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 Everyone, no matter how thin or heavy, has at one time looked in the mirror, grabbed a bulge on their face or body and wished it would just disappear. Diet and exercise, though extremely useful and essential for health, do not determine exactly where the fat will be lost. Certain fat bulges are seemingly resistant to diet and exercise - they seem to have a mind of their own.

liposuction and tummy tuck in New York CityEnter liposuction. First introduced to the United States in 1982 by French plastic surgeons, it has become the most commonly performed cosmetic surgical procedure. Many refinements have been made since its introduction but the basic premise is the same. Liposuction can directly target and remove specific fat accumulation on any part of the body. Common areas that are treated include the face, neck, arms, abdomen, hip rolls (love handles), back, thighs, calves and ankles. Liposuction can also reduce breasts in both men and women!

Liposuction is NOT a shortcut for weight loss and it will not result in substantial weight reduction after surgery. It is a body contouring procedure best done on people at or near their normal weight. In certain cases, it can take a good body and turn it into a great body.

The success of any liposuction procedure greatly depends upon the skin's innate ability to tighten by itself - its elasticity. When the underlying fat is removed it is the skin itself which tightens to a smaller size and thereby provides the improvement in contour. Elasticity is affected by the region of the body, age, cumulative sun exposure, smoking, prior weight gain, general health and of course, your genetic background. Only your surgeon can determine if liposuction is appropriate for you.


HOW IS IT PERFORMED?

Before surgery, photographs are taken and the skin is marked where surgery is to be performed. You will then be taken to the operating room and prepared for surgery.

Liposuction is performed through tiny incisions in the skin. Care is taken to place these incisions in an unobtrusive body crease whenever possible. Tumescent fluid is then injected into all areas to be treated. This saline (salt water) fluid contains additional local anesthetic as well as medication to reduce bleeding and is essential for safe liposuction.

 Long, slender metal instruments (called cannulas) are then used to dislodge the fat and then the loose fat is removed from the body by a high powered suction machine. Since the instruments are blunt (the tips resemble the tip of a bullet), major blood vessels and nerves are pushed aside during surgery and are therefore preserved in the process. What remains after the fat has been removed looks like a honeycomb or a sponge, with many intact blood vessels, nerves and fibrous connections running between the deeper tissues and the skin. The incisions are then sutured with dissolving sutures

A snug compression garment is applied after surgery and is worn day and night (except for bathing) for at least a month. The purpose is to compress the "sponge-like" tissues and thereby prevent fluid accumulation. It also aids in the natural tightening of the skin itself.

Liposuction procedure in New York cityWHAT TYPE OF ANESTHESIA IS USED?

Most operations are performed on an out-patient, ambulatory basis in our certified operating room facility. When requested or if medically indicated, the procedure will be done in a hospital. "Twilight sleep" anesthesia is most often used, occasionally with an additional saddle block - general anesthesia is used only rarely and then only in a hospital setting. Our board-certified anesthesiologist will monitor your vital signs for your safety and administer small, frequent doses of a variety of medications through a vein. The result is a gentle, relaxed sleep while your operation is performed. There is no pain and no awareness and you will awaken quickly and comfortably in the operating room just minutes after the completion of surgery. There is usually no hangover or nausea afterwards.

WHAT CAN I EXPECT AFTER SURGERY?

You will be moved to the recovery room after surgery and allowed to recover for several hours. Eventually, you will be discharged in the company of a responsible adult. You will receive specific instructions for immediate post operative care but it is vitally important that you drink lots of fluids during the first 24 - 48 hours after surgery.

There will be swelling, bruising and numbness in all areas that have been suctioned. These are all temporary and will disappear within a few weeks. There is soreness for a few days and appropriate pain medication will be prescribed for you. Beginning several weeks after surgery, the suctioned areas will begin to feel firm. This is the next stage of healing and the firmness will remain for several months, gradually softening as time goes on. Gentle massage with moisturizing cream will help at this time. It will take three months or more before full healing has occurred.

