Your Questions
Your Questions
Q: Dr. Eppley, My knowledge about Smartlipo is limited. I have watched many tutorial videos and read information that has been posted on doctors websites. I understand that it is a procedure that uses a laser to help extract the fat. It seems to have less bruising, less downtime and less time one has to wear the compression garment than traditional liposuction.
Maybe Smart lipo is not the best procedure for the unwanted fat on my abdomen, flanks, back bra area, thighs and let’s throw in the chin area for good measure. But that is the reason for the consultation….for you to advise me on options that will best fit my needs.
A: The reason I ask about your perspective on Smartlipo is that it is highly misunderstood…which is not the patient’s fault. Many doctor’s marketing of it is false…or at the least a but understated. Smartlipo is not different in terms of invasiveness, amount of bruising, recovery or downtime than any other form of liposuction. It is just a different way to loosen up the fat to remove it but it is still a very invasive procedure just like every other form of liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m wanting to know if you do Smartlipo the non surgical procedure for belly fat?
A: I do use Smartlipo for body fat reduction but it is NOT a non-surgical procedure and it is best done under general anesthesia…if one wants the best result with the most fat removed. Smartlipo works just like any other liposuction technique. It is an invasive procedure that involves the need for tumescent infiltration, the use of probes inserted to heat the fat and the use of traditional cannulas inserted under the skin to extract the fat as the final step. There is a common misconception that Smartlipo is not surgery when nothing could be further from the truth.
Smartlipo is, unfortunately, often promoted and marketed as if it isn’t surgery. It is made to seem that it can be done without much anesthesia, without recovery and that the results are instant. Such marketing claims do make it seem like it isn’t surgery and I can understand how many prospective patients do get that impression. But like many marketing claims…if it seems too good to be true, it almost always is. Your perception of Smartlipo certainly falls into that category.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a my first baby six months ago. Now I am not really happy with my belly. I have gained some weight that I never had before and can’t seem to get it off. What can I do that will not involve much time off work? I have read about Smartlip which seems like the best option and would not involve being off work.
A: Based on your pictures, you would be an excellent candidate for liposuction done under general anesthesia to really thin down your abdomen and waistline. There is always a misunderstanding that many patients are not aware that ‘Smartlipo’ is real surgery and is just another form of liposuction. While it can in the right patient be done under local or sedation anesthesia, it is still an invasive surgical procedure. It is not some external device that magically melts fat. The best results with Smartlipo are like any other method of liposuction…having it done under general anesthesia (if you want the most fat removed possible) and does involve some recovery.
For a treatment that requires recovery at all, you can consider a non-surgical approach like Vanquish. It will not produce the same result as any form of liposuction but does not involve surgery. It is done a series of office treatments, usually once a week for four to six weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having my upper arms “done” by the best method. Another surgeon recommended Smart Lipo. I am researching the best method and am interested in a second opinion. I am 40 years old, not overweight and exercise daily.
A: When it comes to your arms, you represent a classic ‘tweaner’, which is someone who has a plastic surgery problem that can not ideally be treated by either of two different methods.
Your arm problem is not big enough with enough loose skin and fat to justify a formal armlift and its associated scar. No one really wants an armlift but it is the most effective arm reshaping procedure. (because it removes a lot of skin and fat)
Your arm problem is also too big, in my opinion, to have liposuction and GET THE RESULT THAT YOU REALLY WANT. It just isn’t effective enough to make a really big difference or have a dramatic reduction in arm size that any woman that I have ever seen with such arms really wants and hopes the liposuction procedure can achieve. But it is the only procedure that is justified (has no awful scars) and can make somewhat of a difference.
