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Liposuction (Suction Lipectomy)

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Michael Bermant, MD Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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  • What would you advise others?

Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

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Subj: Re: Liposuction

I an interested in Liposuction of the legs - the whole leg. I want to have done first, my inner and outter thigh areas plus knees at one time. Is this to much to do at once?? Also, for the knee area, I would like to have the fat across the front of the knee taken out as the fat there makes a bulge and looks as if I'm a couch potato. I weigh 128 pounds and the fat is very localized to my leg region in places that even when I'm at my desired weight of 118, I still have those pockets of fat that won't go away. Can fat be taken out of that area? I've heard that it can be taken out on the inner sides of the knees.

Is there a new type of solution that can be injected into the fat that makes it easier for the doctor to suction it out?

I have heard some horror stories on the Web regarding people have lipo done and the doctor had injured something called a "scatia?" nerve in the leg and according to the article, this person had to learn to walk all over again which included nurses, physical therapy...etc.. Did this mean that the doctor wasn't good at what he did? Or, is this just a risk and can happen easily?????

I thank you in advance for responding and very much look forward to your response.

Dr. Bermant responds:

Liposuction of the thighs and buttocks is very common and usually has a reasonable risk in competent hands. Liposuction of the lower legs, knees and upper legs can have a much higher risk of complications. It really depends on the problem as to whether a particular anatomical concern can be approached by liposuction. During my in office consultations, I can help a patient better understand what is part of their bony or muscular anatomy and what is localized fat. Realistic expectations is the key to a happy patient after surgery.

Liposuction of the leg around the sciatic nerve can cause injury to this nerve and difficulty walking. It depends on where the liposuction was performed on the leg and what type of liposuction was done and many other factors. I have never seen this complication. This nerve is usually not in the plane where liposuction is performed. This nerve activates the muscle and runs deep or in the muscle. Nerves that run to the surface for sensation are commonly injured to a certain degree (this may be a temporary or permanent numbness) with hypersensitivity part of the healing process. Not understanding the particulars of that case make it difficult for me to comment further.

There are "new" solutions for liposuction described by articles fairly often. Some "new" mixtures turn out to have real advantages, others are a step backwards.

Your best next choice is to have an in office consultation. That is where you can continue your exploration of what plastic surgery may be able to offer you.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: liposuction / abdominoplasty

Hello,

I am a 34 year old male, who for no apparent reason has gained about 30 pounds in a little less than a year. All of this is at my midsection, is unsightly and uncomfortable. My diet has not changed greatly, I eat less if anything. I can only attribute this to a less-than-active lifestyle (I am a computer consultant) and middle aged combined.

Can you help me get rid of this big pile of crap hanging at my midsection? It bothers my back and is very uncomfortable. The rest of my body is much as it always has been, skinny long legs, no ass, arms and upper torso normal. Just have this damn pile of flab at my midsection.

Diets don't seem to do a thing. Nor does excersize seem to help much. I feel better with excersize, but don't look any better. I already don't eat breakfast, eat a small lunch and pick at my dinner.

Dr. Bermant responds:

I wish I was good enough to be able to examine a patient, make a diagnosis, and tell someone I can treat them just from an E-mail message. Unfortunately I am only human and need an examination and evaluation to comment. Localized fat collections can be resculptured with liposuction. Extra skin seen with some bulges however sometimes needs more extensive abdominoplasty (tummy tuck) for remolding. Adding some activity to a lifestyle has many benefits. Surgery is sometimes not a good answer to weight problems. Learning what your caloric intake is during a day may be surprising when you add up the soft drinks and other material ingested. Surgery will not change a positive caloric balance. Your body will start the process all over again of storing extra not used energy in fat cells for future use as it was designed.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: Liposuction

My wife and I have been reading your web page and wanted to contact you. Your web page is very informative, but we were hoping to get more specific answers to more specific questions. Question #1: We have heard that after liposuction, the fat cells never return to the region treated. But that subsequent weight gain is distributed to other areas of the body. Is this true or false? Is this a common myth givin out by less than scrupulous "experts"?

