Skin contraction is just as important as removing fat when you do a liposuction. If you do superficial liposuction correctly, the skin will contract. Not a question of if, it’s a question of how much.
I think there are three things that probably have to do with the skin contracting. One thing is that when you do liposuction, you create a network in the areas where you remove the fat. So if you liposuction something too much as thick, as it heals, it will scar down into a quarter inch think.
So an example of that is here. Her muscles are here. The abdominal wall is here. So this is maybe three, four inches away. As it scars, the skin will pull it back toward the muscle. And you see here, now the muscle is here and the skin is here. So this is a tremendous amount of skin contraction and I think that’s probably the main thing that’s driving that skin contraction.
The second thing I think is probably doing that is actually injuring the skin. When you do the liposuction, you rub the cannula underneath the skin. You are injuring the skin, and when you injure something, you lay down collagen .If you ever had a scar, you feel that skin. It’s always thicker and harder than the normal skin next to it. That’s because of the extra collagen is laid down. So I think that’s also happening.
The last thing is probably magic stem cells. When you shake up fat, you release stem cells. Fat has a lot of stem cells and you’re probably bathing the skin with stem cells and that’s probably has something to do with getting the skin to contract although nobody really knows.
Now, the point is this result from here to here is about removing the fat cells but it’s really about the skin contracting. If the skin was a loose bag after you remove these cells, this result would be horrible. But because the skin contracts from this to this, form that to that, that is a key to really a good liposuction.
The skin contraction is just as important as removing the fat. Let’s look at some examples. And every example we see, the skin afterwards will be tighter than the skin before. A before and after of this lady who have liposuction done before as least by somebody else. Without doing the liposuction correctly, the skin did not contract. When doing the liposuction correctly, the skin contracts. We go from this to this. This skin is tighter than before.
The back, this is the big deal. But this skin again is tighter than that skin.
Stretch marks. But the skin can still contract. She is a very curvy person but it’s all hidden by this, by skin and fat. Remove the fat and get that skin to contract, we see this little tiny waist. Look at the skin at the back. Look at the skin after. Look at the skin in the stomach. Look at the skin after. This skin is much tighter than this. Without the skin contracting, this skin still looks like this, that would be a useless liposuction. The skin contracting is probably as important or maybe even more important than removing fat.
Look at the skin here. Look how it’s tighter there. It’s the skin contracting.
Thin person, still even this person looks muscular. This one not as much muscular.
This back, the skin is tighter than that.
Another example. Look at the skin contracting. It doesn’t always have to be a tummy tuck. The skin can contract.
The back is tighter than it was before.
This skin is tighter than that. The back is tighter afterwards than before. When that skin contracts, it gives you that tiny. Look at the volume of skin here compared to the volume of skin there.
Look how tight the skin is, how loose the skin is here hanging over the bra. Tighter afterwards. It’s the skin contracting. That’s the big deal.
Really the skin tone always shrinks. Look at this little body that’s hidden inside here. Look at the length of that line. Look at the length of this line. This line is 20% shorter. It’s about the skin contracting.
Look at the back. The skin is tight.
This is a thin person. The skin is still tighter.
Again, the skin is tighter.
Making the small back but that skin shrinks to the back.
This skin is tighter than before. The back tighter than before. Wrinkles, no wrinkles.
Look at the skin on the back. Much improved.
Key. Look at the skin of the abdomen. Much tighter afterwards. You find this little body. The skin contracts like a glove. Now, you see the results.
The back, taking down the back. They key, taking down the back and get that skin to contract. It’s the skin.
Again, the same picture. This is really skin contracting.
This back contracted? Maybe not a 100% but it did contract 95%. This surgery is about eh skin contracting.
Good skin, not a big issue.
Adding fat here was a big deal for her.
Look at the skin after. Look at it before. It’s tighter after than before.
Look at the wrinkles on the back. Look how much less. This is only a week. It’s about the skin contracting.
Liposuction is about removing fat but the most important thing is the skin contracting.
Thank you very much for your support.
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Audio Liposuction Virtual Consultation
Today we’re going to talk about liposuction. Liposuction is a fat surgery. What we’re doing with liposuction is we’re just changing where we store calories. Fat is a storage compartment.
