The Insanity of the Modern Tummy Tuck

Trinidad beach scene-by Dr. Yoho. Nothing to do with tummy tucks.

I am concerned about the fact that the Los Angeles tummy tuck has become synonymous with plastic and cosmetic surgery in some contexts. The fact is that this operation is not indicated in most cases. A tummy tuck or abdominoplasty is a major surgery which has a fatality rate of one in 3,000, according to the best medical literature we have. Older studies had a fatality or death rate of one in 625 surgeries. The patient is cut all the way from hip to hip. The fat and skin is separated from the muscle. The muscle is usually tightened, and a large portion of skin and excess fat is removed and then the patient endures a recovery which can last for many months.

Modern liposuction can accomplish many of these goals and for most patients it is the preferred alternative, even for very overweight patients. Recovery from liposuction is very modest compared to a tummy tuck. The death rate for liposuction may be as low as one in 50,000. Although after a liposuction with a large patient, some saggy irregular skin is to be expected, the skin shrinks to a much greater degree than most people would expect. It’s not like cutting and pasting a paper bag. The skin is the magic organ of the body, and just like after a pregnancy, after a liposuction the skin shrinks a great deal. Particularly helpful in this regard is the irritation that is produced by the liposuction process itself. This irritation or injury process accelerates and helps the shrinkage of the skin.

Nothing is perfect. Liposuction can produce irregularities, and just like abdominoplasty, major complications can occur. However, let the reader imagine the number of hospitalizations, major blood losses, and blood clots to the lungs and legs that occur with tummy tucks versus liposuction. It’s a ratio of ten to one or greater with the much safer procedure being liposuction.

Large-volume liposuction, or removal of more than five liters of fat, has become a standard and much safer procedure for the modern surgeon and the contemporary patient. We believe that this can be accomplished safely and efficiently in our hands, using our techniques, with a very modest risk. These surgeries result in very gratifying results, and if extra skin remains after the procedure and the patient is willing to have a secondary touch-up procedure, this can be removed much more easily than when the patient presents with all the fat to begin with. In other words, a second relatively inexpensive surgery can make a result with a smaller scar and less risk of major problems after a liposuction than trying to do it all at once. Particularly risky is the practice of doing a large liposuction and cutting skin out at the same time. This procedure can result in areas of skin death or problems of other kinds, including infection or sometimes other problems.

My firm belief is that liposuction under general anesthesia, particularly large-volume liposuction under general anesthesia, is connected with a much higher risk. My technique involves sedation and local anesthetic combined with two operating professionals who remove the fat rapidly and expose the patient to a much shorter operating time and less medication.

So if your surgeon recommends a tummy tuck, shop this around and be sure this is what you want. Look at pictures online and see Los Angeles cosmetic surgery website in particular to see if there is another part to this story that you haven’t heard.

 Be careful out there.

______________________


Robert Yoho, M.D.

MARKETING WORDS TO UNDERSTAND LIPOSUCTION: VISALIA, LOS ANGELES, PASADENA, AND FRESNO

The photo above is of the fat output from a large volume liposuction case. Notice that the yellow material on the top of the five containers is the fat. The material on the bottom is local anesthetic fluid with a tiny amount of blood in it. The amount of blood loss with liposuction cases is generally minimal. In this case, the fat represents about 6 quarts, roughly 60 per cent of the 10 quarts removed.

Many words are used by physicians to advertise their services in liposuction in Los Angeles, and the Central Valley. See below for explanations.

1. Liposculpture versus liposuction – This does not mean much of anything. Every surgeon doing liposuction aspires to sculpt the bodies of their patients and this is almost a word that stands for itself.

2. Microliposuction and microcannula liposuction – These marketing terms refer to use of smaller cannulas for liposuction than were used in the past. The general evolution of Los Angeles liposuction has been towards smaller and smaller cannulas. Some surgeons use cannulas as small as 2.5 mm in diameter (we do occasionally). Originally, in the 1990s, cannulas as large as 6-10 mm in diameter were used frequently. In 2009, most of us are using 4 mm or smaller cannulas. Delicate areas such as arms and faces and calves often are treated entirely with 3 mm or even the 2.5 mm cannulas with delicate tips. They harvest fat surprisingly well although they certainly are slower than larger ones and prolonging the operation is a disadvantage. The structure of the tissue around the fat can be better preserved with the smaller instruments and generally a smoother result is obtained, although this also has great a deal to do with the surgeon’s skill. In any case, if you are quite overweight and need a lot of fat removal to produce a more shapely body, you do not want your surgeon using the smallest cannula and taking 12 hours to do your procedure. Not only is the anesthetic necessary for such a procedure possibly a bit much for your system (and even have bad effects on your health) but you might have more discomfort.

