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Liposuction

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At least twice a day someone asks me this question, and since I’m a surgeon, I used to just blow it off with the answer: “Oh, that doesn’t really work. To get the stubborn fat pockets off that won’t go away with diet and exercise, you need to have a lipo.”

I am not retracting my answer, but I would like to clarify.

For the wish lists of nearly all of my patients, this is true. This non-invasive/no-downtime fat reduction procedure cannot take the place of a lipo. Usually. It does not work like a lipo, and will never replace what a liposuction surgeon can do it. But it does do something.

I would put it this way: Compared to doing nothing, it works. Compared to doing lipo, it works a little.

Unfortunately, there is a lot of deceptive advertising of the “fat freezing” procedure—I don’t know about other cities, but here in Los Angeles the billboards make it look like if you sign up, you will be one fat freeze away from having the body of a supermodel. This is NOT the case. Unless you are one of those absurd people who already have that body.

I have yet to come across an objective guide to “fat freezing” by an expert for the consumer, so I decided to create one myself, with the help of my friends at Ava MD who always have the latest and greatest lasers, and are honest about all of them.

“Five things to know about Cool Sculpt”

      1)  “Cool Sculpt” is the brand-name for the fat freezing machine made by the company Zeltique. It works by killing fat cells by freezing them, and then over time your body eliminates the fat, meaning you pee it out. The traditional machine has a “clamp” that is really good only for the love handles and abdomen. If it is used anywhere else on the body, it can make a dent. It can still make a dent regardless if not done properly. There is a new machine that has a flat plate and that can be used for other problem areas like saddlebags, knees, and inner thighs, or other areas that are not “pinchable.”

2)  It is a painless procedure that takes an hour per area. (ie) ONE love handle (flank) is ONE area. So YES–to do BOTH sides, that’s TWO HOURS sitting there, if the place you go to only has one machine. There can be some bruising and soreness, and a “pulling” sensation, but it doesn’t require taking pain medication and you can go on about your regular routine afterwards.

3)  Each area usually has to be done at least twice, and should not be done closer than three months apart. It takes several months to see a result, so you will not see an automatic body sculpting like you do with liposuction. So results might not be visible for six to nine months. This system cannot give you liposculpture results. The system is supposed to kill up to 30% of the fat cells in an area, but the result is never guaranteed. I know some people that have had a great result with it, and some that saw no difference. The ones that saw no difference probably needed more treatments.

4)  Okay, so this is the kicker: COST.  At a reputable place, it will usually cost approximately $800/area. That’s EACH SIDE.

So to do both love handles, that’s $1600, and most likely it has to be done more than once to be effective, so that’s $3200 over a period of six months to see the difference. The average cost for a lipo of that area—that is going to GUARANTEE a result immediately– is usually not much more than that. So It’s not as inexpensive as it first sounds.

5)  If you ARE going to do it, and you are in the L.A. area, go see my girls at AVA MD. They have been doing it for a long time and will be honest with you about your expectations. They also do give discounts when you buy packages.

  • ***Note: Remember–with a fat freezing procedure, your fat cannot be used for cosmetic enhancement of your face, breasts or buttocks—a procedure that starts to sound like a really good idea when you get older.

Hope that was helpful! I’m warning you—if anyone starts asking me about “that fat freezing thing,” I’m going to direct you  to here. J

XO

LQ

For those of you who think you don’t know what “Level One Trauma” is, you do. It’s what medical TV shows are made of. If there’s a screeching ambulance pulling up to the hospital, five paramedics holding I.V. bags and shouting things, an Emergency Room full of George Clooneys and McDreamys waiting to crack a chest or drill a hole in someone’s head, and then about ten more outrageously attractive doctors running after the stretcher toward the operating room, it’s a Level One Trauma. While these procedural TV showsE.R., Grey’s Anatomy, and even my personal favorite, Emily Owens, M.D.(so bummed it got cancelled, especially after she finally got the guy)—tend to have a disproportionately large volume of Level One Traumas compared to the average medical center, it is not uncommon.

Laura Sharpe is the survivor of the kind of helicopter crash that you see in an action movie. The three other passengers died instantly. Laura’s life immediately changed from one of dealing with the everyday challenges of being a dedicated wife and mother, to a four-year struggle of overcoming pain and learning to walk again. When I met her a few months ago, she seemed like just another attractive woman who takes care of her figure, and wants a little body contouring in her middle age. Then when she got undressed, I saw a road map of scars on her torso and legs that I haven’t seen since back in my general surgery days.

The scars caused indentations and bulges on her back and abdomen, “pincushioning” pockets of fat where there shouldn’t have been any. Plus she had the usual accumulation of “muffin top” that we all start to see in our forties, no matter how much we work out. She was a great candidate for a lipo–once the  pockets of fat were gone, she had the body of a fitness model again. I was glad that she was so thrilled with her results, but I found it interesting that after all of the previous reconstructive procedures she’d had to rebuild her face and body, she was especially excited about this one.

