Chapter I

Liposuction-What Is It?

1. Fatty deposits appear as a deformity on the inside of this patient's knees.

2. Deposits of fat at the male waistline, often known as "love handles".

3. A female double chin formed by fat deposits and loose skin.

In an unusually short time for any new medical procedure, liposuction has become a very important part of the established repertoire of cosmetic surgery. Its use is now one of the fastest-growing of new procedures in medicine today.

1. Fat deposits on a male patient in pot belly and love handles.

2. Fatty bulges on a female waistline form love handles in two places.

3. Extra padding of fat forming saddle bags on female patient's outer thighs.

Often these bulges are genetically determined. Two recent major studies have concluded that adults, even if adopted and reared by others, strongly resemble their biological parents in degree and pattern of obesity. A research team headed by Dr. Albert J. Stunkard, psychiatrist and obesity specialist at the University of Pennsylvania developed an index of body mass based on the adults' weight divided by height. Using 540 case studies of adults in Denmark, where complete, up-to-date records on adoptees and their biological families were available, Dr. Stunkard and his research team concluded that the body mass of adults who had been adopted in infancy closely resembled that of their biological parents, but was completely unlike that of their adoptive parents.

7. The Doctor demonstrates the amount of fatty deposit on the patient's

upper thigh.

These research findings are similar to those in another study of adopted children in Iowa. Still other studies on obesity show that identical twins, who are produced from one egg and share identical genetic characteristics, are much more alike in fatness than are fraternal twins, produced from two different combinations of egg and sperm, with two different genetic compositions.

Obesity researchers Jules Hirsch, Irving Faust, and Rudolph Leibel of New York City's Rockefeller University have been studying the way in which weight gain and loss affects biochemical changes. Leibel developed a method for measuring the propensity of fat cells to accumulate fat or to break it down. In doing so, he discovered that people who can't spot-reduce--people, in other words, with unsightly fat deposits that resist diet and exercise-may have fat cells in their problem areas that simply will not release fat.

You may be one of these persons who feels despair and guilt every time you look at your nude body in the mirror. Perhaps you have "love handles", bulges of fat around your hips, or extra rolls of flab around your upper legs, commonly called "thunder thighs". You may have "saddlebags"-unattractive fat deposits on your outer thighs. Or you may have a fold of fat that gives you a double chin.

If so, you are not alone. A Fall, 1985, survey of 102,000 Ladies Home Journal readers showed their greatest dissatisfaction was with their body image. Almost half said that if they could change one thing about themselves, they'd want to be thinner. Although few had had cosmetic surgery, 50 percent said they would consider doing so if they thought it would improve their looks.

Clearly, then, unwanted fat deposits are a source of frustration and aggravation to thousands of people. Like you, they want to look better. And you can. Whatever your particular problems, there is an excellent chance that liposuction can help-take away those ugly bulges. That bulge in the region of your belly can be erased. Your hips can be made slimmer. In fact, just about any part of your body can be modified and given a new, more attractive contour.

Liposuction,the operation that allows body sculpturing, can usually be done without much discomfort, and usually without appreciable danger of complications. Many patients have returned to their usual daily routine within a few days after liposuction surgery.

Since liposuction is usually done on an outpatient basis in a suitably-equipped surgical facility, you won't need to stay in the hospital. Costs are reasonable, because generally no hospitalization is required. Many liposuction patients have gone in to see the doctor in the morning, had their surgery, and gone home that afternoon.

If liposuction can do all this, you may wonder, why haven't I heard more about the operation? And why aren't more people having it?

Liposuction is, in fact, becoming significantly more popular as more and more people learn about its benefits. Articles in popular magazines such as Good Housekeeping and Cosmopolitan are making more and more people aware that liposuction surgery exists, and that thousands of people have already benefitted from liposuction body contouring.

Medical meetings, such as the World Congress of Cosmetic Surgeons, have begun to schedule papers and discussions on liposuction. I myself have been a guest speaker at several such professional meetings.

Liposuction surgery, however, has been and continues to be somewhat controversial, even as this book is being written. Not the operation itself-that is generally acknowledged throughout the medical community to be safe. The American Society of Plastic and Reconstructive Surgeons, The American Society Of Liposuction Surgery and The American Academy Of Cosmetic Surgery have evaluated the liposuction procedure, and after observation and discussion, a committee unanimously agreed that liposuction using a blunt-tip cannula method is a surgical procedure that is safe in trained and experienced hands, and offers benefits which have been previously unavailable.

There are several points about that statement you will want to examine. Chapter 8 of this book describes and explains the blunt-tip cannula method. Nearly all surgeons performing liposuction today use a blunt-tip cannula method, which is clearly and demonstrably superior to earlier methods of liposuction surgery. We will talk more of the history and background of liposuction in Chapter 3.

