Posts Tagged ‘liposuction’
Wednesday, January 4th, 2012
Q: Dr. Eppley, I work out almost every day during the week and am very adamant about a healthy diet. But despite these efforts, I have the same stubborn fat areas that will not go away. I am 5’ 4” and weight 118 lbs so I know I am at a very good weight, so more weight loss and conditioning is not the answer. My problem areas are my saddle bags on the outer thighs, my upper arms and my chubby cheeks. As a result, I have been considering liposuction for awhile. My question is can all three areas under liposuction at the same time? Or is this too much?
A: What you have is a common problem, some fat areas that are not really responsive to reasonable amounts of diet, exercise and weight loss. And these are some of the classic body areas in which the fat that is there is not that ‘metabolically responsive’. That is because it is a different kind of fat and its primary purpose for being there is not as a fat depot site. It is more of an insulating or contouring fat role. In essence, you are trying to modify the way your body was built not get rid of accumulated fat from too much storage. That is a surgical problem not a lifestyle one. Those are all areas that can be treated with liposuction as a single procedure. It is very common to treat numerous body areas with liposuction at the same time. And as long as the total volume of fat removed does not exceed 5 liters or take more than few hours to do, you are well within what would be considered the safety zone for liposuction. Be aware that the cheeks may be bettered treated by direct lipectomies from inside the mouth rather than liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, liposuction
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Monday, December 19th, 2011
Q: Dr. Eppley, I am a 22 year old female who is 5’6″ and weighs 165 lbs. I used to weigh 220lbs. I seem to be at a plateau for weight loss over the past year of which I am comfortable with that. But I have a remaining overhanging stomach pouch (I think it is called a pannus ??) that has not really gone away that much with the weight loss. It has gotten less full but now hangs down more. I have very large breasts and thick thighs and butt so I know I will never be tiny, but I would like my overhang gone and to have a flatter stomach area. Should I get liposuction or have a tummy tuck?
A: This is classic question posed by many patients who have some amount of a stomach overhang. By definition, the description of an overhang signifies that there is a skin excess problem as well as too much fat. Liposuction alone will only magnify the prior result of what weight loss has done, it will deflate the overhang (aka pannus) further but it will still leave a flap of skin. You need this cut off by a tummy tuck. Liposuction is only useful in your case when combined with a tummy tuck, as it may help contour the waistline better to the sides where the tummy tuck excision does not go.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, liposuction, tummy tuck
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Sunday, October 23rd, 2011
The removal of unwanted fat through liposuction does not always result in the shape of the desired body contour. This has lead to a liposuction concept known as liposculpture. What is liposculpture and how is it different? Is it a better at achieving natural body contours and a more attractive body shape? Who is it best used on?
Liposculpture moves beyond the removal of just localized areas of too much body fat to a more artistic approach to fat removal. Instead of using large bore cannulas which indiscriminately remove fat rapidly, smaller size cannulas are used. These tools are more selective about how much and where fat is removed. Smaller cannulas may also be combined with powered equipment such as oscillating, ultrasonic and laser-assisted liposuction devices.
But the most important element in liposculpture is that of the surgeon. There has to be an appreciation of what makes up natural and pleasing body contours. The tools used are only as good as the hands that are directing them in shaping new contours. There also has to be an understanding of what the structure of fat looks like underneath. In some areas there may only be a thin fat layer which can reveal an improved body contour through superficial cannula extraction. Such aggressive right-under-the skin fat removal must be applied carefully to avoid scarring and undesireable skin retractions. Areas such as the inner knee, neck, back rolls, axillary breast and flanks are good examples of where superficial liposculpture must be used to get good contouring results as there are not deeper fat layers.
While liposculpture sounds appealing, it is not a method that is needed for most liposuction patients. The most common liposuction patient has larger amounts of fat on the abdomen, waistline, thighs and arms. In these areas there are two distinct fat layers, superficial and deep. Extraction from the deeper layers is needed and should be the first layer that the cannula enters. Treating the superficial layers as well, while improving the amount of contour reduction, will increase the risks exponentially of surface contour irregularities. The abdomen, arms and inner thighs are particularly at risk for this problem with superficial liposculpture. The quality of the skin, its thickness and elasticity must be assessed to determine if it is wise to attempt removal of fat right under the skin.