If you take calories in and you don’t burn the very second you bring them in, they store this fat. Our problem areas have a high concentration of fat cells than the normal area next to it. Because of this when we bring in those extra calories, they all go to the problem area before they go to the normal area.
Now the whole reason why liposuction works and the reason why we have a problem areas is that fat cells don’t replicate. We’re all born with a certain number of fat cells in certain locations. We keep the same number throughout life.
If you gain weight, each cell gets bigger and if you lose weight, each cell gets smaller but the number never changes. Our problem areas just have a high concentration of fat cells and we will always gain weight in that area first and lose weight in that area last because of that high concentration of fat cells.
That’s where liposuction comes in and it makes it a unique procedure. Because once you change those concentration of fat cells, they’re forever changed because the fat cells don’t replicate. When you make the concentration of fat cells even throughout the body, if you gain weight or lose weight, you will gain and lose weight evenly.
Liposuction doesn’t change how many calories are stored. It is not a weight loss or weight changing procedure, but what it does do is permanently change where those fat cells are and where the calories are stored.
If I can get the concentration of fat cells in the back, the waist and the hips exactly even you have a smooth curve. If you gain weight you’ll get wider but the curve will stay because the concentration is even. If you lose weight, we get smaller but the curve again will stay because the concentration is even. That is the key to what we’re doing when we do the liposuction.
The perfect liposuction is an even liposuction. It is not perfect to take away all the fat cells from one place because liposuction is a “rob Peter to pay Paul” type of surgery. If you take away all the storage compartment for one place, you’ll gain weight someplace else.
Theoretically, we took every fat cell from the shoulders down. Every fat cell from the back, the stomach, the legs. If you gain weight, now you gain weight all in your neck and your head and that’s not a pretty sight and there’s nothing you do to fix that. So even is perfect. Taking every fat cell is not a perfect liposuction.
That is kind of fundamental idea of what we’re trying to do when we do liposuction. We try to change those concentration of fat cells.
Now the other important part of liposuction is the skin contracting. When you do superficial liposuction correctly the skin will contract. If you do this superficial liposuction correctly, the skin will always contract. It’s not a matter if it will contract but it’s a matter of how much it will contract. The better the skin tone, the more it will contract, the less stretch marks, the more it contract but it always will contract. That’s one of the key parts of liposuction.
The other things we have to think about is always being conscious of making the liposuction even because we don’t want to burden someplace else with gaining weight.
Physically what you’re doing when you liposuction is taking small cannulas, from 2mm in diameter to 5mm and coring out fat cells. So you’re taking it solid and you’re making it in to a Swiss cheese.
Now when you’re finished with that, you kind of left with is like a sponge or Swiss cheese. Now all those holes where the fat cells where removed will fill with fluid. This is what the swelling is. It’s fluid in the holes where the fat cells were .
The way the swelling goes away is in all these holes heal close. We start off with something three inches thick. As it heals and collapses, it will collapse down into something one inch thick.
As the area that we liposuction heals and scars, the scarring will pull the skin closer to the muscle. So if the skin was three inch away from the muscle before and after scars it will be one inch away. This is the powerful thing that changes the shape.
So if the skin got looser after liposuction, it wouldn’t be a good thing. But if the skin contracts with superficial liposuction done correctly, then we have a nice result and a good appearing liposuction. These are the things were doing mechanically when we’re doing liposuction.
Now the recovery, the swelling goes away when the holes collapse. If you have water between the tissue it cannot scar together. So we wear a garment, we’re trying to make that tissue touch so it can scar together. When we do massage, we’re trying to push that area together to make it scar and stick together.
When I put a tape cast on you I’m trying to collapse that area and get that area to touch. The faster we can get those areas touch the faster the swelling goes away, the faster the skin contracts, the pain will go away also because the pain is caused by the swelling.
The swelling puts pressure on nerves and gives you pains. The faster you get the swelling out, the faster you get that skin to contract and the faster the pain goes away. That’s kind of mechanically what you’re trying to do with the recovery.
Now the recovery. First night is the worst. It is very painful. It’s a throbbing, achy, bruise-y kind of pain. Not a knife pain, not a sharp pain but a throbbing, achy, bruise-y kind of pain.
The second day is better. This pain probably decreases by 10-30% the second day. And then 48 hours later the pain is probably down by 50%.
