Welcome to Plastic Surgery Talk with Dr. Steven Mulholland, brought to you by Spa Medica.
Hello, and welcome. Dr. Steven Mulholland here in Toronto, Canada on Plastic Surgery Talk. Welcome to our weekly podcast series. If you enjoy these podcasts, you find them entertaining, engaging, informational, please share, subscribe and comment.
Today’s podcast is on a very popular topic: liposuction. Liposuction is the number one surgical procedure, cosmetic surgical procedure performed in North America. Last year alone there was over one million liposuctions in North America. In fact it’s so common between men and women that now forms about 5% of all elective surgery is removing fat and contouring figures. So it’s very, very common.
Now, there has been a real evolution and a renaissance in liposuction from the crude, traumatic liposuction you saw back in the days of nip and tuck and Christian Troy, and it’s become a much more refined and sophisticated way to tighten skin and contour shape. So in this podcast today we’re going to analyze what are the new forms of liposuction? How are they performed? Who’s a good candidate and is it right for you?
So how do I know if lipo is the right choice for me? Well, first of all, the best liposuction candidates are those patients that have tried virtually everything on their own. They’ve tried diet and exercise, they’ve worked out, they’re fit, they’ve got a reasonable diet. They may have even tried non-surgical techniques, non-surgical liposuction techniques like Core Sculpting, SculpSure, BodyFX, Vanquish, Ultra Shape, [X-Less 00:01:53], Venus Freeze. These are a number of different non-surgical techniques that purport to kill small amounts of fat.
Once you’ve tried all those things, diet, exercise, technology and you still have annoying, excess, localized fat collections, you are probably then, if you’re medically well, a good candidate for liposuction. What are those annoying collections? They come often with cute, annoying names like the saddle bag for fat on the outer thigh, the trochanter saddle bag. The inner thigh, the bat wing or the arms, the abdomen or the pot, the love handles, the bra line, the double chin, the inner thigh and the inner knees. These are the most common liposuction areas on men and women. Guess for men also, the 50 year old [gynacomasture 00:02:41] male boobies.
So you’re a good candidate if you’ve got localized excess collections of subcutaneous fat, if you’re … tried diet and exercise, got to the best possible weight and fitness you can get at, you may have tried even non-surgical lipo techniques, and you want to do some localized contouring to make a difference in your measurements in centimeters. It’s not about weight. We’re not making difference in pounds. We’re making difference in shape, figure and form. Centimeters. Then you may, if you’re medically well and realistic, be a good candidate for liposuction.
So what is this modern approach to liposuction? What has the evolution been in the last 10 years? Well, it’s been the addition of energy to the fat just prior to the lipoaspiration or the removal. So one of the problems with lipo. You have a little pot or a double chin or an arm, and the fat has tented the skin and the skin is tight. You remove the fat, and the skin is orphaned of that fat support and it goes bleurgh and your skin just droops. So loose, saggy skin is the big enemy of lipocontouring of liposuction sometimes. So the big advance over the past 10 years has been initially the advent of internal ultrasound, which gently liquefies the fat and creates less bruising and less swelling and viable fat cells, but not a lot of tightening.
After Vaser in the mid part of the last millennium, 2005 and 6, we had internal laser, which is internal laser heat. The heat allowed a tightening, a degree of tightening of the skin up to 17, one seven, percent area contraction by doing laser lipolysis or smart lipo followed by suction contouring. So we heat the fat, get the skin tighter, and then remove the fat we want to give you optimal contour, and rely on the heat at the time of the laser to give contraction and shape.
The most modern advance over the past 10 years has been the transition from laser to radiofrequency and the internal probes of RF. The bipolar technique tightening the outside and the inside part of the skin is called BodyTite. BodyTite made by InMode mix a number of applicators. BodyTite for large body areas, NeckTite, FaceTite, AcuTite, LidTite. All different site, bi-polar radio frequency probes that coagulate and liquefy and heat the fat and tighten the skin simultaneous. The advance of BodyTite applicators has meant that we, as surgeons, can get up to 35% area contraction. Tremendous shrinkage without the need necessarily for tummy ticks or arm lifts or thigh lifts. Excisional surgery.
