Dr. Spiro on TV!
I hope you were able to watch my little spot on NBC, Sunday March 25, 2012. We did a segment on America’s Health Front. In it I discussed body and breast transformational procedures, including liposuction, fat grafting, breast augmentation, lifting, body lift, and tummy tuck. We featured several patients who were shown in an exam as well as reflecting back on their experiences. We filmed 2 1/2 hours including in the operating room. Unfortunately, several of our patients who had volunteered, were left out on the cutting room floor!
Try to catch it online or look for it on our You Tube channel (search for Spiro Plastic Surgery) in the coming weeks.
Liposuction in New Jersey
Did you catch the New York Times article regarding redistribution of fat after liposuction? To summarize, it says that if you get liposuction done, the fat WILL come back in other areas. This angers me. Let me point out significant issues with this study. I will debunk their conclusions! Firstly, there is no stratification for patient’s nutritional profile before and after liposuction. Nor, is there stratification for exercise patterns before and after. This is critical because these two factors greatly determine long term success in body contouring. Let me explain. If you eat poorly and don’t exercise and have no plans to change your lifestyle, even with successful liposuction, your good surgical outcome will be short lived. Eventually, you will gain fat mass back. Only now it will go to non- suctioned areas. Liposuctioned sites are less likely to uptake fat due to cell wall disruption from the procedure.
Now take a patient who has not exercised nor has she gone to the gym. What if her poor eating, and lack of exercise is because she is depressed that she is fat or has fat in disproportion to her body. She may be fearful of going to the gym for fear of being the fattest person there. So if she has a plan for lifestyle change, she is apt to be successful! The question some would then ask is why not just make the lifestyle change? Well, for many women fat may be located in difficult to eradicate areas. You can’t wish fat away or spot reduce. Liposuction can be a great jump start. What the article and the New York times fail to account for is the very real changes in pre diabetes, insulin resistance and successful dramatic additional weight loss many women achieve after liposuction.
Finally, this is why some women who eat reasonably well, and exercise moderately, can’t seem to lose weight, but after liposuction, the poorly understood paracrine effect of fat on other hormones, allows some women to loose additional significant weight!!
I hope this helps – be careful how “studies” are set up. They may be trying to prove a point prior to beginning or may not have enough patients enrolled in the study to format it validly with enough stratified groups!
Buyer Beware in Body Contouring
Seeing a number of patients recently with poor outcomes from liposuction previously done elsewhere prompted me to write this blog. A patient came to me with areas of cold fixed thick scarring in her abdomen with other areas of her abdomen unusually thinned out and essentially absent of fat.
The cold feeling to part of her abdomen is from devascularization from over aggressive superficial liposuction using an energy source which produces heat and although liquifies fat can create collateral injury. When these areas heal, they form scarring which is relatively fixed or immobile compared to normal tissue.
So the discussion about liposuction must first start with a discussion about energy delivery to tissues. There are a number of newer technologies available to extract fat. They go by many catchy names and involve a heat delivery system based on laser, internal ultrasound to name a few. The public is often swayed by tempting marketing, promising that these smart technologies provide miraculous fat removal. One problem is that less well trained medical practioners gravitate to these marketing strategies to increase their practice. Instead of marketing good results, they market sexy technology. It can be difficult to predict outcomes when these technologies are used aggressively, but when used minimally, they yield marginal achievement.
Using cold cannula technology, thinner tubes with higher flow systems allows the surgeon to keep the heat source – the surgeon- away from tissues and hence decrease the risk to patient. This is my favored approach. I believe that we as surgeons must leave a little layer of fat in the area we suction. This is only natural. It allows for better healing. Simulating a very lean overall body mass by liposuction is risky. Liposuction should be as an aid to help shape people with inideal shapes, not to rid the body of fat. Once you are shaped by lipo if your ultimate goal is to be extremely lean then the patient must eat and exercise the part. This is the key to success! See the lipo section on my website drspiro.com for cases that depict this! After viewing what I mean, read more below.
The three dimensional approach I take can’t be offered using these other heat sources. They are really only safely reproducible two dimensionally. So, for me it’s a matter of visualizing the female aesthetic and transforming the patient into the best that they can be within reason, safely and reproducibly. I use my approach in 500cc suctions up to 9000cc volumes (which require overnight stay).
Compare outcomes, not fancy names of technology, buyer beware when body contouring!