Answer: It is very uncommon for organs to be punctured during liposuction. This is a possible complication of the procedure but it occurs very rarely. When it does the consequences could of course be serious but it would certainly not always be fatal, especially if recognized early. Liposuction is performed superficial to the muscle fascia. It is possible however, when performing hundreds of passes with the cannulas, that the muscle layer may inadvertently be penetrated. If the cannula were to penetrate deeply enough, it could possibly enter the chest or abdominal cavities and injure organs within those cavities. This would be an occurrence that the surgeon may well recognize and then be more observant for signs of internal injury.

Liposuction is a surgical procedure. It should not be taken as anything less serious. It should always be performed by a properly trained, board certified surgeon at a licensed and certified surgical facility.

Answer: This is a great question. As your plastic surgeon, when seeing you in consultation for chin or sub-mental liposuction, these are exactly the options that I am considering. Improving the aesthetics of this part of the face primarily involves correcting and contouring the angle between the chin and the neck (the cervico-mental angle) as seen on profile. Other factors include achieving the ideal volume, shape and contour of the chin.

When the size of the chin is deficient, particularly in outward projection, it is augmented either with an implant, or with fillers or even with orthognathic surgery which actually advances part of the bone forward.

When excess fat has accumulated beneath the chin and in the central neck, then contour is improved either with liposuction or with direct excision.

When the cervico-mental angle is obscured due to laxity of the skin and underlying soft tissues of the neck, then tightening of these tissues with a necklift is indicated.

In general, for my patients in their 20s and 30s I most often perform liposuction, with or without a chin implant. For patients in their 30s and 40s, using a small incision beneath the chin, I often perform liposuction and or direct fat excision combined with tightening of the muscle (platysma) in the central neck. This may also be combined with a chin implant. For my patients on their 50s and over, I am more likely to recommend a full necklift, with or without chin augmentation.

Answer: At 68 years old, regardless of genetics and how well you have taken care of yourself, there should be concerns regarding whether or not your skin will contract adequately around the new contour created by your liposuction procedures. When the knees are treated, the fat deposits are usually not that large and the skin quality is usually fairly good. In that case, contraction should be adequate without leaving excess skin. The arms are another matter however. This area usually has significant skin laxity with thinning and loss of elasticity. A brachioplasty (arm lift) may be a better procedure for you than liposuction.

There is not much variation in the degree of invasiveness of real liposuction procedures. Some type of incision is required and the fat must be removed one way or another. Truly noninvasive body contouring procedures performed without incisions will most likely yield much more modest results. Again, if the issue is skin with more advanced aging, laxity and inelasticity, then procedures that are more invasive rather than less invasive are likely to be the solution.

Answer: A lower body lift properly describes a procedure that utilizes an incision across the back, at the waistline. Tissues of the buttocks and posterior and lateral thighs are lifted and excess skin is removed along the waistline. This procedure addresses the posterior portions of the trunk and thighs only. Contouring of the anterior portions of the trunk and thighs are similarly addressed by an abdominoplasty and a medial thigh lift. In almost any setting, these procedures are performed in stages. For patients in whom all of these procedures are indicated (a total body lift), most often the anterior procedures would be performed as the first stage, and the posterior procedures would be performed as the second stage. Some amount of liposuction is very often performed as a part of all of these procedures.

Answer: I usually perform liposuction procedures under IV sedation or general anesthesia. If I am doing a minimal touch-up procedure I may use local anesthesia only. I always infiltrate tumescent solution in adequate amounts to provide anesthesia by itself. I usually use more of a super-wet technique, where the volume of fluid infiltration is approximately equal to the volume aspirated with suction. The true tumescent technique involves infiltration of much larger volumes and has a greater risk of complications from toxicity from the local anesthetic. I perform these procedures with IV sedation for the patients’ added comfort, both from a pain and from an anxiety standpoint, when only one or two areas are being treated. For longer procedures where more than two areas are being treated, or when the patient will be positioned face down (prone) on the O.R. table. For these cases, I believe that it is safer to perform general anesthesia, where the anesthesia provider has control of the patient’s airway. For patients with sleep apnea, gastro-esophageal reflux, or any other condition that could compromise the airway, IV sedation could actually have greater risk than general anesthesia.

Answer: Liposuctioncan certainly be performed only in the central breast area under the nipples. If gynecomastia in a male is caused by localized fat only in this area, then liposuction alone may be the ideal procedure to restore the desired contour. More often in men, excess protrusion of the nipples is caused by overgrowth of the small amount of breast tissue that is usually present.

Glandular breast tissue in this area can be distinguished from fat by its typical firmness and frequent tenderness. If nipple protrusion is the result of overgrowth of glandular tissue, then surgical excision of the tissue through an incision at the edge of the areola may be required. This dense tissue is typically very difficult, if not impossible to remove with standard liposuction techniques. Use of specialized cutting cannulas or of ultrasound assisted liposuction with a Mentor, Lysonix or VASER generator may facilitate removal but still may not be enough.

Prior to undergoing any surgery, whether liposuction or direct excision, any male with gynecomastia must be evaluated by a surgeon to rule out the possibility of breast cancer. A mammogram may be indicated, especially if only one breast is involved or in those with a family history of breast or ovarian cancer.

Answer: Liposuction can be extremely effective in treating a problem such as yours, yielding dramatic results with a relatively minor procedure, particularly if the skin of the chin and neck is healthy, with good thickness and elasticity. Only a very small incision beneath the chin is required. In the clinical office in Miami, liposuction procedure can certainly be performed with local anesthesia alone, perhaps with the addition of a small dosage of oral or IV sedation for maximum comfort. Recovery will be fairly easy. As with all liposuction procedures, for ideal results, it will be important to wear a compression garment for several days after surgery.

Answer: Liposuction can very effectively remove the fat pad at the anterior axillary fold and improve the contour of this area. In some cases, prominence in this area is due to ectopic breast tissue instead of fat. In such instances, the tissue may be too dense and fibrous to be effectively removed by liposuction techniques and direct surgical excision will be required. Whether or not prominence in this area is due to fat or to breast tissue, to achieve an optimal result after contouring with liposuction the redundant skin will have to contract adequately. If there is an excessive amount of redundant skin or the skin is too inelastic, some skin excision may also be required.