Question #2: My wife is a prime canidate for this procedure; she is in great shape, of normal weight, with very localized fat accumulation in the lower abdomin. Reguardless of how much she works the area of concern, there is no apparant changes.{the "pooch" is still there} Much to her dismay! Now the question is this: if she was to have this procedure done, would it be nullified by a pregnancy?

Question #3: How long does it take to recover? Best case scenerio?{i.e. How much time off work....a semi-physical job}

Question #4: What is a reasonable time period, after liposuction, to wait prior to getting pregnant? We live in the Seattle area, is there a physician or at least a particular lyposuction procedure that you could recommend? We are sorry to have taken up so much of your E-mail space, but we were impressed by your obvious knowledge of the topic and would greatly appreciate and value your answers and opinions! Thankyou, The Newlyweds, T&S.

Dr. Bermant responds:

Liposuction removes some fat and fat cells. It does not change the basic process of storing energy that the body uses for the extra calories eaten. That new fat will go into remaining cells. You can get fat again.

Liposuction describes a whole set of possible operations, from minimal surgery that there is only limited restrictions in activity, to major operations where time is needed to recover.

If pregnancy is planned in near future, I generally recommend waiting. The body changes with pregnancy. Liposuction is for surgical sculpture. The problem may be different after the pregnancy.

I am glad you liked my web page. It was designed to be the beginning of the education process, not to replace an in office consultation. Your questions are reasonable - for the doctor you will be working with. I am sorry, my staff and I are too busy helping our patients to be a general referral service.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: Liposuction

Following a minimal to moderately invasive lipo suction and tummy tuck procedure is there significant sensation loss in the skin/muscle? If so how long does this usuallly persist? Thanks for the info. Your home page is very informative.

Dr. Bermant responds:

Nerves that supply the skin's sensation can be injured during liposuction. These nerves travel from the deeper tissue to the skin and are in the same region that the liposuction is done. Minimal nerve injury results in diminished sensation that comes back in several days. Complete destruction of the nerves rarely regenerates, other nerves take over to a certain degree. There are all levels of injury in between. Different types of liposuction surgery as well as different parts of the body have their own chances of nerve injury. Your doctor has the best idea of what was done during surgery. My patients have an extensive discussion with me before signing their consents covering nerve possible injuries among other risks and benefits.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Great, thanks for the info.

C

Subj: Re: Liposuction

dear doctor,

Hi there i hope the information that i give you will help patients that want liposuction. I am a 19 year old female university patient and i hade liposuction i am not overweight at all i have a small upperbody and a larger lower body. I have always had a bum that sticks out. I am small boned by the way. Anyways i am very active and worked out lots, however my butt still didn't decrease. Let me tell you about the liposuction, my mom took to me the best doctor in my city, she was very friendly and answered all my questions along with her assistances. I asked them several times if the procedure was painful, and they kept on telling me that i would feel discomfort. well on jan.5 i was going to get my buttox,inner and outter thighs, and saddlebags, i was really excited, anyways, they gave me three valuim pills about an hour before the procdure, by the time i went into surgery the pills wore off i was wide awake. It was very painful i have never felt so much pain in my life the needle they were injecting in me was to freeze specific area i was crying it was just the needles, when they were sucking out the fat that did not hurt as much. I was sweating and crying and the doctor asked me if i stilled wanted to get it done i said yes, but it was so painful i told her not to do my inner thighs which was supposed to be more painful. i was so happy when she said we were done. Anyways it has been less than 2 weeks and i am so happy i got it done, i know the pain was worth it, although i am not fully recovered i am happy i got it done.

Dr. Bermant responds:

Although your letter is typical of how most liposuction patients are pleased with their surgery, it is not typical for your experiences with anesthesia. Local anesthesia for this surgery can be with minimal oral sedation or something more intense. IV sedation does add cost, need for after surgery monitoring and staff. Other patients choose general anesthesia. I cannot remember a single patient having a similar degree of discomfort during liposuction. I am glad things eventually worked out for you.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: Liposuction Questions from Charlottesville

I am a Charlottesville woman who is 29 in excellent health. I am 5'3'' and usually weight between 115-120. I have good eating and exercise habits.

