My Views on Liposuction
When I first started out as a plastic surgeon I saw all types of patients that a general plastic surgery practice might see. These included reconstructive cases like hand trauma and disease (arthritis, carpal tunnel,etc), bad wounds, facial trauma, breast cancer reconstruction, and some cosmetic surgery. As the years progressed I have transitioned such that today I do only Aesthetic surgery more often called cosmetic surgery. An interesting thing has happened though in the past ten years. Now people want to know what area of plastic surgery do I do. Wow have things gotten super specialized! Well I do all areas of Aesthetics but I will say I limit liposuction. “Why”, you ask? Well lets first put things in perspective. According to the American Society of Plastic Surgeons in 2008 approximately 250,000 Liposuction cases were performed in the USA. Placing this procedure 3rd to Breast Augmentation and Nose reshaping. Yet in my practice liposuction is probably 9th or 10th. It’s a rather easy operation to perform with few complications. Patients are usually gratified. So why not do more of these cases. The truth is many of my patients are word of mouth referrals and they all know I typically send away most people asking for liposuction. That’s not to say that there aren’t very good candidates, I just think those are a whole lot less than what most of my colleagues take to the OR.
Consider this, most humans have the number of fat cells they are going to have in their body established by the time they are about two years old. After that the fat cell just get larger, they don’t increase in number. Getting larger by the way is hypertrophy. Increased number is hyperplasia. Anyway some folks are preprogrammed to put on extra weight in an asymmetric way. Take for example the tall slender person with large fatty deposits on their outer thighs. The so called saddle bag deformity. Or, as one of my patients said, the extra stuff that gives women square hips after babies. My feeling is that if you are in reasonably good health and within 10 – 20 lbs of your ideal body weight and have an area of fatty tissue that simply will not respond to serious diet AND vigorous exercise, than you are probably a candidate for liposuction. There are other criteria like skin elsticity, etc too. But what about the patient that is ‘full’ in the calves, thighs, hips, tummy, back and under the chin? Some of my colleagues will offer total body liposuction. Or worse they will call it liposculpture as if that term will make it seem more defensible. It is not. It is mercenary. In fact I believe you are doing these people harm. In two years they will be back where they started except now the fat will have returned in areas possible not accessible to lipo. These areas include inside the belly around the intestines, liver and heart. It has to go somewhere.
On the other hand I see many folks that come in and just have fuller figures, have been stable at their weight for years and have no desire or intention of becoming more slender. They just want an area that is out of proportion reduced. I think it is perfectly reasonable to go ahead with these folks. Likewise an older person with poor elasticity that may get a volume improvement in a difficult area but whose skin may be wavy afterwards due to poor contraction.
So, that my views. Naturally I do liposuction. I just limit patients who need diet and exercise and refer them to the “Healthy Lifestyles” page on my web site: Healthy Lifestyle Houston