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Archive for the ‘Liposuction’ Category

How to Fix a Tummy Tuck

Monday, June 15th, 2015

In my 18 years of private practice plastic surgery. I have now done over 2000 abdominoplasties. Very few, if any, plastic surgeons have done more in an entire career. Amongst them, I have done over 100 tummy tucks on women who have had the surgery before.

When evaluating a patient for a tummy tuck, you have to look at the skin, fat, and muscle, as well as the proportion to the surrounding anatomy and prior scars. After an abdominoplasty, you also have to consider what happened to leave the patient dissatisfied.

Sometimes, the problem is that the woman had a pregnancy after, creating the same problems as before. Sometimes, there has been another big swing in weight, either up or down, to create more laxity. In the rest, the surgery just wasn’t done optimally.

In certain cases of weight gain, a liposuction is all that is needed. In other cases, a full abdominoplasty needs to be repeated. The in between cases are the most challenging, and I believe I have solved many of them.

The modified abdominoplasty is a technique that leaves the belly button attached to the skin, and allows muscle tightening and skin and fat removal. When the initial scar is too high, and the belly button is high as well, both problems are corrected easily. The patient is flat, the high scar is lowered, and the umbilicus sits in the proper place.

While some plastic surgeons refuse to see other doctors’ unhappy patients, I do not. My basic instinct is to help, even if it means dealing with unhappy people. There is often, but not always, hope. I love tummy tucks, and I love my patients. What could be better?


Smart Lipo 101

Monday, October 6th, 2014

As I mentioned in a prior blog, “Is Smart Lipo Smart for You?”, the use of laser assisted liposuction has many potential problems for my latin patients. Darkening of the skin, burns, the inability to use this fat for Brazilian Butt Lifts, and the higher cost without any real scientific evidence of better results are among the most concerning of these issues.

Not to mention the fact that a large number of the providers advertising Smart Lipo and other laser assisted devices are not Board Certified Plastic Surgeons, but Ob/Gyn’s, Anesthesiologists, Family Practitioners, and other MD’s with no formal training in plastic surgery other than the company sending them to watch another doctor do the procedure a few times.

Does Smart Lipo really tighten the skin as they claim? I have yet to see convincing long term scientific studies to back up these assertions. I will say that after liposuction, loose skin can be a problem in certain cases. While I am a Board Certified Plastic Surgeon with experience with thousands of cases of liposuction, there are some cases in which a little skin tightening would improve the results.

Now we have a safe skin tightening laser specifically designed for Hispanic skin. My technique, Smarter Lipo, involves careful liposculpture so that the complications of laser assisted liposuction can be avoided, followed by lymphatic drainage massage and then external laser skin tightening as needed. It provides an even result, and you only pay for the laser you need if you need it at all.
We invite you to come in and see for yourself.


Is Smart Lipo smart for you?

Tuesday, March 18th, 2014

For the last year, there has been a lot of hype surrounding Smart Lipo, a laser assisted liposuction technique that has since had other companies produce machines like Slim Lipo among others. The marketing plan of the company is certainly smart, promising direct advertising to the public and referrals to all the doctors who buy the machine from them. Because they sell them all over the country, they can afford a national ad campaign, and it results in patients for anyone who has the machine. The real question is does it offer benefits for you the patient?
As of my writing of the blog today, I am not aware of any convincing long term study that shows improved results over traditional liposuction. I am aware of many cases of skin burns and permanent contour irregularities as a result of inexperienced doctors performing Smart Lipo. Let me explain why.

The company that sells the machine wants to sell as many machines as possible. They will sell to any doctor, regardless of his/her training or certification. That means your ob/gyn, family practitioner, or internist who wants to make money can buy the machine and get the referrals as a Smart Lipo expert. The only training they get is to watch a doctor do it in his office before doing it on their own. Additionally, laser assisted liposuction has a much higher complication rate of burns and fluid collections.

This is not to say that the procedure is bad- the major problems are with the doctors. As in my prior blog entry “Is your cosmetic surgeon a plastic surgeon?”, never assume just because a doctor does cosmetic surgery that he is a board certified plastic surgeon. Ask “Are you certified by the American Board of Plastic Surgery?” if you want to be sure.

In my opinion, Smart Lipo is smart for the doctor, not the patient. You pay more for a riskier procedure that is possibly done by a less well trained physician with no benefit of better results. Just because something is new and well advertised does not make it better. Be a smart consumer and do your homework.


Let it Snow, Let it Snow, Let it Snow

Tuesday, February 18th, 2014

Like the rest of you in the Northeast, I am quite tired of this endless winter of snow. It is cold, inconvenient, and disruptive. Many schools close, businesses as well. As a Plastic Surgeon, my cases are elective, so technically I can choose to reschedule. The problem is, my patients can’t reschedule their lives.

I have never cancelled a surgery day, despite blizzard conditions. If my patients can make it to Yager Esthetics safely, as well as get home without undue risk, I will walk to my office through the night to make it happen. I am that committed.

When a patient plans surgery, they are often taking time off from work or school that is not easily changed at the last minute. Only a certain number of days are granted each year, and only at very specific times.

Childcare is also an issue. Many of my patients have family flying in from out of the country to help, and this too is an effort to be coordinated. Some send their children out of the country, and these flights cost money to change.

Preoperative testing is also only valid for a short period of time, and often your insurance won’t pay to repeat it in a certain amount of time. Getting another appointment with your primary care physician is also difficult at times.

From my end, surgeries are booked months in advance, and anesthesia and nursing must be arranged. I have a limit to the number of cases I can do expertly in a day, and simply adding the patients on to the next surgery day is unsafe at times.

I can’t control the snow, but I can make every effort to not let it ruin our plans. Let it snow, I will be here as promised. And thank all of you for doing the same.


Liposuction is More Than Removing Fat

Monday, September 2nd, 2013

While having a rare free moment the other day, I was flipping through a Spanish language newspaper. I was surprised by the number of ads offering liposuction. The majority of the doctors offering the service were not Board Certified Plastic Surgeons. Some were ENT’s, others Ob/Gyn’s, and even a Family Practice doctor was touting her skills as an expert. This information wasn’t stated in the ads, and if you were not very diligent in researching or careful in asking, you would have no idea.

I have spoken to a few of these practitioners, and the answer to why they are doing it is simple- making money. None of the doctors I spoke to had any training during residency in their fields. The company that sells the equipment allows them to “train” by watching someone else with experience for either a few cases, or has a weekend seminar outside the US or somewhere by a resort. Amazingly, this is perfectly legal as of now. This is potentially disastrous.

I am a Board Certified Plastic Surgeon, and did my first liposuction as a medical student in 1989. I have done many thousand procedures at Yager Esthetics, and do many hundred every year. Liposuction is not simply removing fat. Patient selection is very important, and the quality and texture of the skin, the technique used, and a comprehensive knowledge of fluid management is essential. This can not be learned in a few days.

Please do your homework and directly ask your liposuction provider if he or she is certified by the American Board of Plastic Surgery, as no other board with a similar name is the same. You can go to www.plasticsurgery.org and check for yourself. You do not have to come to me, but please be smart and safe.