San Francisco Bay area Liposuction
According to statistics released by the American Society of Plastic Surgeons in 2015, liposuction is one of the most popular cosmetic surgery procedure performed in the United States, second only to Breast Augmentation in the number performed. For those who have pockets of stubborn fat, a body sculpting and fat removal procedure can help improve areas that are resistant to diet and exercise.
Liposuction techniques have continued to evolve and the equipment has become more sophisticated since the introduction of the procedure in the early 1980s. Results were limited by the amount of blood loss incurred and blood transfusions were sometimes needed. By the mid-1980s, the development of the Tumescent Technique revolutionized the procedure both in terms of safety and results.
The tumescent technique initially involved combining normal saline (sterile water containing the normal concentrations of the various salts found in the body) with epinephrine, a powerful vasoconstrictor (causes blood vessels to contract and thereby reduces or stops blood flow to an area). This innovation effectively controlled blood loss and allowed safe extraction of a much larger amount of fat. This enabled the fat extraction procedure to go from the removal of two to three liters (a liter being slightly larger than a quart) to many times that amount. Today, many physicians consider the tumescent technique to be the gold standard of fat removal techniques.
In time, lidocaine (a local anesthetic) was added to the normal saline and epinephrine solution. An adequate level of local anesthesia could be accomplished with this combination so that general anesthesia is no longer always required. This also opened the door to liposuction being performed by non-surgeon physicians of many different specialties.
Dr. Delagado, a board certified plastic surgeon and specialist in body sculpting techniques, performs liposuction at his San Francisco Bay area office.
HOW IS LIPOSUCTION PERFORMED?
Liposuction is performed with cannulas, cylindrical steel tubes of varying lengths, diameters and tip shapes. In the early days of fat extraction large bore cannulas were used, 5, 6, 7 and 8 millimeters in diameter. The procedure has evolved to use much smaller cannulas, 2, 3 and 4 millimeters in diameter. Not only are the smaller-diameter cannulas less traumatic to the tissues, they also allow for a smoother, more even extraction of fat.
The cannulas are designed to attach to plastic tubing that is attached to a liposuction machine. This machine provides varying amounts of negative pressure to create a vacuum. This is the primary function of the machine, although it also has a portion that provides positive pressure to inject the tumescent fluid. Also, mounted on the machine, are the canisters that receive the fat and residual tumescent fluid.
First, the machine is used to inject the tumescent fluid into the designated area of fat using a small cannula. A few minutes are allowed for the tumescent to anesthetize, establish bleeding control and emulsify the fat for easier extraction. Then a small bore cannula, attached to the length of tubing providing suction is inserted into the same small incision and the surgeon proceeds with the careful process of extracting the fat. Guided by the map drawn on the skin earlier in the pre-operative area, with the patient in a standing position, the surgeon uses a back and forth motion with the suction cannula. The fat collects in the suction canister for later disposal, as the surgeon smooths and sculpts with the cannula. Slowly, the improved contours emerge until the procedure is completed to the surgeon’s practiced eye and esthetic satisfaction. Dr. Delgado also uses a specialized roller to further smooth out the area.
As technology has advanced, new machines have been introduced. The Power-Assisted Liposuction (PAL) technique placed the cannula into a hand-held power device that moved the cannula back and forth with the push of a button. The design was to make the process less laborious, faster extraction of fat, and an overall smoother contour. The PAL System has the rotation of the powered cannula going back and forth, in addition, to another system rotating side to side. The rotation is over 4000 cycles per minute. MicroAire’s PAL® LipoSculptor™ is a popular device that can be used for more aggressive fat removal. Dr. Delgado has used this system since 2012, which has reduced procedure time and, in most cases, led to smoother smoother results.
Ultrasonic Assisted Liposuction (UAL) is another advanced fat removal technique. Ultrasonic Liposuction employs sound waves that have the power to emulsify, or melt fat. This process also creates heat, which in turn, enhances skin contraction. This technique can be especially useful in secondary, or re-do, cases. Approximately 25% of patients seeking liposuction in Dr. Delgado’s practice fall into this category. These are patients who are disappointed with their outcome and wish to undergo a corrective procedure. The VASERlipo™ System is one of the more popular ultrasonic systems, but there are others on the market.
Laser Liposuction is the newest splash on the scene and Smartlipo TriPlex® by Cynosure is widely used. This technology uses minimally invasive laser technology which creates heat to melt fat and create skin contraction. The other stated advantage is that it can be performed under local anesthesia. This laser technology has a history of being extremely expensive with inadequate or questionable documentation of actual better results. To date, there is only anecdotal evidence to support superior results using laser methods. No large, valid studies exist that substantiate these claims. If Laser Liposuction does prove it can deliver higher patient satisfaction and better quality outcomes and not fall by the wayside as another over-rated marketing gimmick, it will earn a place at Marin Cosmetic Surgery Center. Dr. Delgado has seen many of his colleagues abandon this technology and sell their Smart Liposuction machines. For the time being, however, Dr. Delgado opts to offer only those procedures he knows to be of sound value for his patients.
