The LIPO SHOW: Buying the Perfect Body 

LIPOSUCTION. HEAR THE WORD, AND YOU MAY WELL envision the 35-year-old woman who has made the rounds on TV's daytime talk shows. She has had 22 cosmetic surgeries, including plenty of lipo. She is a five-foot-seven Barbie doll. On one cheek, there's a tiny flower tattoo. Basically, she bears no resemblance to the girl she was in high school. Now, she is beautiful. But, was it worth the cost, emotionally and physically? This Barbie clone would probably say, as she did on television, that yes, indeed, it was. She loves turning heads, commanding attention, and having hordes of men snapping at her heels.

At the same time, though, she is not the typical lipo patient, according to Texas plastic surgeons who do the lion's share of such procedures. Liposuction's the number-one leading cosmetic surgical procedure today, and doctors in the Lone Star State do a large percentage of those national statistics.

Interestingly, though, the age range of takers is much wider than most would imagine. People from 17 to 70 are looking for less fat in certain areas, and they aren't reticent about asking for it.
"One of my best cases was a woman in her 70s who backpacks," says Kimberly Finder, M.D., a San Antonio dermatologist. "She had an abdomen that was bigger than she wanted, so she had liposuction. Then she went on a backpacking trip and said it was the best one ever because she finally didn't have that stomach to contend with."

Dr. Finder's clinic is devoted exclusively to liposuction for females. "This way, I have a staff and clinic doing nothing but liposuction," Dr. Finder says. "When a woman comes to see a doctor about liposuction, it's very important to her. There's a lot of emotion wrapped up in that decision, and I think it's important to explore how she feels, and it's good for her to be in the right environment."

Some patients fear that the doctor who examines them will be judgmental. "There's a big comfort factor in coming to my clinic since I have an all-female staff. It's a private, comfortable place where they can come and have outpatient surgery," Dr. Finder says. "I'm not aware of any other clinic in the country doing just liposuction for women. People come back to see us, and they're teary-eyed about how happy they are. We see women from their 20s to their 70s."

Finder decided to devote her medical practice to liposuction when she discovered how frustrated women became when their workouts and healthy diets failed to eliminate outer-thigh saddle-bags. "What women dislike most is feeling like they don't have control," she notes. "They've exercised, watched their diets, and still have problem spots." Often, according to Finder, a woman will say, "I have my mother's hips or Aunt Matilda's big arms."

'I have this problem.'

"When women come in for a consultation, some are very emotional, while others are matter-of-fact," says Dr. Finder. "Many of our patients have researched it, and they know the pros and cons of liposuction and the safety of it."
Many women fixate on body parts they dislike. "The harshest critic everyone has is herself," notes Dr. Finder. "Then, I look at the problem, and it's not as had as they're making it out to he."
She adds, "This is fun work because you can offer something for women to reshape their bodies, to fix the irregularly proportioned fat deposits you won't be able to get rid of with exercise."

One of the most-asked questions, of course, is: How soon will I see results?   "A week to 10 days," says Houston plastic surgeon Joseph Perlman, M.D., adding that after three weeks, the swelling is down. 

WHAT LIPOSUCTION CAN DO is removing localized areas of fat, says Dr. Perlman, adding, "But it's not an
alternative to dieting." Patients often ask if the fat that's removed will return. "I tell them, you will gain and lose weight in your new shape we have created for you," says Robert Dickey Peterson, M.D., Houston plastic surgeon. "All the fat cells we remove are gone forever."

A commonly asked question about liposuction is how much pain is involved, says Houston plastic surgeon James Moore, M.D. "That varies from person to person, but in my general experience, any pain is easily managed with oral pain medication," he says.
Good candidates for liposuction: "A good candidate is a woman in her 30s or 40s who stays in shape," says Dr. Perlman. The ideal patient has "good skin," which means it's still supple and flexible and will "reshape" after lipo.
 
"There are distinct hereditary factors that affect skin," notes Dr. Finder. "Some people have a skin type that's stretched easily You can have a woman who gains 100 pounds and her skin is still tight, and someone else who gains 30 pounds and her skin is shot."

