Summer is right around the corner. And despite your best efforts at diet and exercise, stubborn or excessive areas of fat may remain resistant to your routine. 

Contemplating liposuction or an alternative fat reduction procedure is very common and understanding your options can be confusing. The goal, of course, is to destroy fat cells. I’ve outlined the most popular treatments available and the benefits and risks of each procedure. 

Who is a good candidate for a fat reducing procedure?

These procedures are great for individuals who have great skin tone and texture, but who are looking to get rid of stubborn fat in the abdomen, thighs, flanks (“love handles”), back, arms, and double chin. 

The ideal patient:

• Is close to her/his ideal body weight and is confident she/he can maintain that weight after the procedure.

• Has an active lifestyle and good general health. Although fat removal usually is permanent, any cells left behind can continue to grow with weight gain.

• Has good skin elasticity.

• Has realistic expectations on what can be accomplished with the procedure.

LIPOSUCTION 

What is Liposuction?

Liposuction is a powerful cosmetic procedure to address stubborn areas of fat that are not conducive to weight loss and exercise. This minimally invasive technique has been popular for decades because it can predictably remove fat and consistently deliver dramatic results.

What areas of the body can be treated with liposuction?

Common areas of treatment include the abdomen, thighs, hips/flanks, chin, arms, and back. Other areas may be considered based on your body’s shape.

How does it work?

This surgical procedure involves making tiny incisions (holes) in your skin to initially place a specific type of fluid and then a cannula or metal tube to suck out the liquid and fatty deposits.  

There is minimal scarring and small stitches at the incision sites are usually removed in a week

How long does the procedure take?

Treatment time varies from 1 hour to several hours and can be done in an outpatient surgical facility. Compression garments are recommended postoperatively. 

What is the recovery time and downtime?

Depending on the amount of liposuction desired, your surgeon will determine if the procedure can be performed in an outpatient facility or in the hospital to monitor you overnight. 

You will likely be placed in a compression garment to limit and improve initial swelling. Most patients complain of dull pain and soreness. 

Downtime is minimal and results can be seen about 1 month after surgery with final results about 6 months postoperatively.

What are the risks?

Every surgery has risks. In this procedure, bruising and swelling are normal. Pain may be present but tolerable. Other complications include dimpling or irregularities in skin contour, infection, asymmetries, etc.

Who is properly trained to perform this procedure?

You should choose a board-certified plastic surgeon to perform this procedure as she is well trained and understands the subtle nuances to obtain the best result. 

COOLSCULPTING

What is Coolsculpting?

CoolSculpting is a noninvasive, office-based treatment that destroys fat cells by cryolipolysis, or by freezing the fat. 

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Once the cells have been frozen, the body naturally eliminates them over the course of a few months.  

What areas can be treated with Coolsculpting?

Treatment areas include a double chin, back, flanks, bra rolls, distal knees, abdomen, inner and outer thighs, distal thighs, underneath the buttocks and upper arms.

How does it work?

During your consultation, you will be fitted with an applicator to determine if you have enough fat for proper treatment. 

During the treatment, the applicator will be placed on the treatment area and there will be a light vacuum sensation. 

You will feel a cooling effect within the first 10 minutes and may experience tingling for the remainder of the time. 

Treatment times vary from 35 – 60 minutes. These applicators cause less bruising, swelling, cramping, firmness, and stinging. 

After the applicator is detached, your provider will do a brief massage on the area to break up the treated fat cells and enhance the fat reduction. 

Describe the recovery and downtime?

There is no downtime, but some patients may experience redness, bruising, lightweight feel tingling, numbness but this is temporary and eventually disappears completely. 

Results are visible after one treatment. However, depending on the desired outcome, multiple treatments may be encouraged. 

When will I see results?

According to clinical tests, the CoolSculpting procedure achieved a satisfaction rate of 95% among patients. 

Although transformation can occur in some patients during the first three weeks following their session, the most dramatic results usually appear one to three months after treatment.

Most patients do not require more than one treatment session for a final result.

KYBELLA

What is Kybella?

Kybella is an injectable medication that hat breaks down the fat by stimulating

a chemical reaction. 

What are the on-label treatment areas?

Kybella is currently only FDA-approved to be used to address small areas of fat under the chin, but some practitioners are using it off-label to treat the upper breasts, abdomen, and thighs for example. 

How does it work?

Your practitioner will determine if you are a good candidate for this procedure based on your anatomy. The medication is often injected superficially over the surface of the treatment area. Kybella may require a few treatment sessions for full effect.

What are the recovery and downtime?

You may experience some redness, swelling, and bruising around the injection sites, but these side effects are typically mild and improve quickly.

Most patients can resume their activities the day after the treatment. 

Results are best seen about 12 weeks after treatment. 

Additionally, there are radiofrequency and ultrasound energy technologies in the noninvasive fat reduction space. 

