INTRODUCTION

Liposuction or Liposculpture is the aspiration (removal) of localized bulges of fat (fat storage areas of the body) with the aim of small cannulas.  In women and men, these localized fat deposits are more commonly deposited on the abdomen, hips, flanks, inner and outer thighs, knees and chin.  Liposuction is not an alternative to weight loss but a means of reshaping the body into a slimmer profile by removing the fat not responsive to the dieting.

AM I A SUITABLE CANDIDATE?

Determining your suitability will partly be defined by the quality of your skin.  In most cases the skin is able to shrink to the new body contour after liposuction.  In some cases however, patients may have decreased skin elasticity as witnessed by loose, hanging, or creepy skin in the affected area.  In these cases liposuction alone will not produce the desired result and you may therefore require some form of skin removal instead (i.e. Tummy Tuck) or perhaps in combination with liposuction.  The best patients for liposuction are those individuals who are on average or near average weight, and have reasonably good skin tone and elasticity.  Age by itself is not a significant factor and in fact patients of all ages have benefited from liposuction.  You should also understand that liposuction by itself will not improve the dimpled skin condition known as cellulite.

WHAT IS LIPOSUCTION WITH THE TUMESCENT TECHNIQUE?

The most significant refinement in liposuction has probably been the development of the Tumescent Technique.  The tumescent technique of liposuction involves the injection of a saline solution containing dilute local anesthesia and adrenaline into the fatty tissues.  It contributes to the loosening of bonds between the fatty cells, thereby facilitating their removal.  As a result of the adrenaline there is a decrease in the bleeding from blood vessels thus allowing us to remove larger quantities of fat more safely.  Less bleeding also means less bruising.  The infiltration of large volumes of dilute an anesthesia also allows the procedure to be performed under local anesthesia with or without sedation if desired.

WHAT DOES THE OPERATION INVOLVE?

To begin the operation a number of tiny incisions (about 3-4 mm) are made in the skin in the areas to be treated.  These slit incisions are made, when possible in inconspicuous places.  Subsequently the areas are injected with the tumescent solution.  The appropriate cannulas are inserted into the fat, and then through backward and forward stroking motions the fat is loosened and drawn off by a strong vacuum pump.  Since the fat is removed by suctioning small “tunnels” through the fat, the skin remains intimately connected to the underlying muscles by multiple attachments called fibrous septa.  These can be described as being the body’s “Velcro”.  It is this process and these structures, which assures that the skin will not hang in loose folds after liposuction.

WHAT TYPE OF ANESTHETIC IS USED?

Liposuction can be performed successfully either with a local anesthetic alone, local anesthesia with mild sedation (twilight anesthesia) or with a general anesthetic (completely asleep).

HOW LONG DOES THE SURGERY TAKE?

This depends on the number of areas treated and the amount of fat which will be removed.  Therefore this can be anywhere from 30 minutes to 2 hours.

DO I NEED TO STAY IN OVERNIGHT?

This very much depends on the number of areas treated and the amount of fat that is removed.  Certainly when small areas, with less that 1.5 liters of fat are removed, day surgery can comfortably be undertaken.  When the amount of fat exceeds this, it may then be preferable to decide on an overnight stay.

HOW MUCH FAT CAN YOU EXTRACT?

It is important to understand that there is a maximum safe limit to the amount of fat that can be extracted during any one operation.  This is usually between 2.5 – 3 liters.  In some instances therefore you may want to repeat or have more removed at another time.  It is usually best to wait at least three months between procedures.

IS IT PAINFUL?

There are very few forms of surgery that are completely painless.  Usually there is discomfort or soreness at the treated areas for few days.

WILL THE FAT COME BACK?

No.  As fat cells have achieved their set number in any given part of the body by puberty, increased caloric intake will not lead to volume gains in the treated site.  It is important nonetheless to maintain your weight afterwards by sensible eating and regular exercise.

WHAT HAPPENS IMMEDIATELY AFTER THE OPERATION?

