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Tummy Tucks and Liposuction

hands on stomach
By Robert Kotler, MD, FACSAugust 31, 2007
From the WebMD Archives

(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.

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