Dr. Delgado incorporates fat cell banking into his practice. The company Adicyte is a FDA registered location in Tucson, Arizona. It is under the direction of world-renowned cell biologist, Dr. David Harris and features state-of-the-art equipment designed for processing fat and stem cells. During a fat removal procedure, Dr. Delgado can collect the extracted fat and send it Federal Express to Arizona, where the fat is processed and frozen. This extra step is a way to make a patient’s own fat available for future use. A portion of the fat can sent back when needed and injected the same day. The annual storage fee is 120 dollars.
With liposuction, the skill and artistry of the surgeon can determine the success of the outcome, more than the specific technology. The amount of fat to extract, the evenness with which it is removed and the blending of one area into another are all artistic judgment calls on the part of the surgeon. Likewise, sound medical decisions, based on years of study and practice, are made by the surgeon, the anesthesiologist and other surgical team members. These are central to your safety while undergoing a procedure such as liposuction.
WHO IS A CANDIDATE?
Liposuction can be effective on people of varying weights and sizes. Results can be impressive, but actual outcomes will vary from patient to patient.
Skin with good elasticity is more likely to adjust to the body’s new contours. Although age is not always a consideration, older patients tend to have less elasticity in their skin and, for this reason, will not achieve quite the same results as a younger patient.
There is rarely any improvement in irregularities in the skin, as the procedure impacts the underlying fat, not the skin itself. The skin acts merely as a drape over the newly shaped contours underneath. Sometimes, the devices can add some degree of heat, which can possibly lead to some contraction to the skin. But this tightening effect would be minimal, if it occurs at all. Patients who expect the procedure to address the condition of the skin may be very disappointed.
Although cellulite is not a contraindication for the procedure, fat extraction will not improve this condition, if it exists.
The most commonly treated areas in women are the inner and outer thighs, knees, hips (post iliac crests and flanks), abdomen and arms, while men most often opt for treatment of their chin, waist and abdomen. Most of Dr. Delgado’s patients are looking for treatment of multiple areas and generally, these can be done in a single procedure.
Prior to Surgery
The first step towards body sculpting surgery is a consultation with Dr. Delgado. This can be scheduled at either his San Francisco office or his Marin County office.
At this appointment, Dr. Delgado and the patient discuss the patient’s areas of concern and goals for those areas. Dr. Delgado often uses digital photography and computer imaging to illustrate the results the patient can realistically expect after having fat removal on those areas. The impact of variables, such as the existence of asymmetries and the degree of the skin elasticity, as well as adverse events, such as cellulitis, bleeding and blood clots, are discussed.
The patient is provided with a booklet that supplies detailed pre- and post-operative instructions, including the use of medications prior to surgery. For example, it is required that aspirin and aspirin-containing products be discontinued, including anti-inflammatory products, two weeks before and two weeks after surgery, as these products have a negative effect on your clotting ability. The pre-operative instructions include a complete list of medications that could pose hazards and therefore, should be avoided. However, Tylenol (acetaminophen) can be safely taken during this time. However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage. The booklet also provides a list of vitamins and homeopathic preparations that promote healing and limit bruising which the patient can opt to use before and after the surgery.
DAY OF SURGERY
Dr. Delgado performs surgical procedures at Marin Cosmetic Surgery Center, a private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before anesthesia is given, a special felt-tip surgical marking pen is used to draw a detailed map on the areas to be treated. This architectural diagram enables Dr. Delgado to make accurate adjustments to accommodate the gravitational changes that occur as the body moves from a standing to a lying position.
After anesthesia is given, Dr. Delgado will inject the tumescent fluid consisting of normal saline (sterile water with body identical salt content), lidocaine (local anesthetic) and epinephrine (vaso-constricting agent that controls bleeding). This process distends the fat layer. Then, Dr. Delgado proceeds to make very small incisions in inconspicuous areas, such as the navel and the buttock crease. A thin cannula is inserted into the tiny incisions. Dr. Delgado may use Power Assisted Liposuction (PAL) or Ultrasonic Assisted Liposuction (UAL) depending on the customized plan for the patient. The device is attached to tubing extending to a machine that provides vacuum. The cannula is pushed back and forth through the fat layer. This breaks up the fat cells so that they can be vacuumed out through the tubing to a canister on the machine. Incisions are then closed with sutures and a compression garment is placed on the patient.
