Archive for the ‘Liposuction’ Category

Does laser (Smart) Lipo offer advantages over other liposuction techniques ?

Monday, January 16th, 2012

I was asked recently by a patient  if laser liposuction was  a superior liposuction technique. The short answer is absolutely not. Laser liposuction is  also referred to as SmartLipo and VASER lipo. Both of these terms are trade marks for laser assisted liposuction. These refer to surgical liposuction, not some of the external beam applications which are promising  outstanding results with no surgery. Those technologies are a completely different topic and will not be discussed here. One thing can be said about some of these nonsurgical techniques: if it sounds too good to be true, it probably isn’t.

Laser technoolgy has been out for years, but most recently some companies have applied this technology for applications in liposuction and have aggressively marketed as being superior to other technologies.The advertising states laser liposuction can be done without general anesthesia, can create better skin retraction, causes less bleeding and therefore less post operative bruising, uses small(er) incisions and can be used on any part of the body. The very same results  occurs with Ultrasonic Assisted Liposuction (UAL), which has been a technology used by many surgeons for liposuction for more than a decade. And some of these claims can be said for any type of liposuction technology if done properly and in the properly selected patient.

Any type of liposuction can be done without general anesthesia, however do not be lead to believe that laser liposuction is somehow painless and therefore no type of anesthesia is required.  Once again I am talking about surgical liposuction procedures.  A local anesthesia  can be utilized for virtually any type of liposuction procedure , as long as the area being treated is small enough to be completely anesthetized safely by local injection of the anesthetic solution. The “tumescent”  anesthesia technique popularized liposuction to a great degree by allowing liposuction to be done without general anesthesia and without  a marked amount of post operative bruising.  This technique utilizes significant amounts of fluid with varying amounts of local anesthetic and epinepherine. This fluid is injected into the area to be treated with liposuction. The local anesthetic numbs the patient to allow for the liposuction procedure to be done painlessly and without the use of general anesthesia. The large amount of fluid allows for the extraction of fat without damage to other structures within the soft tissue. The epinepherine causes the blood vessels to marked constrict which decreases bleeding to a great degree and therefore there is minimal post operative bleeding.  This technique is great when small areas are treated  and limited amounts of fat are to be removed. It can be used in a fully awake patient. Some surgeons will actually have the patient standing up while  performing the liposuction procedure  utilizing the tumescent anesthesia technique.  When large volumes and greater areas are treated at a single setting, then general anesthesia  may be the safer alternative. It is when surgeons inject too much volume of anesthetic solution at one time that  complications occur  which we have all read about. The ideal candidate for local anesthetic techniques are generally within 20 – 30 pounds of their ideal body weight and are trying to improve the contour of specific smaller sites such as love handle or outer thighs. If a large abdomen or multiple  large areas are treated at a single setting then general anesthesia may be the safer alternative. Also general anesthesia maybe a safer choice even if many  smaller ares are treated at a single setting. A qualified and experienced surgeon will be able to make this decision.

Laser liposuction can create superior skin retraction over SAL (Suction Assisted Liposuction) alone, but Ultrasonic Assisted Liposuction (UAL) can create the same type of soft tissue changes that allow for superior skin retraction. Both laser and ultrasonic energy heat the fatty tissue to allow  for its extraction. The technologies differ in how the fatty tissue is heated, but the end result is basically the same. The heat positively affected the deep tissues to allow for better skin retraction. Patients who may be marginal candidates because of their skin characteristics can be suitable candidates if ultrasonic or laser assisted liposuction techniques are utilized. Patients who have poor quality skin may not be  suitable candidates for any type of liposuction procedure regardless of the technology being utilized. Once again a qualified and experienced surgeon should be able to make this determination.

The ultrasonic or laser energy which heats the fatty tissue also allows for  less intraoperative bleeding and therefore less post operative bruising. Once again, the technologies differ in how the fatty tissue is heated, but the end result is basically the same. Even SAL alone does not necessarily create a lot of bruising post operatively if the correct type and proper amounts of fluid is injected into the fatty tissue prior to treatment.

The incision length used to be larger when UAL was first being utilized in the early stages of its use and was widely accepted as a major disadvantage with UAL. This was due to the use of “skin protectors” at the incision sites. The cannula used in UAL  are not necessarily  of a larger diameter than other technologies, but they are made of titanium which can  cause more friction at the incision site and also can become hot with extended use  during the procedure. With experience surgeons found alternative techniques to reduce and eliminate these  downsides of UAL.  Now with improved techniques and experience, these complications can be avoided and the incision length is no longer than with any other technique .

