellulite versus laxity or localized fat.   Up to 90% of women have cellulite.   The Avéli™ treatment will not correct laxity (loose skin) or localized pockets of fat.  Our practice offers body contouring procedures, liposuction, and Renuvion to address these concerns. Please visit these procedure pages for more information as well as the Avéli™ company page.

Patients should be relatively healthy and any medical problems should be optimally treated prior to proceeding with surgery.  The best candidates for surgery are at their goal weight and fitness level.  Weight changes after surgery can lead to changes in the outcome of your surgery.

This procedure does not treat loose skin, but not to worry, we can help you with that too!

Patients need to avoid all nicotine products for at least 4 weeks before and after surgery.

Our staff will review these criteria with you prior to scheduling an appointment to make sure that you are a good fit for surgery.

The Consultation Process

When you make an appointment with our office, we will send you a welcome email for one of our medical record systems, TouchMD.  When you come into the office to discuss a potential procedure, you will be greeted by our office staff.  We ask that you complete all your paperwork prior to your appointment (forms can be found here).  A medical assistant will review your medical history.  Dr. Elswick will then personally meet with you to discuss your concerns and goals, perform a physical exam, make recommendations on what procedures you would be a good candidate for, and then review the recovery process and potential complications.  Dr. Elswick will show you before and after photos of patients with similar body types and results that could be expected when possible.  We routinely document progress with photos, which we take in a sensitive fashion.  These photos are part of your confidential medical record and allow you to track your progress if desired.

Preparing for your Surgery

Any medical conditions should be optimized prior to proceeding with surgery.  If required, you should obtain medical clearance from your primary care physician in a timely fashion (at least one month prior to your procedure).  This allows time for additional testing to be performed if required.

• Medical clearance is generally required for all patients over 50 years old and/or those with certain medical problems (such as a history of diabetes, high blood pressure, high cholesterol, a history of heart problems, history of stroke, and patients on blood thinners).
• Stop certain medications and supplements (a list can be found here).  Most supplements need to be stopped two weeks prior to surgery.  Some supplements have side effects (such as increased risk of bleeding).  Common medications that need to be stopped prior to surgery include but are not limited to blood thinners, some diabetes medications, some weight loss drugs, and some blood pressure medications.  The decision to stop medications depends on the recommendations from your PCP and/or surgeon.

You should ensure you are at a healthy weight and, more importantly, at your goal/ideal weight and fitness level.  Changes in weight post-operatively will result in changes to your results.

You should avoid ALL nicotine products for at least 4 weeks before and after surgery.  If you experience any complications, you need to ensure that those complications have resolved prior to resuming any nicotine use and/or exposure.  We do perform nicotine testing to ensure adherence with our policies.

If desired, you can take the natural supplement, Arnica, to help limit bruising and swelling after your procedure.  We offer this product in our office.

Lastly, in the days leading up to your procedure, ensure you at a well-balanced diet, stay adequately hydrated, and avoid any strenuous exercise.

Where will my surgery be performed?

For cosmetic procedures, your surgery is typically performed at Columbia Surgery Center, our private outpatient surgical suite adjacent to our office.

What type of anesthesia will I have for my surgery?

The Avéli™ procedure is typically performed under local anesthetic.  Local anesthetic (numbing medication) is injected into the areas where you will have surgery and will help limit your pain after your surgery is complete.  You generally will have a prick from the needle and sometimes burning and a pressure sensation when the numbing medicine goes in.

You also have the option to use various types of oral sedation prior to and during your procedure.  These can help you feel more relaxed during your procedure and wear off fairly quickly after your surgery is done, which will get you feeling back to normal more quickly!

The Procedure

For the Avéli™ procedure a few small incisions (about 0.5 to 1.0 cm) will be made in the area of treatment (usually one under the buttock on each side that is treated when addressing the buttocks and posterior thigh).  A solution called tumescent is injected into the treatment area to provide anesthetic (numbing to the area) and help minimize bleeding and bruising. After the tumescent solution takes effect, the provider uses a handheld device to manually target and release the complicated web of septa bands causing cellulite dimples. The provider can confirm their release in real time.  A few stitches will be used to close the incision.  The procedure time will vary anywhere between 30 to 90 minutes depending on the number of dimples treated.

