Liposuction is one of the most frequently requested cosmetic plastic surgery procedures, in my San Francisco Bay Area, Walnut Creek Plastic Surgery office. Almost every day I see someone interested in Liposuction, and curious about what it can do.
Below are before and after pictures of a woman who wanted her pre-baby body back. She is young, in good shape, near her ideal body weight, and had localized, disproportionate fat on her abdomen and flanks (sides). Despite her recent pregnancy, her muscles were in good shape and her skin was tight. In other words, she was the ideal candidate for liposuction.
Abdomen before tumescent liposuction - side view
Abdomen after tumescent liposuction - side view
Abdomen before tumescent liposuction - front view
Abdomen after tumescent liposuction - front view
When the muscles are stretched, and the skin is loose, a tummy tuck is a better choice. This patient, however, had strong, flat muscles and excellent elasticity of her skin. The disproportionate fat was removed via two small (5 mm) incisions placed low on the abdomen. A tumescent technique was used to facilitate fat removal and reduce post operative bruising and soreness. No laser, ultrasound, water jet, or power hand piece could improve this result. Safe, predictable and uncomplicated tumescent liposuction is still the king of liposuction. Every “new” technique uses it.
New Liposuction Technology
There are a lot of procedures claiming to be the best liposuction technique available. Just this morning I have seen advertisements for:
SmartLipo (Laser Liposuction) LAL
InnoGyn’s LaserPro Lipo (Laser Liposuction) LAL
Vaser and the new Vaser 2.0 (Ultrasonic Liposuction) UAL
Body-Jet (Water-Jet Liposuction) WAL
STARS liposuction (Power Assisted Liposuction) PAL
How to Choose
If you are trying to figure out which liposuction is the best liposuction, it can be very confusing. While all the above make the claim that they are the newest and best way to do liposuction, the claims are largely unproven. It is hard to improve upon tumescent liposuction.
If you are a patient considering liposuction, you don’t have to choose the right tool, you have to choose the right doctor. An experienced Board Certified Plastic Surgeon can help guide you in achieving your cosmetic surgery goals. Finding the right doctor and letting them choose the right tool is more likely to get you the results you are looking for.
My recent television appearance discussing liposuction, and recent posts on liposuction, have generated many questions about the use of lasers for fat removal.
Laser liposuction is red hot in the media, but the hype is louder than the truth about laser liposuction.
The Myth
Laser liposuction marketing is focussed heavily on the supposed skin tightening advantage of using a laser. The thought is that heating the subcutaneous tissues can tighten the skin.
The Facts
The only reliable way to tighten skin is to surgically remove the excess. While modalities like lasers and radiofrequency energy have shown promise in this area, in fact, the amount of shrinkage is usually small and unpredictable. Head to head studies of laser liposuction compared to tumescent liposuction show no difference in the amount the skin shrinks.
Thin cannula, tumescent liposuction remains the “gold standard” for all liposuction. It still provides the fastest, safest and most reliable method of spot fat removal available today.
The Science is Still Pending?
There are no published large prospective trials comparing laser liposuction to traditional tumescent liposuction. Laser liposuction has been available for some time now. I have to believe the manufacturers of these devices have tried to prove that is a superior product; however, the evidence is conspicuous by its absence. Evidence that it is not better is available.
The best randomized, double-blinded, controlled study shows no difference between laser liposuction and traditional liposuction. In this study, half the patient was treated with laser liposuction and the other half of the patient was treated with traditional tumescent liposuction. Neither the patients nor the doctors could tell which half was treated with the laser. Both sides appeared to have equally good results. This is a well constructed, prospective, randomized and doubly blinded study.
Laser liposuction requires a laser.
Lasers add expense and danger. You cannot be burned with a normal tumescent liposuction cannula, but ask anyone who works around lasers, lasers can burn. Without any benefits, you get only the risks.
Laser liposuction adds more steps, so it takes longer.
For most techniques, the laser is passed under the skin prior to traditional tumescent liposuction, and sometimes again afterwards. Without any benefits, you get only a longer operation.
Traditional tumescent liposuction has two steps:
Infiltration
Aspiration
Laser liposuction has four steps:
Infiltration
Laser applied to the fat
Aspiration
Laser applied to the subdermal skin
Infiltration is administering a wetting solution (saline+lidocaine+epinephrine) to the subcutaneous tissues. This decreases bruising and increases post operative comfort.