But liposuction won't fix the looseness problem, explains Dr. Finder. "It won't make loose skin tighter."
The psychological aspect of having lipo should be considered. "Patients need to be doing this for the right reason," says Dr. Finder. "It won't solve relationship problems." Most people, she contends, have very realistic goals. "It's the rare patient who wants to be a '10.' Most don't expect that at all."
Henry Mentz, M.D., Houston plastic surgeon, notes that fit individuals are well-suited for plastic surgery because they know which areas of their bodies don't respond to exercise and correct diet. "Persistent areas of fat are perfect for liposuction treatment," explains Dr. Mentz. "Loose skin that doesn't tighten up with exercise is perfect for lifting, like the breasts, the face, and the abdomen."

Melrose PlaceThe ideal liposuction candidate, says Dr. Peterson, is at or near her ideal weight. "The less perfect candidate is further away from her ideal weight."   Although liposuction is not a treatment for obesity, some doctors do operate on those who are overweight. Dr. Moore refers to a special area of liposuction referred to as high-volume. "I don't do that, but if I have an obese person come in, I'll send them to Mark Gilliland (M.D.), who does high-volume liposuction."

Dr. Peterson defines high-volume liposuction as "removing more than five liters at one time, which is well over a gallon of fat."

Cultural ideals
Women and men have a lot to live up to if they are obsessive TV-watchers. Whether it's a Calvin Klein underwear ad or the fit femmes of " Melrose Place" we're surrounded by cultural ideals that are almost too beautiful-bodied to be believed. And that's enough to send some of us to plastic surgeons in search of solutions.

"Women are bothered by their abdomen, outer thighs, inner thighs, and the lateral aspect of the buttocks, which respond well to liposuction because those areas have fat pockets that seem to be better localized and can be more easily accessible to the canula," says Fred Aguilar, M.D., Houston plastic surgeon.

"People are very aware of what they want," says Dr. Aguilar. "They bring in a picture of Demi Moore, who has gotten her body to where she needed to have it for the movie 'G.I. Jane and the idea are to give their surgeon a rough idea of what their goal for liposuction is, even though most patients don't expect to end up with the body of Demi Moore." He adds, "Fashion magazines like Vogue are promoting the idea of sculpted upper arms—women who have worked out or look like they have worked out," says Dr. Aguilar. "You can reshape arms with liposuction, but you have to have enough muscle underneath to give a sculpted look."

Let's pretend
Lets say a woman with a pear-shaped figure goes to see a plastic surgeon; she never exercises, but wants to have liposuction to improve her shape. "If she doesn't have a lot of fat so the skin isn't overly stretched, we can contour that person to more feminine proportions and curves, and it will look better," says Dr. Aguilar. "The problem with women who don't exercise is that the muscle is more wasted...therefore, the muscle doesn’t add to the shape of an arm or leg."

For that reason, Aguilar often recommends working with a personal trainer before or after having liposuction, so the increase in muscle mass will give added shape.

"Let's say I'm doing liposuction on a 38-year-old woman who has had two kids and is a size 10, which isn't very overweight, but she wants to be better sculpted in the areas where fat is causing drooping and making her more pear-shaped," says Dr. Aguilar. "Because we can suction enough fat to recontour her body, she can now fit into a size 8. At 38, she probably won't need a tummy tuck. If she were older, she might." He explains, "What makes a tummy tuck necessary is that when you have more fat, the skin loses its ability to recoil when fat is taken out. Factors that influence that are our age and how much fat has been underneath the skin, stretching it."

Dr. Aguilar notes, "It's not a bad idea for your doctor to do the lipo, and then wait a few months to see if the skin tightens up. If it doesn't, then a tummy tuck may be needed."

Causes for pause

According to Dr. Peterson, women seek liposuction for the stomach, lateral and medial thighs, knees, back, and arms, while men want fat suctioned from their love handles, chin, abdomen, and chest.
Dr. Perlman thinks women worry most about "saddlebags and belly, where they have localized fat that makes those areas disproportionate with the rest of their body" He adds, "And once the fat is gone, it doesn't come back."

After some people have liposuction on their thighs, the skin droops, making a thigh lift necessary for the best result. The down-side of a thigh lift, according to Aguilar, is that you're left with a large scar. "We plastic surgeons don't like scars," he says matter-of-factly, "but sometimes, a woman will take a big scar over wrinkly skin," he says.

Dr. Perlman thinks the thigh lift (in con-junction with lipo) is a good solution for a woman whose legs have some excess fat but also have droopy skin tissue due to the effects of gravity "I take out a goodly amount and suspend the tissue," he says. "There's a scar in the crease where butt and thigh come together, and you're sore for about two weeks."

