Question #1:
>Hello..
>I am currently at 280 lbs and 5'8". My doctor tells me I should be
at 180 or so even with my large frame. What I want to know is exactly how
much Liposuction can remove from my body safely. I am currently dieting
as I have been most of my life. My weight has flucuated greatly depending
on the time of the year until I moved to Arizona about 5 years ago where
the weather allows me to remain active year round. I am 24 years old and
have maxed out at about 340lbs. The problems I have noticed are that I
eat no more than the rest of my family and friends ( who are all thin )
and my daily activities are higher than most of theres. It seems like the
weight just doesn't want to go anywhere. I have tried all the "over the
counter" diets and have lost weight but as soon as I go off the diet and
go back to "regular" food the weight return. So I guess my question, after
all that rambling, is...will liposuction remove the fat cells and keep
them away and if so how much could I remove with liposuction? I currently
follow a normal 2,500 calorie diet and find it quite filling and have been
on this diet for almost 2 years and have healthily gone from 340 to 280.
The thing is that at this rate it will be another 6-8 years before I am
anywhere near where the doctor says I should be. I want to get rid of it
now and I am tired of fighting this endless battle with little results.
Also can you tell me ruffly what it would cost to do this amount of Liposuction.
the areas I want done are 1. My abdomen-where probably 80% is 2. my inner
thighs 3. my chest-also a large portion of the weight 4. Love handles 5.
and under my chin.
An Answer:
As liposuction is more of a contouring process than weight loss, you sound like an extreme case. Anyone that tells you that the fat removed is removed permanently (meaning you can't gain it back) is not providing an accurate representation. I commend you for having lost the weight you have lost, but don't view liposuction as a way to stop the fight. As weight loss professionals will tell you, patients who have been obese prior to weight loss have a lifelong fight to keep the weight off.
Liposuction can help you in certain areas, but the actual amount of weight loss is not as great as you might think. It is dangereous to do large volume liposuction which commonly requires blood transfusions. With this said, as I had mentioned, there is really no guarantee that you'd be able to keep this weight off.
For your abdomen, an abdominoplasty would seem more logical. To try a little liposuction would be reasonable too. Be sure before you have any surgery that you are evaluated by an internist to judge your general health. Anesthesia can be dangerous in people with pre-disposing health problems.
I truly hope that you are able to reach the goals you have set. Professional
weight loss counselling may be helpful.
Thanks for the Question,
John Di Saia, M.D.
Question #2:
>Hello Dr.; I just had Liposuction of the lower abdominal-upper hip and also in the flanks(upper thigh).I am a aerobic instructor and I would like to know if I go back to work to early. What is the worst case that could happen to me? I will keep the garment on for several weeks, but I feel I really need to move. My muscles feel sore is that normal but when I walk or just keep moving I feel much better. I just don't want to damage my chances of having smooth skin if I move too much, so my question is how much is too much to soon? Thank-you your web site is the most informative! and much appreciated!
An Answer:
Considering that I don't know how much work was done and it sounds like you plan on some fairly heavy activity, I would be conservative. I wouldn't start "full tilt" aerobics for two to three weeks.
What could happen?
When we do this type of surgery, we leave spaces between the skin and
the underlying fat and muscle. The garment halps put these surfaces together
so that they can heal together. Rest allows this to happen more quickly.
That is not to say you can't do some walking, but heavier activity causes
things to move against one another. If these surfaces don't adhere early
on, you can get a fluid pocket between them (a seroma). This may need to
be aspired with a needle or in a worst case scenario could cause firm prominent
scarring. I have never seen these poor outcomes, but all my patients so
far have been good about taking it easy for a while.
Thanks for the Question,
John Di Saia, M.D.
Question #3:
>Just a brief question. Is there any way to remove dark patches of skin
on the face? I have recently developed dark patches on my upper lip and
am having a hard time camoflauging the area. My mother has dark patches
as do my sister and brother so we know it is hereitary. I am the only one
with the problem on my upper lip. I would love to have it removed. I read
here about the laser treatment to remove tattoos. Would this work on unsightly
blemishes?
Thank you so much for sharing your valuable information.
