John Q. Cook M.D. - 10 Things You Should Know About Liposuction.

Ten Things You Should Know About Liposuction

Liposuction is best concerned with improving body form, rather than weight loss. I have not been particularly impressed by the results of liposuction as a weight reduction mechanism. Unfortunately, it is often marketed as such. It always makes me sad when a very good surgical procedure is misapplied. Liposuction can achieve a wonderful modification of body lines in the properly qualified patient.
What the doctor leaves is as important as what he or she takes. Liposuction should not be about removing every last ounce of fat underneath the skin. When it is approached in this way, skin tone suffers and there is almost always an undesirable looseness of the skin. In addition, removal of too much fat will leave an inartistic result, in which the graceful curves of the human body are altered in a strange way.
Patients who obtain long-term value from liposuction go into the procedure with healthy habits. I like to describe liposuction as one leg of a tripod. The other two legs of the tripod are healthy eating habits and a good pattern of exercise. If liposuction alone is used to achieve a particular body form and these other two areas are neglected, the result will probably be unstable. This is not emergency surgery. Why not use the surgery as a wonderful motivator to achieve those goals you have always desired? Most of us (including myself) are procrastinators when it comes to changing habits. It is just too easy to put off the change for another day. The decision to proceed with surgery can force us to make the necessary change in our habits. We have had a large number of patients who have used this motivational approach, and it has offered them results that are good at five and ten years after the surgery. This is because they have built a base of healthy habits going into the surgery.
Please investigate carefully the credentials of the physician who will care for you, as well as the facility where you will undergo your surgery. Liposuction, when performed by a properly credentialed surgeon with good judgment in a top quality facility, can be an extremely safe procedure. On the other hand, a poorly trained doctor can cause you serious harm. You cannot learn the relevant surgical anatomy overnight, and you certainly can’t achieve consistent high quality artistic results without years of experience. There are organizations that offer weekend courses in liposuction to doctors with little or no surgical training. Contrast this, if you will, to the experience level of a board-certified plastic surgeon. This individual will have gone through five to eight years of advanced surgical training after medical school, will have been tested in rigorous written and oral examinations, and will have been subjected to scrutiny as to the ethics of his practice, before achieving board certification. You would always be well advised to ask your surgeon who his or her employer is. In most cases, the answer to that question will be simple, as the doctor will be self-employed, or working with a group of high quality doctors. An interesting development in the Chicago and other big urban marketplaces, is the arrival of marketing organizations that aggressively solicit patients for liposuction and other plastic surgery procedures. For some of these organizations, the main profit comes not from revenues from surgery, but from high interest rate loans. The surgery is merely a vehicle to “capture” loan customers. Unfortunately, there are demographic models that can predict those individuals who will not be able to pay off their loans quickly. These individuals, of course, are highly profitable for such organizations. I feel compelled to mention this development because it is an important issue for patient protection. For a physician to be of service to his or her patient, it is necessary for the doctor to honestly advise the patient when surgery may not be in their best interest. If the business model is simply to trap as many people as possible into high interest rate loans, this sort of safeguard may not exist. In any organization, it is the owner who sets the standards. That is why I feel it is important for you to know exactly who this person is.
Liposuction is really about adjusting the curves of the body. At its best, liposuction can be a wonderful form of human sculpture that can be pleasing for both the doctor and the patient and offer true long-term value. It would follow logically that the doctor should be able to articulate what he or she is trying to achieve in terms of the lines of your body. I would suggest that if the doctor is not able to articulate these issues, then it will be difficult to obtain the goal, since it is a basic principle of human nature that we are much more likely to be able to achieve a goal if we can articulate it clearly. If this sort of communication does not seem to occur during your interview with the doctor, I would suggest that you may want to keep looking and find someone who can explain the procedure and its goals in a way that makes sense to you.