When it comes to liposuction, do not get caught up in all the hype about various liposuction technologies including Smartlipo. Despite widespread internet promulgation about its magical skin tightening properties, Smartlipo offers few if any advantages over any other liposuction method. (I can say this quite objectively since I have owned a Smartlipo device for years) Compared to the skin tightening you would need for your arms, no amount of fat melting and heating the tissues by a fiberoptic laser probe is going to make a big difference in the natural skin contraction that can occur with good skin elasticity. And unfortunately most upper arms that need to be made smaller do not have good skin quality over the back/triceps area.
In short, liposuction of your arms is the only reasonable treatment option. But the key to not being disappointed with the results from such a procedure is to have realistic expectations (modest not dramatic improvement) and choose a surgeon who has a lot of liposuction experience and not one based on a liposuction technology. At the end of the day, the most important predictor of success is the hands that is holding the device, not the device itself.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a Smartlipo laser liposuction procedure. I have a fatty tumor behind my arm and would like to remove it with the least invasive procedure. I also have fatty tumors in my legs which would love for them to be gone also.
A: Smartlipo or laser liposuction is one possible treatment approach for smaller lipomas. While all of these lipomas could be simply removed by excision, I could understand why you would not want the fine line scars. What is important to understand is that treating them by Smartlipo/laser liposuction is not quite the same as removing traditional unwanted fat. Unwanted fat is soft non-encapsulated fat that extracts easily and thoroughly after being partially liquified by the laser energy by small cannula liposuction. In contrast, lipomas are well encapsulated ‘balls’ of fat that are really benign tumors. The laser energy may break them up into small pieces but it does not necessarily liquify them completely and thus they are not as easy to extract by liposuction. The point being is that the laser liposuction treatment method of lipomas is best viewed as a reduction method that may or may not result in them being completely removed.
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 55 years old and am interested in getting my saddle bags reduced that have bothered me my entire life. I am concerned, however, that I may end up with skin that is saggy afterwards given my age and the little bit of cellulite that already exists there. What do you think about using Liposonix instead?
A: When you use the term Liposonix you are referring to an energy-based form of assisted liposuction just like Smartlipo or Vaserlipo. All use different energies to loosen the fat before it is suctioned out such as ultrasonic or laser energies. These are all forms of liposuction that pose the same risk of skin irregularities that any other traditional form of liposuction does, because the support of the skin is deflated as the fat is removed and the quality of your skin is not improving. Of all these energy-based liposuction methods, Smartlipo may be best because the heat that it generates in the treatment process may have some mild skin tightening benefits.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am interested in learning more about SmartLipo and laser body sculpting. I workout regularly and have a small amount of belly fat that I cannot seem to get rid of. I am 5’ 4” and weigh 127 lbs so I am anything but fat. But this small amount of stubborn belly fat will not budge no matter what I do.
A: Someone of your lean body frame is actually the ideal liposuction patient…the person who has made a reasonable effort and can just not change the genetics of their fat distribution. Liposuction was originally developed to treat spot fatty areas that are resistant to diet and exercise although its use has widely expanded today for the more convenient removal of larger amounts of fat. Removal of localized abdominal fat can be one of the most rewarding areas for liposuction.
When it comes to liposuction, the the techniques have evolved into a variety of energy-driven methods to initally loosen the fat to help make the vacuum extraction process easier and more efficient. Laser is one of those technologies and the name Smartlipo is a tradename from the manufacturer who developed the initial laser liposuction devices. The heat energy generated with its use can help liquify fat fofr improved results if done properly. The key issue with Smartlipo is to realize that it still is invasive surgery and is not something done magically from the outside, a common public misconception about it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had liposuction on my stomach in 2009. I work out 3 to 4 times a week with a trainer. I actually look bigger than I did before the liposuction. I have gained fat in my back and my breasts went from 34B to a 36C. I look like an ogre. My question is would SmartLipo be an option for this excess fat on my back? Or will I face the same results (fat returning on another area of my body)? I am completely miserable. Thanks.
