Your Questions
Your Questions
Q: Dr. Eppley, At the age of 23, I am in the Navy, and I have always had a tough time with the tape measuring. I was doing some research for liposuction reduction on my butt, thighs, and waist, so I wouldn’t have to worry about the measuring around my hips and waist. And I came across your website. I live in Florida, but I can get time off to complete a liposuction surgery. I was just wondering how much the procedure would cost? Thank you for your time and please reply.
A: I am very familiar with the tape measuring that is done to pass a fitness test as that is the number one reason most people in the service have liposuction in my practice. So your request is not a rare one. How effective that would be in your case, how much fat could be removed and what that would cost would depend on what your areas look like. In other words, what do I have to work with and how big are they? If you can send me a few pictures of the areas in question that would be very helpful. In the interim, I will have my assistant send you an estimated cost based on what I would envision the areas to look like. That may or may not change based on a review of any pictures you would send.
Dr. Barry Eppley
Indianapolis, Indiana
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
Q: Dr. Eppley, I have had a ‘cottage-cheese’ butt my whole life. I hate and want to get rid of it. Would liposuction help smooth out the dents on my butt by removing some of the fat? Besides making it smoother would it make it smaller as well?
A: The search for an effective cellulite treatment has been ongoing for years and to say that it is elusive is an understatement. The buttocks is a prime location for the cottage cheese look of the skin. Over the years such treatments as Endermologie and VelaShape have been promoted but their effects are short-term and any improvement requires regular maintenance treatments. Liposuction surgery, however, is exactly what you don’t want to do. Liposuction removes the superficial layer of fat and removes the support from the overlying skin…this has the high likelihood to make the appearance of cellulite even worse. The newest cellulite treatment, Cellulaze, may offer improvement of buttock cellulite on a more sustained basis but long-term results (years) remain to be reported.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like information on liposuction and butt augmentation. I would like information on estimated cost and recovery time. Thanks I hope to hear from you soon.
A: Thank you for your inquiry. The questions you have asked are broad with different options and make your questions impossible to answer without being very procedure specific. I would need to know more specifics about what exact liposuction and buttock augmentation procedures you desire.
1) What areas of fat removal by liposuction are you seeking? How many different body areas?
2) For buttock augmentation, is it by implants or fat injections?
This information is vital because much of the costs of surgery are based on the time that it takes to do them. For the sake of the most common method of buttock augmentation, which is fat injections from abdominal and flank liposuction harvests (aka the Brazilian Butt Lift), I will have my assistant pass along some costs to you later today for this approach. Those costs will range between $6500 and $8500 depending on how much liposuction is done/needed. This combination has the dual advantage of contouring multiple body areas by reduction of body areas around the buttocks which makes any buttock size increase look even better. Depending on the type of work that you do, I would anticipate a minimum of 10 to 14 days until you get comfortably back to most normal activities of daily living.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am getting quotes and suggestions on liposuction and a breast lift. I already have implants but looking to go smaller and I'm up in the air on replacing them, removing, or keeping the ones I've got. I've have breastfed 4 children and also need a lift and full contouring. What are your prices and are you running any promotions?
A: Unfortunately based on the information that you have given me I can not be of much help to you. It is impossible to give reasonably accurate pricing when you don’t really know what the patient needs. Liposuction can be done on 12 different areas of the body, there are four different types of breast lifts and two types of breast implant options. That leaves a tremendous number of variables to consider all of which take differing amounts of time and effort needed to do the surgery…and that hugely impacts cost. The best way to figure out what you may need is to either see some pictures of your concerns or give me a very specific set of procedures that you want to do. I suspect you need at least a full breast lift but knowing what to do with your indwelling implants is a very important consideration. Remember that when you do a breast lift, the actual size of the breast gets smaller. Taking out indwelling implants with any degree of sagging will leave you with very flat breasts despite the fact that they may be in much better position higher up on your chest after a lift. When it comes liposuction, I suspect you may be focused on your abdomen and waistline. But whether that would be an effective contouring technique in someone who has had four pregnancies with likely loose skin and stretch marks is an issue yet undecided.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am considering getting liposuction on my stomach and waistline but am curious how do you know how much fat to remove. In fact, why don’t or can’t you take all the fat that is there? I don’t want to you can just take it all? I have been searching for answer to this question but have not been able to find it.