So BodyTite has become the king of the industry in terms of soft tissue tightening. Then at the end of that coagulation, which takes about 10 minutes per zone, we have to end up removing the fat like we always have. So liposculpting or lipocontouring happens after the BodyTite heating. I liken it with patients to having a raw hamburger patty sitting on the grill. It’s going to shrink right in front of your eyes over 10 minutes, significantly. Up to 25%. Same things happens with your subcutaneous tissue and your fat. It shrinks after we apply the heat, and the heat itself is applied in a very safe and monitored way so that the risk of a thermal injury or a burn is essentially minimized to next to zero.
So BodyTite has become the most advanced version of lipocoagulation and tightening. We do have Vaser still if you want to preserve fat cells and use that for fat grafting. Laser can still have its advantages in small areas, tiny areas where there’s less fat and less skin to tighten.
How to know which device? Vaser, smart lipo, BodyTite? Well, if you want basic aspiration removal of fat with the tightest possible contoured skin on the tummy, on the arm, on the double chin, on the chest, on the inner thigh, on the bra line, after you remove the fat, make sure you use BodyTite because it contracts and tightens the best. When might you use Vaser? Well, Vaser and I have all three devices.
Vaser can be used when you want to preserve the fat. So let’s say you want to take a little bit of fat before you remove it. Don’t damage it with a hot laser or a hot BodyTite, but you want to save that fat, spin it down and reinject it for better coaugmentation like the Brazilian butt lift or fat grafting to the [inaudible 00:06:59] of the face. Then you use a low energy, gentle system like Vaser to cause a discohesion or separation of the fat cells, remove the fat cells, purify them, spin them down, wash them, whatever preparation techniques the doctor uses, and then reinject them. That’s where Vaser’s big niche is.
Laser, not as powerful nor as fast not as effective as BodyTite, but good for tiny little areas like small like areas of the inner thigh or the upper arm. So if you still have a laser system, you can still use them on small areas. BodyTite can be used on all areas where you use contraction. They have small applicators and large applicators. It just destroys the fat, so it’s not good for transplantation. So that gives you a sense of BodyTite, NeckTite, FaceTite, LidTite, when to use the BodyTite family. Vaser for fat grafting. Laser, if you still have one and you have small zones, it can provide a reasonable amount of contraction and tightening.
What is the cost difference between non-energy based liposuction and energy based? Energy-based liposuction means applying energy. Vaser, which is ultrasound, laser, which is smart lipo, or RF radio frequency, that’s BodyTite. Those are the three energy-based devices that are used to get advantages of contraction or fat graft preservation.
What’s the difference in price between that and your basic old school lipo? If you’re young and healthy, you have super tight skin, you don’t need the fancy, newer technology. That’s if you’re older, weight loss, weight gain, few kids, have loose skin. You really need to do the modern BodyTite approach to lipo. The difference is usually around $2000 a case when you apply energy. So whatever the base line price of a lipo in your city is. It could be 4000 per zone, 3000 per zone, 6000 per zone. Generally you’ll find the BodyTite practices charge a premium of about $2000 to ensure that 35% area contraction, like a scarless tummy tuck or arm lift of neck list, and usually it’s worth it for that extra 2000 because you get massive amounts more … 35% area contraction for the upsell and the technology and the procedure.
Basically physicians will offer you those if they have them in their practice. A busy liposuction surgeon is going to have to have some type of BodyTite procedure in the modern era. If they hope to contour older women, larger women, women with weight loss, weight gain or multiple kids, you need a BodyTite in your practice.
What’s the difference between non-surgical lipo techniques and surgical liposuction techniques? Well, the non-surgical lipo techniques are led BodyTite technologies where you don’t have to go to an OR. There’s nothing going under your skin. There’s nothing invasive. It’s done as an outpatient, and it can be done in medical spa type non-invasive for dermatologic environments. The number one non-surgical lipo technique or body sculpting technique, which is reduction of localized fat areas or without surgery, the number one technique in North America is called Cool Sculpting.
Cool Sculpting is suction coupled and non-suction coupled cooling or hypothermia, that if you expose that fat to minus five degrees for about 45 to 60 minutes, you’re going to get a small amount of fat that will die. So if you want a really … the best contour of your love handle or those localized areas, don’t do Cool Sculpting or non-surgical because you’re only going to get about a centimeter to two centimeters reduction. But if you have eight centimeters of fat, you’re going to still be frustrated. That’s why liposuction, modern liposuction is still your best bet.
