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Liposuction Details Beverly Hills

Liposuction Procedure | Liposuction Case Studies

Liposuction is one of the most popular cosmetic surgery procedures. There is a lot of nonsense and confusion out there regarding this procedure. It is important to understand that liposuction is not a weight reduction method. It is solely about shaping or sculpting the body. It is for those areas and contours you just have not been able to rid yourself of by dieting or exercise. Liposuction is best for individuals who have a stable weight but are looking to improve the stomach, outer and inner thighs, flanks, male breasts, and lower face and neck.

Our weight is very much determined by what we eat and how much we exercise. Your stable weight will be affected only by changing these two components. When liposuction is performed, this equation is disturbed but eventually the weight represented by the fat removed at the time of liposuction will all come back unless you have reduced your caloric intake or increased your workout. The key with liposuction and why it is so successful as a sculpting method is that as this weight is regained it is more evenly distributed over the body leaving the area sculpted with its improved silhouette. While it is possible to gain enough weight to over come the benefit of the liposuction, generally the improvement in contour is relatively permanent provided one’s body weight is stable.

Again, liposuction is not a weight reduction method. It is best for people with relatively stable weight and localized areas of the body that tend to retain extra fat. For women these areas tend to be the so-called saddlebags of the outer thighs, the top of the hips, flanks, abdomen, inner thighs, and inner knees. In men, it is usually the love handles, flanks, abdomen, and breasts. Some doctors advocate liposuction of the female breast but this tends to collapse and flatten the breasts. Aesthetically, most women are not excited to have the breasts flatten. It is more appropriate to consider breast surgery that improves the breast contour and projection. The lower face and neck of both men and women benefit greatly from liposuction.

There has been a great deal of concern and misinformation regarding the safety of liposuction. The main reason for this is that published studies have shown that Board Certified Plastic Surgeons are disproportionately responsible for liposuction related deaths and are much more likely to be sued for liposuction malpractice than other types of cosmetic surgeons. The State of Florida has carefully tracked deaths from office-based surgery since 2000. Between 2000 and 2007, there have been 31 deaths and 143 procedure related complications necessitating hospitalization. Of these, 8 deaths and 25 complications were related to liposuction or liposuction in conjunction with abdomenoplasty. Board certified physicians performed over 90% of these procedures. Board certified general plastic surgeons were responsible for 83% of the deaths and complications related to cosmetic surgery. In a study published in Plastic and Reconstructive Surgery, the lead journal for Board Certified General Plastic Surgeons, members of the American Society of Plastic Surgery reported an alarming mortality rate of 1 in 5000 liposuction cases! Thromboembolism accounted for 24% of the deaths. An article in the plastic surgery literature suggested that the mortality for liposuction in the hands of General Plastic Surgeons could be as high as 1 in 1000 cases (Daane and Rockwell. Analysis of methods for reporting severe and mortal lipoplasty complications. Aesthetic Plast Surg. 1999; 23:303-6). An article in the New England Journal of Medicine in 1999 looked at the toxicology of liposuction deaths and found that the mixture of lidocaine and general anesthesia contributed to the cause of death in 4 cases.

While this data is sobering, it is essential to understand that there is a much safer way to perform liposuction. Liposuction can be performed under very dilute local anesthesia and the fat can be removed with very small cannulas. This technique developed by Jeffery Klein, a Dermatologist, is widely used by Cosmetic Surgeons. In a recent review of 66,570 liposuctions performed using tumescent liposuction, there were no deaths. Dr. Steinsapir exclusively practices tumescent liposuction.