Please know that I am ABSOLUTELY NOT advocating liposuction as part of Level One Trauma post-op treatment, but Laura really wanted to write a guest blog to share her experience so here it is in her own words:

I am Laura Sharpe, a Level One Trauma survivor.  A grateful Level One Trauma survivor.

 At almost the 5 year mark after the 2008 helicopter crash and following….

 43 fractures, 40% of my lower body burned, major bone infection with partial amputation, major brain trauma injury, approximately 50+ surgeries and doctors, 40 – 60 hour medical work weeks for 2 1/2+ years, 100 lb. weight swing , 6 day physical therapy work weeks….

 Level One Trauma is sudden, it happens in an instant, it’s unexpected and it’s devastating.

 Level One Trauma is physical, life threatening trauma that requires immediate medical attention within one hour to save your life. It most often involves disfigurement, disability and the need to re-invent one’s self, as one’s life is never the same as it once was.

 This recovery requires a methodical medical sequence of approach and a long, long time.

After the rehabilitation had been completed–the surgeries, weight gain issues, physical therapy and retraining of the body and mind—I was still left with a severely disfigured version of my former self. My abdomen and back were lumpy, due to the dramatic scarring from all of my surgeries. My asymmetric quasi-moto body was a constant reminder of the nightmare I had endured. Yes, I was a survivor. And I am grateful for that. But still…

 No matter how hard I tried and how much physical training and body therapy, I could not achieve a balanced look to my body.

 Six weeks ago…I made a decision to have a sculpting surgery called liposuction to assist in my process. This is not something I would have ever before in my life considered doing.

 After much research into liposuction, what it is and who I would entrust to do this body sculpting surgery…enter Dr. Suzanne Trott. 

 As founder of Artists For Trauma…where “Recovery is an Art,” I recognize the artist in Dr. Trott . 

 With her detailed artistic eye, laser-like focus, and an astute understanding of the human anatomy and its system functionality, she draws her approach beforehand to surgically sculpt the body much like a sculptor sculpts marble, bronze and clay. 

 With all this said, Dr. Trott removed fat cells from remaining stagnant traumatized areas of my body. All of a sudden I can see the results of these past years of physical therapy because Dr. Trott removed the remaining surface fat. 

And yet it was determined that all of the accumulated removed fat cells added up to only two pounds!   

 Really…? Really.

 I was astounded! 

 Who knew what two pounds could do!  Wow!

 I feel wonderful. The liposuction sculpting process is a powerful healing and artistic surgical tool in helping an individual recovering from disfigurement to reconnect with their body’s physical appearance in a more positive way.

 And this re-connection and new acceptance a person may gain is so positive and empowering in the process of healing one’s self-perception.

 All because of removing a couple of pounds of fat.

 Who knew? … What two pounds could do!

So basically the liposuction had uncovered the body she’d been working so hard to get back. Not even years of physical therapy, weights and cardio could spot reduce what she was trying to get rid of. I don’t think you have to be a Level One Trauma Survivor to understand that J.

Post-op she put on our new Lipo Queen™ Shape Wear garment, looked in the mirror and said, “I’m the sexiest disfigured woman on the planet.” It’s true—she looked like a lingerie model.

IMG_0948

 

Laura is the founder of Artists for Trauma, an organization that helps trauma survivors through the recovery process by pairing them up with artists in the medium of their choice. This is not just another sexy Hollywood charity where you’re like, “exactly where is the money going here…?’” The most difficult recovery for the trauma patient isn’t necessarily healing the external wounds, or learning to use a prosthesis or a wheelchair or a permanent bladder catheter. It’s the internal healing, coming to terms with the fact you now have a prosthesis, or a scar, or only five fingers to get a manicure on…that this is how life is going to be, and you need to somehow accept it, and make it work. And that’s where the artists come in. For instance, one of the  AFT team members is teaching pottery and sculpting to a blind woman.

I am not writing this as a physician talking about patients(i.e.–“other people”), but as a human being who feels as vulnerable to the sudden devastating effects of a trauma as the next person. I do not feel “exempt”, just “aware.” I’m not a skier and I don’t get in two-seater planes, and I have no plans to sky-dive, but I do get on the 405 freeway almost every day. Enough said. You get it.

Lipo Queen™ is a proud sponsor of Artists for Trauma, as a portion of our proceeds from our “Lipo Queen™ Shape Wear garments are being donated to AFT.

AFT is open to assisting both civilians and injured soldiers. So if you know anyone who might benefit from this fantastic organization that Laura Sharpe runs with genuine heart and passion, check it out at artistsfortrauma.org. They are also planning some cool charity events, including a fashion show this Spring that I hear will be featuring our Lipo Queen™ garment.

