bodypostbaby's blog

Oh my.  How confusing all this liposuction stuff is, even for me, a Board Certified Plastic Surgeon. If it confuses me, I can only imagine how it must confuse others. So here is a quick and dirty breakdown of what is out there, and my opinion of what it does…

UAL, ultrasonic, Vaser liposuction

• UAL is ultrasonic liposuction.  It uses ultrasonic energy to help fat cavitate, or liquefy/break up.  It has been around since the mid 1990s.  It is wonderful at breaking up fibrous fat, and is thought to potentially tighten the skin a bit.  It never caught on as much as some other methods. Why if it is so good did it not catch on?  The machine was expensive.  They marketed mostly to true plastic surgeons (there aren’t many of us), so they didn’t sell many machines.  Some people who didn’t know how to use it well would get skin burns and issues with seromas, so they would bad mouth it.  After all this time, I am still a huge fan.  I find it is a good caliber, it really breaks up fibrous fat (which all you athletic people have, and you men, and anyone with any prior surgery and internal scar), and it helps create a smooth even result.  I still love it.
• Vaser is ultrasonic liposuction.  A slightly smaller caliber, not quite as strong an energy as UAL.  Still effective at breaking up fat.  Good.

Laser liposuction, Slim lipo, Smart lipo

• Laser liposuction uses laser energy to break up the fat.  Again, just like ultrasonic liposuction, the energy can potentially cause burns.  If you liquefy the fat and don’t remove it with traditional liposuction, you will get seromas.  My biggest issue with laser liposuction is the marketing.  They purposefully lead patients to believe there is no anesthesia needed, it retracts the skin well, no traditional liposuction is needed, and you will be back at normal life in a day or two.  ANY TIME YOU DO A SMALL AREA THESE THINGS ARE TRUE.  When you do any larger area, which even here with my uber atheletic Palo Alto patient population most of my patients need, they still use ultrasonic liposuction FIRST and then the laser second.  For normal sized cases where they only use the laser, it takes forever.  Because the laser is such a small caliber, it is like painting a room with a small paintbrush, not a roller.  Time on the operating room table is a risk factor for complications.  Smoothness of fat removal is important as well, and painting a room with a small brush doesn’t give that smooth airbrushed quality which a roller can.  Again, I think energy to break up fat is a good thing for most liposuction patients.  When I went to the seminar where they tried to sell me these machines, the instructors admitted for most cases they used ultrasonic first and finished the patients with the laser.  I don’t think lasers are bad.  My issue is with their misleading marketing.  Also these companies are focused on selling machines.  I am concerned about their integrity because they specifically target nonplastic surgeons to do the procedure.
• Smart lipo. Brand of laser liposuction
• Slim lipo. Another brand.  They argue they are faster than Smart Lipo. ??

Noninvasive liposuction.

• No incisions. Not a surgery.  External machines which “melt” the fat, which is then absorbed into your body.   Sonosculpt, Zerona, Cryolipolysis, Ultrashape are some of the machines touted.  There is also mesotherapy and lipodissolve, where you inject fluids under the skin to melt the fat.  I was on the board of directors for a fledgling company which was trying to address noninvasive liposuction.  I think it is a fantastic idea, but has many issues still.  Most of the companies which show true reduction in fat volume could not control the smoothness and amount of fat removal.  And it was painful.
• The goal with liposuction is not just the amount of fat removed.  You want the contour to look smooth.  I had a patient who came to me from Wyoming who had mesotherapy.  It has never really taken off for a reason.  There is no “standard” solution.  For my patient, the solution injected caused her to go into liver failure, and she was taken by emergency helicopter to Salt Lake City and was in the ICU for a week.

