Abdominoplasty can also involve liposuction for a contoured waist - as long as it is safe!

Karen M. Horton, MD answers:  

Can liposuction and tummy tuck be done at the same time?

Abdominoplasty has the goals of removing excess skin and fat from the lower abdomen, tightening the abdominal wall contour, and bringing the rectus abdominis muscles back together in the midline.

On the other hand, liposuction simply removes excess fat in areas where it is deposted in excess.  Sometimes, these two procedures are combined for the most aesthetic result. However, this must be done in the safest way possible, without creating additional risks.

I usually perform the abdominoplasty portion first.  This removes most of the lower abdominal and pubic area fat by direct excision, and liposuction is not needed for these regions.  I then evaluate whether there is any additional fat remaining that may be appropriate for liposuction - for instance in the flank and/or upper abdominal regions.

Of course, other areas of the body such as hips, inner or outer thighs are often addressed at the same time as an abdominoplasty, as complimentary procedures.

Next, if considering liposuction to enhance the abdominoplasty procedure, I will infiltrate the tumescent solution into the remaining abdominal regions.

Tumescent solution functions to temporarily constrict the blood vessels in the area and decreases the risk for bleeding and bruising with suctioning of fat. If any of the abdominal skin appears to have a compromised circulation, then I will stop here and not perform liposuction, to avoid the risk of wound healing problems.

However, if the abdominal skin appears to be healthy and pink, without any circulatory compromise, I may also perform a careful and limited amount of liposuction, usually to the flanks and possibly upper abdomen and/or pubic area at that time.

In Plastic Surgery, healing is based on having a good circulation to the tissues. It is always wise to do the safest procedure and avoid complications, rather than power ahead and risk "doing too much" at one time!  Safety first!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

More about → Abdominoplasty can also involve liposuction for a contoured waist - as long as it is safe!

Mommy Makeover Surgery - Rejuvenation of the Breasts and Body for Moms, Especially After Twins!

For Moms, a "mommy makeover" can be an empowering experience, particularly for mother who have had a twin or multiple pregnancy.  The following is an online article I gave for the incredible website Twin Pregnancy and Beyond.  I was interviewed by its creator, Kellie:

Plastic Surgery After Twins
Getting Your Body Back

We were so lucky to get some of the best information on plastic surgery after twins from a Board-Certified Plastic Surgeon. This informative article covers our interview with Karen Horton, M.D., and her advice on getting your body back after twin pregnancy via plastic surgery.

Her knowledgeable, straightforward counsel will help anyone who is interested in what's commonly referred to as a "Mommy Makeover". You will definitely get a better grasp on what's involved, recovery and costs. She also dicusses what happens to our bodies after twin pregnancy, as well as what to look for in a plastic surgeon and other available procedures. A must read!

WHAT TYPE OF DOCTOR ARE YOU AND WHAT DO YOU SPECIALIZE IN?

I am a Board-Certified Plastic Surgeon and Reconstructive Microsurgeon, practicing in the Pacific Heights area of San Francisco. I specialize in both reconstructive surgery and cosmetic surgery for women, and in particular, Moms! Please visit my bio for additional information.

At least half of my practice focuses on breast cancer reconstruction, using new techniques that are not yet widely performed in the United States: (1) Single-stage procedure using an implant, giving women a natural result without the need for multiple surgeries; and (2) Microsurgical reconstruction of the breast using the body's own tissue, usually from the lower abdomen or inner thigh area. This option avoids the use of implants, and provides a permanent, soft and living tissue reconstruction, while adding the benefit of a tummy tuck or a thigh lift!

The other part of my practice focuses also on women, most of them Moms! The "mommy makeover" spectrum of procedures rejuvenates a woman's body after she has completed childbearing. This type of surgery usually focuses on the breasts and body.

Many women who come to see me after doing an internet search say they feel more comfortable because I am a woman Surgeon. I think many women feel most comfortable discussing their bodies, their body image and self-esteem, and their personal goals for surgery with another woman - with the same anatomy, and who can relate to them as a peer as well as their doctor.

