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PST 019: Surgical Liposuction — Read the Transcript

August 7, 2018

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Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica here in Toronto, Canada. Today’s podcast is on liposuction, not the old-school kind of liposuction you might have seen with Brad Pitt and Fight Club or Nip/Tuck, where it’s a very brutal technique with a lot of mechanical disruption of fat. The modern world of liposuction changed about 10 years ago when we started adding energy-based treatments to the fat before we remove it.

What are those energies? Laser, internal probe-delivered laser, that’s called SmartLipo. Radio frequency electrical current through a probe, that is called BodyTite. Or internal delivery of ultrasound to the fat, that’s called VASERLipo. I thought we’d talk about all three today under this umbrella of modern energy-assisted liposuction. Liposuction is still the most common thing done in North America. Last year alone, there were over one million liposuctions. 4% of all elective surgery in North America is removing fat, unwanted localized fat from peoples bodies. It is by far the most common thing that we, as plastic surgeons, and cosmetic physicians offer.

The problem is, many patients undergoing liposuction have compromised skin tone. Weight loss, weight gain, a little older, a few kids, and suddenly the arms, the inner thigh, the tummy doesn’t have the elasticity and tautness we had at 18, 19, or 20. If we merely just remove the fat, we don’t have the compensatory skin contraction to get a good result. Hence, the development of these modern liposuction techniques. What is the difference between these modern lipos; BodyTite, SmartLipo, VASERLipo?

Well, first of all, BodyTite lipo delivers radio frequency energy current, and it is by far the King Kong of tightening. If you need to control tightening, you’re going to be looking probably for a BodyTite plastic surgeon or liposuction deliverer. BodyTite uses bipolar or radio frequency electrical current to go under the skin, heat the fat to 79 degrees with very elegant thermo controlled techdaptics and strategies, and all the while moving in tandem with an external electrode to tighten the skin, so you get skin tightening, internal contraction at the same time. Peer reviewed articles with BodyTite lipo shows a whopping 35% area contraction. 35%. If you have that marginal loose lower belly skin, upper belly skin, inner thigh, upper arm, loose neck skin, above the knee, BodyTite is your best tightener out there. There are thousands and thousands of BodyTite users all over the world, United States and virtually every jurisdiction. BodyTite is the number one thermo contouring lipo system out there.

Also very popular is SmartLipo. SmartLipo delivers through an internal probe with no external skin heating, a laser energy. The laser liquefies the fat and tightens the skin for small zones. If you have a tiny little area like the tail of breast, that little fullness above the breast or the upper arm or above the knee, a small zone, you could use a small little laser fiber called SmartLipo. That would deliver about 17% area contraction as opposed to about 35% with BodyTite.

Finally, VASERLipo. VASERLipo is using ultrasound energy to separate the fat cells, to create like a mango smoothie of fat cells that are still alive. Why is that important? One of the modern phenomenon of lipo, of removing so much fat, is we look to what we can do with that fat. Rather than just throw it out like we did in the ’90s and the early part of the new millennium, we now offer women the opportunity, after the lipo, to purify those fat cells and re-inject them, redeploy them where you might need them, like the bum. Fat grafting to the buttock called the Brazilian Butt Lift, extremely popular. We can use VASERLipo to rapidly and safely remove fat less traumatically, but those fat cells are alive. Once we heat the fat with radio frequency BodyTite or laser SmartLipo, those fat cells are not alive. They don’t survive. We use VASERLipo for fat grafting to the buttock or the breast, a natural breast augmentation without a cohesive gel gummy implant. Fat grafting to breasts is also quite popular.

Those are the three types of modern energy lipo; VASERLipo, SmartLipo, BodyTite lipo.  At the end of that energy, we still have to remove the fat, but now the fat is liquefied, the small vessels are closed, you have less bruising, swelling, and pain after modern lipo. And at the end of the day, after all that fancy equipment, it still comes down to the talent, artistry, and skill of your surgeon to remove just the right amount of fat in just the right area to give just the right contour. I think that helps define the different types of lipo in your modern world of having to select the right lipo for your specific anatomical problem.

