Does Liposuction Help Prevent Heart Disease?

Does reducing your body fat via liposuction reduce your risk for heart disease? One study seems to suggest so, but not so fast  says San Francisco plastic surgeon Dr. Roy Kim. He shares why liposuction should still be considered just a cosmetic procedure.

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Exercise Essential to Keep Fat At Bay After Liposuction

Studies show that patients who undergo liposuction to remove fat often regain it in different and more dangerous places unless they maintain an exercise routine.

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Dear Dr. Kim: How Can I Avoid Liposuction Rippling?

A patient writes to San Francisco Dr. Kim to ask what causes rippling of the skin after liposuction and how it can be avoided.

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Non-Invasive Liposuction Questions Answered

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France Bans Non-Surgical Lipo

The French government’s High Authority of Health (HAS) has recently issued a new decree that prohibits several kinds of cosmetic lipolysis (fat cell reduction) except when it is liposuction or surgical in nature. According to the French online magazine Anti-Age, a variety of common, non-invasive fat reduction methods are considered by the HAS to be too dangerous to human health.

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Fat Banking for Future Use?

Fat grafting has exploded in popularity recently. In 2010, the number of fat grafting procedures increased by more than 26% over 2009 (ASAPS 2010 survey results). And why not? If you need an area plumped up, your own fat won’t be rejected by your body and has the added benefit of getting a little liposuction done at the same time.

So, are the recent claims true? That banking your fat for the future allows you to access your youthful cells even as you continue to age true? How exactly do you save your fat for the future? And what are the boring, dreary, geeky details related to it? I will stand at the lecture podium and tell you! And don’t nod off!

• How to harvest fat?
• How to freeze fat?
• What to freeze it in?
• How long will it last while frozen?
• How viable is it after you thaw it out and stick it inside me?

How to harvest fat?

It’s important to harvest the fat gently, with liposuction. There isn’t any documented research on how forcefully to suction it out, the optimal diameter of the liposuction cannulae, or any other surgical details. However, you generally do not want too much heat or too much trauma, because many surgeons believe that this will cause the fat cells to break up.

How to freeze fat?

Unfortunately, it’s going to be a little bit more complex and more expensive than just throwing your fat into a Coleman cooler before taking it home to your Whirlpool deep freezer. Fat cells need to be frozen in a controlled, careful and gradual process. There are several protocols, and to my extensive literature review, there’s not really a single protocol that’s too much better than another one - yet.

What to freeze it in?

There are several chemicals which have been shown to increase fat cell viability. Your fat should be preserved in these chemicals to get the most long-term viability after your frozen fat has been thawed out. The chemical names include DSMO and others.

I don’t think the question of whether these chemicals are actually safe for you, even in very tiny concentrations, has ever been addressed. When I liposuction fat and then immediately reinject it into the patient’s body, the only chemicals I use are numbing medicine and saline solution. Both of these liquids have a long, strong history of safety in the human body, and both have been shown to be processed and metabolized in the human body.

How long will it last while frozen?

It’s unclear exactly how long fat cells will last when they are frozen. Most studies have investigated fat viability in terms of months and not years. I am not aware of any study that is statistically significant that has looked at fat cell viability after, say, 5-10 years.

How viable is it after you thaw it out and stick it inside me?

Again, this is a bit nebulous. Animal studies show that “most” fat remains viable, with percentages ranging from 50% up to 90%. But these studies vary wildly depending on how old the fat is, what chemicals were used to store the fat, etc.

Banking your fat for future use is a nice idea, but its effectiveness and safety has not been fully evaluated. In the meantime, we’ve all got plenty of fresh fat at our disposal.

If you'd like more information on Fat Grafting, please contact Caroline, our Patient Care Coordinator.  She can be reached at 415 362 1846 or info@drkim.com.

Please feel free to leave any questions or comments below.

