Patients present to a practice offering high-definition lipoplasty (VASER hi-def™ or VASER 4D Sculpt™) often following media coverage of the procedure or having reviewed the procedure on the Internet or on a website. Invariably, they will already have formed some expectations as to what they might look like following the procedure: athletic arms, sexy curves, and six-pack abs. The patient’s enthusiasm and excitement must be tempered somewhat with a detailed medical discussion of the procedure and steps involved in high-definition lipoplasty. To this end, it is crucially important that the person conducting the initial consultation is the surgeon who proposes to perform the procedure, not a patient adviser, nurse, or other staff member. The consultation should be conducted in a comfortable environment and should not be rushed. A cursory discussion lasting less than 15 min is insufficient and is not in the best interests of both the patient and the surgeon. With a relaxed, pragmatic, and honest discussion, the patient and the surgeon develop a positive rapport. A patient who does not trust the surgeon fully may be dissatisfied with the outcome regardless of the surgical result.

Rather than leading the patient by asking, for example, “what is the problem?”, allow the patient tell their own story. Opening the consultation with “what are you interested in?” is usually sufficient and does not imply that there is any problem. An obese patient who requests to remove “all fat” is clearly unrealistic and should raise a red flag. Patients of normal body weight who wish to reduce bulges and define features in exercise and diet-resistant areas are realistic. Common requests in female patients include toned arms, flat abdomen, reduced bulges in inner thighs, improved curves, and an overall athletic appearance. In men, “six-pack” abdominal wall definition, sculpted pectorals, muscular arms, and removal of superfluous fat in the flanks are the requests most commonly received during a consultation for high-definition lipoplasty. All of these requests can be addressed during VASER-assisted high-definition lipoplasty, either as one extensive procedure or in staged procedures either under general anesthesia or tumescent local anesthesia, with or without sedation.

The procedure must be explained to the patient in detail in terms that are easy to understand, avoiding unnecessary medical jargon. This discussion includes a step-by-step description of the procedure itself, the technology used, and the expected benefits. The postoperative course should be described, and the importance of intensive postoperative care specific to high-definition lipoplasty should be impressed upon the patient. This includes the patient’s role in strict continuous application of compression garments, nutritional support, and attendance at massage and external ultrasound or radiofrequency appointments in the early postoperative course. It is useful to explain the purpose of each facet of postoperative care and remind the patient that suboptimal results, or even complications, may arise if the patient does not adhere to postoperative instructions. The expected benefits are discussed with the patient, and the timeline for visible improvement is given. Although results in terms of improved definition are visible immediately following the procedure, the patient should expect near-complete results as soon as 1 month postoperatively, provided that postoperative care is optimized.

The fees associated with the procedure should be discussed with the patient, as well as any additional fees for touch-up procedures should they be required. Before and after photos of the surgeon’s own work can be reviewed with the patient, but it is important to emphasize that every patient is different, and various factors affect results, including age, body type, skin condition, muscular anatomy and mass, comorbid conditions, and postoperative care.

During the initial consultation, it is important to enquire about the patient’s history of weight loss or weight gain, exercise regime, and dietary habits. If patients have a history of significant weight fluctuations, they are likely to have reduced skin elasticity. This may affect postoperative skin retraction. Patients who do not exercise or exercise infrequently may have poor posture, abdominal protrusion secondary to reduced muscle tone, and fatty areas that may respond to exercise before surgery. It is important to stress to the patient that high-definition lipoplasty cannot be performed in isolation. It is an adjunct to a program of healthy eating and exercise.

A detailed past medical history should be obtained, including previous cosmetic surgery. Enquire whether the patient was satisfied with previous cosmetic procedures or not. Prior surgical procedures on the abdomen, including laparoscopic procedures, have implications for preoperative planning, particularly where surgical scars are adherent to the anterior abdominal wall or incisional hernias are suspected. Previous liposuction on the proposed treatment areas should be documented and may require specific ultrasonic probes in order to emulsify fat in fibrous areas. Cardiac and pulmonary conditions that may preclude extensive high-definition body contouring should be identified in the medical history and review of systems. These include arrhythmias, cardiac failure, pulmonary edema, and chronic obstructive pulmonary disease.

It is helpful to classify the patient according to the American Society of Anesthesiologists patient-physical-status classification (Table 4.1). However, this is only a gross predictor of outcome and not a predictor of anesthetic risk [2]. A history of systemic or endocrine disorders, including hypertension, diabetes, and thyroid dysfunction, requires appropriate investigation and control prior to surgery. Ascertain whether the patient has any personal or family history of thrombosis, embolism, or coagulopathy. A complete list of medications, including herbal and nutritional supplements, should be listed. Medications that are metabolized by the liver’s cytochrome P4503A4 enzymes interact with lidocaine and may increase the potential for toxicity in patients undergoing lipoplasty under tumescent local anesthesia (Table 4.2). Several supplements, herbs, foods, and spices increase bleeding risk or increase anesthetic risk and should be avoided for at least 2 weeks before and for 1 week after surgery (Table 4.3). Similarly, patients who take nonsteroidal anti-inflammatories such as aspirin and ibuprofen are at increased risk of bleeding unless they are discontinued for 10 days prior to surgery. During the history taking, all known allergies should be identified, including allergy to local anesthetics. The history should include general questions pertaining to cardiac, respiratory, endocrine, gastrointestinal, and neurological systems. A history of hypertrophic scarring, keloids, or postinflammatory hyperpigmentation may dictate placement of incisions during surgery.