I give every single patient who walks through the door or my practice my full attention and absolute care. I get to know my patients intimately, and strive to understand them as a whole person. I explore how their desire to modify a part of their body will affect their life, health, wellness and spirit, and I encourage realistic goals and objectives for surgery. Each of my patients is given my personal cell phone number, and my patients are encouraged to contact me directly with any questions or concerns, no matter how big or small.

CAN YOU TELL US A BIT ABOUT WHAT HAPPENS TO OUR BODIES. ABDOMENS, BREASTS AFTER PREGNANCY
(especially a twin pregnancy)?

Many women find their abdomens have permanent changes following pregnancy, including stretch marks, loss of abdominal tone, excess skin and extra fat deposits that have accumulated since having babies.

Most mothers do not have complete recovery of their bodies after children. Many of my patients are personal trainers, who also need a little help once they are mothers!

Regardless of whether you breastfeed or not, having babies "suck the life right out of them" (your breasts)! The breasts are usually more and more deflated with each subsequent pregnancy.

This loss of volume is usually addressed by a breast augmentation, and sometimes a breast lift is incorporated to move the nipple and areola up to a more aesthetic position and to tuck excess breast skin. Twin pregnancies and multiple births can amplify the changes to a Mom's body.

Often the abdominal skin and rectus muscles are stretched so far apart that a hernia occurs, which is visible when you try to do a sit-up as a protruding bulge in your midline. This is repaired in a standard abdominoplasty, together with tightening your muscles and removing excess skin. There is no substitute for this incredible operation, which is one of my favorites to do!

How a mother feels about herself as a mother and a woman is integral to her self image and self esteem. For a mom to want to take care of herself and feel youthful, sexy and confident is NOT self-centered or vain!

WHEN DIET AND EXERCISE HAVE DONE ALL THEY CAN FOR A WOMAN WHO HAS TRIED TO LOSE THE POST-PREGNANCY WEIGHT, WHAT TYPES OF PROCEDURES SHOULD SHE CONSIDER?

A Mommy Makeover can include a breast lift, breast augmentation or breast reduction, depending on the changes of pregnancy and your specific aesthetic goals.

Because the muscles of the abdominal wall are permanently separated after pregnancies (particular after multiple children or twin pregnancies), a million sit-ups will not help! A tummy tuck (abdominoplasty)and/or liposuction is often recommended to bring the abdominal muscles back together in the midline, and to recreate a flat belly.

A "mommy makeover" surgical procedure should only be considered at least 6 months after the birth of your last child so that your body has the chance to recover as much as possible and to enable you to achieve as much as you can on your own, with a healthy diet and regular exercise.

I encourage each of my patients to become as physically fit as possible before considering any major surgery. If you are athletic and your body is used to being stressed physically, with endorphin release and a good heart and lung workout, then surgery will be much less of an insult to your body. If you are a couch potato and do no physical activity at all, then surgery will be a huge stress to your system and your recovery will be much more difficult.

Any Plastic Surgery operation is a major deal. Each procedure involves cutting and sewing, bruising, downtime, discomfort, and healing time. Reality shows and celebrity gossip magazines often portray Plastic Surgery in an unrealistic light, minimizing the downtime and sensationalizing the results.

In addition, many Hollywood celebrities who have had more than their share of cosmetic procedures look abnormal and have lost their natural beauty. The best Plastic Surgery does not make you look different, does not distort your features, and is not overtly obvious to any passer-by. Most women seeking surgery in my office want a natural result, without looking "fake" or "done". Most Moms usually just want their pre-pregnancy bodies back, or perhaps to look even better than they did before!

WHAT TYPES OF PROCEDURES ARE AVAILABLE FOR WOMEN WHO WANT TO ADDRESS THE EXTRA SKIN, STRETCH MARKS, AND BELLY BULGE LEFT AFTER HAVING TWINS?

Two main Plastic Surgery procedures apply to the post-pregnancy tummy:

(1) Liposuction will remove excess fat in areas that are stubborn to weight loss, such as the abdomen, flanks, pubic area, and thighs. Liposuction will not address excess skin or stretch marks, and will not help to tighten abdominal tone.