A: Your question is actually a common one and comes in different versions. Most liposuction patients usually say just before surgery…’take as much fat as you want’…or…’feel free to keep going until none is left’. The answer is while it is possible to take much of the fat from any given area, it is not possible to physically remove all of the fat by liposuction. The way the instruments work make this impossible. The reality is you would not want to remove all the fat even if you could. Fat plays an important role between the skin and the underlying tissues that does beyond its commonly perceived metabolic role. Without fat your skin would stick right down to muscle and bone and not move when you move. The skin would be tethered, contracted and very unattractive as well. Just ask any patient who has ever had skin grafting for burn injuries. While they have a healed wound, they suffer from a loss of normal skin elasticity and flexibility. It is also important in liposuction to leave an adequate amount of fat on the underside of the skin to prevent the cosmetic deformities of irregularities and indentations, in other words to get a smooth result. There is an old plastic surgery saying in liposuction which is just as true today as whenever it was originally said…’it is just as important what you leave behind as what you take in liposuction.’
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to do something with my tummy area but am confused as to what to do. I have had several consultations and have been repeatedly told that I need a tummy tuck. However I don’t want to have a tummy tuck as I am scared of being cut like that and also fear the recovery. I lost 50lbs over the past two years and now weigh 140lbs and am 5’ 2” tall. If I just have liposuction will I be left with hanging skin and look worse?
A: It is clear based on your description of your body from weight loss and the recommendations of several plastic surgeons that a tummy tuck will produce a better result. But if you can not accept the excisional nature of the procedure and the resultant scar, then it is not a good operation for you. This is a common dilemma for many patients. Better result aside, liposuction is a more acceptable procedure for you and appears what you can accept at this time. The key to undergoing just liposuction is your acceptance that the result will not be as good as a tummy tuck. That is the price you pay for a procedure that does not ideally match the problem that you have. Always remember that you can always have a tummy tuck later if you find the deflated abdominal skin unacceptable. Based on your result from liposuction, you will either be glad that you choose just liposuction or will become convinced that a tummy tuck really is a good operation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am confused about whether a just need liposuction or a tummy tuck. I am 5’ 3” and weigh 128 lbs. I have had two children but do not have stretch marks, I can only stretch my skin about an inch or two but it definitely is not loose. I have some excess belly fat which looks strange on me given how thin I am everywhere else. My stomach muscles are tight and I don’t think there is any separation in them.
A: I could not think of a better description of the indications for liposuction than in your question. A tummy tuck is needed when one can grab more than an inch or two of skin, have one or more fat rolls, and can feel that there is separation of their vertical rectus muscle in the midline. Improving any or all three of these undesired abdominal features can justify the low horizontal scar that is the necessary sequelae of any form of a tummy tuck. The lack of stretch marks is significant because that signifies that your abdominal skin still has some elasticity…a key element in the successful obtainment of smooth abdominal skin after liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get information on cost and recovery time for different lipo procedures for various parts of my body – arms, chin, stomach, hips and thighs. I’d like to explore smart lipo and lipo dissolve, but would like to know if I can get good results.
A: Fat reduction by liposuction has a myriad of considerations including effectiveness, cost and recovery. It is impossible to give any reasonable answer to these questions without actually seeing a patient and evaluating each one of their body areas of concernb. The variables that affect these issues you have asked, such as thickness and size of the fat, quality and amount of overlying skin, how many and what body areas would be treated and what one’s physical health and occupation is makes any answers to these questions truly an individual one. I would recommend that you have an actual consultation with a plastic surgeon to get meaningful answers to your very relevant questions. While many people would like fat reduction, most commonly done by liposuction, it may not be the right answer for everyone.
Dr. Barry Eppley
Indianapolis, Indiana
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
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
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 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
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
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
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
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
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
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
Q: I have some bothersome fat areas on my stomach and thighs that I have wanted to get rid of for a long time. I now have the money to do it and have done a lot of research on the internet about liposuction. I never knew there were so many different ways to do liposuction. I keep reading about Smartlipo and it seems that it is the best tool for doing liposuction currently. What are your thoughts?
A: Using devices to remove unwanted fat is a surgical necessity. So, to some degree, we as plastic surgeons have to rely on devices to perform the surgery. Unlike ten years ago, there are numerous devices today that can make the fat easier to suction out. While many will espouse the benefits of one device over another, I would submit that the hands and brain that is using them is far more important than the technology of the device. No matter what the device can do to get rid of fat, it will be no better than the one who is driving it.
