Liposuction

Q: Dr. Eppley, I had liposuction of my stomach, love handles, pubic mound and back rolls one week ago. The doctor said he removed almost 3.5 liters of fat. I am very concerned because I have such massive swelling in my pelvic area that feels so hard that I know there’s blockage of my lymphatic  system. I feel nauseated, toxic and the hardness in pelvic feels like rigor mortis. Not sure of spelling. The rock hard mass that I feel in my crotch can’t be normal for liposuction. It feels like deadening of my torso and tissues inside. I am very scared. Yes, I rejected most of the pain medication becasue I’d rather gauge how I feel instead of covering it up. Outside of my 8 hours sitting at my desk, all I do is bed rest.  All week I have been like a hospital patient. 

My job is stressful and may have caused the collection of cortisol in my midsection in the first place, but I think I can’t eliminate because of medication, stress, constipation and a very compromised lymphatic system. Not sure if I have lymphedema, but I am very sick. I drink plenty of water, but told nurse that I stay moving 3 times a week to keep my blood flowing (typically walking on treadmill 20 minutes regular pace). I eliminated my arm/muscle training and refrained from squats. 

Please help me with the rock hard blockage in my pelvic area, primarily. Massage doesn’t work. What’s good?

A: Everything you are experiencing is perfectly normal and expected with the liposuction you have had. Every patient who has aggressive liposuction of the torso gets every symptom that you have. It is, in fact, a lot of temporary lymphedema as liposuction of any type disrupts normal lymphatic outflow initially.

There is nothing to be scared about with how the tissues feel. All patients do not realize, and now you do, that liposuction is a very traumatic operation and creates a lot of subcutaneous tissue injury. This creates lots of swelling, fluid and overall lymphatic congestion. The solution is simply time. It will takes months for the tissues to fully recover  and feel normal again. Unfortunately there is no magic solution or method to hurry this process…and that is certainly true at just one week after surgery.

With abdominal liposuction women and men will develop substantial swelling at the ‘bottom of the well’ over the pubic and down into the genital area. This effect is magnified when pubic mound liposuction is concurrently done.

Dr. Barry Eppley

Indianapolis, Indiana

Local Anesthesia Liposuction

Q: Dr. Eppley, I’m looking to have liposuction. My main concern is being put to sleep. Ive watched a few YouTube videos and noticed that the Smartlipo procedure was done without general anesthesia, all while awake.

A: If the principle concern about liposuction surgery is being put to sleep (local anesthesia liposuction), then I am not the surgeon for you. My experience with any form of liposuction done under local anesthesia (unless it is a very small area) is not very good with suboptimal results, patient discomfort during the procedure and an experience that the patient and I would usually not like to repeat in most cases. In my experience when a patient chooses local anesthesia for an invasive liposuction procedure, they have to be willing to accept a limited result and that they may need multiple treatment sessions to ultimately get the best result. Such an approach will also cost more than if done one time under general anesthesia. Regardless of what you see on the internet and how it is promoted, liposuction is a very invasive procedure that covers large body surface areas and is a completely effort dependent process. When this surgical effort becomes compromised by an anesthetic choice that limits these efforts, the surgeon’s hands becomes ’tied’ and the result and experience ultimately suffers. At least this has been my liposuction under local anesthesia experience.

Dr. Barry Eppley
Indianapolis, Indiana

Liposuction for Weight Loss

Q: Dr. Eppley, I contacted you last year about liposuction. I’m finally ready to get the right procedure cause I’m not sure what would be best. I’m 5ft 7inchs tall and weight 283 pounds. I would like to lose as much as possible. Can you tell how much I might be able to lose just so I have an idea. I would like to get down to 195 pounds but I don’t know if that is possible or if that is dangerous. Can you please help me pick the safe and best procedure. thank you for your time.

A: I am afraid that you have the wrong idea about liposuction surgery and what it can accomplish. It is not a weight loss method nor would it be appropriate at your current weight of 283 lbs. Liposuction is a body contouring surgery to remove select areas of fat that are diet and exercise resistant.The only way you are going to lose 75 to 100 lbs through surgery is by a bariatric surgery approach with either a lap band or a gastric bypass. Liposuction at 283 lbs is not only dangerous but would be ineffective at making any substantive body shape or weight loss changes.

Dr. Barry Eppley

Indianapolis, Indiana

Is Age 60 Too Old For Liposuction?

Q: Dr. Eppley, Does your age such as 60 years old matter on results on liposuction if you are not over weight and have some loose skin but not bad. I’m in great shape and health as this has been my whole life lifestyle so not sure why my age would have anything to do with results. I understand skin changes with age but again I see a 30 year looks like my situation such as same shape or worst. Is this true?

