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Q: Can liposuction remove internal scar tissue from several C-Sections without producing more scar tissue?

A: C-section scars are often tightly bound with the skin adherent to the underlying connective tissue and muscle layer giving an indented look. Fat then accumulates above and below the indented scar. Doing liposuction to reduce the excess fat can greatly improve the appearance. Also, the liposuction cannula can sometimes be used to carefully release the bound skin from the underlying muscle and connective tissue. A laser may have value in skin tightening, but not in removing the scar tissue.

Q: What kind of liposuction is the safest? I’ve tried to research the safest, best type of liposuction, but can’t seem to find which option is safest. My husband does not want me to undergo general anesthesia and is most worried about the safety of the procedure. He is an anesthesiologist and has seen the dangers. I just want my saddlebags done, I am pleased with the rest of my body. And, if a procedure is safer, does that mean it will be less effective?

A: I believe the safest kind of liposuction is done with local anesthesia. The published evidence in the medical literature is clear that liposuction is very safe when performed with local anesthesia. Here are the important points:

  • The safe dose of lidocaine, the local anesthesia, is well established, and there is a wide margin between the safe dose and an overdose.
  • An allergic reaction to lidocaine is so rare, that it’s considered something that just doesn’t happen.
  • General anesthesia medications are associated with adverse events that aren’t always predictable; patients do have unexpected adverse events that can be life-threatening.
  • When a person is “out” under general anesthesia, they’re unable to communicate with the surgeon if they’re feeling something they shouldn’t be feeling. For example, a patient who is “out” may not feel the surgeon straying from the fat space and invading a part of the body where the surgeon shouldn’t be. Local anesthesia makes only the fat numb and comfortable, but not the other parts of the body; it’s another safety feature.
  • When an anesthesiologist is concerned about his wife undergoing general anesthesia, that’s pretty telling.

Q: Will liposuction remove visceral fat?

A: Sadly, no. Visceral fat is the fat that is located inside our bodies where our organs are located. This fat isn’t reachable with liposuction; only subcutaneous fat that is located between the muscle and the skin can be reduced with liposuction. If you’re unsure if your fat is visceral or subcutaneous, visit a physician who specializes in liposuction who can examine you and tell you what you have. The only way to reduce visceral fat is the old-fashioned way: good eating habits and good exercise habits. By far and away, the most important part of that formula for success involves good eating habits!

Q: I had SmartLipo™ 3 months ago and was wondering if there was a difference between SmartLipo™ and liposuction? What is the difference between liposuction and laser liposuction?

A: Liposuction is the process of removing fat from under the skin by suctioning. The modern version of liposuction was developed in the mid-80’s by a dermatologist when he figured out how to make the fat numb with local anesthesia so that the patient didn’t have to be out under general anesthesia. About seven years ago lasers were introduced to act as an aid to the suctioning of the fat by prepping the fat and heating the skin to aid in skin contraction. The lasers do not substitute for suctioning. That is still the main event when one has liposuction. Not everyone needs a laser to have excellent results with liposuction. The decision to use the laser or not is something to discuss with your surgeon at the time of your consultation.

Q: Nine weeks ago, I had SmartLipo™ to my knees, outer and inner thighs and banana roll. My weight is still 5-7 pounds above what it was pre-lipo even with very clean eating and daily exercise. Will wearing the compression garment at this point reduce swelling and assist with permanent skin tightening and improved results?

A: There is NO benefit to wearing a liposuction compression garment beyond 2 months? The longer answer is that in the early days after the procedure the garment is comforting and minimizes swelling. But after the first couple of weeks, swelling is significantly less, and my patients wear their garments for the duration that they need, based on comfort. This is influenced by swelling, of course, but there is no right or wrong regarding how long one wear’s the garment. It doesn’t have a long term impact on the outcome of the procedure.

Q: Can liposuction create a 25 inch waist? I just had an amazing epiphany and I’ve decided that I am tired of dieting , juicing , starving etc. I will have lipo. I have back fat that never goes away as well as a kangaroo pouch. I’d like aggressive lipo, I’d also like to get my waist line extremely small. Ideally a 25 inch waist . Is that possible?

A: Liposuction can only “give” you the size waist that is naturally present under excess subcutaneous fat. Our bodies can also store fat inside the abdomen, fat that can’t be reduced with liposuction or any other procedure. Liposuction is a wonderful contour procedure, but it can’t substitute for the need to achieve a healthy body. If general weight loss is necessary, liposuction can be helpful either before or after achieving a healthy weight. A consultation with a liposuction surgeon can help you determine what would be best.

