Okemos Michigan Plastic Surgeons Cosmetic Surgery Procedures

Liposuction

Frequently Asked Questions about Liposuction

How long will the results of liposuction last?

Liposuction removes fat cells, which expand and contract with the amount of fat present. We are born with a certain number of fat cells, and those removed do not "re-grow." With a regular exercise routine and a reasonable diet (not necessarily a weight loss diet), the results should be permanent. If you gain more weight and do not exercise, the remaining fat cells in the treated area will swell, but your body contour will not "return" to its "pre-liposuction" appearance. Remember that liposuction is not a "weight loss" method, nor is it a treatment for obesity.

If true tumescent liposuction is such a great method, why is Trillium Comsetic Surgery one of the only surgery locations in Michigan who offers it?

Other surgeons either do not like to do it, are not trained to do it, or both. The vast majority of plastic surgeons have never been trained in the procedure. Among the few who have been trained, most simply do not like to do it, even though it is safer, and better, for the patient. A surgeon can make at least twice as much money per day offering the traditional form of liposuction, because he/she can usually do at least twice the number of procedures in the same time period. Further, most plastic surgeons do not enjoy dealing with patients who are awake (as in true tumescent liposuction). Adding to the unpopularity of this method (in traditional surgical settings) is that anesthesiologists are unnecessary, and therefore cannot bill for their services. Since freestanding surgical centers bill by the procedure and by the hour, they do not welcome surgeries (or surgeons) which always consume at least 3-4 hours of OR time per case.

When I get on the scales after liposuction, will I see a change?

Perhaps, but you are missing the whole point of liposuction, which is not weight loss. The goal is an improved body contour, without the "stubborn" areas of fatty deposits that you could not change with diet and exercise. I can't emphasize enough that an "attractive shape" has absolutely nothing to do with absolute weight in pounds, or measurement in inches. Muscle is heavier than fat, so that those who exercise will look "tighter" and "more shapely," even though their weight may actually be more than when they were less "toned." Very attractive female athletes weigh at least 10 - 15 pounds more than you might think. There is a frightening (and totally illogical) tendency for women (and some men) to judge their bodies by the absolute number of pounds, which leads to eating disorders, disappointment, and anorexia. I guarantee that Cindy Crawford would still be considered attractive if she weighed 190 pounds, as long as her body "looked" the same. Liposuction is not about numbers, it is about body contouring or sculpting, about how your body "looks."

When is the best time to have liposuction? Should I lose as much weight as I possibly can first?

Ideally, you should attempt to reach a body weight within 25 - 30 pounds of your "ideal body weight." This does not mean you must diet and exercise for months or years until you have reached the weight that you think is ideal. It means that your weight should be relatively stable, and usually within 25 - 30 pounds of the "ideal" weight for your height and body type. Moderate daily exercise and a reasonable diet will help you to reach this weight range more quickly, and will improve the eventual results. Some patients have areas of fat deposits that simply will not lessen, even after months or years of dieting and exercise. They are often ideal candidates for liposuction of these "stubborn" areas of fat deposit. These areas often include "love handles," abdominal or stomach bulges, a neck or chin "waddle" or bulge, fatty deposits on hips and buttocks, and bulges either in front or behind the "bra strap line." Patients who weigh more than 30 over their "ideal" weight often have very gratifying results. Although society may consider them very overweight, liposuction can change problem areas, just as it can for those with less weight.

Is there a minimum weight for liposuction "candidates?"

The "short answer" is yes, at least at Trillium. With exceptions, patients who weigh more than 10 pounds below their "ideal body weight" should be cautiously evaluated for liposuction. There is a very popular current trend to maintain a body weight far below the "ideal," as exemplified by so many horrendously thin film and television stars. This has very dangerous physical and psychological implications, which are disturbing. When the fat cells are "maximally shrunken" by excess weight loss and compulsive exercise, they are much more difficult to accurately remove, and the liposuction could "overtreat" by removing too many cells, which is a much worse complication than not removing enough fat. The normal "female form and shape" depends upon fat deposits beneath the skin. This is why so many women experience a significant loss in breast size (and an increase in facial wrinkles) after excessive dieting. If too much is removed, the results can be disfiguring. In fact, a certain amount of fat must be left under the skin to create the desired visual result. Especially after the age of 35, without a sufficient fat layer to "stretch" the skin, excess female weight loss leads to an appearance which most men (and many women) consider very unattractive.