That being said, I can only comment on what my experience with Smartlipo has been over the past two years. In my hands, I can say without question that it does result in less pain and bruising after the liposuction procedure. I think that the swelling seen is about the same as traditional liposuction. I have no scientific data to support that it is more effective but my feeling is that it is. The heat generated in the fat tissues during the procedure accounts for some continued fat cell death and lipid release that otherwise would not be seen with traditional liposuction. While there does appear to be a mild skin tightening effect, most patients overinterpret that result thinking that it can remove inches of unwanted skin. Realistically ti causes some tightening of skin but that is best perceived as firmer skin tautness, not the elimination of an inch or two of excess skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I want to have a breast lift, liposuction on my stomach,thighs,buttocks,under the arms,between my chin and lower neck line, an eyebrow lift, and some under the eye work. (dark and somewhat deep and little wrinkles) I am a mother that is curious of amount of the cost. I’m not even sure that I can afford this but I truly have self esteem issues. My weight topped out at 202 lbs but I i am now down to 178 lbs. I have always been one to want to look and feel good about myself and I do not feel that way at 35 yrs old. I am too young to feel this bad about myself!
A: How we feel about ourselves is one of the most important characteristics of a person. While inner beauty and well-being is all that really counts, there is no doubt that how we look on the outside affects how we feel on the inside. Your plastic surgery wish list is comprehensive and, affordability aside, all of that could and probably should not be done in a single surgery. Therefore, it is important to prioritize this face and body plastic surgery wish list. The best way to approach that, and is what I discuss with all my patients who want an extreme body makeover, is to ask yourself this question. If I could only do one plastic surgery operation and could never return to the operating room, what procedures would you do on this list? I say pick just three and even put those in order of importance to you. Whether you would ever get to phase 2 or not is unknown, but if you don’t, then you will have accomplished the most important changes anyway.
Looking at your list, I can divide it into body and face work. While I am not you, most likely the body work is of greatest importance to you because you have listed/described it that way. It appears that a breast lift (with or without implants) and some abdominal and waistline contouring are your prime targets for change. It may also be possible to do so thigh and arm liposuction at the same time if your budget allows for it.
Dr. Barry Eppley
Indianapolis, Indiana
Q:I have had a c section with my son and I have no feeling toward the bottom of my belly. I have lost 52 pounds but still over weight. I am so frustrated but I think the only thing that will work is plastic surgery. Based on my readings, it looks like liposuction and a tummy tuck will do the trick. What has been your experience with the amount of improvement that thees two procedures can do?
A: Your question is a bit of a loaded one but the answer is in most cases very well. In fact so well for some people that it can be considered a ‘waistline’ miracle. This may seem a bit of an overstatement but for many tummy tuck patients it is not. The sheer removal of a full-thickness piece of skin and fat (either above or below the belly button) does something that no diet and exercise program ever could for someone who has lost a lot of weight. (50 lbs count as a lot!) When this skin and fat removal is combined with liposuction around the waistline and into the back, significant mid-trunk reshaping is done.
Already having a C-section scar (with numbness) and the extra skin created by your weight loss makes the consideration of a tummy tuck a fairly easy one as there are no viable alternatives. It is hard to predict how many inches may be lost around your waistline but it is fair to say at least 2 to 3 inches and maybe more. As impressive as the frontal change may be, I am always excited to help create the narrowing of the waistline by aggressive flank and back liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Cosmetic plastic surgery has long been unintentionally gender-biased. Since the field began, the vast majority of patients who seek cosmetic enhancements, albeit it surgery or office-based treatments, have been women. Men have always made up less than 10% of most plastic surgery practices. Hollywood would lead you to believe otherwise but it just isn’t so. The only rare exception to that has been the more recent popular treatment of laser hair reduction. When it comes to hair removal, men make up about half of the patients seen with the hairy back and shoulders being the prime targets.
But more men are finding their way into the plastic surgeon’s office in the past few years. Besides a steady increase in male numbers, what is noteworthy is the change in what what men are requesting. While there remains some traditional procedures that have always been of interest, technology, societal trends, and younger men have opened up new areas of the face and body for change and improvement. Here are four of the most popular younger male (teenage to early 40s) procedures today.
