Tape measure, close-up


For those of us who have inherited familial tendencies that have us accumulating fat in certain areas, liposuction is a miracle tool, says Dr. Michele Koo of Aesthetic Surgery Institute. “It should not be used for weight loss; its function is to contour and smooth areas of disproportionate fat accumulation due to genetics,” she clarifies. “We all have lumps and bulges that 98 percent of the population can’t get rid of on their own.”

Koo says areas most amenable to liposuction include the thighs, waist, tummy, hips and the chest for men who have gynecomastia (abnormal breast enlargement). “Liposuction is extremely safe in the hands of a board certified plastic surgeon who performs the surgery regularly,” she says.

“And the fat removed won’t easily come back to that specific area, because the fat cells themselves have been removed,” she explains. Koo uses both ultrasonic and low-energy laser liposuction, depending on the problem area. The goal, she says, is to maximize the amount of fat removed and minimize the blood loss. First, the energy is delivered, then the emulsified fat cells are removed. Recovery time depends on the number of areas liposuctioned and the volume of fat removed. “If only the abdomen or thighs are treated, recovery may be as short as two days for return to a sedentary job.”

Plastic surgeon Dr. Terry Myckatyn of Washington University’s West County Plastic Surgeons also uses several different types of liposuction, depending on the areas to be treated. “True liposuction is surgery, regardless of the type,” he emphasizes. “It may include traditional liposuction, power-assisted liposuction, Vaser (ultrasound-assisted), or SmartLipo, a brand of laser-assisted liposuction. There are some treatments touted as ‘non-invasive’ that target the fat from the outside without surgery, but they don’t remove the actual fat cells.”

Myckatyn says one of the best techniques now used involves injection of a tumescent solution. “The injected solution includes normal saline, a vasoconstrictor to shut down small blood vessels, and lidocaine, a topical anesthesia to provide numbing,” he explains. “We do small areas in the office, larger ones in the operating room.” He uses SmartLipo on the neck or other small-volume areas because it seems to produce a modest amount of skin tightening, he says. Vaser, ultrasound-assisted liposuction, is the method of choice for male breast reduction because there is proof it works better on the fibrous fat of male breasts and does a better job of removing that fat.

Myckatyn says when considering liposuction, clients should have a body mass index of 30 or less. Also, he says, the doctor you choose is more important than the type of equipment. “I would rather go to someone who does more than 300 standard lipo procedures a year than to someone who has a fancy machine and took a weekend course,” he says.

Dr. Roque Ramos of Slim Image adjusts the type of liposuction to the situation. He always injects tumescent solution, he says, because its vasoconstrictor and local anesthetic are more comfortable for the patient, resulting in less bruising and easier removal of fat cells. The tumescent solution creates a space between the fat and the skin, making it less likely for heat to reach the skin, he explains. He says the heat also stimulates collagen fibers to tighten the area after the fat is removed. Ultrasound-assisted liposuction works by using sonic waves to rupture fat cells and make them easy to remove.

A new machine, FDA-approved six months ago, uses water for liposculpting. The process is somewhat different, Ramos explains. The tumescent solution is injected at the same time the fat is being suctioned out. Water under pressure dislodges fat cells more gently without destroying the cells. Ramos uses the machine to harvest fat cells he’s going to reuse for fat grafting in other areas of the body: the breasts, buttocks, face, backs of the hands and even ear lobes.