Tummy Tuck vs Liposuction

Many patients are unhappy with the appearance of their abdomen.  They may complain about the extra fat, the loose skin, the lack of tightness, or the presence of stretch marks.  It is important to understand the difference between a Tummy Tuck, or abdominoplasty, and Liposuction in order to decide which is most appropriate.

Liposuction involves the removal of fat with the help of a suction device through very small incisions.  Any volume of fat can be removed – from large volume to just small amount in the problem areas.  After the fat is removed, the skin will generally tighten to accommodate your now slimmer body.  The amount that your skin can tighten depends on several factors: the amount of fat removed, the area it is removed from, and the quality of your skin. 

Liposuction is used specifically to remove fat and improve the overall shape of your body. When performed on your abdomen, liposuction can result in a tighter upper and lower abdomen and flanks, with very small and hidden incisions. Liposuction will not do much to improve your skin. This means that if you have hanging skin, or pannus, liposuction may make this appear worse. Also, if you have abdominal wall laxity because of loss of muscle tone, liposuction will do nothing to help this. Lastly, if you are complaining of stretch marks, liposuction will not eliminate this and may in fact make it look worse.

A Tummy Tuck in New York, or abdominoplasty, is a larger operation but has a significantly greater impact on the appearance of your abdomen. A Tummy Tuck will remove the excess or hanging skin, remove stretch marks, and remove excess fat.  It also involves tightening of the underlying abdominal muscles that become loose with age, after pregnancy, or changes in weight. Tightening the muscles is the most powerful way of giving you a flatter, tighter abdomen.

Your board certified plastic surgeon will be able to examine you and tell you if liposuction or a tummy tuck is best for you.  Oftentimes, the two are combined in order to give you the best improvement in the contour of your abdomen.  Keep in mind that the recovery from a Tummy Tuck is greater than the necessary recovery from a Tummy Tuck. This may also factor into your decision between these two popular procedures.

Silicone or Saline – Which is the better breast implant?

Several times each day I am asked the question, “Is silicone or saline a better implant?”  I explain that I cannot say which is “better” because it is impossible to define “better.”  Also, breast implant selection is a very personal decision.   I do tell my patients that silicone implants tend to look more natural and feel more natural.  They then must decide if this constitutes “better” in their mind.

 Silicone implants have used for a long time.  In the 1980s and 1990s there was immense controversy surrounding silicone implants. There were accusations that silicone implant carried with them a risk of cancer and auto-immune diseases.  In response, these implants were removed from the market, except for the use in breast reconstruction after mastectomy.  During this time, plastic surgeons began to gather an incredible amount of data about these silicone implants and the patients who have had them implanted.  After 14 years of data collection, the data was analyzed and there was no evidence that any systemic or chronic illnesses can be attributed to silicone implants.  In 2007, the FDA removed the restrictions and silicone implants were again approved for use in cosmetic breast augmentations.

 In my practice, approximately 80% of women select a silicone breast implant.  They find the implant softer, more natural, and without the common “rippling” that can be seen in saline implants.  Also, many patients who previously hassaline implants placed, have returned to have the implants exchanged to silicone.

 The rate of implant rupture and leaking is no different between saline and silicone. The only difference is that a ruptured saline implant is very obvious – the woman will “deflate” within days as the body absorbs the salt water.  Detecting a silicone implant rupture is more difficult. Because silicone is not absorbed by the body, the breast will not “deflate.”  Rather, there may be a slight change in the overall shape and feel of the breast. This change may be so slight that it can go undetected for motnhs. An MRI is needed to absolutely detect a ruptured silicone implant.

 The other difference is that a silicone implant is supplied pre-filled, as opposed to a saline implant which is empty and inflated after it is put in the body.  This means that a larger incision is needed to place a silicone implant. It also makes silicone implants more difficult to place through the underarm and impossible to place through the belly button.

As stated earlier, implant selection is a very personal decision. As a physician, I provide the details of each implant type, giving enough information so that my patient can make an informed decision for herself.

Laser Liposuction – Is it worth the hype?

One of the “hottest” trends in plastic surgery is Laser Liposuction.  Many physicians promote this new technique as the latest and greatest in body contouring.  They point to smaller incisions, less bruising and swelling, greater skin tightening, and faster recovery. But is this hype justified, or is this just a creative attempt at marketing in a down economy?

First, let me give my qualifications to answer this question. I have been using Laser Liposuction for several years now and have been involved in several clinical studies to examine the benefits of laser-assisted lipolysis. I am also a luminary for one of the largest laser companies and am given the task of training other physicians about the proper techniques for using this technology.  I am among the most experienced in using this technology so I have a deep understanding of the advantages and limitations.

Laser liposuction has a prominent role in my practice.  I do find that it offers my patients less bruising, less swelling, and a more rapid return to normal activities. Most important is that it has a greater abililty to tighten the skin as compared with traditional liposuction methods. This is because the laser energy causes heating of the underside of the skin. This controlled thermal injury stimulates collagen organization and formation. The result is skin with a thicker dermis and more elasticity – ie. “tighter skin”.

However, there is no magic. Laser liposuction will result in tighter skin than traditional methods but it will not give a tight, smooth abdomen in a person who needs a tummy tuck.  It will not give a sculpted neck and jawline in someone who needs a necklift.  It does allow you to have liposuction in areas that plastic surgeons have traditionally avoided because of the fear of loose skin, such as the neck, upper arms, and inner thighs.

Laser liposuction may allow a more rapid recovery, but it is not the “lunch-time lipo” that has been promoted.  You will still bruise, you will still get swollen, and you will still be sore for a certain amount of time. This obviously will vary according to the amount of liposuction performed and on what area(s).

In summary, laser-assisted lipolysis can offer excellent results when performed correctly. It is commonly used in conjuction with traditional liposuction methods in order to give you an improved contour. I am a huge fan of Laser Liposuction – I use it in my practice and I routinely teach others how to use it.  However, I also make sure to give my patients a realistic idea of the improvements they can obtain. I never “over-sell” this because it will only result in a disappointed patient and an unhappy surgeon.

 Also remember, even though the incisions may be small, this is still a surgical procedure that requires a properly trained physician. Make sure your doctor is a board certified plastic surgeon and experienced with this laser technology. Also make sure this is performed in an accredited facility.

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