Liposuction: Does the fat come back and, if so, where?

August 24, 2012

New study provokes discussion

There is a nagging question that plagues those contemplating liposuction, discussed in an August 2012 Allure magazine blog: “If you gain weight after the procedure, do the new pounds pile on throughout the body – or only in areas that haven’t been treated?”

For years, doctors have noticed that those liposuction patients who consume too many calories and don’t exercise enough usually don’t put on tummy weight after abdominal liposuction but, in a year’s time, store new fat in other bodily areas such as the arms, the back or the breasts.

Dr. Eric Swanson, a plastic surgeon in Leawood, Kansas decided to put this theory to a test; his results were published in a well-respected plastic surgery journal that evaluated photographs of 301 nonobese liposuction patients. Lower body dimensions were measured by photos before and at least three months after surgery. To assess whether or not there was fat increase in the upper body (fat redistribution), upper body measurements were compared among 67 women who underwent cosmetic breast surgery in addition to lipoplasty and 78 women who had breast surgery alone.

The most significant outcome was, according to the study abstract, “There was no difference in upper body measurements when comparing patients who had simultaneous liposuction and/or abdominoplasty with patients who had cosmetic breast surgery alone. Measurements in 46 patients with at least 1 year of follow-up showed no evidence of fat reaccumulation.” Study results show the average weight change was a loss of 2.2 pounds after lower body liposuction and 4.6 pounds when patients also underwent abdominoplasty. Liposuction effectively reduced abdominal, thigh, knee, and arm width.

The conclusion that there is no evidence of fat regrowth gives one plastic surgeon pause. Dr. Gerald Pitman, clinical plastic surgery professor at the NYU School of Medicine, who has written extensively on this subject, feels that, “Liposuction is a superb method for correcting body disproportion with spot fat reduction but it is of no value for losing weight.” He is concerned that the study may lead patients to believe that they can eat as much as they want without consequences, which is untrue. Further, contrary to this study he says, “In my experience, the patient who gains weight after liposuction does increase the size of the body, and usually in areas that haven’t been treated.”

Whether it’s true or not, this has not decreased interest in liposuction procedures in the US. According to the American Society for Aesthetic Plastic Surgery (ASAPS) 2011 statistics, lipoplasty is once again leading as the most popular cosmetic surgical procedure in the United States.

Are they real? Is it easy to spot breast implants?

July 25, 2012

Are they real? Is it easy to spot breast implants?

Are they real? Is it easy to spot breast implants?

The phrase “less is more” may be influencing many women’s decisions on how large their breast implants should be. In fact, many plastic surgeons say smaller breasts seem to be more popular these days. More women are choosing conservative, more natural looking breasts, and some who have breast implants are even looking to downsize.

One of the reasons some women choose a more natural-looking size for their breast implants is so they will enhance their appearance but still look real.

“Breasts are mostly fat and skinny girls don’t have huge breasts, except in very, very rare circumstances,” explained a California-based plastic surgeon to The Orange County Register.

While unnaturally large breasts usually signal that someone has breast implants, there may be some other ways to spot whether or not a woman has them. According to a recent article in Men’s Healthmagazine, other clues include breasts that are too close together, sit too high on the chest and have visible scars.

Of course, some women don’t care if the fact that they have implants is obvious. Others want the most natural appearance possible. Those considering breast augmentation surgery should consult with a licensed, board-certified plastic surgeon to discuss the ideal size and type of breast implant for the look they wish to achieve. In addition, viewing before and after photographs can help potential patients decide if the surgeon can provide a satisfactory result.

According to the American Society for Aesthetic Plastic Surgery (ASAPS), breast augmentation surgery remained one of the most popular surgical cosmetic procedures in 2011, with more than 316,000 total surgeries performed by ASAPS members.

The cost of the surgery varies by location and the type of implant -silicone gel or saline – being used.

In addition to improving the size and shape of the breasts, many women choose to undergo breast augmentation surgery to improve their self-esteem.

Facing the truth: How to look your best

A recent article just came out discussing whether or not face and neck exercises can help make you look younger. The answer: Probably not. If you run a Google search, many electronic and manual devices will come up, but none can conclusively help target facial muscles and rejuvenate your face. While practicing healthy habits like eating a balanced diet and exercising will help you overall, here are some procedures that can keep you looking young without resorting to gimmicks and facial calisthenics.


A recent article just came out discussing whether or not face and neck exercises can  help make you look younger. The answer: Probably not. If you run a Google search, many electronic and manual devices will come up, but none can conclusively help target facial muscles and rejuvenate your face. While practicing healthy habits like eating a balanced diet and exercising will help you overall, here are some procedures that can keep you looking young without resorting to gimmicks and facial calisthenics.


