Thinking About Liposuction? Part II
By Gilly S. Munavalli, MD, MHS
Charlotte HEALTH&FITNESS magazine, May 2006
According to the American Society of Plastic Surgery, Surgical
cosmetic procedures increased 4 percent, with more than 1.8 million
procedures performed in 2005. The top five surgical procedures were
liposuction (324,000), nose reshaping (298,000); breast augmentation
(291,000), eyelid surgery (231,000), and tummy tuck (135,000). In
part one of this series on Liposuction, I discussed the history of
liposuction and how it works. I wasn't trying to be Dr. Cliff
Clavin of Cheers fame, but it is really helpful to understand how
the technique was developed. I also wanted to explain the advances
over the past 15 years with this wonderful technique, which make it
so popular, safe, and effective. In this article, we will discuss
we will discuss patient evaluation, expectations, and what questions
to ask when consulting with physicians for liposuction.
WHO IS A GOOD CANDIDATE FOR LIPOSUCTION?
A good candidate for liposuction can be any person in good health,
which has realistic expectations, and is likely to be happy with the
results of liposuction. Although liposuction can really improve one's
figure, it will not result in the perfect body. For example, it should
not be expected for a patient who weighs 145 pounds at the time of
liposuction, to expect that the removal of 2 and one-half pounds of
fat will allow him/her to wear clothes that fit well when they weighed
120 pounds. Preferably, one should really be within 20-30% of their
ideal body weight. People who exercise and just have stubborn pockets
of fat, AKA love handles, saddlebags, small stomach pouches, that
the just can't seem to be rid of, are the best candidates. Patients,
who are really overweight and view liposuction as a crash diet, are
the worst candidates. Liposuction is not proven to be an effective
treatment for obesity.
 WHO
IS NOT A GOOD CANDIDATE FOR LIPOSUCTION?
The bottom line is if you are not healthy, you may be at greater risks
for liposuction complications than a healthy person. For example,
there is an increased risk of surgical complications associated with
a history of heart problems, seizure disorders, excessive bleeding,
or a significant history of deep vein thrombosis (blood clots in the
legs). Liposuction would not be safe to perform on someone who is
taking certain drugs that may increase the risk of bleeding such as
baby or full strength aspirin, Goody's Powder, non-steroidal
anti-inflammatory drugs (NSAIDs), or blood thinners such as Coumadin.
If you are taking certain drugs that inhibit the metabolism of lidocaine
(the local anesthetic used in the tumescent technique for numbing),
such as antidepressants like Prozac, then you might also be at an
increased risk of drug interactions. You MUST let your doctor know
ALL the medications you are taking to avoid any problems prescription
strength or over-the-counter. The good news is that it is usually
sufficient to discontinue certain drugs two weeks before surgery.
Lastly, if your skin does not have good tone and elasticity, then
you must expect there to be some degree of crepiness or a mild wrinkled
appearance. However in many cases, patients with poor skin tone are
satisfied with their new figure regardless of the slight wrinkled
appearance of the skin.
WHAT ARE THE MOST COMMON REASONS FOR PATIENT
DISSATISFACTION?
Lack of dramatic improvement is a common complaint among patients
who have had liposuction performed multiple areas at the same time.
If a surgeon attempts to treat too many areas on a single day using
the tumescent technique, patient comfort during the procedure may
be compromised. There is a limit to how much tumescent anesthetic
that can be used during a given surgery, so it is best to focus on
only a couple areas and have those areas be very, very numb. Also,
the relative improvement of each individual area might be less than
if a surgery involving many areas were divided to two or more separate
procedures. So, try not to push the surgeon into doing everything
at one setting. Irregularities or lack of smoothness is also a common
complaint. Smooth results that look natural and even are of critical
importance. The use of liposuction cannulas (the metal tube that is
used to suck-out fat from beneath the skin) that have a relatively
large diameter tend to produce results with more irregularities less
smoothness than do smaller liposuction cannulas.
HOW IMPORTANT IS THE COST OF THE LIPOSUCTION
Decisions about liposuction should not be based solely on the cost
of liposuction. The cheapest procedure might mean that the surgeon
does the procedure hastily, incompletely or without the necessary
skill. Liposuction is surgical procedure that resembles an art form.
It is much better to base your decision to do surgery after reviewing
in the surgeon's reputation, experience, and his/her ability to communicate
with you in a manner that is professional, sincere, comfortable, and
not rushed. Five years down the road after your liposuction, you may
not remember the precise cost of the surgery, but quality of the surgical
results will be with you for the rest of your life.
WHAT TYPES OF QUESTIONS SHOULD I ASK THE DOCTOR?
Definitely feel free to ask any question you have about liposuction.
It is your duty as a patient to be as informed as possible. Buy a
book or use the internet to gather information and then present it
to the doctor. At the same time, be wary of what internet sites are
claming about liposuction. If you are confused, then ask, ask, ask!
A liposuction surgeon or the surgeon's staff should be more than willing
to sit with you during the consultation or afterwards on the phone
to discuss any question you have about liposuction. Don't feel
embarrassed to ask difficult questions about the surgeon's level
of experience or about how they perform the liposuction from start
to finish. If necessary, ask for a second consultation to meet face
to face and clear up any problems. It is worth the time and expense
to feel good about the surgery and the surgeon before undergoing the
procedure.
WHAT AREAS ARE COMMONLY TREATED?
The most frequently treated areas for women are the abdomen, breasts,
hips, outer thighs, anterior thighs, inner thighs, knees, arms, buttocks,
cheeks and neck. In men, who account for approximately 15% to 25%
of liposuction patients, the most commonly treated areas include the
chin and neck area, abdomen, flanks ("love-handles"), and
breasts.
WHAT HAPPENS IF I GAIN BACK MORE WEIGH?
Fat cells removed during liposuction are gone forever. New ones do
not appear in the areas where they were removed. Any new pounds that
are put on over time as a result of high caloric intake (eating back
the weight you lost), will be stored in different areas of the body.
Where the new fat is stored depends on the gender of the patient and
genetics, to a certain degree. Liposuction should be thought of as
a single aspect of a long-term plan, along with diet and exercise,
to maintain a consistent weight and body figure over the course of
one's lifetime.
Gilly Munavalli, MD, MHS is medical director of the Goslen Aesthetic
and Skin Center in Charlotte, NC. He has been performing in-office
liposuction for 5 years and speaks internationally on liposuction,
skin cancer surgery, and laser surgery.
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