Liposuction was introduced to plastic surgery by the French surgeon Dr. Yves-Gerard Illouz in 1982, providing a new option for individuals who wanted to get rid of unsightly fatty areas. Its elegance in simplicity and efficacy immediately brought it into the mainstream of plastic surgery. After three decades of use, liposuction remains one of the most popular procedures performed by plastic surgeons, accounting for 325,332 cosmetic surgical procedures in 2011, more than any other cosmetic procedure.
The safety, efficacy and even longevity of liposuction depend on an educated patient. Here are frequently asked questions that, when answered, will best position you for a desirable outcome.
1. Who is a good candidate for liposuction?
As emphasized by the American Society for Aesthetic Plastic Surgery, the best candidates for liposuction are patients with isolated areas of fat that are (1) out of proportion with adjacent areas and (2) don’t go away with diet and exercise. “Love handles” and “saddle bags” are common areas of concern. Since liposuction removes only fat and not skin, other areas considered for liposuction (e.g. “belly”) should have good skin tone and minimal excess skin.
2. What kind of liposuction is best?
There have been many modifications in liposuction equipment over the years. All are variations on the theme of a metal tube being placed in the area of concern and a vacuum pump aspirating the unwanted fat. This is referred to as “suction assisted liposuction.” Various adjuncts have been added to this basic construct to improve results. These include, for example, technology to break the fat away (ultrasound) or melt it (laser). These newer technologies introduce additional variables into the procedure and therefore can have the potential for more complications.
True of many technologies that are designed in the hope of expanding market share, aggressive marketing by the manufacturer generates a patient-driven demand for specific approaches. Patients should discuss the choice of technique in detail with their surgeon. Newer is not necessarily better. A board certified plastic surgeon can help you determine which approach is right for your specific body type and needs.
3. Is liposuction safe?
Yes — if performed by a well-trained physician competent in evaluation, judgment and surgical technique. Liposuction, similar to any cosmetic surgery, involves a real and significant impact on violating the body to improve appearance. There are many potential risks involved including bleeding, infection, nerve damage and delayed healing. Plastic surgeons certified by the American Board of Plastic Surgery go through prolonged specific training, examinations, and requirements for recertification to avoid these complications and make cosmetic surgery safe. All members of both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery must be certified by the American Board of Plastic Surgery to be considered for membership. A fundamental theme of the educational efforts of both of these societies remains patient safety.
Many physicians who are performing invasive cosmetic plastic surgical procedures are board certified in other practices, but not by the American Board of Plastic Surgery. Among those who will say they are qualified to perform cosmetic surgery are those certified in family practice, gynecology, the list goes on: training and certification have far different emphases than that of plastic surgery.
4. Are the effects of liposuction permanent?
It all depends on the patient and their actions after surgery.
For the sake of discussion, we can assume that we are each born with a certain number of fat cells. Liposuction removes fat cells in the area of the procedure and they are gone forever. However, if the patient takes in more calories than they burn, those extra calories are stored as fat. The remaining fat cells enlarge both the cells remaining in the area and cells in other parts of the body.
The only way to maintain the effects of liposuction is to burn the same amount of calories as you take in. In any patient, with or without liposuction, extra calories get stored as fat.
In counseling patients on how to maintain or lose weight, I emphasize two points. One is that restricting calories alone has a much bigger impact on weight loss than exercise alone. Most people overestimate the number of calories they burn with exercise and are unaware of the calories in everyday food — particularly ‘fast food.’
For example, for the average person, one hour of high impact aerobics, vigorous weight training, circuit training, or playing basketball will burn about 500 calories. On the other hand, an order of large fries, slice of pizza with toppings, or breakfast sandwich can each add 500 calories. A fancy cocktail may add the equivalent of another hour’s worth of exercise. The message here is that it takes a lot of exercise to burn a few calories.
Mike Boyle, world famous strength and conditioning coach, says that unless you are an Olympic swimmer, weight loss or maintenance is 80 percent diet and 20 percent exercise.