Liposuction is not about the latest gadget. This is a favorite distracter in marketing campaigns. There are a number of techniques and technologies available for liposuction and each surgeon has his or her preferences. Beware of the surgeon who claims to be the only one with the special gadget that will confer magical results. I know of surgeons whom I consider to be absolute masters of liposuction technique, who produce consistently wonderful results, and do so just with classical liposuction. True success in this procedure comes from experience, skilled hands, and a highly developed artistic sense.
Please be very careful with high volume liposuction. As I have already mentioned, I am not particularly keen on liposuction as a weight reduction tool. I have just seen too many patients who have had liposuction when they were overweight and haven't managed to obtain significant long-term improvement. Be that as it may, if you insist on using liposuction for this purpose, be very careful about the setting in which the surgery is done. Even in a robust and athletic individual, the physiologic changes that occur when more than five or six liters of liposuction is carried out, can be quite dramatic. I would not recommend a person to undergo high volume liposuction in an office setting, and I would even wonder about their wisdom of doing this in a surgery center. There are significant fluid shifts that occur in the body and physiologic changes which are best monitored in a hospital setting. A good percentage of the bad outcomes from liposuction that I have heard of have occurred in high volume procedures.
Skin tone is extremely important and must be carefully evaluated by the patient and the surgeon. If the skin has excellent elasticity, it is possible for the surgeon to be more aggressive. As fat is removed, the skin will maintain a good position. On the other hand, for individuals whose weight has cycled up and down quite a bit, very often the skin tone will be significantly diminished. In such individuals, when fat is removed, the skin will often not contour in very well. There may be significant surface irregularity, and even loose folds in some cases. For most people, this would not be a very good trade-off. There are ways you can determine this on your own. If you examine an area of the body where you want liposuction, pinch the skin immediately overlying the area. If the skin feels tight and springs back quickly, you probably have good skin elasticity. On the other hand, if you can pinch a good amount of skin and it hangs loosely, this may impose limitations. Depending upon your goals, more limited liposuction may still be of help to you, but it is certainly important for you to discuss these matters carefully with your surgeon.
My overall impression is that the best results from liposuction are getting better, but the not-so good results may be getting worse. It is impossible to determine the exact reasons for this, but let me offer some speculation. I think that the reason that the best results are getting better is partially related to improved technique and equipment. Probably more important, is that there is a larger number of highly experienced surgeons doing the procedure, there is better understanding of proper patient selection, and a better set of artistic concepts for the procedure. As we have mentioned already, this is not a contest to see how much fat can be removed, but it is more a sculptural exercise. I also have some thoughts as to why some of the less than ideal results seem to be getting worse. I think that this is in part related to poorly-trained individuals coming into the market. Anyone with a medical license in the State of Illinois can legally perform liposuction. I also fear that as cosmetic surgery becomes, at least for some, an exercise in aggressive marketing, the patients’ best interests are not always served. This can sometimes lead to the use of a procedure in an individual who really isn’t the best candidate for it.
Please make certain that your procedure will be carried out in a safe
environment. At the very least, find out what organization has accredited the facility where your surgery will be performed. Although the accreditation process is not perfect, it at least assures that certain standards of equipment and documentation are carried out, and some of the credentialing organizations, such as the Joint Commission, are really quite rigorous in their standards. You should also know who will be supervising the anesthesia in your surgery. The possibilities here range all the way from a board-certified anesthesiologist to someone lacking even basic credentials. There are some surgeons, particularly in the office setting, who will supervise the anesthesia on their patients. This is usually in the setting of IV sedation rather than a full general anesthetic. I am not particularly impressed by this, as it is then asking the surgeon to concentrate both on the artistry of the surgical procedure and the nuances of anesthetic care. This will save a little bit on the cost of the procedure, but is it really worth compromising safety?

I hope that this summary will be of use to all perspective patients considering liposuction surgery. I do not mean to suggest by the tone of this piece that liposuction is not a good procedure. In fact, with proper patient selection and a highly skilled surgeon, liposuction produces an extremely high percentage of satisfied patients with excellent long-term results. This is probably the reason why liposuction, in recent years, has become one of the most popular procedures offered by plastic surgeons.

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