Dr. Andrew Barnett MD Cosmetic Plastic Surgeon

Liposuction

Liposuction is subtractive sculpture. The goal is to safely remove as much fat as possible, respecting the body's shape and proportion to produce a beautiful form...

-Andrew Barnett, MD

No recent development in cosmetic surgery has caused as much excitement in the field of body sculpting as has liposuction. Liposuction allows the skilled surgeon to change a patient's face, neck, and body contour by permanently removing and reshaping localized collections of fat. Though not a treatment for generalized obesity, liposuction can produce dramatic results in the right patient. Exciting new developments in this procedure, tumescent anesthesia and ultrasound assisted liposuction, have greatly improved this established procedure.

What actually is "liposuction"?

Liposuction is the removal of fat through the use of a powerful suction machine. Tiny skin incisions are made, and a very thin tube is placed into the area that needs to be sculpted. Suction is then applied and through careful movement of the tube, the fat is removed.

Is it painful?

As with most surgical procedures, anesthesia is used. In some cases, a local anesthetic is sufficient, while at other times, general anesthesia is suggested. After the procedure, patients are uncomfortable and stiff, much as after a vigorous exercise workout, but severe pain is very unusual. Mild pain pills are generally adequate for comfort.

Who can benefit from liposuction?

Liposuction is best for those patients who are within twenty pounds of their ideal body weight, and have fatty areas on their body which have not responded to diet and exercise. Virtually any area of the body which seems to be out of proportion to surrounding areas, because of fatty deposits, can be changed with liposuction. After the fat is removed, the overlying skin will shrink to fit the new contour, much like a ribbed sweater shrinks so one size fits all. The problem is that just as the sweater becomes worn with age and loses some of its stretch, so too skin may lose its elasticity. In that case, slight irregularities in the skin can be expected. Age itself should not determine your suitability for the procedure, as I have performed liposuction on patients as young as sixteen and as old as eighty.

How do I know if my skin is good?

The best way is to be examined by a specialist with experience. It's important to realize that even if your skin is not just right, liposuction may be helpful for you. Many patients complain that they have difficulty looking good in clothes because of heavy hips and thighs. They may be a size eight on top, but a size twelve on the bottom. It's the disproportion which bothers them. Even though their skin may not be ideal, they're willing to accept the slight irregularities which would be visible only in a bathing suit, so that they'll look better in clothing.

Won't exercise or diet cure the problem?

Exercise and diet are great, and I strongly encourage them. Unfortunately, they won't help areas of disproportion. Along with the color of our eyes and hair, body shape is strongly influenced by heredity. You distribute your body fat in a pattern determined by genetics. Areas such as lovehandles, heavy thighs, double chins, and chubby bellies, may stay heavy regardless of your general weight. Spot weight reduction is simply not possible through diet or exercise. When you lose weight your general size is reduced, but your body shape is basically unchanged.

Will suctioned fat come back?

No! That's one of the most interesting and frequently asked questions about liposuction. Many studies have been done which show that by the time we reach adolescence, the total number and distribution of fat cells are fixed. When we gain weight, we don't increase the number of cells, we just make each individual cell larger. Likewise, when we lose weight, the cells get smaller. Changes with liposuction are permanent in that actual cells are removed, and they won't be replaced. Therefore, if you have a disproportionate number of cells around your hips, that disproportion will be corrected. When you subsequently gain or lose weight, those areas will also gain or lose, but the disproportion will not be there.

Are there risks with liposuction?

While there are risks, in the healthy patient they're quite small. As with any surgical procedure, there are risks of bleeding, infection, and scar formation. Irregularities in the skin, with rippling and depressions can occur. In addition, asymmetry between sides, when for example both hips are done, may occur. Depending on how you heal, swelling and bruising can be present for a variable period of time, and in rare cases, slight increase in skin pigment can occur. There have been reports of embolism to the lungs after liposuction, and even death. These risks are listed not to frighten you, but to inform you. Although they are possible, they're unlikely. I will be happy to discuss any questions you might have regarding the procedure.

How long does it take to recover?

