Liposuction

One of the most common procedures in plastic surgery, Liposuction involves the removal of fat from the body using special thin metal straws (cannula). The most common question asked during a liposuction consultation is “how much weight should I expect to lose?”

It’s important to realize that liposuction is not weight reduction surgery. Rather, it is meant to sculpt your body into a finer figure. We strongly encourage all patients to lead an active lifestyle and healthy diet in order to achieve their desired figure as liposuction is no substitute for a healthy living. In fact, the best results from liposuction are achieved in those who have given it their all with regards to diet and exercise and have reached a plateau. If such people follow their lifestyles after their liposuction procedure, they are able to obtain the best results with weight loss not jut from the area of surgery, but rather all over their body.

With this brief preface in mind, liposuction patients are categorized into six groups:

1. Mild to Moderately overweight:
The greatest numbers of people coming in for liposuction comprise the first group of patients. They are unable to lose the excess fat at particular areas of their bodies despite an active lifestyle. For genetic reasons, these patients inherit a tendency to accumulate fat in almost predictable distributions. Whether excess fat at the outer thighs leading to a pear shaped figure or love handles that guys just can’t burn off, liposuction is an excellent option for this group of people. If you are in this group, as always we encourage you to exercise regularly and eat a healthy diet with fewer calories in order to increase your metabolic rate before surgery. You should resume your exercise and diet regime 2 weeks after surgery to make use of your higher metabolic rate and lose weight in places that would otherwise be more resistant to your strong efforts. The first group of liposuction patients is expected to enjoy excellent results after their procedures and should see a dramatic improvement in their lifestyle as they can fit into clothes more easily and without as much hesitation in showing off your figures.

2. Excessively overweight
Liposuction is never a substitute for healthy living habits. This is particularly important to realize for excessively overweight individuals. A full medical evaluation in absolutely necessary to look for possible hormonal or other physiological imbalances. Weight loss through exercise, a healthy diet or even a gastric banding procedure is recommended in this group of patients before even considering liposuction. As an additional point, liposuction volumes are limited by the medical boards and the Plastic Surgery societies to 5 liters. This limitation was placed to make liposuction safer for all patients. The five liter limit in liposuction would lead to insignificant improvements in those who are extremely overweight and are considering liposuction as a short-cut to losing weight. If performed properly and at the appropriate time, liposuction can have dramatic results in this group but only after significant weight loss and changes in living habits. We would love to guide to through these changes and assist you in developing the excellent health and dietary habits necessary to lose your excess weight. You only have to come in for a consultation and let us arrange the rest.

3. Fit but desire greater definition:
Many people come to our office with already excellent figures hoping to achieve exceptional figures which they have not been able to accomplish themselves. Typical examples are men who desire a more sculpted six-pack on their abdomen and women who want sculpted and athletic appearing thighs or backs. Some may even wish to have a more sculpted jaw-line or accentuate dimples on the face or sacral region.

Liposculpture, the sculpting of body through liposuction, is used in this group to achieve the unbelievable detail in already beautiful figures. A very narrow cannula (metal straw) is used to carefully and gradually remove fat in small amounts while sculpting the body. Among the various procedures in plastic surgery, liposculpture represents surgery as an art as the body is sculpted much like a piece of carrera marble. Unfortunately though, Liposculpture has been used excessively in the plastic surgery world to become synonymous with liposuction. Indeed much sculpting goes into every liposuction procedure, but to improve an already perfect figure deserves its own distinction and terminology. While we strive to achieve the perfect figure in every patient, it is important to highlight the need for practical expectations. The quality of your tissues, your overall proportion and height, skin elasticity, age and pure genetics must all be considered when undertaking any procedure in plastic surgery. These factors constitute the material with which we have to work with as surgeons and artists in sculpting your figures. Incredible improvements are possible in liposuction and liposculpture, but your ultimate results will always depend on the material we have to work with.

4. Male enlarged breasts (Gynecomastia)
Enlarged breasts in men, called Gynecomastia, can be a source for great anxiety in those men who are unfortunate to have them. Typically the breasts in such people begin to enlarge during puberty. With surge in hormone secretion at puberty, many young men develop enlargement of their breasts in response to the hormones. In most of these young men, however, the breasts return to their normal shape and assume the contour of the pectoralis major muscle. In a few young men, the breasts continue to enlarge after puberty as they never return to their normal size. It’s normal for such young men to be self-conscious about exposing their chest in public and to wear multiple layers of clothing to hide their feminine like large breasts. Another cause for enlarged male breasts occurring later in life is anabolic steroids taken by body builders or people with wasting (progressive weight loss) such as those with HIV or AIDS. Another rare problem which can lead to enlarged male breasts is hormonal imbalance such as increased Prolactin secretion by a brain tumor. A thorough evaluation of the cause for the enlarged breasts it’s therefore necessary particularly in those who notice the onset of their problem later in their adult lives.

