The gold standard with the American Board of Plastic Surgery for liposculpture is the use of tumescent technique.  Tumescent liposuction is associated with three components.  Number one is the tumescent fluid of lactated ringer or sodium chloride.  This fluid is used to infiltrate into the fat specifically, hydrating the fat and allowing the contouring of the specific body part with reduction of contour surface irregularities and deformities.  The second component is Lidocaine.  Lidocaine is a numbing agent.  Lidocaine allows for up to 24 hours of pain relief and is very useful for tumescent technique liposculpture.  Finally, epinephrine, which is added in order reduce bruising and bleeding, as well as allows for vasoconstriction of the arterial blood vessels and thereby allowing for a great reduction of bruising in the postoperative period.  Postoperative compression garments should be included at 6 to 8 weeks of girdles and abdominal binders to reduce the swelling as well as to allow for a confluent smoothing effect of the abdomen, hips, flanks and inner and outer thighs.

The picture here describes preoperatively a patient with significant lipodystrophy of the iliac crest roll hips, periumbilical lower abdomen, as well as the interomedial and posterolateral saddlebags and the infragluteal fold banana rolls.  This patient underwent a 2 liter tumescent liposculpture procedure and is now six months postoperatively showing a nice contour softening of the inner and outer thighs, infragluteal fold as well as a reduction of the muffin top and hip area as well as the periumbilical fat.

There is no better time than now to get the body that you desired through the years.  Whether it is associated with hypoplasia or small breasts or a full mommy makeover with implants, breast lifts, tummy tucks or total body liposuction associated with weight gain throughout the holiday season.  If diet and exercise cannot get you to the shape that you desire, tumescent liposculpture may be an excellent decision.  2012 will be an excellent year.  We look forward to serving our patients worldwide for their breast revision, breast reconstruction, breast enhancement, augmentation, breast reduction, lifts, tummy tucks and full body liposculptures.

Cheers!

The example to the left is a patient with significant lipodystrophy adiposity of the iliac crest rolls, the belt area, extending to the periumbilical and lower abdomen.  This patient is not an excellent candidate, but rather a good candidate for liposuction, as he does have significant intraperitoneal fat including omentum and mesentery.  However, liposuctioning the sides and the lower abdominal periumbilical area will help to reduce some of the lateral distention along the hip area and along the lower beltline.  The patient underwent tumescent liposculpture procedure.  Postop one week results show a great reduction in fat around the iliac crest roll and the hip region extending to the periumbilical lower abdominal area.  Liposculpture in men is quite different than in women in that the fat is fibrotic, usually thicker, and harder to get out within the subcutaneous Camper’s and Scarpa’s fascia.  These patients however do well with aggressive tumescent liposuction technique and six to eight weeks of compression garments postoperatively.

MICRO LIPOSUCTION

The above patient is a young 22-year-old female presenting with gynoid appearance, significant iliac crest roll hip fat as well as anteromedial, posterolateral and infragluteal fold fat.  The patient is an excellent candidate for tumescent liposuction using micro liposuction techniques with infiltration of tumescent fluid.  The patient underwent the procedure and this is her 8-week postoperative visit.  Notice the smoothing out nicely of the iliac crest rolls and the lower anteromedial thighs.  Notice also softening of the lateral thigh saddle bag areas with great reduction in size of the diameter of the thigh itself.  She has a more smooth even appearance of her upper, middle and lower third of her body.

Performing tumescent technique liposuction with Lidocaine, epinephrine and sodium chloride for wetting solution and small 2 and 3 mm cannulas in the bi-directional fashion of the iliac crest roll hip area as well as suctioning the deep localized fat of the inner and outer thigh and infragluteal banana roll area can lead to a very nice natural result with a tapering affect of the lower third to be evened out with the upper and midriff area.  This is a classic example of severe gynoid appearance, correctable by micro liposculpture tumescent technique.

This patient is a 21-year-old female presenting with severe gynoid appearance, a pear-shaped appearance with a significant amount of lipodystrophy adiposity fat in the lateral saddle bag area and extending to the infragluteal fold.  This can be removed both along the inner and outer thigh through tumescent liposculpture technique and the iliac crest roll muffin top can be suctioned out in order to obtain a nice contour.  This is referred to as tumescent liposculpture under general anesthesia.  On this patient 1.25 liters of fat was removed after tumescent fluid was instilled. 