Liposuction still remains the most requested male procedure. The culprits are always the same, the stomach and love handle areas. But most men that want liposuction are not fat and many are not even overweight. To the contrary, they are lean but have fat collections at the side of the waist and flanks. Even in men that work out regularly, those love handles can be impossible to work off. Today’s liposuction techniques can even give that ‘six-pack’ look for those leaner men that are not opposed to a little surgical cheating.
Chest recontouring is the one male plastic surgery procedure that is really on the rise. Male breast enlargement, known as gynecomastia, has always been an issue. But with increasing teenage weights and the present young male aesthetic for a completely flat and smooth chest, improvement in the male chest is sought out like never before. Even small nipple protrusions can be bothersome for the teenage male. Obvious man boobs are not desireable at any age.
Nose reshaping (rhinoplasty) has always been a popular male operation and that has not changed. It is the one procedure of the face that young men are not afraid to change. Noses that are big with prominent humps and wide nasal tips are bothersome and distracting to an otherwise balanced face. Sports and recreational activities make the young male nose a good target for injury causing twisted and deviated noses that often pose problems for breathing as well.
One set of procedures that is really new and undoubtably influenced by movies and models is structural facial reshaping. Creating that chiseled and angular face is what some young men aspire to achieve. A good jawline in particular is associated with enhanced masculinity. While one perceived just as making a strong chin with an implant, modern plastic surgery implants can be extended all the way to the back of the jaw. With the development of jaw angle implants, the jaw line can become more defined than just with a chin implant alone.
A new generation is redefining male plastic surgery. Have a lean body, flat chest, and a nose and jaw line that creates a well defined face has probably never been out of style. But modern surgical developments make them more attainable than ever before.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 50 years old and my average weight hovers around 108 lbs. I have had four pregnancies. I have already had a mini tummy tuck but now have belly fat above my belly button and at the rib cage. There is also fat around the hip area as well. I have a surgery scheduled for liposuction but was told I would have to later have a “full body lift” to get the loose skin off. There is maybe two inches at the sides. I am in good shape. I use to go to the gym. Is it possible to do the liposuction with the other procedure or will it “kill the skin” as I am told and would not a tummy tuck be preferred to a “full body lift”?
A: At your age, regardless of how good your skin quality may be, liposuction will not tighten up the skin to any significant degree. While I can’t see what you look like, your statement that you have extra skin now is a certainty that you will have more extra skin after liposuction.
It makes sense, therefore, to consider some type of skin removal when you are doing the liposuction procedure. It would be unusual for someone like you to need a full body lift. Body lifts are exclusively done on patients who have lost a lot of weight, whether by bariatric surgery or on their own. You more likely need an extension of your previous tummy tuck out to the hip areas or maybe a little beyond to get the excess skin. The 360 degree or circumferential scar that results from a body lift is not likely needed in your case.
Liposuction can be safely done at the same time as the skin excision. While devascularizing the undermined skin is possible (‘killing the skin’ as you have indicated), an experienced plastic surgeon will know how to blend those two together to minimize that risk.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Can liposuction of the ‘love handles’ be combined with the hip and inner thigh areas? I have lost several pounds through the years. I was told laser treatment to melt the bit of fat would be the way to go but not sure what would happen with the bit of excess skin?
A: It is extremely common for multiple body areas to be treated during any liposuction surgery procedure. As a general rule in my Indianapolis plastic surgery practice, I treat as many body areas that can be done in two hours or less of operative time…with no more than five or six liters of aspirate removed. This is known as ‘normovolemic’ liposuction. Studies have shown that the medical risks of liposuction increase significantly with high volume liposuction surgery. (greater than five liters) There was a time when I performed high volume liposuction but now feel that such volumes are best done in two separate procedures.
Loose or excess skin is always an issue when the underlying fat is removed by liposuction. While some minor amount of loose skin will shrink and tighten after surgical fat removal, significant amounts of excess skin will not go away and are at risk to hang more afterwards. This is of most significant concern in the abdominal area but is also an issue in the inner thighs.
Laser liposuction (aka Smartlipo) will cause more skin to tighten than traditional liposuction because of the heat it generates during the procedure. But it is not a miracle skin tightening device and one’s expectations should be tempered if more than a little loose skin exists.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a baby about 16 months ago and still have a little pooch I cannot get to go away. I am interested in finding out about whether lipodissolve, smart lipo, and liposuction and seeing which one may be best for me.
