July 24, 2013
If you are uncomfortable with your body’s appearance due to changes that have resulted from significant weight loss, aging, pregnancy or heredity, body contouring may be an option for you. When exercise and diet alone will not produce the results you need, surgery may be considered by you and your physician. Body contouring refers to a number of different procedures that can improve body shape and contour, tighten excess or loose skin, and enhance body image.
Some body contouring procedures include tummy tucks, liposuction, arm or thigh lifts, and surgery after significant weight loss. Other body sites that can be contoured include female and male breasts, hips, back, outer thighs, buttocks, thighs, knees and ankles. Body contouring can enhance your appearance and boost your self-confidence.
About the Speaker
Armand Lucas, MD is a board-certified plastic surgeon and staff physician in Cleveland Clinic’s Dermatology and Plastic Surgery Institute. His specialty interests include body contouring, such as tummy tucks, liposuction, arm lifts, thigh lifts, breast reduction, and surgery after significant weight loss. He also performs cosmetic and facial reconstruction surgery, including face lifts, neck lifts, eyebrow lifts, nose reshaping and breast surgery.
Dr, Lucas completed his plastic surgery fellowship at Cleveland Clinic following his residency in general surgery at Berkshire Medical Center, in Pittsfield, Mass. He completed his internship in general surgery at Rhode Island Hospital, in Providence, RI. Dr. Lucas gradated from Dartmouth Medical School, in Hanover, NH.
Let’s Chat About Liposuction, Tummy Tucks and More — Your Body Contouring Questions Answered
Moderator: Welcome to our ‘Liposuction, Tummy Tucks and More—Your Body Contouring Questions Answered’ online health chat with Dr. Armand Lucas. We are very excited to have him here today! Let's begin with the questions.
Body Contouring Overview
Smore: What is body contouring?
Armand_Lucas,_MD: Body contouring is a term that refers to the various surgical procedures performed by plastic surgeons to address the excess skin, localized fat or the effects of great weight loss. These surgeries include facelifts, breast lifts, abdominoplasty (tummy-tucks), lower body lifts or liposuction among others.
Body Contouring After Weight Loss
perfect: Can liposuction be done on obese people? Or do you have to lose a certain amount of weight first?
Armand_Lucas,_MD: The American Society of Plastic Surgery limits liposuction to no more than eight to 10 pounds on an outpatient basis. Therefore, obese patients are not good candidates for liposuction. If a patient is obese, it is recommended that they lose weight before any type of body contouring surgery. This can be through exercise and healthy eating, or even bariatric surgery. How much weight loss depends on the patient and what his or her desire is. After massive weight loss, plastic surgery options, such as tummy tucks and lower body lifts, can be considered.
PSMFD: I am currently on a doctor-monitored diet—the protein sparing modified fast (PSMF) program. I have already lost about 28 lbs in about 40 days. I need to lose about 100 lbs. I am anticipating that by the end of this program, I will have loose skin all over the place. What are my different options?
Armand_Lucas,_MD: Congratulations on your weight loss! One hundred pounds is a major accomplishment. After such a weight loss, your skin will shrink for 12 months. I recommend an evaluation at that point. You may need a facelift, breast surgery, tummy tuck, liposuction and other surgery. Good luck.
rosey: I am in the process of losing a lot of weight. Do you recommend
surgery for the loose and hanging skin as I lose weight, or when I have reached
my desired goal?
Armand_Lucas,_MD: We usually recommend waiting one year after you have lost the weight. The skin will continue to tighten for up to a year after weight loss. After that time, you can safely see a plastic surgeon to discuss your surgical options for skin removal.
snowball dye: Is it true that when you get older your skin does not act like it used to? I had gastric bypass for weight loss in 2002, and I have a lot of loose skin.