The other point to understand is that “healthy” foods can be just as detrimental to your figure as “junk” foods. It all depends on the number of calories you consume. Adrian Norris, one of Mr. Boyle’s associates, uses juice as an example. She points out that juice, with its “good for you” image, is essentially sugar and water. In fact, a 12-ounce bottle of grape soda has 159 calories. The same amount of unsweetened grape juice packs 228 calories.
A before-and-after photo showing the result of the corrective procedure. Picture: Supplied
Flap design. The flesh-ring is divided at the junction of the anterior one third and posterior two thirds. The posterior longer flap is then rolled up like an anchovy. Pictured: Supplied
WHILE some might argue anyone who stretches their ears for fashion doesn’t deserve help, a group of surgeons have devised a novel way to repair the looped lobes.
Plastic surgeon Dr Broughton Snell said patients who gouge flesh tunnels in their ears often regret it down the track, particularly when they change careers or enter new relationships.
“The fashion trend involves a piercing of the earlobe being gradually expanded over a period of years by insertion of graduated rings,” he wrote in the Journal of Plastic, Reconstructive and Aesthetic Surgery.
“Patients can find themselves subject to discrimination in various facets of life including employment and interpersonal relationships.”
Dr Snell, of the Royal Adelaide Hospital Department of Plastic and Reconstructive surgery, tells doctors to snip the loose earlobe and roll the skin “like an anchovy.” (See diagram)
His technique worked a treat for a 21-year-old patient who stretched his ears by 2mm every three months to reach a 4cm diameter. (pictured)
“Surgeons can plan how long the lobe will be and the angle of the root after discussion with the patient and by looking at pictures of pre-stretched lobes,” Dr Snell said.
“Our method involved division of the tissue ring at approximately the junction of the anterior first and second third. Then de-epitheliased both anterior and posterior surfaces of the posterior flap, and then just the inner surface of the anterior flap. The longer of the two flaps folded upon itself and used the short flap acts as a cover.”
“I used to have huge wrinkles, and they are gone,” she said recently, two days after getting a Botox treatment. “It’s also preventative. If you get rid of the wrinkles now, they are not going to be so entrenched when you get older.
“The Juvederm, as I get older, because I’m 49, I can see that my skin is thinning, and some of it’s starting to droop,” Will said during a break in treatment at the Midlothian office of Dr. Joe Niamtu III, an oral and maxillofacial surgeon whose practice is mainly cosmetic facial procedures.
“The Juvederm or Restylane… it tends to lift it up a little bit, and I don’t have these caves right here,” Will said, pointing to areas of her face. “It kind of smoothes it so it’s more of an even flesh. Trying to keep young,” she said, laughing.
She’s hardly by herself.
Last year, cosmetic patients had more than 5.6 million Botox or Dysport (another brand of botulinum toxin type A) procedures and more than 1.8 million soft-tissue filler procedures, according to figures from the American Society of Plastic Surgeons.
Soft-tissue filler procedures — using products such as Juvederm and Radiesse, as well as using the patient’s own fat — were up 7 percent over the previous year, compared to 5 percent for Botox and Dysport procedures.
Doctors have close to a decade or more of clinical experience with some of the products, time enough to refine how they use them to get the best results.
In addition, more is known about how the face ages.
“There is no question that the most important new development over the past five years has been the recognition of the role of volume loss and facial fat atrophy” in facial aging, said Dr. Lewis T. Ladocsi of Richmond Plastic Surgeons.
“We now understand that the facial aging … is the result of three categories of problems … surface damage due to environmental exposure, sagging of facial skin and soft tissues, and facial hollowing due to volume loss from the atrophy of facial fat. As a result of this new understanding, a variety of products have been developed to provide a nonsurgical way to restore a youthful facial contour,” Ladocsi said.
Explained another way, it used to be thought that by just tightening the skin, pulling and lifting, you could make a face look younger. But you can only tighten so much before it starts to look strange.
“Fillers are for volumizing the face,” said Dr. Nadia P. Blanchet, a plastic and reconstructive surgeon whose office is in the Stony Point Professional Park.