5 Questions to Ask When Getting Liposuction

1. Am I Really a Candidate for Liposuction?
2. What Type of Liposuction Do You Do?
3. Will I Lose a Lot of Weight?
4. What Kind of Scars and Recovery Can I Expect?
5. Will I Stay Skinny After Liposuction?

1. Am I Really a Candidate for Liposuction?   

Liposuction works best for patients who already follow a routine of healthy eating and consistent exercise.  If you have smaller, localized areas of fat that stick around no matter how many calories you forego or how many reps you do, you’re a great candidate.    Liposuction is not meant as a solution for overall weight loss.  If that was the case, we’d all get our fat vacuumed out on a regular basis.  Liposuction is best suited to external fat.  If you have internal, or what we call "visceral" fat, which is inside the abdominal cavity, then liposuction will not be able to remove that type of fat.

Calculating your Body Mass Index (BMI), is a good first step to finding out if you are a good candidate for liposuction.  BMI is a measure of body fat based on height and weight that applies to adult men and women, and you can calculate your own BMI number by clicking here.   With this information, you can ensure that you are NOT obese, and thus a good candidate for surgery.  I, as well as most plastic surgeons, would like my patients to have a BMI of around 35 or less.  This is highly variable, and even patients with a lower BMI may not be candidates for surgery.  Only a consultation and a physical examination can determine the best candidates.

What Liposuction Techniques Do You Use?

Traditional Liposuction – In traditional liposuction, tumescent fluid that slows down bleeding and provides some numbing is injected into the targeted areas where liposuction will be done.  Small incisions less than 5mm long are made, and the liposuction instrument is inserted into the openings.  The fat is then broken up mechanically and suctioned out.

Ultrasonic Liposuction – In ultrasonic liposuction, tumescent fluid is still injected, but the fat is broken up by first melting it with the ultrasonic equipment.  The ultrasound device a solid metal cylinder that melts the fat with sound waves.  Regular suctioning is then done afterwards to remove the melted fat.

Laser Liposuction -  Another way of performing liposuction is using a laser after the tumescent fluid is injected.  A thin plastic tube or catheter is inserted into the area of excess fat, and a laser light is fed through the tube to melt the fat.  Depending on the device, this fat is either absorbed or removed using suctioning techniques. 

Zeltiq – This is a newer, non-invasive device that uses very cold temperatures to freeze your body’s fat.  Its effectiveness is still under review, and it has the drawback that only an area that can actually be clamped by the devices arms will undergo fat loss.

I use all of these techniques selectively.  As a surgeon, I tend to remove more fat in very small areas, so I usually use the traditional liposuction or ultrasonic liposuction techniques.  As a patient, you will need a physical exam to determine what is best for you.

Will I Lose a Lot of Weight?

Liposuction does NOT result in a large amount of weight loss.  Rather, it results in a lot of fat being removed from your “problem” areas.  If you weigh yourself immediately after surgery, you may find that you way the same or even more!  Don't be discouraged, depressed or angry.  The swelling will go down and so will the pounds on the scale.  However, long-term, you will find you will probably only be 2-5 pounds lighter.  The great news is that you will be lighter in the areas that you've found hard to reduce.

What Kind of Scars and Recovery Can I Expect?

Your scars should be quite small, usually 2-5 mm long, and in hidden areas.  Typically, the scars are in skin folds, such as the belly button, groin fold, etc.  Occasionally, these tiny scars need to be placed in slightly more visible areas but will fade to nearly white in about 12 months.

You will feel very sore in the areas that received liposuction, similar to what you feel the next day after a tough gym workout.  The recovery length depends on your overall body resilience, how many areas you have treated, and how much fat has been removed.  You will wear a compression garment for the first week or so to help your skin tighten and adhere to the underlying tissues.  Most patients return to work 4-7 days after their liposuction procedure.

Will I Stay Skinny After Liposuction?