A: Based on your description of your liposuction experience, I am assuming that you had improvement from the procedure in 2009 and have gained weight subsequently in other areas of your body. When considering liposuction now, your concern would be that fat would just accumulate somewhere else again. Your concern is based on the fat redistribution theory that states removal of fat from one body area will merely cause other areas to get bigger. (fat homeostasis) While commonly believed, this theory has never been proven to exist on a wide scale basis although perhaps it may be true for a small number of people. Whether it exists in you or not I do not know, but let us assume for the sake of this conversation that it is true. Then fat removal from the back will cause it to accumulate elsewhere although there are not many other places that it can practically go.
That discussion aside, fat removal from the back is difficult with liposuction because it is a different kind of fat which is more fibrofatty and harder to to remove. (unlike the stomach area) Smartlipo, a fiberoptic laser method of fat emulsification prior to suction extraction, is a good technique for this fibrous back fat.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am interested in either smartlipo or lipo dissolve for my abdomen/love handles. I was wondering if you do Smart lipo under local anesthetic or if you require going under general (I really do not want to go under general anesthetic). Also, I was wondering if you knew approx costs for those procedures.
A: Any form of liposuction, like most surgeries, can be done under local anesthesia. The potential use of local anesthesia is a common inquiry in regards to liposuction. The question is not whether liposuction can be done under local anesthesia but whether it should. Contrary to popular perception and much marketing, the results from doing liposuction under local anesthesia versus general are not the same. Often the results are not even remotely comparable in my experience. The results from any liposuction endeavor is entirely dependent on effort and being thorough. While local anesthesia provides some pain reduction, it is rarely enough to do a good job of maximal fat extraction. The patient’s level of discomfort always becomes a limiting factor. The size of the operative field that must be made numb in liposuction is quite different than that of just a small surgical incision.
I honor patient’s requests to do liposuction under local anesthesia but I caution them that one must be prepared to accept much less of a result. This is particularly true in large areas like the abdomen and flanks. (i.e., love handles) Interestingly, and quite surprisingly, the cost of liposuction under local anesthesia will ultimately cost more than if done under general anesthesia. The simple explanation is that it often takes two or three times the amount of time for me to do liposuction under local anesthesia than what can be accomplished much faster (and better) under general anesthesia.
In addition, lipodissolve injections are no longer done for significant fat removal and are certainly not a replacement or alternative to any form of liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in having Smart Lipo to remove some fat on my chin. However, I have a chin implant that I got 16 years ago. One doctor told me that the risk of infection would be higher and the heat from the laser could move or melt the implant. He advised me to get another opinion and to ask the doctor before I make the appointment because some doctors’ immediate answer may be no. Can you please tell me about the risks and whether this is a good idea or not. Thanks very much.
A: My question to you is what you mean by ‘chin liposuction’. Do you mean having liposuction on the chin pad proper (which is highly unusual and associated with risks of irregularities) or do you mean liposuction under the chin area, formally known as the submental region?
Either way, I would see no negative effect of the laser probe on a chin implant. The location of a chin implant is deep and against the bone and is beneath the fat layer of the chin. There is also the mentalis muscle which exists between the chin fat pad and the implant. In addition, the melting temperature of polymerized silicone is quite high (over 350 degrees F) and the heat generated by a fiberoptic laser probe does not create or should not create field temperatures higher than 145 degrees F. In addition, inadvertent touching of the end of the laser probe to the implant (which should not happen based on the previous description of where the implant is located) will still not cause it to melt.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting liposuction for my belly area. I am 36 years old and had very successful breast reduction surgery seven years ago. While I was put to sleep for my breast reduction and had no problems, I am more anxious now considering it since I have two small children. Do you think it would be better to have regular liposuction under general anesthesia or Smartlipo under local anesthesia? I think I want to flatten my hips area as well. It is time to get ready for the summer!