When fat is liquefied, it gets absorbed into your bloodstream, so safety and health issues to consider:

• ?Change in blood triglyceride and cholesterol levels?  I recently went to a talk for a noninvasive liposuction machine.  They said the triglyceride and cholesterol levels were fine after the procedure.  When I asked for more detail (I was curious), they had only taken a single blood test six weeks after the procedure to look at levels.  That does not tell me the safety at all!  What was the level in the blood during the procedure? An hour after? 6 hours after? 24 hours?  I need to know my patients who are doing elective procedures for cosmetic reasons are safe.  If your blood stream is flooded with fat, can it cause organ damage? etc etc.
• ?How much fat can you safely remove at a time?
• ?Smoothness and evenness of fat removal?
• ?Fat emboli in your blood stream?
• ?Is the size reduction long lasting?  We all have seen massage and body wraps “take off inches” which we know will come right back after a few days.

So. I have gone into this on my website with liposuction pitfalls: I and II.  I may repeat myself a bit, but I hope to educate you and demystify the madness a little.  I like to think of myself as a girlfriend’s guide to plastic surgery.

Tell a friend.  I am always so sad when I meet a patient after they have been snookered into surgery by promises of a rainbow: no pain, no surgery, no scars, no downtime.  And some things I can’t fix.

Is plastic surgery a right choice for you?

As I said earlier, there is a price you pay for plastic surgery.  The price is scar, time off work and exercise, healing, getting someone to watch your kids for a week so you can do this, and the risks of surgery.  What price are you willing to pay? How much are you bothered? How easy is it to fix?

Some people scar well.  For these women, when they have a scar, it will start as a red scar, then turn purple, and then fade away into nothingness.  I have seen some of my patients come back, and I can’t find their scar.  I know where it is, but it faded away.  They pay a lower price than someone who may hyperpigment  (fancy way of saying scar turns darker, black, or brown) or keloid (fancy term for a condition where you form an elevated, itchy, ropey scar).

Some surgeries have small scars and potentially large changes.  Breast augmentation, eyelifts, and liposuction tend to have big changes with small scars.   Small price.  But now let’s say you come in, you were a 34D prior to kids and now you are more like a B, and your breasts droop.  Hmmmm. Tougher choice.  Breast lift with an implant is a bigger surgery, more scar, more potential for sensory change, etc etc.  What price are you willing to pay?  Would you rather have a small scar and the ideal sized breast implant for you, but still be a little droopy? Would you rather go to a larger volume breast implant if it meant you could be perkier and avoid doing a lift? How much larger? If you think, “no way! If I am going to go through surgery and get a breast implant, I want them to look perky and fantastic. I need the breasts up!”, then you might need a breast augmentation with a lift, with the larger length of surgery, recovery, and scar it entails.

Most of my photos I show are women 6 to 8 weeks after surgery.  I am reprimanded for it a lot.  Why do you show red scars? Why don’t you show scars when they are farther out? Why don’t you put underwear on your tummy tuck patients so we don’t see the scar?

I have photos of patients a year out with beautiful scars.  Most have beautiful scars. I don’t think that is helpful. You will see the scar the photos hide under the underwear. Anyone can look at a photo of a wrinkled, strech marked, hanging belly and think “of course they should do a tummy tuck.”  But you, the patient, will need to do the surgery.   You will feel the changes. You will see the scar while you heal.

So, find an honest surgeon.  I don’t candy coat.  I show my large surgery scars on purpose when they are new. Red. Raw. Visible.  New.  I discuss the risks and complications in detail.  When you do surgery there are elements we can’t control as plastic surgeons.  How will you heal? How will you scar?  When we say there is a 1% chance of something, will you be that person?  Education can be scary.  When choosing to do elective cosmetic surgery, you need to know what you are choosing.  I do hundreds of surgeries a year.  For these women, the “price” of surgery was worth it.  Only you can make the decision of what is right for you.

There is a price for plastic surgery.   (yes. yes. I am a plastic surgeon who will not give you a hard sell to do surgery do surgery do surgery.)  Because plastic surgery, the yummy mummy, mommy makeover is not for everyone.

When you get done having your beautiful babies, you wait a bit.  I strongly recommend you wait a bit.  What will your post baby body be like? Will your breasts stay full or will they deflate? Will they be anywhere near your neck or will they touch your waist? Will your belly look like you are permanently 4 months pregnant or will it get back into an okay territory?  How bad does it look when you sit down? And most importantly, does it bother you?

