contact us | home 

Robert S. Hamas, M.D.
8345 Walnut Hill Lane
Suite 120
Dallas, TX 75231
(214) 363-1073
(214) 890-7844 (fax)

Liposuction is the most commonly performed cosmetic surgery procedure in the United States. A better term would be liposculpture because the operation sculptures the body’s fat layer. This removes unwanted bulges, but is not meant to remove all the fat in an area so there is nothing left to pinch. The goal is to contour the fat layer to give an attractive body shape. Perfectly straight legs are rare in a woman and a perfectly flat abdomen does not exist. Even young bathing suit models have slight curves of their legs and abdomen. So after liposculpture you should look natural, with proportionate contours and a pleasing body shape. Clothes will fit better and some patients even wear a smaller size because they need less fabric to go around bulges of the thighs, hips or abdomen. This is why liposuction is so popular!

 

before  /  after Click image to enlarge

liposuction of hips, outer and inner thighs

You are born with a certain distribution of fat cells on your body that is determined by your genetics. Some areas have more fat cells and so have thicker fat layers or bulges that look disproportionate. Dieting and exercise do not change the relative proportions of your body shape – they just make all areas thinner. Bulges may get smaller, but are still present as disproportionately thicker areas. The goal of liposculpture is to thin the disproportionate fat layer in an area, so the bulge is gone and you have a more proportionate contour.

In women, the areas of thicker fat and bulges are on the outer thighs, inner thighs, hips and abdomen. Other areas include knees, back rolls and arms.

In men, the areas of thicker fat and bulges are on the abdomen and flank areas, commonly called love handles. Another problem area for some men is prominent breasts, or gynecomastia.

Both men and women may have disproportionately thick fat in the neck.

Your body fat will increase due to a gain in weight, less exercise, and hormone changes related to aging, menopause or stress. The percentage of body fat can increase even if you stay the same weight but exercise less – because muscle is converted to fat.

When your body fat increases, you do not grow new fat cells. Instead, all your existing fat cells enlarge equally as your percentage of body fat goes up. No matter where the fat cells are located, they all respond the same way. For example: If you have a one-inch layer of fat cells on the front of your thigh, but a two-inch layer on the side of your thigh, and the percentage of body fat increases enough so all fat cells double in size, then the front of the thigh layer will increase from one inch to two inches, while the side of the thigh layer will increase from two inches to four inches. You certainly will notice the four inches on the side of your thigh, but you may not notice the two inches on the front of your thigh – even though all fat cells have doubled in size all over your body.

This is why sometimes people say, "When I gain weight it all goes here" and point to one bothersome area. Actually, all their fat cells enlarge an equal amount. Fat cells can not enlarge in just one area without enlarging in all other areas as well. It’s just that a disproportionate bulging area with more fat cells in the fat layer shows it more.

Liposuction removes the excess fat cells in an area so the bulge is gone and the body proportions are improved. In the example above, the original two-inch layer on the outer thigh is trimmed to one inch like on the front of the thigh. The important thing to remember is that fat cells cannot move from one area to another. Once they are removed from an area, they can not grow back. The change in your body contour is permanent.

Cellulite is dimpling or irregularities of the skin, often on the back of the thighs. Its presence is determined somewhat genetically and has to do with the thickness of the fat layer and the elasticity of your skin. Liposculpture usually makes little overall change in cellulite. Though some patients may notice a slight improvement, others notice no change or even a little further irregularity.

Liposuction is not for weight loss. The ideal candidate is at or close to their normal body weight relative to their height. Nevertheless, liposculpture can be effective on some patients who are slightly over their ideal weight.

If you are trying to lose weight and are on a diet, you should continue your diet program and stabilize at your new desired weight before liposuction. On the other hand, if you have been slightly overweight for many years, there is no reason to attempt weight loss prior to liposuction.

Overweight patients may lose some weight after liposculpture because of an enhanced body image and improved self-esteem. They may have been discouraged in the past because their clothes never fit correctly or looked unattractive due to fat bulges. After liposculpture, clothes tend to fit better, which can be an incentive to lose those extra pounds.

While obese patients may be treated using techniques such as ultrasonic liposuction (UAL), I feel these patients are best served by weight loss before body contouring. For an average size patient, ultrasonic liposuction has not been shown to give any better results than traditional liposuction methods. Since ultrasonic liposuction may irritate sensory nerves, there may be more postoperative pain.

Sometimes patients who are underweight request liposuction. They diet endlessly to keep their percentage of body fat low so their fat cells are small and their fat layers thin. After liposuction of even very small bulges, these patients can relax and actually gain a few pounds, yet show a better body contour than before. Though all their fat cells enlarge with the slight weight gain, the disproportionate cells have been removed from the bulging areas so their body looks more proportionate and has a better shape.

Patients bothered by abdominal bulges should remember that fat is inside the abdomen as well as between the muscles and skin. Liposculpture can get to the fat layer between the muscles and skin, the usual "bulge" or "pot belly."