A: You are under a classic misconception that Smartlipo is a liposuction procedure done only under local anesthesia. While it can be done in some smaller areas under local anesthesia, the reality is so can regular liposuction. The type of anesthesia has little to do with what type of liposuction can be performed. But it often controls how good a result one can get from any type of liposuction procedure. How thoroughly fat can be removed from multiple areas largely depends on a patient’s comfort to do so. In my experience, better liposuction results are almost always obtained under general anesthesia. More body areas can be concurrently treated and a more aggressive approach can be taken with how much fat is removed. While Smartlipo can be done under local anesthesia, I have found in many cases that patient comfort and the desire to treat more than one body area make it less than an ideal approach to liposuction fat reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 36 yrs old , weigh 132 lbs and work out three to four times a week. Despite these good numbers, I have big saddlebags that definitely don’t fit the rest of my body. I have had them my entire life ever since I was a teen. They make my bottom half completely mismatched to my small and toned upper half. I have read that after liposuction fat can reappear and in different places. I would not want to ruin my upper half at the expense of improvement in my lower half. Is this something that I should be concerned with?
A: Liposuction of your saddlebags will provide great improvement and patients like yourself are exactly what liposuction was designed for and is best at…spot fat removal. There are many fallacies and inaccuracies about what happens to fat after liposuction. When it comes to potential future weight gain, the saddlebags unlike the stomach and waistline is not an area that fat will reaccumulate. It is not a metabolic depository site for extra calories. But other body areas are and it is certainly possible that fat can appear in other body areas with weight gain. The concept that you are really referring to is known as ‘fat equilibrium’, the belief that everyone has a certain amount of fat that they are genetically predisposed to have. And by removing one area of fat, the body in an effort to maintain a fat balance will just have it accumulate elsewhere. This fat concept, while often talked about as if fact, has never been scientifically proven. A recent small study in plastic surgery did show that abdominal and thigh liposuction patients one year after surgery did have some measurable increase in thickness in the arms and upper back. But it was not something that the patients noticed. I would not be concerned that your saddlebag liposuction by Smartlipo will change your upper body shape to any noticeable degree if at all.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a fatty area on my very upper inner thighs that is always rubbing even though the rest of my legs are fairly muscular. I also have an area of fat between my breasts and armpits that I cannot stand. I exercise daily and these problem areas are never resolved. Do you think Lipodissolve would be beneficial? Thank you.
A: Thank you for your inquiry. In answer to your question, I do not think that Lipodissolve would be the way to go for all of those fatty areas. Lipodissolve requires a series of injections, which cause swelling and discsomfort for a week afterwards. It would take three or four injection sessions spaced four to six weeks apart to see results. With multiple fat areas you would find that process slow and mildly unpleasant, in essence an inefficient fat reduction method whose results are uncertain. While it is a non-surgical treatment, it just won’t work well for what you want to achieve. It would be far better, achieving more efficient and effective fat reduction, to undergo a one hour Smartlipo procedure under anesthesia. This may be exactly what you want to avoid but you would also want whatever treatment is chosen to work as well. Interestingly, a one hour liposuction procedure will actually cost less and have a quicker recovery than a series of Lipodissolve injection sessions.
Dr. Barry Eppley
Indianapolis, Indiana
The stomach area is the number one region that almost all women, and some men, would like to improve. Many have discovered, however, that improving that body area is not as easy as one would like. Many people work hard at it but eventually ‘hit the wall’, get frustrated and may even quit their diet and exercise routinue with no more changes are seen. But the fault may not be your own. Loose stomach skin and fatty bulges at the waistline from pregnancy or significant weight loss are not amenable to internal calorie or fat burning. This brings some to the conclusion that the only way to a more shapely torso is a surgical one.
Everyone knows that a tummy tuck is the removal of skin and fat with muscle tightening to get a flatter stomach and better waistline. While it is almost always a very satisfying procedure, and many patients say afterwards they wish they had done it sooner, it is major surgery and is not just a weekend recovery. When considering a tummy tuck, be aware of the following considerations.