After your surgery, an elastic compression garment will be in place.  This must be worn over the treated area to control swelling and bleeding, and to help your skin shrink to fit your new contour.  You will need to wear this garment compression continuously for one week (apart from taking it off for a shower) after surgery, then just in the daytime for a few weeks more.

WHAT ARE THE SCARS LIKE?

Scars are not a complication but a normal event after any surgery.  Thankfully scars in liposuction surgery are tiny and almost invisible.  The scars are about 2-3 mm in length.  They are usually placed in natural folds of the skin and fade with time.

WHAT CAN GO WRONG?

Complications that can occur include irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides, but these are very infrequent.  Despite any surgeon’s best efforts, it is possible that a small number of patients may require a secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape.

HOW LONG BEFORE I GET BACK TO NORMAL?

The recovery time varies with how many areas are treated and the type of activity the patient intends to resume.  Most patients resume light activities within 2-3 days and depending on their work can be back between 5 -7 days.

SUMMARY

Liposuction is the most popular cosmetic surgery procedure. It is a highly effective technique for giving you a new body contour without scarring.  The results are permanent.  As long as your expectations are realistic, and understand that the final results may take a few weeks before becoming apparent, you should be happy with your new shape.

AM I SUITABLE FOR TUMMY TUCK?

This will be decided at your consultation. Women who plan to become pregnant imminently should postpone the operation until after their family is complete.

As mentioned there are a number of variations in the technique of abdominoplasty.  The decision will be based on the quality of your skin, the presence of stretch marks, the laxity of your muscles, and the amount and distribution of fat.  If you have loose muscle and excess skin in both the upper and lower abdominal areas with only modest fat deposits you will most likely require a full abdominoplasty.

If however you have loose skin confined mainly to the lower abdominal area but have retained good skin and muscle tone above the umbilicus with little or no excess fat, then a “mini tuck” may be used.  Alternatively if this is accompanied by modest excess fat in the upper abdomen then liposuction may be used in conjunction with the “mini tuck” to improve the result.

WHAT DOES THE OPERATION INVOLVE?

In the Full Abdominoplasty, you must understand that there is a long incision made within the so called “bikini line” just above the pubic area, from hip to hip.

In the “Mini Tuck” technique the skin is separated only between the lower incision line just above the pubic region, and an incision just below the umbilicus.  The umbilicus is left in place without the need for a further incision.

Liposuction of the flanks may be combined with the abdominoplasty procedure if the distribution of fat calls for this.

WHAT TYPE OF ANAESTHETIC IS USED?

Abdominoplasty is usually performed under general anaesthesia (completely asleep).  You will usually require an overnight stay at the hospital.

HOW LONG DOES THE SURGERY TAKE?

Depending on the technique used, and whether this is combined with any other surgery such as liposuction, it usually takes between 2 – 3 hours.

WHAT HAPPENS IMMEDIATELY AFTER THE OPERATION?

Once you’ve recovered, you will notice a compression garment around your waist and abdomen.  This is to provide compression of the surgical site to reduce the postoperative swelling and bleeding.  In addition you will notice the presence of 2 tubes or drains, which are usually placed under the skin to evacuate any fluid, build up following the surgery.  These usually stay for few days until no drainage can be observed in the drains.

You will find that the abdominal area will be quite uncomfortable and that you will have 1-2 pillows placed behind your knees in order to keep these bent to reduce the tension in your abdominal muscles.  Likewise you will need to walk slightly bent forwards once you are up and about, for the first few days.  You may gradually straighten up as the days pass.

Instructions about washing will be given to you. You should keep the wound dry for few days (4-5 days) according to the progress of your healing.

IS IT PAINFUL?

Pain and discomfort are subjective sensations.  Pain is usually minor.  For the first week or so you will need to take regular painkillers in order to minimize this.  You will not be able to stretch completely your body and you will feel some tension at the incision line.  This is probably more noticeable when standing or during walking in the first few days following surgery.

WHAT KIND OF AFTER EFFECTS SHOULD I EXPECT?

