To answer your questions...

Liposuction - Tummy Tuck questions, vol I

 

Question #1:

Dear Dr D, I found your letter quite interesting as I am scheduled for liposuction on my thighs on June11. I am really wrestling with this decision as I am happily married, athletic, and am considered thin at size 6. However, I've always hated my legs which relatively " thick". I was wondering if "lipo" is ever done on calves? What are the results? Does increase the chance of complications? Is it done very often? My husband is a physician also and won't even discuss this with me...He went ballistic when I mentioned adding the calves. (He suggested I have my head examined) What do you think?? Thanks for your input/opinion.

An Answer:

Liposuction works by removing (parts) of the fatty deposits in the area of interest. Calves are not routinely done as they are more often composed of muscle as opposed to fat. There is a layer of fat, but not the usual deep layer that is especially amenable to liposuction. I would suspect that liposuction on the calves may have a high incidence of causing "streaks" or surface irregularities as a function of the anatomy of the fat present there. I have not seen liposuction performed in this location with good results.
Thanks for the question,
John Di Saia, M.D.

Question #2:

>I have a friend who I'm concerned about. After having 10 children, her
>stomach muscles are very stretched out, and together with being
>overweight, she appears as if she will give birth within a week. She
>is talking of doing liposuction as well as tightening of the stomach
>muscles. (She has tried many diets but has always regained the
>weight.) I am very concerned and think she should research more before
>she decides on this operation.
>
>Could you help me give her some basic information by answering the
>following questions:
>
>1. Will the fat removed by liposuction return if she eats normally (which happens after dieting)?
>2. Is this major surgery? What are the risks of complications, immediate and many years later?
>3. How long is the hospitalization, and how soon do most people return to normal functioning?
>4. How many years has this operation been done and have many people had it?
>
>I guess what I'd really like is a detailed brochure that discusses
>this procedure and answers these questions. I've also heard of a tummy
>tuck and wonder if this would be better for her. However, I don't know
>enough details. Would you have an official brochure that discusses
>these procedures, and could you send it to me? I would be most
>grateful.
>

An Answer:

This is a multi-faceted question. I have answered several aspects in the liposuction/abdominoplasty sections of the site, but in short.....

It sounds like your friend probably would require Tummy Tuck. When there is muscular laxity in addition to fatty excess, liposuction alone will probably not result in a marked improvement. As far as the safety of the operation, it has been performed for over fifty years. Complications are not terribly common but include blood clots in the legs (Deep Venous Thrombosis), infection, and scarring. If properly selected patients are almost universally happy with the results. Fat can re-develop as can abdominal laxity but this is variable. The procedure does not specifically prevent the re-accumulation of weight and is not a "weight-loss" operation. Most patients are done as "outpatients" for cost concerns, but we routinely recommend specialized "aftercare" facilities. Patients spend between one and three nights in such a facility. The degree of disability again is variable (pain tolerance is highly variable) with most people getting up and around well by two to three days post-operatively. Brochures are available at the offices of many Plastic Surgeons, but there is no one brochure that all surgeons provide to patients.
Thanks for the question,
John Di Saia, M.D.

Question #3:

>Dr. Di Saia,
>(Is this how you prefer to be addressed? E-mail is usually so informal) Anyway, on a rather slow day at work, I came across your plastic surgery home page. The actual thought of having liposuction/sculpture? has intrigued me for quite sometime as I have 5 nagging lbs on my abdomen that refuse to go away through the traditional methods.
>
> I have numerous questions about the procedure, far too many to address here, so I'm limiting my questions to two: 1) What are the long term consequences of fat removal on an otherwise thin/petite person? Will I need that extra fat somewhere down the line (e.g. child birth/wilderness survival etc. ) or will I be doing myself a favor by getting rid of it now (I'm 29)? I'm 5'3'', petite, exercise frequently and all my unsightly weight is pretty much centralized on my stomach.
>Any info you have would be great. Thanks.