Any type of liposuction technique can be utilized on virtually any body part. There is nothing unique with the use of laser technology which lends this specific technique to one body part over another. With that being said, both laser and ultrasonic technologies make treating more fibrous areas much easier, such as the flank regions and the upper abdomen. Also redo liposuction procedures are much easier and there is less intraoperative bleeding with both laser and ultrasonic technologies over standard SAL.

Do not be mislead into thinking that laser assisted liposuction techniques are superior to all others just because laser is used in the name of the technique.  Always remember that the most important variable in successful and safe liposuction procedures is NOT the type of cannula or technology being used;   what is at the end of the cannula  makes the biggest difference: the surgeon. Be sure that the surgeon you chose for your liposuction procedure is qualified, well trained and just as importantly, well experienced.  Hope this has shed some light on the topic of liposuction and will help you in the future.

 

 

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Liposuction can remove inches from your waist

Wednesday, February 2nd, 2011

Liposuction can remove inches from your waist by removing localized fat deposits at the Flanks (known as “love handles”) and the area of the lower abdomen ( sometimes referred to as a “pooch”).  Liposuction is considered body contouring and is not to be considered as a method of weight reduction, however, in the properly selected individual a dramatic reduction in waist circumference can be obtained.

I just saw a patient in follow up who lost over 7 inches from a single UAL (Ultrasonic Assisted Liposuction) procedure.  This individual was frustrated at prior attempts to lose the “love handles and “pooch”  of the lower anterior abdomen.   In addition, this individual had to reduce the waist circumference by four inches because of occupational requirements. Based on the well localized areas of fat deposits, I was quite certain I could attain this degree of improvement utilizing  Ultrasonic Assisted Liposuction.  Although I do not guarantee or promise a certain amount of circumference loss when performing a liposuction procedure, experience has taught me who can expect the most improvement  We were both pleasantly surprised with the measurements at three months post op.

Ultrasonic Assisted Liposuction (UAL) is especially useful in removing  fat from the flank region of the waist. This area is quite fibrous and the fat is not as easily or consistently removed with conventional Suction Assisted Liposuction (SAL) techniques.  Also,  UAL has the added benefit of potentially increasing the amount of skin retraction, thus improving the final contour of the treated area post operatively.  This individual went from the typical convex deformity of the flank region before the UAL procedure to having a youthful concave curvature to the flank region post operatively. The anterior lower abdomen responds just as favorably to SAL (Suction Assisted Liposuction) as it does to UAL  (Ultrasonic Assisted Liposuction) procedures. This is because this area is not fibrous.  UAL may be more beneficial in this region if there is poorer skin tone or some stretch marks on the skin. This is due to the increased potential to cause a more pronounced skin retraction utilizing Ultrasonic Assisted Liposuction

What liposuction will NOT do is provide an individual with a “six pack”  of the abdomen or increase muscle definition.  It does not matter which liposuction technique is utilized. It is false advertising when you see a before and after photo where an individual goes from being a “fatty” pre op to having  a “Mr. Universe”  physique post op. The same can be said for “Lipo Dissolve” and the other non invasive “laser” techniques  which so often  promises results which simply can not be attained. Remember:  if it sounds too good to be true, it probably isn’t.

Liposuction procedures are not methods of weight reduction!  I often am asked “how much weight will I lose?”.  I have no idea how to answer that question and I have done literally a thousand liposuction procedures over the last fourteen years.  I tell my patients who pose that question the same thing : I can reduce the thickness of the area treated  so that you can only “pinch an inch” post op,  but I can not tell an individual how that will correlate to weight loss.

So how do you know if you can expect to decrease your waist circumference with a liposuction procedure? Only a thorough  examination  and consultation will tell.   There are many factors to be considered and a qualified plastic surgeon who is well trained and thoroughly experienced in the use of liposuction can make those types of determinations.

I have seen many men who present with the classic “pot belly” or “beer belly” who thought that they could “lose their gut”  with a liposuction procedure only to be told “not so”.  In some individuals this type of  deformity is due to fat accumulation inside the abdomen and not an accumulation of fat beneath the skin. Only subcutaneous fat (the fat beneath the skin) can be removed with liposuction procedures.

Other patients have poor skin tone which makes them poor candidates for liposuction. The skin has to be able to retract post operatively for liposuction to be a viable option. Other individuals simply have too much skin and fat to be addressed with  only liposuction  and would be better served with an abdominoplasty procedure,  sometimes with  concurrent liposuction .  Abdominoplasty surgery in conjunction with  liposuction can absolutely do wonders to improve the contour of an individual’s waist.