Most folks can be up and out around by day four or day five and then doing much better. The average amount of time people take off from work for a liposuction could be five to seven days.
The stoic folks go back to work at two days. Some people will take a week to ten days. But on the whole, you start to turn the corner about the fourth or fifth day.
The swelling actually takes three months to get 90% of the swelling go away. In the first month, maybe 50% of the swelling goes away. In the second month, maybe 70%. By third month, maybe 90-95% of the swelling will go away.
It takes time for all those areas to heal and scar close. No one looks their best at one month after a liposuction. Everyone has a smaller waist and tighter skin at three months then they do at one month.
It’s a slow and gradual process but you do notice a change the very next day. There will be a change in the shape the very next day after liposuction and you look very good. But you look better in a month and you look better than that in two to three months.
So far as activity, I recommend no exercise for two weeks. At two weeks, light exercise and three to four weeks heavy exercise. If you do too much too soon, you get more swelling. It takes long for the swelling to go away and longer for you to heal. That’s really the determining factor.
After two weeks to three weeks, you kind of just use your judgment as to the amount of activity you can do. Pretty much, you can do anything that does not make you have swelling. There’s nothing to rip or tear when you do a liposuction.
It’s just that if you do too much activity, you get more swelling. After two weeks after three weeks, you try to increase your activity. If you don’t have swelling after you do it, you’re fine to do that. If you do have swelling, you have to wait a week and try again later.
So far as the garment, I recommend the patients wearing the garment 24 hours a day for one month. And then after one month again it becomes trial-and-error. First step would be to take the garment off overnight. If you don’t have additional swelling in the morning, it’s fine to be off at overnight.
Maybe a week or two later, now you can try to take the garment off when you’re sitting down, eating dinner or just sitting down and relaxing. Because when you’re resting, you don’t get a lot of swelling.
The last thing you want to do is to think about taking the garment off with exercise or activity. When you’re standing all day is when you’re going to get more swelling. When you’re exercising you’re very active and that is when you’re going to get more swelling.
Everything you do is really kind of a trial-and-error and so far as the activity and the garment. Again it will take three months for you to get the majority of the swelling gone. Everyone looks better and look significantly different at two to three months they do at one month. That is the kind of the idea of the recovery.
Now, the complications. The complications that you always have to worry about whenever you have anesthesia. and I do the liposuction under general anesthesia because I think it’s safer.
When you have general anesthesia, you have airway control. If something happens, you can control the breathing of the patient. If you do this under local and something happens, you don’t have airway control so there’s not as much assistance as you can give.
In that fashion, I do think that general anesthesia is safer. But whenever you have general anesthesia you are at risk for blood clot.
When you have general anesthesia your muscles are paralyzed, your blood vessels dilate, blood can stood still in your leg and clot. If it clots in your leg, it’s called a Deep Vein Thrombosis. That would be one leg swollen and painful, the other one normal.
The dangerous thing is called Pulmonary Embolism – the clot breaks from the leg and goes to lung. Now if that happens it would cause shortness of breath or chest pain. That’s the emergency of the situation. That’s the 911 of the situation. That’s the thing you don’t wait for and things like that.
During surgery, we use what’s called the Sequential Compression Device which is a pneumatic pump that’s placed in the legs that periodically just compresses the leg and makes the blood flow to try to decrease from clotting. I also use Blood thinners in the appropriate patient who has a high risk for clot. These things can also be done.
After surgery, it’s important to move and to drink. If you’re dehydrated, your blood is thicker and you have more chance for clot. If you stay still like a statue, the blood sits in your leg and has more chance for clot.
Moving after surgery and being very-well hydrated prevents clots. That’s what the patients can do to help themselves to prevent clots.
Liposuction is a dehydrating type of procedure. The reason why is because when you do the liposuction it’s like an internal burn meaning that just like a burn makes a raw surface outside of the body and you weep fluid outside of the body.
The liposuction makes it burn inside of the body and so you weep fluid inside of the body. All that fluid that’s weeping from your blood vessels. The only storage compartment for water in your body is really the blood vessels.
When you swell you also get dehydrated. If you swell a thousand cc’s, you have wept a thousand cc’s of fluid out of your blood system. Liposuction pretty much automatically makes you dehydrate. How to compensate for this dehydration? You have to drink a lot of fluid to keep up with the fluid you lose.