Postop Day One appearance with the patient in the sitting position shows nice smoothing out of the hips and narrowing of the inner and outer thigh, giving her much more proportionality with her upper and mid third.

Other consultations that day also included mommy makeover, including breast implant lift, tummy tuck and liposculpture of the hips.  These patients present to Beverly Hills from Las Vegas for surgery, including breast augmentation, breast revision, breast lift, breast reduction, liposculpture, and abdominoplasty.

Patients are presenting for cosmetic dentistry with Dr. Kevin Sands, a world recognized leader in cosmetic dentistry, including all forms of dental bonding, veneer and perfect smile dental work.  He has a multitude of celebrity clientele who have undergone his masterful artistry in perfect dental reconstruction and cosmetic perfection.  Patients are also presenting for facial rejuvenation surgery, including eyelids, rhinoplasty and dermal fillers. 

Dr. Robert Kotler is a facial cosmetic surgery specialist who performs absolute remarkable beautification and rejuvenation, creating a youthful appearance to the face through his eyelid surgery, brow lift and facelift procedures.  He is a world recognized leader in rhinoplasty and nasal surgery, creating the absolute perfection of proportionality of the nose to the specific woman’s facial structure.  Robert Kotler is considered a truly greater facial plastic surgeon with well over 35 years of experience and celebrity clientele from every major Hollywood studio. 

In a similar fashion, patients present for body sculpting, including breast enhancement, breast revision, breast reduction, breast lifting, tummy tucks and total body lipo-contouring, to us, Dr. Linder, Beverly Hills Body Sculptor.  The name Linder with the Dr. Linder Bra has become a “figure in the community,” consistency with body sculpting from patients of every walk of lift, from celebrities and patients of international travelers worldwide. 

The Beverly Hills Extreme Makeover includes complete body and facial transformations from worldwide leaders and experts, including cosmetic dentistry, Dr. Kevin Sands; facial plastic surgery and rejuvenation with Dr. Robert Kotler and total body mommy makeovers and extreme body sculpting, lipo-contouring with Dr. Stuart Linder.

Many patients are confused as to the terms, Tummy Tuck, Abdominoplasty, and Panniculectomy.  In fact, all three of these are very similar operations.  An Abdominoplasty and a Tummy Tuck are both the same operation in which skin is removed after significant undermining of the abdominal wall and tightening and plication of the rectus sheath muscles with permanent sutures.  A Panniculectomy is an enormous abdominoplasty, often referred to as removal of an abdominal pannus.  This can occur after massive weight loss such as bariatric surgical or gastric bypass patients.  These patients who have lost well over 100 pounds, often have a massive abdominal apron or pannus which requires careful dissection and removal of the pannus.  Usually the abdominal wall is so diastatic and so thin that suturing the wall is not feasible or appropriate.  Paniculectomies are enormous abdominoplasties.  The dissection is usually less aggressive superiorly up to the subcostal margin in order to maintain blood supply of the flap down to the abdominal wall.  The umbilicus is usually spared, but in some circumstances must be removed in the larger paniculectomies.  Paniculectomies are always performed under general anesthesia, two, if not three, Jackson-Pratt drain tubes will be placed in order to drain the fluid that accumulates after the flap dissection, for at least 7 to 10 days postoperative.  In the enormous paniculectomies I do not tighten the muscles internally.  This is instructed to the patients preoperative and that normally the muscle will tear with these sutures, increasing the risk for bleeding and not really greatly affecting the final outcome.  Paniculectomies are a functional surgery.  In fact, patients often have hygienic problems with as dermatitis along the suprapubic region extending along the inguinal creases bilaterally.  They may also have lower back pain significantly due to the massive amount of skin over-draping, which can drape all the way to the suprapubic region. 

Abdominoplasties on the other hand are normally considered a cosmetic or elective procedure in which again simple removal of tissue and skin with tightening of the rectus sheath is performed.  Patients who undergo abdominoplasties normally have had one or more children, large deliveries or have had a mild to moderate amount of weight fluctuation.