An intelligent question is to ask why there is such a big difference in the death rate associated with liposuction under general and tumescent liposuction under local anesthesia. Part of the issue is cultural and part of the issue is human nature. General Plastic Surgeons are accustom to operating on their patients under general anesthesia. Under general anesthesia there is no pain awareness by the patient. The surgeon can perform liposuction using oversized cannulas very quickly. An abdominal and flank liposuction that requires 4 hours in the office under local anesthesia may take as little as 45 minutes to perform under general anesthesia. However, there are some consequences of this speed. First, there is much more trauma. The muscles just under the fat tend to get beaten up. This translates into a prolonged recovery. Literally, it can take 6 to 8 weeks to feel normal after such a procedure. These procedures also create more blood loss even to the point of necessitating a blood transfusion. In contrast, the same liposuction performed under dilute tumescent local anesthesia is associated with almost no blood loss. Tiny cannulas that are used are no wider than 2 mm and some are the size of the needles used to deliver the dilute local anesthetic. Because the patient is awake for the procedure and only the fat to be removed is numb, the patient will report discomfort if the cannula approaches the underlying muscle. This prevents the muscles from being traumatized by surgery. Recovery is very rapid compared to the same procedure performed under general anesthesia. It is not unusual for people to return to work and their workouts in 2 days. The compression garment that is worn for 6 weeks after liposuction under general anesthesia is only needed for 5 or 6 days after tumescent liposuction. The downside is that tumescent liposuction takes significantly longer for the surgeon to perform and the surgeon needs to be prepared to talk with their patient during surgery. This means more contact time with the surgeon and ultimately a more expensive procedure. However, the increased safety and rapidity of recovery makes this a very easy choice.

Liposuction Case Study

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Frequently Asked Questions

Midface Surgery Expertise

  • Dr. Steinsapir is one of the key pioneers of midface surgery.
  • In the past 15 years, surgeons have been grappling with what is essentially a new frontier in the field: midface surgery. In contrast to many of the classic techniques of periocular plastic surgery, midface surgery is still in a process of rapid evolution and flux.
  • Dr. Steinsapir’s midface lift with hand carved ePTFE orbital rim implants is widely hailed. This workhorse procedure is often called upon for reconstructive procedures after unsatisfactory lower eyelid surgery and other complex reconstructive situations.
  • It is important to understand that his extensive training and experience permit him to offer solutions that other surgeons lack the experience to perform. Dr. Steinsapir is often called upon to fix the midface work of other surgeons. He teaches other surgeons and lectures extensively.

Benefits

  • Mid facelift addresses the descent of the malar fat pad that contributes to the under eye hollow, the midcheek groove, the nasolabial fold and the jowl at the bottom of the cheek.
  • As people age and their skin loses elasticity and tone, the cheeks and eyelids tend to sag, creating a tired or haggard look.
  • The mid facelift is a procedure to improve the look of the cheekbone area as well as the area underneath the eyelids. The Midface lift is a plastic surgery procedure that restores a smooth, youthful look to the lower eyelids and cheeks. It restores fullness to these areas and this makes the patient look younger.
  • Many of the reasons lower eyelid surgery fails are due to a failure to appreciate the role of midface descent in the lower eyelid changes. Improving an unsatisfactory lower eyelid surgery almost always involves also addressing the midface issues and the lower eyelid.

Options

  • Midface Surgery options include arcus marginalis release, tailored lower eyelid surgery, lower eyelid/midface chemical peel, fat transfer, midface surgery with or without an orbital rim implant.
  • Arcus Marginalis Release: The lower eyelid fat is surgically rotated over the orbital rim to fill the under eye hollow. The surgery is performed from a small incision behind the lower eyelid and is comfortably performed under local anesthesia. Typically 10 to 12 days are required to recover from this procedure.
  • Tailored Lower Eyelid Surgery: By carefully tailoring standard lower eyelid surgery it is possible for some individuals to improve the overall appearance of the lower eyelid as it transitions into the top of the cheek. This can be combined with a reinforcement of the orbitomalar ligament to improve bags that form at the top of the cheek.
  • Vertical Midface Lift: Significant midface issues are addressed with a vertical midface lift over a hand carved ePTFE implant. This procedure is very effective for midface deficits following trauma, and prior lower eyelid and midface surgery. Patients who previously had cheek implants and have a hollow lower eyelid syndrome due to the placement of the cheek implants can significantly benefit by having their cheek implants removed at the time of vertical midface lift. Swelling from these procedure persists 2 to 3 weeks or longer but many feel ready to return to work in 10 to 14 days. A personal consultation with Dr. Steinsapir will determine if you would benefit from this procedure.
  • Chemical Peel: Another highly effective midface option is a medium depth chemical peel that includes the lower eyelid, crowsfeet area and is feathered out over the cheek. Typically, phenol 89% is used for this purpose. Dr. Steinsapir is a master chemical peeler. These treatments are comfortably performed under local anesthesia. Recovery for this peel is 8 to 10 days before the skin is intact and able to hold makeup. Redness persists typically 6 to 8 weeks. While the redness is generally not an issue for men, women usually prefer to cover up the redness. The lower eyelid peel can be combined with a full-face peel for a truly awesome treatment with a very acceptable down time. The peel firms the lower eyelid skin tightening the midface and reducing lower eyelid fullness.