We all have these thoughts.  No woman goes through labor and gets done and doesn’t think UGGH when they see their belly skin flop over when they lie on their side that first day. Thank heavens we are ramped up on adrenaline looking at the beautiful new baby next to us, and then sleep deprived and can’t see straight for the next few months.  When women show up in my office, they have thought about doing surgery for months, sometimes years.  They are not happy.  On a frequent basis some thought haunts them.  “I can’t buy a bathing suit.”  “I was dancing and my bra padding migrated down my dress.”  “I look like a boy.”  “I look four months pregnant all the time.”  “I can’t do sit ups.”  “I have to always take in my jeans at the waist, because when I buy pants to fit my thighs the waist is too big.”  “I look like I hopped out of National Geographic.”

If you are happy with your body, don’t do anything.

Seeking advice from a plastic surgeon is the next step.  You have thought about it, talked to your friends perhaps, and read too much on the internet.  You need a doctor to evaluate you.  Please here take my advice:

• See a Board Certified Plastic Surgeon.  Anyone can call themselves a plastic surgeon.  True plastic surgeons are trained as general surgeons first.  We are well trained to do all breast and body surgery.  I keep seeing women who have the wrong surgery done (especially liposuction when they needed a tummy tuck) because the doctor is not a real plastic surgeon.
• See more than one doctor.  I joke if you see three plastic surgeons, you’ll get at least two different answers on how to do something.  Many patients fall into what I call a grey area: no surgery is perfect, but all will improve the situation.  An example:  You have lost breast volume and are mildly droopy.  Do you do a breast implant alone? Do you do an implant with a lift?  Do you just do a breast lift? Every woman is unique in what they look like and what they want to look like.  My Palo Alto patients are smart women.  They know their body, they know what amount of scar is okay, they know what look is okay.  I educate them, so they can make the right choice for them.

So, getting back to my original point, you pay a price for surgery. The price is not actual money (though yes, you do need to pay actual money too).  There are some procedures where the “price” is low: the surgery is easy, short, fast recovery, little downtime, small scar, scars heal well.  There are other surgeries where the price is higher: longer, bigger surgery, longer recovery, larger scar, higher chance of other things.

Aaaah. 

So that age old question: “How does that giant baby fit into my belly?”  It does so by moving the other things around and stretching your muscles and skin.  Your abdominal muscles are the rectus muscles (the “six pack”) and oblique muscles.  The muscles of the abdomen do not cross the midline.  This central line is called the linea alba.  It is made of a leathery substance called fascia.  When you are pregnant, your muscles separate in the middle.  This separation between the muscles is the diastasis.  Everyone who has had a pregnancy has some separation.  This is the reason you can’t “suck it in” as tightly as you did before pregnancy.  This is also part of why your waist gets wider.

The amount of separation varies.  Some people have a small amount, some a wide.  It tends to get worse with the number of pregnancies and the amount of weight you gain.  (Another reason that large babies should give their moms large presents on mother’s day.) Some women have poor genetics though and get a lot of loosening with their first child.  If your diastasis is bad, you will have a flat belly lying down, and then look pregnant when you stand up.  When your abdominal muscles are loose, you may have back pain due to weak abdominal strength.

Since no muscles cross this midline, you can’t tighten it up again with exercise. (To many a husband’s chagrin. So tell him that his “honey you just need to do more sit ups” will not work.) A diastasis is fixed with a tummy tuck.

A tummy tuck is two parts.  That bottom part is internal and fixes the diastasis separation.  You can’t see it.  It is a corset which brings those muscles back together.  I use a two layer muscle tightening approach; both layers are permenant sutures.  This will tighten your core again as it brings the muscles together.

The second layer to a tummy tuck is removing excess skin. 

A hernia is a true hole in the abdominal wall.  This commonly occurs at the belly button, and is why some women are no longer an “innie” after pregnancy.  Sometimes people will call a diastasis a “ventral hernia.”  Most women have a simple separation where the sheet of tissue keeping the “insides in” is still intact, not a hole.