Is there an "ideal age" to have liposuction?

No. Most patients should be over 18, and most are under 70, but there are some exceptions. Optimal results are more easily achieved when the skin is elastic, a property which decreases with advancing age. Although patients over 55 years of age can have very pleasing liposuction results, their skin will be somewhat less "taunt" than the skin of patients who are under 50 years of age. For some patients, particularly in the face and neck areas, skin and/or muscle tightening may be considered during or after liposuction.

Which areas of the body can be "contoured" with liposuction?

Some of the most commonly treated areas are the neck, chin, jowls, arms, legs, breasts, and abdomen in both sexes; the thighs, buttocks, hips, stomach, and back in females; and the flanks (love handles) in both females and males.

Is liposuction safe, I've heard so many negative things about it?

Correctly done tumescent microcannula liposuction with only local anesthesia (and no IV fluids given) is one of the safest cosmetic surgical procedures done in office surgical suites or ambulatory surgical centers. (Please see the above chart) Done in this manner, it is probably as safe as (or safer than) modern cataract surgery, particularly considering the fact that the average liposuction patient is much younger and healthier than most cataract patients. In addition, many cataract patients are given systemic anesthesia.

Current data indicates that the following factors increase the risk of liposuction by a factor of 1000 to 10,000 times:

IV fluids are given during surgery
More than 4% of body weight of fat is removed during a single surgery
Systemic anesthesia is given (IV sedation or general anesthesia
Operating time is more than 3 - 4 hours
Several other cosmetic surgeries are done at the same time as liposuction.

What can I realistically expect as a final result after my liposuction?

A realistic result of 50% - 65% (often more) reduction in adipose tissue in the area treated. If you are looking for more improvement than this, you may disappointed after liposuction. In most problem areas, 50% loss of fat causes very significant "visual" improvement. This is difficult to visualize (and difficult to show on "imaging"). Remember, "a little too much" (which is very, very difficult to correct) fat removal will give a much less pleasing result than "a little too little," (which can be corrected). Excess fat removal can leave unsightly depressions and the appearance of "thinned skin." Ideally, the "problem areas" will be "sculpted down" the most, and other areas will be pleasingly decreased and contoured, to leave you with very noticeable improvement. Final results are not complete until 4 - 6 months following surgery.

What are the advantages of liposuction (over dieting and exercise)?

The results are relatively rapid, with many patients returning to work in 2 - 3 days, assuming no complications after tumescent liposuction with local anesthesia. The efforts of diet and exercise are certainly reduced, but at least some of that effort is required to maintain the results. Some "problem areas" cannot be reduced, no matter how much dieting and exercise is used.(see Myths) These areas are excellent indications for liposuction. Given the cost of special diets and many exercise programs, the cost of liposuction may compare very favorably.

What are the disadvantages of liposuction (over dieting and exercise)?

Liposuction is not a "weight loss" technique, nor can it routinely remove cellulite. (Some patients may have some improvement in the cellulite "appearance") Some liposuction techniques can cause very serious complications, (both cosmetic and medical) and/or long recovery times, as noted above. Excessive dieting and exercise can also be very dangerous. Liposuction will not cause as much cosmetic improvement if you do not maintain a reasonable, healthy diet and a moderate exercise routine. The cost may be considered a disadvantage, depending upon the patient's goals, lifestyle, expenses, and expectations. Remember that for many patients, expensive exercise and diet regimens may not improve those areas that bother you most.

When can I return to work after liposuction?

Depending upon the patient's age, general health, areas treated, occupation, and activity levels, (assuming tumescent liposuction using local anesthesia and microcannulas) many patients return to work within 2 - 3 days. Many patients continue to wear the "semi-compressive garments" for 7-14 days, under their clothing.

If I have several areas that I want treated, can they all be done at once?

