Bosshardt & Marzek Plastic Surgery Associates

Liposuction/LifeSculpt

Suction assisted lipectomy is a technique for suctioning unwanted fat from the body. It is commonly called liposuction. Originating in France ,it is now one of the most commonly performed cosmetic surgical procedure in the United States.

In theory, liposuction is pretty simple. Tiny incisions are made in the skin around an area of undesirable fat. Thin metal cannulas with small holes at the end are introduced into the fat and the fat is then suctioned out. The procedure leaves tiny, nearly invisible scars. For liposuction to deliver on its potential as a cosmetic procedure, several conditions must be met.

Patients must be in good health. There must be available fat to be suctioned from areas accessible to liposuction. Areas treated by liposuction in women are typically the hips and thighs, abdomen, buttocks. Arms, calves, and neck can sometimes be treated. In men, typical areas are the abdomen and flanks (love handles). Some men have excess fat in the breast area and liposuction can remove this.

The skin must have sufficient elasticity so that when the fat is removed, it will retract and not hang loosely. This, more than a patient's age, determines the likelihood of a good outcome. Older patients with good skin elasticity will do better than younger patients with poor elasticity.

Given the above conditions, most patients will do well so long as expectations are realistic. Most patients will not achieve the smooth, blemish-free, firm skin contours seen in professional models unless they have this type of skin to begin with. Patients with some skin irregularities, dimpling, creases, etc. will likely have these after liposuction. Liposuction is not a treatment for the dimpled skin condition which is called cellulite. This is not a type of tissue but simply describes the puckered skin contour some women have on their thighs and buttocks. Liposuction will not make this go away but should not worsen it either.

The procedure is done as an outpatient and local, regional, or general anesthesia can be used according to the areas and extent of work to be done. Postoperatively, patients will be put into a firm, elastic compression garment which will be worn 24 hours a day for the first week or so. This helps reduce any bruising and swelling of the tissues and speeds up the recovery process. Pain is usually mild and much like a bruise. Most patients can return to routine daily activities, including work, in a few days; sometimes even the next day or so.

Much has been made of the tumescent technique for liposuction. This technique involves nothing more than the injection of fluid into the fat before the suctioning is done. The fluid used is sterile saline mixed some local anesthetic and some epinephrine, to aid in postoperative pain control and to reduce bleeding. This fluid puffs out the fat and stabilizes it, making it easier to remove. In some cases tumescent technique is used in order to perform liposuction using purely local anesthesia. This allows virtually any doctor to perform this procedure in their office but sometimes results in massive doses of local anesthesia being given and this can be toxic. We use a variant of this technique because it does improve results but we limit our amount of solution to quantities that are well below any toxic levels. Because we have the capability to provide any type in anesthesia in our surgical suite, we have can offer numerous options for our patients to make the procedure safer and more comfortable.

As with all surgical techniques someone is always seeking to improve on it. The newest form of liposuction is laser assisted. In this technique, the area is first pre-treated using a laser. The purpose of the laser is to melt the fat and enhance skin tightening to yield better results in a wider variety of patients. It is also used in areas notoriously resistant to liposuction, such as the arms.

We are pleased to offer laser assisted liposuction with the Palomar Lifesculpt laser system. Unlike other platforms (CoolLipo, Smartlipo) for laser assisted liposuction, which use one laser wavelength for both fat removal and skin tightening, the Lifesculpt system uses two patented lasers. One is the ideal for fat and the other is the ideal for skin tightening. Devices with only one laser must use a compromise wavelength between those two ideals. We feel that our unit is the most advanced and effective device on the market at this time.

Some surgeons perform large volume liposuction, removing thousands of cubic centimeters of fat at a time. This is sometimes done as a weight reduction technique. Large volume liposuction carries some real risks and most of the serious complications have occurred with large volume techniques. These should be done in a hospital and patients very carefully monitored for 24 hours postoperatively. At this time we are not convinced that the benefits of large volume techniques outweigh the risks and do not offer this particular variant of liposuction.

The ideal candidate for liposuction is the patient who is at or near their ideal body weight, or at least at a weight that they are comfortable with; who have discrete accumulations of fat in areas accessible to liposuction, and who have reasonably good skin tone that will allow for retraction after the fat is removed.

Properly done, and on carefully selected patients, liposuction is a wonderful addition to plastic surgery and is here to stay.

Arm Lift (Brachioplasty)

Fluctuations in weight, growing older and even heredity can cause your upper arms to have a drooping, sagging appearance.

Exercise may strengthen and improve the underlying muscle tone of the upper arm, but it cannot address excess skin that has lost elasticity or underlying weakened tissues and localized fat deposits.

If the underside of your upper arms are sagging or appear loose and full due to excess skin and fat, an arm lift may be right for you.

An arm lift:

• Reduces excess skin and fat between the underarm and the elbow
• Reshapes your arm to result in smoother skin and contours
• Results in a more toned and proportionate appearance

A special note: In order to achieve your improved image, there will be a scar on the inside of your upper arm.

What is an arm lift?

An arm lift, or brachioplasty, is a surgical procedure that reshapes the under portion of the upper arm, from the underarm region to the elbow. The procedure is performed to:

• Reduce excess sagging skin that droops downward
• Tighten and smooth the underlying supportive tissue that defines the shape of the upper arm
• Reduce localized pockets of fat in the upper arm region

Is it right for me?