If you go to the bathroom ten times in the night after the surgery, that’s also a fluid you lost, you have to replace that fluid. These are the things we’re doing to try to prevent the problems with blood clot.
Now another complication you have to worry about is infection can happen with any surgery but it’s very rare with liposuction. Personally, I’ve seen an infection with liposuction when I was a medical student and I have not seen one since. It can happen but it’s very rare.
The other things would be contour irregularities, the liposuction is uneven or tissue heals unevenly. The way you get a perfect result with liposuction is to have a perfect liposuction leaving the exact even concentration of fat cells and a perfect garment that puts even compression on the tissue.
A road to perfection is a narrow road. All these things have to be done properly in order to get the best result.
If you have a perfect liposuction and then a garment with seams and indentation, you can get a permanent indentation and you can’t have a perfect result. You can have a perfect garment but not a perfect liposuction and you also will not have a good result. These are things that you have to consider when you’re doing your recovery with the liposuction.
Other complications have to do with the complications related to anesthesia. If it’s general anesthesia, you can get pneumonia after anesthesia. You’ll get laryngeal spasm after anesthesia. Those are things you have to consider.
Lastly when you’re doing liposuction if you place the cannula in a wrong location, if you poke in through the muscle – you can get an internal organ injury. You’ll get an injury to a bowel or even the lung.
If you have hernias that you’re already unaware of, cannula go through a hernia and injure the bowel. These are the things that you have to look out for and these are complications that can happen with liposuction.
The real dramatic thing about liposuction is that it is a powerful tool to change the look of a person. I think it’s probably one of the procedures in cosmetic surgery that makes the most dramatic change in your appearance. The skin contracting is a big deal and that is the things that we’re trying to do with the liposuction.
Here is just one example, if you kind of look at the before and after. If you kind of look at the area of the waist or the flanks, the fat is thicker here and just more fat and a thicker layer fat through the bottom of the abdomen than she does at the top of the abdomen.
You can see how after the liposuction, we’ve got more than even concentration in the back, waist and the hips so there’s more of a smooth curve.
That’s what we’re talking about when you do the liposuction. We change the concentration of fat cells in those problem areas. We have lowered the concentration of fat cells here to equal the concentration in the normal area.
If you look at the back you can see again higher concentration, thicker fat cells here also here. The skin is looser but the skin does contract and you see it’s tighter. Now we’ve got high concentration, low concentration, high concentration.
Afterwards, we have more than even concentration again on the front of the abdomen. You see the skin is tighter after than it was before and again higher concentration of fat cells here. As we even out those concentration of fat cells, we got the improvement in the shape. That is the idea of liposuction.
Liposuction is a procedure that gives you a permanent result because fat cells don’t replicate. Once you change the concentration, they’re forever changed. It is not a weight-changing procedure.
If you gain weight if you’re taking calories, you will gain weight but the shape and things should be consistent. Even if you gain weight, the concentration with fat cells don’t change so you should gain weight evenly if the liposuction is done correctly.
The last thing is if you get the skin to contract and can get a tighter trunk, you have a better look and that’s depending on doing the superficial liposuction correctly. That is the idea of the liposuction.
There’s one additional thing. Liposuction does not affect future pregnancies and tummy tucks do. What happens with tummy tuck is you tighten the fascia, you tighten the muscles and it causes problems during pregnancy for the skin and the abdomen to expand for the baby.
The liposuction doesn’t affect the future pregnancy because you’re affecting skin and fat and skin will always stretch during a pregnancy or with any other situation. That is one thing to consider liposuction and something you can do when you plan future pregnancies.
Tummy tuck is something you probably shouldn’t think about doing when you plan future pregnancies.The tummy tuck is necessary when the abdominal muscles and the abdominal fascia are weak and you have to tighten the abdominal muscle. This is a case of a person that has no choice but to have a tummy tuck if they want to make a flatter abdomen.
If the muscles are strong and the stomach is round because of skin and fat, liposuction is an option for that patient. That is really the primary difference between liposuction and tummy tuck. “Who should have tummy tuck? Who should have liposuction?”
Thanks for watching this video on liposuction and we’ll try to make more videos in the future. Take care.