This depends entirely upon the areas to be treated, the amount of fat to be removed, and the length of surgery required. In general, it is much safer (and recovery is much quicker) if one or two (sometimes a smaller third) bilateral areas are treated during one "session." If more liposuction in other areas is needed, a second "session" can be scheduled, usually with at least one month between surgeries. Please remember, the risks of liposuction are very greatly increased if more than 5% of body weight in fat is removed all at once, if systemic anesthesia is given, or if too much surgery is done during one "session."

How soon can I wear clothing (or not wear clothing) that reveals the areas of liposuction?

The tiny incisions used to insert the cannulas may be slightly visible for 2 -4 months, sometimes longer. Make-up can usually be applied to these areas within 7 - 10 days. Do not expect to wear a bathing suit that shows the incision areas (without make-up) for at least 3 - 4 weeks.

How soon can I exercise after liposuction?

We urge you to walk at least 1 mile the day after surgery and for at least several weeks after that. This helps to reduce the swelling especially when areas below the chest are treated. You may resume moderate (not strenuous) exercise 36 - 48 hours after surgery.

What are the possible complications of liposuction?

Undertreatment, overtreatment, "depressed areas" of too much fat removal, uneven contours, inflammation of the treated area, prolonged swelling of the treated area, and temporary pigmentation and/or scarring of the incisions are the "less serious," most frequent complications. The unusual medical complications include anesthesia (lidocaine) toxicity; muscle or organ trauma by a cannula, infection, excess bleeding, blood clot of the legs (DVT), fluid overload, and heart beat abnormalities. These are virtually unknown (but theoretically possible) when true tumescent liposuction by local anesthesia is used.

Who should perform my liposuction?

If you wish to have the safest type of liposuction, you should search for a physician who uses true, microcannula tumescent liposuction, using only local anesthesia. They emphatically do not absolutely need to be "board certified in plastic surgery." In fact, unless the surgeon's residency was later than 1990, it is highly unlikely that he/she could have learned this technique "in their training." (The technique was first described by a dermatologist in 1987) They must have taken courses after residency (or studied with someone else) in order to learn this technique. Many specialties perform this type of liposuction. Find a doctor, who will listen to your concerns, treats you with respect and dignity, discuss reasonable, realistic results, and candidly present the risks and possible complications. Consider the following quote from the dermatologist who pioneered tumescent liposuction. "A public relations campaign implying that only surgeons certified by a particular board should perform certain cosmetic surgical procedures is viewed by other specialties as undignified, offensive, and unethical. The claim that any group of surgeons is better trained to do cosmetic surgery is a meretricious argument; it is plausible but specious. Self-serving claims of clinical superiority, unsubstantiated by objective data, transform "medical ethics" into an oxymoron. The intensity of belief in the superiority of one's own training is not a measure of the validity of such beliefs."

Should I be concerned if my tumescent liposuction surgeon is not "board certified in plastic surgery?" Can other specialists perform skillful liposuction?

Please read above and the included article regarding liposuction surgery "Just the Facts, Ma'am" written by a prominent plastic surgeon. Board certification in plastic surgery is a wonderful accomplishment, and the vast majority of plastic surgeons are skillful and accomplished. Nonetheless, it is no guarantee whatsoever that a specific surgeon can skillfully perform a specific surgical technique. In the case of liposuction, about 250,000 operations per year are performed in the United States. Dermatologists and other "non-plastic surgeons" perform roughly 45% of these surgeries (~ 110,000), the majority of which use only local anesthesia. Of those surgeries performed by "board certified plastic surgeons," many are not "true" tumescent liposuction with local anesthesia, but use systemic anesthesia and larger cannula. Most "non-plastic surgeons" bring significant "strengths" to the performance of tumescent liposuction using local anesthesia. These include, but are not limited to the following:

raining and practice in precise, microscopic surgery
Attention to detail and patience
Significant experience and comfort with surgery using only local anesthesia
Familiarity with skin surgery
Specific training in the techniques of tumescent liposuction with local anesthesia
Unwillingness to perform multiple procedures requiring many hours of surgery
A high "comfort level" performing surgery on "awake patients."

I saw this procedure on The Learning Channel. It looked rough and there was blood loss. Is this tumescent liposuction?

