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PST 016: Surgical Liposuction vs Nonsurgical — Read the Transcript

July 26, 2018

Listen to the full audio here

Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica in Toronto, Canada.

Today we’re going to really talking about one of the most popular and fastest growing areas of the aesthetic plastic surgery; non-surgical lipo and surgical lipo. What are the differences? How does it work? How to choose?

When looking at permanent reduction of fat and body contouring, you really have two options. You have surgical modern liposuction and non-surgical liposuction techniques that are non-invasive, so surgical and non-surgical. We can destroy fat now two different ways, but they are different from each other.

The surgical liposuction is using a device, a device that goes in under the skin into the fat, it usually does something to that fat. We can use Smartlipo which emitting a laser, we can use BodyTite which emits radiofrequency energy, we can use VASER, which emits ultrasounds. Three principal modern liposuction techniques; ultrasound, VASERlipo, radiofrequency, BodyTite, and laser, Smartlipo.

These energy forms go into the fat from the little probe under local anesthesia and they liquefy the fat, coagulate the fat making it very, very easy to remove. One big difference liposuction surgical versus non-surgical is we actually physically remove the fat during the treatment.

The emission of that energy, especially BodyTite, will lead to a tremendous amount of skin contraction. The surgical options also include the ability to tighten the skin up to 30% during the session. It is minimally invasive, it’s done under local anesthesia. We disrupt the fat, heat the fat and the skin, control contraction, and then remove it all in one session.

You need a little bit more recovery. There is some bruising, some swelling, some down time. You get the best possible definitive body contouring you can get.

Let’s contrast that with non-surgical liposuction. These are techniques that work on the top of the skin, there’s nothing that’s going on inside. These are completely non-invasive. Again we have some energy options; we have suction-coupled cooling, and we cool the skin and the fat down to about 5 degrees. That will kill a certain percentage of the fat cell. Cooling is called CoolSculpting.

We can also take a heating device that rests on the top of the skin, on top of the fat we want to treat. We can heat the fat with a laser, and that is called Sculpture. We can also take a device that will suction-couple the fat we don’t like from the outside and emit electroporation radio frequency, special high voltage radio frequency waves. That’s called BodyFX.

We can also use ultrasound from the outside, that emits ultrasound waves across the skin to kill the fat cells using ultrasound. That’s called UltraShape. We also have a number of radiofrequency devices that are not high voltage, not BodyFX, that with longer exposure times can kill some fat. These are products like the Vanquish, like the Venus Legacy, like the Venus Freeze, like the Exilis, and the VelaShape III.

We can use external techniques that are non-invasive and over a series of treatments, two, three, four, six, depending on the technology; we can kill a centimeter to two centimeters of fat. A pinchable amount of fat which is noticeable, depreciable, but there’s essentially no risk and no down time.

There’s nothing that goes into the fat, we’re not removing all the fat at that session. We allow the body to remove the fat with very natural processes once we either cool it, heat it, electroporate it, or ultrasound it.

At SpaMedica, as you can tell, this is a center that is dedicated to non-surgical liposuction. We have the most technology you could possibly accumulate in one center. We’re allowing ourselves to customize the right technology for your outcome.

Many of our patients will come in and do non-surgical liposuction techniques, and after getting a result they’re pretty happy with it. At some point in their life may want to get a better result, they move up to the more surgical treatments. We have surgical patients that get a non-surgical program after to refine, contour, and improve their liposuction results.

SpaMedica, we have accumulated the best technology to give you the best possible result. The cool thing about the modern era is you’ve got non-invasive and minimally invasive techniques. Non-surgical lipo and surgical lipo to change your figure, shape, and form in the frustrating areas where diet and exercise fails you.

How to decide non-surgical versus surgical liposuction? There’s a few common elements that will help guide your decision analysis. Number one, do you want the best possible result? Do you want the maximum reduction of fat in an area to get the best possible result?

That’s always going to happen by seeing a physician like me, a plastic surgeon who’s going to put something under your skin directly in the fat. Use some local anesthesia, do something to that fat, liquefy it, coagulate it. Tighten the skin from the inside out, and then remove it through suction technology.

Through aspiration we remove the fat, hence liposuction, to get the best possible shape. Then we can remove all the fat cells to give you the best possible contour. Really the limit is what your skin tone will tolerate and how much fat is safe.

Contrast that with non-surgical and minimally invasive; who’s a good candidate for that? Someone by contrast that doesn’t want to do surgical liposuction, that wants no risk procedure, no down time, nothing inserted into their fat, a quick recovery, directly right back to work.

Yes, there’s a more modest outcome. A well chosen, a well selected candidate for non-surgical lipo like CoolSculpting, Sculpture, BodyFX, Vanquish, UltraShape, Venus Legacy, Exilis, and Venus Freeze, are those patients that during the consultation acknowledge they don’t want to do lipo. They’ll accept a lesser outcome but still a noticeable, pinchable reduction of fat that’s permanent.

Then of course, the obvious credentials for our criteria: have to be medically well, no uncontrolled medical diseases. You cannot be pregnant, you cannot have a pacemaker, cardiac or bladder. There’s a low level of radiofrequency field around these devices and it could trigger a pacemaker.

Medically well patient, realistic expectations. On one hand, the best possible result, that’s lipo. A noticeable and permanent improvement, that’s non-surgical lipo.