While good marketing and pictures of models (who have never had the surgery) are appealing as sales tools for liposculpture surgery, it is important to remember that traditional liposuction methods with solely deep fat removal will satisfy most patients. Liposculture techniques should be applied judiciously and applied to areas that are best served by them. It is a liposuction technique that takes into account the anatomy of the fat and the contouring goals and not a method that replaces traditional liposuction for most body areas.
Dr. Barry Eppley
Indianapolis
Tags: dr barry eppley, indianapolis, liposculpture, liposuction
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Sunday, February 6th, 2011
Q: I am a 35 year-old female and I exercise but not as much as I could because I just don’t seem to be able to lose weight. For years I would exercise for months, 5 days a week for 2 to 3 months and not lose weight that people can see, then I’d stop for lack of results. I start up again for a couple of months then the same results occur. With my history, is liposuction or SmartLipo not right for me? I thank you for your response.
A: As a general concept, any form of liposuction should not be viewed or undergone if the primary objective is weight loss. Liposuction is a body shaping or spot reduction method, not a weight loss technique. There is no doubt that many patients do lose weight after liposuction which is usually in the range of double (at 6 to 8 weeks after surgery) of the fat weight that is taken off surgery. This is the result of a combination of immediate fat removal followed by a metabolic weight loss due to a negative caloric balance from healing and reduced intake. Liposuction’s primary objective, which it can do very successfully, is to remove fat areas that are resistant to diet and exercise efforts. Any weight loss is a secondary benefit. This surgically-induced weight loss can be just short-term, however, if lifestyle changes do not support the new weight. It doesn’t take very long (at 3500 extra calories = a lb of weight gain) to regain the weight removed after liposuction if one is not vigilant over the long-term.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, liposuction, weight loss after liposuction
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Monday, January 24th, 2011
Plastic surgery, unlike some medical specialties, seems to always find its way into the news. 2010 was no exception in this regard. As a plastic surgeon, most of the items that become newsworthy were an incredible mix of the freaky, incredulous and even fantastic events.
Breasts always seem to make the news and the more freaky seems to be better. Whether it is basketball-size implants of quadruple FFFF proportions, dancers subject to IRS scrutiny trying to write off their surgery, or breast augmentation as part of a marathon makeover (aka Heidi Montag), women who seek their ten minutes of fame marr the perception of an otherwise highly successful body contouring surgery. While the real breast augmentation news this coming year will be the introduction of a new form-stable (gummy bear) implants, this will likely be overshadowed by the media’s never-ending focus on celebrities, their breasts and Hollywood’s version of silicone valley.
There is always the continued incredulous news of patients suffering complications and even death at the hands of so-called cosmetic surgeons. This seems to be most evidenced with liposuction, largely due to its popularity and the larger body surface areas that it treats. There is an obvious difference in the size of the trauma to the body from abdominal and thigh liposuction from that of a nosejob or eyelid surgery for example. Liposuction attracts a large number of inexperienced and often unscrupulous practitioners because of the relative ‘simplicity’ of the procedure and easy access to new liposuction devices. It only takes a medical license and a credit card to buy the newer laser liposuction machines. Equipment manufacturers are more interested in sales than safety as evidenced by their marketing and selling behavior. Patients died last year from one coast to the other at the hands of doctors with dubious credentials. The public would think that better regulations would exist but they would be wrong. Doing your homework is your best protection.
Botox continues to show its fantastic benefits and those are not only in those worried about their frown lines or crow’s feet. Last year Botox was approved by the FDA for the treatment of migraines. For some migraine sufferers, Botox injections can be a miracle even if its effects are only temporary. The benefits of Botox have translated into an actual migraine surgery procedure developed by plastic surgeons. If Botox injections relieve one’s migraines, a relatively simple muscular decompression around the nerve trigger points can provide a more permanent amelioration of one’s migraine pain and frequency of attacks. It’s a rare example of a cosmetic treatment turning into a really useful medical or reconstructive surgery, usually that works in reverse.
One other piece of fantastic plastic surgery news from last year has been the emergence of face transplants. While once thought impossible and something more akin to a movie or science fiction, more and more partial or complete face transplants are being done around the world. While the patients who need them are last resort problems of massive facial deformities and tissue loss, that is the history also of all organ transplants which are commonplace today. From the extreme technical advances of today come spinoffs that will benefit many more facial reconstruction patients in the future.
