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Liposuction remains one of the most popular and successful of all cosmetic plastic surgery procedures. Patients considering the procedure have many typical question about it and here are the most common.

How much weight should I lose before having liposuction?

Ideally, liposuction is best used as a ‘spot’ treatment for resistant areas of fat. This would imply that one should be near to what they consider to be their ideal body weight. On a more practical basis, one’s weight should be down to what can be achieved with a reasonable effort.

The ‘weight loss before liposuction’ approach is best for two reasons. First, the amount of liposuction needed will be less…and less surgery of any kind is always better than more. Secondly and most importantly, the losing weight process allows one to have made lifestyle changes before surgery. The effort to do so and the induced lifestyle changes provide for a better chance that the liposuction results will be longer lasting.

What type of liposuction is the best?

There are numerous liposuction devices currently available such as ultrasonic, laser (hot), and water jet (cool)devices. With these methods comes the associated marketing and hype that is associated with the manufacturers as well as endorsements by surgeons. In addition, because some of these devices are new, they are promoted as the latest and the greatest.

What all these liposuction technologies share is that they are used for the first phase of the surgical process…loosening up the fat…which is then suctioned out as the second phase. Whether anyone of these methods is better than another can be debated but no one can conclusively prove that one is better than another. The reason is that the technology is only as effective as the surgeon who is using it.

The current use of Snartlipo (laser-assisted liposuction) has a three or four year history of widespread clinical use. While just a promising tool a few years ago, today’s units have higher powers, temperature monitoring, and multiple wavelengths. The very sensitive nature of fat cells to heat makes this technology very appealing and effective.

 Are liposuction results permanent?

One of the common myths is that once fat is removed, it can not come back. As patients often say, ‘I have heard that once fat cells are removed, they can not return.’

This perception is false for two reasons. First, not all fat cells are removed from any area that is suctioned. That is not only impossible but unaesthetically undesireable. There needs to be a certain layer of fat between the skin and the muscles so the skin is not stuck down and tethered. Secondly, stem cells exist in fat which always have the potential to turn into fat cells if properly stimulated. Excess food intake and the need for fat storage is just the stimulus for fat re-accumulation.

The best answer is that the long-term results from liposuction are stable if your weight remains fairly stable. If you gain weight of any significance (greater than five pounds), it has to go somewhere and that will likely be from whence it was originally removed.

How much time should I allow for recovery before going on vacation or a trip?

It is quite common that I see patients who have a trip or vacation planned and want to do some body shaping before they go. The biggest mistake is to not give enough time for a ‘full recovery’. You don’t want to go on a well planned and long thought out trip only to still be sore or limited in what you can do and enjoy. Depending on the number of body areas and amount of liposuction, I would allow for at least six to eight weeks (as a minimum) before leaving. Three months is most ideal.

There are also some patients who want to use a trip to recover and their intent is to go and lay around somewhere. In this case, I would recommend one week before you leave.

Dr. Barry Eppley

With the summer season nearly here, spending time outdoors and ditching those layers of cold-weather clothes has many of us worrying about how our bodies fared over the winter!. For some people, the ‘getting in shape’ process seems to never end, and for others there seem to be problematic areas that just won’t improve no matter how much they diet and exercise. Whether it be a small stomach pooch, love handles, or a little fullness on the thighs, improving these areas would not simply offer a better look, but would provide more self-confidence in shorts and at the pool.

Enter the consideration of liposuction. While most people know what liposuction is, today’s Smart liposuction is a huge step forward from the traditional standard of the last twenty years. Liposuction  is no longer a brutal beating that  you may have seen on TV or the internet. The latest advance in liposuction is known as Smartlipo or laser liposuction. SmartLipo is a cutting-edge, highly effective method to significantly improve the safety and effectiveness of traditional liposuction.  Routinely used in dental procedures, lasik eye surgery, and other fields of surgical reconstruction, laser technology is what sets SmartLipo apart from all other methods of liposuction.

Traditional liposuction uses a vacuum with a metal tube attached, which the plastic surgeon moves back and forth manually. Because the human hand is not that precise, patients can sometimes get a lot of bleeding, swelling and trauma to the tissues. SmartLipo is different in that it uses a carefully calibrated laser to liquefy fat deposits in the top layers of the skin. The laser actually ruptures  the fat cells, like a hot knife going through butter, and the resulting oily, liquid substance is then suctioned out through a tiny incision in the skin. The small laser can also seal blood vessels as it zaps fat, so there is less swelling, bleeding and bruising than with traditional liposuction….and less pain! Research has shown that little, if any, fat is reabsorbed back into the body. The more gentle technique of the SmartLipo procedure allows patients to recover faster and see the results they are looking for more quickly.

