Common liposuction questions – from my patients
Posted in: Liposuction, Plastic Surgery Safety, Q&A | April 14, 2011 | Comments Off
With summer coming up – I’ve been performing A LOT of liposuction procedures the last few months! I’ve had the same few questions come up multiple times from my patients. Here is a quick Q & A of the most common questions.
Q. If I gain weight after liposuction will I need it again?
A. Your body genetically has a certain number of fat cells deposited in particular areas. Some people are just born with more fat cells in their abdomen, flanks, inner thighs and no matter what they do, they just can’t lose the fat there. Liposuction removes the total number of fat cells that has preferentially deposited in these areas. If you gain weight, each fat cell in the body gets bigger, but because you have fewer fat cells in liposuctioned areas, you should proportionately gain less in the liposuctioned areas. It is always a possibility that if you gain a lot of weight, you may need liposuction again.
Q. Can liposuction help me lose weight?
A. Liposuction is not a treatment for obesity or a substitute for diet and exercise. It is for re-shaping the body to treat areas that have a dis-proportionate amount of fat. Liposuction is ideally designed for pockets of fat in isolated areas that do not respond to diet and exercise. Also, the law limits the total amount of liposuction that can be removed at one time to 5L of liposuction for safety reasons. I always tell my patients to start with diet and exercise and to maintain a stable weight before undergoing liposuction. However, having liposuction often motivates patients who look better in their leggings or workout clothes, to begin a healthier lifestyle, and many people lose even more weight after their procedure.
Q. Is liposuction dangerous?
A. Any surgical procedure has risks of anesthesia, risks of getting a blood clot, and a number of other complications. Many of the serious complications from liposuction in the past involved cardiac reactions to the local anesthesia injected in the body before the procedure. Also, procedures involving large volumes of liposuction (> 5L) resulted in fluid shifts that caused cardiac and respiratory problems. These occurrences are now quite rare. A safe, well-trained surgeon will carefully calculate and keep track of the amount of local anesthesia used as well as the amount of liposuction removed. A partnership and good communication with the anesthesiologist will help to ensure the safest conditions possible.
Q. I’m fit and everyone tells me I’m in shape and don’t need anything done, but I hate the pocket of fat that bulges – am I still able to have liposuction?
A. I would say that the ideal candidate for liposuction is someone who is of healthy height and weight with small pockets of fat that they just can’t lose despite diet and exercise. As long as there are a few centimeters of fat present in an area, it can be removed. Many of my patients are very fit bikini models who don’t like the extra fat bulge or shape of their inner or outer thigh, or feel that they have a “muffin top” making their waistline bigger than desired. Liposuction is ideal for this type of re-shaping. I had an extremely small amount of fat removed from my knees and inner thighs over 10 years ago when I was modeling – so I can really relate to wanting removal of these small fat pockets. On the other hand, I have turned away patients who just didn’t have enough fat to be removed. In general, if you’re unsure, it’s best to see a plastic surgeon in consultation to evaluate your particular anatomy and decide if you are a candidate for liposuction.
Q. I’ve seen some bad liposuction – what happened there?
A. I know exactly what you are talking about – I can spot bad liposuction a mile away. There is always the possibility of asymmetry, skin dents, wrinkling, or folding. However, an experienced liposuction surgeon should be able to avoid most of these things from happening. Most of the really bad liposuction results often come from over suctioning the fat causing the skin to stick unnaturally to the underlying structures. I always tell patients that I have to leave a small cushion of fat under the skin to keep this from happening. I do the majority of the fat removal through surgery, and they do the rest with diet and exercise.
Q. Why do I have to wear compression garments?
A. The liposuction cannulas make tiny tracks as they remove fat. I tell patients to imagine a sponge with small holes. The compression garments help squeeze all the fluid and tissues down to allow for a smooth flat thin contour. They are sometimes cumbersome to wear, but worth it to have the best possible outcome. One of my celebrity liposuction patients who had to do several red carpet events soon after her surgery found some compression garments that give a nice smooth contour under clothing. I now use these often for my patients so the garments are less obvious under clothing.
I hope this helped answer most of your questions! Please remember that liposuction as well as any plastic surgery procedure should always be performed with a good understanding between patient and doctor of realistic expectations, and with an emphasis on safety.
Dr. Catherine Begovic M.D.
Gynecomastia 411
Posted in: Gynecomastia, Q&A | October 4, 2010 | 2 Comments »
Gynecomastia, enlarged breast tissue in males, can be very emotionally devastating. My patients tell me they feel embarrassed by their “man boobs” and have to wear oversized clothing. They wear t-shirts in the pool and at the beach. Overall their enlarged breast tissue makes them extremely self-conscious.
1. Who does it affect?
Gyencomastia is most frequently seen in teenage boys and in older men because of hormonal changes. In more than 90% of young boys, the condition resolves spontaneously. However, up to 40% of ADULT men are affected to by some degree of gynecomastia.