Maintaining a healthy diet and exercise regimen are vital to keeping your new shape after liposuction.  I have noted that some of my patients are disappointed with the results of their liposuction surgery 6 or 12 months after surgery.  When I weigh them, I’m often surprised that the patient has gained weight, despite having liposuction! I cannot control a patient’s calorie intake, and I can only hope that you’ll treat your new body in the same way you treat a new car … with TLC!

Long-term, you should have a smoother, thinner and more shapely contour in all areas that you decide to treat.  The fat that is removed with liposuction is gone forever.  Liposuction removes fat cells, or lipocytes, that are plump and filled with fat.  However, liposuction does NOT remove the thin, non plump lipocytes that left behind.  So, if you do not maintain your diet and exercise, your thin cells will turn into plump cells, and you will gain the fat back in all of the original areas in which your body likes to store fat.

If you have any more questions, please feel free to leave them below, and I'll try to answer them. 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com or (415)362-1846.

Non-Surgical and Surgical Options for Your Face

How a Plastic Surgery Face Lift Can Help You Look More Youthful and Vigorous

Gone are the days of plastic surgery face lifts that made patients look like they had just taken a ride in a convertible F-16 fighter jet. When people think feel nervous or anxious about how they will look after facelift surgery, they usually have a mental picture of a “bad” celebrity facelift. Think Kenny Rogers, Rupert Everett, Joan Rivers, Donatella Versace, etc. What most patients don’t realize is just how many celebrities have had great face lifts. That’s because the results are natural and leave them looking amazing instead of….well, weird.

Before considering a plastic surgery facelift, it’s important to find a facial plastic surgeon that specializes in facelift surgery and the newest face lift techniques. I can create a customized plan for you, including alternatives to a traditional plastic surgery face lift such as a “weekend facelift” or a “mini-lift” (keep reading to see if you might be a good candidate for these less invasive procedures).

Most patients will need a combination of treatments, but the following list might help you understand which treatments will .

Common symptoms of aging and which cosmetic treatments might best treat them:

Symptom: Forehead wrinkles

Treatment: Botox

Symptom: Wrinkles between the eyebrows, also called glabella lines

Treatment: Botox

Symptom: Cheeks not as full, fat that used to be on the cheek slides down the face

Treatment: Dermal filler, fat grafting and/or face lift depending on severity

Symptom: Jowling or loose skin along the jawline

Treatment: Neck lift and/or liposuction

Symptom: Hollow looking eyes

Treatment: Dermal filler, fat grafting and/or face lift depending on severity

Symptom: Eyebrow position too low

Treatment: Eye lift, also known as brow lift

Symptom: Loose skin in the upper and lower eyelid areas

Treatment: Eye lift, often in combination with a full face lift

Symptom: Loose skin around the neck

Treatment: Neck lift

Symptom: Double chin, extra fat under the chin

Treatment: Liposuction

Symptom: Deep nasolabial folds, the lines running from the corners of the nose to the corners of the mouth (also called smile lines or parentheses)

Treatment: Dermal filler, fat grafting and/or face lift

Symptom: Sun damage, dark spots and sun spots on the skin or melsasma (dark skin blotching) from pregnancy

Treatment: Intense Pulsed Light (IPL), chemical peels, laser resurfacing

When to consider a “weekend” face lift? And At what Age?

Keeping in mind that a “weekend” face lift is not really a face lift, you should consider it when you have no “major” signs of aging and will be happy with subtle results.

A weekend face lift, also known as a liquid face lift, is clever marketing to help convince some patients that dramatic results can be achieved with no scar, no recovery and no significant price tag. In reality, it is simply the use of non-surgical facial fillers, Botox and laser resurfacing to achieve a younger look. It can be a great alternative for those patients who are younger than 40-45 years of age, don’t have the resources for a traditional face lift, or don’t have the time for a 7-10 day recovery.

When to consider a mini face lift? And at what Age?