A: Generally speaking, skin does not retract very well at age 60 as compared to age 30. There is an overall loss of skin elasticity as one ages. So liposuction results tend to not be as ‘good’ when one is older. The fat can be removed equally well, regardless of age,  but the smoothness of the skin tends to be more irregular and imperfect once the fat has been removed at an older age. As long as one can accept that trade-off, there is no reason one can not have liposuction at age 60. This can also change by the body area being treated such as the flanks will always do better than the thighs for example at any age.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Tummy Tuck Be Done In A Kidney Transplant Patient?

Q: Dr. Eppley, I had a kidney transplant six years ago. My transplant team believes I could have a procedure to diminish the abdominal-flanks area. The side where the kidney is is larger. I weight 195 lbs and am 5’11”. I dislike being lopsided and have exercised (I am in pretty good shape). I was interesting in you because of your experience with a few transplant patients. There are great surgeons where I live but I trust you more.

A: I can see in your picture the protrusion/lop sidedness of the left side. That is the same side as your kidney transplant as can be seen by the location of the oblique abdominal scar. However, the bulge that is sticking out I doubt is where the kidney is. Generally that would be under the incision away from the bulge sitting on top of the abdominal fascia. Thus I do think that the protrusion could be reduced by a combination of liposuction and skin excision. (tummy tuck) The skin excision could extend across the whole abdominal incision as there may be skin excess there as well.

You would be on some level of immunosuppressive medication currently and we compensate for that by giving ‘stress steroid’ dosing at the time of surgery. Any other considerations/needs based on your transplant doctors input is also important.

I would estimate that you would need to be here no more than three to five days based on whether the placement of a surgical drain is needed. (which I would work towards not using.

Dr. Barry Eppley

Indianapolis, Indiana

Should I Have Liposuction Before Or After Ankle Surgery?

Q: Dr. Eppley, I am interested in getting the abdominal and flank liposuction. However, I currently need to get surgery done on my ankle by an orthopedic surgeon.  The surgeon will not do it, however, until I quit chewing tobacco. Therefore, I want to ask you another question. Could both surgeries be done close to each other or do I wait a period of time between both? Should I get liposuction first or does it matter? The chewing tobacco issue is still a work in progress but my ankle is hurting worse by the day and I need to get it fixed soon.

A: Quitting tobacco is a good idea regardless of any type of major surgery you are considering. The nicotine in tobacco has as very negative effect on bone healing, particularly in the lower extremity. Certainly these two surgeries can be spaced relatively close together (one to two week sapart) and the order is dependent on how one affects the other in terms of recovery. It is question of which one is going to make you more immobile and what type of physical therapy would be needed afterwards. I assume that the ankle surgery will put you in a boot/cast with some limitation of movement afterwards. it would make the most sense then to have the liposuction first and then the ankle surgery afterwards. There is also the issue of typical bacteremia (release of bacteria in the blood stream) which occurs after any surgery. With a load of bacteremia released from liposuction, you do not want that to adversely affect the ankle bone healing. (seed the healing bone with bacteria) This would also require input from your orthopedic surgeon to see his thoughts as well as on this issue.

Dr. Barry Eppley

Indianapolis, Indiana

Do I Need Liposuction Or Fat Freezing?

Q: Dr. Eppley,  I am a 20 year-old female who is 5′ 4′ and weigh 119 pounds. I leave for college in two months but would like to get liposuction on my belly and thighs yet this summer. I’m not sure if I need something invasive like liposuction or maybe non-invasive like fat freezing. I know you haven’t seen me but would be interested in your thoughts.

A:  It is hard to imagine that you have too much fat on you at 119lbs but that is always a relative perception. The most effective and efficient fat removal method is going to be liposuction because it offers an immediate effect and will remove the most fat. Non-surgical fat reductions methods, of which fat freezing (cryolipolysis) is one of them, always requires multiple treatments done over months that ultimately will remove much less fat than a more invasive method. That is the fundmental difference between invasive vs. non-inavse fat reduction…surgery equals quick results with a recovery while non-invasive offers less results over a prolonger period of time with no recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Will Fat Come Back To Body Areas Treated By Liposuction?

Q: Dr. Eppley, I am interested in liposuction of multiple body areas including the abdomen, love handles, thighs and knees. But I have a few questions that I hope you can answer for me. 

1. As I age, if I gain a bit of weight (I’ve been within these same 20 pounds since I was a late teenager—I don’t intend to go out and purposely gain weight!), where will it go? One plastic surgeon told me since he’d “be removing all the fat cells” from under my breasts to my knees that the fat couldn’t return there, but would go to my bottom or my breasts.  Now that we’re doubting most things he told us, can you please confirm or deny this?