In the past ten years, my weight has fluctuated between 105 and 140, but no matter what weight, I still have an unusual amount of cellulite in my upper thighs (it's an inherited trait in my family.) People that saw me with clothes on would assume that I am a normal, if not petite, person. But put me in a pair of shorts or a bathing suit, and it's a shock. It makes me incredibly self-conscious and has robbed me of the joy of good weather for as long as I can remember.

Anyway, I am considering tumescent liposuction, but am concerned about two major issues.

1 - Will it make my cellulite worse? I have read that it does not improve the appearance of cellulite in most cases and can sometimes make it worse.

2 - What are the risks? I would hate for my husband to have to explain to my children and family that I died on the operating table trying to make my thighs thinner. How can I miminize risk?

I hope you actually do answer these e-mails. Thank you for your time.

Dr. Bermant responds:

"Cellulite" is an abnormal rippling of the surface of the skin seen when fat cell enlarge against the structures that hold the skin. These septal walls do not stretch as much as the sections between them creating a "bubble like" surface. The problem is that many people have different concepts what this cellulite really is. It takes an examination and evaluation to determine if a patient can benefit from liposuction. It is during such a consultation that the risks, benefits, and alternate methods of care are discussed, I cannot spend the needed time on an E-mail response to all the requests I get. Liposuction is not trivial surgery. Done in a cavalier fashion or in the wrong hands, it can be dangerous. When safe limits are exceeded, this surgery has caused death. Normally this surgery has few serious complications. You can minimize the risks by going to a well trained board certified plastic surgeon and having reasonable surgery performed.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: scars from liposuction

DEAR DR:

I HAD LIPOSUCTION ABOUT NINE MONTHS AGO. EVER SINCE, I HAVE BEEN VERY UPSET ABOUT THE SCARS, SMALL AS THEY MAY BE. I HAVE OLIVE COMPLEXION AND MY SKIN SURROUNDING THE SCARS IS STILL VERY RED. I HAVE BEEN TOLD BY MY DOCTOR, AND ONE OTHER, THAT IT IS STRICTLY A MATTER OF TIME, AND IF THE SKIN AROUND THE SCAR "BLANCHES", THEN THAT IS AN INDICATION THAT EVENTUALLY IT WILL RETURN TO NORMAL COLOR.

ORIGINALLY, I WAS TOLD THAT AFTER A COUPLE OF MONTHS THEY WOULD DISAPPEAR. NOW NO ONE WILL PUT A TIME ON IT. I AM VERY DISTRESSED AND I KNOW THAT THERE ARE MUCH BIGGER PROBLEMS OUT THERE, BUT TO ME THIS IS OVERWHELMING. THE SCARS ARE INSIDE MY KNEE AREA, INSIDE MY UPPER THIGH AREA, ON MY HIP AREA, AND IN THE CREASE OF MY BUTTOCK AREA. I NEED TO FIND AN EXPERT ON SKIN TYPES AND SCARRING. WHERE DO I LOOK? PLEASE LET ME KNOW AT .... THANK YOU!

Dr. Bermant responds:

I wish I could make scars disappear. That unfortunately is not possible, the body heals with scars. We plastic surgeons just try to optimize the appearance of scars. Wounds evolve over the first 6 months or so. During this time they tend to remodel and change from a reddish color to a more pale color. I never tell my patients that scars will disappear. If your doctor knows how to do that, I would like to learn.

