Your Questions
Your Questions
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
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
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
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
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
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
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
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:
- 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.
- 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.
- 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.
- 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
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.
A: 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
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.
A: 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
Q: Dr. Eppley, I am interested in a Brazilian Butt Lift. Could this procedure include having liposuction for weight loss reasons as well as butt enlargement? It seems like you get two benefits at once, a bigger butt and dropping your weight at the same time.
A: Every Brazilian Butt Lift requires liposuction to harvest the fat that needs to be transferred by injection into the buttocks. This almost always comes from the abdomen, flanks and waistline and as much fat is taken as possible in most cases. But to call this liposuction harvest, or any liposuction procedure, a weight loss method would not be appropriate. That is not what it accomplishes. Liposuction is a shaping technique but it does not create any substantial or sustained weight loss in most cases.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am not sure if I need Lipodissolve or a tummy tuck. I have gained 15 pounds or more since I have turned 40 and now can not seem to lose it. I am not sure what I need to get my clothes to fit right again. Does the lipodissolve work? How much is the cost between them? What is the diffenence? How much time will be needed off work for a tummy tuck? Will the weight come back right away? The weight is around my middle, love handles and my thighs and butt.
A: Choosing between liposuction and a tummy tuck is a common dilemma for many women, although many times it is a more hopeful wish that liposuction alone will create the result they want. While I don’t know what you look like, I am absolutely certain based on your description that lipodissolve injections are not the answer. They are for very discrete small areas of fat which is not what you have. The question is only then whether it is liposuction alone or liposuction combined with a tummy tuck. Seeing a picture of your stomach would be helpful in answering that question. There is no doubt you need liposuction, it is just whether there is enough loose skin across the stomach to justify a tummy tuck as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 21 year old female wanting to have liposuction to get rid of my stomach and reduce the fullness on my sides. I feel it would give me a much better figure and more of the hourglass look. My questions is whether doing it at my age would be a waste since eventually I am going to get pregnant. I want to look better now but I also don’t want to throw money away either. Please advise.
A: You have to recognize that many cosmetic procedures are not always going to create permanent results. This is particularly true when it comes to fat removal liposuction procedures. There are a lot of factors that influence the long-term retention of liposuction results, of which future pregnancies are certainly one of them. You also have to recognize, which you already know, that whether you have liposuction or not that an eventual pregnancy is going to change your stomach and waistline area. These changes will effect skin more than fat but they would not be considered to be beneficial at keeping the look of a liposuctioned result. The issue with looking at the ‘value’ of liposuction is how soon after were you planning to become pregnant. In other words, how much time would you enjoy the benefits of liposuction? If you were looking to become pregnant within the year after the procedure then it would not be a good use of your effort and money. But if there are no foreseeable plans for pregnancy as far as you can see in the future (years), then the benefits of liposuction may outweigh its cost when it amortized over that period of time. To put it any other way, how much would you pay a month to have a better looking stomach over that period of time?
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had liposuction recently on numerous areas of my body including my stomach, love handles, and thighs. My doctor told me he removed two and a half liters but couldn’t tell me exactly how much it weighed. He showed me a picture of a bag that contained the fat removed, which looked like a lot, but he said he didn’t weigh it. can you tell how much you think it weighed?
A: A question that I often receive from my Indianapolis liposuction patients is “how much does fat weight after removal?” While plastic surgeons remove and record the volume of fat in liters, this often has little meaning to most patients.
In calculating liposuction weights, one has to start with knowing that 1 US gallon equals close to 3.8 liters. While a gallon of water weighs about 8.4 lbs, fat however will weigh less because it is less dense. A gallon of fat is known to weigh about 7.4lbs. The density of fat is 0.9 grams/ml or 1000ml (1 liter) or a weight of 0.9 kg. Taking these calculations, one liter of fat equals roughly 2 lbs. Therefore 2.5 liters of liposuctioned fat will weigh close to 5 lbs.
While one liter of pure fat weighs about 2 lbs, it is actually less straightforward than that when it comes to fat removed by liposuction. What is removed in liposuction is called the aspirate and not just pure fat. Liposuction aspirate is a mixture of solid pieces of fat, free fatty acids (broken fat cell contents or oil) blood and tumescent solution. (what was injected into the area before liposuction) Thus, liposuction aspirate is not 100% fat but just a fraction of it. (a big fraction just not 100%) As a result, one liter of liposuction is really less than 2 lbs of fat removed and may be realistically closer to 1.5 lbs of actual fat. However when you factor in the number of fat cells that have remained behind inside the patient that have been damaged or destroyed and will be lost as the tissues heals, it is still fair to round up the total fat ‘removed’ to 2 lbs/liter.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in liposuction or a tummy tuck, preferably liposuction though. I have had two pregnancies, seven years apart with the last one being five years ago. This has left me with loose skin and fat around my mid section. I am 38 years old and weigh 140 lbs and have a 34″ waistline measurement. I feel great, I just can’t get rid of the skin and fat around and under the naval area. I have had two abdominal surgeries in the past and skin hangs over the suprapubic scar. If I just have liposuction will I be left with flabby skin?
