1. Is liposuction reasonable treatment for obesity?

Liposuction is not the ideal treatment for obesity. Typically, the best treatment for obesity is for the patient to change their habits or find out other abnormal hormonal issues such as hypothyroidism. If the patient has had a full medical workup and shows no abnormal findings, then discussions about diet and exercise are emphasized in our practice. Once the patient is motivated to move forward with weight loss, liposuction can then be considered six months to a year later. I often tell my patients that I am not interested in liposuctioning their wallet. I am interested in sculpting their bodies. In other words, a patient who has not changed their lifestyle or been able to control with medical hormone therapy is at a high risk to have a poor long-term outcome. Initially, the patient will look nice because the volume has been removed, but because the underlying cause has not been removed, the patient will regain the volume back into their bodies, potentially in zones outside of the liposuction area. The end result is again a poor outcome, and a disappointed patient and also a disappointed surgeon.


2. What is a successful liposuction surgery?

I think about liposuction surgery as lipo-sculpting. I try to re-create the normal natural contours of the body, and once that is achieved, I feel it has been a successful liposuction surgery.


3. Does liposuction cause dimpling or indentations in the skin?

Liposuction can form indentation and dimpling in the skin, but surgeons attempt desperately for this not to occur. There are multiple types of liposuction techniques that are meant to be fashioned for specific patients. It is important that the surgeon performing the liposuction has a good understanding of the human anatomy and a sculptor' s eye to get natural results. Even if liposuction surgery is performed at the highest level, however, there is always a risk of some dimpling and indentations. If this occurs in my practice, I will typically go under local anesthesia to the regions that have dimpling and correct them with a minimal amount of fat transfer, or I will release the dimpled area with a needle technique.


4. What alternatives are there to liposuction?

I would recommend a good medical evaluation to make sure that there are no underlying medical reasons for increased weight. I also would recommend exercise and healthy nutrition. I am a huge fan of the Zone diet, which is nutrition based, and promotes a lifestyle change.

Although some patients follow the ideal nutrition and exercise routine, it is still possible to have zones where the fat will not go away. These situations are ideal for liposuction, and in the end are probably the patients best bet to long term results.


5. What type of liposuction is the best?

This is an extremely controversial discussion because everybody feels that whatever technique is in their hands at that time is the best technique. The lipo technique that I perform is a small cannula (tube) type liposuction. This small cannula vibrates as I pass it underneath the skin, allowing me to directly sculpt the small lumps that are difficult to remove with a larger cannula. The smaller size of this cannula also greatly reduces the risk of dimpling, and it uses a smaller port site when inserting. I usually only use a different cannula tip on male patients with fatty breast tissue, or female patients with very dense fatty tissue so that I can remove the fat without using ultrasonic heating or laser techniques. There are multiple physicians today that use both ultrasonic and laser techniques. Both of these techniques can be very effective, but should be performed only in well-trained hands. Oftentimes, various lipo techniques are promoted to drag patients into the office, but the reality is that the results can be very disappointing. Ultrasonic laser therapy basically melts the fat in front of the cannula, and therefore, the cannula sucks away the melted fat. Laser liposuction destroys the fat and then is carried away by the cannula.


6. How much liposuction is excessive, staged liposuction and mega liposuction?

In the outpatient setting, the American Society of Plastic Surgery recommends liposuction in the five liter range. It is not uncommon for patients to have five to six liters of lipo performed and then return home, but this is an absolute maximum for outpatients. In our practice, we usually only allow for a four to five liter range in order for a patient to be able to return home, but we highly recommend that they stay overnight in our monitored care facility. The patients having five to six liters taken are required to spend the night in a monitored setting. In volumes of eight and above, this is considered mega liposuction, although some people consider volumes above six as mega. Those patients undergoing staged liposuction require eight to twelve liters of lipo to be performed, and wants to have it done in stages approximately six to nine weeks alter. We typically do not do staged lipo before the six week mark because the initial results of liposuction take anywhere from three to eight months to have a true effect.