Liposuction Long Island - Vaser Lipo
LIPOSUCTION: description and brief history
Liposuction, originally described in the early 1970’s, is a cosmetic surgical procedure utilized to remove unwanted areas of fat from various areas of the body. The incision used is very small, about ¼ inch in size. A narrow, hollow metal tube called a cannula is inserted through this incision. The cannula is attached to a vacuum source which permits the removal of the fat and transfers it to a collection canister. The removal of this fat is designed to improve the contours of your body.
The original version of liposuction used fairly thick cannulae which easily caused “divits” in the skin surface, and was fairly bloody. In 1985, tumescent liposuction was described. In this procedure, liposuction is performed in two steps. In the first step, a very thin metal cannula is inserted in the skin incision and used to infiltrate (insert into the fat under the skin) saline (salt water) solution containing epinephrine. Epinephrine is a substance naturally produced in your adrenal glands that causes blood vessels in the fat to constrict tightly. This dramatically reduces the blood loss during the procedure to very little, allowing one to remove more fat and in a much safer fashion. If it is desired to do the procedure under local anesthesia or with sedation, lidocaine, a local anesthetic, can be mixed into the saline solution as well to numb the skin. The second step consists of inserting the cannula with suction applied to remove the fat.
In the 1990’s, ultrasound was used in an attempt to break up the fat and permit its more efficient removal. Ultrasound was applied externally to the skin, and even internally through the cannula just prior to the application of suction. Results were improved, but still not where we wanted to be.
introducing the vaser
In the next decade, a new concept for the application of high energy internal ultrasound (VASER) was created. This is an alternative to the traditional, more physically traumatic technique of traditional liposuction. The VASER procedure is now performed in three steps instead of two. The first step is the same as before – infiltrating the fat with saline solution + epinephrine. The new step is the second step. A thin, solid titanium probe with one or more “rings” at the tip is inserted into the skin. The handle of the probe transmits high energy ultrasound which, due to the ringed design of the tip of probe, is concentrated and emitted from the tip of the probe. The probe is now directed by the surgeon into the unwanted fat. Ultrasound energy is “tissue specific” for fat, in other words, targets the fat only, leaving the nerves, blood vessels and muscle alone. Without damage to these other tissues, patients experience less discomfort and achieve much smoother results than with traditional lipo. The heat generated by the ultrasound does give some tissue tightening, which is a desirable benefit. When the ultrasound contacts the fat, it emulsifies, or liquefies, and separates from the rest of the fat. In the third step, a cannula is inserted under the skin through the same incision and the liquid fat is easily, and far less traumatically removed. Think of it as a "gentler, more efficient" form of liposuction. The many advantages of this technology will be discussed further down.
For more information on the VASER®, please read "VASER – the latest technique in liposuction".
VASER probes of 1, 2 and 3 ring design used to emulsify fat
While early liposuction was designed to debulk fat, it was not the most artistic procedure. It as great for outer thighs (“saddle bags”) the abdomen, and sometimes the inner thighs, but not much else. Contour deformities were not uncommon.
Using the much thinner probes and cannulae with the VASER system, the surgeon can now target the fat in the individual layers – superficial, intermediate and deep. When creating contours, it is not how much fat the surgeon removes that matters, it is what you leave behind that gives nice, youthful contours. So by targeting the fat in the individual layers of the skin more precisely, rather than just “debulking” fat, it can be removed in such a way that muscular definition can be achieved.
Using the VASER system, the fat that is removed is still viable, in other words, the fat cells are still alive and therefore can be reinserted back into the body in areas that are deficient in volume such as the buttocks and hips. This fat can even be inserted into the male pectoral, deltoid and biceps muscles to give the muscle greater bulk. It won’t make you stronger, but it will make a male look more muscular.
With the advent of the above techniques, the early procedure of lipo which just removed unwanted bulges of fat now is taken to a new level. Now we have a sophisticated system called “liposculpture” to treat both volume excesses (removing excess fat) as well as volume deficiencies (adding additional fat) to create a more youthful, sculpted look. These techniques will yield much better results in patients of any age. For the purpose of simplicity, in further discussion, when I use the term liposuction as I perform it, I am referring to liposculpture.
Let's get this one myth out of the way quickly: Does the fat travel elsewhere? Absolutely not!, The fat cells are permanently removed and so is the fat. If you do not watch your dietary intake, you can increase the size of the remaining fat cells and gain weight. However, if you maintain your weight, the fat cells removed by lipo will not appear elsewhere in the body.
IDEAL CANDIDATES FOR LIPOSUCTION
The ideal candidate is healthy, not overweight (or maybe slightly so) and is concerned about one or more problem areas. Often these areas will not respond to diet or exercise. Patient expectations need to be realistic and you must understand that this procedure is not a substitute for a proper diet and exercise. It is instead used to improve the contours of your body.
Some of the more commonly treated areas are:
- Chest/Male breasts
This procedure may be performed alone, or in combination with other cosmetic surgical procedures. One of my favorite applications is to combine liposuction with an abdominoplasty (tummy tuck). Liposuction will thin and shape the abdominal skin, then the abdominoplasty will tighten the abdominal muscles and remove the excess skin. The result is a much shapelier and defined abdomen. Just about any portion of the body with excess fat under the skin can be safely treated with VASER. In order to determine how much fat can be safely removed, a personal consultation is necessary. The goals remain created a slimmer, more shapely and defined you.