However Cool Sculpting, if you’ve got a modest amount of fat expectation and reduction, kills fat permanently, consistently, one to two centimeters of pinchable fat. Cool Sculpting can be a very viable option. It’s less expensive than lipo. There’s no recovery. There are some side effects, but they’re reasonable and they’re tolerable, and so it’s very popular.
The next most popular after Cool Sculpting is a technique called SculpSure. SculpSure is non-surgical, non-invasive. Again like Cool Sculpting it does … as an outpatient in a medical spa. It’s the application of laser heat on the outside of the skin. Doesn’t go inside, just like Cool Sculpting. That’s called SculpSure. That again is non-invasive. You can kill one to two centimeters. It’s less expensive than Cool Sculpting, but it doesn’t give you the definitive contour which is still the domain of liposuction.
There’s some other technologies that kill fat, like BodyFX, which uses electroporation and RF to kill fat. electroporation damages the cell membrane. You can get a good two, three centimeters of reduction. It takes three or four treatments over six weeks, whereas Cool Sculpting or SculpSure is two treatments. One at the beginning, one at the end of six weeks. BodyFX, again. Cool Sculpting, SculpSure.
True Sculpt is using non-suction coupled radio frequency with skin cooling to kill fat. We have the Vanquish, which is placing the extra fat of the thighs or the tummy under a microwave technology which will oscillate the fat molecules using a hypothermia technique, but with microwaves, not a laser, will kill fat. That’s a permanent reduction technology. Then we have some ancillary techniques that are not as commonly used, but those are the big four or five. Cool Sculpting, SculpSure, BodyFX, Vanquish …
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… CoolSculpting, SculpSure, BodyFX, Vanquish, truSculpt, proven fat killers. Multiple treatments, non-invasive, two centimeters of pinchable fat reduction. If you select your patients well, if you want two centimeters with no risk, those are your best bets.
If you want the best option and you want all fat gone in that localized area, liposuction. Then decide to add energy not if you need skin tightening, and the contour of coagulation, and contraction, BodyTite being your best option.
The two big fears of liposuction are, “Will I have excess skin,” or, “Will I have indentations or irregularities?” Excess skin, that’s when we make the wrong assessment and we take the fat. What’s left behind is loosey goosey, wiggly jiggly skin. How do we minimize that? Well we add the right energy device to get good soft tissue contraction. BodyTite with radiofrequency energy. Smartlipo with laser energy. These can provide internal contraction to compensate for the risk of loose skin.
Now if the skin is too loose you’re not going to have enough compensation, 35% isn’t enough. You need to know which patients are going to benefit from BodyTite or Smartlipo, lipo coagulation, and aspiration, and skin removal. Like a skin pinch tummy tuck, or a mini arm lift, or a mini behind the ear neck lift in addition to liposuction. We have three options when it comes to the risk of loose skin after lipo.
Have excellent skin, have the right technique, get good contraction, the skin tone should be fine. If you have compromised skin you may do the BodyTite lipo, get 35% [aeric 00:13:32] contraction and a modest, mini skin removal procedure, like a mini behind the ear neck lift, or a mini arm lift, or a mini C-section size tummy tuck, or inner thigh lift in combination with lipo. Some patients have such loose skin that the right physician, with the right experience, is going to be able to tell that patient, “No, you’re not a lipo candidate. You need a formal tummy tuck. You need a formal face or neck lift. You need a formal arm lift. You need a formal thigh lift. You can not get away with lip, even energy based lipo like BodyTite, alone. You need real surgery.”
How to avoid loose skin? Pick the right surgeon who has the right energy devices. Pick the surgeon that has experience. Pick a surgeon that’s going to be able to tell you whether you can get away with BodyTite lipo versus an excisional surgery like a tummy tuck.
The next most common feared side effect of liposuction is irregularity or indentations. Indentations are the lumpy bumpy appearance of the skin after lipo. You see that with some of the Instagram posts from some of the stars who have been caught in Mexico, or in southern California, or the beaches of Hawaii with indentations or irregularity. Most famously the Tara Reed tummy with multiple indentations or irregularities. Those are lipo contour defects from over aspiration. A zone of over sucking leads to an indentation.