Of course, no discussion regarding cosmetic surgery  would be complete without stressing the importance of patient safety. You must be in good physical condition to undergo liposuction surgery. Once again, a well qualified plastic surgeon can make that determination.

Posted in Liposuction, Ultrasound Assisted Liposuction (UAL) | No Comments »

Gynecomastia/male breast enlargement

Friday, November 5th, 2010

Gynecomastia (male breast enlargement)  can be successfully treated surgically with  minimal visible scarring in most patients.  Liposuction alone , or a combination of liposuction and surgical excision is used to remove excess fat and in many patients, abnormal breast tissue. The choice of procedures is very much dependent upon each individual’ s physical characteristics, as well as the surgeon’s experience and expertise in treating gynecomastia.

Gynecomastia is more prevalent than most people realize, affecting 10-15% of the male population. The reasons why gynecomastia occurs is beyond the scope of this discussion, but it can be a socially crippling situation for most males. Patients affected by gynecomastia are very reluctant to wear form fitting shirts and often times refuse to remove their shirt in public.  It is amazing to witness the change in self confidence in the patients who elect to have their condition treated surgically. Each one of my patients have gone from wearing loose fitting dress shirts pre -operative to wearing form fitting pull over polo shirts post operative. This type of scenario  is very gratifying for both patient and surgeon.

In my experience, most males who present with gynecomastia (enlarged breast tissue)  are of relatively normal body weight and  have mostly localized fat  in the chest region as the predominant physical finding, with  (and sometimes, without) a variable  amount of palpable breast tissue directly beneath the nipple areoalar complex (the nipple and the dark pigmented tissue around the nipple is referred to as the “nipple areolar complex or NAC).   In this type of patient, liposuction alone , especially Ultrasonic Assisted Liposuction (UAL) can be utilized to remove this tissue to produce a smooth post operative contour of the chest. This is an option only if the patient does not have an excessively large breast and  has good quality skin which will allow for adequate skin retraction post operatively.

Ultrsonic Assisted Liposuction (UAL) has been utilized for the treatment of gynecomastia for years and is the method which I  routinely utilize as well. The ultrasonic energy can remove breast tissue as well as fat provided there is not an excessive amount of palpable breast tissue. Suction Assisted Liposuction (SAL) and its variations, can not reliably address breast tissue.

In patients in which  palpable breast tissue remains after the liposuction  has been performed, surgical excision of the breast tissue is necessary. The incision can be well hidden along the border of the pigmented tissue of the areolar to minimize or completely hide the post operative incision scar. It has been my experience that the scar is not visible at conversational distance given adequate time to allow for healing, usually 8 – 12 months post operative.  Most times I can tell the patient to anticipate a scar depending on my  pre -operative physical  findings, but I always make provisions in the consent process to tell a patient that I may have to perform an excision even if I anticipate that liposuction alone should be sufficient.  There are times when I can palpate more breast tissue in the  operating room after the surrounding fat tissue has been removed than I could pre-operatively.  In this instance, I perform adiitional excsional surgery.

In some patients the most predominant pre operative physical finding is a palpable breast “bud” (  a “breast bud” refers to actual abnormal breast tissue directly beneath the nipple areolar complex which is well demarcated and can be of variable size, from the size of a grape to as large as a plum).  In these cases, excisional surgery is required with a variable amount of liposuction used in order to contour the surrounding chest tissue to prevent what is known as a “saucer deformity”  post operative.  Imagine a circular depression in the chest where the breast tissue had been excised…we all want to avoid that type of situation and that is the reason to augment the excision with liposuction.  Syringe liposuction can be utilized in these cases.  I have never seen a “suacer deformity” in my practice utilizing the combination of techniques.

I have seen patients who are morbidly obese with very large, redundant breasts. These  individuals are not candidates for the types of surgical approaches just discussed. In these individuals a formal breast reduction surgery is required. It is the same type of scarring pattern as seen in the female population. Men  who present with this situation must be accepting of the necessary post operative scarring if they are to have a smooth, flat chest contour post operative.

The only way to know for sure if you are candidate for any of the interventions just discussed is to be seen in consultation by a well trained, highly experienced and properly credentialed  surgeon. Not only will you be educated as to your surgical  options, and  if you are a suitable candidate for surgery, but you  should also expect to  learn about the expected post operative recovery and have all of your questions and concerns addressed.

Posted in Gynecomastia (male breast reduction), Liposuction, Ultrasound Assisted Liposuction (UAL) | No Comments »

Am I a Candidate for Liposuction?

