1. How much weight should I lose before having liposuction?
Ideally, liposuction is best used as a ‘spot’ treatment for resistant areas of fat. This would imply that one should be near to what they consider to be their ideal body weight. On a more practical basis, one’s weight should be down to what can be achieved with a reasonable effort.
The ‘weight loss before liposuction’ approach is best for two reasons. First, the amount of liposuction needed will be less…and less surgery of any kind is always better than more. Secondly and most importantly, the losing weight process allows one to have made lifestyle changes before surgery. The effort to do so and the induced lifestyle changes provide for a better chance that the liposuction results will be longer lasting.
Conversely, I have seen a few patients who have taken the opposite approach. They were interested in having liposuction as a starter method to their weight loss program. While the immediate results seen after liposuction can be initially stimulating, long-term diet and exercise changes may or may not follow. This is a more risky and less certain approach to good long-term results. Plus, more liposuction surgery is needed in a patient who is not in as good as shape as someone who has better prepared their body for recovery and healing.
2. What Alternativesto Liposuction Exist?
Localized or spot fat reduction has been touted with a variety of non-surgical methods. Dissolving fat with injections, often called Lipodissolve, has been widely marketed over the past few years but has lose much of its appeal recently. Besides being a non-FDA approved injection method, it produces only very mild fat reduction and does so very inefficiently…requiring months of injection sessions resulting in a week of swelling afterwards each time.
The more recent non-surgical method is Zerona. Using low energy external laser sessions, combined with daily water intake and oral niacin supplements, inches are promised to be lost around one’s mid-section. This is relatively new and widespread clinical use is just beginning. W e will know in a few years if this will go the way of other hyped non-surgical weight loss devices and techniques or will find a long-term niche as a viable method of localized fat reduction.
3. What type of liposuction is the best?
There are numerous liposuction devices currently available such as ultrasonic, laser (hot), and water jet (cool)devices. With these methods comes the associated marketing and hype that is associated with the manufacturers as well as endorsements by surgeons. In addition, because some of these devices are new, they are promoted as the latest and the greatest.
What all these liposuction technologies share is that they are used for the first phase of the surgical process…loosening up the fat…which is then suctioned out as the second phase. Whether anyone of these methods is better than another can be debated but no one can conclusively prove that one is better than another. The reason is that the technology is only as effective as the surgeon who is using it.
The role of the surgeon in performing liposuction is so important that any technology can produce great or poor results based on how well and carefully it is used. The most important element in liposuction, therefore, is the surgeon’s experience and familiarity with whatever approach they use.
The current use of Snartlipo (laser-assisted liposuction) has a three or four year history of widespread clinical use. While just a promising tool a few years ago, today’s units have higher powers, temperature monitoring, and multiple wavelengths. The very sensitive nature of fat cells to heat makes this technology the most theoretically appealing.
4. How type of anesthesia is used for liposuction?
Liposuction can be done under every conceivable method of anesthesia, from local, sedation, or general anesthesia. But what can be done with each type of anesthedia is different. And the time and costs to do it are also affected.
Local anesthesia, using tumescent or Hunstad infiltration, works well for smaller areas of fat removal. It is not an effective method for larger areas of fat reduction on multiple body areas. For this reason, some perform liposuction in stages for larger areas while others do all areas at once under a general anesthetic.
Sedation is used as a supplement to local anesthesia and helps reduce anxiety that comes from the longer times that the use of local anesthesia requires. It is given by pills an hour or so prior to the procedure or through an IV at the time of surgery.
Which type of anesthesia is best for your liposuction procedure depends on a lot factors including extent of the procedure, your level of anxiety about surgery and anesthesia, the time you have to recover, and the surgeon’s background and experience.
5. How much pain is there after liposuction?
The trauma induced to the tissues from liposuction is not pain-free. While how much liposuction you are having and your own pain tolerance influences the level of discomfort, you should prepare yourself for more recovery time than you think. Patients are naturally very optimistic as to how well they will do after any surgery and how quickly they will return to normal. I would not anticipate that it will take twice as long as you think to feel close to normal. This does not mean that you will be incapacitated or bed-ridden, just that you will feel more sore and be slowed down more significantly than you think.
6. Are Liposuction Results permanent?
One of the common myths is that once fat is removed, it can not come back. As patients often say, ‘I have heard that once fat cells are removed, they can not return.’
This perception is false for two reasons. First, not all fat cells are removed from any area that is suctioned. That is not only impossible but unaesthetically undesireable. There needs to be a certain layer of fat between the skin and the muscles so the skin is not stuck down and tethered. Secondly, stem cells exist in fat which always have the potential to turn into fat cells if properly stimulated. Excess food intake and the need for fat storage is just the stimulus for fat re-accumulation.
The best answer is that the long-term results from liposuction are stable if your weight remains fairly stable. If you gain weight of any significance (greater than five pounds), it has to go somewhere and that will likely be from whence it was originally removed.
7. How much time should I allow for recovery before going on vacation or a trip?
It is quite common that I see patients who have a trip or vacation planned and want to do some body shaping before they go. The biggest mistake is to not give enough time for a ‘full recovery’. You don’t want to go on a well planned and long thought out trip only to still be sore or limited in what you can do and enjoy. Depending on the number of body areas and amount of liposuction, I would allow for at least six to eight weeks (as a minimum) before leaving. Three months is most ideal.
There are also some patients who want to use a trip to recover and their intent is to go and lay around somewhere. In this case, I would recommend one week before you leave.
Dr. Barry Eppley
Indianapolis, Indiana