Minimally Invasive Options

  • Restylane Lyft® are highly effective at treating almost all midface deficits without the necessity of surgery.
  • These treatments last on the order of about a year. However, it is critical to get enough product in order to have a satisfactory result. How much filler is needed is an entirely an individual consideration.
  • Dr. Steinsapir will assess you and make a recommendation. Some will elect to do less treatment because of financial limitations. Dr. Steinsapir will work with you to get the most from whatever service you decide to afford yourself.
  • Facial volumizing with the Hyaluronic sugar gels is less expensive than having surgery. Yet volumizing can accomplish results that can’t be obtained with surgery. Surgery and surgical recovery is avoided. For many, the downtime associated with surgery is a big consideration. These noninvasive methods truly provide a fantastic alternative to having midface surgery. Combine this with Microdroplet™ BOTOX® forehead lift. Think of this as the liquid facelift: surgery in a syringe.

Testimonials

  • “I am thirty year old actress and the roles I perform often call for a twenty year old. It is so great to have a non-surgical treatment that lets me look 10 years younger and no one knows that I am having my face done. Dr. Steinsapir is the best.” Anonymous
  • “I only got smart after my first surgery. When I realized I didn’t heal correctly, I consulted everyone-literally everywhere. The plastic surgeons treated me like I was crazy or something. Dr. Steinsapir really understood my concerns and developed a surgical plan that made sense. I am now about a year out from surgery. My eyes close and my dry eye symptoms are so much better. Just as important, when I speak to people, talk to me and look at me like I am a human being. I feel beautiful again thanks to Dr. Steinsapir.” BX

I had a C-section with my last pregnancy. My daughter is now four. I’ve lost my “baby fat,” but I have this roll of fat just above my C-section scar that I can’t seem to loose. I saw a plastic surgeon who told me I needed a tummy tuck but I really don’t want my C-section scar made any bigger and also he told me I’ll have a scar around my belly button. Isn’t there some other option?

What you’re describing occurs when the obstetrician sweeps up the belly fat to flatten the area above the pubis before making the C-section incision. This traps fat above the incision. That is what accounts for that bulge above the C- section scar that no one likes. Tumescent liposuction is very effective at reducing this bulge. Tumescent liposuction will stimulate some skin contraction. The procedure can be done in the office under local anesthesia with minimal down time. While liposuction will not resolve all the issues, it will make a significant difference without the necessity of a tummy tuck. For many women this is a great alternative to having an incision from one hip to the other and 10 weeks of recovery.

What does Dr. Steinsapir think of Mesotherapy? Is this a good alternative to liposuction?