Following surgery you will experience considerable swelling and bruising of the abdomen.  This will be even more noticeable if the abdominoplasty was accompanied by liposuction.  The bruising usually lasts about 3 weeks.  While most of the swelling will have dissipated by this time, some subtle swelling will still be present for up to 3 months.

In addition you will notice that the abdomen will feel firm to touch, particularly along the edges of the incision site.  This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing.  When this occurs, massage will speed up the recovery.  It gradually resolves in time but may take a few months to complete.  You should expect the sensation to the skin over the lower abdomen to be reduced after surgery.  This is as a result of surgical trauma to the nerves in the region.  Although this usually recovers in a few months, permanent numbness in the region can ensue.

Whilst it is true that when an abdominoplasty is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.  As in any procedure the risk of significant infection is always possible. This is minimized preventative administration of antibiotics both at the time of surgery and after.

HOW LONG BEFORE I GET BACK TO NORMAL?

Abdominoplasty is a major operation and should always be respected as such.  Therefore you should expect a few weeks to pass before you feel yourself again.  Remember variations do occur in the time individuals take to heal.  Although many people go back to light work duties by 2 weeks.  Heavy lifting or strenuous activity is prohibited in the first 6 weeks after surgery.  Overall common sense rules in the recovery period.

SUMMARY

Abdominoplasty has always been a popular cosmetic surgery request.  It will give confidence to the individual and allow them to wear clothes that were previously unsuitable.  The effects are generally long lasting provided you follow a balanced diet and exercise regularly.

WHAT IS TOTAL BODY LIFT SURGERY?

Through our lifetimes various factors, such as weight gain or loss, pregnancy, aging, smoking, and others, contribute to a decrease in the tightness of our abdominal wall.  Additionally, extreme weight gain and loss causes loss of tone and elasticity of the skin, and often results in significant excess skin and fat in a circular nature involving the abdomen, flanks, hips, back, and buttocks.  A total body lift, also known as lower body lift or belt lipectomy, is a procedure performed to reshape the entire lower torso by removing excess skin and fat from the lower abdomen, flanks, hips, upper buttocks, and back. Total body lift is an extensive procedure and is performed in only specific clinical conditions.

AM I A GOOD CANDIDATE FOR TOTAL BODY LIFT SURGERY?

The best candidates for total body lift are individuals in good physical condition with fat and loose skin at the lower abdomen, the flank and hips, the buttocks, and the lower back.  Usually, these are patients who were formerly obese and have lost massive amounts of weight either through bariatric or anti-obesity surgery such as gastric bypass surgery, the lap band, sleeve gastrectomy, or through diet and fitness habits.

INITIAL CONSULTATION PRIOR TO TOTAL BODY LIFT SURGERY

At your initial consultation, Dr. Skarparis and you will carefully discuss your aesthetic concerns, and define a tailored plan to improve the appearance of your abdomen, flanks and hips, buttocks, and lower back.  Your goals and expectations will be carefully considered and clarified.  Your medical and surgical history will be reviewed in detail, and a physical examination will be conducted.  Dr. Skarparis will advise you which type of total body lift surgery technique is best for you, and also discuss whether any additional procedures are appropriate.

WHAT TYPE OF ANESTHESIA DO YOU NEED FOR TOTAL BODY LIFT SURGERY?

Total body lift surgery is performed under general anesthesia.  We will carefully explain in detail all of the risks, benefits, and alternatives to general anesthesia.

PROCEDURE

There are several different techniques for performing total body lift.  Common to all is the removal of fat and excess skin from the lower torso, including the lower abdomen, the flanks and hips, the upper buttocks, and the lower back.  The scar is hidden below the bikini line, enabling you to show off your results in shorts and jeans. Tightening of the abdominal muscles is performed.  Total body lift can be combined with liposuction, or other procedures.

RECOVERY AND THE POSTOPERATIVE PERIOD

You will have surgical drains, and a compression garment applied to the treated area.  You will be encouraged to stay as less active as possible at home for several days while maintaining appropriate positioning and posture.  In most cases the bruising is minimal and resolves after the first week, at which time the drains are removed.  Most patients return to work and social activities after 2 weeks.  Dr. Skarparis recommends avoidance of strenuous physical exercise for approximately 6 weeks following body lift surgery.

