Liposuction Considerations

Liposuction is a procedure to remove unwanted fat deposits from specific areas of the body. It is not a substitute for weight reduction, but a method of removing fat that doesn't respond to dieting or exercise. Before surgery, you will want to discuss several factors with your surgeon. Foremost, be realistic about your expectations. Liposuction can improve your appearance and enhance your self-confidence, but it won't drastically change your life. It is recommended that your weight be relatively normal, but you have pockets of excess fat in certain areas. You also should have firm, elastic skin. If you have loose or sagging skin, it will not reshape to your body's new contour and may require additional surgeries to remove the excess skin. Also, liposuction is not recommended if you have poor circulation or other skin complications. Discuss these factors with your surgeon as well. Your surgeon will be able to address these and other concerns with you if you are considering liposuction. For more information, contact a plastic surgeon.

Cellulite, What Is It?

Cellulite is fat which accumulates in areas where the skin and underlying tissue tend to pucker and wrinkle. These areas are commonly found around the waist in men, and in the thighs, buttocks, and abdomen in women. Some people attempt to rid themselves of cellulite using creams, gels, and wraps. These anti-cellulite products may work on a temporary basis by giving the skin a thicker appearance, however, these products are at best, a one day respite from some of the deeper craters of cellulite.

Because the puckering of the skin is due to engorged fat compartments in between the skin and underlying structures, the key to controlling cellulite is through fat reduction. This can be done by switching to a low-fat diet, by exercising, or, if the problem is unusually unsightly or persistant, through liposuction. Liposuction removes these pockets permanently but is best performed on isolated areas that remain after diet and exercise have failed to help. The best candidates for liposuction are those of relatively normal weight but who have pockets of excess fat in particular areas. You should be physically healthy, psychologically stable, and realistic in your expectations. Most important, having firm, elastic skin will result in a better final contour. Hanging skin won't reshape to your body's new contours, and may require an additional procedure to surgically remove the excess skin. This procedure will leave visible scars. For more information on cellulite, talk with a plastic surgeon.

What Will Happen During Breast Surgery?

Breast surgery is used either for medical or personal reasons. There are three types of surgery involving the alteration of breast tissue. Breast reduction, where the breasts are made smaller, is most common in women with disproportionately large breasts that cause pain to the back or shoulders.

During the breast reduction procedure, incisions are made around the nipple area and in the crease of skin under the breast where it meets the chest. Excess fat, tissue and skin are then removed. Depending on how much the breast is reduced, the surgeon may have to reposition the nipple and underlying tissue. Incisions are then sutured and the healing process begins.

The second type of surgery is a breast lift and is available to women with sagging breasts. The incisions are similar to those of breast reduction but all that is removed in the breast lift is excess skin. Finally, breast augmentation is an option for those who wish to enlarge small or underdeveloped breasts.

The breast enlargement is accomplished by use of an implant surgically placed either directly under the tissue in the breast or under the chest muscle behind the breast. Incisions can be made either around the nipple, under the breast, or in the armpit for placement of the implant. The first step for breast surgery is a consultation with a plastic surgeon. He or she can discuss your options and decide which treatment is best for you.

Placement in Breast Enlargement

A woman can choose to enlarge her breasts through a process called augmentation. This surgical procedure involves the placement of an implant under the breast in order to increase its size. There are two types of placement options for implants. A breast implant can be placed either over or under the pectoralis chest muscle. There are advantages to each approach depending on a patient's age, degree of breast sagging, and requirements for mammography. In general, the sagging breast requires an implant to be placed above the muscle in order to provide the most aesthetically contoured breast. However, an implant placed below the muscle makes mammography a little easier. These factors as well as others should be carefully considered to determine which placement option is most appropriate for you. Consult with an experienced board certified plastic surgeon familiar with both approaches.

Techniques for a Natural Looking Face Lift

Today's deeper and more advanced facelift redrapes skin and underlying tissue for a younger, natural facial look. A composite facelift, or composite rhytidectomy, is a technique that can make you look year's younger. It lifts not only your skin, but also the underlying fat of the cheeks and drapes the skin and fat back over the cheek bones. Rather than a stretched, mask-like look, the skin and fat are repositioned to your facial structure which creates a more natural appearance. the surgeon will surgically tighten your neck muscles to give you a more defined and firmer neckline.

In the composite facelift, the neck muscle that goes over the jawline is lifted with facial skin to correct any sagging jowls. This new technique is more effective and natural looking than ever before. Gone is the streched mask-like plastic look of yesteryear's facelift. Not every plastic surgeon performs this particular type of facelift. During your consultation, ask the surgeon if he or she performs the composite facelift and to advise you of the risks and benefits involved.