>P.S. Incidentally, I was your 801st web-site visitor.

An Answer:

Dear Miss, You can call me whatever you want. How funny that you should ask. It doesn't much matter to me. But when I am answering questions regarding medical subjects, I feel it appropriate to label my name with the title. It underscores that I do know what I'm talking about. I don't mean to be pretentious.

When dealing with younger people, I usually mention that the changes of liposuction are (as you'd mentioned) "sculpting." A definite post-operative picture cannot be drawn for you. It is more appropriate to talk about relative change. A good aspect to your age is that your skin has more of a tendency to contract following suction thereby leaving you less likely to form a "skin fold" over the area of suction.

With regards to "need" for fat....liposuction does not prevent you from forming fat. It seems to change your tendency to gain weight in particular places (those suctioned) because it changes your fat distribution. You may gain weight in new and interesting places (if you gain too much weight post-operatively). A few pounds is usually not significant.

Thanks for your input,
John Di Saia, M.D.

Question #4:

>I am interested in liposuction in the thigh area and the lower stomach area. I saw the Q&A section with an answer to the stomach area so my questions will be about the thigh. I would like to have the front and back done. Are these separate procedures? how long are the procedures for people looking to shed a few extra bags of weight and how long are hospital stays. Any information would be more than I have now. I live in Pacific Northwest.
>What is a good way of finding qualified doctors for this type of surgery.
>
>Thanks
>
>JT

An Answer:

Dear Miss,
This surgery is usually performed as an outpatient (you go home the same day). The procedures you mentioned could be performed at one sitting. Look for a Board Certified surgeon (American Society Of Plastic And Reconstructive Surgeons). Otherwise, you could be treated by anybody from a Dermatologist to a Gynecologist. There are no laws (that I know of) against anyone performing Cosmetic Surgery, as long as a facility grants privileges. There are a few agencies that aim to refer you to a surgeon, but I have yet to see one that isn't a paid service (by the surgeons). In this situation, I would be suspect. A referral from a friend is best, but demand information on the training of your surgeon. A qualified surgeon (as long as the question is phrased respectfully) should not object to this kind of questioning.
Thanks for your input,
John Di Saia, M.D.

Question #5:

>I would like to know not only the cost involved for multiple procedures (abdominoplasty / breast augmentation), but also if both were done at the same time. How and where the procedures are done (office or hospital), how long of a stay, time off work to heal for each procedure, how much notice to schedule the procedure. I am in Michigan, so would I be able to fly out and have the consult the same day as the procedure to lower my time away from home. Also I have two other friends interested in breast augmentation, would we be able to get a group rate? Seriously! Well, I think I have grilled you with all my questions at this time, I would appreciate all the information you can give me.
>Thank you,
>K

An Answer:

Dear Miss,
For both abdominoplasty and breast augmentation, it is possible to do the surgery as an outpatient. Your surgeon should see you in consultation however at least several days before the procedure to answer questions and help you decide whether the procedure is right for you. I can't think of many people who would feel right about doing an operation (cosmetic) on a patient the day he/she met that patient. In addition, operating room time is a limited commodity.
On group rates: People occasionally ask questions like these. I do not routinely give group rates as my overhead costs are not different for multiple procedures on different patients. Multiple procedures on the same patient get a discounted rate relative to doing them separately however. I discuss rates with patients at the initial consultation where appropriate.
With all this being said, I would be more than happy to see you.
Thanks for the question,
John Di Saia, M.D.

Question #6:

Dear Dr. J., I found your site quite interesting as I am scheduled for liposuction on my thighs on June11. I am really wrestling with this decision as I am happily married, athletic, and am considered thin at size 6. However, I've always hated my legs which relatively " thick". I was wondering if "lipo" is ever done on calves? What are the results? Does increase the chance of complications? Is it done very often? My husband is a physician also and won't even discuss this with me...He went ballistic when I mentioned adding the calves. (He suggested I have my head examined) What do you think?? Thanks for your input/opinion.