The heat from the laser also has another very valuable contribution to the final result – it helps tighten loose skin. The historical problem in traditional liposuction is that it relies on the patient having good,  taut skin to begin with. Otherwise, removing fat will simply make skin looser and to sometimes  ‘sag’ after the procedure . By heating the underside of the skin to temperatures of 45 degrees C (approximately 112 degrees F), the skin is made to shrink to some degree. This makes it possible for some people to successfully undergo liposuction today who may not have gotten good results in the past.

SmartLipo also makes it possible for many patients with smaller problem areas to require only a local anesthetic for the procedure. Traditional liposuction often requires general anesthesia. This makes it more practical for some people,  as they can drive to and from the procedure, eliminating the transportation and care needs of a typical surgical operation.

Liposuction has a long history in plastic surgery of being a very good body contouring method for the right patient who is willing to undergo the recovery. Like most everything in life, liposuction has now gotten better….smarter if you will. SmartLipo is a technological advance for certain – but it is not a miracle. One still needs to have realistic expectations about what the procedure can and cannot do. But for smaller fatty deposits, or for someone who is fairly fit to being with,  Smartlipo may be the simplest solution to regaining confidence with their body.

Dr. Barry Eppley

Liposuction continues to be one of the most popular plastic surgery procedures. Without question, significant changes in one’s body contours can be achieved. The marketing and promotion of liposuction across all types of media strongly suggest that it is a precise surgical procedure. Inferences are not subtle that surgical fat removal is equivalent to sculpting or the chiseling out of body parts.

While some body areas can be sculpted, most liposuction results are not like art work. The body is not a bar of soap nor a block of marble. And most patients will not end up like the model that appears in an advertisement. The outcome of a liposuction procedure is certainly influenced by the surgeon performing it and the tools that are used. But there are numerous logistical factors that will always limit the exactness of the results that can be achieved.

The topography of the treated area is one important factor. Most of the body is not flat but rather a curved surface that has different thicknesses of fat as it curves around from area to another.  This certainly makes it difficult to always ensure evenness of fat removal, particularly when the removal is done with a straight cannula.

Liposuction surgery is almost always done with the patient in the horizontal position.  While this does not affect some body areas such as the stomach, such positioning allows most fat collections to shift backward and become distorted as they lie pressed up against the operating table. The concept of ‘standing up’ liposuction is theoretically appealing but currently impractical.

Skin quality remains a very important determinant of liposuction outcomes. Looseness of skin, stretch marks, and cellulite over a treated area does not bode well for the needed skin contraction of deflated areas. One must appreciate that it is highly likely that the smoothness of overlying skin will never be better after liposuction and, in some cases, can be made worse. Liposuction, by any method, is not a treatment method for cellulite as some patients mistakenly believe.

To work around these limitations, there are some presurgical and intraoperative  techniques that are used to get the best results possible. Marking the surgical sites immediately prior to surgery is critical. One must look at the planned treatment areas like a topographic map. The marks will indicate how far one has to go as the body areas shift and distort when one lies down. Marking the high and low spots also indicates how much time should be spent or tissue removed from one encircled area to another. Positioning the patient on the table can help see the marked areas more ‘three-dimensionally’. For example, it is better to treat the lateral thighs or the flanks with the patient turned on one side. While this is more difficult for the surgical team, it is the best way to avoid seeing irregularities and missed areas of fat when the patient is seen standing weeks later in the office.

While new liposuction technologies appear fully capable of improving how well and even fat is removed, they are not magical devices. The use of laser liposuction (a.k.a. Smartlipo) is one example of how using a thermal approach (melting and liquefaction) may produce more consistent and even fat removal. The heat that it creates is promising for helping skin contraction, but it will not transform skin that is already damaged.

Liposuction is an improving plastic surgery technique but it is not yet an absolutely precise art. Patients should appreciate that perfect symmetry and evenness throughout a treated area can not be guaranteed and the desire for secondary improvement through touch-up procedures is not rare.

Dr. Barry Eppley