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Stony Brook, NY

Dr. Epstein's Current Approach to Body Contouring

PLEASE READ THIS FIRST (It’s well worth the time!)

In 1990, when I was a resident in plastic surgery, and up until 2013, my approach to body contouring was simple. If there is a part of the body that a patient doesn’t like, then you select from the available procedures at the time and correct it. For instance, if there is extra fat in the flanks, remove it with liposuction. Extra skin in the abdomen from three pregnancies, then go with abdominoplasty. My results got better and better with refinements in technique and experience, and both my patients and I were happy. The approach was clear, concise and afforded significant improvement.

I will never be content with the status quo. My entire surgical career has been one of evolution. Always look for a better approach, a better technique, better technology. In 2013, I gave great thought to what I was doing and sought to improve it further. I traveled to Bogota, Colombia where I was personally trained by Alfredo Hoyos, M.D. and became one of a small group of surgeons worldwide certified in 4D Lipo.

I will explain the difference. In the past, liposuction was about removal of deep layers of fat. We were taught NOT to treat the superficial layers for fear of creating dents and divots and other deformities. We were taught to focus upon areas of excess deep fat, from the hips, the abdomen, the thighs and remove it. It worked, and results were good. With advancements in technology, a device called the VASER was developed. The VASER uses ultrasound to emulsify fat and less traumatically separate it from the skin and muscles so that it may be removed with suction. The interesting thing is that ultrasonic energy is tissue specific for fat and does not disturb adjacent nerves, blood vessels, skin and muscle. With the VASER, it has now become possible to safely address the superficial layer of fat. The ability to sculpt the superficial layer of fat is what permits to surgeon to create definition. I have been using the VASER since about 2005, but only addressing the deep layer of fat. The newest generation of the VASER, along with special accessory equipment including custom-made probes and cannulae, permits me to address both deep and superficial layers of fat with the ability to sculpt the body. Now, I can remove deep pockets of fat to “debulk” areas, as well as remove smaller collections of superficial fat to yield greater definition of the underlying musculature. I can now even “etch” lines of definition to accentuate the musculature (ie create a “6-pack” over the abdomen). Lastly, and this is an added bonus, as it turns out, about 85% of the fat removed by the VASER is viable (alive). This means that I have a new tool: I can take the fat I remove and use it to add volume to areas of the body deficient of volume such as augmentation of the buttocks, male pectoral (chest) muscles and even the face. The removed fat, now harvested in a special sterile canister, has been elevated from “medical waste” to “liquid gold”. I now have the ability to take down areas of excessive contour, enhance areas of poorly defined contour, create muscular definition and add contour, all in the same operation!

Meet the doctor Dr. Mark Epstein
Dr. Mark D. Epstein is a board-certified plastic surgeon with additional qualifications in surgery of the hand, currently practicing in Stony Brook, New York. Dr. Epstein also serves as the Chief ... » Learn More

When Hoyos quietly developed these procedures, he initially called it “Hi Def” or “VASER Hi – Def”, and several surgeons became trained in it. Recently, Hoyos further refined the technique. The fourth dimension referred to in the term “4D Lipo” is dynamic definition of the underlying muscular anatomy as it relates to muscular motion is now also considered. This has taken liposculpture and my results to a new level.

What I learned to do is to stop looking at isolated regions of excess fat and instead to focus upon the entire trunk, sometimes with the upper arms and thighs as well, as one unit and to sculpt the body using all the tools I described above so as to achieve the most natural, physically fit and three dimensional aesthetic results possible!

When addressing the abdomen, in the past, I would decide if the patient needed an abdominoplasty (excess of skin, not much excess fat) OR liposuction (excess fat, not much excess skin). It was an either/or decision. In Bogota, I learned to perform a 4D VASER lipoabdominoplasty which is like a marriage of the two procedures. Like traditional abdominoplasty, it is applicable when there are small or large excesses of skin. However, there are several advantages to 4D VASER lipoabdominoplasty:

  • The abdominal skin flap is contoured with VASER liposuction before it is elevated from the underlying muscles. This affords more muscular definition and three dimensionality to the results. In typical abdominoplasty without VASER liposuction, the skin flap is pulled downward and the excess skin is trimmed, however, the thickness of the abdominal skin varies at different levels and simply pulling the skin down can result in improper skin thickness, distorting results. Also, the abdomen looks more like a flat sheet of skin pulled over it rather than having shape and contour.
  • There is usually less blood loss associated with 4D VASER lipoabdominoplasty.
  • Less abdominal skin needs to elevated off the abdominal wall to premit proper re-draping over the muscles. This preserves more circulation to the abdominal skin and therefore there are less problems with wound healing. Thus, 4D VASER lipoabdominoplasty can be thought of as a SAFER ABDOMINOPLASTY.

4D VASER Lipo and 4D VASER lipoabdominoplasty are more detailed procedures, and as such do take longer to perform. Surgery is generally performed under general anesthesia. Smaller areas can be performed under local anesthesia with or without sedation. Due to the increased amount of surgical detail required as well as longer operative times, 4D VASER Lipo and Lipoabdominoplasty does cost more to perform. However, the results far and away justify the extra effort expended!

Although I still perform traditional (without VASER liposuction) abdominoplasty without drains (see below), 4D VASER lipoabdominoplasty does require a single drain under the lower portion of the abdominal skin (at the waist crease) for a week or two. I have also found that a special 4D Lipo compression garment with a foam vest for four weeks helps greatly with limiting swelling and assuring that you get to your maximal contours as soon as possible. Patients frequently drive a week or so (sometimes less) after 4D VASER lipoabdominoplasty and report very little discomfort after the surgery. In my opinion, the improved natural quality of the result after 4D VASER lipoabdominoplasty justifies the extra inconvenience of the one drain and the garment. Note: this garment is NOT a binder but a special elastic garment manufactured exclusively for 4D lipo procedures.

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