Procedures

Liposuction (Body Contour)

Liposuction is the removal of unwanted body fat by suction. The term lipodystrophy is used to describe areas of disproportionate fat placement. Even at a perfect weight, one can have excess fat in any given area. What areas are amenable to liposuction treatment? A better question would be what areas are not amenable! Just about any area you can imagine may benefit from this procedure in the properly chosen patient. Let's make a list:

• Face (cheek, neck, nasolabial folds)
• Dowager or Buffalo Hump (back of neck & upper back)
• Back
• Male Chest (Gynecomastia)
• Female Breast (limited)
• Axilla (armpit)
• Hyperhidrosis (stop armpit sweating)
• Arms
• Abdomen including midriff
• Flanks (hips)
• Iliac crest (top of hips)
• Buttocks
• Thighs 360º
• Knees
• Pubis
• Calves
• Ankles

The best liposuction candidate is contour challenged and is within an ideal weight. However, overweight patients that are carefully selected can greatly benefit from liposuction and often use it as a launch toward further weight reduction. As we all know, weight reduction alone seldom improves contour in problematic areas; the overweight individual often becomes frustrated with dieting. Liposuction can at least insure that the fat will leave specific areas. I have written papers, presented lectures, and given courses for other plastic surgeons on the topic of large volume liposuction. If done properly, large volume liposuction can be done very safely. Dr. Bruce Halperin (anesthesiologist) warns, "always remember, large volume liposuction can be done very safely, but also remember, it is possible that the smallest volume can be dangerous if improperly done." Large volume liposuction is an excellent procedure allowing up to 25+ lbs. to be removed from the proper candidate. If you are in this group, your candidacy and realistic expectations will be extensively discussed.

Many factors play a part in the outcome of liposuction. We have already discussed volume, but contour artistry must also be considered. It is not our desire, nor the patients' to just remove bulk. The goal is to create a more desirable shape. One of our nurses proposed calling this procedure "Lipo Transformation", because we do transform the body's shape. When "shopping" for the right surgeon to perform this procedure, four questions should be asked and the evidence evaluated. Is the surgeon an artist at contour, or just removing bulk? How long has the surgeon been performing liposuction and how many procedures has the surgeon performed? Does the surgeon's work show significant change or is it difficult to determine that anything was done? What is the surgeon's safety record? Just a note of caution here, there are doctors who have technicians or nurses doing wetting solution injections. I do all my own injections. I don't want any abdominal perforations by needles or cannulae. The wetting solution injection is part of the surgery. Only the surgeon is licensed to do the surgery and only the surgeon should do the surgical infusion of the wetting solution (epinephrine, lidocaine, Lactated Ringer's Solution). Always check this step out before your surgery.

Over the years, there have been other liposuction techniques. Liposuction surgery comes under many names: dry liposuction, wet liposuction (tumescent), laser liposuction, large volume liposuction, liposculpture, Smart liposuction, ultrasonic liposuction and my endorsement, Vaser® liposelection. The Vaser® term liposelection does, however, reflect the delicate selective nature of this lower thermal ultrasonic approach.

Let's get a little background on some of these techniques:

In 1982, liposuction was originally performed by inserting a metal cannula with an open tip into the fat layer. Mechanical motion loosened the fat cells and suction removed the fat. Only limited liposuction could be done to protect against blood loss. The old dry technique produced more excessive bruising and bleeding than subsequent techniques. In the late 80's, a new wet technique (tumescent) was introduced involving infusion of epinephrine and lidocaine in saline solution. The epinephrine constricted the blood vessels and thereafter, blood loss was rarely a problem when liposuction was properly done. It is interesting to note that I have taken as much as 28 lbs. of fat with less than a unit of blood loss. Today, essentially all liposuction is via the tumescent delivery.

In 1996, I was appointed to the Ultrasonic Liposuction Review Committee to be one of the original preclinical release evaluators of ultrasonic liposuction in the United States. I was given a new ultrasonic machine, as were selected others with vast experience. For one year, we evaluated the ultrasonic liposuction systems. What is ultrasonic liposuction and how does it work? The wetting solution is instilled in the tissues. A cannula is placed under the skin and passed through the fat causing the fat to emulsify. The control and precision is excellent. The old ultrasonic systems worked, but were a little hot and could produce burns and seromas. Surgeons had to be very careful. Great strides have been made since then. The world-wide state of the art technique is now the Vaser® system. NOT laser, but Vaser®! Unlike the original ultrasonic technique, the Vaser® a second generation ultrasonic technique has a cool delivery that selectively destroys fat cells while preserving blood vessels and nerves. The cannulae in the Vaser® system and the system itself are so safe it is possible to treat the skin with ultrasonic energy and actually shrink the skin to some extent. The Vaser® system was the brain child of William Cimino, Ph.D., the most noted ultrasonic technology expert in the world.

Laser liposuction has come in many waves, all fundamentally proven to be of little value and possibly harmful. The concept was that the laser would blast down the tube and melt the fat and stop bleeding. It simply did not work very well and required a large cannula. The most recent form of laser liposuction consists of a small fiber optic cord of several millimeters that is surgically placed into the fat to melt the fat and then surgically suction the fat. It is for tiny areas. I think it is less efficient than the standard tumescent technique and ultrasonic Vaser® technique. I do not plan to adapt this slow technique that offers no advantage. Of course, I always assess all new techniques and then decide.

Microwave liposuction and radio frequency liposuction never came to fruition. Again, Vaser® is where it is at, until another system is proven better.

The recovery time for liposuction will depend on the magnitude of the procedure. Recovery can range anywhere from a couple of days to 10 days for a very large procedure. During this time, the patient will feel sore and stiff, similar to the feeling you get after over-exercising or lifting weights. Compression garments are placed on the suctioned areas to minimize swelling and will probably be worn for a few weeks. These garments won't interfere with normal work attire. Some numbness can be expected for up to six months. Many patients look good at three to four weeks, while others may need longer for the swelling to go down. Watching the sodium intake is advised for earlier results. Of all the procedures performed, liposuction continues to be one of the most gratifying surgeries for our patients.