A: As a general rule, if one has significant loose skin on their abdomen before liposuction they will still be loose skin afterwards. While many forms of liposuction have been touted about their ability to tighten skin, the amount of skin tightening obtained is almost always far less than what patients desire. As I always tell patients, liposuction can tighten skin in the range of millimeters, however, patients are interested and need skin tightening in the range of centimeters most of the time. With loose skin around the belly button and overhanging a suprapubic scar, you would be better served by having a mini tummy tuck which would incorporate liposuction with it. Given that you already have a suprapubic scar you might as well take advantage and use the entire scar for a mini tummy tuck. It does not add that much more scar length and its ability to remove skin make it more than a worthwhile trade-off.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in liposuction or perhaps one of the non-invasive body contouring approaches. I am a petite 23-year old female who is 5’4” tall and weights 112 lbs. I am in pretty good shape, but have areas of fat on each of my inner posterior thighs that will not go away with any form of exercise and have been there all my life. I would be very happy with a visible reduction of this area and the bulges eliminated. I am also very apprehensive about any procedure requiring general anesthesia and would greatly prefer to reduce risk. But on the other hand, I don’t want to waste money on noninvasive treatments that don’t offer a significant improvement.
A: Liposuction would be the most efficient and effective method of fat removal for your inner thigh areas. But given their small size, this could be done under local anesthesia with or without oral or IV sedation if you were so motivated. While Coolsculpting or Exilis devices would produce some positive changes in the inner thigh bulges, it would not be as much nor as fast as with microcannula liposuction fat extraction. Since these inner thigh bulges have been present your entire life and this body area is not a known fat depot side, the reductive changes induced by liposuction should be permanent.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in Liposuction of the Dorsocervical fat accumulation. I am curious if you do this procedure and what ball park of cost would this procedure be in. Please advise as I need your help.
A: Liposuction is an excellent option and often preferred treatment for neck fat. I believe when you refer to the dorsocervical fat accumulation, you seek the classic ‘Buffalo Hump’ reduction. This is a procedure that I have done numerous times (most commonly in the HIV patient although not always) and I have found that the use of laser liposuction (Smartlipo) can give a very effective reduction without the need for an open operation with a long incision. This is a procedure that takes less than an hour to do, often under sedation or general anesthesia. (it is helpful to have the patient have a good anesthetic depth so the liposuction procedure can be aggressive) Buffalo humps consist of a very fibrous type of fat (often looking more white than yellow) as opposed to a softer and more buttery type of fat more commonly seen in many areas of the body including the anterior neck. This is why laser liposuction or power-assisted liposuction (PAL) is used as it is more effective at breaking up this more dense fat that is held together by fibrous tissue bands. Buffalo humps can be very effectively reduced by this liposuction approach. In my experience, patients have not reported a recurrence of this posterior neck fat accumulation. The ballpark cost would be in the $4,000 to $4,500 range.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How much for liposuction, specifically smart lipo, of the abdomen? Here is a picture of my abdomen. I am not interested in a tummy tuck scar and the recovery time. Thanks.
A: While I can understand why you would want to pursue some form of liposuction, it is neither the appropriate or effective contouring procedure for your abdominal problem. You have as much excess skin as fat as part of the loose abdominal overhang. Removing fat will only cause more loose skin and will not get rid of the overhang. It may likely leave your abdominal problem with no substantative improvement. While no one understandably wants a tummy tuck scar or the recovery from it, this is the only procedure that will be effective for your concerns. Do not waste money or effort on a liposuction procedure that will not work for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, when you do liposuction do you close the incisions with stitches or staples or just leave them open? A relative of mine across the country had liposuction recently on her stomach and thighs and they didn’t close her incisions. I didn’t realize that liposuction was done that way. She said her incisions bled for days and she had to keep changing her wet bloody garments. How does this affect the liposuction result and does it increase the risk of infection?