There are two basic types of tummy tucks. If your excess skin and fat is mostly located below the belly button, you may do just fine with a mini tummy tuck. Because the skin and fat removal is done below the belly button, there is a shorter incision that can be placed very low and the belly button is not moved. There is also a slightly shorter recovery with emphasis on the word ‘slightly’. If the loose skin and stretch marks are above the belly button, only a full tummy tuck will do. With that comes a longer scar, a bellybutton scar and a longer recovery.
I have seen recent treatment approaches, particularly online, that tout a ‘scar-free tummy tuck’. There is no such thing and this is just marketing spin to say they are offering stomach liposuction. That raises a question that many people would like to pursue…liposuction instead of a tummy tuck for their flabby and sagging stomachs. That has become a popular request, particularly since Smartlipo (laser liposuction) technology has become available. While it is true that Smartlipo does have some skin tightening ability, it is quantitatively different than what many people need. Smartlipo tightens skin as measured in millimeters, most people need stomach skin tightening as measured in centimeters. With this understanding, it is easy to see that liposuction is not a substitute for a tummy tuck.
Liposuction, however, is very often a part of a tummy tuck. But it isn’t necessarily used to make the tummy part looking better. It is used to shape the areas outside of where the effects of the tummy tuck occur…the outer waistline and back. (i.e. muffin tops) A tummy tuck alone is a 180 degree or frontal torso change. By adding waistline and back contouring with liposuction, the results becomes more of a 270 degree torso change.
Dr. Barry Eppley
Indianapolis, Indiana
When a product or manufacturer calls itself ‘smart’, there should be a good reason. Such is the case with the plastic surgery method known as Smartlipo. Highly touted as a better and more efficient method of liposuction, its name clearly suggests that it is better than traditional or ‘dumb’ liposuction. Grandiose claims are made all over the internet, most of which by doctors who use this liposuction technique. The manufacturer of the liposuction device, Cynosure, focuses on the established science behind it.
Smartlipo is a laser technique for melting fat to make it easier to extract. By first heating up the fat to a specific temperature, like oil in a cooking pan, it is turned from a solid into a liquid. This is done by using a laser probe that is passed through the fat area until the right temperature is reached. Then a liposuction cannula is used to remove by vacuum the oily liquid and any other fatty chunks in the area.
But what makes this liposuction so smart and why is it better? First, what it isn’t. Because a laser is involved, many potential patients think it is not invasive surgery. It is just as invasive as traditional liposuction which means there will be a recovery. This is not some magical approach that works from outside the body. Just because it is a laser, it doesn’t really zap the fat like a video game. It is about raising the temperature of the fatty zone until the fat begins to melt. The laser is just a way to heat the fat like the burner on the stove.
What makes Smartlipo better is that it creates a global melting effect which removes more fat than suction alone. Because of the heat damage, more fat is lost later than just what comes out at the time of surgery. Fat continues to die days to weeks later, thus the full effect of the fat removed is not really seen for months even though the early results are apparent within weeks after the procedure. This heating effect also accounts for its skin tightening capability. Such an effect, however, is almost always overstated and over expected. Do not expect Smartlipo to replace what a tummy tuck or armlift can do.
While many doctors tout Smartlipo as being done under local anesthesia with little recovery, this is often not so. Because there is considerable heat generated during the procedure, it is not hard to see that local anesthesia is often not enough for a comfortable operative experience. One can only remove enough fat if the patient is comfortable and will allow it. It is not a test to see who is the toughest. This is why I recommend a general anesthetic. The best result in the shortest period of time can be done when the maximal amount of fat can be comfortably removed.
Recovery from Smartlipo is not much different than traditional liposuction. While the amount of fat removed can be better, this does not mean there is less recovery. The laser does result in less pain and bruising but the amount of swelling is about the same, requiring months to eventually see the final body contouring effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in tumescent liposuction. I’m in the Army stationed overseas. I have a permanently damaged leg from being in Afghanistan and I’ve gained a lot of weight due to my workout limitations. I’ve lost 20 pounds but can’t seem to lose anymore. I will be visiting family in your area this year and I am researching doctors that may help me shed some fat in the abdomen area.