How would you contrast the results if you’re looking at the results from surgical lipo versus non-surgical lipo? Basically surgical lipo gives a very dramatic, optimal improvement in contour and shape. Basically, the perfect contour that your body could achieve can be achieved through modern liposuction techniques.

In the modern liposuction world, we use BodyTite, Smartlipo, VASERlipo to tighten the skin while removing fat, BodyTite being the most impressive of those technologies. If you want to look at the results of the best possible contour of your outer thigh, tummy, hip, arm, neck, you’re going to look at liposuction.

Results for the non-invasive lipo are noticeable but they’re not as dramatic as you would expect of course from the surgical lipo. A pleasing improvement in an area that’s frustrating like the tummy, the hips, the inner/outer thigh. A noticeable and appreciable before and after result, but not the dramatic improvement you’d expect and do get from liposuction.

Modest expectations, realistic patients are happy in the non-surgical lipo program because we permanently kill fat they can’t kill on their own through diet and exercise. The results are modest, but there’s also no risk.

The two often balance each other well. Most of our patients, once they understand the risks and the benefits, the outcomes, will choose the right pathway for them.

What areas are you a candidate for in your surgical lipo consultation process, or your non-surgical? What body parts can you treat both with non-surgical lipo and lipo?

If we go from head to toe, under the chin, very popular. That double chin, the dreaded turkey chin or the waddle. That’s accessible through surgical techniques like FaceTite and NeckTite and Smartlipo of the submentum, which is the fancy term for under the chin. Or non-surgical techniques like the Sculpture submentum, or CoolSculpting submentum, or BodyFX Mini. The double chin you can treat both surgically and non-surgically.

The tummy, the number one zone for women and men. The lower tummy, the pot, both surgical and non-surgical. The love handle can be treated both surgical, non-surgical. The inner/outer thigh, surgical or non-surgical. The bra line, surgical and non-surgical. That fat that rolls over a tight bra above and below.

Virtually all the most common areas that we treat with liposuction techniques are also now treatable with our non-surgical lipo program. The few areas that are special niche areas for lipo include the breast gland tissue. Male gynecomastia, which is glandular, needs energy to disrupt it and remove it. The non-surgical techniques don’t kill gland, so that needs to be a surgical technique.

The inner knee, the very tiny areas of the inner knee, very hard to do sometimes with the technologies other than maybe BodyFX. That’s often more effectively treated with lipo, like the calf or the ankle. The vast majority of areas that 90% of areas that patients present with are available and treated both with surgical and non-surgical techniques.

One of the big concerns with liposuction in general, lipo surgical and non-surgical lipo, is the quality of the skin when the fat’s been removed. Skin often looks better smooth and plump than deflated, loose, and hanging. It’s very important if we’re going to do non-cutting techniques, non-incisional techniques, non-tummy tuck, non-thigh lift, non-arm lift techniques; we need to have lipo and non-lipo technologies that tighten skin.

The best tightener of skin without a scalpel are the surgical lipo technologies, BodyTite particularly. 35% area contraction after removing the fat, that saves a lot of patients from traditional surgery. Smartlipo about 17% contraction, and VASERlipo 8% or 9% contraction. You get a contraction while removing fat, the skin snaps down and saves you the loose skin.

What about the non-surgical world? Some technologies tighten skin and kill fat simultaneously like BodyFX, suction-coupled electroporation, and basic radio frequency. We tighten skin while we kill the fat, which is why it’s a series of six treatments. After two or three, you kill enough fat like the other technologies but the six treatments are there because you need to tighten skin at the same time.

BodyFX uses bulk heating radiofrequency energy is a good killer of fat through electroporation and a good tightener of skin through RF. If you look at technology like Sculpture which is a laser, hands free, hyperthermia or heats the fat externally but cools the skin, or CoolSculpting that cools the skin and the fat, they don’t tighten the skin significantly.

For those technologies, if someone’s got modest skin tone, we’ll add a second technology like BodyFX, or Exilis, or Venus Freeze, or VelaShape during the interval treatments between the first CoolSculpting Sculpture and the last treatment which is six weeks apart. In the intervening weeks we do bulk heating RF to tighten skin.

Again, one of the advantages of a center like SpaMedica is we will offer you the skin tightening technology as well as the fat destruction technology. Not all the fat destruction technology has the capability of skin tightening, so you often need two technologies in your program and a series of treatments to get tight skin and less fat.

It sounds a bit confusing, you’ve got all these liposuction technologies, all these non-invasive and cool sounding non-surgical techniques. What’s the best one for you? What’s the best combination for you?

The best way to find out is come in for a consultation, meet with some of our well trained consult coordinators that can walk through your expectations, your goals, make sure they’re realistic and get the best technology or technology combination to give you the best possible fat reduction.

Thank you for joining me today. Dr. Stephen Mulholland here in Toronto, Plastic Surgery Talk, and our podcast episode on non-surgical versus surgical liposuction. If you found this interesting, entertaining, informative, please share this with your friends on your social media channels. I look forward to seeing you again at our next podcast here at Plastic Surgery Talk.

Dr. Stephen Mulholland
Posted by Dr. Stephen Mulholland
Dr. Stephen Mulholland has been practicing Plastic Surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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