(2) Abdominoplasty or "tummy tuck" addresses both the inside and the outside of the abdominal wall, in a three-dimensional manner:

Tummy tuck surgery not only removes excess skin and fat from the lower abdomen (including some stretch marks), but it also tightens the muscles of the abdominal wall through "rectus plication". This step of surgery "corsets" the fascia overlying your abdominal muscles together in the midline and truly decreases the diameter of your waist from the inside! The bulge of pregnancy ("rectus diastasis", separation of the rectus abdominis muscles) is an integral part of this operation.

Depending on your particular situation, either liposuction or a tummy tuck, or both, may be recommended to achieve your specific goals.

An abdominoplasty has major downtime and recovery, and will require 4-6 weeks off of exercise and heavy activities that raise your heart rate or blood pressure, including carrying your children. You will need to have help with the activities of daily living during the immediate postoperative period, and ensure that you take care of yourself during this time, with others helping to care for your family!

LET'S TALK ABOUT BREASTS. FOR THOSE OF US WHO HAVE BREASTFED OUR TWINS, WHAT CAN WE DO ABOUT THE INEVATABLE SAGGING?

Loss of breast volume after having children is corrected by placing a breast implant behind the breast tissue to fill out what has been lost.  

Breast augmentation can help restore a woman's sense of proportion to her body, and in many cases can improve a Mom's self-esteem and confidence. Breast implants are placed either behind the breast tissue (subglandular position) or behind the breast tissue and the pectoralis major muscle (submuscular position). There are proponents for each technique, based on opinion and surgical training.

Regardless of the placement of the implant, the fill material and the size, having breast implants does not interfere with breast self-examination, physician breast exams, mammograms, ultrasound, MRI or any other cancer detection techniques.

Breast implants are safe! All implants have a silicone shell; silicone breast implants are the most widely studied medical device in the history of the FDA. To read more about the science and safety of all implants, visit the BreastImplantAnswers.com website.

Breast augmentation using implants will not interfere with breast cancer detection. Implants of all shapes and sizes have a shell made from silicone, which is an inert solid and is used in many implantable devices. The fill can be either saline (sterile salt water) or silicone gel. Sizes range from 125 cc to 800 cc, and implants may be smooth-walled or textured, round or shaped.

If you are "happy in a bra" and do not usually wear padding in your bras to achieve your aesthetic goals, a breast lift alone may be your answer for sagging breasts. Breast lift surgery (known as mastopexy) can restore droopy breasts to a normal size and shape. This operation, although similar to breast reduction, is considered cosmetic and is rarely covered by insurance.

A mastopexy reshapes and lifts the breasts, removes excess skin from stretched-out breasts, lifts the nipples and areolas to a more youthful position, and makes the diameter of stretched areolas smaller. Breast lift surgery creates scars that are permanent, but which fade with time, and are hidden in a bra and even a triangle-string bikini top. If you desire both replacement of lost volume and a lift to your nipples, a combination augmentation-mastopexy may be indicated.

ARE THERE ANY OTHER PROCEDURES OR TOPICS YOU WOULD LIKE DISCUSS?

I also see women with concerns about excess tissue in their external genitalia region, the labia minora. Hanging or redundant labia skin can cause embarrassment, pain with intercourse, or friction or sores when walking or doing exercise. One procedure I perform to correct this is called labiaplasty.

Labiaplasty surgically reduces excessive large labia minora tissue to create symmetry when it is lacking, and to make the labia appear more cosmetically appealing. Occasionally excess tissue around the clitoral hood is also carefully trimmed, without any injury to the nerves that provide sexual stimulation.

A FINAL WORD OF WARNING: 

It is important to realize that any body-modifying surgery can have a major impact on body image and self-esteem. Hopefully, the change is a positive one!

However, just like a drastic haircut, there can be a "body image adjustment" period or temporary feeling of remorse after surgery. I counsel my patients at their initial consultation that this adjustment period of potential feelings of uneasiness, anxiety or "what have I done?" is completely normal and common after surgery. It can take some time to adjust to your body after any surgery, and the most healthy approach is to acknowledge how you are feeling and to communicate this to your loved ones who are assisting you after surgery.

WHAT SHOULD WE BE LOOKING FOR IN CHOOSING A DOCTOR TO PERFORM THE AFOREMENTIONED PROCEDURES?