A: Pregnancy does one thing that works against the effectiveness of any fat reduction method alone…it changes the abdominal skin. By stretching out the skin and losing some of its elasticity for most women, the abdominal pooch problem is often a combination of extra skin and fat.
It may be possible that liposuction (Smartlipo or traditional) alone will provide a satisfactory result for that abdominal pooch. But in most cases it has to be combined with some form of skin removal, maybe just a mini-tummy tuck will suffice.
One observation about Smartlipo that has become apparent to me over the past year is its apparent confusion as being different than traditional liposuction. Smartlipo is still liposuction and is invasive. It is simply a different and improved method of initially melting and loosing the fat before it is suctioned out. For whatever reason, patients often mistakenly think that Smartlipo is not surgery and is not liposuction.
The use of fat-dissolving injections for body fat removal has largely been relegated to a non-role in body contouring today. Despite its popularity from several years ago, it has failed to live up to the results we had hoped. While it can have some effectiveness, the fat areas must be quite small. Even in small areas, the use of Smartlipo under local anesthesia produces better results in a single stage procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Can “love handle” surgery be combined with the hip and inner thigh area? I have lost several pounds through the years. I was told laser treatment to melt the fat would be the way to go, but not sure what would happen with the excess skin?
A: It is very common to combine at least two, and often, up to five areas at a time during liposuction surgery. It is actually very uncommon to do just one area. Since liposuction is about reshaping body areas, it usually takes several areas at a time to get the best result. The only limit that I put on liposuction in my Indianapolis plastic surgery practice is the amount of volume removal and time, which are closely aligned. I have learned by experience that it is usually best to get a single session of fat volume removal under five liters or 5,000 ccs. If more is required, then the liposuction procedure should be done in stages. This decreases the potential risk of complications and makes the recovery more tolerable for the patient.
How much skin exists around a liposuction area is critical in determining what type of result can be obtained. The skin can shrink only so much even with laser liposuction or Smartlipo. If too much skin exists, then one may need to consider some type of excisional procedure. This is particularly relevant in the neck, arms, abdomen, and inner thigh areas.
Dr. Barry Eppley
Indianapolis, Indiana
Q : I had liposuction in December and still have pain in my stomach. Also I have an ugly lump under my chin after my liposuction and facelift. Have you seen such chin lumps before?
A: While liposuction doesn’t look like much from the outside, what goes on inside is quite extensive and traumatic to the fatty tissues. While liposuction can be very effective at fat removal and contouring, full recovery is not quick and really takes time often as long as three months to four months.
As part of this prolonged recovery process, there are some very typical aches, pains, and irregularities which one will experience. While liposuction is not acutely painful, soreness and discomfort persist at different intensities over time. As one gets more active and moves about more, twinges of shooting pain and tightness will occur. This is the stretching out and breaking loose of scar tissue that has formed as a result of the procedure. The skin over any liposuction-treated area will also be numb. Full feeling will return but again will take months. Some of the those shooting pains may also be nerves that are healing and re-establishing feeling.
One of the very common sequealae of liposuction is the temporary areas of lumpiness or irregularities that will be felt. These are collections of dead fat, scar and blood that have accumulated in an area. These feel very firm and painful to manipulate or massage. They are extremely common in the neck area because of the thinner neck skin and being an easy place to accumulate in the center of the neck. With time, they will get softer and eventually go away. The neck can get quite indurated after liposuction and will create fullness that temporarily distorts the good result that was seen at the end of surgery. One can massage the neck area several times a day which will help soften it faster.
The recovery after liposuction is a prolonged process and patience is definitely needed. I would not judge the final outcome until you are six months out after your surgery.
Dr. Barry Eppley
Q: I am interested in getting liposuction done on my stomach and flanks but am confused about the different types that I have read about. There appears to be regular liposuction, ultrasonic, laser, water jet…and and even something like ultrasonic done from the outside without surgery. Which type of liposuction is the best?
A: Liposuction has come a long way since its first introduction in the United States in 1981. It is a two-part process during surgery that involves the first phase of breaking up the fat and a second phase of removing or suctioning it out. All of the advancements in liposuction have come forth for the first phase, different methods to help loosen up the fat for evacuation.