Again, how do you minimize that? Well sometimes it happens even in the best of hands but you want to pick out a surgeon with a lot of experience. The more experienced a good body contouring surgeon is the less likely they’re going to leave you with very noticeable irregularities or asymmetries. There’s always some slight imperfections but they’re subtle. So pick the right surgeon. The surgeon with the right technology. Making sure you have access to BodyTite, Vaser, energy based devices that help him contour and contour symmetry.
Then post operative care. Most body contour liposuction surgeons are going to put you on suction coupled heating devices like BodyFX, Venus Freeze, the FORMA Plus, the tripolar, devices that bulk heat the skin and get tighter, smoother skin after the lipo. You usually start those treatments around six to eight weeks.
Indentation and irregularity, loose skin, the two most common side effects you want to watch out for. Most are mitigated by the selection of the right surgeon who picks the right procedures for you.
What are the contour indications to liposuction surgery. Number one contour indication, unrealistic expectations. Make sure your patient is realistic about the kind of outcomes they can get. Patients out there who have medical illnesses. If you have advanced cardiac disease, or hypertension, or uncontrolled diabetes, or breathing problems, COPD, emphysema, asthma, you’re not a good candidate for even a minimal invasive treatment like liposuction. You’ll need to consider non-surgical lipo techniques.
If you have really excess loose skin and you need an incisional procedure, not a candidate for liposuction. If you have a pacemaker or have a bladder of the heart, you’re not a candidate for any kind of energy device and you might not be a candidate for liposuction. If you have a lesion, a sore, an undiagnosed non-healing wound in the area of the treatment you want to make sure that’s not a skin cancer, you’re not a candidate for liposuction. If you’re pregnant. If you are pregnant you are not a candidate for any surgical procedure, liposuction being one of them. You need to wait till you’ve had your baby, and your skin has retracted, and you’ve recovered from … Pregnancy has subsided, which takes about a year, six months post-breastfeeding. Then you could consider liposuction to some problematic post-baby areas in a mommy makeover.
What is the safest methodology of performing liposuction in the modern world? Well generally safety will involve avoiding a general anesthetic with intubation, and ventilation, and paralysis, and pretty serious medications, if possible. Well trained liposuction surgeons should now be able to offer you non-general anesthesia lipo, where it’s done under a twilight sedation, usually oral, subcutaneous, light IV sedation. Then I use a lot of laughing gas or nitrous oxide, so we use the laughing gas or a nitrous oxide while we put the localized anesthesia, the local freezing. Once your fat is frozen and there’s no feeling you don’t feel the liposuction procedure being done so you don’t need any kind of heavy anesthesia, just that light twilight sedation.
The anesthetic technique has evolved from everyone getting general anesthesia 10 years ago to out-patient, ambulatory, local anesthetic liposuction cases. Where we can then add the right local anesthesia with laughing gas, and some intravenous, and oral sedation. Then using gentle techniques. Techniques that heat the fat, liquefy, coagulate so the fat comes out easily and induce a nice contraction. That’s usually BodyTite or other technologies like Smartlipo or Vaser. It’s a combination of technology and technique that leads to the safest possible lipo contouring results.
Then, of course, don’t take too much. You don’t want to take over five liters of combined aspirate. Make sure you replenish the fluids, through the IV, that you’re taking out through lipo. Adequate fluid resuscitation. Making sure the patient’s well volumized. Thinning the blood by using some specialized blood thinners like Lovenox or Heparin minimizes the risk of a DBT. These are all the elements that you bring to a very safe liposuction procedure. Many of which the patient doesn’t even know what’s happening, in order to keep it as safe as it has become.
What to look for in a liposuction surgeon, a liposuction facility, that keeps it as safe as, and efficacious, and quality as possible. Well first and foremost you want to make sure that the surgeon is a surgeon. Many physicians in North America perform liposuction and they’re not always surgically trained. Now there’s some very good liposuction surgeons that are not surgeons, that are family doctors or internists that have garnered a tremendous amount of experience, but if they’re not surgeons they should belong to a surgical society like The American Academy of Cosmetic Surgery. They should have done hundreds of cases, have a lot of experience, and a good reputation with good online testimonials, but make sure you have a surgeon. A board certified plastic surgeon or a cosmetic surgeon who may not be a board certified plastic surgeon but belongs to a surgical society and liposuction’s a big focus of their business.