A: Sometimes people do need some help surgically with their weight issue. Liposuction can be beneficial when one has ‘hit the wall’ in their weight loss despite their best efforts, when they need a jumpstart to get them motivated to make or continue with their lifestyle changes, and to help those that simply can not work out due to physical limitations. While liposuction is not the long-term solution to troublesome body areas with excess fat, it can be a successful part of one’s weight loss efforts if properly understood.
When it comes to liposuction, there is nothing special or new about using the tumescent concept. Perhaps 20 years ago, tumescent liposuction was an advanced technique. But today, every liposuction method uses tumescence or the infiltration of fluid prior to the actual extraction of fat. This fluid is essential, not only for numbing the tissues, but to help control bleeding from the trauma to the tissues. Whether it be Smartlipo (laser liposuction), Vaser, or ultrasound methods, tumescent fluid infiltration is a part of all of them.
Dr. Barry Eppley
Indianapolis, Indiana
Liposuction remains the most rapid way to lose unwanted fat albeit a surgical one. While it is ideally for those people who have made every effort to lose fat areas on their own through diet and exercise, not every fat area responds the same. Some fat areas are more difficult to lose than others and certain fat areas can not be reduced at all except in the face of extreme weight loss. It is these non-metabolically responsive fat areas that justify liposuction intervention.
One of the very good questions any prospective patient should ask about liposuction is will my fat return? Will I keep this fat off years from now or is this just a short-term fix? Economically does this procedure have a good ROI? (return on investment) There are many urban myths about whether fat can or can not return after liposuction. Where some of these purported claims come from I do not know, but science and a lot of patient experience provides the following insights.
Fat will not return after liposuction. This is patently false and perhaps was started and propogated by what one would hope will happen. The reality is fat can return. The results from liposuction are closely aligned with your weight. If your weight stays the same years from now then so should the result. Fat after liposuction can return just as easily as after weight loss…and then weight gain. Some body areas are more resistant to fat return than others (knees or arms vs stomach and waistline), but no body area or fat cell is completely immune to the allure of extra calories.
If fat comes back after liposuction it will go to other body areas. This is sort of true but not to the extent of what was originally removed. A recent published study showed that fat suctioned from the stomach and thighs from women had some slight increase in measurements in the arms and upper back a year after surgery. But not to the extent that the women noticed or was bothered by it…or that they regretted having the procedure. If fat returns it must go somewhere and it is logical that it may have more trouble going back to a treated area that is now embedded with scar tissue.
Fat cells are permanently destroyed by liposuction. This is not true. Those fat cells that have been suctioned out are permanently removed. But there are always lots of fat cells left behind as you can not or would you want to remove them all. (otherwise your skin would be stuck down to your muscles and wouldn’t move) While the fat cells that are left behind may be damaged, they have a great ability to heal and regrow. Since it has been discovered that fat sites have the highest amounts of stem cells in the body, and stem cells can be easily stimulated to grow and transform into fat cells, liposuctioned fat sites are not immune to recur. This may be different with the current use of Smartlipo (laser liposuction) where the heat from the laser energy can cause more fat and stem cell damage.
Despite the effectiveness of liposuction to reduce unwanted fat, the long-term success of the procedure is highly dependent on the lifestyle habits on whom it is performed.
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:Hello, I am 58 years old and I had a full hysterectomy in May and then another surgery a few weeks later when all my stitches ripped out and I totally opened up. My son is in Afganistan (fourth time) as well as my daughter in law. I also served in the Navy years ago. Anyway, as I cannot afford the smart lipo on my abdomen (upper and lower) presently, I was wondering how much of a discount the patriot plan saves on this procedure and how long will this promotion go on? Also, does the skin actually tighten up and not sag? This email is just a question about the future possibilities and any information you can give me would be appreciated. I really want to get rid of my stomach and maybe next year I would be able to afford it. Thanks for your time – I appreciate it.
