Liposuction


While the surgeon’s skill sets and qualifications will largely determine the success of liposuction—a body contouring surgery that breaks up and removes “unwanted” fat—the techniques and equipment will also have their influence.

 

Dr. Tarick Smiley, a leading Los Angeles plastic surgeon, has recently posted a video on Snapchat to demonstrate one of his liposuction machines imported from Germany.

 

liposuction machine

Dr. Smiley says the Moller liposuction machine can perform “liposuction, lipo-filling, and infiltration all at the same time,” hence the operative time is shortened and thus may contribute to improved patient safety.

 

Hence, the liposuction machine is ideal for Brazilian buttock lift (BBL) in which large volumes of fat are suctioned out of the body, purified, and re-injected through a process called lipo-filling.

 

Nowadays, lipo-filling—also referred to as fat injection or structural fat grafting—is an established technique that can be applied to various plastic surgery procedures including BBL, three-dimensional facelift, cheek augmentation, and breast surgery (cosmetic and reconstructive).

 

Because BBL typically requires “aggressive” or large volume liposuction, one of the most pressing issues is the increased bleeding. During fat extraction, the cannula (straw-like device) inadvertently removes some blood.

 

Large blood loss can result in longer recovery, more fluid imbalance, and higher risk of complications; therefore all efforts are made to minimize the amount of bleeding. For this reason, Dr. Smiley uses another equipment called Cell Saver.

 

Cell Saver is a liposuction machine that can process the fluids, collect the red blood cells, and re-infuse them into the patient while the surgeon is doing liposuction. This piece of equipment is also used in hospitals to control bleeding, which is a risk when an operation takes too long (more than 6 six hours).

 

To further reduce the amount of bleeding, prior to liposuction Dr. Smiley infiltrates the fatty area with tumescent fluids, which are infused with several drugs that include epinephrine.

 

The renowned plastic surgeon says that epinephrine works by constricting the blood vessels, ultimately reducing the amount of blood loss by up to 90 percent compared to the dry liposuction, which is now a passé technique as it entails prolonged recovery and increased risk of skin asymmetry.

 

(Note: Dry liposuction means the fatty area is not infiltrated with tumescent fluids or any wetting solution before the fat is removed with cannula.)

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The vast majority of liposuction patients will have their scars heal and fade well into the background. This has become possible with the use of microcannula, a straw-like device whose outside diameter is generally defined as 2.2 mm or smaller.

 

Aside from microcannula and the use of meticulous surgical techniques, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says “how well a scar fades” will also depend on patient commitment. For instance, sun exposure is best avoided for about a year to prevent the scar from turning dark and thus becoming more visible.

 

liposuction and keloids

Photo Credit: Medscape

Furthermore, prudent patients should not apply any topical treatments (e.g., scar creams and gels) without first consulting their surgeons and avoid submerging their incisions in water (pools and bathtubs) until these are fully sealed, which happens around three weeks.

 

Nonetheless, liposuction and keloids risk remains an issue among patients with a history of aggressive scarring.

 

While having a history of keloids is not a contraindication to liposuction, prudent patients should disclose their susceptibility to aggressive scarring to their doctors who can explain the risks and the possible need for aggressive and proactive scar treatments and preventions.

 

Keloid is a tough scar that grows beyond the injury site (or liposuction incision). It usually appears pink or purple and has an irregular shape that tends to expand progressively.

 

To prevent visible scars, Dr. Smiley says all efforts are made to position the liposuction incisions within the natural skin fold and beneath the “bikini area.” To further allay the concerns of patients, he says that only certain parts of the body are prone to keloid scarring such as the earlobes, chest, and upper outer arms—places that are generally avoided during the creation of small puncture wounds used in liposuction.

 

While follow-up consultation is important for all patients after liposuction, this is particularly true of individuals with a previous history of keloids who require closer monitoring so their surgeons can aggressively treat scars that are becoming thick and unsightly.

 

The use of cortisone injections is arguably the most common treatment for keloids. However, they are only performed a few weeks apart to prevent skin changes such as depression and hypopigmentation (lightening of color).

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Some type of body contouring and liposuction are often performed together to achieve a more holistic improvement. This “combo” procedure is particularly common after massive weight loss since the patients not just have loose skin but also have highly fibrous fat, which does not respond to further weight loss.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley explains the most common body contouring procedure combined with liposuction.