Burlesque, anyone? 😉

XO

LQ

I realize that by writing this post I’m risking turning this blog into just another fun blurb that channels our inner twenty-two year-olds, but I can’t help myself. Besides, Lipo Queen is an objective source of inside information about what what we can do to keep looking good. This blog is about beauty, after all. And, well, ummm…what’s more beautiful than this?

This is a still from the movie “Magic Mike” which hits theaters this Friday and this is one film I’m not going to wait for on DVD. Because judging from the picture above, it really doesn’t matter if it sucks. It stars Channing Tatum and it’s about hot male strippers with perfect bodies who have their shirts off most of the time, and that’s really all we need to know. Besides, the fact that it’s based on the true story of how he got his acting career off the ground by dancing in male strip clubs makes for an intriguing documentary—don’t you think?

When I first saw the trailers for this movie I immediately Googled it for more info and discovered that apparently I wasn’t the only red-blooded American female anxiously awaiting its premiere. There were already thousands of posts on the Internet from women counting down the days. It’s undoubtedly going to be the biggest stampede at the box office since Twilight.

I casually asked my husband if he would like to see it with me, and pretended to be disappointed when he gave me a fast and definite “no.” I did offer, after all. I guess I’ll just have to leave him at home while I go along on the girls’ night out. 😉

But what fascinates me the most—and the real reason I wanted to write about it—is how timely it is. I bet Warner Brothers can’t believe their amazing luck. The timing could not have been better. A year ago trailers for a movie like this would have seemed “cheesy”–or at least, that’s what we’d be expected to say about them. But “Fifty Shades” has opened the floodgates and made it perfectly acceptable for women to have controversial discussions centered around fantasizing about hot sex from a complete stranger. Besides, most of us are done with the books and now we’ve got something even better to look forward to. This movie is going to ride the aftermath of the hysteria that E. L. James created. Universal may have gotten the movie rights to her book, but this is the movie that’s going to make a billion dollars. And I’ll take Channing Tatum over that creepy Christian Grey any day.

And by the way, if anyone is interested, it just got an amazing review in The Hollywood Reporter and on Rotten Tomatoes… 🙂 See you there!

XO

LQ

P.S. To make this a legitimate LQ post, I will mention that this weekend I was at the 96th Annual Pacific Coast Oto Ophalmological Society Meeting in Lake Tahoe, where I gave a talk on my technique for performing Liposuction Under Local Anesthesia

Between working on the book and doing my day job as a plastic surgeon, I’ve had to take a vacation from blogging for the last couple of weeks…But I was so inspired by this article in the May issue of Plastic and Reconstructive Surgery (Our plastic surgery Bible) that I had to make time to share it with everyone. In layman’s terms 🙂

Most of you who know me are aware that I have been performing autologous fat transfer for breast augmentation (liposuctioning your fat from wherever you want to get rid of it and putting it in your breasts instead of an implant—yes, it’s a dream come true) for over two years and that I think it is an amazing procedure. (See my previous blog, “When fat is your friend.”) My patients have been thrilled with their results and I have had tremendous support from Doctors Lebovic, Schwimer and Goldberg–a very prestigious group of radiologists in town who specialize in breast imaging. So far the fat injections have not interfered with any of my patients’ mammograms.

If you have been seriously researching this procedure for yourself, you have most likely heard of the BRAVA. Developed by Dr. Roger Khouri in Miami, it is an external soft tissue expansion device that looks like a “Madonna Bra.” When you’re wearing it, it literally suctions your breasts out like a giant suction cup would, temporarily enlarging them. The theory is that wearing it before and after the procedure will increase the percentage of fat that “takes.”

Breast augmentation with fat grafting is probably the hottest new topic in plastic surgery, but the multiple variables involved with the technique still leave a lot of unanswered questions:

1)    Does it matter where we take the fat from (ie, is back fat better than thigh fat)?

2)   Does centrifuging it (spinning it down before injection to separate out the blood and fluid) really select out precious fat cells or just destroy them? There are two opposed camps on this topic.

3)   What type of system should we be using to harvest the fat? Hand-held syringes or suction machines with the pressure turned down? Two opposed camps here as well.

4)   What type of system should we be using to inject the fat?

5)   Does Dr. Khouri’s BRAVA thing really work or is it another marketing gimmick?

6)    Is selecting out stem cells with an expensive machine and calling the procedure a “stem cell breast augmentation” necessary for the fat to take? (The plastic surgeons who own the stem cell machines will say it is, but see my blog “What is a ‘stem cell breast augmentation’ or a “stem cell facelift” and is it worth the extra money?)

