Saturday, September 22nd, 2012
My latest article printed in the Plastic Surgery Post:
We all want to lose fat. But not all of us want to go under the knife to do it.
According to the American Society of Plastic Surgeons, last year 204,702 Americans underwent liposuction, making it the third most common cosmetic surgery performed. This is in stark contrast to 2000, when 354,015 Americans had liposuction, making it the most popular cosmetic surgery of that year.
Our population appears to be getting heavier and heavier. So why is there such a decline in people undergoing liposuction?
One possible factor is the emergence of FDA-approved, nonsurgical fat reducing devices. More and more people are having their fat removed without going under the knife. In 2010, the FDA approved Zerona, the first device cleared in the U.S. for circumferential reduction. While multiple studies show this treatment to be effective-when combined with dietary changes, exercise and supplements-the ability to control where the fat is reduced is minimal.
The next nonsurgical liposuction device to receive FDA clearance, Zeltiq, was cleared by the FDA approximately a month later. This novel device reduces the thickness of fat by aggressively cooling it. Although Zeltiq undoubtedly works, the large treatment head allows fat to be removed from only a few locations, such as the hips and abdomen.
This brings us to Liposonix. In September 2011, the FDA approved this device, which reduces fat by blasting it with ultrasound waves. These are the same ultrasound waves that can allow us to see into a pregnant woman’s tummy. Studies found that after one treatment, patients lost an average of an inch from the circumference of their waist. This is equivalent to one pant or dress size. Best of all, unlike Zerona and Zeltiq, Liposonix can reduce fat in just about any part of the body the patient chooses, including the arms and outer thighs.
While these treatments are no doubt popular and effective, patient expectations are key. None of them will give results comparable to liposuction. In fact, the variability of changes in the before-and-after photos is huge. Some patients appear to have dramatic results, whereas others have changes that can barely be seen.
In the end, if you want to get rid of fat, then diet and exercise is the best way to go. If you’re unwilling or unable to lose those problem areas the old-fashioned way, then liposuction is still the gold standard. It’s safe, effective and can achieve dramatic results. However, if you don’t want surgery, have modest expectations, and have $1,000-2,000 burning a hole in your wallet, then one of these nonsurgical liposuction devices may be right for you.
Thursday, August 2nd, 2012
There is a very interesting study that was recently published in Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons (ASPS). From the ASPS website:
The new study by ASPS Member Surgeon Eric Swanson, MD, Leawood, Kansas, evaluated 301 patients having liposuction, either alone or in combination with abdominoplasty, using standardized photographs and computer-assisted measurements of body dimensions obtained preoperatively and at least three months after surgery. The study revealed no evidence of fat regrowth in treated areas of the arms, abdomen, or lower body. Additionally, upper body dimensions were unchanged after surgery, indicating no fat redistribution. Average reductions in hip measurements remained significant in patients followed one year or more after both liposuction and combined liposuction/abdominoplasty procedures. The average hip reduction was significant even among a subgroup of 34 patients who gained five pounds or more after surgery.
“Previous studies have evaluated small numbers of patients and used imprecise measuring techniques, limiting their power to reliably detect changes,” said Dr. Swanson. “Our study included a sufficient number of patients and used precise measurements, making the conclusions highly reliable. Patients can be reassured that their improvements will last and they need not worry about putting weight back on disproportionately.”
Dr. Swanson adds, “Of course, liposuction does not change your ability to gain or lose weight. Its value is in permanently reducing the number of fat cells in problem areas. For any given weight you will be in the future, your proportions will be better after liposuction, barring extremes in weight gain.”
The results of this study are in stark contrast to the one published in Obesity last year. That study revealed that fat removed via liposuction appeared to return to other unoperated areas of the body, such as the arms.
I’ve been performing liposuction surgery for the past 11 years. I’ve never had a patient claim that the fat removed from one area, such as the thighs, returned to another part of the body. I inform my patients that, in general, if you keep your weight stable, the fat that is removed via liposuction doesn’t come back. It’s nice to have some scientific proof of that now!
Tuesday, October 4th, 2011
A new study recently presented at the annual conference of the American Society of Plastic Surgeons has found that liposuction will not only make you thinner, but can also potentially decrease the triglyceride content in your blood.
According to ABC News:
Researchers studied levels of cholesterol and “bad” fats called triglycerides in the blood of more than 300 patients who were undergoing liposuction. Patients who had elevated triglyceride levels before the procedure showed an average 43 percent reduction in their triglyceride levels after they had liposuction.
The patients showed no changes in their cholesterol levels, but researchers did find a post-liposuction reduction in counts of white blood cells, which are associated with heart attacks, obesity, strokes and high blood pressure.
While this is the first study to show any beneficial health effects in removing subcutaneous fat via liposuction, it’s still a stretch to say that the procedure alone makes a person healthier. Recent thinking has correlated fat which cannot be removed via liposuction (a.k.a. visceral or intra-abdominal fat) to a higher risk of heart disease, not subcutaneous fat.
Liposuction is obviously not a substitute for a good diet and regular exercise. It’s primarily meant to treat stubborn areas of fat in people who have a healthy body weight.
Friday, August 26th, 2011
This is great. One of the contestants on Celebrity Big Brother has had no shame in showing off his impossibly sculpted six pack. This is when abdominal etching (specialty liposuction to make the fat look like a six pack of muscle) goes horribly wrong. Who ever saw a man with a potbelly have a six pack? He looks like a Teenage Mutant Ninja Turtle!
