General Procedure

Liposculpting can be done under general anesthesia with the patient asleep or under local anesthesia with sedation.    Through a tiny incision, a fluid is infiltrated into the fat.  This fluid has anesthetic agents, and saline.  This mixture is called Tumescence fluid.  It limits bruising and blood loss in all forms of liposculpting.  Then a narrow tube or laser fiber (SmartLipo™) is inserted to break up or melt the fat in the fibrous tissue.  Next the fat is removed with a vacuum.  Following this the residual tissue is felt to see if fibrous lumps exist.  A power assisted lipo is used to break this fibrous tissue.  The area are manually massaged to render a smooth result.   After eliminating the excess fat and breaking up the fibrous tissue, the incisions are left open compression dressing and bandages are applied.  Allowing fluid to escape from the liposculpted area is important to prevent fluid collections underneath the skin.

Liposculpting can last  several hours depending upon the amount of fat to be removed.  Liposuction surgery is an excellent procedure that can benefit those who want to remove unattractive fatty deposits.

Recovery Process

New techniques allow for faster recovery from liposuction procedures.  The length of the recovery will depend on how extensive of an operation the patient undergoes.  Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and reduce the recovery time.  A support garment are to be worn for several months after the surgery.   Patients sometimes report minor pain associated with surgery which can be treated effectively with oral medication.  While complications are rare, patients can minimize the risk for potential problems by carefully following the directions given after surgery.

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Reasons for Considering Liposuction

  • Eliminate fat from any of the following areas:
    • Chin and Neckline
    • Back
    • Upper Arms
    • Stomach and Waistline
    • Hips and Buttocks
    • Thighs and Knees
    • Calves and Ankles
  • Create a more proportioned figure

Liposculpting uses several different methods during a surgery to remove and improve the shape of the body.   Liposuction is just one method.   Think of each method as a different “artistic brush”.  Artists uses different size brushes to paint a canvas; broad strokes for background color and small brushes for the fine detail.

Like artists, plastic surgeons uses several techniques to reshape the human body.

When preforming liposculpting  I favor using Power Assisted Liposuction, a unique liposuction cannula I developed, and SmartLipo.  I also find beneficial, Smartlipo’s study proven ability to tighten overlying skin.  This is the added “fine detail brush” not found in other methods of liposculpting.  Many Smartlipo studies demonstrate the effectiveness of the collagen building and skin tightening benefits of SmartLipo.

The Evolution of Liposuction to Liposculpting

The Evolution of Liposuction to  Liposculpting

Liposcupting developed over time.  Although liposuction was the first step in the development of liposculpting by itself it was inadequate.  The principles that govern liposculpting are time-tested principles.

Principle 1: Pretunneling

Pretunneling breaks fat away from its surrounding fibrous tissue.  In the 1990′s there was pre-tunneling to dislodge the fat from the fibrous tissue before the removal of the fat.The fibrous tissue is the structure the fat lives in under the skin.  I liken it to a fibrous “sponge”. I’ve use this analogy of “sponge” underneath the skin for a couple of decades.  The unique understanding is that the shape of the fibrous sponge is the shape of the bulge.  It is not the fat.  For example the sponge that sits on your kitchen sink, when dry (no fat) it is square and small, when wet (full of fat) it is big and large.    The shape is the same but is size is different.  Essentially, fat is the water and the fibrous tissue is shaped sponge.

Principle 2: Liposuction

In the 1980′s there was liposuction alone.    When liposculpting is done with the principles in mind and the postoperative instructions followed, smooth results are obtained.

Principle 3: Fibrous tissue flattening

In the late 1990, methods to break up the shape of the residual fibrous sponge  were developed. They ranged from manual disruption, Power Assisted Lipo, internal and external ultrasound, the use of a rolling pin, and etc.

Myths Associated With Different Liposculpting Techniques

Myth 1: Are results obtained from one technique better than another?

Not when it comes to the uniform flatness of the tissue.  (There is for the issue of skin tightness).  A surgeon following the above time-tested principles is a very important in order to give you the best potential results.  However, to get the best results it is just as important for you to follow the time-tested postoperative instructions.  Like I tell everybody, what I do and what you do are just as important, in order, to obtain the best results.  Why?