Answering a common question, Dr. Aguilar explains, "We don't suction all the fat. If you take all the fat out of an area, we're going to have skin on muscle, and it won't look human. We desire women because their curves are gentle and not sharp or angulated, and fat is responsible for giving a woman beautiful curves.

"So, the point is, we try to make sure a woman doesn't lose her femininity with this procedure. When we put our arm around a woman, we expect softness. In other words, softness isn't something you should be trying to get totally away from (except in the case of arms)."

Finetuning on the far end of the lipo spectrum is a procedure that could be viewed as icing-on the-cake for an already fit male or female body. Called abdominal etching, this procedure selectively removes a small amount of fat around the patient's natural muscular contours, according to Dr. Mentz.

PRIOR TO DOING THE PROCEDURE, Dr. Mentz makes detailed markings of the ab muscles while the patient stands before him, flexing. Mentz will then follow these markings to remove fat and high-light the patient's individual muscular structure. "The fat pad over the muscle is thicker and obscures the muscular detail," Dr. Mentz points out. "Using abdominal etching, we can selectively remove a couple of ounces of fat and get the right look."

A person who wants abdominal etching should be relatively young and very fit. Typically, abdominal etching on females is a modified version of the procedure.

Another kind of finetuning comes in the form of multiple procedures," making your trip under general anesthesia kills two or more birds (procedures) with one stone. "Sometimes, I do liposuction in combination with a tummy tuck or breast reduction," says Dr. Perlman.

Dr. Peterson notes that in a healthy per-son, liposuction can be done in conjunction with other procedures. "But you have to be careful with multiple procedures," he says. "It all falls back to surgical judgment. If you're not a good candidate, a 13-hour operation isn't a good idea."

Surgi-babble on an initial visit for liposuction, you may be confused by talk of tumescent and ultrasonic, traditional and super-wet. You've heard 'about it, read about it, yet doubt if you'll ever get the jargon down. But, basically, all you need to understand is that this procedure is predictable and safe, thanks to technological advances and more experience.

"With both ultrasonic and traditional liposuction, you have to prepare the fat by injecting a large amount of fluid (saline solution with zylocaine and adrenaline)," explains Dr. Moore. "In tumescent, or super-wet, you're removing fat with a hollow tube (canula) that has suction on the end of it," he says. "With ultrasonic, you're inserting a solid tube that emits a sound wave and emulsifies the fat and then you suck the emulsified fat out with a hollow tube, but you don't need suction that's as strong to get it out."

Performing traditional liposuction is so physical that it helps to have a doctor who is in good shape, notes Dr. Moore. "Ultrasonic is easier, but it has more limited application—you can't go around curves. It's a straight wand."

"The old liposuction, 20 years ago when it was first started, was dry," explains Dr. Peterson. "But very few people do it that way anymore. Most use some form of tumescence because it minimizes bleeding and permits you to take more fat out safely"

"With ultrasonic liposuction, the canula vibrates 22,900 times a second," Dr. Peterson adds. "Ultrasonic is like going to a pecan tree and having nuts fall out, compared to conventional liposuction, which is like taking out branches—you remove entire cells and tissue. Ultrasonic is excellent in that it permits us to remove more fat safely, combined with conventional liposuction. I use ultrasonic in almost every case. It's very good in certain areas like male breasts and the back. With the old way, in doing male breasts, we couldn't get the canula through." Ultrasonic is also effective on the "double bubbles" under a woman's bra, Peterson notes. "Ultrasonic glides through heavy fibrous areas very efficiently"

"Syringe liposuction means that instead of having the canula hooked to a machine, it's hooked up to a syringe," says Dr. Perlman. "This kind of liposuction is used to touch up. It's a long haul for a short gain because it's very hard." In contrast, he says, ultrasonic is a breeze. "It's not as labor-intensive as traditional liposuction," explains Dr. Perlman. "I'm tired after doing regular liposuction, going through the fat back and forth. In doing the abdomen and thigh, you do it about 1,000 times," he says. "You move an inch and do it some more. Sometimes it doesn't glide through easily, but using fluid (tumescent technique) makes it glide better."

According to German Newall, M.D., tumescent liposuction can be effective even in obese patients with large fat-volume removals. "By varying the amount of fluid injected, blood loss can be reduced in a liposuction patient of any size."