Recovery time is variable depending on the particular area of the body, and the individual. Patients generally go home the same day as the surgery. Elastic bandages or tight fitting garments are applied at the end of the surgery and remain in place for one week. Although many patients go back to work in as little as three days, I generally recommend one week off from work. Bruising and black and blue last one to three weeks, and most swelling is gone in six weeks.

What is tumescent anesthesia?

Developed in the late 1980's, tumescent anesthesia is a technique where large quantities of dilute anesthesia solution is placed in the areas of proposed surgery. The technique has dramatically changed liposuction. Blood loss is greatly reduced and pain from the procedure has decreased significantly. General anesthesia, once required for most liposuction, has become optional for many procedures. Tumescent anesthesia is used in almost every liposuction case I perform.

What is Ultrasound Assisted Liposuction?

Ultrasound Assisted Liposuction (UAL) is a new and very exciting development in body sculpting. Developed originally in Europe, where over 50,000 cases have been performed, UAL became available in the U.S. in 1997. UAL uses ultra high frequency sound waves to "melt" fat prior to its removal. Through a skin incision slightly larger than the standard liposuction incision, a UAL cannula is placed into the fatty deposit. When the ultrasound is applied, the fat surrounding the end of the cannula is liquified and is removed with much less suction than conventional liposuction.

Has UAL replaced conventional liposuction?

Absolutely not. Conventional liposuction is actually more precise and must be used in conjunction with UAL. UAL is most effective in areas of "fibrous fat", the upper abdomen, love handles, back, and breast area, particularly in men. It is generally not used in the thighs, legs, and facial region. In your consultation, I will discuss UAL and its possible application to your particular needs. There are some additional risks and costs involved with UAL, and these will be discussed as well.

What about laser assisted liposuction, or "smart liposuction"?

Laser assisted liposuction, also referred to by the commercial name of “Smart liposuction” uses laser energy to melt fat cells prior to removing them with conventional liposuction. Like Ultrasonic liposuction, the energy is “tuned” to target fat cells over other tissues. The theoretical advantage of laser liposuction is that there is less bleeding and it can reduce cellulite. This has not been proven and in fact the manufacturer in their own brochure hedges by writing “(Laser assisted liposuction) may improve the body’s shape and may improve cellulite to a certain degree.” There are no good studies that show that laser assisted liposuction offers any significant improvement over conventional liposuction. Under any circumstances, it is only recommended for very small areas, it increases the time for the liposuction, adds some additional risk, and adds additional cost. At the current time, I am evaluating laser assisted liposuction, but at this time, I am not using it in my practice.

What about the cost of liposuction?

Cost vary depending on the areas in question. My fees reflect the attention and expertise I bring to this artistic procedure. At your consultation, you will receive a written price quote which will outline the anticipated costs, including the surgical fee, operating room fees, and anesthesia fees as necessary.

Is liposuction right for me?

The best way to decide that is to speak with a plastic surgeon who has a large experience and specializes in liposuction and body sculpting. It is important to find a surgeon who has an artistic touch and sensibility. Speak frankly, ask questions, and explain your expectations. At your consultation, we will work together to make the decision that's right for you.

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“I am a registered nurse… so after a lot of research and speaking to other physicians and fellow nurses… my decision was made. He is an artist and I believe the best in his field. Now my favorite thing to do is shop for bras. Thanks Dr. B, you are truly the best.”

-AN, RN, Napa, CA

“As a physician, I know about physician hype and marketing, the go to surgeon nonsense… Having lived and worked in the Bay area for many years, when it was my time I asked colleagues who performs consistently excellent facial work. Your name came up repeatedly… While I was impressed with your professionalism, it is the artistic, balanced, natural result that reminds me everyday that I made the right choice putting my face in your hands. Thank you.”

-LC, MD, Palm Springs, CA

“When I tell people that I have two adult children, they look at me and say, “You must have been a child bride.” Well I love the look on their faces when I tell them I’m 63. Sometimes I say “You know, Dr. Barnett is my secret weapon”, but most of the time I just say, “Oh, I guess I’m lucky. Good genes…” If they only knew! You are wonderful.”

-JG, San Francisco, CA

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Copyright 2014. All rights reserved. Andrew Barnett, M.D.