Once the appropriate cause for the enlarged male breast has been identified, plastic surgery is extremely effective in dealing with the problem. If small, liposuction alone can remove the excess fat at the breasts. A small incision at each breast is enough to enable us to remove all the excess fat. A thorough job is absolutely necessary as the excess fat in the male breast can be fibrous and tough. If a moderate degree of fat is present, or even in those with mild excess fat at the breasts, a breast bud or firm rubbery breast tissue can be present just under the nipples. Aggressive liposuction will unfortunately not remove this tough tissue at times, requiring an incision around the nipple/areola to surgically excise the tissue. Though the scar around the nipples tends to heal very well, we realize it is not optimal. Every attempt is made to remove the fat and fibrous tissue with liposuction alone. But as a last resort, a surgical excision of the breast bud may be necessary.

The last group of men with enlarge breast tissue includes those severe excess fat and skin. The droopy breasts in such men require a surgery to remove the excess loose skin after the fat has been removed by liposuction. Most patients readily accept the scars resulting from surgical excision of the excess skin at their breasts as they feel anything is better than “man breasts.” To come to this decision, we will spend as much time with you as necessary over a few consultations until you have decided if the male breast reduction is an appropriate surgery for your problem.

5. Skin with mild to moderate decreased elasticity
One of the most important factors determining outcomes after liposuction is skin elasticity. People with greater skin elasticity can have more fat removed by liposuction with better results whereas those with less elasticity can have less fat removed with resulting loose skin after liposuction. To understand this, you must know that at birth we our skin is extremely elastic (it quickly returns to its usual position after being stretched). As we age, however, we progressively lose the elastic collagen in our skin. Our skin takes longer to return to its usual location as it is less “springy.” The perfect analogy is spandex versus linen. Our skin resembles spandex when we are born as it is stretchy and elastic. As we age, our skin becomes more like inelastic linen with no stretch.

After removing the excess fat, we count on your skin to shrink-down to fit your new figure. After a certain age, as you have lost more elastic collagen and subsequently skin elasticity, your skin does not shrink-down as readily leading to excess loose skin. The particular age at which point there is a greater tendency for excess skin is different among people. Factors contributing to early loss of elasticity include genetics, sun exposure and smoking. People who smoke or tan frequently are expected to lose more elasticity at a younger age. As far as genetics is concerned, we are essentially helpless and must do everything we can to minimize the loss of elasticity from other factors. People with very fair skin, blue eyes and blond hair will lose their elasticity at a younger age than those with darker Mediterranean or Asian skin tones.

With these factors in mind, we pay particular attention to your skin type and elasticity at the particular area of concern before ever offering liposuction as an option. Once you pass a certain stage in your life where most of the elastic collagen has broken down in your skin, liposuction results are compromised by development of loose skin after the procedure. It’s a direct relationship: the more fat that is removed, the more excess skin that results from the liposuction. So we weigh the aesthetic benefit of removing a certain amount of fat from your areas of concern against the disadvantage of the loose skin which results from the liposuction.

6. Laser Liposuction
Laser assisted liposuction as developed in the recent years to improve recovery from liposuction. Simply stated, a laser is used to melt the fat prior to suctioning the fat out of your body. The reported advantage to this technique included the immediate burning of the smaller blood vessels thereby minimizing the bleeding and thereby bruising. The disadvantage, we believe, is the inability to fine-tune liposuction results as the melting of fat by the laser is less predictable than removing the fat by a standard cannula (hollow metal straw used in liposuction). So if you have a strong preference for laser liposuction, we will be able to perform it for you. If you are unsure about it, we would recommend waiting another couple of years until final long-term research results are available for us.

7. Power-assisted Liposuction
Power-assisted liposuction is a device which liquefies the fat by reciprocal back and forth motion like a jackhammer. It enables the surgeons to remove fat in an easier manner with less force as the vibrating cannula is able to chisel its way through fat in a smooth motion. For first time around liposuction procedures, this technique is of little benefit for the average patient. In second time or even third time around liposuction revisions, the device enables us to go through scarred fat in an easier fashion.

Another group of patients who would benefit from this device are men. Male fat tissue is generally more dense and fibrous than female fat, making it more difficult to remove. Typical cases of this include abnormally large male breasts (Gynecomastia) and abnormal fat at the upper back from various medications (buffalo hump). The dense fat in such cases can easily be removed using the power-assisted liposuction technique.