Number two, make sure your surgeon’s done lots of cases. Make sure they’ve got hundreds of cases under their belt. They can show you lots of before and afters. They have lots of testimonials. Then go outside their practice online to rating sites where the surgeon can’t control the messaging, to see that there’s lots of liposuction patients that sing the praises of the quality and the experience of the facility you’re exploring.
Make sure they have a high quality certified liposuction OR that is certified because many states require certification for liposuction over a certain amount, under local anesthesia, under an IV sedation or general anesthesia. A certified OR by a regulatory body, a state medical board, or a national OR certification like AAAASF, or some certification body. Make sure that the physician keeps a log of complications. Ask them what complications they’ve had with liposuction that they kept for their state medical records and how they manage those complications.
You want to make sure that the operating facility has all the resuscitation, the 911 equipment and a 911 protocol that would be needed if there was an adverse event like a cardiac arrhythmia in your case. What’s the 911 protocol and transfer to a tertiary hospital protocol in place for that physician? Does the physician have hospital privileges or did have hospital privileges in a hospital for liposuction because that means they’ve been vetted by a regulatory body, like a medical board, that assesses their qualifications and vets their skillset being able to perform liposuction safely.
These are the things I would look for. Look up the state medical board records or the college records. See if the patient’s been disciplined for liposuction or any surgical procedure. Make sure there’s no medical legal actions by looking up medical legal malpractice suits in your state or province.
Then, at the end of the day during your interview, make sure there’s a confident sense that this physician and their team is going to offer you comprehensive care post-op followup, to minimize the risks of complications, which can happen to any procedure and with any physician. Make sure you setup all the odds in your favor by having the best physician and the best facility.
Okay. The liposuction is done. You’re on the table. You’re going to get a great result but in that canister, in the aspiration canister or canisters, you got a number of CCs of your fat. Sometimes one, or two, or three, or four milk bags, which are liters and liters of your fat. What can you do with this fat? Do you throw it all away? Most of the time yes. We just dispose of it through a certified biological waste company. However, in certain circumstances patients can re-deploy that fat. They can re-inject that fat and make it work somewhere else for you. Steal it from Peter and use if for Paul.
Where are the three most common areas we inject fat, where there’s needs for fat? The number one area is the breast and the buttock, so body areas. Fat grafting the buttock is called the Brazilian butt lift or BBL. When done in the subcutaneous fat, not in the deep muscle, it can be very safe. It can add a nice, modest, round muscular look to a bum. Give a bit of a bum lift by using fat you’re going to throw out anyway. Steal from your hips and put in your butt. Number one area.
Number two area is the breast. The upper pole of the breast. After weight lose, weight gain, multiple breastfeeding, multiple children, age, you get a pfft or deflation of the fullness of that upper pole. Fat grafting to the breast is never going to replace a cohesive gel gummy bear breast implant. That’s still your best option for breast fullness but you can get a nice half cup improvement, little fullness in that upper pole, by fat grafting to the breast. Fat grafting to the breast, number two.
The number three area for fat is the face. Facial fat grafting. Marionette lines, smile lines, under the eye, across the cheeks, along the jawline, lips and nose. These are the areas that I commonly will fat graft. That’s another area where you can re-deploy fat that’s destined for the garbage that given you a nice contour on your body for enhancement or …
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Nice contour on your body for enhancement and rejuvenation in your face. Lastly and less commonly would be fat grafting to previous liposuction defects. So areas we’ve got indentations and concavities we can use release and fat grafting techniques to smooth in your post liposuction irregularities.
