The removal of unwanted fat through liposuction techniques is effective but has as its main complications that of irregularities and asymmetries of body contours. While taking down the size of fat collections, it does not always result in the desired body contours or a show of the underlying muscular detail. This has lead to a liposuction concept known as sculpting or liposculpture. What is liposculpture and is it really different? Is it a better at achieving natural body contours and a more attractive body shape? Who is it best used on?

Liposculpture moves beyond the removal of just localized areas of too much body fat to a more artistic approach to fat removal. Instead of using large bore cannulas which can indiscriminately remove fat rapidly and creates large diameter internal tunnels through the fat, smaller size cannulas are used. These tools are more selective about how much and where fat is removed. Smaller cannulas may also be combined powered liposuction equipment such as oscillating, ultrasonic and laser-assisted devices. Whether these energy-driven devices are more effective at liposculpture is a matter of debate.

But the most important element in effective liposculpture is that of the surgeon. There has to be an appreciation of what makes up natural and pleasing body contours. The tools used are only as good as the hands that are directing them in shaping new contours. There also has to be an understanding of what the structure of fat looks like underneath. In some areas there may only be a thin fat layer which can reveal an improved body contour through superficial cannula extraction. Such aggressive right-under-the skin fat removal must be applied carefully to avoid scarring and undesireable skin retractions. Areas such as the inner knee, neck, back rolls, axillary breast and flanks are good examples of where superficial liposculpture must be used to get good contouring results as there are not deeper fat layers.

Superficial liposculpture has also become well known because of abdominal etching. This is the most aggressive application of this technique. It is the deliberate removal of all fat possible between the underside of the skin and the underlying muscle layer. When done over abdominal areas that lie over the muscular inscriptions and outlines, one can achieve a ‘six-pack’ look. While achieving this desired look for some, it is actually creating an anatomic result that is almost always to be avoided in liposuction, skin retraction and scarring. Abdominal etching is reserved for those that are near their ideal body weight and have a thin layer of abdominal fat.

While liposculpture sounds appealing, it is not a method that is best for many liposuction patients. The most common liposuction patient has larger amounts of fat on the abdomen, waistline, thighs and arms. In these areas there are two distinct fat layers, superficial and deep. Extraction from the deeper layers is needed and should be the first layer that the cannula enters. Treating the superficial layers as well, while improving the amount of contour reduction, will increase the risks exponentially of surface contour irregularities. The abdomen, arms and inner thighs are particularly at risk for this problem with superficial liposculpture. The quality of the skin, its thickness and elasticity must be assessed to determine if it is wise to attempt removal of fat right under the skin.

While slick marketing and pictures of models attempt to attract prospective patients for so-called liposculpture surgery, it is important to remember that traditional liposuction methods with solely deep fat removal will satisfy most patients. Liposculture techniques should be applied judiciously and applied to areas that are best served by them. It is a liposuction technique that takes into account the anatomy of the fat and the contouring goals and not a method that replaces traditional liposuction for many body areas.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background: Liposuction is a well established method of surgical fat removal. While it may seem crude in the manner in which it is performed, its effectiveness is undeniable in extracting large volumes of fat. The extraction method is primarily based on pulling fat through a tube (cannula) based on a negative pressure of about one atmosphere. The size of this cannula determines how fast the fat is removed. As the size of the cannula increases so does the risk of visible skin irregularities afterwards as it ‘punches’ bigger holes in the fat tissue.

When most people think of liposuction, they envision people who are grossly overweight or just plain fat. The reality is that most liposuction patients, while not thin, are far from being obese. Most are likely in the 15 to 30lb above their ideal body weight category and just can’t lose the stomach or skin rolls that they have. Others have an inherited or congenital fullness of the thighs, knees and arms that is not exercise and diet-responsive. Liposuction is also used as a complement to other body contouring procedures such as tummy tucks, armlifts and breast reshaping.