Skin, Skin, Skin – taking care of your skin can go a long way. First step is having a good skincare regimen at home that consists of cleaning, moisturizing and exfoliating. Treatments like facials, microdermabrasion, laser and light skin resurfacing helps maintain and treat conditions like acne, rosacea, large pores, wrinkles and sunspots. For deeper wrinkles, sagging and loss of volume, you may seek out injectables like  botulinum toxin, hylauronic acid and other fillers.


Eyes – they say the eyes are the windows to the soul. If they’re framed by dark circles, sagging lids and crows feet, they might not be representing a clear image (or vision for that matter). Eyelid surgery or blepharoplasty can make your face appear brighter, younger and more welcoming. In combination with fillers and botulinum toxin, your windows can finally reflect a younger you.


Lift it up – a good forehead, face and neck lift should never leave you looking tight or overstretched. Loose skin can be removed, skin smoothed and extra fat “liposuctioned” away. While there are many different techniques and methods, the result should be to turn back the hands of time, so you look like a younger you – not someone else!

Undecided about face-lift

Dr. Wolf in Napa by Carlos Wolf
14 hours ago  •  Carlos Wolf

Dear Dr. Wolf, I have wanted to get a face-lift for the longest time, but every time I see women walking around with taut skin by their ears, I decide against it. I think face-lifts are extremely noticeable, especially around the ear area where the incision is placed in front of the ear. Do plastic surgeons ever do the incision in the hair or behind the ear for a more natural look? When considering a surgeon, what should I look for?

Face-lifts do not have to be noticeable or look tight. If done properly, the face-lift should be an added boost to your look and not take it over.

The incision can be planned to be in the hairline behind the ear and in the temporal hairline above and behind the ear. The incision in front of the ear may be placed inside the ear itself so that the incision is virtually invisible.

The “tight” effect is due to an overzealous surgeon or a surgeon who tightens the skin and not the underlying muscle.

If done properly, the face-lift should enhance one’s natural aspects and make the patient look better.

Choosing a surgeon should be a careful and well-thought-out endeavor. Use the following criteria:

• Choose a surgeon who is board-certified in facial plastic surgery or plastic surgery.

• Make sure he does face-lifts frequently, and that it is a big part of his practice.

• Ask to see pictures of previous patients before and after. There is no excuse for your surgeon not to have them, so do not accept any.

• Make sure you like your surgeon’s aesthetic views, because what he may deem a successful operation may be your worst horror.

• Get referrals from friends and family members who have had surgery, and ask if they were satisfied.

• Finally, get on the Internet and check out the physician’s data bank to determine if your future surgeon has had chronic complaints against him or her. Remember, where there is smoke you may be burned.

Carlos Wolf, M.D., is a board-certified facial plastic surgeon who sees patients in Napa and Miami. Send questions to

Summer Is the Best Time for Injectable Treatments

Summer is the ideal time to rejuvenate the face with injectable treatments, as little to no recovery time is needed

By Central Park Plastic Surgery
Published: Monday, Aug. 20, 2012 – 5:21 am

NEW YORK, Aug. 20, 2012 — /PRNewswire/ — Injectable treatments are ideal facial rejuvenation therapies for the busy summer social season, says plastic surgeon Dr. Scott Zevon. Nonsurgical therapies with little downtime, injectables offer an alternative to the long recovery time associated with surgeries such as a facelift or a blepharoplasty (eyelid lift).

Advances in nonsurgical facial rejuvenation offer many alternatives for those seeking a quick, yet profound improvement to the face. Injectable dermal fillers plump up the skin to disguise wrinkles, while Botox injections treat wrinkles by temporarily weakening the muscles that cause them. Some injectables offer results immediately, while others develop over a short time period. A board-certified plastic surgeon can suggest the best summer skin treatments to achieve the desired results. The following are treatments with little or no recovery time to interfere with summer activities:

  • Juvederm®. The famed “lunchtime” treatment yields immediate results. When administered by a skilled surgeon, possible after-effects like redness and swelling are lessened. Juvederm is made of hyaluronic acid, a natural substance produced by the human body that binds water in the cells, adding volume to the skin.
  • Restylane®. This dermal filler restores fullness in areas of moderate to severe wrinkles. Restylane treatment doesn’t require allergy testing, as it is composed of non-animal-based hyaluronic acid which completely breaks down in the body.
  • Radiesse®. Radiesse works beneath the surface of the skin to stimulate the growth of collagen; collagen is the substance that gives volume to the skin. While it has immediate results, Radiesse injections offer the long-term benefit of increased collagen production over time.
  • Botox®. Botox injections improve the appearance of wrinkles caused by repeated facial expressions. While not immediate, the effects of Botox treatment are apparent within three to five days and continue to improve over a period of weeks. Repeated treatment with Botox causes the affected muscles to relax over time, making wrinkles less severe.