Sedentary activities can be resumed within a few days after surgery and many patients return to desk-type work in less than a week. All strenuous activities should be avoided for a minimum of three weeks after surgery. A gradual return to full exercise training can begin at four weeks post operatively.

FREQUENTLY ASKED QUESTIONS

  • Is liposuction safe?
    Absolutely! It is one of the safest operations, hands down! Remember, liposuction is performed just under the skin - it does not invade any body cavity. However, it is still surgery and must be performed under the care of an expert, skilled and experienced surgeon.


  • What is the difference between liposuction, lipoplasty and liposculpture?
    Nothing! These are all terms that have been used to describe the same process. Some doctors use smaller, finer cannulas in certain areas and then call it liposculpture, but it is basically all the same.


  • What is microliposuction?
    This is liposuction performed with the aid of extremely fine cannulas for delicate areas of the face. For example, jowl or cheek fat removal and sculpture must be done with microliposuction.


  • Would liposuction work if my skin is loose and flabby?
    Yes and no! Certainly liposuction can work to remove the excess fat. However, the fat that was supporting your flabby skin is now gone and the result will be even greater flabbiness. Therefore, additional surgery, at the same time or at a second operation, will be needed to tighten the lax skin. This can take the form of a necklift, facelift, tummy tuck, arm lift, thigh lift, etc. These are much more extensive operations.


  • Is there an age limit for liposuction?
    Liposuction can be performed at any age. However, the older you are, the less elasticity is retained in your skin. And it is this elasticity that is depended upon for the skin to tighten up by itself after liposuction surgery. For example, liposuction on the abdomen of a 50 year old can remove the fat and love handles but the remaining skin might not tighten a great deal and may end up with a "lumpy-bumpy" look to the skin. However, some people will gladly accept this in trade for a major improvement in contour.


  • Can liposuction treat a very large abdomen?
    Liposuction can successfully be used to remove fat under the skin anywhere on the body, including the abdomen. In essence, if you can "pinch it"-- it can be suctioned. However, there are instances where fat is located deeper in the body, within the abdominal cavity, for instance. This type of "beer belly" cannot be treated by liposuction (except for the small amount of outside fat that can be pinched) or by any other surgical means. The only known treatment is extensive weight loss.


  • Liposuction with Tummy Tuck, NYC
  • Are the results of liposuction permanent?
    Yes! Normal fluctuations in weight always results in individual fat cells either enlarging or reducing in size. But they are always there in the same numbers! Liposuction physically removes the excess number of fat cells from the body and they do not multiply and rebuild after surgery. However, if you over-eat and gain weight after liposuction surgery, each of the remaining fat cells will enlarge and you will then gain weight and bulk symmetrically over your entire body. The bulges, though, will never return. On the other hand, should you lose weight after liposuction surgery, then you will lose bulk symmetrically around your entire body and the results of the surgery will be even better!


  • What can be done with the fat that is removed?
    The fat is usually discarded as medical refuse. However, some new studies have shown that fat is rich in stem cells and some new companies are working to concentrate the stem cells and preserve them for individual patients.

    In some patients, the suctioned fat can be replaced as a "fat graft" in areas of the body that are deficient. Small amounts of harvested fat can be used on the face to fill in lines and hollows or to augment a cheekbone. Or, for example, there can be a depression in the buttock cheek which can be filled in with fat harvested from other parts of the body to make it smooth and round. Sometimes the entire buttock can be enlarged with fat grafts, the so-called "Brazilian butt lift."

    A new and exciting technique is to use fat grafts to enlarge the female breast. This is still controversial and the appropriate techniques are still being worked out. But it does hold the promise of providing breast enlargement without breast implants.


  • Is there a limit as to how much liposuction can be done at one time?
    Emphatically yes! Liposuction is real surgery and always results in some amount of fluid and blood loss. A properly trained plastic surgeon will always use his best judgment as to how many areas of the body can safely undergo liposuction at any one time. If you want to suction many areas of your body, it is oftentimes best to split the procedure into several, separate operative procedures rather than to try to do everything at one time. Safety first!!!