A Mom should do her homework when seeking a Plastic Surgeon! You will be trusting your body to this person! Do your 'due diligence'. The surgeon should be Board-Certified and a member of the American Society of Plastic Surgery (ASPS - if in the United States) or another major professional society, and should be current in their Board Certification and training.

They should have a great deal of experience in the procedure you are seeking, and should show you multiple before-and-after photographs of their results - not just the best outcomes, but "average" results in body shapes and types just like you! Ask to speak to some of their patients who have had surgery with the Surgeon, and don't be shy about asking them all about their experience - you need to know the good, the bad, and the ugly!

Bring a list of questions with you, and bring a friend to act as another listener and objective observer. There should be a "good fit" between you and the physician - in terms of personality, aesthetic goals for the procedure, office staff atmosphere, etc.

COST WISE, CAN YOU GIVE US A BALLPARK FIGURE ON WHAT WE SHOULD EXPECT TO PAY FOR SOME OF THE MENTIONED PROCEDURES (plastic surgery after twins)?

I don't usually discuss the costs of surgery - this is left up to my Patient Coordinator Mary, who spends time with patients once they have completed their consultation with me, which usually lasts 45-60 minutes on our first visit. Mary then reviews the procedures we have discussed and provides an estimate of the total costs of the procedure(s), which include a surgical fee, operating room time, anesthesia fees, and sometimes an overnight stay in the hospital.

Estimated costs for the doctor's fee for some common procedures include:
* Breast augmentation $ 4,200 - 5,000
* Breast lift $ 6,000 - 8,000
* Breast reduction $ 6,000 - 8,000 (some cases may be covered insurance)
* Abdominoplasty $ 6,000 - 10,000
* Liposuction (per site) $ 2,000 - 3,500
* Labiaplasty $ 3,500 - 4,000

Keep in mind that when multiple procedures are done at the same time, the overall cost is less and discounts are given. I usually recommend no longer than 6-8 hours under anesthesia, and mandate an overnight stay for any procedure longer than three hours.

Karen M. Horton, M.D., M.Sc., F.R.Cf.S.C.
Womens's Plastic Surgery
San Francisco, California

More about → Mommy Makeover Surgery - Rejuvenation of the Breasts and Body for Moms, Especially After Twins!

Full "tummy tuck" closure with DIEP flap breast reconstruction... A good idea?

"It is possible to do rectus plication with DIEP flap donor site closure for a full abdominoplasty result"

Karen M. Horton, MD answers: Possible to do full tummy tuck while doing diep flap procedure?

I understand that the diep flap benefit of a real 'tummy tuck' is not covered by insurance. Is it reasonable to ask for the cost of a full tummy tuck (sewing together muscles, etc.) while the surgeon is performing a diep flap procedure? My surgeon seems very reluctant to even discuss outlying procedures such as abdominoplasty and liposuction, which I believe are both necessary to achieve the best final results. If I'm willing to pay for these procedures out of pocket, I don't know why my surgeon won't discuss them. Any insight appreciated.

By Karen M. Horton, MD - San Francisco Plastic Surgeon

When the DIEP flap (deep inferior epigastric artery perforator flap) is used for microsurgical breast reconstruction, usually a small split is made in the muscle fascia (thick layer of collagen over top of the rectus abdominis muscles) to dissect out the blood vessels used for transplantation of skin and fat from the tummy to the breast.

Usually, the fascial split is simply closed, and the overlying anterior abdominal wall (sheet of skin and fat over the muscles of the trunk) is pulled tighter and closed, resulting in a tummy tuck scar.

It IS possible to perform rectus fascial plication (corsetting of the rectus abdominis muscles of the abdominal wall towards each other in the midline AT THE TIME of DIEP flap donor site closure.
However, doing so may change the pressures inside the abdominal cavity (i.e. on the stomach, intestines, diaphragm, etc) and may increase the risk of complications to the flap circulation in the short term. The worst case scenario would be to perform cosmetic steps during surgery and to lose the flap altogether!

Performing a full tummy tuck closure with the DIEP flap is something I HAVE performed successfully on a number of occasions, but patients must be very carefully selected and we would all have to be willing to accept an increased risk for complications.

