Tummy Tucks and Liposuction

(Because I limit my practice to cosmetic surgery of the face and neck, I asked Dr. Leif Rogers of the Cosmetic Surgery Specialists Medical Group of Beverly Hills to respond. Dr. Rogers specializes in body sculpture procedures. He is certified by the American Board of Plastic Surgery and had additional fellowship training in cosmetic surgery. Here are his thoughts on tummy tucks and liposuction. -- Dr.Kotler)

Tummy tucks CAN be done immediately following childbirth but the results will never be as good as if one waits 6 months to a year after childbirth.

Immediately after childbirth the uterus is still enlarged and most people have some extra weight on them from pregnancy, both of which will prevent the optimal abdominoplasty result. If a woman were to get an immediate tummy tuck following childbirth, they will almost certainly have some recurrence of loose tissues (skin and abdominal muscles) due to shrinking of the uterus over 6 weeks and the usually weight loss most women experience over the next 6 months to a year after childbirth. The extra volume of the uterus and subcutaneous fat will prevent maximal tissue tightening. Should this happen, a revision may not even provide an equally optimal result as compared to abdominoplasty after the patient's body reaches a steady state or new baseline.

Liposuction (or suction lipectomy) by definition is the removal of subcutaneous fat by the mechanism of negative pressure (or suction). Therefore any variation on the theme is purely an additional mechanism to assist the basic technique. Any technique that does not remove the fat via liposuction is not a variation of liposuction, but a different technique entirely. I will touch on those techniques as well.

Liposuction and Liposculpture refer to the same technique that requires the infusion on fluid that contains epinephrine to help control bleeding and lidocaine to control discomfort. The fluid also assist the fat to flow through the cannula more easily. Liposculpture is actually the same as liposuction, though some have come to use the term to refer to liposuction meant to fine tune the physique.

Liposuction techniques do vary in terms of the amount of fluid pre-injected prior to the suctioning out of the fat, the most common of which is named the "Super-wet" technique. Liposuction can also be done under local anesthesia (awake) or general anesthesia(asleep) depending on how many areas and patient/surgeon preference.

The most common mechanical enhancements for liposuction currently include "Power Assisted Liposuction" (PAL) and the "Vaser". PAL refers to a mechanical cannula that allows the surgeon to pass the cannula through the subcutaneous tissue with less effort and possibly more precision. The Vaser is a pre-liposuction step which treats the subcutaneous fat layer with ultrasound, which partially liquefies the fat allowing the suctioning step to be more effective, and possibly induces more skin shrinkage.

Other techniques of fat removal include Laser, injections, radio-frequency, infrared light therapy and combinations of the previous.

• SmartLipo is a laser device that is applied under the skin in a similar fashion to a liposuction cannula and melts fat. However, the fat is not removed, the body resorbes the melted fat. The results are less predictable than liposuction and less dramatic.



• Mesotherapy is a injection (Lipodissolve is one trademarked formula) that emulsifies the fat. The key ingredient in all mesotherapy recipes is lecithin, with essentially acts as a detergent.



• Radio Frequency (RF) is an electromagnetic energy wavelength that can be delivered through the skin, targeting and super-heating the fat layer causing destruction of fat cells. This technology is still under development and available in limited efficacy at the time of this writing.



• Infrared, another electromagnetic wavelength is currently available with limited efficacy for fat reduction, applied similarly to RF.



• Ultrasound (very high frequency sound waves) are being applied across the skin that heat the fat layer. Ultrashape has been used in Europe for several years and Liposonix is new company with a similar device. Neither is yet FDA approved in the US at this time.



• LipoZap is a Trademarked process that uses a combination of mesotherapy, RF and Infrared.

True liposuction is still the gold standard.

Liposuction can be very effective for reducing specific pockets of fat, and can give patients a way to lose those areas that are resistant to diet and exercise.

However, liposuction can have some less desirable effects. Liposuction is not a good treatment for cellulite. In some instances the appearance of cellulite can be improved, but in some instances it can become more pronounced. It is difficult to predict which patient will have which result.