It is a misconception to believe that a thin person is not a candidate for lipo. A thin person may still have small isolated excesses of skin such as in the outer thighs, or may benefit from the improved definition that precisely targeted removal of small excesses of fat may bring (see below)
Before and After: Creating a Hi-Def Abdomen
The VASER liposuction procedure
Prior to entering the operating room, with you in the standing position and the assistance of a long mirror for you to see, I will mark the problems areas with skin markers of several different colors. This information will assist me in determining how much fat to remove from the individual areas, as well as noting the areas that will receive fat transfer.
My nurse will escort you into the operating room, and you will lie down on the operating table. The anesthesiologist will start an intravenous line (IV), place monitoring EKG pads on your chest and you will begin to receive anesthesia: sedation or general anesthesia.
Once you are under anesthesia, and your skin is treated with antiseptic and sterile drapes placed, I will then mark specific areas for tiny incisions, approximately ¼ inch in length. These will be later used for the metal tubes, or cannulae, to pass into the skin to inject fluid and then remove the fat.
Next, a dilute solution of lidocaine (a local anesthetic to numb the skin), epinephrine (to reduce bleeding by making the blood vessels in the fat constrict tightly) will be injected into the fat through the tiny incisions made earlier. The amount of fluid given causes the skin and the fat to swell and become tense (tumesce), hence the name “tumescent technique”. By making the fat tense, it becomes easier to remove. The epinephrine permits fat removal with minimal or no blood loss.
When the VASER® is being used, a thin solid probe, about the thickness of the metal suction cannula (3-4 mm diameter), is introduced into the incisions. The ultrasound energy is turned on. This energy is emitted from the tip of the probe. Any fat that is in contact with the probe is emulsified (liquefied).
The last step involves inserting the hollow metal tube (cannula) into the incisions. The tube is connected to a suction line. The excess fat is removed. In the case of traditional liposuction, the fat is removed by suctioning it off the underside of the skin. If the VASER® is utilized, the liquefied fat is removed. This fat can also be collected and re-injected into problem areas deficient in volume such as the buttocks and hips.
The wounds are sutured and dressed. In certain areas, a drain may be placed for 3 - 10 days. This helps evacuate excess fluid and hastens the time it takes you to recover. You are then transferred to the recovery room. Compression garments to reduce post-operative swelling may be applied at this time. As you recover, your nurse will tend to you and you alone. When you are ready for discharge, she will give verbal and written instructions to you and your caregiver who will be escorting you home.
VASER Hi-Def and VASER 4D Lipo
This technique is credited to it’s inventor, Alfredo Hoyos, MD, a plastic surgeon practicing in Bogota, Colombia.
Whereas traditional liposuction is all about improving body contour by removing excess deposits of fat, VASER Hi Def is a technique that uses the VASER ultrasound fat removal technology to sculpt the body. Excess fat may be removed from one area of excess, and grafted into another area where there is a deficiency of volume. Yet other areas, not noticeably excessive in fat are further sculpted to enhance the natural contours and form.
The Difference Between VASER 4D Lipo and VASER Hi-Def
While VASER Hi-Def took liposuction to a new level and introduced the ability to sculpt and etch definition during surgery, Hoyos was still not finished innovating. Consideration needed to be given to natural motion and underlying muscle anatomy, as well as accounting for future weight loss to enhance the final surgical result. The final product is a more sculpted, more natural and youthful body. The beauty of these techniques is that they are applicable to both men and women.
I was personally trained in these technique by Dr. Hoyos at his surgical facility in Bogota, Colombia. I am fortunate to have not only the benefit of his expertise and skills, but also his ongoing friendship. After acquiring these exciting skills, I have been able to surgically create contours like never before imaginable! Offering these techniques to my patients represents my unending dedication to bring the latest technology and quality of care to my practice.
The above photos depict Dr. Hoyos and myself in surgery in Bogota, Colombia at the 4D Lipo course and receiving my certificate of completion of the course.
RECOVERY AND RESULTS
After the liposuction procedure, patients will experience swelling, occasional bruising and discomfort in the treated area. Compression garments are usually used to help reduce these symptoms and reduce swelling. You may return to work when comfortable, and strenuous exercise may be resumed in about three weeks in most cases.
Dr. Epstein answers the question patients are usually too embarrassed to ask: When can I have sex after my procedure?
I will give you special postoperative instructions to facilitate your recovery and help you to get the best possible results. Final contours will not be visible until after swelling and bruising subside. This may take 4 -6 months, results will appear gradually during this time period.
I have found it very helpful to begin postoperative massage therapy combining deep tissue massage, lymphatic drainage and external ultrasound to mobilize the fluids in your tissues, reduce swelling and maximize the visible results of your liposculpture. This can be performed by a physical therapist or a massage therapist.
Your results can be permanent if you maintain a healthy diet and exercise. One last thing – some believe that removed fat goes to other parts of the body – that is a total myth! Fat cells removed are gone forever. They do not multiply in adulthood. However, if you do not eat properly, they will enlarge! However, if you maintain a healthy lifestyle of proper diet and exercise, your results should last for years to come. Normal aging changes will occur, and that will vary amongst individuals.
The cost will vary by the amount of areas that will be treated, as well as the amount of fat that is anticipated to be removed. A personal consultation is required to provide an exact quote.
The RISKS of Liposuction
Although liposuction is considered safe, there are certain risks associated with any type of procedure. Infection is very rare, but ore common minor complications include small areas of fluid collection and minor contour deformities. Liposuction is one of the most commonly performed cosmetic procedures and is almost always performed with no serious complications.
You can minimize potential risks by choosing surgeon experienced is this procedure as well as by following his/her pre and postoperative instructions. To learn more about the liposuction procedure, I encourage you to call my Long Island office today and schedule a consultation with me.