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Q: How do I successfully choose between injective dermal fillers such as Juvederm®, Restylane®, Perlane®, Radiesse® and others? What is the most cost-effective method? (Juvederm or Restylane?) How do I know what facial filler to choose?

A: It’s easy to be confused about the fillers. It’s really not your job to have to know which one to choose. The choice that’s important for you to make is the selection of physician to inject the filler for you. Always choose a physician who is very experienced with fillers. Get recommendations from friends, or check out the physicians in your community who are participating on RealSelf. The most experienced physician injectors will use all the available fillers and be able to explain the differences between each one. They each have very specific characteristics and I don’t consider them to be interchangeable in general. When there are circumstances where it truly doesn’t matter which one is best, then I’ll tell my patient, and the decision may be based on cost of the product or longevity or prior patient experience with one vs another.

Q: Is a cheek dermal filler safe? I am 27 years old i want to have cheek filler and, I’ ve already made an appointment with a private. Will a nurse be performing the filler for me and I don’t know whether it is safe or not ???i f a nurse will do it?

A: There’s a great new (to us in the US) filler in the Juvéderm family of fillers. It’s called Juvéderm Voluma. It has a very good safety record of use in Europe and Canada for many years prior to its arrival in the US in late 2013. Juvéderm and Voluma is specifically indicated for augmenting, shaping and lifting the cheek. It has a tremendous lifting capacity and has been show to result in a satisfying result even 2 years after a full correction. I would recommend having a physician who is very experienced in aesthetic injections do your treatment for you. A physician knows and understands anatomy the best.

Q: After helpful advice on here I booked a consultation and was told I was too young for fillers and was advised to have epionce peels. I liked them but they didn’t help with what I wanted as I am sure it is loss of volume. Would fillers help? I feel I have lost volume between and above the brows causing my eyelids to droop slightly and also from my cheeks giving me hollows under my eyes and also lines beside my mouth. I am just looking for some advice before I go to another consultation. The peels have more the skin appear smoother but didn’t lift cheek.

A: Juvéderm® Voluma is for cheek volume and lift, not brow creases, Juvéderm® Voluma is a fabulous new filler that does an excellent job of lifting and shaping cheeks. Based on your photos you’d be a good candidate for that or possibly other fillers as well. The area between the brows is best treated with Botox to relax the muscles that are creating the pleated appearance. Usually Botox alone will rejuvenate that area. Sometimes following with a filler, such as Restylane® or Juvéderm® Ultra or Ultra Plus is helpful, but not Voluma. Voluma is not meant for between the brow.

Q: Are you able to have Sculptra® under eyes then have a filler too?

A: Sculptra® is great for volume, but not under the eyes. Sculptra® is a fabulous product that stimulates your soft tissue to make collagen, achieving a very natural result. It can be placed in most areas of the face, except under the eyes and around the mouth. Those locations are best treated with fillers. I routinely use Sculptra® in the areas of the face where it is ideal and use fillers under the eyes and in the peri-oral areas. One place that I will use both Sculptra® and a filler is the temple area. The temples are a very overlooked area for rejuvenation, and treating the temples can peel back the years!

Q: How best to use the new filler Belotero®?

A: Belotero® is a relatively new, and much anticipated, hyaluronic acid (HA) filler. All the hyaluronic acid fillers are slightly different from each other, and therefore allow physicians to match the best filler to the problem. Belotero® blends very well into the skin is best for:

  • Creased skin and etched-in lines, like the smile creases
  • Under eye area where the skin is very thin
  • Etched lines that radiate from the lips
  • Any place where superficial placement is needed and the other HA fillers may be visible through the skin
  • I am 33 years old. I have a very asymmetrical face when I smile. This is something new I’ve noticed over the past 3 or 4 years. I don’t notice it as much when my face is at rest (but that’s my untrained opinion). What would be the best route to fix this issue?

Q: Would BOTOX® Cosmetic fix my facial asymmetry or is surgery a better option?

A: BOTOX® Cosmetic can often help brow asymmetry. BOTOX® Cosmetic works by modifying how muscles move. A skilled physician can place BOTOX® Cosmetic in such a way that we can selectively reduce some areas of motion, while allowing other areas to continue to move. This is a quick and easy to balance facial motion. Be sure to see a physician who understands the anatomy well.

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