An Answer:
This depends upon the actual identity of these "dark patches." Some
of these may be only slight changes in the pigment cells of the skin and
may be appropriate for bleaching creams or laser treatments. Others may
be moles of a sort that should be surgically removed. Very few if left
alone can go on to form cancers of the skin, so the areas on your face
should be examined by a physician.
Thanks for the Question,
John Di Saia, M.D.
Question #4:
>Thank-you very much for your web site! I found it to be very informative
and straightforward. Reading some of your question & answer section
helped answer some of the questions I also had.
> I very seriously wanted to get surgery when I was 19 but, on the
advice of my parents, I decided to wait and see if I would develop anymore.
I have been very active in tennis since I was 11 and was told this may
have hindered my development. What do you usually tell your young patients
when they come in for a breast augmentation? Do you usually encourage them
to wait? If so, at what age do you recommend?
> Well, I have finished college tennis and I am now in the process
of looking for a plastic surgeon. (Waiting, did not prove to have any benefit
in my case!)
>Thank-you again for your web site and your time!
An Answer:
On young patients, I have encouraged them to wait if they were below
the age of 21 years or so. The youngest patient in which I have performed
this surgery at the present time was 24 years old. Other than this the
decision is very personal and the maturity of individuals is quite variable.
Patients need to be old enough/mature enough to realize that this type
of decision has lifetime implications.
Thanks for the Question,
John Di Saia, M.D.
Question #5:
>I am interested in rhinoplasty, however a concern of mine is of course in not knowing how I will look afterwards. The question I have is there any professional way, may be through a computer program to may be scan a few pictures and then "play" around graphically, on the screen, to show an "after operation" final product. How do I know the surgeon is thinking of the same nasal contour that I am thinking of?
An Answer:
Getting a patient-specific result in rhinoplasty can be difficult for
the reasons you outline. People are often very particular about their nasal
character. It is useful to address the issues of concern with your surgeon
in the order of preference. Perhaps the most important issue is the "hump"
or the "wide tip." Some surgeons use computer models to provide some estimate
of the potential result. There is no computer currently available however
that can predict with any real certainty an operative result. Drawings
in consultation can help graphically describe the contour in rough terms,
so patients don't get too attached to one image (feeling it "shows" the
result).
Thanks for the Question,
John Di Saia, M.D.
Question #6:
>I live in the UK and find the only information I can get on cosmetic
surgery on the internet derives from the US, but so be it. Would you be
able to advise if you know anything about the (relatively minor) procedure
of lip tattooing / lip lining?
>I am interested in the procedure for cosmetic purposes, but have heard
contradictory advice about the safety, longevity and natural effect (or
not) of lip tatooing. I have naturally very white/colourless lips and spend
a fortune on lipstick! An Answer:
I cannot tell you that I am wholely unbiased on this issue as in my
laser clinic I have seen patients who wished this tattoo (like other tattoos)
taken off. "Permanent tattoo" is a bit of a misnomer. These tattoos (like
any other) go through periods of fading and color change. Sometimes they
change into a color that the patient doesn't like with the patient then
presenting to a plastic surgeon interested in removal. I would really advise
you look deeply into this procedure before having it done.
Thanks for the Question,
John Di Saia, M.D.
Question #7:
> After years of avoiding the beach and pool parties, etc... I keep reading about how a person must be a "candidate" for implants. What exactly is the surgeon looking for when they decide if somebody is good candidate? I imagine I'm not. I'm 90lbs and 4'10 and right now about a 32AA. However, I'm not skinny, the rest of my body is very full and healthy looking. I'm also worried I wouldn't be able to get them because of my age, 22, and because I have a history of cancer in my family. Does all this make me an unacceptable candidate? I'd rather hear the answer is no over e-mail than from a doctor in person, I have wanted and saved for them for a few years. Also, I was thinking about the possibility of having my entire natural breasts removed and then reconstructed. My grandmother lost parts of her arms, and both breasts to cancer, could I get mine removed as a preventative measure? Can I nurse future children if I keep my breasts and get implants?
An Answer:
The criteria upon which patients can be judged for simple augmentation include several. There are few absolutes however there are lower and higher risks.