I am currently reviewing my results on this combined procedure and will be presenting my work at upcoming meetings and in the form of a scientific paper, to be published on my website.

Often, the best solution is the simplest. On the day of your DIEP flap, it is usually best to focus only on microsurgical success. "Touch-ups" can be done any time in the future, including liposuction contouring of the abdomen (done in most of my patients) together with their nipple and areolar reconstruction, and/or rectus fascial plication, if needed.

See the photographs below of an example of rectus fascial plication done either at the time of DIEP flap donor site closure.  Trust your Microsurgeon to make the best decision for you, and to ensure a SAFE and SUCCESSFUL breast reconstruction as the #1 goal!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.
www.womensplasticsurgery.com

More about → Full "tummy tuck" closure with DIEP flap breast reconstruction... A good idea?

Words of Thanks from a Breast Cancer Survivor

The following is a message from one of my patients who underwent bilateral skin-sparing mastectomies and immediate reconstruction using the DIEP/SIEA flap.  

Words like hers are the exact reason why being a Plastic Surgeon and Reconstructive Microsurgeon is so absolutely rewarding...

Dear Karen,

    My breasts are so beautiful. My torso, too. I'm overflowing with affection, appreciation and feelings of indebtedness towards you. This is so personal. YOU led me here. Not you, the doctor. Not you because this is your job. But the loving, caring, giving you. 


   Your training and gift as a surgeon are your vehicles but it's your heart and your soul that speak to the patient.You gave me the chance to put aside fear, stale ideas, and martyrdom (from childhood! YIKES! I didn't even know it was still there until all of this,) to reach in and stretch my uninformed "normal" view. When Dr. Richards first mentioned "reconstruction" I thought I had misunderstood. I had cancer. What does reconstruction have to do with that? Of course, everyone is familiar with breast cancer and, afterwards, reconstruction,  but these are remote concepts to those who have never experienced it.  

     "Let's just get rid of the cancer," I said to myself. "I don't need new boobs. They haven't been cute since I was last breast feeding. I'm already settled in with older-ish woman boobs, anyway. My middle-aged persona has been developed with older-ish woman boobs playing a key role. WHAT are they all talking about?" Now, I have breasts and they are lovely!

    When I met you, I was scared. Maybe you were the first person ever to say, " Joanne, What do YOU want? This is for you. Only you. What do you want ?" Maybe I was very receptive at that time in my life to consider such a question. My body, my choice. In those days, I would have been satisfied to get rid of the cancer, but I did consider your question . You gave me an open door to think about it. I did think about it. A lot. Before long I was able to decide that I did want new boobs. You know the rest of the story.

    Now that you've completed your magic on me, I feel so new. So alive. So complete. I haven't been swimming for awhile. Now I can't wait for summer.  My sexuallity was dormant. Now it is reawakened! I was a bit reclusive. Now I'm not. Each moment of my life has been improved, deepened, and is more satisfying since having received your care.

    I will be thanking you for the rest of my life for the most awesome and generous gift I have received from you. 

    Karen, I am so eternally grateful to you for staying with me at a time of great despair.

    With love, gratitude, and appreciation,

    Thanks so much, ~joanne

More about → Words of Thanks from a Breast Cancer Survivor

The Psychology of Potential Cosmetic Surgery Patients - The Surgeons' Perspective

The following was taken from an ASAPS publication, Selling the Invisible: 7 Simple Strategies to Increase Your Patient Census, by Catherine Maley, MBA, Author, Your Aesthetic Practice

 Since this is what the Plastic Surgeons who perform cosmetic surgery are reading, I thought it would be useful to post this article for potential patients and the general public to read as well!  I welcome comments about its content and its perspectives. 

Imagine being an aesthetic patient today trying to swim through the sea of information and options available for cosmetic enhancement. It is often daunting to sort out fact from fiction, hype from reality and marketing from credibility.  The aesthetic patient wants to improve something that bothers them and they have to take a big leap of faith to get the result they are imagining.

When you understand how difficult this process can be for the aesthetic patient, you can more easily establish rapport with them and help guide them to make the best and safest decision.

What Is The Patient Buying?