Aspiration is the suction assisted removal of the fat (or burned fat for laser liposuction). Fat is very soft and easy to remove with suction. The laser heats, melts, damages the fat cells (and surrounding cells). Some proponents advocate using only the laser and letting the body absorb the damaged cells, but removal decreases the inflammatory mediators.
Skin Shrinking Ray
Treat all you friends to the latest laser treatment.
I am a proponent of finding a way to shrink skin without surgery. This would be a huge leap forward for plastic surgery. Many technologies are being investigated; however, when it comes to liposuction, I am still waiting for a technology that does a better job. A technology that provides a result every time, for every patient, not just for those who have tight elastic skin. Great skin will remain firm not matter what is done to it. A true skin shrinking ray will tighten poor skin and make it great again. If I find a skin shrinking ray, my San Francisco Plastic Surgery Blog readers will be the first to know!
This is the fourth and final installment of my recent KRON4 Body Beautiful television appearance reviewing the latest techniques in Liposuction. Liposuction is one of the most popular cosmetic plastic surgery procedures, and there is on going research to make it even better.
With the advent of wet techniques, like tumescent liposuction, the safety and predictability of liposuction took a giant step forward. This innovation alone is what has made liposuction an accepted cosmetic plastic surgery procedure, that is applicable to a wide range of patients. Now matter how good it is now, plastic surgeons and patients both would like to make it even better.
The next leap forward may be the ability to skin the skin. Many patients have enough elasticity in their skin to allow for excellent post-operative results, but when the skin is loose, other surgeries are more effective and provide superior results. Many treatments have been tried, but none are effective enough for widespread use. Technology such as laser liposuction, smart lipo, ultrasonic liposuction, vaser liposuction, radiofrequency liposuction, cold or cryoliposuction, power liposuction have all been tried with varied success. None have had overwhelming success however. Is the magic wand of skin tightening out there?
Liposuction Video for San Francisco’s KRON Body Beautiful
What is the latest technology available for liposuction, and does it provide you the benefits promised? This segment reviews the current art of liposuction on KRON‘s Body Beautiful with host Vicki Liviakis. The show a half hour long, so I have divided this liposuction video review into four segments. The third lipo video segment is in this post. Links to the other three parts, and the liposuction introduction post can be found below.
Additional liposuction information is available on the Liposuction Page of DrMele.com. Your questions about liposuction will be answered if you to use the contact form to the left. Without an in person consultation, I can only offer generalized answers. Specific answers regarding liposuction are best answered in person.
For more liposuction information, liposuction price ranges or to schedule a personal professional consultation appointment, please call my Walnut Creek Plastic Surgery office at (925) 943-6353. Please do not call the 800 number in the video below. It is only used for viewer questions during the live broadcast.
This lipo video covers:
Laser liposuction
How to evaluate before and after pictures.
Why do we have to age at all?
When considering liposuction, What should I do?
Can I gain weight after liposuction?
The other segments of this broadcast can be found here:
In this segment from KRON’s Body Beautiful, I talk about ways to get safe and predictable liposuction. Are the latest technologies the best? Some are more controversial than others. There is still something very beneficial about seeing a Board Certified Plastic Surgeon before choosing any treatment.
With a consultation, I can provide you with a list of treatment options, and match the most appropriate treatment with your goals. More importantly, I can get to know you and what the problem is. I can provide much more targeted treatments, after I know where we are starting, what your perceptions are, and where you would like to be after we are done.
Liposuction currently comes in many flavors. Whenever there are multiple solutions, either there are multiple problems, or no one solution is clearly superior. Most liposuction problems are consistent, but there are a few instances that need special treatment to get the desired goals. My patients come to me, because I have years of training and experience. While I try to share this information via the SanFranciscoPlasticSurgeryBlog, you can’t get all the information necessary from reading articles.
As my patient, you need to know, and trust, that I will use the smallest hammer it takes to get the job done. For disproportionate fat pockets, most the time, tumescent liposuction is going to get the job done; however, it is not the only option. I like to keep up with all the latest technology, so in the cases where the technology has something to offer, I can choose it as the best treatment. For the situations when liposuction is not going to be enough, I can offer you more, discuss the options, and take it up a notch when necessary. This is the advantage you get, when you see someone fully trained and dedicated to all aspects of Cosmetic Plastic Surgery.
Liposuction Video for San Francisco’s KRON Body Beautiful
What is the latest technology available for liposuction, and does it provide you with the promised benefits? This segment reviews the current art of liposuction on KRON‘s Body Beautiful with host Vicki Liviakis. The show a half hour long, so I have divided this liposuction video review into four segments. The third lipo video segment is in this post. Links to the other three parts, and the liposuction introduction post can be found below.