(1) A history of breast cancer in the family must be graded in severity. If the patient has had breast cancer, she should certainly be concerned about the possibility in the other breast. If the patient's mother and grandmother have had breast cancer, this would indicate a strong family history and a likelihood of the patient developing the disease later. The potential risk of cancer needs to be discussed as this of course affects the patient's outcome (having to later have the implants and breast removed if cancer develops).
Indeed if there is a very strong family history of breast cancer, consideration for prophalactic mastectomy and reconstruction is appropriate. Mnay surgeons believe that the procedure can reduce the risk of later breast cancer development. This has not been rigorously proven however. Careful observation may be more reasonable.
(2) The patient's physical dimensions may help determine the technique that should be used, but rarely make the procedure inappropriate.
(3) You can breast feed following simple breast augmentation.
(4) The most important criterion is a reasonable informed patient that
realizes her risks and takes them into consideration. This procedure is
a personal decision.
Thanks for the Question,
John Di Saia, M.D.
Question #8:
>Thank you for your informative web-page. I have read through all of your questions and I hope my questions are not redundant. I am a 29 year old male and wanted to know if the risk for removing just excess fat from the tip of my nose ( rhinoplasty) is less expensive and less risky than other rhinoplasty procedures? Also does liposuction on a person's face have a lower risk of scarring? I am also interested in any risk involved in a chin implant. Is a chin implant remain stable over one's lifetime? How long would the implant surgery take?
An Answer:
I would not recommend liposuction of the nose as I have not heard of
it and it seems potentially dangerous (part of the nasal skin may die).
Facial liposuction has limited usefulness in the cheek depending upon that
which you are seeking. It is also sometimes useful in males in the area
under the chin. Chin implants can be helpful to fill out the chin if the
jaw is small and not inset (relative to the cheeks (midface). The surgery
is quite short (an hour or so alone). In rare cases the implant can wear
into the jaw over time. I have not seen this however.
Thanks for the question,
John Di Saia, M.D.
Question #9:
>I had a nose plastic surgury about 3 years ago. At the beginning my nose looked great, but little by little I started getting a small bump on the left had side. Injecting Steroid in it did not solve the problem so my doctor did another surgury and another and another ( 3 times after the initial surgury). Each time it would look great for a couple of months and then it starts getting scar tissue again. The steroid injection does not solve the problem. Do you have any idea what could stop scar tissues from building. I would appreciate an answer.
An Answer:
Scar tissue can be problematic in any type of surgery. The question is what kind of scar are we talking about?
Keloid scarring is exuberant scar that forms in a (sometimes) minimally traumatized area. This scar grows right out of the wound explaining the old name "proud flesh." Some people are more prone to form these (particularly those of African descent). It is difficult to treat successfully. Steroid injections, re-excision and even radiation therapy can be used although I'd be wary about the latter in the nose as it may damage the delicate cartilage.
Hypertrophic scarring is heavy scarring that does not grow up out of the wound. It tends to respond better to treatment. Steroids and re-excision can be helpful.
As you have seen however, therapy on poor scarring is not always successful.
A newer technique involves the application of a gel sheet to the area following
surgery. This may reduce the tendency to form scar.
Thanks for the Question,
John Di Saia, M.D.
Question #10:
>I have had two breast augmentations about six years ago. I'm currently a 38C. I'm 40 years old and am interested into having one more enlargement. I looked at some of your Images and really want to be large like the women in those photos. I would like to find a surgeon who can make me look like the girl, or close to that, as the girl who is in the second photo on page two. I know this is extreme but thats what I want to look like. This women is proof that there are surgeons out there who can provide these results.
An Answer:
The "exploding" look is attractive to some, but hard to maintain. All
implants tend to settle with time and the breast skin (especially in middle
aged to older women) tends to relax. You could have a short term result
like the images to which you refer (perhaps you have), but the question
of how long it would last is open. Consultation with a plastic surgeon
may help you decide how possible this is for your breast geometry. All
breast implant results change in character similarly to non-augmented breasts
over time. Take into the account that the images to which you refer are
merely a snapshot in time. Seeing how these patients look over the course
of time is far more revealing.
Thanks for the question,
John Di Saia, M.D.