What are your patients really buying?  Prospective aesthetic patients want to change something about their appearance and they hope fixing, repairing or enhancing a certain aspect of themselves will make them feel better. They feel vulnerable and are looking for help.

Psychologically, they are buying hope, happiness and self esteem. They are also buying peace of mind. Patients want to avoid making a bad choice. They are considering risks and how to minimize them. Because they do not want to regret their decision, they are looking for reassurance. It is important to them that they are in the right place for the right procedure and that they trust they will get a good result.

Aesthetic Patients are Consumers

Since this target market is using their own disposable income to look and feel their best, they are consumers and have the power and freedom to choose their aesthetic practitioner at whim. Ultimately, aesthetic patients are doing a cost-benefit analysis to determine if what you offer is worth their time, money and effort.

Consumer behavior is a complex subject since it involves emotions, personalities and life experiences so, to simplify, the following concepts should help in your understanding of what your patients want and need.

Your aesthetic patients are consumers.  The following are four buying groups they fall into and includes advice on the best approach to reach them:

1.  "Tire Kickers"

This group doesn’t know what they want. They seem to have a lot of time on their hands because they will attend your events, eat your food, take your samples and never, ever buy. They may even book a consultation, go through the motions but never book a procedure. Do not exert energy on this group since it’s a waste of time.

2.  "Deal Makers/Price Shoppers"

This group is looking for the best deal in town above all else. They have a tendency to regard cosmetic enhancement as a commodity and will spend much of their consultation negotiating with you and your staff. To them, it’s an art form to get you to lower your prices or throw in freebies. Beware of them. Shut them down
on their first attempt to lower your price by firmly restating what it is.

3.  "Brand Loyalists"

This is your favorite group. They love you and would not go to anyone else—even if a competitor was half your price!  They are your cheerleaders, your advocates and your loyal followers. Treat them well and they are yours for life. Most of your efforts should be concentrated on this group and growing it to include their loyal friends, family and colleagues.

4.  "Luxury Innovators/Quality Shoppers"

While this group wants only the best and will pay for it, they can be difficult.  They have a tendency to flaunt their money and expect better treatment than your other patients get. While you should treat all of your patients with respect and special care, spending a little extra time and effort on this group can pay off since
like-minded people know other like-minded people and this can be a profitable group to appease.
The Aesthetic Patient’s Decision-Making Process

Aesthetic patients are emotional and act on prejudices and habits much more than knowledge. They reach decisions quickly with emotions and then justify those decisions with logic. And, while it takes a patient a split second to make a decision; getting ready to make that decision can take months or even years.

The answer to bonding with your prospective patients, giving them what they want and closing more procedures, is effective communications. It is most helpful to communicate with each patient the way they can best understand—especially when discussing the invisible. Patients use their senses to take in information and digest it accordingly and, typically, one sense dominates over the others. Keep these in mind when consulting with your patients:

"Looks Right" Patients
These patients make decisions based on what they see and then they visualize how it will look for them so show them lots of before and after photos and/or computer imaging. Paint them a mental picture with words. Draw out what you envision. They trust what they see. They will say things like, “This looks right to me.” or “I see what you mean.”

"Sounds Right" Patients

These people make decisions based on what they hear. When they hear words that make sense to them, they respond well, so tell them about the procedure with confidence and sincerity. Have your staff and other patients tell them about their own experiences. They will say things like, “That sounds about right.” or “I like the sound of that!”

"Feels Right" Patients

These people make decisions based on what they can physically feel so hand them a mirror, give them product samples and let them try on breast implants.  Pat them on the shoulder to physically connect with them. They will say things like, “I feel good about this.” Or “This feels right.”

"Makes Sense" Patients

These people need reasons for what they do. Answer the “why” for them. Give them facts, data and reasons so they can justify their decision in their own minds.  They respond well to logic. They will say things like, “Well, that’s logical.” or “That makes a lot of sense.”

Steps to Closing More Procedures

When selling the invisible service—which is you—you have no product between you and the patient. You are the product so they have to examine you as they would any other big, disposable investment they make.

Conclusion

Understanding the decision-making process of an aesthetic patient and then addressing each patient individually will improve your closing ratio. Learning to build rapport, communicate effectively, and establish trust with your patients by using the senses, will bond them to you.  That means they will consistently choose you over all the others.