Consideration of use of fat, redeployment, ecologically sound, environmentally friendly, and aesthetically pleasing. You’ve probably read about liposuction, scars, or ports. Where do we go? Where did they go? Where do we put them? How do we hide them? Women have gotten very sophisticated now. They know what little lipo marks look like, those little three millimeter scars that are in the open tummy or in the bra line or the flanks are a no-no nowadays. We want to hide those little three millimeter, four millimeter lipo port insertion areas. The access ports in creases where possible, between the gluteal fold, out the top of the gluteal fold, under the bum crease, in the groin crease, in the belly button, under the chin point, under the breast fold, areas where people typically are not going to see a mark in the open area of your skin.
So gone should be the days of obvious liposuction marks. Through judicious use of creases and longer probes and cannulas, we can always keep those incisions hidden so you can keep them guessing, “Did she or didn’t she? Is that all hard work and personal trainer and diet and exercise commitment, or that plus a little help with lipo?”
What about numbness after liposuction? Because you read a lot about the numbness that can occur in everybody after lipo get some numbness. Because undermining that fat and traumatizing the fat damages those little sensory nerves and you can get numb skin. Fortunately, unlike a scar or a tummy tuck or a general surgery tummy scar or breast augmentation lifts scar, these scars often stay numb forever. With liposuction, the skin that is numb usually comes back within 6 to 12 months, there’s a natural return.
Now, what can you do as an adjunctive technique to improve your liposuction result that’s nonsurgical? Most good liposuction surgeons will have after care treatments starting at around the 10th to the 12th week if you’re not too tender to, number one, tighten your skin using noninvasive bulking technologies such as Forma Plus, Venus Freeze, Exelis. These are the big three that are used to heat your skin to 42 degrees and get you even more tightening than BodyTite skin will give you. So you get maybe 35% under the BodyTite, another 10% from your noninvasive technologies. So series of treatments once a week or once a month for about four to six treatments after your liposuction to get tighter skin.
We can also deploy other technologies if you have a little extra fat on one hip or one side, not quite symmetrical, which is very common after lipo. We don’t want to leave indentations, but it’s not uncommon to have a little bit of fat asymmetry between one side and the other.
We can use our nonsurgical killing techniques such as Body Effects, Cool Sculpting, Sculpture, Vanquish, non-surgically, starting at 10, 11, 12 weeks to kill additional fat.
Last but not least, we’ve added other technologies to work on the next layer, skin, fat, and now muscle. So we can work on a six pack. Once you’ve done that abdominal lipo and you’ve revealed, and thin that fat layer on top of the rectus abdominis, we use something called the Emsculpt, which increases the muscle mass, increases the muscle definition and tone after a series of four to six treatments after lipo. So, Emsculpt, additional fat killing technology, and skin tightening technology, all noninvasive, can be performed on your lipo areas starting around 10 weeks after surgery to get an even better result than we’ve ever had before.
A lot of patients ask me, “Can I freeze my fat and use it next year if I take it out?” Unfortunately, no, you cannot store your fat. Although it’s possible to do it, you cannot store your fat to redeploy it later. That would require in every state in the United States, every province in Canada, to have a very expensive and complex transplant center, a center that uses fat and tissue banking and needs a tissue banking license to have these auto transplantation. So tissue banking is very regulated. No private plastic surgery office is going to have a tissue banking license in order to facilitate freezing your own fat. So you use it or you lose it. Use it when it’s fresh, reinject it, or we’ve got to throw it away.
Let’s say I have some loose skin and I want to combine my lipo, my BodyTite Lipo with a mini skin removal procedure. That’s done all the time. Rather than a great big long tummy tuck or extended tummy tuck incision from hip to hip, we can do shorter scars and BodyTite Liposuction with good contraction of the upper belly. We can do BodyTite in combination with little armpit lifts rather than a full brachioplasty, little anterior thigh groin crease lifts rather than a full thigh lift, or under the chin and neck with neck tight and a behind the ear limited neck lift scar. So the combination of Lipo contouring with energy based thermal devices such as BodyTite, NeckTite, FaceTite, AccuTite, and limited excision surgery is one of those hybrid procedures that’s found a good niche because it gives an even better result than BodyTite Lipo or energy based lipo without the big scars.
So let’s say you’re interested in Lipo. You find the right surgeon, great safe facility, good reputation. What are you looking to pay, usually? Most surgeons in North America will charge lipo by zone. And in general you pay anywhere from 2,500 to $3,000 for a zone in less expensive markets or cheaper practices, and upwards of 4,000, 5,000, 6,000, $7,000 for the first zone, and 4,000 or 5,000 for every zone thereafter. And those are the range in prices you see in North America.