Unfortunately, The Learning Channel has sometimes featured surgeons and surgical procedures that can be misleading. Many of the liposuction procedures often shown on this program are not, in fact, true tumescent microcannula liposuction using local anesthesia. This does not mean they are bad surgeons or bad procedures, but the relative risks and possible complications are rarely fully discussed or understood by the media. Many surgeons do not fully understand true tumescent liposuction, have not been trained in it, and are uncomfortable using only local anesthesia. Usually, this does not cause problems, but the complication rate by these surgeons is much, much higher than for those who use true tumescent liposuction.

So, should I consider having liposuction?

If you are comfortable with, and completely happy about, the appearance of your body (regardless of your weight) don't bother, it would be a waste of your time and money. If you are more than 30 pounds above your ideal weight, and cannot change certain areas with reasonable diet and moderate exercise, liposuction is an excellent alternative. If you are more than 10 pounds below your ideal body weight, liposuction should be considered with caution afte a complete consult. If you are within 30 pounds of your ideal body weight (with moderate diet and exercise), and you have areas of "fatty deposits" that look "out of proportion" to the rest of your body (or are displeasing to you), then liposuction can be a tremendous procedure. Let us know if we can help.

What about mesotherapy? I read that it is a non-surgical method of weight loss and body shaping?

Mesotherapy began in France over 50 years ago, and has been used in the USA only in the last 3-5 years. It is touted as a "non-surgical" method of weight loss and body shaping. Unfortunately, the drugs injected into the skin during these treatment are not FDA approved for these uses, there is no scientific proof that it is either safe or effective, it is said to "last" only 1-2 years, requires 10-12 treatments, and is often at least as expensive as liposuction. For prospective cosmetic doctors, its allure is that it does not require any surgical training or experience. Please refer to the graph which follows.

Comparison of True Tumescent Liposuction vs. Mesotherapy

Comparisons True Tumescent Liposuction Mesotherapy

Treatments required per area 1 10-12

Total Cost per Area $600-3,600 $3,000-6,000

Needle "Sticks" per area, per treatment 6-10 60-80

Total hours spent in treatment 4-4.5 10-18

Total Fat Removed 1-4 liters (1000-4000cc) 200cc-400cc? (unmeasured)

Scientific data Vast None

Drugs FDA approved for use All None

Drugs used banned in multiple countries None Several

Duration of Effect Lifetime 12-18 months

Downtime 1-3 days Minimal

Oral sedation required Usually Often

Systemic complications Rare Completely Unknown

Given the choice of any liposuction for my family, or myself, I would choose the type that we offer at Trillium. In fact, I would not perform any other type of liposuction. The quotes below are taken from Dr. Klein's textbook of "true" tumescent, microcannula liposuction using local anesthesia. He" invented" the procedure. We present them as "food for thought" for any patient considering liposuction. Please call us with any further questions that you may have.