The liposuction wand needs an entry point into the body. To have a small scar at these points is a part of the price of the operation. Unrealistic expectations of having "no scars" at these sites can lead to an unhappy patient. Minimizing the scars with careful technique during surgery, meticulous wound closure and scar aftercare is what most of us use to keep such scars as reasonable as possible. Beyond that some scars are part of the operation.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: scars from liposuction

DEAR DR. BERMANT:

I RECEIVED YOUR RESPONSE, THANK YOU FOR BEING SO TIMELY. MY QUESTION IS THIS... IS IT LIKELY FOR THE PURPLE COLOR SURROUNDING THE SCARS TO FADE OVER TIME? I REALIZE THE SCARS THEMSELVES WILL NEVER COMPLETELY DISAPPEAR, BUT IS IT POSSIBLE OR NOT THAT THE SKIN AROUND THE WOUND FADE? I KNOW I NEED TO MOVE ON, AND I DON'T UNDERSTAND WHY I'M BEING TOLD THIS IF IT IS NOT LIKELY GOING TO HAPPEN. PLEASE RESPOND AND LET ME KNOW IF THERE ARE ANY ALTERNATIVES IF THEY ARE PROBABLY PERMANENT. MAYBE SOME KIND OF LASER OR SOMETHING?. THANK YOU,

CC

Dr. Bermant responds:

Scars do tend to evolve from a reddish color to one much more pale. You need to get your advice on possible treatments and permanence from a doctor who has examined you.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Neck Liposuction:

Dr Bermant:

I am a 30 year old male interested in a consultation for neck liposuction. I have done some general research into this procedure and would like further information. I am very active and have a normal to lower than normal percentage of body fat. I have always had the beginnings of a double chin even as a teenager heavily involved in sports throughout the entire year. As I've gotten older and had small weight gains this has become more pronounced.

Unfortunately, I travel frequently and have very little time in Richmond during normal business hours. I have several questions I hope you can address to further my education on this subject prior to scheduling a consultation.

My questions are as follows:

How long in advance does a consultation need to be scheduled, and what is your fee for this type of consultation?

What forms of liposuction do you perform (traditional, tumescent, ultrasonic)?

In an average patient, specifically undergoing liposuction surgery of the neck, how long after the surgery does all noticeable bruising, scarring, and swelling disappear? This is especially important to me as I prefer not to tell anyone of my surgery (except my wife).

Lastly, assuming that there are no complications and the only procedure needed would be limited strictly to liposuction (I have young, elastic skin), what is an estimate for the overall fee for this procedure including anaesthetic, operating room, and surgery (as well as any other related fees)?

I hope you will have the time to address these questions. I am very serious about pursuing this procedure but quite frankly time is very valuable to me and any information I can gather before committing to a consultation would be greatly appreciated. Also, unfortunately, the financial impact of the surgery will affect my decision to pursue it or not.

Thank very much for your time and help.

Dr. Bermant responds:

Our office books consultations as early as the next day to months away. Availability depends on load which fluctuates greatly. We may have a next day slot or be backlogged for weeks depending on factors beyond my understanding. I see such consultations Mon, Wed, and Fri. Jane is my office manager and can better discuss our consultation fees and what time we have available. She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Elective surgeries are not performed the same day, but scheduled at a mutually convenient time

I perform regular and tumescent liposuction. Ultrasonic liposuction is not a good idea for the average neck. Bruising and swelling are a function of what needs to be done and the patient's own nature. Your problem is that not all necks are suitable for liposuction. Liposuction is best for localized fat accumulations and does not handle redundant skin well. There are many causes for the double chin. If the muscle laxity or redundant skin play too significant a factor, liposuction alone may not be the treatment of choice. Examination and evaluation would be the best way to explore what would be best.

If you only needed liposuction some patients are so minimally bruised that by the end of the week others would barely notice anything was done. However others bruise like crazy leaving black and blue marks that fade over the next couple of weeks. You probably have gotten bruised somewhere before, resolution of bruising in the neck usually follows the time for resolution you have seen elsewhere. (The real answer however depends on how much blood was deposited in the tissues and how fast that person tends to absorb the blood pigments.) Initial swelling improves over the first few days but can take weeks to return to a less noticeable state. We encourage our patients to wear a neck garment after surgery to speed this process up. The rate of resolution can depend on how long each day this neck garment is worn as well as other factors.

The cost of liposuction includes the surgeon's fee, operating room charges, and anesthesia. The actual price depends on what needs to be done. Additional costs vary depending on the patients health, where the surgery is performed and type of anesthesia. Office based local anesthesia alone is much less expensive than hospital based general anesthesia.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

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