Armand_Lucas,_MD: There are a many reasons why skin can lose elasticity, including the amount a person weighs and age. Those at heavier weights usually have stretch marks. After a patient loses weight, the skin will shrink for one year following weight loss. However, if there are numerous stretch marks, there is a greater chance that the skin will not bounce back. Age is also a factor—as we get older, there is a loss of elasticity. For younger patients, the skin will tighten better than for older patients. If you lose more than 100 pounds from bariatric surgery, it is also likely that the skin will not bounce back fully afterwards. If this is the case, I recommend an evaluation with a plastic surgeon to see which types of procedures may be suitable for you.
Zara: I have a flat chest. How do I increase it?
Armand_Lucas,_MD: You would need an evaluation for breast augmentation at which time the surgeon can give you advice on implant size and location according to your desires.
mpda31: What are the best options for breast enhancement surgery that produce a natural shape and feel?
Armand_Lucas,_MD: Depending on the anatomy of the breast, there are two measurements that are very important—breast diameter and the distance between the nipple and the breast fold. If there is a good distance and diameter, than you can enhance the breast nicely and receive a relatively natural shape. We also place the implant under the muscle of the chest, which creates a nice slope, rather than under the breast which can create the appearance of two bubbles.
When consulting a plastic surgeon, you will want to discuss what types of results you can expect, and whether the implant is placed under the breast or under the muscle.
Silicone implants have proven to be safe after many years of study. They have been found to have a more natural feel as they have a more gel-like consistency. Saline implants have more of a watery consistency, and sometimes can create visible ripples in thinner patients. If you are under 22 years old, the FDA does not allow plastic surgeons to use silicone implants.
diamondm35: I would like to know whether Cleveland Clinic performs breast implant removal without replacement surgery for women who are having complications, including pain and capsular contracture?
Armand_Lucas,_MD: Yes, that can be done. Depending on the size of the previous implant, it may or may not leave extra skin that might need to be addressed. The excess skin may need another implant, breast lift and/or a combination of both.
Tummy Tuck (Abdominoplasty)
kellyk: After you have lost weight, how long should you wait to consider a tummy tuck?
Armand_Lucas,_MD: It depends on the amount of weight loss. For example, if you lost 10 lbs you do not need to wait at all, but if you lost 100 lbs you would need to wait one year because the skin shrinks during that time.
kellyk: What are the health risks for a tummy tuck?
Armand_Lucas,_MD: Since we choose healthy patients with no medical conditions who are between the ages of 18 to 60 years old, it is highly unlikely to encounter any problems during tummy tuck surgery. Body weight, i.e. BMI ratio, is important to minimize complications. There are events that may happen after surgery such as a collection of fluid under the skin called a seroma (blister fluid). This may occur about five percent of the time in patients.
Liposuction for Various Body Sites
mpda31: Can you please discuss the different options for liposuction (abdomen, thighs and buttocks), and what type of success rates can be expected?
Armand_Lucas,_MD: All three areas can be treated with liposuction, but each area has a different type of anatomy. We generally address the particular areas of fat for each area and, depending on the need, different depths of liposuction is carried out. For the abdomen, we generally use liposuction on both layers of fat—the deep layer and the superficial layer. For the thighs, we use liposuction on the deep layer. And for the buttocks, we tend to do liposuction more for the fat of the upper hip or flank area. Success really depends on what your need and expectations are. During a consultation, a plastic surgeon can discuss your expectations with you, and better give you an idea of what types of success can be expected. At Cleveland Clinic, we also use before and after images to help patients get a better idea of what the results of surgery might be.
grumpfaye: I am interested in surgery to remove excess skin on my upper arms. My concern is the scar that it will leave. Can you tell me more about this surgery, and tell me how you can reduce scarring?
Armand_Lucas,_MD: To remove the excess skin of the arms—also known as an arm lift, the first thing we do is liposuction to decrease the tension between the skin and the arm. This is followed by skin removal designed in the medial arm (side close to the body), so that the scar is neither visible from the front or the back.
