Liposuction Update at the Millenium

Dr. Donn. H. Hickman

by Dr. Donn. H. Hickman | August 10, 2010 @ 09:00AM

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If you are someone who is generally in good health and has worked hard to get in shape, lost some extra pounds, but can't seem to shed those troublesome deposits of fat in key areas no matter how diligent and devoted you are, you may be a good candidate for liposuction and liposculpture.

What is the difference between liposuction and liposculpture?
Liposuction is the removal of medium to large amounts of contour fat to reduce the peaks and mounds that portray a heavy and sloppy appearance. These include areas such as below the chin, upper arms, outer breasts, lower abdomen, flanks, hips, and thighs. Liposculpture is the removal of small to medium amounts of fat in rather normal to full areas to sharpen features, accentuate the muscles beneath, and create a more cut appearance in the neck, lower cheeks, upper abdomen, outer buttocks, calves, and ankles.

Who are good candidates for these procedures?
These procedures are for anyone who cannot obtain the trim and properly contoured look with diet and exercise, possess good skin elasticity and are not looking to lose large volumes of weight. Patients who exceed their body weight by 30 to 50 percent may only be candidates for limited fat removal because of safety concerns and should undergo these procedures in stages. Patients who exceed their ideal weight well over 50 percent should seek other remedies for weight loss as an initial step and consult a physician experienced in weight management.

Does the removal of fat tighten the skin as well?
Not exactly. In fact, some fat deposits on the body may be unforgiving to major fat removal and lead to more relaxation of the skin. Many new methods are being investigated in order to test their effect on skin contraction and tightening. Ultrasonic liposuction has been suggested as a stimulus to skin contraction. Some cosmetic surgeons are recommending the application of laser energy to the liposuction site. Unfortunately, it is the heat generated by these modalities that is believed to be the stimulus for the contraction process. If the heat of ultrasonic and laser energy combined with the rigors of the suction pressure is applied too aggressively near the skin, it can lead to serious skin injury. On the other hand, the use of the microcannulaes at less than three millimeters in diameter, if applied near the skin in selected areas, can help achieve contraction as the fat is removed with little risk.

How do I decide whether to have liposuction, liposculpture, or ultrasonic liposuction?
The surgeon should review his experience with the various methods and analyze your body type. Some surgeons may advise ultrasonic liposuction for large volume extractions, especially in tough areas such as the back, flanks, and hips. It was designed principally for the hard to extract deep fat and to reduce surgeon fatigue. External ultrasonic energy can be applied and is recommended by some surgeons before or after the fat is removed by regular liposuction. Ultrasonic liposuction must ordinarily be combined with traditional liposuction when deep and surface fat is being removed. This does add to the operating time or to the cost of the surgery and may offer no advantage for most surgeons. For gynecomastia (large breasts in the male), some experts advocate the sole use of ultrasonic liposuction but it should not be used aggressively near the nipple skin.

Where is the surgery performed?
The surgery can be performed in the hospital, as an inpatient or outpatient, in an outpatient surgery center, or in an accredited office surgery center having capability for sedation, local sedation, or general anesthesia.

How is the surgery performed?
The patient is prepared for either local anesthesia, local anesthesia with sedation, or general anesthesia. Tiny cuts are made at the sites where fat is to be removed and a wetting solution is infused to provide some anesthesia, reduce bleeding, and improve fat extraction. If straight local is used, then the wetting solution is delivered in large volumes with a high concentration of local anesthetic to tumesce or create a glistening tightness to the tissues, so that the fat can be comfortably removed with minimal discomfort and practically no blood loss.

All the anesthesia is provided in the wetting solution. This requires careful monitoring of the local to avoid toxicity and must be performed by those experienced with local anesthesia. If sedation or general anesthesia is used, then lesser amounts of local anesthetic are added to the wetting solution and is only applied for its constriction of small blood vessels and low level of blood loss. General anesthesia does permit more areas to be treated in one session and may be more cost effective, but one must limit the total volume of fat extracted for the safety of the patient regardless of anesthesia method. The suction instruments, called cannulaes are inserted under the skin, moved in a back and forth and criss-cross fashion within the fat (under either hand syringe pressure, gas reciprocation power, or ultrasonic and/or suction-assist pressure), and the fat is vacuumed away.

The output of fat is measured in CCs, not to exceed three to five liters in the majority of patients. The patient is then checked for symmetry and the procedure is completed when a safe level of fat removal for that patient is achieved. A garment or binder is then placed over the operative site. Rarely, a drain may be placed under the skin where a lot of fat has been removed. The patient is monitored for a while to make sure she/he has received enough fluid hydration and is able to make clear urine. A responsible adult should accompany the patient home for large outpatient procedures and stay with the patient for a while, including over night.

How Do I Choose A Liposuction Specialist?
A patient should seek a cosmetic plastic surgeon who is certified by the American Board of Plastic Surgery. A consultation will help determine whether the patient is a good candidate for liposuction or liposculpture and whether the surgery may be safely performed in the office or hospital setting and under what anesthetic. If the office setting is chosen, then one must check to see if the office is accredited for Outpatient Surgery and for the level of anesthesia planned. The surgeon should also have privileges to perform the same surgery at a local hospital, which indicates some peer review and oversight mechanism for his practice of surgery. Further weight loss, stabilization of any medical conditions and perhaps a surgical contouring operation may also be advised, in the planning and patient preparation process. A discussion of fees is provided and financing can be arranged.

Dr. Hickman originally came from Miami, Florida, and attended college at Mercer University in Georgia. He was accepted to Medical School due to his academic achievements after three years of undergraduate education and then completed four years of Medical School at the University of Miami School of Medicine in 1976. He finished 6 years of General Surgery training at the University of California at Davis and obtained Certification by the American Board of Surgery in 1983. He underwent Plastic Surgery training at the University of Miami School of Medicine from 1982 to 1984, and became certified by the American Board of Plastic Surgery in 1985. He has been in Private practice in the Long Beach area of Los Angeles since 1984. He is a member of the American Society of Plastic Surgeons, and California Society of Plastic Surgeons. He is an accredited inspector for Surgical facilities under the American Association for Accreditation Ambulatory Surgical Facilities (AAAASF). He was recognized as a Top Doctor in Plastic Surgery for the Los Angeles/Orange County Area of California in the September 1999 Survey by the Washington, D.C. Center for the Study of Services in the United States 

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