2. Does doing this liposuction once mean I’ll need to do it again in years to come because it will look unnatural or lumpy when I’m 65, 75, etc?  How will things “settle?”  I guess I’m unsure of the “deconstruction” you’re doing and how naturally my body will function afterward (and years later as my life goes on).

3. I read your packet of information and wonder about revision surgery.  I certainly know you can’t tell me I would never need it, but I do know you said I am a rare “good candidate” for his procedure.  I’m hoping this fact significantly reduces the possibility for needing revision surgery.  Your packet says roughly 15% of patients need it.  I’m just curious where you think my risk for that lies (of course, I know there’s always at least a little risk).

4. Will the sudden removal of this fat have negative implications for my metabolism? Does fat secrete the hormone that controls metabolism?  What happens if a lot of that fat is suddenly gone?

A: Your questions are all good ones about liposuction and many of them touch on the basic science of fat metabolism.  While fat has been studied for over 100 years, it is still not a body tissue that is completely understood and it is more than just a blob of fat tissue that sits there only to accumulate excess calories. It is best thought of as a dynamic organ with complex metabolic and hormonal functions. How the removal of some body fat by liposuction affects its functions beyond a simple contour change is, again, incompletely understood. In answer to your questions:

  1. Liposuction does not and can not remove all fat cells from any body area, that is an impossibility. Some fat cells (and probably more than just some) always remain in the liposuction treated area. There is just less fat cells than there were and that is why the body contour is less full or convex. If one does gain weight in the future, the treated area can change because the existing fat cells can accumulate more fat. (the cells get bigger) One can not grow more fat cells but the existing cells can themselves get bigger. Whether excess ‘calories’ will be prone to be deposited  from whence it was removed or whether it goes elsewhere differs for each individual. Ultimately it has to somewhere so the long-term sustainability of a liposuction result is highly dependent on the stability of one’s weight.
  2. The contour results from a liposuction procedure are generally fully known by three months after the procedure. This reflects the final external appearance of the evenness of the fat removed. It is not an issue where it continues to change or settle for years.
  3. Being a good candidate for liposuction means that the quality of the overlying skin is good (has the ability to shrink down to a lesser contour after the procedure) and the fat is not too excessive that a good result can be obtained. Unfortunately being a great candidate for liposuction does not preclude the possibility of revisional surgery although it may make that risk less. Revisional surgery in liposuction is almost always done to even out any irregularities or asymmetries in the treated areas. In my experience, some small touch-ups may be desired in about 10% to 15% of all liposuction patients.
  4. The amount of fat removed in liposuction is rarely ever enough to have any impact on one’s metabolism. If this were true, many diabetic patients would be treated by liposuction to lower or eliminate their insulin needs.

Dr. Barry Eppley

Indianapolis, Indiana

What Is The Recovery Time For Liposuction?

Q: Dr. Eppley, What is the recovery time for liposuction? I was looking to have liposuction done on my stomach, upper back, thigh and  bottom area.  I am not sure what type of liposuction would be right for me. I am 38 years old, eat healthy and exercise, but I can’t seem to tone those areas after having two children. I look good in clothes but do not like what I see in swimsuits. 

Abdominal Liposuction Dr Barry Eppley IndianapolisA: The areas you are considering having treated by liposuction would be many of the typical areas of the truck. I would not get too focused on what type of liposuction, all have the exact same amount of recovery and final results. In terms of recovery, it all depends on how you choose to define it as to how to answer it. If you judge it by when are you up and around…that would be the next day. If you judge it by when will you be doing all normal activities including exercise…three to four weeks. If you judge it by when all areas will feel perfectly normal and are looking at the final results…6 to 8 weeks.

Dr. Barry Eppley

Indianapolis, Indiana

Can I Have Liposuction and Breast Augmentation At The Same Time And Soon?

Q: Dr. Eppley, I have thought about liposuction a long time on my abdominal area which has always had a roll, even as a child. I would like to consult on liposuction and perhaps breast augmentation. I am going on vacation by the middle of June and did not know if it is even possible to schedule with you prior to that time.

Breast Augmentation in Hispanic Women Dr Barry Eppley IndianapolisA: It is very common to perform breast augmentation with any number of other body contouring efforts. Coming breast implants with a little bit of liposuction would not extend that recovery to any significant degree. Given that you are going on vacation in the middle of June, I would recommend that you have this surgery at least six weeks in advance of that event so you can be fully recovered, have few if any twinges of discomfort/soreness and be able to be completely in the the benefits phase of the surgery with little body ‘memory’ of the actual surgery. Thus it would be ideal for you to have this surgery no later than the end of the month. We strive to service our patients in an expeditious manner so I can see that happening on our end. I will have my nurse contact you tomorrow to find a convenient consultation time as soon as possible.

Dr. Barry Eppley

Indianapolis, Indiana