RESULTS OF TOTAL BODY LIFT SURGERY

The results of cosmetic total body lift surgery are a new abdominal and flank region that is smooth and flat.  Hips that finally don’t sag and now show your real curves.  Buttocks that are lifted into place, and a back free of redundant skin and tissue.  Not only will you look great, you will also notice an immediate change in the way your clothes fit.  The change in the appearance of the entire torso is immediate and dramatic.  In fact, it is not uncommon for patients report additional weight loss following total body lift, due to the increased level of physical activity.  Total body lift surgery results are permanent, though various lifestyle and hereditary factors may impact on your long-term results.

Droopy, sagging upper arms can make you feel self conscious in a short sleeve shirt, and you may as well forget about that red strapless dress you have been eyeing at the local boutique.  Sound familiar?  If so, you may be a candidate for an Arm Lift (Brachioplasty).  This popular plastic surgery procedure can help your arms go from “flabulous” to “fabulous.”

An arm lift – with or without liposuction – can help create a well-defined, trim and toned upper arm that complements your figure as well as your wardrobe.  Today’s arm lift techniques are safer and the scars are much less conspicuous than they have been in the past.

CANDIDATES FOR ARM LIFT

An arm lift is one of the top four most popular plastic surgery procedures performed following massive weight loss, according to the American Society of Plastic Surgeons.  This is because people who lose massive amounts of weight tend to have significant amounts of fat hanging under their arms.

The soft tissue of the arm becomes lax, setting the stage for ptosis (sagging), otherwise referred to as the bat-wing appearance.  Thin people, too, may have sagging upper arms due to the effects of aging and genetics.  Even people who engage in regular exercise including Pilates and strength training cannot get rid of excess, sagging skin that develops in this area.

PREPARING FOR YOUR ARM LIFT

Dr. Andreas Skarparis will supply you with a list of pre-operative instructions to follow in the days and weeks leading up to your arm lift.  These instructions may include quitting smoking as smoking can have deleterious effects on wound healing.  Plastic surgeon will also ask you to stop taking certain medications such as aspirin, non-steroidal anti-inflammatory medications and certain vitamins/homeopathic regimens that are known to increase the risk of bleeding.

Sometimes doctor may also suggest that you take certain supplements before your surgery to reduce swelling and bruising.  This may include arnica or bromelain.  A high protein diet may also enhance the healing process.  Talk to Dr. Skarparis about what type of nutritional regimen is recommended before your arm lift.

THE ARM LIFT PROCEDURE

An arm lift typically takes one to three hours depending on the extent of the surgery.  It may involve local anesthesia with intravenous sedation – leaving you awake, but not totally aware – or general anesthesia.

Liposuction may be sufficient enough for people with smooth skin and just a small amount of flab.  The more invasive total arm lift procedure may benefit people with larger areas of fat underneath the arms, poor skin quality and sun damaged skin.

To perform an upper arm lift, plastic surgeon will make incisions on the inside or back of your arm.  Incisions may span from the underarm to just above the elbow. Some people may only require minimal incisions from the area where the inner, upper arm joins the armpit.  This is known as a Minimal Incision Arm Lift.

You may be a candidate for a Minimal Incision Arm Lift if you have a small amount of extra skin located near the armpit.  Others, such as people who have lost massive amounts of weight following bariatric surgery, may have more excess skin and will need an incision that runs from the elbow, along the arm pit and onto the side of the chest.  Your incision pattern will vary based on the extent of the surgery and surgeon’s preferred method of treatment.

After the incision is made, excess fat may be removed with liposuction.  Excessive skin is then trimmed, tightened and sutured in place with absorbable sutures, or stitches that will be removed within one or two weeks of the surgery.  Your skin is then smoothed over the new contour of your arm.

RECOVERING FROM YOUR ARM LIFT

While there is some swelling and bruising, your new trim and toned arm will be apparent almost immediately after your arm lift.  You may feel some mild discomfort right after the procedure.  Dr. Skarparis can prescribe prescription pain medication to help alleviate this pain.