  • Must I lose weight prior to surgery?
    Not necessarily! If you are at or close to your normal weight, then you are just fine. If you wish to lose just a few pounds before surgery, that is also fine. If you are grossly overweight, you may not be a candidate for liposuction at all. However, if you are 20 - 30 pounds or so above your ideal weight and still wish to have surgery, you do not necessarily have to lose those 20 - 30 pounds. The reason? Liposuction will remove excess fat cells and it doesn't matter whether the fat cells are large or small - they will be removed in any case.


  • What should I do in preparation for surgery?
    Eat a proper and healthy diet - no fads at this time. Stop smoking for a minimum of two weeks prior to and two weeks subsequent to surgery. Stop aspirin and other products (a list will be provided) at least two weeks prior to surgery. Follow the doctor's instructions about individual medications you may be taking.


  • What should I do after surgery? After surgery, drink plenty of fluids for the first 24 - 48 hours. Eat a healthy, balanced diet with lots of protein, which you will need in order to heal. Some additional Vitamin C and Zinc supplements are helpful. Arnica pellets (available at the doctor's office) and arnica gel can help reduce swelling and bruising.


  • Can liposuction treat a fatty tumor? Yes, it is very successful in treating fatty tumors, commonly called lipomas. The only problem is that liposuction will destroy the tissue in the process of removing it, so an absolute diagnosis cannot be assured. Also, these fatty tumors can sometimes recur after liposuction. The alternative is surgical removal of the lipoma, which will leave a linear scar and also a possible contour deformity.


  • Can liposuction treat cellulite?
    Cellulite is a non-medical term. Some people simply use it to describe large bulges of fat anywhere on the body, on the outer thighs for example. In this sense, liposuction will work.

    Cellulite has also been used to describe the dimpled, "cottage cheese" appearance of the skin surface, often on women's thighs. In this circumstance, standard liposuction does not work. This is a surface phenomenon while standard liposuction is performed well below the skin surface in the deeper fat layers.

    The cause of the dimples is strands of fibrous tissue which anchor the skin surface down in places, similar to buttons on a mattress. Treatment consists of cutting the individual fibrous strands and placement of a small fat graft at the site so that the two divided ends do not find each other again and re-form the same problem.


  • What is meant by ultrasonic liposuction, PAL, Vaser and SmartLipo?
     These are all different methods of removing fat. Ultrasonic liposuction was introduced with great fanfare, claiming to make standard liposuction better and easier. It utilized an ultrasonic probe which turned the fat into liquid and then standard liposuction had to be used to remove the liquid. Unfortunately, in some cases, the ultrasound probe produced burns and extensive post-operative pain. It has lost following but in the hands of an experienced surgeon, it can still be useful.

    PAL is short for Power Assisted Liposuction. In essence, it is a cannula attached to a motor which creates very short back and forth strokes. Although originally touted as a finesse tool, it is now used simply to make the work of liposuction less strenuous for the surgeon. It is useful but not essential and does not offer any benefits as regards the final results of surgery.

    Vaser is a pulsed ultrasonic liposuction machine. It has reduced some of the problems of the original ultrasonic liposuction and is still being used. It is not substantially better than traditional liposuction.

    SmartLipo (and others) are the latest additions on the liposuction scene. It offers a laser which travels under the skin to destroy fat cells. The body then scavenges and removes the dead fat cells and released fat. Some surgeons use the laser and then traditional liposuction to remove the released fat. Its main claim is that it tightens skin at the same time. However, this has not as yet been scientifically proven. There have been some reports of skin being burned by the laser. SmartLipo has yet to prove itself amongst many plastic surgeons but it is being heavily hyped to the general public.


  • What is on the horizon for body contouring?
    Non-invasive is the key word here. Studies are proceeding to use focused external ultrasound to kill fat cells. The cells are then scavenged and removed by natural bodily processes. The machines do have limitations but stay tuned - this is exciting!



  • Dr. Elliot Jacobs, M.D., Plastic Surgeon
    815 Park Avenue
    New York, New York 10021
    Telephone (212) 570-6080

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