The newest form of abdominal etching is called Hi Def Liposculpture, and is performed by a small group of highly trained plastic surgeons. The results can be very impressive, but the TMNT shown here demonstrates that not everyone should be a candidate for this surgery. As he gets older and his skin sags, I betcha it’ll turn into a twelve pack or party ball!
Wednesday, May 4th, 2011
There is a fascinating liposuction study recently reported about in the New York Times. This new study, from the University of Colorado, focused on whether fat removed via liposuction can come back in a different area. From the NY Times:
In the study, the researchers randomly assigned nonobese women to have liposuction on their protuberant thighs and lower abdomen or to refrain from having the procedure, serving as controls. As compensation, the women who were control subjects were told that when the study was over, after they learned the results, they could get liposuction if they still wanted it. For them, the price would also be reduced from the going rate.
The result, published in the latest issue of Obesity, was that fat came back after it was suctioned out. It took a year, but it all returned. But it did not reappear in the women’s thighs. Instead, Dr. Eckel said, “it was redistributed upstairs,” mostly in the upper abdomen, but also around the shoulders and triceps of the arms.
Is this really possible? I do a lot of liposuction surgery (probably over 150 a year) and have never had a patient come back and claim that, while their weight remained stable, fat returned to a different body part. I’ve always believed, as many plastic surgeons, that the fat removed from liposuction is gone forever. As long as the patient keeps his or her lifestyle the same, the fat should not return. Dr. Ramona Bates, a board-certified plastic surgeon in Arkansas, and author of the excellent Suture For a Living Blog, explains her theory about this in a recent post, which can be found here.
When I did my fellowship in Beverly Hills, one of our employees underwent liposuction twice. She would laugh that she could gain weight and every year just have it liposuctioned back out. Joking, I’d reply that eventually she’d have a tiny little body but chubby fingers and toes. Maybe there is actually some truth to that!
In Stitches News: I will be doing a book signing and reading at Schuler Books in Okemos, Michigan at 7pm Thursday, May 5th. Hope you can make it! For more, click here. Please be sure to buy a copy of my book, In Stitches, on sale via Amazon.com or BarnesandNoble.com today to read all about the shocking, secret life of a plastic surgeon!
Saturday, February 26th, 2011
The latest journal of The American Society for Aesthetic Plastic Surgery reveals a survey that found the majority of cosmetic plastic surgeons prefer traditional tumescent liposuction over all the other types of liposuction put together. According to the study:
• Most currently employ or have previous experience with SAL (traditional tumescent lipo – 92.7 percent), UAL (ultrasound assisted lipo – 59.6 percent), and PAL (power-assisted lipo – 44.7 percent). Fewer have experience with LAL (laser assisted lipo – 12.8 percent), mesotherapy (5.7 percent) or noninvasive devices (12.8 percent);
• Preference rates for fat-removal techniques were 51.4 percent for SAL; PAL, 23 percent; UAL, 20.9 percent; LAL, 3.9 percent; and noninvasive devices, 0.8 percent;
• Respondents felt that newer fat-removal technologies compared unfavorably with more traditional methods in terms of complications;
• Most respondents (68.3 percent) felt that marketing was the most common reason that patients choose newer treatments such as LAL.
These results mirror my opinions of these treatments. I recommend to my patients the following:
1. Regular SAL for most first time female patients who was looking for a significant fat loss (1 liter or greater of fat to be removed)
2. UAL (I use Ultrasculpt) for men with gynecomastia (breasts) or people having revision surgery.
3. LAL (I use Lipolite) for small areas, such as under-the-chin.
4. I do not use PAL, although am interested in purchasing a machine some day. I do not recommend mesotherapy (not FDA approved).
5. I believe the nonsurgical treatments like Zerona and Zeltiq work, but expectations and patient satisfaction are my big concern with these modalities.
Make sure to consult a REAL plastic surgeon who is a member of The American Society for Aesthetic Plastic Surgery (ASAPS)!
Thursday, April 13th, 2006
What is the most common plastic surgery for celebrities? The following comments are my opinion only, deduced after working as a Hollywood plastic surgeon for a time and becoming a pop culture and celebrity plastic surgery “expert.” By far the most common cosmetic procedure is Botox. Botox has gotten so widespread in Hollywood nowadays that I notice when people do not have Botox more than when people do. This was most evident when I watched Tea Leoni act all flustered in that Adam Sandler clunker, “Spanglish.” She had so many forehead wrinkles and crow’s feet in that movie that I found it almost distracting to watch her. That many forehead wrinkles are rarely seen in beautiful Hollywood actresses today, so I applaud her for going au natural.
As far as surgery goes, the top three in my opinion are liposuction, breast augmentation, and rhinoplasty. All three of these occur much more often in celebrities than in the normal population. Breast augmentations are often obvious (hello Mariah Carey!), whereas liposuction can be difficult to determine (I’ve had people tell me that J. Lo has had it done numerous times), and rhinoplasties are either good (Halle Berry?) or bad (Jennifer Grey?). There are many more celebrities who’ve had these surgeries done than most people may realize. (I even believe that the great Julia Roberts has had her nose done!) At some point, the normal population may catch up with Hollywood celebrities in the amount of plastic surgery performed, but by then the celebrities may have gone onto bigger and more drastic ways to keep themselves young and relevant. Maybe they will have started cloning themselves by then. Just what we need, another Carrottop!
Have a great Easter! My son Daniel (3 months old) is getting baptized on Easter Sunday, so we are very excited…