Most Liposuction procedures are performed under general anesthesia and are usually performed in an outpatient surgery center or a hospital. At Marin Cosmetic Surgery Center, general anesthesia is administered by Randy Gaynor, MD, a board certified anesthesiologist with more than 25 years experience. For the past 15 years, Dr. Gaynor has worked exclusively in outpatient office surgery centers such as Marin Cosmetic Surgery Center.
Dr. Gaynor has developed LMA (Laryngeal Mask Airway) techniques that are specifically suited for the cosmetic surgery patient. Light levels of anesthesia are used so that patients need not be pharmaceutically paralyzed for procedures, as is often the method used in hospitals. The LMA technique allows patients to breathe on their own while anesthetized. Patients are completely comfortable and unaware of anything that is happening.
With Dr. Gaynor’s techniques, patients awaken quickly and most are far less likely to experience nausea than with conventional anesthesia.
Dr. Delgado and Dr. Gaynor assist the patient in making the best choice for the anesthesia. Additionally, Dr. Gaynor calls each patient the evening before surgery to review his/her medical history, confirm last minute instructions and answer any questions they may have regarding the anesthesia.
The first few hours after surgery will be spent in the recovery room. When the patient is fully alert and oriented, he/she can go home or to a local hotel. A responsible adult is required to drive the patient and to assist them for the first 24 hours following surgery. If a patient does not have such a person available, the Marin Cosmetic Surgery Center patient coordinator can arrange for a specially trained medical assistant to drive the patient to his/her destination and stay with them during this time period.
Some patients will spend the night in the recovery room at Marin Cosmetic Surgery Center, especially if a large volume of liposuction is performed. Overnight care is provided by a registered nurse who is trained in post-operative care, including ACLS (Advanced Cardiac Life Support) certification. An additional person, experienced in post-surgical care, is also on hand to assist the nurse as needed throughout the night. In the morning, Dr. Delgado personally checks these patients before they are discharged from the surgery center.
A compression garment is worn over the treated areas for four to six weeks. The purpose of this garment is to control swelling and promote skin contraction.
For most patients, discomfort after surgery is generally limited to soreness, rather than pain. Pain medications are prescribed to lessen any discomfort felt during the first few days. Most patients often find that the discomfort is too minimal to merit the use of narcotics.
Bruising is normally quite evident and may not resolve completely for a week or two. Most of the swelling disappears after four to six weeks, but there may be a small amount of residual swelling for up to two to four months. For six to nine months, the patient may experience a fluctuating return of 10-15% swelling with exercise or excessive activity.
Sutures are removed seven to ten days after surgery. Patients usually return to work within a few days following the procedure, depending on their type of work.
It is important to resume light walking as soon as possible in order to discourage swelling and prevent blood clots in the legs. However, strenuous exercise should be avoided for four to six weeks because it can trigger unnecessary fluid retention in the treated areas.
RISKS AND COMPLICATIONS
Like all surgeries, liposuction procedures carry the risks of bleeding, infection, blood clots and adverse events related to anesthesia. However, these risks are minimized by the combination of Dr. Delgado’s team of licensed and credentialed professionals and Marin Cosmetic Surgery Center, an accredited, state-of-the-art facility, located contiguous to Novato Community Hospital, a Sutter Health Facility. These factors create a very safe environment for the patient.
The most common problems with liposuction are irregularities in skin contours, due to poor skin quality (i.e., low elasticity, loose skin tone) or pre-existing cellulite. Sometimes under-correction occurs; often, this can be easily remedied in the office setting with a touch up procedure using local anesthesia. If over-correction has occurred, fat injections can be done to fill any concavity.
Swelling and bruising are normal and not considered complications. Both of these should resolve in time. In a few cases, some bruising will persist beyond the usual one to two weeks. Very rarely, areas of light discoloration can remain indefinitely after surgery.
If a patient gains weight in the future, the fat may distribute differently than it did prior to fat extraction. Generally, less fat will deposit in those areas that were treated.
Patients can see significant changes in his/her bodies after liposuction. In most cases, patients will see an improved esthetic balance in the relationship between the areas treated and the rest of the body, as well as a reduction in overall size. Depending upon the extent and volume of the liposuction performed, a patient may go down in clothing size. Some patients also may discover they can wear a greater variety of clothing styles than prior to the procedure. The results are long lasting barring the impact of significant weight gain in the future. Scarring is minimal and continues to fade with time. The attractive results can evoke a higher sense of self-esteem for patients. With these satisfying outcomes for patients, it is not surprising that the latest statistics available (www.cosmeticplasticsurgerystatistics.com), show that liposuction is the first or second most commonly performed cosmetic surgery procedure in the United States.