A: Thank you for your inquiry. The general discount in the Patriot program averages around 25% off the full procedure and the program continues without any deadline. What type of procedure is best for your stomach area, however, remains unclear based on your description. My concern is that the description of your problem sounds more like some form of a tummy tuck than that of Smartlipo. If there is any substantial skin excess, then no form of stomach liposuction is the way to go. One of the great misconceptions about Smartlipo is that it is a great skin tightening method. It is not and is highly overpromoted that way. While it does have some skin tightening ability, it will tighten inches of loose abdominal skin which many people that come in for it have. Between a hysterectomy and its after surgery problem, multiple pregnancies and your age, I suspect that the skin issue is beyond what Smartlipo can improve. A tummy tuck in some form is likely more appropriate for your problem.
Feel free to send me a picture of your stomach and I can answer that question very quickly.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hi. I know I might be young to ask, age 19, but I was wondering what you called a plastic surgery that takes care of love handles. But I am not talking about the hip handles. I have some pretty good handles right under my breasts that wrap to my back. I believe it is some loose skin as I have managed to loose 25 pounds this past year. I am just wondering what you would call that specific body part and maybe an average of how much it would cost to fix it. Thanking you in advance for replying. From a discouraged yound girl.
A: The important question is whether the rolls underneath your breast that extend into your back are skin, fat or a combination of both. With weight loss, most loose skin is going to develop and be seen lower due to gravity. That being said, I would have no doubt that it is a combination of loose skin and fat. Whether one is more predominant over the other would require an actual physical examination to make that distinction. But given your young age, I would recommend a liposuction procedure for fat reduction first and see how the skin adapts. The fat in the upper abdomen and the back is more fibrous in nature than lower abdominal fat and a liposuction technique, such as Smartlipo, will be more effective than traditional liposuction. There are methods of skin and fat removal by excision in the upper abdomen, which do leave lower breast fold scars, but they are usually reserved for more extreme cases of weight loss where the sagging skin is the predominant problem.
Dr. Barry Eppley
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 have approximately 30 lipomas on my arms that range from a large pea to an almond to a large marble. On my rib cages and abdomen are about a dozen the size of walnuts, and on my legs there are too many to count and of the same various sizes. I am a 45 y.o. female that has always taken pride in eating healthy and being overweight no more than 5 to 10 pounds. I was physically very active, an avid runner, and love to mountain hike. In the past two years the lipomas have erupted in such great quantities all over my body that my life has changed and taken away much of the life that I enjoy. I know that these lipomas can be cut out but that would leave so many scars that it would be horrible and maybe just as bad as the original problem. Are there any new methods for lipoma removal that would not leave so much scarring?
A: With so many lipomas, you obviously have the condition of familial lipomastosis. While you have many now, this suggests that there are more to come in the future. Besides excision (cutting them out), there are not any other conclusively proven methods of lipoma removal. However, I have found some success with both Lipodissolve injections and spot Laser Liposuction (Smartlipo) treatments. Lipodissolve injections cause an inflammatory reactions within the lipoma that causes it to shrink. Most of the time, it takes more than one injection session to get ti to go completely away. Laser liposuction treatment uses the tip of the laser probe to melt the lipoma. Through a small stab incision, the probe is inserted into the lipoma and it is turned on until the lipoma begins to melt.
With so many lipomas, I suspect that the combination of excision, Lipodissolve injections, and laser probe treatments may be needed based on their size and location. Given the multiple locations, all of this could be done in a single outpatient procedure done under general anesthesia. That would be the most comfortable way to treat all of them in a single setting.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I would like to know more about laser liposuction. I had two C-Section deliveries and abundance of skin because of it.
