Not infrequently we see potential clients in the office who come in with requests foreshadowing later dissatisfaction. One of those statements is believe it or not: “I want lipo.” Yes, you read that right. Liposuction, one of the most popular of the cosmetic surgical procedures, does not deliver in all cases.

When people come in “shopping a procedure” it can be difficult to explain to them that their chosen operation might not get them where they might like. This goes part and parcel to the commercialization of plastic surgery. Ten or twenty years ago people shopped to find a good surgeon. These days clients more commonly choose their procedure and then shop to find someone to do it. This approach can produce problems at times.

When done correctly on the right client, liposuction is a pleasing operation with pretty low key recovery. It is substantially advertised and in this advertising the negatives are frequently minimized. This in part explains the attraction, but the actual procedure can be pretty limited in the results department. When patients coming in for lipo consults grab their tummies and say, “I want this gone” this is cause for concern. Lipo does not really make things disappear. It makes fatty areas smaller. Liposuction is the operation of “thinner.”

The best way to conceptualize this is that liposuction can make a person thinner if a significant amount of fat is present under the skin in the right areas. It will not make the skin tighter over the fat that is removed. Some areas are better treated than others. For skin tightening, a tummy tuck might be in order. The shape of your tummy relates to fat, as well as the quantity of skin and the muscle around that fat. Liposuction (including the tweaked versions of it – SmartLipo, Vaser and laser-assisted lipo) do not substantially affect anything other than that fat. I have used these “advanced lipo modalities” and have gone back to more traditional liposuction, as the results are quite similar and less costly. This of course assumes your surgeon knows what he or she is doing. Liposuction should not be performed by your local butcher. The unfortunate truth is that it has been.

When patients who might have been better served by tummy tuck surgery have tummy lipo, they sometimes complain of lumpiness and looseness afterward. This has been referred to as bad lipo. They are more like “not so great” lipo candidates who had lipo anyway.

When you want “tighter,” liposuction alone will not usually get you there. There are body lifts (of which tummy tuck surgery is one) that balance the benefits of tightening with longer incisions and larger scale surgery. When tightening is to be the main goal, skin more commonly than not must be removed and re-arranged. Sure there are scars but there are results too. Good surgeons know how to hide those scars and minimize them.

The common denominator is “good surgeons.” You need them when you consider plastic surgery so you can stay out of the news.

Best Regards,

John Di Saia MD

Originally posted 2011-07-18 07:30:55.