Liposuction of Flank Area
hrwright: What is a realistic expectation for the number of inches lost around the flanks with liposuction? What is the limit of fat you can remove at one time? Is it true that liposuction removes the fat cells from that area permanently?
Armand_Lucas,_MD: A patient really needs to be evaluated to properly determine the amount of inches they will lose through liposuction. This may differ from patient to patient. The American Society of Plastic Surgery recommends removing no more than eight to 10 pounds of fat from any patient at one time, on an outpatient basis. Removing more than this amount can lead to complications.
The only cells that regenerate in the human body are liver cells. Fat cells do not regenerate—once you lose them, they are gone. That being the case, liposuction can be very effective in permanently reducing any area, such as the flanks, provided that the patient maintains his or her body weight.
Liposuction of Thighs
GD24: I cannot seem to get rid of the fat in my upper thighs regardless of the type of diet and exercise I try. I am hesitant to try liposuction because of the out-of-pocket expense and my fear of the surgery. Are there other alternative options I can try to remove excess upper thigh fat that are less invasive than liposuction? I recently read about laser liposuction. Does that really work?
Armand_Lucas,_MD: Weight loss and exercise are still the best approach. Liposuction can be effective in localized areas. I would like to refer you to Cleveland Clinic surgeon J. Vicente Poblete, MD at Fairview Hospital who is an expert in the field. I do not have experience with this device.
hrwright: Are there any types of laser liposuction that are more effective than traditional liposuction? What is the cost for laser liposuction vs traditional, including anesthesia?
Armand_Lucas,_MD: There are claims that laser liposuction may be more effective, with the thought that laser tightens the skin better. But there are no scientific studies (i.e. double blind, multi-center studies) that prove that lasers are more effective. In my opinion, both forms of liposuction are just as effective depending on the skill of the surgeon. Regarding your question about the cost of procedures, when scheduling a consultation appointment you can speak to a financial advisor about the costs involved.
lw: I am scheduled for arm and belly SmartLipo™. Does arm liposuction damage the arm muscles, or make it difficult to raise or lower the arm? How long is recovery time generally?
Armand_Lucas,_MD: Any type of liposuction addresses the fat space, or subcutaneous tissue, and should not damage the muscles or interfere with function at all. Most liposuction procedures provide for anesthesia to make the patient more comfortable during the procedure. This may take some time to wear off. Recovery time is generally not that long for arm liposuction. You may be sore following the surgery, but generally patients can return to work in a few days.
Minimizing Liposuction Complications
GD24: I have heard horror stories about excessive bruising and misshapen body parts after liposuction. What do you do to ensure that does not happen to your patients? Also, how much does a typical cosmetic procedure like liposuction run since I know insurance does not cover it?
Armand_Lucas,_MD: An experienced plastic surgeon and a healthy, non-smoking patient with localized excess fat is the best combination to avoid complications. Financial issues are addressed at the consultation.
Stretch Mark Surgery
tnguye76: Do you perform skin surgery? I have really bad stretch marks, which is a wide and deep scar, in the underarm area.
Armand_Lucas,_MD: The area in question needs examination to determine whether it can be excised and whether the resulting scar would be better or worse than the original scar.
Correcting Radiation Scars
33117485: I had extensive radiation treatment years ago that was done to the head and neck area on both sides. Now, years after the radiation treatments, I am still seeing the after-effects of the radiation on my neck. It has the appearance of a rash, and I assume it’s just small broken blood vessels. I remember a few years ago that a physician mentioned that I could have them removed. Is treatment available that could help remove this rash appearance?
Armand_Lucas,_MD: The effects of radiation are difficult to correct, and I would recommend an evaluation by a dermatologist with experience in laser therapy of the skin.
Plastic Surgery with Ehlers-Danlos Syndrome
Tracy Z.: I have Ehlers-Danlos syndrome (EDS) and I would like to have upper arm skin reduction. Will this be more difficult because of the EDS?