The Avéli™ procedure can be performed in isolation or in combination with other procedures (for example, skin excision, liposuction, skin tightening, or fat transfer).

Recovery

Time

Moderate discomfort, pain, and numbness at the procedure site is expected.  Most of this will subside within the first 24 hours. You will likely feel sore and tender for 1 to 2 weeks. Most of your discomfort can be controlled by over-the-counter medication such as Tylenol or Motrin.

Recovery is typically a few days.  Your cellulite reduction results should be visible once swelling and bruising subsides. By one-month post-procedure you should start to see the effects of the procedure but it will take six months to see the final results.  To expedite the resolution of swelling, we offer numerous treatments at our spa including Endermologie, Velashape, and lymphatic massage.  For recommendations on scarring please look at our FAQ.

Work

Most patients will take 1-2 days off work.  The amount of time required depends on your recovery, your preferences, and what you do for work.  Patients who work from home or have a desk job may be able to resume work as soon as the next day.  If you have a physical job or one requiring repetitive movements, you may need to take 1-2 weeks off work.

Dressings, Drains, and Compression Garments

Dressings typically consist of absorbent pads and compression shorts such as Spanx or gentle shape wear.  The pads can be removed two days after surgery.  After they are removed you do not require a dressing.

The compression shorts should be worn for up to 2 weeks.  We typically provide two sets of compression garments, but just like any other piece of clothing they do not fit all patients the same.  You may purchase alternative garments as long as they provide moderate compression.

Activity Restrictions

You will have activity restrictions in place during the recovery period.  These entail no strenuous exercise (generally keeping your heart rate less than 100 beats per minute), no heavy lifting (more than 10 pounds) for 1-2 weeks.   Generally you can walk as much as you want after surgery (at a leisurely pace).

Driving

You may drive when ALL the following conditions are met:

1. You are 48 hours out from general anesthesia or IV sedation.
2. You have not taken any narcotics (such as oxycodone or Tramadol/Ultram) or benzodiazepines (such as Valium or Xanax) for 24 hours.
3. Your pain is well enough controlled that you can safely drive a car (i.e. you can turn the steering wheel and push the gas/brake pedal without a delayed reaction secondary to pain).

Follow up Appointments

We believe in providing exemplary care so will see you regularly while you are recovering to guide you in this process and monitor for any complications.   You will see Dr. Elswick regularly in conjunction with our Nurse Practitioner and team of medical assistants.  We are always available after hours if needed for emergencies by calling our office at (248)524-0620.

Risks of Surgery

All surgeries come with some degree of risk and complications.  However, most patients experience no or minimal complications.  We believe in transparency and properly informing patients of things that could go wrong.  Your decision to proceed with surgery assumes that the potential benefits outweigh these risks and hence you are accepting of these possible risks.  It is extremely important that your surgeon discuss these risks with you so you can make an informed decision to undergo this procedure.

The most common side effects reported were mild pain within the first 24 hours and bruising and tenderness to the touch which typically resolved within 30 days. Small areas of firmness, usually not visible or painful, typically resolved in a couple of months.

For any surgery there is a risk of bleeding, infection, wound healing problems, unfavorable scarring, changes in sensation, need for additional surgery, and the risks associated with anesthesia.  There is also the potential for changes in the results of your surgery with weight gain or loss, aging, and hormonal changes (such as pregnancy, breast feeding, and menopause).  Moreover, people who have poor skin quality (secondary to weight loss or gain, stretch marks, aging, and/or sun damage) will not have as good of a result as those patients without these factors.

To decrease your risk of complications, you need to ensure that you are doing your part to create optimal healing conditions, including following all pre-operative and post-operative instructions and adhering to the guidelines listed in “Preparing for your Surgery” above

WHY CHOOSE REVITALIZE PLASTIC SURGERY

At Revitalize Plastic Surgery, we are committed to delivering exceptional, patient-centered care with personalized solutions to help you look and feel your best. Led by a highly skilled and board-certified plastic surgeon, our practice combines advanced surgical techniques, the latest non-invasive treatments, and a compassionate approach to provide outstanding results in a safe and comfortable environment. Choose Revitalize Plastic Surgery for results-driven care and a refreshed, confident version of yourself.  Your transformation starts with us!

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To make an appointment, please call our office at (248)524-0620.  We look forward to meeting you and providing you with exceptional care!