No technique by itself is superior to another without following postoperative instructions.  It is important that you follow the postoperative use of the compression garment and massage.  Without doing them correctly the result can be less than you may desire.  Here is the simple reasons why: 1) your body does not care what you look like before or after the surgery.  2) Left to its own device, the body will heal the area of trauma, but possibly not in a way to your liking.  The fibrous tissue that was broken during surgery will heal, but its’ God given nature is not to heal flat but to heal by bunching up on itself.  This will produce subtle raised areas and waviness.  The massage and compression garment are strategies to keep the fibrous tissue flat as it heals.

Myth 2: Does one technique give better skin tightening that another?

Yes, Smartlipo™ has been clinically and scientifically proven to tighten the skin by producing and restoring collagen lost from the skin over time.  Collagen production results in tighter skin.  Other liposculpting methods do not demonstrate this remarkable attribute.

Myth 3:  Is there a safer liposculpting technique over all the rest?

Above are the principles around the current methods of liposculpting.  All liposculpting technique carry the same risk. This is because, whatever the technique, liposculpting is basically a trauma.  All my patients are told that every surgery I do is a “calculated trauma”, and therefore “I just beat up on people for a living”.  The fact is our bodies look at trauma base upon the volume of tissue “beat up”, not the type of tissue.   The volume of traumatized tissue, by all liposculpting techniques, is essentially the same.  The greater the volume to traumatized fat the greater the risk of surgery.  All liposculpting techniques carry the same risks.

SafeLipo™ is a great method of teaching younger plastic surgeon, but don’t assumed that it is any “safer”.  Clinically there is no evidence for it.  Remember trauma is trauma no matter the method.

Myth 4: SmartLipo™ Laser or ultrasonic devices are more destructive than regular liposuction or SafeLipo.

Clinically here is no evidence that laser liposculpting or ultrasonic liposculpting is more destructive than regular liposuction, PAL (power assisted liposuction), water jet liposuction, or SafeLipo™.  (SafeLipo™ is just another form of the liposuction method.)

This myth ignores two well know facts. 1) All methods of liposculpting damage to fatty tissue. (That is the point of having the surgery.)  Our bodies cannot distinguish between the trauma produced by any liposculpting method.  The SmartLipo is FDA approved because it is a unique “device” that is used in liposculpting.  Its approval demonstrates that the FDA does not consider the technique anymore damaging to the body than any other technique.  SmartLipo is recognize for its’ unique ability to melt fat cell as well as tighten the skin over the area treated.  This is its’ unique ability over traditional liposuction.  Regular liposuction or SafeLipo is not FDA approved because it is not a device nor are they different from traditional liposculpting. 2) the second point is that any damage is short live due to the remarkable healing powers of the body.  As a surgeon I depend upon the body’s built in ability to heal itself, otherwise there would be not surgeries. The bottom line is fatty and fibrous tissue damage during liposculpting is traumatic whether using a steel cannula, ultrasound or a laser.

In this area some plastic surgeons want to bash SmartLipo because of a non-plastic surgeon that advertised his use of SmartLipo and he had some poor results.  There is a gross lack of knowledge associated with their assertion that problems seen in the patient they described was due to SmartLipo™.  The problems they tout was not due to SmartLipo but due to the VASER.  The real story his primary tool for liposculpting was a VASER, a ultrasonic liposuction and not the SmartLipo.   Knowledge of the SmartLipo lasers and the model the non-plastic surgeon was not noted in their webpage article.   I’ve been doing SmartLipo for 7 years and I know the machines and each model and what they can and cannot do.  What was overlooked is that the surgeon owned a 12 Watt Smartlipo.  This was the second generation of the SmartLipo series in a series of 6.  A very early model only suitable for neck skin tightening, maybe.  You could never use that model for an area over 3 inches in diameter or you would be there all day long.  No energy to melt fat much bigger than that.  The energy of that unit would not have any value on any place but the facial region.  I looked at that model 6 year ago but I decided I could do more fat disruption with a flashlight than that particular model. I currently have the SmartLipo Triplex with Cellulaze and patients have been extremely happy with the result.  I would reiterate also that if your looking to have liposculpting then you should look for a well-trained board certified plastic surgeon.  Remember every company selling liposculpting devices can sell a canula, laser, ultrasonic device, PAL device etc. to anyone with a medical degree.  They do not have to have any training except for a 1 day, maybe 2 day training on the technique.  Remember there is a lot of skill in liposculpting.  You need someone who is well trained not someone who touts the “Flavor of the Month” liposculpting.

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