Swelling peaks two to three days after your arm lift, typically dissipating within two weeks.  Elevating your arm with pillows can help reduce swelling and increase comfort during recovery.

Dressings are typically applied to the incision.  Many of the stitches will dissolve, but those that are not self-absorbing are usually removed within a week.  Dr. Skarparis may prescribe a compression garment to allow the skin to adhere to underlying tissues.

You can shower one week after the procedure, and most people can go back to work two to three weeks after the procedure.  Plastic surgeon will likely tell you to avoid any strenuous exercise for one month, and to avoid heavy lifting for at least six weeks.  Individual instructions vary.  After recovery from arm lift, some patients prefer to have additional cosmetic procedures to improve the arm’s appearance, particularly to remove unsightly hair.  Various Laser Hair Removal options are available for the forearm and upper arm areas.

RISKS OF ARM LIFT

With every medical procedure there is a possibility of complications, which can cause a longer recovery period. Arm lift risks include:

• Infection
• Hematoma
• Anesthesia risks
• Loss of sensation
• Scarring
• Swelling of the hands
• Seromas (fluid filled masses along the incision line)

ENHANCING YOUR APPEARANCE WITH A THIGH LIFT

If fitness and weight loss efforts have not achieved your goals for a body that is firmer, more youthful-looking and more proportionate to your overall body image, a surgical thigh lift may be right for you.  This surgery reshapes the thighs by reducing excess skin, and in some cases fat, resulting in smoother skin and better-proportioned contours of the thighs and lower body.

CANDIDATES FOR THIGH LIFT ARE:

• People whose weight is relatively stable
• Individuals with excess soft tissue along the inner or medial thigh region and/or the outer thigh
• Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
• Individuals with a positive outlook and realistic goals for what thigh lift surgery can accomplish

Both men and women who have saggy, flabby and/or dimpled loose tissue and skin on their thighs may be candidates for this body contouring procedure.  Many people who have lost massive amounts of weight due to bariatric surgery may also benefit from thigh lifts to get rid of the excess fat and flab in this area.

TYPES OF THIGH LIFT

There are several Types of Thigh Lift, each of which differs according to incision pattern.  For example, an Inner (Medial) Thigh Lift involves incisions in the groin fold.  This is the most popular type of thigh lift. It is best for people with a moderate amount of skin and fat in this area.  For an inner thigh lift, Dr. Skarparis basically lifts up the thigh skin and tightening it.  A Vertical Thighplasty involves a vertical incision that starts at the groin crease and extends to the inner knee.  The scar is visible when the inner thighs are exposed such as while you are wearing in a bathing suit or mini-skirt.  During a vertical thigh lift, Dr. Skarparis removes a wedge of skin from the inner thigh. Individuals with more significant fat and loose skin may need a vertical thighplasty.  An Outer Thigh Lift requires an incision that extends from the groin around the hip.  The procedure targets the front, back, inner and outer thigh.  This procedure is ideal for people who have lost weight.

COMBINATION THIGH LIFT SURGERY

Sometimes, several types of thigh lift are performed at the same time.  Which thigh lift or combination of thigh lifts is right for you depends on a number of factors, including:

• How much fat and skin need to be removed
• Your skin quality
• The areas to be treated

Thigh lifts can also be performed in combination with other procedures such as a Lower Body Lift and Liposuction.

THIGH LIFT PROCEDURE

Regardless of the thigh lift treatment you choose, the basic steps are similar.  Whether the skin is excised or lifted varies based on the type of incision and the amount of fat and skin that needs to be removed, re-shaped and/or tightened.  Dr. Skarparis will likely use deep, support stitches that help form and support the new contours of the thigh as part of the surgery.  He will also close up the incisions with sutures.  The length of the surgery and your hospital stay varies based on which type of thigh lift is chosen and if it is done with Liposuction or as part of a Lower Body Lift.