Mini Tummy Tuck

A mini-tuck is a partial abdominoplasty and is best performed on a patient with loose skin and muscle only in the lower abdomen. This out-patient procedure usually allows the patient to go home the same day. Although you will probably be able to recover quickly, you'll need to spend your first week primarily resting and recuperating. Liposuction, or fat suction, is often performed at the same time as the mini-tuck. An incision is made just above the pubic mound. The excess skin is cut away and the remaining skin is stitched back together again forming a tighter, firmer tummy. The navel remains in it's original place. The resulting permanent scar can be easily concealed by clothing or swim wear. After the procedure, you'll have a flatter, firmer tummy by excising loose skin and paunchiness in the lower abdomen. The success of this operation is quite high if you choose your surgeon carefully and follow his or her advice. Complications are always a risk when undergoing any type of surgery and your surgeon should discuss these in length with you.

Medium and Deep Facial Peels

A chemical peel, also known as chemosurgery, is a process that minimizes the aging effects of fine lines and wrinkles of the forehead, eyelids, cheeks, and mouth. The peel is also effective for acne or uneven skin pigmentation. A peel doesn’t give you the same results as a face lift, but is often performed along with a face lift. How does a face peel work? A chemical solution is applied to your face to peel away the top layers of the skin. A peel can be light, medium, or deep, depending on how deep into skin the solution penetrates. A deep peel, or dermabrasion, is a procedure that uses a high-speed wheel with a sandpaper-like surface to abrade the skin. This type is used when you have extensive sun damage, acne scars, or deep skin wrinkles. You may feel a burning sensation when the chemical solution is first put on, but the solution acts as a local anesthetic and masks the pain shortly afterwards. The procedure lasts a little more than an hour and is done on an outpatient basis. Afterwards, you’ll have to wear a mask made of adhesive tape for one to two days. Within 24 hours of the peel, a crust or scab will form to protect the new skin. When this falls off, the skin appears bright red as if you’re sunburned. Your skin will gradually lighten to pink, and in the end will be a lighter tone than it was prior to the peel.

Cosmetic Surgery is Increasing in Popularity

Is Everyone Doing It?
Cosmetic Surgery is Increasing in Popularity — for Some Very Good Reasons. Not so long ago, cosmetic plastic surgery was one of those "does she or doesn’t she?" topics. Except for obvious celebrity transformations such as Ivana Trump and Cher, many people couldn’t be sure why even a good friend looked so rested and relaxed after a recent trip to Manhattan or southern California. On the newsstand, articles about cosmetic plastic surgery were generally confined to magazines devoted to health. Today, however, cosmetic surgery has become a popular subject at suburban cocktail parties, coffee shops and in the workplace.

Articles about microdermabrasion ("Improve your complexion on your lunch hour!"), collagen injections ("Kiss your thin lips goodbye!") and other cosmetic surgery trends can be found every month in high profile fashion magazines such as Vogue, Harper’s Bazaar and Elle.

An Affordable Option for Millions of Americans
No longer the private domain of wealthy women, cosmetic surgery is rapidly becoming an affordable option for millions of Americans. Recently, a vibrant 73 year old woman approached a plastic surgeon at a Minneapolis cocktail party. Smiling, she said "I know who you are, I know what you do and I’ve been thinking about breast implants." As they chatted, she told him that she was a widow and that she felt it was time to do something that made her feel good about herself. She said "I could go out and buy a whole new wardrobe, but I want to do something more meaningful for myself. I realize there will be some risk, some pain and some recovery time associated with the surgery, but to me, it’s worth it." As the surgeon recounted their conversation, he smiled and said "This woman’s vitality, confidence and realistic expectations make her an ideal candidate for cosmetic surgery. I’d be honored and delighted if she chooses me to be her surgeon."

Over One million Procedures in 1998
According to statistics published by the American Society of Plastic and Reconstructive Surgeons (ASPRS), the number of cosmetic surgery procedures has increased 50 percent over the last two years and 153% over the last six years, to top the million mark at 1,045,815 in 1998. Liposuction, at 172,079 procedures, (a 57% increase since 1996 and a 264% increase since 1992) remains the most commonly performed cosmetic procedure in the United States, followed by breast augmentation at 132,378 procedures (a 51% increase since 1996 and a 306% increase since 1992), eyelid surgery (120,001 procedures), facelifts (70,947 procedures) and chemical peels (66,002 procedures).

Cosmetic Surgery for Aging Baby Boomers
The ASPS has identified a number of trends that account for these dramatic increases in the number of cosmetic surgery procedures, including the vast number of aging baby boomers, the increasingly competitive workplace and the general decrease in the cost of cosmetic surgery. According to American Demographics, over the next ten years, a baby boomer will turn 50 every 8 seconds. Since 1996, when the first boomer turned 50, the number of cosmetic surgery procedures in this age group rose from 164,662 (1996) to 242,427 (1998), an increase of 47%. Says Paul Schnur, MD, ASPRS president, "Due to healthier lifestyles, men and women age 50 and older are feeling good about themselves and want to maintain a youthful appearance. As this large segment of the U.S. population ages, we anticipate the increase in cosmetic surgery to continue."