Mesotherapy involves the injection of solutions containing, among other things, the bile salt deoxycholate and phosphatidylcholine. These treatments are marketed under the names Lipo-dissolve, Lipodissolve, LipoShape, and Lipostabil. Other chemicals that may be in mesotherapy solutions may include: Aminophylline, Dimethylethanolamine, Glutathione, Hyaluronidase, Isoproterenol, L-arginine, Lidocaine Pentoxifylline, and Yohimbine. What you may not know is that mesotherapy is an untested, and unproven treatment with a lot of documented unpleasant side effects. Whenever a doctor (or whoever) picks up a syringe and injects fat with a mesotherapy solution, they are essentially conducting an uncontrolled experiment. Mesotherapy solutions are not FDA approved. The labs that concoct these solutions are unlicensed. In many cases, doctors buy the raw materials and mix them up in their office. There are numerous reports of infections due to the less than ideal conditions in which these preparations are made. These treatments particularly deoxycholate and phosphatidylcholine do destroy fat cells but they also damage blood vessels and produce scaring. Ultimately with a better understanding of these agents and preparation under sterile conditions, there may be a role for these agents in reducing a small fat deposit. However, at this time, Mesotherapy does not live up to the hype and represents an unreasonable danger to the public. Mesotherapy is not a replacement for liposuction.

Is it possible to get all the fat out if liposuction is performed under local anesthesia?

It is important to understand that liposuction, whether it is performed under general anesthesia, intravenous sedation, or local anesthesia, is a sculpting technique, and that the ultimate goals is shaping the body, rather than sucking all the fat out. Believe it or not, body fat plays an important functional role, and is needed to cushion the skin from the underlying muscle. When all the fat between the skin and muscle is removed, the skin sticks to the muscle and creates very unattractive results.

I am thinking about having liposuction but I am black and it seems like every needle stick causes my skin to darken around where I get poked. Will this be a problem for me when I have liposuction?

It certainly can be an issue. All skin types, including the darkest skin types, can develop what is called post-inflammatory hyperpigmentation where the skin is traumatized, including the needle tracks used to infiltrate the fat with dilute local anesthetic. Not everyone has this reaction. Generally the hyperpigmentation fades over a period of months but some people retain residual discoloration of the skin. It is appropriate to talk with the doctor regarding your concerns.

I am considering Lap-band® surgery because I am 100 pounds above my desired weight. Will liposuction help me achieve my desired body weight?

Absolutely not. Liposuction is truly a sculpting surgery not a weight reduction technique. This does not mean that only skinny people benefit from liposuction. Heavier individuals with stable weight can benefit from liposuction if it is the purpose of sculpting or shaping a localized area of fat. A personal consultation with Dr. Steinsapir will help determine if liposuction is right for you.

I am a male bathing suit model. I am 5’10” and weigh 140 pounds. In my pictures I think that I would look better if my love handles were not so obvious. Could liposuction help me achieve my goals?

Most likely the answer is yes. Even a relatively small fat deposit can be sculpted with tumescent liposuction. You probably already work out like crazy and control your diet. Liposuction is the perfect means to address this type of concern.

I am in my late thirties and I hate my arms. I seem to be getting those flabby fat deposits in my arms. Can this be improved with liposuction?

Absolutely. However, liposuction should be used to sculpt the fat deposits. If too much fat is removed, then the skin becomes deflated and this can make the area look worse. Generally the goal is a 20-30% improvement.

I previously had liposuction. I don’t think it was done with tumescent because I had general anesthesia. I definitely had an improvement but the surgery left me with some irregularities. In particular, my belly button looks like there is a donut around it. Can anything be done about these irregularities?

In general, these issues are the result of either too much or too little fat being removed at the time of the original liposuction. The donut you are describing is a common contour defect following liposuction and can be resolved or significantly improved with revisional liposuction. Even though your original liposuction was performed under general anesthesia, you are likely to do well having this addressed with tumescent liposuction under local anesthesia.

I had liposuction a few years ago and I think that in a few places the doctor took too much fat. I actually think that in a few places the skin is sitting on my muscle. Is there anything that can be done about this?

A personal consultation with Dr. Steinsapir will be very helpful so he can specifically examine your concerns and answer your question. However, in general, these areas can be grafted with your own fat as a fat transfer, which will significantly improve these types of divots.

 

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