1. How is liposuction performed?
Liposuction is performed through small, 3-millimeter incisions that are strategically placed in the treatment area. Through these incisions, tumescent fluid (consisting of salt water, local anesthetic and an agent that controls bleeding) is injected within the region to enhance fat extraction and control blood loss. Then one or more techniques may be used to extract the fat. Tumescent liposuction technique consists of cannulas being moved back and forth extracting fat with moderate pressure vacuum. Prior to this, ultrasound may be used to break down the fat with ultrasonic waves, laser may be used to break down the fat using heat, power assisted liposuction may be used to extract the fat. The skill of the procedure lies in making sure that the remaining fat layer is smooth. At the conclusion of the procedure, a compression garment is placed to further assure a smooth skin surface.
2. What can I expect during my consultation?
In your initial consultation, you and Dr. Delgado will discuss your concerns and your goals for the appearance of your body. You will be asked whether your weight tends to fluctuate and if so, to what degree. Dr. Delgado will evaluate the areas about which you are concerned in terms of the amount of fat in the area, the degree of skin laxity and the quality of the skin in terms of stretch marks or overly loose skin, all of which affect the outcome of liposuction. He will indicate where incisions would be placed. You will have the opportunity to view before and after photographs of patients on whom Dr. Delgado has performed liposuction. Dr. Delgado may use computer imaging to demonstrate the results you can expect from your liposuction procedure. Lastly, you will receive a price quote for your procedure. CLICK HERE to Get Started: Schedule Your Free Consultation Now!
3. Is there anything I need to do to prepare for surgery?
In preparation for your surgery, you should plan to have reliable and competent help the first 24 hours after surgery. You will need to arrange to take time off from work and household chores during your recovery. You will need some assistance in the early postoperative period with your medications, help to the bathroom and getting the garments on and off. A family member or a friend can lend invaluable help during this period. For two weeks prior to your surgery, you should discontinue or avoid blood-thinning products like aspirin, ibuprofen, Aleve, Advil, Motrin and other blood thinners. You will receive a 20-page pre-operative instruction booklet that will guide you through additional preparations.
4. How long does the liposuction procedure take?
The amount of time your procedure will take depends on the size and number of areas being treated. Most procedures are completed in two to four hours. Dr. Delgado will be able to give you a more accurate time estimate during your consultation.
5. Is general anesthesia used?
The surgery is performed under general anesthesia. Modern anesthesia medications wear off very quickly, so you wake up promptly and, depending on the amount of fat removal done, can feel like your normal self immediately after the completion of surgery. Our board-certified physician anesthesiologist, Randy Gaynor, MD, uses laryngeal mask airway (LMA) anesthesia, a state of the art method that allows you to breathe comfortably on your own. Dr. Delgado uses general anesthesia for liposuction procedures, because he uses aggressive techniques. General anesthesia assures Dr. Delgado that you will be comfortable throughout the procedure and he will be able to give you the best results possible.
6. Will I be able to return home on the same day as my surgery?
In most cases, patients are able to return home on the same day as their procedure. However, due to the use of general anesthesia, you will not be able to drive yourself home. If you plan to have an extensive amount of fat extraction done, Dr. Delgado will advise you to stay overnight at the surgery center for observation and pain management.
7. Following my procedure, how long must I wait to return to work?
Most patients are able to return to work within one week. However, there will be some discomfort, much like the soreness from strenuous exercise. You may resume exercise programs and sports activities in four to six weeks.
8. What areas of the body can be treated?
Liposuction can treat any part of the body that contains fat. Men usually opt to treat the abdomen, flanks and underneath the neck. Women generally choose areas like the neck, arms, abdomen, flanks, back, inner and outer thighs and knees.
9. Will there be scars following my surgery?
Scars are very minimal. Dr. Delgado will place the small incisions in the most inconspicuous areas possible and in areas that would normally be covered by clothing. He will discuss the placement of these incisions with you prior to your procedure.
10. How old should I be?
Though there is some controversy regarding this, Dr. Delgado believes that a person should be at least 18 years old and have the maturity and motivation to lose weight by exercise and diet. Especially with a younger patient, Dr. Delgado will want to be sure that he/she understand the serious risks of the surgery. Patients will be evaluated on an individual basis regarding their suitability.
11. Can other surgical procedures be done at the same time?
Yes, this is quite commonly performed. For example, with a tummy tuck or other body contouring procedures.
12. How much does liposuction surgery cost?
The cost of liposuction surgery can vary greatly depending on how many areas are treated and how much fat is to be removed. At the time of your consultation you will be given a detailed estimate of all your surgery fees.