Liposuction Tricks of the Trade
As we've previously discussed, surgeons have little "tricks" and beliefs which they feel either improve aesthetic results, recovery time - or both. Some of these we may have mentioned earlier and some are still good little "tricks" that not every surgeon is even going to know about whatsoever. But it is worth the mention!
"Customized" Techniques: Many surgeons find that by altering an action or combining standard actions and even adding an action or product to a procedure gives better results in their practice.
Superficial Liposuction to tighten the skin: removal of the superficial fat and undermining the dermis may help patients who have compromised skin laxity. However, if not performed correctly can result in a mottled appearance.
Finishing up a patient while they are upright: Many surgeons are starting to do this - even having the patient stand up towards the end or suspended between O.R. staff or with neoprene a suspension harness. Surgeons believe it helps them remove fat the way it should be, not distorted from the patient lying down but as the patient would naturally be presented - standing up.
No suturing of incisions: This is actually very controversial. Some surgeons believe that incisions should have a suture to properly close the tissue which creates a better scar. however, there are surgeons who adamantly disagree and believe that suturing of standard sized incisions only creates a worse scar. However, the surgeons who do not suture may use tissue glue or surgical paper tape as opposes to nothing but even this varies. Some surgeons just let the fluid leak out as much as it possibly can to help decrease swelling, pain and bruising.
Surgical Paper Tape (SteriStrips™): Many surgeons believe only a little paper tape is necessary for incisions to help keep them closed, flatten them and keep out bacteria. However paper tape is porous and bacteria can surely infiltrate. SteriStrips™ have been proven to flatten scars although this very well may be from pressure and not the product itself as even pressure from silicone sheeting is beneficial.
Retin A: Some surgeons suggest the use of Retin A and paper tape application. Wait a few days and repeat. These surgeons insist aesthetic properties of scars are much improved having faded, increasing patient satisfaction
Compression Garments: Not all surgeons recommend their use. In fact my own liposuction surgeon does not. He says that it isn't necessary for standard liposuction cases unless skin laxity is going to be an issue. He believe they are unnecessary and more of a hindrance than a help. Of course there are tons of surgeons who disagree with this and insist upon their use. Of course, controversial issues will abound in plastic surgery.
Homeopathics: Some surgeons recommend homeopathics such as Arnica montana and/or Bromelain. Some believe they do nothing. Ask around to speak with real patients. I personally take both for any surgery but that's just me. Never go against your surgeon's wishes.
Massage: Some surgeons recommend that you massage the treatment areas to prevent scar tissue build up and lessen the chance of dimples and dents. Some surgeons insist that if you do not massage natural scar tissue formation will form within the "tunnels" created by the cannula and will begin to contract and lump up pr pull your connective tissue and superficial fat down with it creating undesirable surface irregularities. Patients are usually instructed to massage beginning at a week post-operatively and for about 15 minutes a day. Vigorous massage is said to prevent fibrous bands of scar tissue to contract around your existing fat and will also help with edema (swelling). What do I think? It's always better to be safe than sorry.
Endermologie: For this same reasons as above, but for a prrice and perhaps more effective. Who knows? Ask your surgeon. Endermologie was designed for a non-invasive, non-surgical - yet temporary "cure" for skin contour irregularities. The Endermologie machine is a patented vacuum device which creates suction to temporarily immobilize and lift your soft tissue while dual "rollers" create deep, subdermal massage to the connective tissue and fat globules to improve the appearance of cellulite. The stretching of the fibrous bands loosens and releases the fat by mobilizing it or "setting it free" from the tight and compact grasped of the connective tissue. Endermologie can also reduce body mass by a few inches. The Endermologie machine literally sucks the skin up and rolls the skin out resulting in deep tissue massage. This simultaneous act of "massaging" loosens tightly, packed fat from the skin and promotes better circulation. The act of massage promotes new collagen growth which is thought to help strengthen the connective tissue thereby prohibiting fat globules from "pressing" through the honeycomb structure of the connective tissue itself. When fat globules are constricted and pressed towards the skin - the cellulite and other irregularities are more visible. Endermologie is thought to help release these constrictive bands and prevent fibrous scar tissue formation post-operatively.
Lymphatic Drainage Massage: Lymphatic Drainage Massage (let's refer to this as LDM for simplicity) is thought by some to "detoxify" the body and alleviate edema after liposuction. LDM is performed by massing the body in a circular motion using flat palm and fingers. Some technicians use essential oils which can be customized for your own needs. Some of these essential oils may include rosemary, juniper, cypress, geranium, rose, citrus oils, spearmint, and others. If you have a history of allergies or seizures PLEASE let your masseuse know! LDM is thought to help increase circulation of fluids which may be "pooled" and stagnant. Proper function and circulation may help alleviate post-operative swelling. LDM is thought to help with lymphatic flow and collection so that toxins can be excreted by the body and perhaps lessen the appearance of cellulite, remove toxins from the body as well as "water weight" from hormonal/medication issues. It is also believed that LDM helps strengthen the immune system. not all surgeons recommend this but it is worth asking. Some liposuction patients (and plastic surgery patients in general) swear by this.
Hyperbaric Oxygen Therapy: HBOT is the treatment in which the patient breathes 100% oxygen at pressures greater than normal atmospheric (sea level) pressure. HBOT involves the systemic delivery of oxygen at levels 2-3 times greater than atmospheric pressure. This way oxygen is literally forced into the tissues to promote nitrogen bubble release for Decompression Sickness (DCS) in which scuba divers, pilots, etc. In medical uses it is recognized for many uses in curing all sorts of problems. In liposuction applications, chances of wound problems, necrosis and delayed healing are significantly lessened.
Erwin J. Bulan, MD
Bulan Plastic Surgery
75 Main Street
Millburn, NJ 07041
Joshua A. Greenwald, MD, FACS
Cosmetic Surgery Associates of New York
166 5th Avenue
New York, NY 10010
Nikesh K. Patel, MD
New Reflections Plastic Surgery
1001 West Main Street
Freehold, NJ 07728