 

body contouring and liposuction

  • Tummy tuck surgery with liposuction

 

Before creating a hip-to-hip incision to remove the pannus (apron-like skin), Dr. Smiley often performs liposuction of the flanks. The idea is to remove the unwanted superficial fat (it lies beneath the skin; this is different from the intra-abdominal fat that only responds to real weight loss) so he can pull tight more skin.

 

By pulling more skin downward and centrally, Dr. Smiley says he can deliver a more hourglass torso, which is the quintessence of a feminine figure.

 

  • Arm lift with liposuction

 

This combo procedure starts with liposuction of the entire circumference (or at least 75 percent) of the upper arm, allowing him to tighten more skin.

 

After removing the unwanted fat, he then creates an incision that will allow him to excise the loose skin and tighten the deeper structures as well. Meanwhile, the scar pattern will primarily depend on the extent of loose skin; for instance, massive weight loss patients will generally need to accept the appearance of a scar that extends from their armpit down towards their elbow.

 

The scar from arm lift surgery is typically positioned on the inner aspect of the arm, although some patients may have theirs in a more posterior location.

 

  • Liposuction followed by buttock enhancement

 

Instead of the discarding the fats collected during liposuction, they are purified and injected back into the buttocks and hips; this staged surgery is colloquially known as Brazilian buttock lift or BBL.

 

During BBL, the flanks and lower back are typically used as a donor site because they normally carry adequate amounts of unwanted fat. Furthermore, “scooping out” this area allows the buttocks and hips to appear curvier.

 

  • Back lift with simultaneous liposuction

 

Back lift typically uses incisions that are positioned where the bra strap would lie, leading to optimal scar concealment. The idea is to remove the excess skin responsible for the appearance of bulges that are seen beneath [tight] clothing.

 

However, a simultaneous liposuction can further “refine” the effects of back lift surgery.

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Liposuction remains the most commonly performed body contouring surgery for men and women. Despite the introduction of some newer techniques and technologies, the basic principle of this procedure remains unchanged: Remove the unwanted fat that sits next to the skin to achieve a slender, more athletic physique.

 

Leading Los Angeles plastic surgeon Dr. Tarick Smiley shares some of the surprising liposuction facts that you may not know about.

surprising liposuction facts

  • It is only suitable for patients with a relatively good physique.

 

As with any body contouring surgery, liposuction requires that you are at least within 25-30 percent of your ideal weight. Bear in mind that the lipo cannula (a stainless steel probe) can only remove the superficial fat, which has not responded to diet and exercise.

 

The “stubborn” superficial fat is more likely due to genes than lifestyle. The deeper visceral fat, meanwhile, is linked to obesity and will only respond to weight loss, which of course is only possible through lifestyle changes, as opposed to fad diets, pills, and body contouring surgeries.

 

  • You may gain more body fat afterwards, particularly the visceral fat linked to obesity-related problems. But only if you’re not careful.

 

Some researchers have suggested that the body makes every effort to protect its “natural” fat distribution and composition. Hence, after liposuction patients who remained sedentary were found to have their visceral fat increased by around 10 percent (from its pre-surgery level), predisposing them to increased risk of heart problems, insulin resistance (diabetes), and inflammation.

 

However, you can “re-train” your body, preserve the results of your liposuction, and ultimately maintain a healthy physique. According to the same researchers, doing moderate exercise (i.e., one hour of cardio combined with strength straining three times a week) has prevented patients from the “exercise group” to regain fat.

 

Furthermore, these patients were found to have improved their health just after six months of moderate exercise.

 

  • It’s more about what’s left behind, and not about removing the optimal amount of fat.

 

In fact, removing all fats from the treated area can lead to disaster—e.g., surface irregularities, unnatural contour, and sagging/gaunt appearance. To avoid any sign of botched result, a good surgeon preserves some fats especially beneath the skin.

 

  • Any doctor can perform liposuction, even if he has no standardized training.

 

Liposuction is best performed by a board-certified plastic surgeon—i.e., a member of the American Board of Plastic Surgery. Medical literature has suggested that they have the lowest complication rate due to their specialized training, in addition to the fact that they are required to pass rigorous oral and written exams, which they need to take every 10 years.