Additional liposuction information is available on the Liposuction Page of DrMele.com. Your questions about liposuction will be answered if you to use the contact form to the left. Without an in person consultation, I can only offer generalized answers. Specific answers regarding liposuction are best answered in person.
For more liposuction information, liposuction price ranges or to schedule a personal professional consultation appointment, please call my Walnut Creek Plastic Surgery office at (925) 943-6353. Please do not call the 800 number in the video below. It is only used for viewer questions during the live broadcast.
This video includes viewer phone calls and more information about liposuction. Walnut Creek plastic surgeon, Joseph A. Mele, MD, FACS, answers these questions and more:
Viewer phone call:
Rochelle from Berkeley, had gastric bypass weight loss surgery one year ago. She has questions about how to treat the skin on her arms and inner thighs. Liposuction may help if the skin if tight and some disproportionate fat remains, but if the skin is loose, other procedures may be more appropriate.
More information including:
Does age effect liposuction?
Does weight loss effect liposuction?
Does skin elasticity effect liposuction?
How often is liposuction performed?
Why should you see a Board Certified Plastic Surgeon for your Liposuction?
What does Board Certification mean?
Lip augmentation with HA’s (Hyaluronic Acid)?
Lip augmentation Collagen vs. HA’s (Hyaluronic Acid)?
What types of liposuction are being tried, and do they provide superior results
Tumescent liposuction (dumb lipo) – Still the best liposuction?
The other segments of this broadcast can be found here:
Liposuction is a very safe and reliable procedure. Like any medical procedure, it works best when used properly. For the removal of disproportionate fat, it can’t be beat, but liposuction should not be used as a method of weight loss, and liposuction should not be expected to tighten loose skin.
The Ideal Liposuction Candidate
The ideal liposuction patient is near their ideal body weight and has sufficient intrinsic skin elasticity, so that after the fat is removed, the skin will follow the new and improved contours. Pockets of fat, which form localized and disproportionate bulges, respond best. While some newer modalities of liposuction are claiming to reliably tighten loose skin, the jury is still out.
Skin Tightening Procedures
So how do plastic surgeons reliably tighten loose skin? The most common method is through surgical removal of the redundant skin. Abdominoplasty (a tummy tuck), for example, removes loose skin for the abdomen. A brachioplasty (an arm lift) removes loose skin from the arm. This liposuction video compares what liposuction can do for the abdomen and arms compared to what surgery can do. The recovery and indications for each are also discussed.
Body Beautiful
I recently reviewed the current state of liposuction on KRON‘s Body Beautiful with host Vicki Liviakis. The broadcast was a full half hour, so I have divided this liposuction video into four segments. The second lipo video segment is in this post. Links to the other three parts, and the liposuction introduction post can be found below.
Additional liposuction information is available on the Liposuction Page of DrMele.com. If you have questions about liposuction, you are invited to use the contact form to the left.
Please note: The 800 number in the video below was used for viewers to call in and ask questions during the live broadcast. Please do not call it now. For additional information, or to schedule a consultation appointment, please call my Walnut Creek Plastic Surgery office at (925) 943-6353.
This segment on Liposuction covers:
The areas of the body most commonly treated with Liposuction:
Abdominal Liposuction
Back Liposuction (Muffin Top Liposuction)
Flank Liposuction (Love Handle Liposuction)
Thigh Liposuction (Saddle Bag Liposuction & Banana Roll Liposuction)
Arm Liposuction
Neck Liposuction (Below the Chin Liposuction)
Buttocks Liposuction
Favorable Predictors
Stable weight
Near Ideal Weight
Younger Age
Good Skin Elasticity
Disproportionate Fat
Good Health
Healthy Lifestyle
Before and After Pictures: Lipo vs. Surgical
Arm Lipo Before and After Pictures
Brachioplasty (Arm Lift) Before and After Pictures
Abdominal (Belly) & Flanks (Sides) Muffin Top Lipo Before and After Pictures
Abdominoplasty (Tummy Tuck) Before and After Pictures
How the location of the fat effects liposuction?
Liposuction Garments
Liposuction Recovery
The other segments of this broadcast can be found here:
What is liposuction? Liposuction, also called suction assisted lipectomy or SAL, is the removal of fat, facilitated by suction. A cannula is inserted through a small incision often hidden in a skin fold. I like to protect the skin along the edges of the incisions by inserting a protective sleeve first. This prevents the cannula from rubbing on the skin. This way, the incision heals more quickly, and with a better scar.