A: Whether a plastic surgeon chooses to close liposuction incisions is a matter of personal preference. There is no evidence that not closing these incisions increase the risk of infection or affect the outcome of the procedure in any way. It is common for the liposuction incisions to leak fluid for 24 to 36 hours after the procedure which is primarily induced by the wearing of the compression garments. (squeezing it out) What one sees, although it looks like a lot of blood to the patient, is actually just a little bit of blood mixed with the tumescent solution that was infused at the time of the surgery. One could argue that the more this fluid comes out the less swelling and bruising that will subsequently occur. If the fluid does not come out it stays in the body and must be absorbed over time as one heals. If the incisions are closed probably less fluid comes out but a fair amount will still ooze out anyway. This is why I tell patients to not sit or lay on anything they value (without a blanket) for the first few days after surgery.
That being said, I do prefer to close my liposuction incisions (with the exception of those placed inside the belly button) as it increases the likelihood of better scars, small as they may be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in liposuction surgery. I have never been terribly overweight, however, I can’t lose the belly fat. I would also like to take a few years off my face. Most people tell me I look to be about 45, I’m actually 56. My looks probably matter more to me than most people as I currently work in a very visible public position so I feel I need to look my best so I can stay in this business until I retire. I would like to know what I can get done and not have to be off work any long periods of time. I am very interested in liposuction of my stomach/butt/thighs/ and arms, possible facial work later.
A: Since body contouring (liposuction) in your primary focus for now, I will keep my comments to that area. The most important question based on your inquiry is what is the best treatment for your body fat concerns. The abdominal area is always the one body area where the debate is between liposuction and a tummy tuck. It has been my experience that most people assume that liposuction can do too much, that it can magically remove a lot of fat and tighten up a lot of loose skin. While liposuction is a very good fat reducer, it can do little for excess skin. Thus whether it is an appropriate surgical method for your abdomen, arm, thighs and buttock issues will require a physical examination to answer. My concern for you is that the desire for great body contour changes and little time of work often do not go together very well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wanting some more information about the Smart Lipo and discounts under the Patriot Program.
A: Thank you for your inquiry. I would need to know what body areas you desire for liposuction and what they look like before a cost quote could be provided. You may feel free to do that by description or sending pictures, whichever conveys what you need. I would also point out that although I use Smartlipo technology for liopsuction it is done under general anesthesia and not local anesthesia to achieve the best results possible.
The Patriot Program is a discount program for plastic surgery for active military and their families. The amount of discounts from regular surgery fees are determined on a per patient basis. As a general rule, we make a 25% reduction from the normal surgeon’s fee for the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to know if I need liposuction, a mini-tummy tuck or a full tummy tuck? I am 28 years old and have had two children. I had breast augmentation done three years ago and go pregnant right afterwards. I have a big hard stomach and can’t seem to lose it even though I work out and try to eat right. I am 5’ 8” and weigh 190 lbs. I think surgery is only thing I can think of to help but I am not sure what I need, liposuction or some type of a tummy tuck. Please help!
A: With a relatively high BMI (body mass index) and a ‘hard and big’ stomach, I have concerns that any form of plastic surgery is appropriate for you at this time. You need to lose some weight by some method before considering any tummy reducing plastic surgery procedure. A hard stomach indicates that the skin is tight and a tummy tuck, while it can be done, would not produce a result that may be worth the effort. (the tight skin would not allow that much to be removed) A better yield on a tummy tuck would occur if you dropped 20lbs to 30 lbs, creating greater looseness of skin. Similarly liposuction would produce less of a result that expected as some of your fat is intraperitoneal (located behind the abdominal muscles) where it is inaccessible to a liposuction cannula.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am curious about having liposuction on my abdomen and thighs what is the average cost, I want to remove about 15lbs.
A: Thank you for your inquiry. While it would be helpful to see some pictures of your abdomen and thighs, let me ask you a few questions in regards both areas:
1) Is this your full abdomen?
2) Do you need the flanks or muffin tops t.reated as well as your abdomen?
3) Do the thighs include both sides, inner and outer? Knees?
When considering cost, knowing exactly what areas needs to be treated as this allows the time to do the procedure to be properly determined. Fundamentally, liposuction like all cosmetic surgery and its cost revolves around the timer to do it.
While 15 lbs of aspirate (1 liter of liposuction aspirate roughly equals 8 lbs) may be removed in surgery, this does not necessarily mean that will translate into 15 lbs of actual body weight lost.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, How is fat accurately determined and measured before suctioning it out by liposuction. I haven’t read anything about how body fat is measured to accurately determine how much might be safely suctioned out from each target area. How do doctors concretely know how much of fat to remove so the patient gets the best result and is even on both sides?