No telling what this coming year will bring, but if past history is any predictor of future events, plastic surgery will continue to make the headlines…let us hope it is largely in the fantastic category.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox, breast augmentation, dr barry eppley, face transplants, indianapolis, liposuction, plastic surgery
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Monday, January 10th, 2011
Fat is one of those topics that we hear too much about and want as little to do with as possible. Most people feel like they have a little or maybe a lot too much. For some, fat is a definite the enemy that makes the choice between what tastes good and one’s waistline a difficult one.
When thinking of fat, it is almost always perceived as this blob of yellow jelly-like stuff that just sits there without much purpose. This collection of extraneous lipids and carbohydrates appears as nothing more than a piggybank of kitchen and restaurant memories. The reality is quite the contrary, however, as fat is really a dynamic body tissue that is a lot more active than it looks. And it has different bodily functions than just being an annoyance.
Seeing patients daily who have chosen to finally battle their fat with plastic surgery, I get to hear a lot of personal stories and insights into how fat is perceived and what is believed to get rid of it. Such experiences have prompted me to write a little mini-tutorial on one aspect of the biology of fat and body contouring.While fat may look the same throughout the body, it is actually quite different in structure. The size of fat globules, for instance, is quite different from that of the abdomen (big) versus that of the face or neck. (small) This is clearly evident when performing a tummy tuck versus a facelift. Because structure follows function in nature, it should be not surprise that the role of fat in the two places is different. Fat in the abdomen and waistline (men and women) and in the buttocks and thighs (just women) is depot fat. These are the primary storage areas and they offer a good central location with a lot of storage capacity. Fat in the extremities and the face and neck is largely insulating fat. Yes you can accumulate there but it is harder than storing it in your trunk regions.
This may be interesting biology but how is it relevant? While diet and exercise is a great first line of fat defense, it will not spot reduce any single area. And it does not work well on peripheral insulating fat areas. You can reduce tummy fat but it is virtually impossible to do the same with arm, neck or knee fat for example. And that flank or back fat is just about as stubborn. (it has smaller fat globules as well even though it is a trunk area) You can do all the crunches and twists that you want (and it is worth giving it a try first) but core fat reduction comes from overall weight loss. Spot or resistant fat reduction is most effectively reduced by liposuction, a focused fat removal method.
Will fat return after liposuction? The parallel question is will fat return after weight loss? Yes but the difference lies in what body areas are being treated. Depot fat site removal can return just like that of weight loss. But peripheral or insulating fat site removal is much more difficult (not a primary depot site) and those results are more likely to persist over time.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, fat biology, indianapolis, liposuction, plastic surgery
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Monday, January 10th, 2011
Q: I am interested in getting Smartlipo for my love handles. I am a 42 year old healthy HIV positive male since 2005. My CD4 count is 435 and my viral load is undetectable. I am 5′ 9 and weigh 170lbs. I am on HIV medications with no signs and symptoms. I have been recently diagnosed with Hepatitis C but am not on any medications for it. My liver enzymes are close to being normal and my liver ultrasound is normal. Would I be a candidate for Smartlipo?
A: Having these two viral infectious diseases does not preclude you from having any form of liposuction surgery. The key is that your medical conditions are stable with good counts that would not make your risk of infection significantly increased and that you could safely go through a short surgical procedure without any adverse effects on your health. You would need medical clearance from your physicians as they are most familiar with the details of your current condition and laboratory values.
Smartlipo of the flanks is a fairly small liposuction procedure that can have a dramatic effect on the waistline and the flanks. It is a common treatment for men that reduces a fat problem that is otherwise impossible to exercise and diet off. Done as an outpatient procedure, it is completed in under an hour with minimal recovery and restriction of activities.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, hepatitis C, hiv, indianapolis, liposuction
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Thursday, December 2nd, 2010
Q: I have been unhappy with my lower abdomen area so I had Smartlipo done three years ago. So I went and asked another plastic surgeon in my area what he could do and he said either try Thermage to tighten the skin. Then if I was still unhappy I could go for a revision and do a fat transfer. I went ahead and did the Thermage and now I’m waiting o see whart the results will be. But I don’t think that it is going to even out the areas. It seems that when Smartlipo was done some fat was left behind and formed these bump and lumps. Since I’m almost 40 years old I thought the Thermage would help. I wasn’t over weight I was just trying to get a little help in sculpting since I routinely workout. And it is very apparent that the surgeon overdid it. And since then I’ve been trying to get used to seeing myself like this. But haven’t really gave up hope yet. What are your suggestions?