Okay, BodyTite lipo, SmartLipo, VASERLipo. What to decide? Which kind of lipo in which area? Well sometimes, I’ll use two or three different techniques on one patient in different areas of the body. But in general, BodyTite lipo would be used in any area of the body where I need very strong contraction. You’ve got a lot of loose skin, or potential for loose skin, like a tummy after a baby. It’s the arm after weight loss, weight gain. The inner thigh. BodyTite gives you a 35% area contraction.

SmartLipo. One might use SmartLipo with small delicate areas. Maybe under the chin. Maybe the upper inner arm, above the knee; small delicate areas where you need a modest amount of contractions, upwards of 17% with SmartLipo.

What about VASERLipo? We use VASERLipo when we want to fat graft those cells. We don’t want to kill them with thermal energy. We want to loosen them, get them out easily, have less bruising, swelling and pain, but deploy those fat cells in the buttock or the breast through fat grafting techniques.

Once you deploy either BodyTite, SmartLipo, or VASERLipo, what are the advantages in your results? Well first of all, you have fewer symptoms. Any one of those techniques are going to result in liquification of the fat; turn that fat into like a mango smoothie, making it much easier for a surgeon to remove that fat with gentle aspiration techniques. Less swelling, less pain.

Number two, BodyTite and SmartLipo coagulate and congeal, not only the fat, but the small vessels, so you’re going to have less bruising. Back in the ’90s and the early part of the last millennium, if you did lipo of your hips, sometimes your entire leg could be bruised. Now, we have very localized, if no, bruising, thanks to the coagulation powers, the thermal coagulation powers of BodyTite and SmartLipo.

Number three, you’re going to get quicker recovery. Less swelling, less bruising, less pain, quicker recovery, back to work sooner.

And last, contraction. We talked a lot about that. You’re going to get the best contraction with BodyTite, the next best contraction with SmartLipo, and you’re going to get the least contraction with VASERLipo, but you’re going to use it to preserve fat cell integrity and viability so you can transplant that fat. Those are the niche areas where those energy-based lipo systems work the best.

Okay, you’ve done your lipo. You’ve done your BodyTite, SmartLipo, VASERLipo. The fat’s been coagulated, liquified, and now removed. You’ve recovered. You’ve worn your garment. You do need to wear a garment for about six weeks. What’s a garment? It’s a specialized tailored and measured compression garment, like a Lycra-spandex meets a LuLu Lemon/Under Armor type of garment that gives you a compression to the skin to hold the skin to the right contour, so you get the best shape. You need to wear that garment. Most surgeons are going to make you wear that lipo-compression garment for about three weeks, 22 hours a day. It’s going to provide support under your work clothes. It’s going to provide support at night. You take it off maybe to shower for a couple of hours. Air-dry it after hand wash it, and put it back on. Good friend for three weeks.

Then, the second three weeks, you’re going to wear it during the day, and leave it off at night. After six weeks of garmenting, and contraction and adherence, you can get back to high impact activities like jogging, high energy workouts. For the first three weeks, it’s basically walking, keeping active. End of three weeks, low-impact activities; stair climbers, elliptical, gentle yoga. That’s sort of your recovery and garmenting.

Is there a maintenance required? Once you’re done and looking good, six weeks you’re seeing the results. You still have some swelling, and that can take upwards of six months to a year to get rid of all the subtle swelling following lipo. Many practices, including here at SpaMedica, at about that eight to 10 week mark, we’re going to put you on non-invasive technologies; devices that suction-couple, lymphatic massage, thermo stimulation from the outside in to get additional tightening. Maybe even some technologies that will kill a little bit of fat to give you a smoother result.

We start to do adjunctive treatment, things like the BodyFX radiofrequency device, the Venus Freeze, the Venus Legacy, the Exilis. Maybe SculpSure on some areas of residual fat, or CoolSculpting, or even the Vanquish or Zerona. These are some of the common SpaMedica technologies that we will put on liposuction treatment areas, starting about eight to 10 weeks. We do a treatment about once every four to six weeks. Usually about four to five of them. Six months of non-invasive treatments to give you a better result.