More about → The Psychology of Potential Cosmetic Surgery Patients - The Surgeons' Perspective

Liposuction Q & A with Dr. Karen Horton

1. How soon will I see liposuction results?

The results of liposuction take at least three months, up to a full year, to be evident.  As with any surgical procedure, you can expect some swelling, bruising, numbness and discomfort that will take a few weeks to resolve.

Postoperative tissue swelling, known as "edema", tends to persist in the tissues that underwent liposuction.  Edema feels like firmness and woody texture to the tissue, sometimes with dimpling of the skin and/or a darker pigmentation.  This is entirely normal; edema is the body' s response to injury! (just like a "goose egg" swelling of the scalp with a bad fall). Initially after liposuction, you may in fact gain weight, despite the removal of a few pounds of fat!  This is again due to edema - the body holds on to extra water as part of its injury response.  

Do not weigh yourself for at least a few weeks after surgery, at least until after the bruising has resolved (2-3 weeks).  When bruising is gone, your healing will be well on its way.  You will notice your clothes begin to fit differently (better) after the first three months, and every single month you will notice subtle but significant changes. The results are permanent!

Remember to be patient after having any Plastic Surgical procedure!  Any type of surgery takes up to a year for every last bit of swelling and tissue edema to go away.  Plastic Surgery is an investment in your body.  You will need to continue your regular exercise regime (beginning at 3-6 weeks postop, or when you receive permission from your Surgeon), a nutritious and balanced diet, and healthy overall lifestyle. 

 2. What anesthesia is used with Tumescent Liposuction?

During liposuction, a fluid mixture commonly called "tumescent solution"containing normal saline (sterile salt water), epinephrine (adrenaline) and a local anesthetic (Lidocaine) is injected into the areas of fat that your surgeon has marked for removal before surgery.  Tumescent solution functions to help "puff up" the fat cells for suctioning, decrease bleeding and limit bruising, and to make the area numb both during and for many hours after surgery. 

After the tumescence is infiltrated, it is allowed to circulate for at least 10 minutes in each area.  This is to maximize the "vaso constriction" effect of the epinephrine (to shrink the blood vessels in the fat and under the skin, to help avoid their injury). 

The local anesthetic will keep you comfortable after surgery, although this is not the only method of anesthesia used during liposuction in most cases .Most of the time, you are also fully asleep under general anesthesia, or at a minimum under intravenous sedation so that you do not feel or remember anything during surgery. 

Next, through tiny "stab incisions" that are placed in natural creases of your body, a thin and blunt-ended wand known as a "cannula" is inserted to permanent suck out fat cells.  These incisions are later closed with sutures(stitches), a dressing is applied over each incision, and you are placed in a postoperative compression garment.  The purpose of the compression garments is to limit swelling and bruising, encourage skin contraction, and to keep you as comfortable as possible. 

3. Who can perform Tumescent Liposuction?

Liposuction is a surgical procedure, and should be performed by a specially trained Plastic Surgeon.  Most Plastic Surgeons have completed at least 5 years of surgical Residency at an accredited University, with an additional year or two of subspecialty training.  At least two years, and up to six of these years should be in Plastic Surgery for a Physician to call themselves a "Plastic Surgeon". 

In the United States, it is important to seek out a Board-Certified Plastic Surgeon who is credentialed by either the American Board of Plastic Surgeryor the Royal College of Physicians and Surgeons of Canada (equivalent licensing Boards).  Unfortunately, not all Physicians are Board-Certified. Another good resource is the American Society of Plastic Surgeons (ASPS)and/or the American Society of  Aesthetic Plastic Surgeons (ASAPS).  Entry to these professional societies is limited to Plastic Surgeons who have been in practice for a minimum number of years, are certified by their respective Boards, and are reviewed and accepted into membership by their peers. 

It is up to you, as the patient, to do your homework not only to learn about your surgical procedure, but about your potential Surgeon!  Board Certification is unfortunately not a requirement to obtain a medical license in the U.S.  In Canada and other countries, Board Certification is a rule; a Doctor cannot obtain a medical license without this certification. 