“Most facial rejuvenation surgeries are excising skin and reshaping. It is usually some combination; I don’t ever do a facelift now without doing fat-grafting at the same time, because if you just pull the skin, the patients look tighter but not necessarily younger. But if you tighten and fill — I use fat because they are under anesthesia already — then they look more natural,” Blanchet said.
The dermal filler market is full and getting more crowded.
The U.S. Food and Drug Administration website lists more than a dozen products — from collagen products approved for the market in the 1980s to Belotero Balance, the latest hyaluronic acid gel product brought to the market. It was approved in November.
The FDA data lists Restylane, approved in 2003, as the first hyaluronic acid product approved in the U.S. Before then, fillers were made from animal-based materials and patients had to undergo allergy testing before they could get injections.
Two of the first soft-tissue cosmetic fillers to the market in the 1980s were Zyderm and Zyplast, made from purified cow collagen.
Patients had to wait about a month for allergy test results, Niamtu said.
“That was a big drawback. Now with these nonanimal fillers, allergies are pretty much unheard of,” he said.
The most popular soft-tissue ones are made with hyaluronic acid (Juvederm, Perlane, Restylane), poly-L-lactic acid (Sculptra) and hydroxylapatite (Radiesse). Hyaluronic acid can be found in the skin, umbilical cord and fluid in joints. Poly-L-lactic acid is a synthetic material used in resorbable stitches. Calcium hydroxylapatite is a mineral found in bone and teeth.
Most were used in other medical applications before companies ventured into the lucrative cosmetic products markets.
One of the latest developments, Blanchet said, is dilution of the fillers to treat some areas, such as under the eyes or in the lines in the skin of the face, instead of using laser resurfacing.
Sally Partlow, 42, is seeing Blanchet for a more serious reason — breast reconstruction after undergoing a bilateral mastectomy for breast cancer. Weeks of worry and crying left her with under-eye circles. Blanchet offered the dermal filler as a morale booster.
“Oh, wow,” said Partlow, of Goochland County, a married mother of three teen and pre-teens, as she looked into a mirror. Almost immediately, the results were apparent.
“You can go as superficial as you need to and get a more natural effect, because it doesn’t lump,” Blanchet said.
Before, “I would inject it in the hollows under the eyes, where the skin is thin, and squeeze,” Blanchet said. “Sometimes it did OK. Sometimes you would have a lump of visible filler, then you would melt the lump — because many of the fillers are dissolvable — and then there would be a dent. So then I would just go really deep, which wasn’t really the area that needed to be filled. Now that it’s diluted, I don’t have the filler visibility issues. It’s really neat to be able to put the filler where it needs to go visually, and I just don’t worry about lumping. That’s been nice,” Blanchet said.
If patients have a change of heart and don’t like the results, doctors can inject an enzyme that immediately dissolves the filler.
Most want to know, however, how long the results will last.
Blanchet said she’s had Perlane in soft under-eye areas for up to two years.
“How long the filler lasts depends on the filler, but it also depends on where you put it,” Blanchet said.
“So if you inject it around the mouth, the mouth is constantly moving, it doesn’t last very long. But in the cheeks, that’s a static area. The chin is a static area. I’ve had it last for a long, long time” in those locations.
Some people call soft-tissue fillers a “liquid face lift,” but fillers don’t compare to surgery when it comes to permanence. Cost comparisons have to factor in because repeat procedures of filler are needed.
Niamtu said patients generally need at least two syringes of filler, which average about $500 a syringe, to get the results they are after.
Will, pleased with her youthful look, put the cost, of Botox in particular, in perspective:
“The way I figure it, if you get your hair highlighted once a month and pay $100, that lasts about a month. But yet you do this every year, and it comes out about equal. It’s just an initial payment in one lump as opposed to doing it every single month.”
For all of that, she said people generally don’t notice.
“I find people really are into their own selves. I will go home and look in the mirror and I will notice. People will ask, ‘Is that a new shirt?’ They can be that far off. But I notice, and that’s what’s important.”
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