A: The reason you can’t find anything on this aspect of liposuction is because it does not exist. There is no way to know beforehand how much fat to remove from any area. That is and will likely always remain the ‘artistic’ side of liposuction. It is based on the surgeon’s experience and artistry to do the fat removal. The amount of liposuction aspirate is measured as it is removed and that does help in establishing some symmetry by taking equal amounts from any body area that is bilaterally treated…but this assumes that there is good symmetry beforehand which often is not the case. Thus liposuction remains an inexact surgical procedure and also explains the highly variable results seen in liposuction patients in general.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am considering liposuction again after having it 15 years ago on my abdomen. I am now 61 years old, 5’5″, 138 pounds and in good health. I’ve developed a spare tire around my middle since menopause. Do women my age have a good outcome with liposuction? I had some dimpling with my prior experience although I was delighted with the results. Also, should my doctor use a particular size cannula? I have also considered a tummy tuck but don’t want that much down time.
A: The contour results of liposuction at any age are based on a variety of factors including the quality (elasticity) of the skin and how the fat is removed which definitely includes cannula size and type. In today’s numerous liposuction methods, however, there is so much more involved than just cannula size that determines the amount of fat removed and the resultant smoothness of the overlying skin. A variety of liposuction technologies now exist based on different energies (ultrasonic, laser, high pressure water, power-assisted etc) as well as techniques to use them. How your liposuction is going to be performed and why should be discussed with your plastic surgeon. All of this aside, the risks of skin irregularities always exists with any liposuction method and given your prior liposuction experience it is always important to remember….past history predicts future behavior. If you have had skin dimpling before you will likely end up with it again.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am interested in Bodyjet lipo. It seems to offer the best result with the quickest recovery. What are your thoughts on it?
A:Bodyjet lipo is just another method to perform liposuction. It is no better or worse than any other available method. Instead of an energy like laser, it uses water under pressure to evacuate the fat. The key to a successful liposuction outcome is not so much the technology, contrary to the manufacturer’s marketing, but the skill and experience of who is holding and driving the technology. Using the best liposuction technology available in unskilled and inexperienced hands will still lead to a poor outcome. Old-style liposuction techniques in skilled and experienced hands can still lead to a great outcome. One thing touted by all new technologies, and I have used most of them, is that the recovery will be quicker and easier. This is simply not true since no matter how liposuction is done it involves the same trauma to the tissues over a broad surface area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 20 year old female. I used to weight 105 lbs and gained a lot of weight after going on the Depo shot. I currently weight 145 lbs. My height is 5’0 so I believe it is a lot of fat for my size. I have fat on my arms and back and a lot on my belly area, also my legs are very thick. I would like to know an estimate on having the fat removed from those areas and having it place on my butt and breast. I am a B cup and would like a little more in that area but don’t want to go for implants at all. Maybe around a 36C. I have a little fat on my butt but I would like it to be round and firm with a little more extra fat. I wear a size 7 going on 8 pants, I can also fit a size 9 already. A lot of my fat is on my thighs. I’ve been interested in having this procedure done for a while but I’m not sure on the price and would like to know how much you would charge for the procedure. I have looked at your reviews online and I was very impressed. So if I do decide to get the procedure I would definitely like to go to you. Can you give me an estimate on the procedure for both breast and butt together and an estimate for butt only? Thank you very much for your time. I’m looking forward to hearing back from you.
A: Thank you for sharing your body description and your goals. With these in mind let me provide with some clarifications.
1) While liposuction can effectively remove fat, it cannot do it equally well everywhere on the body. The thigh is a particularly challenging area because circumferential thigh liposuction can not be done. It can not effectively reduce large thighs. The outer thighs (saddle bags) and the knees can be treated but only some areas of the contours of the thigh can be changed.
2) Transferring fat from liposuction to the buttocks is commonly done and is known as the Brazilian Butt Lift. Provided one has enough fat to harvest, the shape and and firmness of the buttocks can be improved.
3) Fat grafting to the breasts, however, is not so simple for an augmentation effect. While fat can be injected directly into the buttocks without stimulation, it can not be done so in the breasts. The breasts must be pre-treated by an external suction device (Brava) for weeks before the procedure, have the injections, and then have the suction device used for several weeks after. Fat injections into the breasts are a lot like planting seeds to grow. The ‘garden’ must first be prepared and fertilized to receive them. Also it is highly that you would have enough (after processing and concentrating it) to inject both the buttocks and the breasts at the same time. You would have to pick either the breasts or the buttocks for fat injections, you can not do both.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am interested in a non-invasive procedure for fat reduction basically at thigh and abdomen. I would like to know what you recommend and what do you think about CoolSculpting. I have had 3 c-sections, no other medical conditions. Thanks.
