Liposuction Irregularites: Excessive Fat Removal Can Be Difficult to Treat

Do any of you know a friend whose liposuction results were less than optimal?  Consider the following patient...

I had a few question about revision liposuction.  I'm tall and slender (5' 9", 145 lbs.), and I had small pockets of fat around my flanks and outer thighs that I had VASERed last May. [The VASER is the latest and greatest ultrasonic liposuction machine.]

At the time, most of my friends thought I was crazy for getting anything done, since most people thought I looked good in a bikini.  My thighs were smooth with no dimpling or cellulite, even though I'm 46. I look much younger than my age with good muscle tone (I'm an ex-dancer, and I still workout everyday), and I have very good skin elasticity.

I had the ultrasonic liposuction done by a dermatologist who does VASER procedures in New York City.  I ended up paying way too much, considering I could have had the same areas done with traditional lipo for less, but I figured, since there was very little there, I would do the VASER.

Now almost 10 months after the procedure, I still have the SAME small pockets of fat on my flanks.  My outer thighs, while slimmer, are very dimpled with contour errors.  I went from people telling me I look good in a bikini, to not even being able to wear short shorts--because of all the dimpling on my thighs from the procedure.

The doctor who performed the procedure offered to fix one leg for free, but I am not going back to him.  If he couldn't fix it when it was perfectly smooth, I doubt that he could now since it is so severely dimpled.  Also, I've read many horror stories about revisions that made things worst.

I probably should have gone to a respected plastic surgeon to begin with instead of a dermatologist with a talent for PR, and this time I don't want to repeat the same mistakes.  I would like to fix the contour errors on my thighs and do things the right way, as a way of making amends to myself for this disaster, so I would like to ask a few questions.

1. Are there any plastic surgeons with a specialty in revision liposuction?
2. Do you think I should stick with traditional lipo for revision work in order to get the best results, since I am so disappointed in the VASER?

Really tough situation.  How should I answer?

Tummy Tucks: What if You Have Already Had Operations on your Belly Button?

It's not uncommon that patients ask me what I do with the belly button during an abdominoplasty (also known as a tummy tuck).  The short answer is...

• I preserve the belly button that your mother gave to you.
• After I tighten the skin and muscles of the abdominal wall, I make a new hole for the belly button, and I suture the belly button into its new position.

This technique works because the belly button has a dual blood supply....

• from the surrounding skin
• from its "stalk"

When I perform an abdominoplasty, obviously I disrupt the blood supply from the surrounding skin.  However, I preserve the blood vessels from the stalk.  Hence, with at least one good blood supply, the belly button continues to have good nutrition, and so it heals without incident.

What happens in the patient who requests a tummy tuck but whose umbilical stalk has probably been disrupted?  Here is a recent question from one of my patients...

My question is about my umbilicus. I had a lap chole [a laparoscopic cholecystectomy, which is the removal of the gall bladder through tiny incisions with the aid of a small video camera].  And I have had an umbilical hernia repair. (The hernia was quite big from 3 pregnancies).  Due to that, I have no umbilical stalk--no blood supply to the umbilicus.  How would you go about creating a belly button during my tummy tuck?  Is it possible to "create" an authentic looking belly button during the tummy tuck procedure?  Or does it have to be done at a later date?

Difficult, huh?  What should I do?

Breast Reductions on Smokers: Proceed with Caution

Recently, I refused to perform breast reductions because the patient was a heavy smoker.  My concern was for her well-being.  Smoking is the single greatest contributor to complications after all types of plastic surgery.

However, one of my colleagues did reduce this patient's breasts, and the patient healed uneventfully.  She sent me the following note:

I have heard all of the issues related to smoking and breast reduction.  In fact, you told me personally you would not perform a reduction on me unless I stopped smoking.

I had a reduction in October.  I had cut down to two cigs a day, and I have had NO problems at all.

My question is...

• Do you think everyone is different in healing?
• Or did I just get lucky?

My plastic surgeon has 34 years of experience, and he didn't seem too worried that I smoked!

Breast Asymmetry: A Real Patient's Struggle

Recently, a patient presented me with the following scenario:

At age 18, I had a breast reduction on one breast and breast augmentation on the other, due to radically asymmetrical breasts.  Since my small breast was so small, the doctor used a small implant, and there was still a considerable difference in size between the two breasts.  Moreover, the implant immediately encapsulated, leaving a small, hard bump high on my chest.

Fast-forward 30 years:  The natural breast is large, sagging, empty on top, and full on the bottom; while the implant remains a hard bump, with a flat triangle hanging beneath it.  As you can imagine, this looks pretty bad naked, and it is difficult to find clothes to disguise it.

Because of the capsular contracture of the initial implant, I'm not really keen on the idea of replacing it with a larger implant--I'm afraid of ending up with a large, hard bump instead of a small one! The only alternative that's been offered to me is to remove the implant, do a lift, and reduce the other breast to match. I'm a pretty large woman, and I don't want two itty, bitty breasts.

Are there any alternatives to implants? Is there any way to use fatty tissue to fill up the small breast?

There is no "right" answer to her problems.  My goal is to customize a plan that will work for her.

Extreme Makeover after Weight Loss: "Can You Fix My Tummy, Pubis, Buttocks, Arms, Breasts, and Thighs All on the Same Day?"

NO!

Safety must always come first.  Combining major plastic surgery procedures can be dangerous, even if each individual operation is safe when performed by itself.

The extreme makeovers  seen on television are deceptive.  When you watch the shows, you don't always realize that the patients are returned to the operating room on multiple occasions to achieve the desired results.  All those implants, liposuction, tummy tucks, etc., are usually not performed at the same time!

Weight-loss patients are unique because they are frequently concerned about multiple areas on their bodies, and many would like to have a whole body make-over.

Breast Implants: "Should I Wait Until I've Completed All My Pregnancies?"

It's up to you.

Many young women are interested both in breast augmentation and in having children.  They frequently wonder...

• Are breast implants dangerous for the baby?
• Do breast implants create issues when breast feeding?
• Will the implants still look good after pregnancies?

My short answers:

• Among mothers with implants, breast feeding is safe for the babies.
• On the other hand, breast implants may decrease the chance (by about 5-10%) that a mother can successfully breast feed.
• Breast implants may improve chest appearance both before and after pregnancies and breast feeding.
• Ultimately, a patient must decide for herself after she has had a chance to consider the facts....

Medical Tourism: "Should I Go to Mexico for Plastic Surgery?"

Probably NOT.

Medical tourism has become increasingly popular.  A few recent newspaper articles have even praised "medi-tours."  However, as an American Board Certified Plastic Surgeon, I am firmly opposed.

Since I practice in Southern California, I take care of 5-10 patients each year, whose aesthetic surgeries were botched during overseas plastic surgery adventures.  After paying for the cost of secondary management (hospitalizations, prolonged antibiotics, wound care, etc.), each recognizes that her plastic surgery would have been performed much less expensively in the US.

To me, the thought of obtaining medical care—especially surgery—overseas is ridiculous.  Plastic surgery is real surgery.  It is not at all similar to the TV programs.  Plastic surgery really hurts.  It requires real recuperation.  Real complications happen frequently.