There are obvious benefits to all of these options, but the only way to truly know which will be best for you is to meet with a board-certified plastic surgeon who has the knowledge and surgical experience to guide you on the best result.

Interested in trying Botox? A Juvéderm filler? A laser resurfacing procedure? 

You may want to see a Board-Certified Plastic Surgeon for that.

Individuals seeking out a cosmetic procedure often assume that cosmetic surgeons and plastic surgeons have the same training and that the word plastic and cosmetic are interchangeable. 

This is misleading, confusing, and can even be dangerous. 

As a board-certified Plastic surgeon, I often refer to my practice as a mix of reconstructive (i.e. breast reconstruction) and cosmetic, because I’ve had extensive training in both. 

However, properly Board-Certified Plastic Surgeons do not refer to themselves as “cosmetic surgeons.”

What is Plastic Surgery?

The goal of plastic surgery is to restore the form (appearance) and function to a damaged area of the body. 

Plastic surgeons use a variety of techniques to move healthy tissue to an area affected by a birth defect, burn, traumatic injury, tumor, or other condition. Some plastic surgeons may focus on congenital defects (cleft lips), hand trauma, breast reconstruction, as well as cosmetic surgery.

What is Cosmetic Surgery?

Cosmetic Surgery is a combination of nonsurgical and surgical techniques to enhance appearance. Examples include facelifts, abdominoplasty (tummy tuck), liposuction, and Botox or Juvéderm fillers. 

What’s the difference between a Plastic Surgeon vs a Cosmetic Surgeon?

Legally, any physician with a valid medical license can perform cosmetic procedures, regardless of their training. I know, this is unbelievable. However, because of a number of factors - including declining insurance reimbursement and stress of keeping a practice financially secure - many physicians are looking towards elective cash-based procedures to survive.  

Several organizations have established “cliffs notes-type” courses with the goal of training these physicians in the same procedures that I, as a Plastic Surgeon, was trained to due over 6 years in my residency. 

Think about it: an emergency room physician with no surgical training goes to take a 2 week “crash course” on breast augmentation and is now ready to advertise as a cosmetic surgeon. 

And while your OB/GYN is offering you Botox or filler after a weekend training in cosmetic surgery, he or she may not be offering the best treatment, nor be able to handle complications (because OB/GYNs did not have focused training in facial anatomy). Scary, right?

On the flip side, a board-certified plastic surgeon would be able to offer the full scope of cosmetic options and let you know what works best for your body and your desires because we have been specifically trained to do so, without any shortcuts. Expertise cannot be achieved with a quick weekend course.

What does it take to become a board-certified plastic surgeon?

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In order to become a board-certified plastic surgeon, an individual must complete 

1. Four years of medical education and obtain a medical degree (MD or DO) 

2. A minimum of 6 years of accredited surgical residency training with at least 3 years of education dedicated to cosmetic and reconstructive surgery

3. Pass both written and oral examinations. At this point, he/she is board-certified by the American Board of Plastic Surgery (ABPS).

4. Remain in good ethical standing within their community and the board, as well as routinely participate in continuing medical education (CME) on the latest innovations and abide by up-to-date patient safety recommendations.

What if my doctor says he/she is Board Certified in Cosmetic Surgery?

At this time, there is no formal certification in Cosmetic Surgery and so anyone claiming to be board certified in this area is actually recognized only by a self-created organization (American Board of Cosmetic Surgery) and not an official licensing board by the American Board of Medical Specialties (ABMS).

In this situation, I encourage you to ask him or her a few more questions.  Ask about his/her background training (what is he really certified in), ask him/her how many of these specific procedures he has performed, and ask him/her how many years he/she has been practicing.  You might be surprised at what he/she says…and even more by what he/she does not.

How do I know if my surgeon is board-certified in plastic surgery?

Check online, and if in doubt, as your potential surgeon which board they are certified in. 

How do I find a Board-Certified Plastic Surgeon? 

You can easily find a list of local board-certified plastic surgeons by visiting the American Board of Plastic Surgery website.

When meeting with your surgeon, ask which board (i.e. Internal Medicine vs. Plastic Surgery) she or he is certified in

Lastly, If the surgeon routinely does procedures within an office operating room, as them where they have privileges. A reputable hospital will only accredit a board-certified plastic surgeon.

At the end of the day, it’s your body. And when it comes to your time, energy, and money, you should do the proper background research to ensure you are in the best hands. 

What is Breast Implant Illness (BII):

Breast Implant Illness (BII) is a combination of various systemic symptoms that women have been reporting and believe to be related to their breast implants.

To date, these symptoms have been reported in women with saline, silicone, smooth and textured implants:

These symptoms include (but are not limited to):

-fatigue

-chest pain

-hair loss

-headaches

-chills

-photosensitivity

-chronic pain

-rash

-body odor

-anxiety

-brain fog

-sleep disturbance

-depression

-neurologic issues

-hormonal issues

At this time, breast implant illness (BII) is not an official medical diagnosis.