An injectable treatment can take as little as 15 minutes – the perfect way to renew the skin before a special summer getaway. Side effects are generally minimal, consisting primarily of temporary redness, bruising, and/or swelling. While all injectable treatments are considered temporary, the effects can be seen for as long as 6 to 12 months, depending on the product. A summertime treatment can often last until the winter holiday season, at which time it can be repeated. The benefits of each therapeutic approach can be addressed during a consultation with a plastic surgeon.

Women and aging: What are we so afraid of?

Posted on August 13, 2012 By Amanda King Beauty and Fashion

aginghires acs Women and aging: What are we so afraid of?

As women in the media age, they turn to cosmetic procedures to even out their wrinkles and tighten up their skin tone, making it appear that they’re not really aging at all. (Photo acs)

Have you ever lied about your age? Have you turned 29 years old multiple times? Women in the U.S. are notoriously afraid of getting older. There are countless anti-aging products in stores promising greater elasticity, fewer wrinkles and overall younger looking skin. Cosmetic surgery and Botox are big business. Women are willing to go to great lengths and spend exorbitant amounts of money trying to appear as though they aren’t getting older.

Why is aging such a big deal?

The media and societal ideas about beauty are likely to blame. The president of the National Research Center for Women and Families, Diana Zuckerman said, “We’ve made a decision about what beauty looks like in this country, and everybody… wants to fit the mold.”

Unfortunately, youth and beauty are synonymous in U.S. culture, and there aren’t very many role models for aging gracefully in the public eye. As women in the media age, they turn to cosmetic procedures to even out their wrinkles and tighten up their skin tone, making it appear as they’re not really aging at all; and if they don’t choose to cosmetically alter their looks, they get put away in a corner reserved for stars who aren’t sexy or appealing anymore.

Though these women disappear from the public eye, they still exist. Isabella Rossellini, 60, recently said in an HBO documentary by filmmaker Timothy Greenfield-Sanders, “My social status has diminished because I know I’m not invited to the A parties anymore. My daughter is. As you grow older, you don’t count anymore.”

While there could be biological reasons for fearing old age, such as a fear of approaching death or bodily frailty, our ideas about beauty could also be influenced by a woman’s ability to bear children, making youth more appealing on an evolutionary scale. However, a  woman’s fear of aging is most probably due to this idea that we become invisible as we get older – that as we grow older, we don’t matter.

There is evidence that this fear of aging is now starting to appear among younger and younger women. According to the American Society of Plastic Surgeons, last year, Botox was injected into 12,000 teenagers between the ages of 13 to 19.

When some of these teen girls were asked about why they chose to get the injections, they said they wanted to prevent wrinkles or “appear fresh” in front of the camera.

However, Dr. Michele Borba, author of several parenting books and expert for the Dr. Oz show, was quick to point out that teenagers seeking Botox aren’t in need of a physical freshening up. She said to the NY Times, “There’s a much deeper issue at stake and I’m betting it’s self-esteem. Say no to that injection. Address her feelings of ‘inadequacy’ and not her need to cover up a so-called wrinkle.”

Perhaps this advice should be taken by women of all ages, not only teenagers.

The signs of aging such as skin wrinkles, grey hair, loss of skin elasticity and body changes are totally normal and shouldn’t be considered flaws or evidence that a woman is no longer beautiful. There is nothing wrong with a woman who experiences these symptoms as she ages, but there is something wrong with a society that devalues older women, making them feel ugly, ill and invisible.

Optimized Vivian 030512 Women and aging: What are we so afraid of?

Dr. Vivian Diller works with adults, adolescents and couples in short and long-term psychotherapy on the upper east side of Manhattan. (Face it, the book)

Dr. Vivian Diller, a New York City psychologist and co-author of a book on women and their attitudes and experiences regarding aging, said in an interview with the L.A. Times, “When you see lines around your smile, your eyes, it’s part of this process. Healthy aging is learning how to see those lines as natural and being comfortable with saying, that’s who I am.”

Dr. Diller suggests that there are many things women can do to maintain positive body image as we age, such as exercise, healthy eating and getting regular checkups from a doctor. The best thing we can do though is to stop thinking about our personal beauty in terms of looking younger.

Dr. Diller points out that aging in a healthy way means saying, “When I am 47, I’m not going to look like I did at age 37. I can look great for 47, but my looks will change at some point, no matter what I do.”

Accepting that every woman gets older and that there are physical changes that happen, and learning to love ourselves for those changes, are the only ways we’ll be able to diminish our anxiety about getting older. We would not only serve ourselves by making these changes to our attitude, we would also be helping the teenage girls who are lining up to receive Botox.

The world needs to see women of all ages who aren’t hiding behind cosmetic procedures or from a world that devalues them. Society needs to be constantly reminded that beauty comes in many forms, whether it conforms to a superficial standard, or comes from somewhere more substantial and brave, like being unafraid of, and unapologetic for, the changes that happen naturally with age.

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