Dr. Newall cites advantages of ultrasonic over traditional lipo: possible less blood loss in obese patients; less surgeon fatigue in very large fat-volume removals; fibrous areas (male breast and back) are easier to perform with ultrasonic than with blunt-tipped canula. By the same token, he adds, there are disadvantages of ultrasonic compared to traditional liposuction, including the possibility of burns; the necessity for longer incisions; greater possibility of seromas (fluid collection that may require drainage); longer operative time; and greater expense.

Most surgeons use general anesthesia when they do liposuction. Dr. Finder, how-ever, likes doing the tumescent technique with a local anesthetic. The patient is talking to me during the procedure," she says. "They feel movement, pressure, twinges. It makes the doctor gentler during the procedure, which means the patient will be less sore afterward.

Downsides
"In some liposuction patients, ripples can be a problem," says Dr. Perlman. "The late Frank Gerow, who was a professor of mine at Baylor ( Medical School ), said that before surgery, if you point something like that out to a patient, it's an anatomic variant. After surgery, it's our fault."

In other words, the problem may have been there, but once a patient has liposuction, she may want her surgeon to take responsibility for all physical flaws, even those that existed prior to surgery. Bottom line: Liposuction can't make you perfect; it can only make you a little more perfect than you were before.

People should be aware, cautions Dr. Peterson, that liposuction results aren't as good on those with poor skin tone. "You may get dimpling or saggy skin if it doesn't shrink and reshape," he says, adding that the compression garment does, however, help skin to shrink up.

Talking shop, post-op
"The first 24 to 48 hours, you can expect to be swollen and experiencing some tenderness and bruising," explains Dr. Peterson. "After six weeks, you'll begin to see your results, although even in seven days, some change is apparent.'

One post-op hassle you must endure is wearing a girdle-like compression garment for about six weeks. "That's not a hard and fast rule," notes Dr. Perlman. For facial lipo, the compression is worn for two weeks at night. The purpose is to help restore your skin's original elasticity.

After liposuction, you should expect a certain amount of soreness. "For a day or two, you'll feel like you ran a marathon," explains Dr. Perlman. "If you have liposuction on the front and hack, you'll be sorer."

Another caveat: no rigorous physical activity for three weeks after surgery.

Pleased people

PATIENT Satisfaction WITH liposuction is good," relates Dr. Perlman. "If someone isn't happy, though, I'm always willing to do what I can to make them even happier."

Occasionally, doctors report that a patient's view is obscured by the fact that she gains weight afterward and wants to blame her surgeon for "not getting enough during lipo." At the same time, though, others find having liposuction exactly the inspiration they needed to lose weight and shape up.

Dr. Moore recalls the case of an 18-year¬old college student who had large fat deposits around her hip and thighs. "I'd done a face lift on her mother, who wanted to see if there was anything that could be clone for the girl, who was bothered by the way she looked," he says. "The surgery came out great. Her skin shrunk down real well. Her personality has changed. She used to dress in loose, frumpy clothes, and now she wears miniskirts. For her, it reduced her hip rolls (like love handles in men) and her large

pones that extended in to her buttocks. She was really happy with the result."

Cost of the perfect body to give you some ballpark figures, Dr. Perlman's fees are: stomach liposuction, $1,000; inner and outer thighs (both legs), $2,500-$3,500; Gynecomastia (men's chest), $1,500; love handles for men, $1,000; face lipo, $750. Remember that most doctors' estimates don't include anesthesia. And insurance companies seldom pay for cosmetic procedures.

Dr. Moore's fees for liposuction are $1,500 to $7,000. "If you're having every-thing done, it's about $7,000 to $8,000," he notes. "The average is $4,500 for the doctor, operating room, and anesthesia."

And so...
Describing his total body contouring approach to liposculpture, Houston plastic surgeon Christopher Patronella, M.D., says, "It's important to address the issue of ideal body proportion with feminine body con-touring during the process of liposuction rather than traditional spot fat removal that often leaves poor contour lines."

"I wish more people knew that liposuction is safe and easy," says Dr. Finder. "It's very frustrating when you see these shows on TV that tell only one side of the liposuction story Overall, though, today's patients are knowledgeable about liposuction because it's so well publicized and described and accept-ed. They've read about it on the Internet and in magazines...”  

Dr. Peterson emphasizes , "What people need to understand is that liposuction is not a weight reduction operation; it's a volume reduction procedure. I don't like to talk about pounds when a patient wants to know how much weight she'll lose. We reshape the area, and generally, patients are incredibly happy."

BY DIANE STAFFORD 

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DIANE STAFFORD

Source: Texas Women Magazine
http://www.texaswomenmag.com

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