Q: Dr. Eppley, I had liposuction on my stomach in 2009. I work out 3 to 4 times a week with a trainer. I actually look bigger than I did before the liposuction. I have gained fat in my back and my breasts went from 34B to a 36C. I look like an ogre. My question is would SmartLipo be an option for this excess fat on my back? Or will I face the same results (fat returning on another area of my body)? I am completely miserable. Thanks.
A: Based on your description of your liposuction experience, I am assuming that you had improvement from the procedure in 2009 and have gained weight subsequently in other areas of your body. When considering liposuction now, your concern would be that fat would just accumulate somewhere else again. Your concern is based on the fat redistribution theory that states removal of fat from one body area will merely cause other areas to get bigger. (fat homeostasis) While commonly believed, this theory has never been proven to exist on a wide scale basis although perhaps it may be true for a small number of people. Whether it exists in you or not I do not know, but let us assume for the sake of this conversation that it is true. Then fat removal from the back will cause it to accumulate elsewhere although there are not many other places that it can practically go.
That discussion aside, fat removal from the back is difficult with liposuction because it is a different kind of fat which is more fibrofatty and harder to to remove. (unlike the stomach area) Smartlipo, a fiberoptic laser method of fat emulsification prior to suction extraction, is a good technique for this fibrous back fat.
Dr. Barry Eppley
Q: I have a quick question…I got liposuction last year and I recently had to have it touched up in March. I noticed these “indentions” on the side of my back so I googled to see if it is normal and I ran across your post on Explore Plastic Surgery. I was just wondering if you could tell me if my back looks normal or if it is something that I should be concerned about? I never noticed this before I had the surgery and it is driving me crazy now because I am not sure if it looks right. I really appreciate your time. Thank you!
A: What you have is linear indentations from the liposuction cannulas. That has created a groove or inward depression in this portion of your back. This is due to the amount of fat that has been removed in that one area compared to the surrounding back areas. This gives your upper back that V-shape look. It is not an issue of medical concern only one of aesthetic judgment. Whether this tapered look is considered aesthetically pleasing or not is a personal one. Some would consider that this aggressive liposuction has created an improved back contour. Others may feel that these indentations have created an undesired back contour.
Dr. Barry Eppley
Q: Hi. I know I might be young to ask, age 19, but I was wondering what you called a plastic surgery that takes care of love handles. But I am not talking about the hip handles. I have some pretty good handles right under my breasts that wrap to my back. I believe it is some loose skin as I have managed to loose 25 pounds this past year. I am just wondering what you would call that specific body part and maybe an average of how much it would cost to fix it. Thanking you in advance for replying. From a discouraged yound girl.
A: The important question is whether the rolls underneath your breast that extend into your back are skin, fat or a combination of both. With weight loss, most loose skin is going to develop and be seen lower due to gravity. That being said, I would have no doubt that it is a combination of loose skin and fat. Whether one is more predominant over the other would require an actual physical examination to make that distinction. But given your young age, I would recommend a liposuction procedure for fat reduction first and see how the skin adapts. The fat in the upper abdomen and the back is more fibrous in nature than lower abdominal fat and a liposuction technique, such as Smartlipo, will be more effective than traditional liposuction. There are methods of skin and fat removal by excision in the upper abdomen, which do leave lower breast fold scars, but they are usually reserved for more extreme cases of weight loss where the sagging skin is the predominant problem.
Dr. Barry Eppley