Armand_Lucas,_MD: Ehlers-Danlos syndrome is a genetic disorder that makes skin lax and easily distensible, and causes joints to be very flexible. Wound healing is not normal, and I do not recommend any surgery that is not absolutely necessary.
Surgical Correction of Diastasis Recti
33117485: I am a 51-year-old female who is very fit and active. I was diagnosed with diastasis recti (DR)(abdominal separation). Does having five previous laparoscopic surgeries through the belly button have any bearing on the cause of having a DR?
Also, when I am sitting, it seems that I feel most uncomfortable in my abdominal area, mostly around the stomach, My stomach seem full most times. Is DR the reason why I have that ‘full’ feeling? Although I have tried many exercise techniques, I have had no results. Is corrective surgery warranted, or is exercising the best alternative treatment?
Armand_Lucas,_MD: Diastasis recti means there is a separation between the two rectus muscles. It is often the result of pregnancy. It is not a hernia and it is not considered a medical procedure. Corrective surgery is not necessary, and these muscles are usually approximated (brought together) at the time of abdominoplasty. The stomach is an internal organ and problems should be referred to your internist or gastroenterologist.
Plastic Surgeon Selection
hills2: What is the best way to choose a plastic surgeon?
Armand_Lucas,_MD: You want to make sure that they are with a reputable institution, and board certified by the American Board of Plastic Surgery. Plastic surgeons certified by the American Board of Plastic Surgery are trained in both plastic surgery and reconstructive surgery. Word-of-mouth experience and reputation is also a helpful indication. Additionally, many plastic surgeons will show you before-and-after photos of their patients to give you an idea of what types of results you can expect. This can also help you see how many of these procedures they have done, and what type of experience they have. Make sure to do your research, and ask a lot of questions during your appointment and before your procedure.
Addressing Poor Surgical Outcomes
nu me: I have had two series of plastic surgeries in the past two years. Both were on the same day, and both turned into three-month nightmares ending with home health care and the need for PICC (peripherally inserted central catheter) lines. I had the same physician for both surgeries, but I am not getting answers or explanations on what went wrong. Is this the norm or should I dig deeper? I have requested all of my records, but have received very little information. I wanted to have additional procedures, but I am concerned about what to expect. There doesn't seem to be much regulation whether it is private pay elective surgery versus insurance approved. Where do I get accurate information?
Armand_Lucas,_MD: This situation needs to be addressed with your surgeon and your insurance company.
Moderator: I'm sorry to say that our time is now over. Thank you again, Armand Lucas, MD, for taking the time to answer questions today about body contouring procedures.
Armand_Lucas,_MD: Given the volume of information that is available today, I want to close and remind patients to do their homework if they are considering plastic surgery. This includes evaluating a surgeon’s surgical outcomes, experience, reputation and certification. Thank you for all of your questions today!
To make an appointment with Armand Lucas, MD or any of the other Cleveland Clinic cosmetic plastic surgery specialists, please call 216.444.6900 or call toll-free at 800.223.2273, ext. 46900. You can also visit us online at clevelandclinic.org/renewyou.
For More Information
On Cleveland Clinic
Cleveland Clinic’s Department of Plastic Surgery and Cosmetic & Plastic Surgery Center provide cosmetic procedures including facial contouring, breast and body contouring. The center offers patients access to a range of cosmetic specialists, including plastic surgeons, oculoplastic surgeons, head and neck surgeons, dermatologists and aestheticians. Additionally, our plastic surgeons are dedicated to improving patient outcomes through innovative cosmetic surgery advances including minimally invasive facelift techniques, alternatives to face and neck lift surgery, short-scar facelifts, and SmartLipo™ technology as well as injectable solutions such as Botox®. To see a full listing of our cosmetic services, specialists, locations, and before/after patient images, visit clevelandclinic.org/renewyou.
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