Many patients are reporting their symptoms on social media and state their symptoms have been improved and resolved with the removal of their implants.

Common Questions:

1.    Is there a link between BII and silicone?

Silicone is an element that exists in nature as crystalline silica. The silicone used in breast implants is different as it has had antioxidants, dyes, and plasticizers removed during processing.

Silicone gel implants have been studied by the FDA for many years and to date have not been proven to cause any disease.

2.    Can you diagnose Breast implant illness with a test?

Currently, there is no diagnostic test for BII.

Many different organizations in Plastic Surgery, such as the American Society for Plastic Surgeons and the American Society of Aesthetic Plastic Surgery, are funding research to further understand this potential disease process.

There are tests for autoimmune diseases that your plastic surgeon may recommend. However, patients who self-identify as having BII have tested both positively and negatively on laboratory tests for autoimmune disease. So, at this time, there is no causal relationship between BII and autoimmune disease. 

3.    Does implant removal improve BII symptoms or cure patients?

At this time, there is no definitive epidemiological evidence to support a direct link between breast implants and any disease.

However, some women have reported different degrees of improvement in symptoms after implant removal. Improvement may be temporary or permanent. It is unclear what specific symptoms may or may not improve with implant and capsule removal.

4.    what is the difference between BII and capsular contracture?

When a foreign object is placed into the body (hip implant, breast implant, catheter), the body’s response is to form scar tissue around it.

In women with breast implants, the scar layer around the implant is called the breast capsule, and it usually takes 4-6 weeks to form.

In a small percentage of women, the scar capsule can become irritated and can contract tightly around the implant, pushing it up and out and causing pain or discomfort. This is known as capsular contracture. There are many theories as to why this occurs, and there are strategies to decrease the risk of this contracture.

The treatment for this contracture is the removal of the breast implant and the capsule.

In women with BII, there has been no association with capsular contracture. Women do not usually complain about pain and tightness around their implants. Rather, they have systemic symptoms such as fatigue and malaise. However, the treatment is the same – removal of the implant and the capsule (scar layer) surrounding the implant.

5.    What is the risk of developing BII

At this time, because there is no definitive link between symptoms and breast implants, there is no “known risk.”

6.    What should I do if I think I have BII?

There are legitimate concerns about a potential link between breast implants and symptoms of BII.

If you are concerned you may be experiencing these symptoms and feel they are attributed to your breast implants, see your Board-Certified Plastic Surgeon.

Just remember, breast implant surgery is elective surgery, and you can always elect to have your implants and overlying breast capsule removed if you believe doing this will improve your symptoms.

9. How much do the removal of breast implants and capsulectomy cost?

Each patient is different, and your needs are unique. The cost of this procedure will depend on the conversation between you and Dr. Parcells during your one-on-one consultation.

After reviewing your medical history, Dr. Parcells will perform a physical exam to evaluate your breasts as well as skin tone, laxity, nipple position.

She will then provide her expert advice and discuss your surgical options.  She will also address all risks and benefits of the procedures you are interested in.

At the end of your consultation with Dr. Parcells, you will meet with our surgical coordinator who will address the logistics and finances of the procedure you are best suited for.

Dr. Parcells is board certified by the American Board of Plastic Surgery.

I recently wrote about a certain type of cancer associated with breast implants, known as Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

As medicine is always changing, it is important to stay up to date on new developments. 

This past week one of the major manufacturers of textured breast implants (Allergan) has decided to suspend the production of its BioCell textured tissue expanders and implants. 

This morning, Allergan agreed to provide assistance for patients who would like to prophylactically remove textured implants and switch to smooth implants.  Allergan will provide the smooth implants for FREE, but will not cover the surgical, anesthesia, or facility fees.

If you have had a tissue expander or implant placed, it is important to reach out to your plastic surgeon to determine the type of device you have and to be examined if you have any concerns. Here are some fast facts to keep in mind:

1. There have been less than 600 cases of BIA-ALCL reported to date. It is estimated that between 5 – 10 million women have breast implants worldwide. Allergan is not the only breast implant manufacturer. There are currently no recalls on Mentor, Sientra, or Ideal implants.

2. Currently, neither the FDA nor any Plastic Surgery Society recommends that women should preventatively remove textured breast implants to prevent BIA-ALCL. This is not a disease of breast tissue, rather it is related to the texturing of the implant device.

3. It is important to perform self-breast exams and look for changes in your breasts. Symptoms associated with BIA-ALCL include swelling of the breast, often caused by fluid building around the implant. Other symptoms include pain, lumps, and asymmetry between breasts.

4. BIA-ALCL is not the same as Breast Implant Illness (BII). BIA-ALCL is (at this time) thought to be specifically related to the texturing of the implant device. Though not a disease, BII has recently gained credibility. So much so that the FDA has incorporated the patient-coined term into its website among cautions about implants, citing "systemic symptoms" as one potential risk, although "what causes them are poorly understood."

When in doubt, see a plastic surgeon.