A: Let me make some general comments about the differences between non-invasive vs. surgical treatments for body contouring. (fat reduction and skin tightening) First, when it comes to considering non-invasives (e.g., CoolSculpting, Exilis etc) the patient never has anything to lose…other than money. There are no medical risks or downtime. The only risk is in how well it will work. Thus if someone is dead set against surgery then go ahead and do the non-invasive approach. It will either produce a satisfying result or it will not. Second, understand that no non-invasive therapy will ever produce a surgical looking result. I don’t care what is said about it or how good some before and after pictures look. The role of noninvasive treatments for many patients is a bridging therapy…I don’t want surgery but I want some improvement. ..and I will accept that it will likely do less than I ideally want. Lastly, no patient wants to waste their money and effort on a treatment that never had a good chance to work for them. Thus it is important to get a qualified answer beforehand as to what your chances are for success with any non-invasive treatment.
While I have no idea what you look like, the fact that you have had three pregnancies/c-sections give me cause for concern about the success of any non-invasive treatment approach for your abdomen. Your abdominal skin is stretched out and probably has poor elasticity…that would be inevitable after three pregnancies. If you have any stretch marks at all, there is next to no elasticity. That skin has a very limited ability to shrink back down on its own no matter what energy treatment is applied to it. So even if you can shrink some fat what will happen to the skin? Without skin shrinkage with fat reduction the change in the abdominal contour will likely not be an aesthetically significant improvement. On your abdomen after three c-sections the real question is whether anything will really work short of a tummy tuck.
The thigh area is always different because the skin always has better quality. The issue here is the debate of something like CoolSculpting vs liposuction. I think that answer lies in how much reduction is needed and what does your abdomen really need. If a tummy tuck is the only answer to your abdominal concerns, then you might as well have liposuction done on the thighs at the same time.
I would be happy to review of any pictures of your abdomen and thighs to give you a more definitive answer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I currently weigh 255. I would like to get down to 215. I’ve improved my eating and exercise, but I’m not seeing results. I would like 6 inches of fat removed from my waistline to help improve the fit of my clothes and my appearance.
A: I think it is important to put liposuction into proper perspective of what it can and cannot do. It is not a weight loss method nor can it remove a specific amount of fat in inches from anyone’s waistline. In some patients it may be possible to remove that much fat but in most cases that is not a realistic goal for what liposuction can do. While I have no idea as to what you look like, your height or your body frame, I do know you are a male who likely has a rounder more rotund belly. Much of men’s abdominal fat is not extraperitoneal (between the skin and the abdominal muscles) where it can be safely accessed and treated by liposuction. Most male abdominal fat is intraperitoneal, around the internal organs, behind the abdominal muscles and inaccessible to liposuction. There are two simple tests to tell where your abdominal fat is located. Is your belly hard or soft? (feel like a watermelon or like a firm pillow) How much skin can you pinch between your fingers? (an inch or two or a whole handful) A soft belly in which one can grab a whole handful of tissue means that liposuction can make for a productive result.
The real question is whether liposuction can and should be done now or wait until you have lost more weight. (I know this is why you are asking for liposuction because the weight is not budging but there are other non-surgical means to pursue if needed) That is going to require an actual physical examination for me to see and discuss whether liposuction has a useful role in your abdominal contouring objectives.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting liposuction to reduce the size of my waist and hips. Attached are some pictures of my waist and hips. I am after achieving very specific circumferential measurements in these areas. I have a measurement of 34 inches on my waist, and 46 inches on the widest part of my hips/ buttocks. I am 5 foot 8 inches in height. I need to be at least a 32 inches in my waist and 40 inches in the widest part of my hips/ buttocks. I am also interested in getting my thighs done. Is this possible.
A: Thank you for sending your pictures. On a realistic basis, I do think it is possible that your waist could go from a 34 inch down to a 32 inch waistline. However in the hip/buttock area a 6 inch reduction is simply not realistic. This is an area whose diameter is highly influenced by the hip and pelvic bones as well as the thickness of the attached muscles. Fat plays a role in its shape but not the level of a 6 inch reduction. A more realistic goal would be 1 to 2 inches, and maybe even 3, but I am not sure with your body shape how realistic a 3 inch reduction would be. My concern for any patient that comes in for any form of liposuction body contouring that is going to use a quantitative measurement as a determination of the success of a procedure is that they may end up disappointed.
Dr. Barry Eppley
Indianapolis,Indiana