Disproportionate, or localized accumulations of fat, can be targeted. The areas of fat deposits are selective removed with the use of gentle suction. It is not a good way to lose weight; however, it can remove the stubborn fat that won’t go away with regular diet and exercise. The use of a wetting solution, or tumescent liposuction, facilitates the selective removal of the fat, while minimizing bruising and discomfort.
Body Beautiful
I recently had the opportunity to discuss liposuction on KRON‘s Body Beautiful with host Vicki Liviakis. It was a half hour broadcast, so I have divided the liposuction video into four segments. The first lipo video segment is in this post. Links to the other three parts will go live over the next few weeks and can be found below.
If you have questions about liposuction, I would be happy to answer them. Additional general information is available on the Liposuction Page of DrMele.com. Feel free to use the contact form to the left, or call my Walnut Creek Plastic Surgery office at (925) 943-6353 for additional information. Please do not call the 800 number in the video. This was used for viewers to call in and ask questions during the live broadcast.
This segment on Liposuction covers:
How many people have liposuction in the US every year?
Can Liposuction substitute for a proper diet and exercise?
What advantage does Liposuction have over diet and exercise?
How do I get rid of the stubborn fat that won’t go away no matter how much I diet and exercise?
What is the difference between dry liposuction and wet liposuction techniques?
What is the difference between super wet liposuction and tumescent liposuction?
The other segments of this broadcast can be found here:
As spring is upon us, more and more people are coming in to the office considering body work. The most popular cosmetic plastic surgery procedure is still breast augmentation, but liposuction is a close second.
Traditional Liposuction
“Traditional” liposuction has come a long way. We have progressed from the removal of a few hundred cc’s (ounces of fat) to the removal of thousands of cc’s (pounds of fat). From a procedure that had a good chance of requiring a blood transfusion, to a procedure that very rarely has significant blood loss. From an in hospital treatment, to an outpatient procedure. It can remove stubborn areas of disproportionate fat that are not responsive to diet and exercise.
Tumescent Liposuction
Most the improvements in current, advanced liposuction come from the introduction of a wetting solution. Better known as tumescent liposuction, it is the safest and most predictable form of liposuction currently available. This innovative method of liposuction has resulted in the ability to remove more fat, more quickly, more safely, more predictably and with less bruising, less pain and less down time.
The Latest Liposuction Technology
There has been a big push in the last few years to further improve results. I call these procedures “value added” liposuction, and the additions come in a variety of flavors:
Laser Liposuction (LAL)
Ultrasonic Liposuction (UAL)
Power Liposuction (PAL)
Radiofrequency Liposuction
Cold Liposuction (Cryo Lipo)
All use a tumescent technique, and the tumescent technique alone provides for added safety, less bruising and quicker recovery. No carefully controlled clinical trials have demonstrated that they are better than carefully controlled tumescent liposuction for the vast majority of patients.
Fat is quite soft. Powerful lasers, high frequency ultrasound, radiofrequency and cold therapy are not necessary to remove fat. The goal with most of these methods is to improve skin shrinkage. Unfortunately, none seem to shrink the skin to any significant extent. And worse, the “value added” liposuctions come at a price. Added energies cost more, and the additional energy makes it possible to burn the skin. Proponents of these techniques will say the added risk is small, but a small risk without a benefit is too much risk. A simple, safe, cold, hollow cannula is sufficiently powerful to remove fat, without the chance of a burn.
The claims that laser liposuction shrinks skin are unproven. Published reports are rarely blinded or controlled and tend to be anecdotal, i.e. it looks like it shrunk. Liposuction cannot be depended on to shrink skin. Every plastic surgeon has patients whose skin seems to shrink after liposuction, but this is more likely due more to the patient’s skin, rather than the liposuction. If the patients’ skin is elastic, it will “shrink” to fit the new contours.
The best randomized, double-blinded, controlled study shows no difference in outcome between traditional tumescent liposuction (SAL) and laser assisted liposuction (LAL). The study is sited in an article (Updates and Advances in Liposuction) in the the current issue of the American Society for Aesthetic Plastic Surgery‘s Aesthetic Surgery Journal.