Liposuction is also not a license to eat an unhealthy diet. Weight can be gained again, however, the distribution of fat WILL be different. Some areas may appear to gain weight faster than before liposuction. This occurs because the fat cells removed from a given area never grow back. It can be assumed that all fat cells in one's body are approximately the same size, therefore, as one gains weight all cells grow at approximately the same rate. Since the ratio of fat cells from on body part to another have been altered permanently by liposuction, so will the ratio in which fat is deposited.

Another potential pitfall is uneven contour. This can be caused by uneven suctioning, but just as likely, can be caused by scar formation that is specific to each patients physiology. Just as some people form thick scars in the skin regardless of surgeon skill, so do some form thick scars in the deeper layers. Exuberant scar formation in the skin does not seem to predict similar scarring in the deeper layers and vice-versa.

Loose skin can also be a problem after liposuction. This is more common for older patients who have lost much of the elasticity in their skin. Occasionally skin resection is necessary to remove the excess skin. Women in their 40s to 60s are more likely to have irregular contour as well due to thinning of the skin, which will show imperfections.

In instances when irregularities do not improve with time, fat transfers and touch-up liposuction can correct irregularities.

Related Topics:

• WebMD Video: Power Liposuction
• WebMD Video: Cellulite Treatment with Heat

Technorati Tags: tummy tuck, liposuction, fat removal, SmartLip, Mesotherapy, laser, infrared, ultrasound, body sculpting

Traveling for Cosmetic Surgery

While some "immigrate" for cosmetic surgery, some Americans "emigrate." Our specialty has long been aware of this, but rarely has it been seen as news. What makes it newsworthy is that several countries, hungry for American dollars, are waging an aggressive marketing campaign to attract Americans seeking low-cost cosmetic surgery. No question surgery costs less in Mexico, Costa Rica, Brazil, Thailand or Russia.

We have had a little peek into this world from patients and prospective patients who have shared their experience or that of a friend with "foreign cosmetic surgery." Some are happy. Some are disappointed. For you, if you consider this option, the dilemma lies in the "what if?" "What if" there's a serious complication or unintended results? What is the contingency plan? What happens when you're 10,000 miles from home?

In the U.S., we have very stringent licensure and credentialing processes for doctors, hospitals, outpatient surgery center, clinics, etc. No other countries match our standards. In a third world country, proper sterilization techniques, safety of the blood supply, and available, competent emergency care cannot be taken for granted. Most third world countries have nowhere near the safety standards, modern equipment, or highly specialized personnel to which we've grown accustomed.

There is some excellent work performed by foreign cosmetic surgeons (some American-trained) who are operating in their homeland. There are also some patients who receive terribly botched surgery and must then return home for an American surgeon to do the necessary repair work. Certainly this double dose of surgery will erase any savings.

This is not to say problems and complications never occur in Beverly Hills, New York or Miami. But, consider the world-class medical back-up available here in the United States, if needed. As one patient commented, "I do not turn over my face -- and potentially my life -- to the low bidder 8,000 miles from home." If you want to visit an exotic locale, take a vacation. If you want cosmetic surgery, be cautious and analytical in your decision-making process. Here are some questions that will help you be objective:

7 Smart Questions You Must Ask before Having Cosmetic Surgery in a Foreign Country

1. Is the doctor board-certified by one of the official American boards, e.g American Board of Plastic Surgery, The American Board of Otolarynogology/ Head and Neck Surgery, The American Board of Ophthalmology or the American Board of Dermatology?



2. Is the surgery facility a hospital? An outpatient surgery center? Or inside a doctor's office? What safety accreditations does it hold? Is it licensed by the government or any other recognized entity, such as we have in the U.S., e.g. the American Association for Accreditation of Ambulatory Surgery Facilities, The Accreditation Association for Ambulatory Health Care or the Joint Commission on Accreditation of Healthcare Organizations?



3. Who performs the physical exam and appropriate laboratory tests to assure my health is satisfactory for the operation(s) and anesthetic? How far in advance of surgery will this be done?



4. When I first visit the foreign clinic, what if I don't feel comfortable with the surgeon, the facilities or staff? Can I get my money back and fly home without major financial penalty?



