Your Questions

Q: Dr. Eppley, What is the difference between liposculpture And liposuction? I am 55 years old and scared of the skin sagging or wrinkling At my age with liposuction, I would love my inner thighs, knees and saddlebags gone forever.

A: On the one hand, the difference between liposuction and liposculpture is largely one of marketing. The term liposculpture implies a greater degree of finesse and precision than the historic term of liposuction . As a result some doctors use this term for any form of liposuction because it simply sounds better. That does not necessarily mean, however, that it is or that the body is truly sculpted. Conversely, if applied to the right situation, the term liposculpture may have some real meaning. The right situation in my experience is when one is doing smaller areas of fat reduction using smaller cannulas where getting a more precise result and truly creating a visible contour change occurs. In short, liposuction implies large volume fat reductions where a simple size change occurs. (i.e., a full abdomen) Liposculpture implies smaller and more precise volumes of fat removed to create curved contour changes. (i.e., neck, knees)

Based on your age and areas of concern, however, these liposuction concepts are not what is important for you. You are appropriately concerned about what will happen to your skin at your age with any form of liposuction. The effects of liposuction on the overlying skin change based on the area being treated. I would not be concerned about the knees as skin never sags in this area no matter how much fat is removed at any age. Conversely, the inner thighs are a treacherous area for irregularities and skin sag at any age. I would approach the inner thighs with modest fat removal or none at all. If any significant skin sag exists now you would be better off with some form of an inner thigh lift if you want to go that far. As for the saddle bag area, this is a good area to treat but the key is to not remove too much fat as skin sag as some irregularities will occur with too much deflation. You may also have to accept some negative changes in the skin in the saddle bags no matter how much fat is removed.

Dr. Barry Eppley

Indianapolis,Indiana

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

Q: I was just curious about whether I am a good candidate for liposuction on the buttocks and my abdominal oblique areas.  I am pretty small as it is but I have always had stubborn fat no matter what I do. I work out and eat right, I only weigh 105lbs and I am only 5 ft tall. My buttocks is a lot bigger than my size and that is what I consider my worst problem.  I have been trying to get sculpted for a couple of years, but nothing has worked. I have thought about getting this procedure done, but never had the nerve to get it started. If you could e-mail me back your thoughts that would be great.

A: Small discrete areas of fat on someone who is absolutely weight appropriate for their height, despite working out and eating right, is a common problem that I see in many patients. As such a slight frame and build you can be assured that these fat collections are genetic in nature and not metabolically responsive, which is why you can’t get rid of them by your own efforts. Such small areas I would refer to as liposculpture (shaping) more so than liposuction. (significant volume reduction) Small areas such as these respond quite well to small cannula liposuction.

One caveat about any type of liposuction is in the buttocks area. You have careful to not be too aggressive with the fat removal in this area as one can end up with a ‘deflated’ or sagging buttocks after volume is removed. Fat removal in the buttocks should be more conservative and carefully done to avoid this potential problem. Most likely in a small frame such as yours that is not a significant concern.

Dr. Barry Eppley

Indianapolis, Indiana