Competitive Workplace Pressures
Increased pressures in the workplace are one reason that 9 percent of all cosmetic procedures are performed on men. In bold letters, the cover of Fortune magazine (February 1) declares that experienced executives are "Finished at 40." Inside, the article states that "…a new trend is emerging: In corporate America, 40 is starting to look old." To combat the painful reality of this trend, more and more men are choosing liposuction to eliminate their not so lovable love handles, blepharoplasty to adjust their drooping eyelids and facelifts to boost their sagging jowls. Wrinkles, crows feet and other tell-tale signs of aging are being erased with laser skin resurfacing and chemical peels. Says Dr. Schnur, "More and more men are having cosmetic surgery, not only to look and feel younger, but also to give themselves a competitive edge in the workplace."

"I don’t Want to Look Like my Mother!"
Another reason why cosmetic surgery appeals to the baby boom generation is the ability to minimize their resemblance to their parents. As the first generation to dramatically redefine adulthood in America, both men and women boomers are loathe to let Nature take its toll. Says John M., a successful 49 year old business owner, "I run and do push-ups every morning, even when I’m on the road. I watch what I eat and I just got some hip new eyeglasses. Despite my best efforts, whenever I look in the mirror, I see my dad staring back at me!"

Says Claire N., a striking woman in her early 40’s, "I’m comfortable with my age – I didn’t mind turning 40 at all. However, when someone tells me that I look like my mother, I feel like crying!" When asked if she’d consider cosmetic surgery, Claire admits that she’s already scheduled a cosmetic surgery consultation as a birthday gift to herself.

Active, youthful boomers are not the only ones choosing cosmetic surgery. More seniors age 65 and over are choosing to enhance their retirement years with cosmetic surgery. Like the boomers, the most popular procedures with seniors are eyelid surgery, facelifts, liposuction and laser resurfacing. While many Americans may question the decision to undergo surgery at an advanced age, thousands of others would no doubt agree with the vibrant 73 year old Minneapolis woman when she says "I just want to feel good about myself again."

The Silicone Breast Implant Controversy

In 1992, the Food and Drug Administration officially banned the use of silicone breast implants in most cosmetic surgeries, citing concerns over the dangers of silicone leakage in the body.

Today reputable surgeons use saline-filled implants which are less harmful when leakage occurs but may still elicit an immune response if the silicone shell the saline is housed in breaks down in the body. I've performed numerous breast surgeries in the past 12 years and I myself have had silicone gel breast implants since 1985, -- so I can understand women's concern on this issue. Ongoing studies may not produce conclusive results for many years, but here is what we know so far:

1. All Implants Can Rupture or Leak.
Most silicone gel implants, especially those manufactured prior to 1985, were known to have small amounts of silicone gel "bleed" or leak through the shell. In the early 1980's, Dow Corning developed a "low bleed" gel implant with a silicone shell that was less likely to bleed, although this leakage occurs to some extent in all silicone gel implants-even those that have not ruptured.

Since silicone-gel implants were banned for use in most surgeries in 1992, plastic surgeons today generally use either smooth-wall saline-filled implants (which are felt to have fewer problems with wrinkling) or textured saline-filled implants (which have a lower incidence of capsular contracture, a tightening or hardening of the scar tissue around the implant).

2. Silicone Leakage in the Body Can Require Additional Surgery.
When saline-filled implants leak out of the silicone shell, the salt water is usually reabsorbed by surrounding tissue without much difficulty. But when silicone bleeds through the shell, it usually requires surgical removal of the material. Fortunately, the body tends to isolate the majority of the silicone within the scar capsule, making this removal much easier. It is important that the explanting surgeon use a technique that minimizes the risk of free silicone coming into contact with bodily tissues and that all of the scar capsule be removed, since it contains silicone particles.

3. Silicone Leakage May Cause Complications or Disease Elsewhere in the Body.
In the past three years, I've seen more than 120 patients with silicone breast implants who have suffered a variety of chronic ailments. Their symptoms range in severity from mild chronic fatigue and occasional joint and muscles aches to more debilitating illnesses, such as fibromyalgia, Lupus, and rheumatoid arthritis. Some plastic surgeons speculate that a low-grade chronic infection around a silicone gel implant may lead to a chronic illness, in which the immune system is unable to eradicate the infection or dispose of the foreign body.

The good news is that we have seen an improvement of symptoms after surgeons remove the scar capsule and implants. Patients often report return of their normal energy levels, sometimes within several weeks following surgery. Some patients only experience a partial improvement, but to date most have not had their symptoms progress unless large amounts of silicone gel still remain in the body.

4. If You Experience Symptoms of Rupture, Consult Your Surgeon as soon as Possible.
Any woman with silicone gel breast implants who experiences a sudden change in shape and/or contour of her breast, or develops burning pain or numbness and tingling in the arm should be evaluated by a plastic surgeon for the possibility of implant rupture. If you experience generalized symptoms such as chronic fatigue and muscle and joint aches-and especially if these symptoms are progressive-you may wish to consider removal of the scar capsule and implant, even if tests do not show a ruptured implant. If the symptoms are severe, I would not advise replacement of the implants with saline implants-recovery is often delayed if the saline implants are replaced at the time of implant removal.