A mini face lift (not a real medical term, but rather a reference to the length of the incision) is a good option for patients who don’t have much loose skin and who don’t need a neck lift. It can usually be performed in an office or operating room without the need for general anesthesia, and it offers a quicker recovery time.

Unfortunately, most people are not candidates for a mini facelift. They usually have more skin than the procedure can accommodate, they also need a neck lift, or they need more adjustment to their SMAS (superficial musculo-aponeurotic system) than can be accomplished with a mini lift. Typical candidates are 45-55 years old.

When to consider a plastic surgery face lift? And at what Age?

If your skin needs tightened and your face requires more fullness in your cheek and eye areas or if your neck and chin are sagging, you should consider a plastic surgery face lift. If your symptoms can’t be significantly improved or have a long-lasting result with diet and exercise or less invasive procedures, you should consider a plastic surgery face lift. Typical face lift patients are 45-65 years old. The benefits of a plastic surgery face lift are many, but the biggest reward is a youthful and vigorous appearance that is natural and long-lasting.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com or (415)362-1846.

If you have any comments or questions, feel free to leave them below.

How to Avoid Gaining Weight over the Holidays

Normally, as a plastic surgeon, I would suggest eating as much as you can, and then making an appointment to see me in early January for some liposuction. However, since I’m in a giving mood, and since I am a MD/ Medical Doctor, here are my hints to avoid gaining weight over the holiday season.  Basically, these hints come down to diet and exercise. I hope you can put them to good use.

In terms of diet, drinking more water and fluids in general will help with maintaining your weight. Sometimes you may feel hungry, but your body may actually simply want some water. Try drinking water first before you eat something- you may be pleasantly surprised to feel your hunger go away.

Eating smaller portions of fatty food may help avoid weight loss. Please feel free to indulge in your holiday foods, but consider taking fewer bites or smaller portions. Maybe you won’t gain any weight, and at least you’ll be able to try more kinds of food!

Avoid too much alcohol, since any alcoholic drink has calories in it. Also, any clear alcohol (vodka, white wine, etc.) tends to not generate as big of a hangover as colored alcohol (brandy, whiskey, red wine, etc.)

Doing more walking may help you maintain your weight. If you have plans on shopping, try parking far away from the entrance, using stairs in the mall, and just doing laps in the shopping mall while waiting for your family and friends. Any extra movement will help you maintain or lose weight.

If you still need liposuction after the holidays or should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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Are Limited Surgical Liposuction Alternatives Effective?

There are several limited incision and minimally invasive liposuction alternatives on the market. Some of my patients have asked me if they are effective or not. The alternatives to surgical liposuction do work to remove fat, but in generally, they may not be for everyone, and will not result in as much fat loss as traditional liposuction.

Some alternatives to traditional liposuction include use of a laser. Generally, an incision still needs to be made, and a plastic catheter is placed underneath the skin and into the area of fat. The laser is then activated, which melts the fat. The fat still needs to be removed with traditional liposuction.

There is a different technique that uses cold to “freeze” the fat externally, and your body absorbs the fat and excretes it. This method relies on clamping the fat, and then applying the cryo-device. The problem with this technique is that the clamp can’t actually clamp all areas, the skin and fat under the clamps may have a dimple after the device is applied, and not much fat can actually be removed.

Liposuction requires a small incision to access the skin, and then either suction or ultrasound or both are needed to melt and/ or remove the fat. This can remove the most amount of fat and give you the best contour possible, but it may require general anesthesia, more swelling, and a longer recovery time. However, traditional liposuction still remains the gold standard of body contouring and fat loss.

There are other technologies on the horizon. The one I closely follow is use of an external ultrasound device that melts fat, and your body excretes the dissolved fat. This technology has the advantage of no incisions, true fat loss, even contour, and no down time. The problem with this technology is that it will still not remove as much fat as traditional liposuction. This device exists in Europe and Asia, but is not in the US, and is still awaiting FDA approval.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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