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Liposuction scar generally fades into negligible “marks” after 6-12 months, although patient commitment to recovery remains critical to achieve the best results possible. For instance, sun exposure must be avoided for at least six months since UV rays can cause hyperpigmentation in which the scars turn dark.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley shares his scar management tips that will further ensure that your liposuction scar will blend well into the background.

 

liposuction scar

The after photo on the right shows no visible scar, which contributes to high patient satisfaction.

* Minimize tension on the skin. When there is no or very minimal tension on the scar, it tends to heal nicely. Hence, the use of surgical tape and/or Steri-strips can be helpful as they eliminate the stress and “pulling” that can delay healing or cause the scar to widen.

 

* Achieve your optimal health well in advance of the surgery. When you’re healthy, there is less risk of infection, which can affect the appearance of your scars. Simply put, liposuction or any other body contouring surgeries will require commitment to superb diet and healthy lifestyle.

 

* Eliminate risk factors of infection. Each doctor has his own specific wound care instructions, although there are generally agreed upon guidelines such as never submerging your incision in water for at least three weeks; not using any topical product unless with the approval of your surgeon; and avoiding smoking.

 

* Treat infection immediately. In the hands of a board-certified plastic surgeon, infection is extremely rare because of the use of tumescent fluids injected into the fatty area prior to extraction. But should it occur, it must be treated immediately to prevent complications and poor scarring. Common signs of infection include asymmetric swelling, fever, chills, and drainage of pus.

 

* Use of topical treatments containing silicone. Once the incisions are completely sealed, which happens around three weeks postop, patients may choose to apply topical products such as silicone sheets and creams known for their hydrating effects. Scars that heal in a moist environment usually heal better and fade quicker.

 

* Use sun protection for one year. While staying out of the sun is the best way to reduce risk of hyperpigmentation, this is generally difficult or even impossible to accomplish. Hence, the use of sunscreen, protective clothing, and makeup products that offer SPF protection remains valuable.

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Extended tummy tuck surgery with PAL liposuction is generally reserved for patients who have lost a significant amount of weight, leaving them with large pannus or apron-like skin along their abdominal area. Pannus not just causes unsightly rolls beneath one’s clothing, but it also results in skin breakdown, non-healing irritation, and foul odor due to the trapped sweat and moisture.

 

Compared to the standard technique in which the resulting scar goes from hip to hip, the extended tummy tuck uses an incision pattern that goes a bit longer and so the scar may be visible along the flanks (or lower back).

extended tummy tuck with PAL liposuction

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the length of tummy tuck incision must cover the “entire rolls of skin and excess tissue” to achieve a smooth and natural contour. Attempting to use a shorter scar technique despite the extensiveness of the redundant skin, meanwhile, will inevitably result in poor outcome due to the residual rolls.

 

In Dr. Smiley’s previous Snapchat post, he showed one patient who had extended tummy tuck and PAL liposuction as its ancillary procedure. The idea is to further contour the flanks and achieve a more feminine silhouette.

 

PAL, which is an acronym for power-assisted liposuction, uses a cannula (straw-like device) that has a vibrating tip that makes fat extraction more precise and quicker, thus leading to shorter operation, improved safety, and less surgical trauma.

 

He first performed PAL liposuction along the lateral aspect of the torso before placing a flank-to-flank incision. The idea was to remove the unwanted fats, allowing the skin to “shrink down” before removing the pannus through an extended tummy tuck technique.

 

Liposuction uses tiny round incisions about the size of a grain of rice. The goal is to remove the excess superficial fat beneath the skin. It is important to note that it cannot suction out the obesity-related visceral fat (it is positioned deep within the abdominal organ and cavity) that only responds to real weight loss.

 

After liposuction, Dr. Smiley proceeded to tummy tuck to remove the pannus and then performed muscle repair in which the idea was to tighten the pair of vertical muscle by suturing them in the midline, further contributing to the cinching effect on the waistline.

 

Before closing the tummy tuck incision (ensuring that the scar would lie very low that it is hidden beneath the patient’s underwear), Dr. Smiley injected Exparel, a drug that can numb the surgical site for up to four days.

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