There have been multiple conflicting reports on this topic without real scientific data. Most of the plastic surgery journal articles are like second grade classroom show-and-tells: “This is what I did, and this is how it looks, Ta Daa!!!” As of yet the only thing that everyone agrees on is that there is no standard way of doing this procedure to give the optimum results.

But at least now we have an answer to question #5:

 According to this new study, yes, wearing the BRAVA seems to increase the fat volume “take” from about 50 to 80 percent.

 There is a strong possibility that this is accurate information. Last summer I was able to compare notes with Dr. Scott Spear on this topic. Since Dr. Spear is the chairman of plastic surgery at Georgetown University and one of the renowned breast surgery experts in the world, I felt validated to learn that my experience and results have been identical to his. We agreed that the most important determinant of success with fat grafting to the breast is the “skin envelope.” So, whether it’s from breastfeeding or age, in this situation, “sagginess” of the breast skin is good news. It gives the transplanted fat more room to live comfortably and survive better. I like the analogy in Dr. Khouri’s paper: when planting crops, the most important thing to a farmer is not the seeds, but what kind of soil he is planting the seeds into. If it’s crappy soil, the seeds won’t do well, no matter what kind of magic potion (ie, stem cells) they are mixed with.

This is why the BRAVA makes sense. It stretches the skin and tissues—and by doing so may also increase blood supply to the area–to allow for a more accommodating “home” for the fat grafts.

Other “pearls” that can be taken away from the results of the article are that:

1)    when done correctly, the fat injections really do not interfere with the reading of mammograms as much as we first thought they would

2)    spinning it down fast in a centrifuge is probably a bad idea.

 So what does this mean?

 In the past, when my patients have asked me about whether or not the BRAVA was worth the extra money (It’s about $800 at cost) I told them that it probably helps, it couldn’t hurt, and that the patients who used it seemed to have more of the fat volume survive, though I couldn’t guarantee it. I do not like “selling” things to people if I can’t justify it. I still can’t guarantee anything, but now at least I can quote this paper, that the patients who wore the BRAVA had about 80% retention of volume as opposed to about 50%.

However…

 The results of this study may make more patients more motivated to wear the BRAVA, but most still won’t be able to do it. Logistically, it is quite difficult.

For one thing it looks like this:

 

Okay, sorry–I had a picture of someone wearing it here but I guess it got remove by the people that own this blog server for “porn” so I am working on a censored version of it with my IT guy–hopefully it will be up later today. How annoying is that? I mean, really. So you can see the shadow of a woman’s breast underneath it–so what? For now, just imagine big plastic domes that project about ten inches in front of your chest.

So, unless you’re okay with people staring at you for reasons other than being famous or impossibly gorgeous, you can’t wear it in public. Your regular clothes won’t fit over it. And the protocol calls for wearing it ten hours a day for a month before the procedure (with 24 hours a day for the last few days) so unless you work from home, you have to learn to sleep in it. The logistics are even challenging for “stay-at-home” moms, because most of them don’t really “stay-at-home.” You can’t show up to school drop-off wearing a BRAVA unless you have tinted windows, and forget about making the rounds at Whole Foods/Costco/the drycleaners unless you’re okay wearing a tent.

But at least I can assure my patients who are dutifully wearing it in preparation for their surgeries that yes, it does work.

 Again, for all of you BRAVA-wearers out there, here are some inspiring before and afters:

 

Before, an A cup

 

One year after BRAVA and fat-grafting, a C cup

 

Here is the link if you would like to read the full article:

 http://journals.lww.com/plasreconsurg/Fulltext/2012/05000/Brava_and_Autologous_Fat_Transfer_Is_a_Safe_and.25.aspx

 

One more thing I would like to add:

 

In his video discussion of the article, Dr. Spear mentions that we must “respect the donor sites” (the places where the fat is being taken from) and that is EXACTLY what I tell my patients. I often see patients who have been told by someone else that they are candidates for the procedure. But as a surgeon who has performed thousands of liposuctions for over ten years—and someone who understands how a woman wants her body to look—I have turned some of them away because I felt that I could only get the fat out at the expense of causing deformities at the donor sites. MAKE SURE that your plastic surgeon understands that you CARE what your legs/arms/abdomen/back are going to look like after the fat’s been removed (unless, of course you don’t.) And make sure that your doctor is GOOD AT LIPOSUCTION, which is not as easy as it sounds, especially when the patient is thin to begin with.

For example, if someone looks like this to start with:

…she should look like this when you finish:

XO

LQ

Yes. In fact, I did one in the office the other day for a forty-five year-old woman under her chin to give her more definition around her jawline. She took an antibiotic, a Valium and a Percocet beforehand and she was sleepy and high, but other than that I used all local anesthesia and she was awake the whole time, and she had no pain.

However, this answer has to be clarified. The amount of lipo you can do under local is limited for the following reasons:

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