But there is a distinct subset of liposuction patients who actually are reasonably lean and do not have fat rolls in the classic sense. They may have always been very thin and now have some unacceptable thickening of some body areas as they have aged. Or they may be very athletic and want further body refinements that they just can not achieve with rigorous diet and exercise. These represent a more finesse form of liposuction that is much lower in the volume of fat that needs to be removed. This is best known as liposculpture since the objective is shaping more than it is about high volumes of fat removed. To avoid irregularities in these small volume extractions, it is necessary to use small cannulas.

Case Study: This 42 year-old female was unhappy with her lower stomach and waistline areas. Despite being a good weight, she could not lose the small amount of accumulated fat and a little loose skin that had developed as she had aged and after having children. Her fat problem was around the waistline and into the back or flank areas.

Under anesthesia, she was treated with Smartlipo. Through small stab incisions inside the belly button and at the lateral waistline and flanks, she was initially infiltrated with a Hunstad solution. Approximately 10,000 joules of laser energy was delivered by a fiberoptic probe to the problem areas. Then a 3mm cannula was used to extract 575cc of aspirate in a cross-tunnel fashion from the lower abdomen and 175cc of aspirate from the flank areas in a radiating linear fashion. The entrance incisions were not closed to allow for drainage afterwards. She was placed in a circumferential binder with absorbant pads underneath.

She unwrapped her binder the next day, removed the pads, and showered. She wore her abdominal binder for the next week. While she saw improvement in her waistline from the very first day, it took a full 6 weeks until all the swelling had resolved and the final shape appreciated.

Critical analysis was done at three months after surgery. She was pleased and a visible reduction with some skin tightening achieved. There were a few areas of irregularities across the lower abdomen but these were not of a concern to her.

Case Highlights:

1) Small volume or discrete areas of liposuction can be described as liposculpture or finesse body contouring.

2) Liposculpture is used for average weight to thinner patients who need discrete areas of contouring, usually of the stomach, waistline and into the back. Smartlipo can help not only in the removal but can produce some slight skin retightening as well.

3) In small areas of fat removal and body contouring the biggest risk is that of skin irregularities and asymmetry after surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Liposuction Surgery in Indianapolis
One of the most frequent questions that I get asked by any patient considering liposuction is…..do the results last? That is a great question which, quite frankly, defies one simple answer. It is a very important question for any patient considering any type of cosmetic procedure because it addresses the issue of …value. What am I getting for what I am paying? If the procedure is easy to do, like Botox for example, then its relatively short durations (4 months or so) is well tolerated. But when it comes to actual invasive surgery like liposuction, where there is pain and recovery, the long-term benefits are a lot more important.
The basic answer to the duration of liposuction is…..if your weight is stable, then the results will be fairly stable. I certainly think that this is generally true but that answer are also influenced by what body area was treated and the sex of the patient. Not all fat is the same throughout the body. For example, stomach fat is a preferential depot site for storage of unused fat. Conversely, for example, the inner knee is not a depot site. It’s size generally does not go up or down based on how your weight fluctuates. Whether an area is depot site is different in men vs. women. The buttocks and thighs, for example, is much more of a depot site for women but is not for men at all. (how many heavy men with large stomachs have a small butt….very common!) So these factors must be considered as well. Meaning, greater ‘permanency’ will occur from liposuction in areas that are not depot sites. Depot sites are more likely to regain weight than non-depot sites.
A liposuction study that I read recently looked at two-year outcomes from liposuction surgery. The results were disappointing but not surprising to me. Nearly half of the patients treated had gained weight in the liposuction-treated areas, some bigger than they were before. (the good news is that half still had good results at two years!) This is a condemnation to the benefits of liposuction. It merely indicates, as I tell all potential patients, that liposuction is an adjunct to your body contouring efforts, not the sole solution. The long-term results are often only as good as the continued effort that you make through proper nutrition and exercise. Liposuction surgery is best thought of as a part of your overall body improvement program.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Pectoral Etching and Liposculpture in Indianapolis

Contouring of the chest region by pectoral etching helps provide better definition to the pectoral muscles and the shape of the chest wall. Borrowing the concept from abdominal etching, in which the use of linear liposuction is used to define muscular edges and definitions, a similar technique can be applied to the chest with equally good results.