5. If I do opt for the surgery, will there be a doctor-anesthesiologist in attendance at all times? Is that doctor certified by the American Board of Anesthesiology?



6. Typically, how long would I have to stay in the foreign country before it is wise to return home? How often will the doctor see me? Will all stitches be taken out before I leave?



7. What if a complication or problem develops after my return home? Who manages the problem? Who pays?

Related Topics:

• Guide to Plastic Surgery
• Cosmetic Surgery in Paradise

Technorati Tags: cosmetic surgery, cosmetic surgery vacation, travel, surgery, beauty, skin

What's With Snoring?

Here is a clever poem, which apparently hits home to many families:

Night Blight
The Burden of the Unfortunate Who Sleep
With Those Whose Noses are Blocked

The bad thing about a snorer,
In fact the very worst,
Is, with two people in the room,
He always drops off first.

Yes, snoring is a very common problem. As a specialist in cosmetic and reconstructive nasal surgery, I see many for "nose jobs" who also report snoring (noisy breathing). They ask, "Can anything be done about it while you are fixing my nose?"

There may be one or more causes of snoring. It is important to know what the source of the snoring is.

Let me list, in order of frequency, what they are:

1. Blocked nasal passages. By far the most common cause of snoring, particularly in men. Either due to allergies, a previous broken nose or "the way you were born," the nasal passages do not carry enough airflow to satisfy the body's need, and the patient is forced to breathe through the mouth. Not an ideal second choice; such mouth breathing is noisy, particularly at night, because when laying on one's back, the relaxed soft palate flops back and forth as the airflow goes in and out via the mouth.
   
   As medical students we were taught that "normal breathing is quiet and unheard; abnormal breathing is noisy." Remember that nature created the nose to be the route for the body's incoming air. The nose has three specific functions that are not fulfilled when one becomes a "second choice" mouth breather:
   

   1. Humidification
   2. Filtration
   3. Warming

   Many medical studies have proven that airflow through the nose provides optimal lung function. Incoming air, by-passing the nose and hence not availing itself of the above three services, is a less-ideal present to the lungs.
   
   People who have a blocked nose due to deviated septum, enlarged turbinates, nasal polyps, or allergies give their body no choice but to breathe through the mouth.
   
   The good news is that patients whose snoring is due to blocked nasal passages can be significantly improved or cured. To be certain that the blocked nose is the culprit requires a complete exam of the nose, sinuses, throat, and neck by a qualified specialist. Indeed, since nasal obstruction is the most common cause, in some patients the correction of the deviated septum and enlarged turbinates saves the day for the patient. As one happy patient said, "Doctor, you took my nose from a two-lane highway to a four-lane highway."
   
   In our practice, half the patients coming in for cosmetic surgery have breathing problems and, if appropriate, both cosmetic nasal surgery and a breathing operation can be done at the same time. Both are done from within the nose; no external incisions.


2. An enlarged adenoid. The common cause of children's snoring. The adenoid, a large mass of lymphoid tissue, part of Nature's defense system against infection, is located at the back of the nasal passages, high in the throat, behind the palate. Often it cannot be seen without special mirrors.


3. A down-hanging, swollen uvula, commonly the result of allergies. It flips back and forth causing that snoring sound.


4. Body build. Typically, an overweight man with a short, stocky neck. Think wrestler. After age 40 or so, the tissues inside the throat begin to lose some of their strength. They get a bit soft and floppy. In men with this triad of thick, short, wide neck, the soft tissues of the walls of the throat literally fall into the air passage causing the noisy breathing that one sleep-deprived wife called "the sound of a freight train rolling through our bedroom."


5. An enlarged tongue. Perhaps due to an under-active thyroid gland or other medical condition. Here, the over-sized tongue falls back into the throat when sleeping causing blockage, hence snoring.

To properly ascertain the cause of snoring, be sure to have a thorough examination by a head and neck (ear-nose-throat) specialist.

Related Topics:

• Sleep Breathing Holds Depression Clues
• WebMD Video: Titanium Nose

Technorati Tags: snoring, nasal surgery, nose job, health and wellness