Generally, the guys that are very busy, very experienced, own three or four image based technologies have a good market reputation, are going to charge a little more per zone than less experienced individuals with less notable reputations. You also pay a little more per zone if you’re bigger. So you have a tummy and you weigh, let’s see, a BMI of 34 and you have another patient with a BMI of 24 and a small amount of pinchable fat, that tummy is going to cost the smaller patient a little less than the bigger patient. So there’s large zone prices as well.
And then there’s sometimes quite often an upsell for energy based technology, like the addition of BodyTite or Vaser or Smart Lipo. These are usually upsells for the advantage of that tightening you get. One of the energy based devices that typically doesn’t cost you more is something called power assisted. Power assisted, or PAL, is a cannula with no energy, basically basic liposuction cannula, that’s motorized. So it goes back and forth about 1,000 times a second, and the surgeon’s arm is moving about one cycle per second and it removes fat much faster, speeding up the procedure, making it safer. And so, those are the prices you can see in North America in general.
And the last category is secondary lipo. These are patients who’ve had lipo before, they have irregularities, indentations, laxity problems. They usually are going to pay more for secondary lipo, upwards of sometimes 8,000 or 9,000 or 10,000 for the first zone, and it can easily cost them 14,000, 15,000, 16,000 for two or three zones, because these are tricky cases, much more complicated, take longer and take a greater amount of expertise and therefore costs more.
So you’ve done your lipo, you’re about to get a great result. What’s the postop care like in terms of a compression garment? One hundred percent of surgeons in North America nowadays are going to insist on a compression garment, and it’s going to be a nice specialized custom made to measure, form fitted, Lycra spandex kind of combination. They’re breathable, but they get a good 22 to 28 millimeters of mercury of pressure per square centimeter, which results in a nice controlled contraction and retention of your skin while it’s healing to the underlying muscles. So there’s no way of regularities or laxity. So it controls the wound healing process in a good position while that six weeks of healing of neocollagenesis is occurring. So you get it measured before your surgery, it’s usually combined with some foam padding, which is going to give you better compression in certain areas, and the foam padding lasts about a week.
You wear that garment 22 hours a day for three weeks for most practices. Then you can wear it during the day, leave it off at night for another three weeks. At the end of six weeks you can fold your garment up on the shelf and go back to your normal activities like high impact aerobics and exercise.
“When can I return to a high impact aerobic activity or my normal exercise routine after liposuction?” That’s a common question. I tell most patients the first three weeks, brisk walking, keep active. You’ve got your post liposuction garment on, but no high impact arobotic activity, no balancing, running, no pilates or crunches if you’ve done abdominal work. So high impact activity start at six weeks. So you’re back on elliptical, a stair climber at three weeks, you can start to isotonic muscle exercises where you haven’t done lipo, like bicep curls, Thigh Master if you haven’t done lipo in those areas at about three weeks.
High impact activities like jogging, yoga, pilates, crunches, these kind of activities, you’ve got to wait about six weeks so you get some adherence between skin and the underlying muscle, then you can begin those activities. Starting gradually and build up your endurance and your strength over time. Return to swimming typically needs healed incisions and that’s going to be usually around three to four weeks, before that you want to get in the lake or a dirty pool or whirlpool water. And what about flying away, flying out of the city after surgery and going on a vacation? Generally, I recommend people stay around for about a week until some swelling is subsided, the garment compression has worked and it minimizes the risk of a airplane induced pulmonary embolism or DVT. So you want to hang around a week before you travel at 31,000 feet and go off for a vacation.
What about the use of a drain after a liposuction surgery? Typically loose areas like a tummy or very loose upper arm treatment might require a drain, and usually it’s for several days to encourage contraction and coaptation of the skin to the underlying muscle.
So thank you for joining us. Dr Stephen Mulholland here in Toronto, Canada on plastic surgery talk for our weekly podcast series. This one was on liposuction, a deep dive into modern liposuction and all the questions around that. If you found this engaging, interesting, educational, please sign up, subscribe, and comment. See you next time.
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