Wednesday, November 3rd, 2010

“I’m interested in having liposuction” is something I hear from patients during consultation on a regular basis. But are you a candidate for liposuction surgery.

First and foremost, liposuction is a surgical procedure and patient safety is the number one concern for any experienced, well trained and ethical surgeon who performs liposuction. If there are any patient health issues which could adversely affect patient safety then the answer would be “no”. Some of the conditions which may preclude undergoing an elective procedure like liposuction would be a history of bleeding problems, ongoing serious heart conditions or a recent heart attack, a history of serious wound healing conditions or conditions which make exposure to anesthesia unsafe. Small areas can be addressed by using local anesthetics so the use of general anesthesia can be avoided, but even a local anesthetic could be dangerous for someone with some of the conditions just mentioned. This list is not by any means all inclusive.

Other considerations in deciding if a patient is a candidate for liposuction surgery is the condition of the skin and the amount of fat which needs to be removed. If the skin is of poor elastic quality (ie older patients, someone with alot of stretch marks or who has lost a tremendous amount of weight and has very saggy skin, certain medical conditions of the skin, etc.) then this type of patient may not be a good candidate for liposuction. The skin must be able to retract satisfactorily after the removal of the fat otherwise a poor result will occur. This situation may also occur if there is a very large volume of fat which needs to be removed. In these situations the only reliable way to achieve a good result is by surgical excision of skin and fat. This is commonly performed on patients who have experienced “massive weight loss” and in patients with poor skin tone for whatever reason.

Ultrasonic Assisted Liposuction (UAL) has been shown to be beneficial in patients with marginal skin tone who may not be considered a good liposuction candidate otherwise. The reason for this is because UAL causes heating of the deep surface of the skin which in turn induces more skin retraction. I have utilized UAL for the past 12 years and I can attest to its effectiveness in this regard.

Another consideration for patients interested in liposuction surgery is that it does require a significant amount of time to see the final results. Patients must be willing to avoid strenuous exercise/activity and also be will to wear the necessary compression garments for several weeks post op. While a patient will note an improved contour immediately, it will be weeks for the swelling to completely resolve. So don’t expect to have liposuction done tomorrow and expect to be laying out on the beach in a bikini next week. It doesn’t work that way.

Another very important consideration regarding liposuction is patient expectations. Liposuction will not give a patient “Christy Brinkley legs” or a “Brad Pitt six pack” regardless of the bogus advertising which claims as much. Liposuction is not for weight control or a substitute for exercise and a healthy lifestyle. However, liposuction is very effective in contouring areas with moderate amounts of well localized subcutaneous fat which are resistant to diet and exercise.

While there are many additional factors to consider for those interested in liposuction, this is still one of the most widely performed cosmetic surgery procedures , and for good reason….it works!! If you are interested in having liposuction surgery, the only way to know for sure if you are a suitable candidate is to see an experienced and well trained surgeon who routinely performs liposuction. Hope I’ve shed some light on this issue. If you have any specific questions which I have not addressed, don’t hesitate to contact us. Thanks for you time. Tim Bradley, MD

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Tummy Tuck (abdominoplasty)

Monday, November 1st, 2010

Saw a patient the other day who wanted an abdominoplasty (tummy tuck)  to improve the contour of her waist after having five children.  She was unsure if she needed liposuction in conjunction with the abdominoplasty procedure. So how do you know if liposuction will be needed and is it safe to do both the abdominoplasty and liposuction procedures together?

First, it is safe to do liposuction with an abdominoplasty if the surgeon has the proper experience and training.  “Lipoabdominoplasty” is the term commonly used nowadays to describe this procedure.  The blood supply to the abdominal skin must be preserved utilizing specific surgical techniques. As long as the blood supply is not compromised then liposuction can be safely performed. Liposuction does add time and complexity to the procedure. Liposuction not only removes unwanted fat from beneath the skin to improve the final result, but it serves a secondary function in allowing the skin to be repositioned during the abdominoplasty procedure thereby enhancing the contour of the waist.

So how do you know if you would benefit from lipopsuction in conjunction with the abdominoplasty procedure?  If you can pinch 2+ inches in the area above the belly button and/or along the sides of your waist or you have “love handles” you are a candidate for liposuction. The excessive skin and fat below the belly button will be removed surgically during the abdominoplasty procedure so this area is not considered when making the pre-operative decision as to whether or not to perform liposuction.

Posted in Abdominoplasty (tummy tuck), Lipoabdominoplasty, Liposuction, Tummy Tuck | No Comments »