3. Tumescent liposuction – Refers to putting local anesthetic in the tissues before the procedure in large quantities. The idea is to accomplish as little discomfort as possible and thus require less sedating medications. This stretches the fat in such a way that makes the removal of it more effective and probably less painful. This term was invented by Dr. Jeffrey Klein, who did some of the pioneering work with local anesthetic liposuction. If you Goggle tumescent: definition, there are also sexy overtones to the meanings so this too is marketing term.

4. “Liposuction totally by local anesthetic” – This is the liposuction that dermatologists are promoting. Some of them do not even use intravenous safety catheters and this may be reasonable for some cases, although it’s against California Law currently. The number of areas that are treated by these surgeons are by necessity limited because the patient does not take other medications besides local anesthetic. Dr. Yoho has had a lot of experience with the use of pure local anesthetic liposuction; he thinks that the fear factor and the anxiety factor can be countered easily by modern light anesthetic methods and that this much more humane. After all, we have cars now, you don’t have to ride a bicycle! Occasionally the patient has very limited areas that are going to be operated on, and pure local anesthetic is reasonable.

5. “Large volume liposuction” generally refers to liposuction of total fat output of over 5 liters. This does not include the fluid that is placed in the fat and then partially removed again. This is actually more of a medical distinction than a marketing distinction

6. "Adit" – This is a term for a kind of incision made with a punch instead of a slit with a scalpel. The theory is that the round hole heals better than a slit hole made by a scalpel. This is dermatologist term invented by Dr. Klein and is not used by the plastic surgeons or other cosmetic surgeons. Dr. Yoho does not like to use this technique, because he feels that the healing is not better.

6. “Ultrasonic” or “laser” or “vibrating cannula” liposuction – There are liposuction, vibrating instrument liposuction rotating instrument liposuction; these are all technologies which have been developed in an attempt to make either the operating time shorter or the experience by the surgeon easier or perhaps the result better. I think that none of these aims have been clearly achieved and there are no good studies that show that any of these techniques are superior to the liposuction we use which varies the cannula size based on the case and uses relatively large volumes of local anesthetic. We do have access to various technologies of these types if you want us to use them; just ask. There is a small extra charge. For Liposuction Fresno visit our office in Visalia, visit our Pasadena location for Liposuction Los Angeles

CALIFORNIA LIPOSUCTION LEGAL STANDARDS

Weight Loss with Liposuction: Some patients get drama! This is 6 weeks after surgery.

I’ve reprinted the law regarding liposuction standards in California, below. I was involved in developing these standards. I testified several times before the California Medical Board and supplied them with materials and documentation to aid them in their decision-making process. I believe that these rules are important and necessary for safety. I want to make several points.
1) If you are seeing someone who does not start an intravenous line, they are violating the surgeon’s “standard of care” and also California law.
2) The other requirements that are seen below include blood oxygen and blood pressure monitoring, which are simple, modern devices to see how well you are breathing and how well your heart is working.
3) Modern liposuction is a very, very safe procedure in experienced hands. However, there are risks and if you find someone who says that it is risk free, you should look elsewhere. Common surgical complications such as infection are unlikely but possible.
4) If your surgeon uses no relaxation medicines at all, some sort of liposuction may be performed and the risks may be lower. However, like anything in life, there are trade-offs, in other words you have to accept possibly a lower standard of results—in particular less fat removal--in exchange for not going to sleep. Additionally, we have found that many of our patients find the option of having nothing but local anesthetic frightening and sometimes quite uncomfortable. This is not to say that I approve of general anesthesia for liposuction, I don’t. I think this compounds the risk.
5) For individuals who need significant amounts of fat removed, California law requires a certified surgical center, such as a hospital would have. Ask to see the certificate if this is the case.



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( B ) T h e p a t i e n t s h a l l o n l y b e d i s c h a r g e d t o a r e s p o n s i b l e a d u l t c a p a b l e o f u n d e r s t a n d i n g p o s t o p e r a t i v e i n s t r u c t i o n s .