Friday, August 31, 2007
Tummy Tucks and Liposuction
(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 tucks1 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.
1Cosmetic Procedures: Tummy Tuck ( Abdominoplasty)
Are sit-ups just not giving you the taut tummy you desire? If you've got a little too much flab or excess skin in your abdomen that won't diminish with diet or exercise, you may want to consider an abdominoplasty, popularly referred to as a "tummy tuck."
This procedure flattens your abdomen by removing extra fat and skin, and tightening muscles in your abdominal wall.
But be cautioned: This is a major surgery, so if you're considering it, take the time to educate yourself, thoroughly analyze your own situation and do not rush to make the final decision.
A tummy tuck should be the last resort for people who have exhausted all other measures, and the procedure should not be used as an alternative to weight loss.
Who Are the Best Candidates For a Tummy Tuck?
A tummy tuck is suitable for both men and women who areWho Should Not Consider a Tummy Tuck? in good general health overall.
It should not be confused with a liposuction (the cosmetic surgery used to remove fat deposits), although your surgeon may elect to perform liposuction as part of a tummy tuck.
Women who have muscles and skin stretched by multiple pregnancies may find the procedure useful to tighten those muscles and reduce that skin. A tummy tuck is also an alternative for men or women who were obese at one point in their lives and still have excessive fat deposits or loose skin in the abdominal area.
Who Should Not Consider a Tummy Tuck?
If you're a woman who is still planning to have children, then you may want to postpone a tummy tuck until you're through bearing children. Here's why: During surgery, your vertical muscles are tightened. Future pregnancies can separate these muscles.
Are you still planning to lose a lot of weight? Then you do not want to consider a tummy tuck.
It's important to note that a tummy tuck can cause prominent, permanent scarring. If this is something you don't want, you may want to reconsider. Your doctor will discuss all these options with you when you go for the consultation.
How a Tummy Tuck is Done
Depending on your desired results, this surgery can take anywhere from one to five hours. The complexity of your particular situation also will determine whether you have it completed as an in-patient or outpatient procedure.
You will receive general anesthesia, which will put you to sleep during the operation. It's important to have someone with you who can drive you home. If you live alone, you also will need someone to stay with you at least the first night after the surgery.
There are two options for a tummy tuck. You and your surgeon will discuss your desired results, and he or she will determine the appropriate procedure during your consultation.
· Complete abdominoplasty. Your abdomen will be cut from hipbone to hipbone in this procedure, the option for those patients who require the most correction. The incision will be made low, at about the same level as your pubic hair.
Your surgeon will then manipulate and contour the skin, tissue and muscle as needed. Your belly button will have a new opening if you undergo this procedure, because it's necessary to free your navel from surrounding tissue. Drainage tubes may be placed under your skin and these will be removed in a few days as your surgeon sees fit.
· Partial or mini abdominoplasty. Mini-abdominoplasties are often performed on patients whose fat deposits are located below the navel and require shorter incisions.
During this procedure, your belly button most likely will not be moved. Your skin will be separated between the line of incision and your belly button. This type of surgery may also be performed with an endoscope (small camera on the end of a tube). The procedure may only take up to two hours, again, depending on your own personal situation and the complexity of your needs.
How to Prepare For Tummy Tuck Surgery
If you smoke, you will have to stop for a certain period as determined by your doctor. It is not enough to just cut down on smoking. You must stop completely for at least two weeks prior to surgery and for two weeks after. Smoking can increase the risk of complications and delay healing.
Make sure you eat well-balanced, complete meals and do not try to diet excessively before the surgery. Proper nutrition plays a key role in healing properly.
If you take certain medications, your surgeon may instruct you to stop taking these for a certain period before and after the surgery. Your surgeon will determine this as part of your pre-operative consultation.
Before undergoing the surgery, you'll need to get your home ready for your post-operative care. Your home recovery area should include:
· Plenty of ice packs
· Supply of loose, comfortable clothing that can be taken on and off very easily
· Petroleum jelly for incision sites
· Telephone within reaching distance
· Hand-held shower head and bathroom chair
You know yourself best, so make sure you set up the safest, most comfortable recovery area before you undergo the surgery to meet your personal needs.
What Are the Complications and Side Effects of Tummy Tuck Surgery?
As expected, you will have pain and swelling in the days following surgery. Your doctor can prescribe a painkiller if needed and will instruct you on how to best handle the pain. Soreness may last for several weeks or months.
You may also experience numbness, bruising and overall tiredness for that same time period.
As with any surgery, there are risks. Remember, this surgery affects a very crucial part of your body. Though they're rare, complications can include infection, bleeding under the skin flap or blood clots. You may carry an increased risk of complications if you have poor circulation, diabetes or heart, lung or liver disease.
You may experience insufficient healing, which can cause more significant scarring or loss of skin. If you do heal poorly, you may require a second surgery.
As we mentioned before, the scars from a tummy tuck are fairly prominent and though they may fade slightly, they will never completely disappear. Your surgeon may recommend certain creams or ointments to use after you've completely healed to help with the scars.
Taking Care of Yourself After Surgery
Whether you're having a partial or complete tummy tuck, your incision site will be stitched and bandaged. It's very important that you follow all your surgeon's instructions on how to care for the bandage in the days following surgery. The bandage used will be a firm, elastic band that promotes proper healing. Your surgeon will also instruct you on how to best position yourself while sitting or lying down to help ease pain.
If you are an exceptionally physically active person, beware: You will have to severely limit strenuous exercise for at least six weeks. Your doctor will advise you on this as you go through the process. You may need to take up to one month off of work after the surgery to ensure proper recovery. Again, your doctor will help you determine this based on your personal situation.
Return to Living
Generally, most people love the new look after they've undergone this procedure. However, you may not feel like your normal self for months after the surgery. You've gone through a tremendous amount to make this happen, both emotionally and physically, and it's very important that you follow proper diet and exercise to maintain your new look.
Does Insurance Cover a Tummy Tuck?
Be warned: Insurance carriers generally do not cover elective, cosmetic surgery. But, your carrier may cover a certain percentage if you have a hernia that will be corrected through the procedure, or your anterior muscles are abnormally spread.
It's extremely important that you begin communicating with your insurance company early on, and that you discuss your insurance concerns with your surgeon. In most cases, your surgeon will write a letter to your insurance carrier, making the case for medical necessity, if it applies to you.
It's also very important to realize that insurance may only cover certain portions of the surgery, so make sure you get details. With any cosmetic surgery, this may affect future insurance coverage for you and your premiums may increase.