An Answer:

Liposuction works by removing (parts) of the fatty deposits in the area of interest. Calves are not routinely done as they are more often composed of muscle as opposed to fat. There is a layer of fat, but not the usual deep layer that is especially amenable to liposuction. I would suspect that liposuction on the calves may have a high incidence of causing "streaks" or surface irregularities as a function of the anatomy of the fat present there. I have not seen liposuction performed in this location with good results.
Thanks for the question,
John Di Saia, M.D.

Question #7:

>If you have a few minutes, I was hoping you could help me. I'm 34 years old and I've had "saddle bags" ever since I was a teenager. I used to be really athletic and in pretty good shape (I'm not so athletic anymore, or in especially great shape, but I'm in OK shape). Anyway, I've ALWAYS had problem thighs and have thought about liposuction for many, many years. However, I've seen those shows that show the terrible side of what happens to some women who have the surgery performed. I have also seen recent news reports about a newer, safer liposuction that is being performed. Would liposuction really get rid of my problem thighs, and also, approximately what could the cost be?
>Thank you for your time. I look forward to hearing from you.

An Answer:

It is really impossible for me to answer your patient-specific question without seeing you. I would suggest you seek a consultation with a Plastic Surgeon to look at your problem areas and perhaps render an opinion. I don't know what "newer, safer" form of liposuction you are talking about. Take into account that what the television news programs consider "new" may not be new to surgeons. The producers of these shows often attempt to make what surgeons consider mundane into something "new and exciting" for the lay public....unfortunate but true. It's called advertising.
Thanks for the question,
John Di Saia, M.D.

Question #8:

>Could you please tell me how long it takes for the skin to heal after having liposuction under the chin? Also why does the tissue seem so hard where the lipo was preformed 10 days after the operation. In this instance it does not seem any smaller right now.
>
>Thanks in advance

An Answer:

This is a difficult question as it really depends upon how much work was done and your own healing tendency. Often with post-operative swelling, the change cannot be seen for a few weeks. The tissue may be firm due to swelling. You should be followed carefully by your doctor to be assured that things are as expected for your particular case.
Thanks for the question,
John Di Saia, M.D.

Question #9:

>I just have one question and I would appreciate it if you could give me your best possible answer.
>How defined could liposuction of the chest and abdominals get. Is it at all possible for the doctor to get the specific spot defined enough so that the muscles show through the skin. Right now I am about 16% bodyfat.
>Thank you!

An Answer:

Liposuction is aimed at the deep layer of fat. There are superficial and deep layers in the abdomen more than the chest. A complication seen when suctioning too superficially is the formation of stretch marks. In addition, suctioning to excess can cause necrosis (death) of the overlying skin. Liposuction is designed to change contour. Radical changes tend to look obvious and lead to increased complications. With this said, it really depends upon exactly where the area of concern is and it's size. Often improvements can be made.
Thanks for the question,
John Di Saia, M.D.

Question #10:

>Hello.
>I was wondering what type of liposuction technique
>you used. Is it using local anesthesia or general?
>
>Thanks.
>Sonya

An Answer:

Except for very small jobs we prefer at least Intravenous anesthesia. The patients generally (no pun intended) like it the same way. It is difficult to impossible to adequately numb large areas with local medication. Local anesthesia is used in the tumescent solution to decrease bruising and for post-operative relief, but alone it is often inadequate. Liposuction can be difficult as it is. It is harder to do (and less humane) when working on a moving target. With general anesthesia, it is easier on the patient as well as the surgeon.
Thanks for the question,
John Di Saia, M.D.


Please note that this information (as well as that on all my pages) is offered freely to individuals considering cosmetic surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Beware that although efforts have been made to assure accuracy, many of the issues discussed here are a matter of professional opinion. Consultation with a qualified Plastic Surgeon should be obtained to answer more detailed and potentially personal questions.

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