In this study, each patient was treated with both SAL and LAL. How each side was treated was randomized, If the patient’s right side was treated with SAL and the left side was treated with LAL, and visa versa. Patients where not told which side was treated which way (this is the blinded part.) The results were evaluated by the patients and doctors. These doctors, did not do the surgery and also did not know which side was treated with which modality (They were blinded too.) The results: Neither the patients, nor the doctors could tell which side was treated with which modality. In other words, there was no difference between the side treated with traditional tumescent liposuction and laser assisted liposuction.
What Is Smart Liposuction?
I like to evaluate each patient’s problem areas independently before deciding what treatment to use. Only after a careful medical history and physical examination, can the correct tool be selected. The “value added” liposuction techniques are still in their infancy, and with time, they will either have more to offer, or fade away. There is a small group of patients who may benefit from these technologies; however, as the study above shows, for the average liposuction patient, they do not offer any significant improvement in outcome, and they do bring additional risks. Smart liposuction is the method of liposuction which is the safest and most predictable method that will work for you.
Liposuction Videos
Links to my most recent Body Beautiful appearance cast can be found below. It was a half hour show, so I have divided it in to 4 segments:
Introduction – What’s New in Liposuction San Francisco? (You are here.)
Liposuction has been practiced for decades. It can be performed using several methods. The traditional “dry” techniques have largely been replaced by wet techniques. The most common term used for this is tumescent liposuction.
Tumescent liposuction allows for the removal of larger volumes of fat, while providing increased predictability and safety. It also improves your post operative comfort, while decreasing swelling and bruising. Ultrasonic liposuction and laser liposuction are additional modalities that may provide additional benefits for selected patients. Since they come with additional risks, I do not use them for every patient. There needs to be some additional benefit for me to accept the additional risks.
Liposuction Video – Body Beautiful
What follows is part two of a segment from KRON4′s Body Beautiful, discussing Liposuction San Francisco. The 800 number in the video was for the live show only. If you have questions about liposuction, please use the contact form provided to the left, or call my Walnut Creek Plastic Surgery office directly at (925) 943-6353.
This segment reviews liposuction and liposculpture in general. Any advice needs to be reviewed with a Board Certified Plastic Surgeon prior to the decision to proceed.
In this video you will see Liposuction Before and After Pictures of:
Liposuction of the Abdomen
Liposuction of the Flanks (Sides)
Liposuction of the Thighs
Liposuction of the Lower Back (Love Handles)
Questions from viewers answered include:
Can liposuction help an uneven C-section scar?
How can a C-section scar be treated?
Liposuction?
Scar revision?
Tummy Tuck?
Can Liposuction treat Cellulite?
Can Liposuction remove 30 pounds?
More information is available on the Liposuction Page of my main web site.
Liposuction is always one of the most popular cosmetic plastic surgery procedures. Last year it was the second most frequently performed cosmetic surgery with almost 300,000 liposuction procedures performed in the Unites States alone.
Liposuction Video – Body Beautiful
What follows is a segment from my appearance on KRON4′s Body Beautiful discussing Liposuction San Francisco. The 800 number in the video was for the live show only. If you have questions about liposuction, please use the contact form provided to the left, or call my Walnut Creek Plastic Surgery office directly at (925) 943-6353.
This segment reviews liposuction and liposculpture in general. Any advice needs to be reviewed with a Board Certified Plastic Surgeon prior to the decision to proceed.
In this video you will learn:
How popular is Liposuction?
How many pounds can be removed with Liposuction?
What is Liposuction?
What is Tumescent Liposuction?
What is Smart Lipo?
What is Lipo Disolve?
What is Ultrasonic Liposuction?
What is Laser Liposuction?
What are the popular areas treated with Liposuction?
How are Liposuction and Diet and Exercise complementary?
Who is the ideal candidate for Liposuction?
More information is available on the Liposuction Page of my main web site.
The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) have released their annual statistics on cosmetic plastic surgery for 2009. Surgical and non-surgical procedures are tallied and compared to previous years. Overall the numbers are down 2% from 2008, but still up 147% since 1997, when the statistics were first compiled. Of the almost ten million procedures performed in 2009, 85% were non-surgical and 15% were surgical. He are some quick facts, a link to the full statistics can be found at the end of this article.
Additional information can be found on the ASAPS web site, or downloaded here. It is a large file, and may take a while…
*Dr. Joseph Mele offers these procedures through his Walnut Creek Plastic Surgery Office. Search the San Francisco Plastic Surgery Blog categories to the left, or click on the links above for more detailed information available on DrMele.com.