In general, candidates for an arm lift include:

• Adults with significant upper arm skin laxity
• Adults of any age whose weight is relatively stable and who are not significantly overweight
• Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
• Non-smokers
• Individuals with a positive outlook and realistic expectations

Thigh Lift

If fitness and weight loss efforts have not achieved your goals for a body that is firmer, more youthful-looking and more proportionate to your overall body image, a surgical thigh lift may be right for you.

This surgery reshapes the thighs by reducing excess skin, and in some cases fat, resulting in smoother skin and better-proportioned contours of the thighs and lower body.

Is it right for me?

Candidates for thigh lift are:

• People whose weight is relatively stable
• Individuals with excess soft tissue along the inner or medial thigh region and/or the outer thigh
• Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
• Non-smokers
• Individuals with a positive outlook and realistic goals for what thigh lift surgery can accomplish
• Individuals committed to leading a healthy lifestyle including proper nutrition and fitness

What it won’t do:

Thigh lifts are not intended strictly for the removal of excess fat. Liposuction alone can remove excess fat deposits where skin has good elasticity and is able to naturally conform to new body contours. In cases where skin elasticity is poor, a combination of liposuction and thigh lift techniques may be recommended.

Tummy Tuck (Abdominoplasty)

An abdominoplasty, or tummy tuck, as it is commonly known, is a wonderful procedure for improving the aesthetic appearance of the abdomen. A variety of problems can be addressed by this surgical procedure- stretch marks, loose skin, excess fat, and flabby muscles.  

Many women, as a result of pregnancy, will experience loss of both skin and muscle tone of the abdomen and often this cannot be totally reversed by even vigorous exercise. Stretch marks, or striae, are a result of overstretching of the skin to the point where small tears actually occur in the deeper layer of the skin. These produce the thin, shiny, silvery stripes and “crumpled tissue paper” texture of the skin. At this time, the only effective way to tighten skin, tighten the loose muscles, and remove stretch marks is by surgically excising the skin, i.e. a tummy tuck.

People who have lost a great deal of weight will sometimes develop a fold of loose skin and fat in the lower abdomen. In more severe cases, this fold can be deep enough that the skin is constantly irritated by moisture and rubbing and this can lead to chronic irritation and even yeast infections. Correction of this requires that the loose and hanging skin be cut out.

We perform most abdominoplasties in our surgical suite. After a consultation and examination have determined that you are a candidate for this a date for surgery will be scheduled. The procedure is done under a general anesthetic and takes about two and a half hours to perform.

An incision is made in the lower abdomen. The more skin available for removal, the longer the incision must be in order to avoid unsightly puckering of the skin at the ends. The decision is designed to curve along the lower abdomen in such a fashion that it can be covered by even a small panty or bikini bottom. We will sometimes ask patients to wear something as small as they might dare to the office on the day of surgery and we’ll use this to outline where the scar will be placed.

Once the incision is made, the skin and underlying fat are released from the muscle all the way up to the bottom of the rib cage. The belly button is cut free of the skin and remains as a narrow stalk attached to the muscles in the midline of the abdomen. At this time, if the muscles need tightening, stitches will be placed to cinch them up. Once the freeing of the skin is completed, and muscles tightened if necessary, the patient is flexed at the waist and the loosened skin is pulled down toward the feet to tighten it. Everything that overlaps the incision is excess and is trimmed away. A new hole is made in the skin to which  the belly button is stitched. The incision is then closed with stitches. One or more small drain tubes are placed to suction any fluid which might build up from under the skin. Small catheters (tubes) for a pain pump are placed as well and the pump will bathe the area with an anesthetic solution for 2-3 days after surgery.

Patients are placed into an elastic abdominal binder and this completes the procedure. After recovery, patients are released to return home in the care of a responsible adult. Prescriptions for pain medications, antibiotics, and any other necessary medications are given before the day of surgery so that they will be readily available upon discharge from the office.

Patients are concerned about postoperative pain and care of their surgical site. Although there will be some tightness, stiffness, and discomfort, the routine use of a pain pump, together with prescription pain medications will keep patients surprisingly comfortable. You will be able to get up and about at home as you wish but will probably spend the first day or two mostly in bed or on a couch. The stitches require no care and will be covered with a waterproof dressing. The drain must be emptied about three times a day and the output recorded. This is very simple and painless to do and you will be shown how before leaving the office.

Your first postoperative visit will usually be on the fourth or fifth day after surgery. Dressings may be changed and the drain will be removed if there is little output. In any event it will be removed in seven days or less. Most, if not all, sutures will dissolve and need not be removed. You will receive instructions at each visit on what you can or cannot do.

Most patients can resume routine day to day activities within a few days and many can return to work in 2 weeks or less so long as strenuous physical activity is not required. Full, unrestricted physical activity such as exercise or manual labor should wait until about 4 weeks after surgery.

All of our patients are carefully followed for from 4 to 6 months after surgery. This is because there is a gradual settling process of healing before the tissues return to a normal state. During this time swelling will subside, scars will soften and fade, areas of numbness will regain feeling, and feelings of tightness will diminish. It may take 6 months or more to see the final result. Satisfaction rates are very high.

In occasional patients, the problems in the abdominal area are so severe and/or disfiguring that insurance coverage for surgery may be possible. We will let you know at your consultation if you might fall into this category and if so, we will submit a letter to your insurance company requesting pre-approval for the surgery if you wish.

The benefits of a tummy tuck are life long. As long as you don’t get pregnant again, or lose (or gain) substantial amounts of weight after surgery, the results should be evident years later. There are risks for tummy tucks, as with all operations, but complications are infrequent. Your surgeon will discuss these in detail with you at the time of your consultation.