A: While laser liposuction does have the ability to tighten some skin, it is not a replacement for a tummy tuck. Your description of having had two pregnancies with C-sections and now an ‘abundance of skin’ suggests that your skin excess problem is not slight. In addition, the skin that is there has lost its elasticity (which is why there is an abundance) and does not have the ability to respond to the tightening caused by the heating effect of the laser. Such loose abdominal skin is always more effectively removed by an excisional procedure, aka a tummy tuck.
Laser liposuction, often called Smartlipo, is an improved method of fat removal than traditional liposuction. By using a laser probe to create an elevated temperature in a zone of fat, the fat cells break apart and loose their lipid content. This not only makes it easier to suction out, but fat cell damage continues beyond the surgical period much like the progression of a burn injury on the skin. Even some fat cells which were not directly injured by the laser probe at the time for surgery may go on to die later from the laser injury. This produces more fat loss in the days ahead. Whether that amount of fat loss is significant or not depends on how high and uniform the temperatures were at the time of the laser liposuction procedure.
The skin tightening effect of laser liposuction is similarly caused by the heat created. The temperatures must be high enough and close enough to the underside of the skin for this effect to be created however. Whether that occurs is dependent on the skill and the expertise of the physician driving the laser probe.
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: I have multiple lipomas over my arms and legs. Is there anything new to having them removed?
A: The standard treatment for lipomas remains excisional, making a small incision over the lipoma and pushing it out. While effective, this does result in a very small skin scar. While this approach is fine for several or even up to ten or so lipomas, it is tedious and results in many fine scars.
An alternative non-surgical approach is Lipodissolve injections. A needle is used to inject each lipoma with about a .5ml solution of phosphatidylcholine and deoxycholic acid. This is a fat dissolving solution that will shrink the size of the lipoma and in some cases get rid of it completely. Usually, however, it takes more than one injection to be assured of its complete eradication. If you are seeking a truly non-surgical approach, these injections are a treatment to be considered as long as one understands that more than one injection may be needed for maximal results.
Another ‘minimally-invasive’ approach is spot laser treatment. Using a Smartlipo (laser liposuction) fiberoptic probe, a nick is made in the skin and the probe is inserted next to or into the lipoma, it is turned on and used to heat up the lipoma until it is melted or destroyed. Like excision, this does require a local anesthetic.
Dr. Barry Eppley
Indianapolis, Indiana
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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
Q: I am writing you because I need information on gynecomastia reduction. I have been battling with fat around my chest ever since I was young. I am now 28 and not the least bit out of shape. Actually I am a certified personal trainer and have participated in body building contests. Even when dieting down to as little as 4% body fat I still have this fat on my chest. It is very humiliating and I have never been comfortable with my body because of this reason. I am completely happy with my body except for this part. Being a trainer and a single man my appearance is important. Can you help me?
A: Male breast enlargement, known medically as gynecomastia, comes in all forms. How it appears in different men is as variable as breasts are in women. While many people may think that gynecomastia presents as an actual breast, that is only partially true. About half the men I see today in my Indianapolis plastic surgery practice have what I call ‘minimal gynecomastia’. Their stories are all very similar. They are younger (under age 40) men who are in extremely good shape (many are trainers and body builders) who just can’t get off that little bit of fat on their chest. While a lot of other people may not think it significant, they are extremely bothered by it due to their understandable sensitivity to their body shape. I suspect in some patients their extraordinary focus on conditioning and body shaping may be a compensatory response to their self-image issues with it.
Such smaller amounts of gynecomastia are easily treated and resolved with simple liposuction techniques. This leaves essentially no significant scarring, can be done in one hour of surgery, and there is minimal recovery. Because of its effectiveness and skin tightening potential, I prefer to use laser or Smartlipo as the liposuction method. Men can return to full chest exercises in two weeks.
Dr. Barry Eppley