When you’re said and done, if you’ve got good contraction, nice contour, and you’re happy, you don’t necessarily need maintenance treatments, because you’ve got that internal tightening, let’s say BodyTite. 34%. Nice flat tight tummy, but as you age, your now lipo-contoured tummy is going to be subject to the same aging forces as anybody. You’re going to get collagenase breaking down your collagen. You’re going to get looseness. You’re going to get some laxity. Either you get a good BodyTite or SmartLipo, VASERLipo result and age gracefully, or you come back to your clinic where you did the procedure, and you do a maintenance treatment every three to four months. BodyFX, Venus Freeze, Exilis, one of the bulk heating radio frequency tighteners. Temperature, [Palovay 00:11:05], those types of products. If you look them online, they’re all bulk heating temperature measured RF devices.

What will they do? They’ll help maintain your skin tone and your tightening. You’ve already killed the fat. You’ve already contoured your figure, now you need maintenance to keep tight skin for years to come. That’s my recommended maintenance, bulk heating RF after a good body contouring liposuction using SmartLipo, BodyTite, or VASERLipo.

Who’s a good candidate for this liposuction approach using an energy assisted device? Well, patients who are medically well. Patients who are realistic. We can’t give you back the skin of a 16 year old, but we can give you back a very good contour. Patients who don’t have a pacemaker, either cardiac or bladder, because they’re RF devices. And patients who don’t have a medical illness that precludes undergoing the procedure. There’s a lot of exclusion criteria, but most patients who are reasonably healthy, and they’re not pregnant, of course, are candidates for modern liposuction.

The procedure can be performed under local anesthesia with some light oral sedation. It can be performed under IV sedation, like colonoscopy, and if you’re really quite a nervous Nellie, and the thoughts of hearing the surgery bother you, then you could do general anesthetic. The vast majority of liposuction in my practice is done with some oral analgesia, some laughing gas, nitrous oxide or Pro-Nox, and local anesthetic. Very safe. You don’t need a general anesthetic to do this procedure.

Candidates, after they have the procedure, are generally going to have a longterm reduction of localized fat. The best candidate has done their work first. They’ve done diet and exercise. They’ve tried their best. They’ve tried to get rid of that love handle. They’ve tried to get rid of the pot and they can’t. So, medically well, realistic expectations, they’ve taken diet and exercise as far as they can. Then you would come to someone like me for energy-based modern liposuction; BodyTite, SmartLipo, VASERLipo.

What are the most common areas that North Americans get liposuction on? Well, let’s divide them into men and women. 85% of all liposuction is done on women. What are the most common areas? By far, the most common is the pot, or the lower tummy, especially after children. Now, after children, there’s often loose skin, so we want something like BodyTite, or for moderately relaxed skin, SmartLipo to tighten skin and remove the fat. Second most common area, the love handle or flank. Third most common area, inner and outer thigh. Fourth most common female area, the bra line, or that annoying roll of fat that rolls over and under your bra. After the bra line, the arms; the bat wings, the upper arms. And finally, with women, what’s called the breast tail. That little bulge of fat when you put your arm down, it comes above your bra. Women also, the double chin, which leads into men.

Double chin, one of the most common areas that men will do; a double chin, that wobble under the neck. Very good for BodyTite, SmartLipo and VASERLipo. With men, the love handle very common. And for men, the lower tummy. Men, love handle, lower tummy, double chin. Women, the pot, the love handle, inner and outer thigh, the square zone, and then the arm, the bra line, the double chin, and rarely, the inner knee and the banana roll, that roll at the back of the bum. These are the common lipo-contouring areas that we treat after patients have tried diet and exercise.

Thank you for joining me, Dr. Stephen Mulholland, here in Toronto, Canada, Plastic Surgery Talk, for our podcast on modern liposuction. If you found this interesting, informative and entertaining, please share this on your social media channels, and we look forward to seeing you again for our next podcast here on Plastic Surgery Talk.

Dr. Stephen Mulholland, MD
Posted by Dr. Stephen Mulholland, MD
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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