In addition, many non-Surgeons (Family Doctors, Internists, Dentists) or Doctors with other specialties (Oral Surgeons, Ear, Nose and Throat, OB-GYN)take a weekend course on liposuction and begin offering this treatment at a discounted rate to their patients.  Beware!  Just as you would not go to a foot specialist for open-heart surgery, you should not trust your body and your life to a practitioner who does not have the training and experience in the procedure you are seeking. 

Lastly, be cautious of the terminology "Cosmetic Surgeon", and certification and the like.  Nearly anyone can call themselves a "cosmetic" anything -most of the time, it means very little!  The American Board of Medical Specialties (ABMS) and the Royal College of Physicians and Surgeons of Canada (RCPSC) only recognize University-accredited training programs in Plastic Surgeon for certification. 

 Again, be cautious and take your time to research your Doctor the same way you would research your nanny, a new school for your child or a contractor for your home.  There is only one of you, and you are a very valuable commodity!  Be sure to put yourself in the hands of the best practitioner for the job. 

4. How safe is Liposuction?

Any surgical procedure carries with it potential associated risks, such as the risks of anesthesia, early risks of surgery, and late risks.  Safety is always the number one goal!  Most surgeries are performed in the operating room or an accredited out patient surgical facility with appropriate intraoperative and postoperative monitoring to ensure your procedure goes as safely and smoothly as possible. 

For liposuction specifically, possible early risks include persistent numbness of the surgical area ("anesthesia" of the skin) that can last weeks to months, pins-and-needles or electric shock sensations of the skin as the nerves are waking up ("paresthesias"), or sometimes unpleasant sensations("dysesthesias") as a temporary experience.  Bruising is common for at least 2-3 weeks after surgery, and swelling may persist for 3 months or more.

Potential late complications can include uneven contour of the skin or rippling, darker pigmentation of the treated areas, or asymmetries between sides of the body.  Differences between your right and left sides will likely be pointed out by your Surgeon preoperatively.  Although symmetry is always the goal, you may never be an exact mirror image from one side to the other - no one is! 

As long as the procedure is performed by a Board-Certified, specially trained Plastic Surgeon with a great deal of experience in liposuction, the benefits of liposuction usually far outweigh the risks.  You should also be healthy and physically fit enough to undergo surgery and have clearance from your Primary Care Physician before having any elective surgical procedure. 

 5. What areas are most common body regions treated with Tumescent Liposuction?

 Fat deposition is primarily based on genetics.  Every woman' s body is different, and your area is likely a little different from your best friend' s.

 

The most common areas of the body that are appropriate for liposuction are the lower abdomen hips, flanks (sides or "spare tire" area), inner and outer thighs, the upper neck beneath the chin , upper arms and the "butttockroll" (the area immediately below the buttocks). These regions are the trouble spots that most women (and some men) deposit fat and are stubborn to diet and exercise.

Areas that are not appropriate for liposuction include the knees, lower legs, ankles, lower arms, or the face (with the exception of the front of the neck).  These areas are not usual areas where fat is stored, and liposuction in these regions is risky for injury to nerves, tendons, blood vessels, and the skin. Liposuction is also not applicable to internal abdominal fat - the fat that is deposited around the internal organs.  It is also not a treatment for obesity or for weight loss.  Liposuction is for body contouring only! 

6. Can I have other operations with Tumescent Liposuction?

 Liposuction is commonly performed together with other procedures - for instance breast augmentation, breast lift or reduction, abdominoplasty, or a face lift.  So long as the total time under anesthesia is not excessively long (I limit my patients to maximum 8 hours of elective surgery). it is safe to have combined procedures with liposuction. 

 7. How does the Tumescent technique reduce risk of infection?

Vasoconstriction of the blood vessels may slightly decrease the risk of infection, as the blood flow to the area to be suctioned is reduced temporarily during the operation.  However, the risk of infection is very low as a baseline risk for liposuction.  Usually, a single dose of intravenous antibiotics is given immediately before surgery in the operatingroom.  Oral antibiotics are often continued for a few days after surgery to also prevent infection. 

More about → Liposuction Q & A with Dr. Karen Horton