Unfortunately, some people carry a lot of their abdominal fat on the inside. In other words, you might have a bulging abdomen, but the layer of fat between muscles and skin is quite thin. The only way to make an abdomen like this smaller is by diet and exercise. It is just not possible to liposuction fat inside the abdomen because of the internal organs. Large collections of fat inside the abdomen occur more commonly in men than women.

To determine where your abdominal fat is located, lie flat on your back and do a "crunch" (tighten your abdominal muscles as you just begin to sit up). If you feel a fat layer bulging in front of the tightened muscles, this fat layer can be treated by liposuction. When you pinch the layer, you are actually feeling twice the thickness of the actual fat layer because the skin is folded in half. If there is very little fat to pinch when you do this test, most of your abdominal fat is on the inside and could not be removed by liposuction.

To evaluate the fat layer in your neck, tighten the neck muscle under the skin (the platysma) and look for a fat layer in front of it. If this is thick, it can be thinned by liposuction to improve the neck contour.

Some people have a weak or receding chin along with excessive fat in the neck. This makes for an unattractive neck contour and facial profile. Fortunately, correction is relatively easy with a chin implant at the time of neck liposuction.

If the platysma muscle lacks tone and shows bands or cords extending vertically under the chin, it may be necessary to do a neck lift in addition to the fat removal. This situation begins to occur in the early 40s and becomes more noticeable by the 50s. To get their best neck contour, these patients need a lift of the platysma muscle layer in addition to neck liposuction. Click here for more information on a neck lift.

The fat layer in an area is sculptured and thinned by using cannulas (hollow tubes) to remove the undesirable fat cells. I never use a cannula larger than 3.7mm for any area including abdomen and thighs. For some areas such as the neck, cannulas as small as 1.8mm may be used. It is easier to contour with small cannulas, and there is less chance of irregularities or waviness. Also, less bruising and pain occurs with these very small size cannulas.

In performing liposculpture, it is necessary to take the time to get the contours as smooth, even and symmetrical as humanly possible. To do this, criss-crossing passes are made with the small cannula, and the fat is removed from relatively deep within the fat layer. Nevertheless, liposuction may leave some contour irregularities or waviness, more noticeable in the patient with poor skin tone.

Skin shrinks remarkably well at almost any age, though it shrinks better and is tighter in some patients than in others. Factors that affect skin elasticity include the amount of sun damage, genetics and age. In other words, a patient in their 60s may have good elastic skin while another patient in their 20s may have less elastic skin because of genetic factors and severe sun damage. With rare exceptions, all patients have enough elasticity in their skin to benefit from liposuction. I have personally done liposuction on patients as young as 15 and as old as 80.

The more elastic and better the skin tone, the smoother the final result. Other factors that affect the smoothness of the result are the amount of fat removed, the diameter of the cannula used, the experience of the surgeon, and the patient’s inherent healing.

Liposuction is performed with you asleep under a very light general anesthetic so you are completely unaware of any aspect of the procedure. In traditional liposuction, a moderate amount of a solution containing adrenaline is injected into the bulging area to constrict blood vessels and thereby minimize bleeding. It also contains some local anesthetic, which reduces the amount of general anesthesia needed.

Theoretically, liposuction can be done under just local anesthesia, but this requires the unpleasant injection of large amounts of anesthetic solution to numb your legs or abdomen. Tumescent liposuction refers to the injection of very large amounts of fluid (many liters) to control bleeding, usually in obese patients. Such techniques of large volume fluid injection are not necessary for an average size patient and can distort the areas making contouring more difficult.

After sculpturing the fat layer, the small one-quarter inch incisions are closed with absorbable stitches under the skin. You are placed in a compressive garment to minimize swelling. This compressive garment is worn day and night for the first two weeks and then only during the day for two additional weeks. The garment may be removed to shower starting the next day. When the neck is done, compression is applied for only three to five days.

Massage is beneficial beginning two or three days after surgery using either the flat of your hand or even a rolling pin. This helps to resolve swelling and probably helps smooth the sculptured fat layer to give a better result.

Postoperative pain is minimal with traditional liposuction methods. Some bruising may last for up to four weeks depending on your skin type. Most of the swelling resolves between two and four weeks. At no time are the areas swollen larger than they were before surgery.

Most patients can return to activities, such as they might do in an office, within two or three days and can resume full athletics without restriction by 10 days.

In the hands of an experienced surgeon, traditional liposuction has had a good track record with very few problems. Some of the risks with traditional liposuction include infection, bleeding, minor contour irregularities and asymmetry. Detailed information is provided during the consultation.

Cosmetic surgery is done in my own accredited office operating room facility. Click here for more information.

You may wish to use your VISA or MasterCard to pay for your surgery. Should you desire a personal loan, your own bank or credit union is your best source since they are already familiar with your credit history. If you prefer, the office will recommend a source for financing your cosmetic surgery.

For more information, or to schedule a personal consultation, call 214-363-1073

Robert S. Hamas, M.D.
8345 Walnut Hill Lane, Suite 120
Dallas, Texas 75231

Certified
American Board of Plastic Surgery

A Complete Guide to Cosmetic Surgery