THIGH LIFT RECOVERY AND RESULTS

Following thigh lift, there will be bruising, swelling and soreness, but some of the results – namely the smooth, tight contours – will be visible immediately.  You will feel some discomfort and tightness for the first 48 to 72 hours, but you should begin to feel normal after day three.  Prescription painkillers can help relieve discomfort and pain.  The swelling in your lower body and upper thighs may take three to five weeks to subside.  You will be fitted with a compression garment to protect the incisions and promote shrinking and tightening of the skin after your surgery.  Dr. Skarparis will likely tell you to keep your legs slightly bent at the hips during the first week after your thigh lift.  This will minimize any tension on your incision line, reduce pain and result in a thinner, less-visible scar during the initial healing process.  It is important to try to start walking as soon as possible after a thigh lift – even if you are uncomfortable.  Early ambulation will reduce the risk of developing a blood clot in your leg.

THIGH LIFT RISKS

There are certain risks associated with any medical procedure. Some of the risks associated with thigh lifts include:

• Scarring
• Bleeding
• Infection
• Poor wound healing
• Numbness or other changes in skin sensation
• Asymmetry
• Recurrent skin looseness
• Possibility of a secondary surgery
• The thigh lift gives very rewarding results in people with realistic expectations

Sometimes men are looking to increase bulk and add muscular definition and contour to their calves.  Patients may opt for calf augmentation so that their legs and thighs are symmetrical.  In addition, calf implants may be appropriate for people with certain medical conditions such as club foot, because they tend to have contracted calf muscles.

CALF IMPLANT PROCEDURE

Calf implants are made of malleable silicone.  They are available in a host of shapes and sizes.  Dr. Skarparis will choose the right size for your leg and mold the implant to the shape of your calf.  Calf implant surgery takes approximately two and a half hours to perform.  It is usually performed with a local anesthetic and intravenous sedation, or under general anesthesia.

To place the implants, Dr. Skarparis makes a small incision on the back of the knee and places the implants into pockets formed over the calf muscles in each leg.  There are two muscles that make up the calf.  The implants are basically tucked under the thick tissue beneath the skin and the fat in the calves.  Calf implants can be combined with Liposuction of the knees or ankles to improve the overall appearance of the legs.

CALF IMPLANT RECOVERY

Calf implant surgery requires 2-3 weeks recovery time when activities must be moderate.  Walking must be moderate at first. Leg elevation can help minimize the swelling, as wearing high-heeled shoes when walking.  Compression stockings or ace bandages around the calves will also help alleviate swelling and discomfort. Most people can resume their normal activities within eight weeks after calf implant surgery.  As a general rule, exercise is off limits for four to six weeks after calf augmentation, and running must be avoided for up to three months.

CALF AUGMENTATION RISKS

Risks of calf implantation surgery include:

• Infection
• Implant shifting (rare)

Calf augmentation can give very rewarding results and enhance the appearance of the lower limbs.

Because our hands receive so much exposure, it is one of the first places to start showing visible signs of aging.  Natural aging, and exposure to sunlight, causes this appearance.  The more common visible signs of aging include darkened spots (age spots).  A loss of fatty tissue also occurs, making our hands look bony.  Hand rejuvenation treatments can help restore the hands to a more youthful appearance.  Various treatment options are available, so one treatment or a combination can be used to help achieve a look that patients desire.

There are various types of hand rejuvenation treatments.  All of these options possess their own set of risks, benefits, costs, and techniques.  The most common include:

Chemical Peels: When these chemicals are applied to the skin, it causes age spots to disappear while tissue appears less transparent.

Sclerotherapy: When a sclerosing solution is injected into unsightly veins.  This chemical solution irritates the veins, causing them to turn white and gradually disappear.

Laser Skin Resurfacing: Through short bursts of laser light, unsightly veins and dark “age” spots are gently removed from the skin.

HYALURONIC ACID FILLERS

When these fillers are injected into the hands they can plump up the skin and give it a more youthful appearance.

FAT TRANSFER

Fat can be transferred to a skeletonized looking hands and give a more full and youthful appearance. The fat harvest and transfer technique is the same as elsewhere at the body. Is a procedure that is performed under local anesthesia with minimal downtime.