By selective removal of fat (liposculpture) from the side and lower borders of the pectoralis major muscle, the muscular appearance of the chest wall can be improved. This virilizes the chest contour while creating few visible scars. By sculpting the borders, and leaving fat over the main body of the muscle, the pectoral muscle bulk appears greater. This pectoral etching technique provides better shaping than simple gross fat removal in an even unsculpted manner across the chest wall.

Pectoral etching adds visible and palpable pectoral inscriptions to the chest wall. In a recent study published in Plastic and Reconstructive Surgery in December 2007, Dr. Ruiz-Razura and colleagues report treating over 200 patients over the past three years.with only a few minor complications. (small hematoma, irregular contour, too conservative of a result) Their experience has been that the results have been maintained, even in the face of weight gain and skin loosening with age. When pectoral etching is combined with abdominal etching, a more muscular-appearing torso is achieved. The procedure is becoming very popular in non-athletic males whose physique may not get sculpted even with regular strength training.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Liposuction vs LipoDissolve – Comments on the Importance of Patient Selection

The treatment of undesired fat today can be done by either traditional liposuction or the newer fat injection technique known as lipoDissolve. The frequent question then for many patients is….which is best for me? The answer to that question lies in the understanding that liposuction and lipodissolve are different……in how they work, in how well they work, and the time course in which they work. As a result, selecting liposuction vs lipodissolve for each patient is critical if good results are to be achieved.

As a general rule, lipodissolve is good for small fat deposits (usually the size of your hand or a coke can) such as in the neck, back of the arms, side of the waists (flank), small saddlebags, or the inside of the knee. Fat collections this small are generally not worth making a trip to the operating room to treat nor the higher costs to do so, unless you are having other procedures done as well. In this case, a series of three or four lipodissolve sessions, and the swelling that occurs after, is usually worth it. For larger fat collections, or when more than one or two areas of the body are involved, liposuction surgery is far better. Yes the costs are higher and there is an immediate recovery phase after surgery, but so much more fat can be removed that the effort is well worth it.

In short, Lipodissolve is not a substitute or replacement for Liposuction. In select small fat deposits, it may give results close to liposuction. It provides an alternative treatment to liposuction in medium-sized fat deposits that are limited to one area if one is willing to accept less of a result than that achieved by liposuction. The critical issue in these cases is the issue of value….are you getting a good return on your investment. That is best decided by a thorough discussion with your plastic surgeon to weigh out the advantages and disadvantages of each approach.

Liposdissolve has one other use that is usually better than liposuction….in the treatment of post-liposuction irregularities. “Spot’ reductions can be done by precise placement of lipodissolve injections. This can avoid the costs of another trip to the operating room for a minor touch-up.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Six-pack Abdominal Surgery

The ultimate abdominal definition is the visible outline of the underlying abdominal muscles. Known as the six-pack look, it is actually caused by the enlargement of the rectus muscles, the lack of fat between the skin and the muscles, and the outward appearance of the inscriptions of the rectus muscle (which actually creates the lines of the six-pack) It usually takes a great amount of exercise and dieting to create this sought after look. For some patients, it is just not possible to thin the fat out that much to reveal the inscriptions. For these patients, a surgical shortcut can give them this look.

Using liposuction techniques, the fat can be precisely removed along vertical and horizontal lines, mimicking the inscriptions. This liposculpture technique requires the use of small cannulaes to suck the fat out along these carefully placed lines. This creates troughs (etchings) underneath the skin so that the underside of the skin sticks directly to the muscle. Hence, the six-pack look is achieved. The key to a natural result with abdominal etching is proper patient selection (the patient should be thin, in athletic condition, and have made a good effort to achieve the look on their own) and careful placement of the etch lines so that they lie along natural lines. (the patient’s skin is marked with them sitting down and slightly bending over)

The one downside to the procedure is what may happen long-term. If the patient gains weight, fat will unnaturally bulge between the etched lines creating an unusual appearance. The procedure is not reversible or easily correctable by fat injections, so the patient must accept long-term responsibility for maintaining their physical condition and now allowing much abdominal weight gain.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis