Liposuction, Abdominoplasty & Weight Loss
I see a lot of patients that are struggling with their weight. They have a sense of frustration because they can't seem to figure out what to do. They end up at my office because they feel liposuction is a solution, or they think perhaps abdominoplasty or another type of operation would help. In my opinion, these kinds of procedures are not for people who need to lose weight — and that can come as a surprise.
One reason is that being overweight is largely a factor of lifestyle. With that understanding, even if we perform operations on people that really need to get down to a healthier weight, they are going to gain the weight right back without a lifestyle change. To make matters worse, if they gain weight again after having liposuction it accumulates in other areas, and the body's form goes out of proportion. It's not attractive. A recent and reliable study showed that people who are overweight have many more complications around surgeries, particularly with procedures like abdominoplasty where the patient has a long incision. This is another important consideration.
When a patient really wants to be lighter, I explain that it's primarily about a lifestyle change, not just "going on a diet." Diets typically work in the short term, but once the patient quits the diet, the weight comes right back. Really I'm baffled: Why are there so many diets in this culture? It seems like there are two or three diets attached to almost any phenomenon -- a vegetable, a doctor, an exercise program -- and they don't really last! I believe we should be talking about healthy lifestyles and changing habits rather than picking up on somebody's idea of a diet.
Changing our lifestyles involves both diet and exercise. We have to be educated on what to include and exclude in our meals, as well as what to consider a treat for special occasions but not eat on a daily basis. We also need to understand how much exercise we should undertake. This alteration of diet and lifestyle needs to be relatively strict for a while to get to the desired weight, and then we can start adding some things back. A somewhat obvious tip is for the patient to weigh himself almost every day. We need to keep tabs on our weight; otherwise we gain weight without really noticing. Most people don't gain a lot of weight all at once; they gain a pound or two a year. Twenty years of that equals forty pounds -- that's a lot of weight.
I encourage my patients first to get to their best weight, a healthy weight, before we do any kind of procedure. If they are not there yet, I recommend we delay until their weight is where they want it.
The massive weight loss patient is medically in an entirely different realm. A person that has had a procedure to reduce the volume of their stomach or in some way altered their GI tract has lost a large amount of weight in a short period of time. We've grown to realize that after massive weight loss, patients are, in fact, malnourished -- even though they don't look like it. In most cases operations should be delayed until we can see that their nutritional blood work is normal and stable. That can be anywhere from six months to a year after the initial weight loss.
It may appear that I turn away every liposuction and abdominoplasty candidate! Not at all. I have and continue to perform many of these procedures with excellent results on hundreds of appropriate candidates. Liposuction really is for contouring; it's not for reducing someone's weight. A person with a shape that is too full in one area or another can be safely reduced through liposuction. The main areas of the body I treat with liposuction are the abdomen, hips, thighs, back, and chin. If the patient has had children or if there is a lot of redundant tissue in their abdomen from major weight loss, then certainly abdominoplasty is a fabulous operation that gives very nice results.
These operations are not "maintenance" procedures. They are typically performed only once and last a long time. Sometimes a one-time "tune-up" after five or ten years can be beneficial. The incisions I make for liposuction are extremely small, only about a quarter of an inch, and that really reduces the risk of infection and visible scarring.
All too often, I see premature and heavy marketing around something that needs to be studied better. A good example is the recent introduction of other liposuction procedures. I performed "Liposelection"
(ultrasonic liposuction) for almost four years, but I didn't find it made a lot of difference in my results. It only added expense and risk. New "laser liposuction" has also been recently introduced, but
its safety and efficiency are largely unproven. In the end it's about safety and results. For now, I trust my long history of good results using proven, classic techniques.
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