A: Abdominal irregularities after liposuction is unfortunately not rare. They appear as lumps and bump as you have described. While the concept of non-surgical skin tightening sounds theoretically appealing, I would not be optimistic that would be a solution to the problem. The problem is differential thickness of the underlying subcutaneous fat layer.
When considering treatment of theses lumps and bumps, you must first decide whether they are problems of fat excess or fat deficiencies. In other words, are these lumps and bumps high spots or is the area between them low spots. That decision is critical because the treatment is radically different. If the lumps and bumps are areas of fat excess, they can be treated by Lipodissolve or dilute steroid injections to cause fat atrophy. Depending upon their topography, they may also benefit by spot liposuction reduction. If the problem is that the lumps and bumps are normal and the areas between them are deficient, then fat injection grafting is the treatment of choice.
Dr. Barry Eppley
Indianapolis Indiana
Tags: abdominal irregularities after liposuction, dr barry eppley, indianapolis, liposuction, plastic surgery, smartlipo
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Wednesday, December 1st, 2010
Q: I would like to know the differences between slim lipo and smart lipo. I have read its more the Doc, than the process. I would like to get cost estimates, and a list of good Docs near my location. Thank you.
A: You have asked three very good questions about liposuction of which all three are understandably misunderstood.
The names, Smartlipo and SlimLipo, are brand names from different manufacturers of laser liposuction equipment. Smartlipo was the original company that introduced a laser liposuction device to the market back in the mid-2000s. Since then they have undergone numerous technologic developments with better and more powerful laser liposuction machines. Along the way numerous manufacturing competitors have arisen with their own branded names of which SlimLipo is one but there at least a half dozen others. Both companies and their docs can argue all day about which one is better but, in the end, it really comes down to the skill and experience of who is driving them so to speak…as you have already pointed out.
Cost estimates in liposuction can not really be accurately done without knowing the specifics areas that one wants to treat. It is all about the time and effort that it takes to do the procedure. There is a big difference in cost, for example, from a simple neck liposuction which takes 30 minutes to total abdomen, flank and thigh treatments which could take around 2 to 2 1/2 hours to surgically complete. One would have to be specific as to the areas involved to even get a cost estimate without being evaluated in the office.
Lastly, the concept of what constitutes a ‘good Doc’ is a matter of perspective. There are no lists of good or bad docs anywhere. What you want to find is the right doctor for you. That requires doing your research online of various websites and eventually getting yourself in front of some actual doctors and gathering more information.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, liposuction, plastic surgery, smartlipo
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Wednesday, December 1st, 2010
Q: Can lipodissolve be used to eliminate lumps of fat left on the abdomen after liposuction?
A: Irregularities of the abdomen after liposuction is not a rare outcome. The abdomen is the most common body region for noticeable irregularities to occur after liposuction. This has to do with several factors including its flat surface and easy visibility (the entire surface can easily be seen and scrutinized), the unpredictability of how the abdominal skin will tighten particularly if there is any loose skin present, and the relative imprecise nature of the liposuction procedure when it comes to evenness of fat removal under the skin. While such words as ‘sculpting’ are often throw about in liposuction marketing and promotion, these are often an overstatement of what can actually be achieved in many body areas. Liposuction, of any type and technology, is best thought of as fat reduction, recontouring or reshaping. But the combination of the concepts of liposuction and sculpting is more fanciful than reality in most cases.
Lipodissolve injections, using a phosphatidycholine and deoxycholic acid mixture, can be used for any ‘high’ spots that remain after liposuction. While once conceived as possible for more major areas of fat reduction, time has not borne out that out for its utility. But for very small ‘lumps and bumps’ after liposuction, it can be very effective. The prior experience with Lipodissolve for larger fat areas showed that it has some results but just not enough. But for small fat collections, it can offer a non-surgical solution. Two things are important for patients to realize with Lipodissolve, it may take more than one injection session to get the best result and it is not an FDA-approved treatment.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, lipodissolve after liposuction, liposuction, plastic surgery
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