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.

Fat Transplant Problems and Opportunities

Fat transplant has become an increasing trend in the last few years. Transplantations can be performed on various areas, including to buttocks, face, and breast. Buttocks fat transplant is done in Dr. Yoho’s office almost every week. We’ve had experience that may extend to a thousand patients. We have seen very few complications with it because the fat is sterile. It’s kept sterile through the use of enclosed containers and is transplanted almost immediately back into the patient’s own tissues. However, when the volume of fat is increased to large quantities, the risks of problems become higher and higher because the buttocks’ blood vessels and supporting structure can only take so much of the new material before areas of fat become isolated and susceptible to infection. We have seen this in several cases where very large quantities of fat were used. The result is a prolonged recovery and an unhappy patient, intravenous antibiotics and procedures to wash whatever fat we can out of the buttocks. For this reason, we’ve limited our volume to a sensible amount and don’t claim to produce very full buttocks with one procedure. That said, repeat procedures can be done and improvement is progressive.

Facial fat transplant, of course, has been of great interest to the cosmetic surgeon for at least 15 years. Transplant of tiny amounts of fat to the cheek areas around the brow, the lips and chin, and even the muscles of the jaw produce very pleasing results if done carefully and by an experienced surgeon. It’s a bit tedious, but the tiny amounts of fat transplanted make for very smooth results. The problem here is that in the case of massive weight gain later, sometimes the patient ends up with a very fat face. This fat transplant to the face, if done properly, is permanent or at least very, very long-lasting. The general rule of thumb is that what you see is what you get after about three to four months.

Breast fat transplant is a very different kind of procedure. We do perform breast fat transplant and have experience with hundreds of cases, but it basically doesn’t work in breasts that are very, very small, because the breast can’t support and give nutrition to the new fat if there’s not much breast to begin with. For larger breasts, breast fat transplant is successful and can make them even larger. The most important point for the potential patient is to understand that they’ll never get an increase in size anything like a breast implant. However, if this is successful, breast fat transplant produces natural results and rarely any mammogram changes. The fear of the mammogram changes looking like breast cancer is generally misplaced, although I suppose it’s possible. The mammogram changes that show breast cancer are relatively characteristic of breast cancer, and any breast surgery can produce calcification and scarring that is visible on a mammogram that doesn’t look like breast cancer. That said, the small possibility of a biopsy for breast fat transplant in the future mistaken for breast cancer must be factored in by the potential patient. We’ve actually never seen, in our practice, abnormal mammograms after breast fat transplant. They always seem to come back “interval increase in breast size with no apparent other change.” 

In any case, there are risks and the patient should be aware of it all before fat transplant. This article isn’t complete and you need to speak with Dr. Yoho about your specific situation and he can tell you what to expect and what the potential problems are for your case and your body type. Please visit Dr. Yoho's main website for more information on many types of cosmetic procedures. Here, you can also find contact information to make an appointment for your complimentary consultation.

Dr. Yoho's adventure with a horse in Buenos Aires

Dr. Yoho took a trip to Buenos Aires to attend a medical meeting about cosmetic surgery.  During the trip, he went into the countryside and did some touring and jumped on a horse for the first time in 20 years. 

He was having a wonderful time until the horse found that he was on his way back to the corral at the end of the ride and began to break into a faster pace.  Dr. Yoho was anxious about the horse's speed and was afraid that he'd fall off, so he pulled back on the reins and the horse bucked him right off. 

While Dr. Yoho insisted that he fell gracefully, close observers claim that he looked like a sack of potatoes as he flew through the air and hit the ground.  Fortunately, very little was bruised except for his right buttock and his ego, and he continued on the sightseeing trip with no further mishaps.