2. Workup
You will likely be referred to an endocrinologist “hormone specialist” to rule out conditions that can cause gynecomastia. These include diseases like hepatitis, various cancers, or thyroid and testosterone imbalance. Street drugs like marijuana and heroin, as well as many prescription drugs, have been associated with gynecomastia. Steroid can also cause gynecomastia. Your physician must always rule out the possibility of breast cancer. Obesity causes enlarged breasts from the accumulation of fatty tissue. Once the serious medical conditions have been eliminated, many patients choose to proceed with surgery.
3. Surgical options
The goals of surgery are 1) to reduce the volume of the breast and 2) to remove and shape the redundant skin as needed.
To reduce volume, I start with liposuction. If there is firm fibrous breast tissue, I use power-assisted liposuction or PALS. This is where the liposuction cannula has a vibrating tip that helps break up thicker tissues. If there is residual tissue under the breast, I may also perform a “direct excision.” I make a small crescent shaped incision placed at the edge of the areola. Through this incision, the remaining breast tissue is removed. The scar usually heals nicely. For younger patients with good skin elasticity, this is usually all they need. The skin slowly tightens and forms a nice flat contour. Patients should know that this process of skin tightening takes time, and for many months they may have skin bagging or wrinkling.
In a few cases – usually older patients with poor skin elasticity, or in cases where a large volume of breast tissue or fat is removed, there is excess skin that needs to be removed. The safest way is to first perform liposuction to remove the volume, and then several months later perform the skin excision. The skin excision is tailored to the patient’s individual anatomy but can consist of removing a circle around the areola, removing a vertical section of skin under the nipple, removing an ellipse of skin near the armpit where the skin folds, or removing a large section of skin and moving the nipple as a free graft. All patients undergoing surgery should understand that they will have a significant improvement in their breast appearance but that there can be visible scars, skin depressions, and persistent skin wrinkling.
Overall my patients have been extremely happy with their results. They feel comfortable going to the beach or wearing a t-shirt for the first time. Gynecomastia surgery can often improve a man’s quality of life and help him feel more confident.
Breast Augmentation 101
Posted in: Breast Augmentation, Q&A | July 18, 2010 | 8 Comments »
I’ve recently had several girlfriends of mine come in for a breast augmentation consultation. Even in this day and age where information about anything can be found on the internet, it is often still confusing for patients. I remember when I got my breast implants, I felt a little overwhelmed by all the information that was out there. Therefore, I use a simple algorithm for my patients to help them through the process.
1) Saline vs. Silicone
Silicone breast implants have recently been FDA approved. Whether a woman undergoes augmentation with saline or silicone implants is a personal choice. The benefits of saline are that if there is a rupture, saline is absorbed by the body. The downside is that they feel less natural than silicone, especially if the patient has little breast tissue. The implants feel quite different – in my office I have my patients feel both a saline and silicone implant to help them make a decision. I also have a silicone implant where I’ve poked a small hole so they can see how the cohesive nature of the gel helps contain the leak
2) Incision
Breast implants are placed through three different incisions. Inframammary fold (in the crease beneath the breast), periareolar (around the nipple), trans axillary (through the armpit). This decision will be made on an individual basis and depends on each patient’s anatomy and the implant size. Overall, all heal well. My implants were placed around the nipple and are barely perceptible. Many of my patients have an inframammary incision and their scar is barely visible.
3) Size
Most of my patients come in and tell me they want to be a “full C”. However, because bras are sized differently, distorted by padding, and the cup size varies based on the chest width a “full C” is often not what most women think. In general, because I’m a women, I can get a good idea of what my patients are visualizing and it’s easy for me to estimate what size implant they want. We then do the fine-tuning by trying different implants in the office. This is the fun part – to see what you will look like with implants!
4) Implant placement
Implants can be placed under or over the muscle. In general, studies have shown that implants placed under the muscle have decreased incidence of capsular contracture (hard scar tissue forming around the breast causing distortion) but sometimes implants are placed over the muscle create a little breast lift in patients who have mild droop. The decision where to place the implant is made on an individual basis based on the patient’s anatomy.
When you come in for a consultation, I’ll take you through a hands-on, step by step process. There is nothing like feeling the implants in your hands or seeing how they look under your clothes. I personally feel that having breast augmentation was one of the best decisions I ever made. I loved not having to wear padded push up bras under EVERY outfit and even as an active person I actually felt MORE comfortable running and working out in a sports bra not being so flat chested. Living in LA where the average woman spends more time than most in a bikini, tank top or halter dress, I felt so much more versatility in my wardrobe. Honestly, I could talk about breast implants for hours and I truly love being part of this life-changing experience for my patients.
Dr. Catherine Huang-Begovic