In 1997 to 1999, 257 surgeons were sued for liposuction using systemic anesthesia. During that same period, 2 surgeons were sued who performed liposuction totally by local anesthesia.
"Systemic anesthesia has been responsible for virtually all liposuction deaths. Every death reported in association with liposuction has been associated with systemic anesthesia or heavy IV sedation or with bupivacaine. To my knowledge, no deaths have been associated with tumescent liposuction totally by local anesthesia."
"I would estimate that the risk of death associated with liposuction is at least 1000 to 10,000 times greater with general anesthesia compared with pure tumescent local anesthesia."
Most cosmetic surgeons also prefer local anesthesia for themselves when having cosmetic surgery. In a survey of plastic surgeons who previously had cosmetic surgery, 90% chose to have local anesthesia. In contrast, among the patients of these same surgeons, only 40% received local anesthesia for their cosmetic procedures.
The safety of tumescent liposuction is based on (1) avoiding the risks of general anesthesia, (2) elimination of bleeding, and (3) elimination of intravenous fluids. Surgeons who claim to do tumescent liposuction but use general anesthesia are misleading patients. Patients and media have failed to recognize the distinction between tumescent liposuction totally by local anesthesia and tumescent liposuction with systemic anesthesia.
In fact, the incidence of liposuction-associated malpractice litigation increases with increasing years of surgical training in systemic anesthesia.
A cavalier attitude about the consequences of extensive surgical trauma in elective cosmetic surgery is probably the greatest risk for death in liposuction surgery.
More than 90% of all liposuction related malpractice lawsuits have involved surgeons with several years of training in treating major trauma, but virtually no training in tumescent liposuction with local anesthesia.
Tumescent liposuction is so gentle and causes so little discomfort that most patients do not require oral medication for sedation or anxiety.
Pooled data from 1996 to 1998 from physician owned malpractice insurance companies showed that 70% of all liposuction related malpractice cases were performed in hospital. Surgeons who currently have hospital surgical privileges for liposuction might learn more about liposuction safety from specialists who are routinely denied such privileges.
What are the risks of general anesthesia in ambulatory surgery? What are the most risky aspects of cosmetic surgery? Which surgical specialty has the most deaths among its liposuction patients? Surgeons simply do not have accurate answers. More surprisingly, the perpetuation of this ignorance seems to be institutionalized throughout U.S. society.
The true tumescent technique for liposuction uses no intravenous (IV) fluids, with supranatant (removed) volumes of fat less than 3.5L and/or less than 4% of the patient's body weight.
A recent survey of surgeons who use the "superwet" liposuction technique reported that the risk of death associated with liposuction under systemic anesthesia is 1: 5000. Among surgeons who limit volumes of supranatant fat to less than 4 L and do not use IV infusion, the mortality should be significantly less than 1:100,000. I estimate that approximately 100 deaths have been associated with the extreme superwet technique or with ultrasonic liposuction(quote from 1999, many more since then)
Two classic (but totally false) philosophical arguments are used to justify systemic anesthesia for liposuction: The consensus gentium fallacy (everyone agrees it is true or because it has always been accepted as true) and the improbability fallacy (a proposition is true because all alternatives are believed to be highly unlikely).
Succumbing to the urge to do too many separate procedures on one occasion is the greatest risk of general anesthesia. Excessive liposuction accounts for the most complications associated with liposuction surgery.
The greatest contraindication to using any drug is the lack of an indicated use. The most common cause of death or serious injury (in general anesthesia) is failure to ventilate the patient. Substantial literature documents that the risk of death attributable to general anesthesia is 1:2,000 to 1:10,000.
To my knowledge, the following have never been associated with tumescent liposuction totally by local anesthesia: Cardiac arrest, pulmonary edema, fat embolism, pulmonary embolism, peritoneal cavity penetration, or death from lidocaine toxicity. In contrast, liposuction with systemic anesthesia has been responsible for at least 130 deaths (in 1999, many more since then).
Fatal pulmonary embolism, however, is one of the leading causes of death associated with liposuction using general anesthesia.
It is not the fat that is removed, but the fat that remains after liposuction that determines success.
Skin excision is a last resort in cosmetic surgical body contouring.
Patients usually need not return until 6 weeks for postoperative photographs. (After tumescent liposuction)
About 96% to 98% of patients should require only minimal oral sedation during infiltration.
With true tumescent liposuction the patient is fully alert and fully conversant and can drink fluids at will.
Closing incisions with sutures (after liposuction) dramatically worsens and prolongs post liposuction edema.
Tumescent liposuction has an infection rate of less than one per 2000 cases. Few routine surgical procedures have a lower incidence of infection than tumescent liposuction.
Most patients lose more blood during the preoperative laboratory evaluation than during the entire tumescent liposuction procedure.
The tumescent technique eliminates the need for supplemental IV fluids.
Tens of thousands of tumescent liposuction patients have received 35 to 50 mg/kg of lidocaine with no known reports of deleterious effects.
A one-compartment model best represents tumescent lidocaine pharmacokinetics. Tumescent adsorption is a zero-order process.
After initial enthusiasm for internal ultrasonic assisted liposuction, most European liposuction surgeons eventually rejected it because of an unacceptable incidence of complications. The European experience has shown that internal UAL is less safe than tumescent liposuction. No convincing data show that external ultrasound provides any clinical benefit. In spite of this, many American liposuction surgeons continue to use internal and external ultrasound for liposuction.