One highly touted liposuction method that is neither new or novel is that of tumescence. This is an original advance in liposuction that began to be used in the mid-1980s and is part of every liposuction procedure today. Prior to doing phase one particulation, a special solution is first instilled that provides numbness to the treated area and helps cut down the extreme bleeding that would otherwise occur. This does make it possible for small areas of liposuction to be done under local anesthesia, but is also used even when you are going to sleep for the procedure.
Most of the advancements in liposuction that are highly marketed and promoted on the internet are relatively new. Whether one method really offers any improvement over the other has yet to be proven no matter what the endorsement and advertisement says. My current preference is for laser liposuction, branded as Smartlipo. We all know that fat is very sensitive to heat and can be melted as is observed during cooking. So the concept of heating up a treated area makes sense and is something that can really be felt during surgery. It is usually touted as also having skin tightening capabilities, and while I have observed that some of that does occur, it will not solve skin laxity problems where more than an inch of excess skin is present.
No matter what the tool that is being used, the most important element in getting good liposuction results is the experience and skill of the one holding the instrument or device. One of the real negatives to technology (and probably the only one) is that it enables those surgeons of lesser skill or training (and sometimes not a surgeon at all) to look equal to others of extraordinary experience and expertise.
At this time, I would be leary of any device that offers significant fat reduction through some method of external application. While the concept is harmless and certainly appealing, what you really risk is your money. If you are prepared to be dieting and exercising and doing everything to help lose weight anyway, then these device approaches may be reasonable. I suspect they do offer some benefit in the very weight loss conscious patient who is even more motivated by their economic investment. It is probably the ‘coach potatoes’ who make up the greatest percent of failed results with these devices.
Dr. Barry Eppley
Too much fat is a near ubiquitous problem. The sheer number of weight loss diets, medications, and exercise programs that we are inundated with each day is a testament to their ‘popularity’. Accompanying these fat concerns, to no surprise, is the desire for liposuction as a surgical fat removal method. Liposuction is by both number and surface area the most common cosmetic plastic surgery procedure in the United States.
Contrary to the perception of some is that most liposuction patients are not trying to use it as a weight loss method. Almost every liposuction patient that I have ever seen in my Indianapolis plastic surgery practice has come in with a history of diet and exercise efforts. Whether it is the 35 year-old mother who can’t get that stomach pouch off after her second child or the very trim 42 year-old male who just can’t get rid of those stubborn love handles, liposuction is usually sought out for the right reason…as a spot method of body contouring.
As potential patients seek out liposuction today, they are surrounded by an array of technology that did not exist just ten years ago. And such information is freely available for their assessment on the internet. Between marketing ads and alleged patient testimonials, every manufacturer and many doctor’s practices tout one liposuction method over another. Whether it is tumescent, ultrasonic, laser, water jet or cold liposuction, they all seem to be the ‘best’. At the least, many are relatively new and after all newer is better…isn’t it?
To understand this maze of liposuction technology, it is important to appreciate how the liposuction process actually works. Essentially, it is a two-part process. Simplistically, the first part of liposuction requires that the fat be loosened by some method. The second part is that the loosened fat is then suctioned out. All the different liposuction techniologies need to use the second phase, suctioning. The difference between all of them is in the first part, the method they use to loosen up the fat.
In traditional ‘old-style’ liposuction, good old elbow grease is how the fat is gotten free. Most everyone has a good vision of how that is done by the in and out motion of a cannula that looks like a good beating up, to quote quite a few patients. In ultrasonic liposuction, it is the high intensity sound waves that do it. With laser, it is the heat and melting of the fat. With water jet, it is the high pressure of water. With cold, it is the reverse thermal effect of heat that does it.
I have left out the tumescent method as it is not really a liposuction method per se. Every liposuction technique first infuses a fluid to make the suctioning part easier, to make the treated site numb, and to lessen bleeding. It is called tumescence because it inflates or tumesces the planned treated area. It is necessary to do this first for all liposuction methods. While this may have been a liposuction advance by the late 1980s and early 90s, it is standard today and not a novel liposuction approach.
While great and appealing arguments can be made for each of these liposuction technologies, the reality is that none of these methods have been proven or shown to be better than another. They are accepted techniques that can make for an acceptable liposuction outcome. The most important technology or technique, however, remains that of the hands and the experience of the plastic surgeon wielding the device. The greatest tool ever made is only as good as the person using it. Conversely, skill and experience can make an average tool do a great job. More focus should be placed on that assessment by potential patients, if possible, than the allure of the next great liposuction wand.
Dr. Barry Eppley