A cannula is simply a slender hollow tube-deliberately made with blunt edges so that when it is inserted into the body area undergoing liposuction, it will not tear delicate blood and lymphatic vessels or slice through underlying tissue. Doing that could cause less-than-desired results or complications.

The end of the cannula is attached to a high-powered suction pump which extracts the fat being chiseled off. In liposuction surgery, however, the cannula becomes more than just a hollow tube, or surgical instrument. Indeed, it is like a tool in the hands of a skilled sculptor. The successful, experienced liposuction surgeon combines medical and scientific skill with an artist's eye for the body contours most apt to match the bone structure of the patient.

THE SIGNIFICANCE OF TRAINING AND EXPERIENCE
The significant controversy surrounding liposuction today-and it is an important one for you to be aware of, if you are considering the operation-is indicated by this phrase in the Committee's conclusion: "effective in trained and experienced hands." Within the medical community, there are considerable philosophical differences on what training and experience a doctor should have in order to perform liposuction, even though all licensed physicians are legally able to do the operation. Liposuction is cosmetic surgery. It has great physical and psychological benefits when it is successful. But it is not surgery performed to save a life.

Doctor Tcheupdjian Forrester and a prospective client, shown during the first phase of initial consultation at The Liposuction Institute. Patients are asked detailed questions about their medical history and that of their family.

Liposuction is elective surgery. That means patients choose to have the operation. It is not required in the same sense that an appendectomy is needed to take out an inflamed appendix that may burst and spread germs throughout the abdomen, causing dangerous peritonitis.

Because liposuction is elective cosmetic surgery, performed--as doctors agree--solely for the purpose of making you look and feel better, it is not taught as part of the routine training a doctor undergoes in medical school. Instead, any physician or surgeon who performs liposuction has learned the surgical technique in seminars or in closely supervised study with another doctor who does the operation. It is, or should be, a one-on-one, hands-on, training. Ideally, the physician whom you allow to operate on you with liposuction should have a great deal of experience in performing the procedure, and should perform it frequently enough to be at peak form. Such a surgeon becomes an artist, knowing not only how to complete the surgery and fat extraction successfully, but how best to achieve the appropriate and desirable finished results for a particular patient.

Questions such as, "How long, and where, did you study liposuction?" "Under whom?" "How many liposuction operations have you performed?" "How many successful, satisfied patients have kept the weight off?" "What physical, psychological, and social, nutritional and exercise support will you give me after you perform liposuction surgery?" are questions you should be asking of any doctor you are considering for your own liposuction operation. If the doctor hesitates, or seems reluctant to answer your questions, you should find another physician.

In my opinion, if a doctor is not thoroughly experienced in performing liposuction, he or she may not be sufficiently familiar with the surgery and latest research in that field to give you correct answers. Many times, patients have come to my offices with wrong information about liposuction, apparently provided by persons who were not acquainted with all the details of the surgery and what it can do for you. Patients have worried that liposuction could cause cancer, or, that excessive and dangerous bleeding often occurs.

These concepts are simply not accurate. You are being an aware and cautious patient when you spend time learning about liposuction before deciding to have the surgery. Be sure, however, that you are getting your information from people who know the answers to your questions-doctors and former patients who have first-hand knowledge about the surgery.

You will read more about discussing liposuction with your prospective surgeon in Chapter VI: Your Initial Consultation. That chapter also discusses a fee range for liposuction surgery, which can be as high as several thousand dollars for the surgery, appropriate pre-surgical visits, laboratory tests, surgical facilities, anesthesia and appropriate follow up care.

YOUR SURGEONS BACKGROUND
From a physician's point of view, liposuction is an increasingly popular operation. More and more doctors are beginning to perform the surgery. Some are learning liposuction in a two- or three-day course, leaving their practice to travel to a central location where lectures and discussions on liposuction are stressed. However, liposuction, while not dangerous or complicated surgery to do, requires the doctor to have skill and experience, that in my opinion can best be learned by hands-on training from an experienced physician. In short, I believe that to perform liposuction well, a doctor can benefit most by watching and assisting in actual surgery, rather than "learning" the techniques only from lectures.

1. Areas from which fatty deposits can be removed on upper hips and buttocks.

2. This same patient's protruding abdomen and buttocks showingunusual contours.

4. Fat accumulation under the arms-sometimes called "double breats"- forms bulges

on outer arm which can be removed by liposuction.

5. Flabby fat deposits on patient's underarm and around armpit are typical

depositories of unwanted fat, for female patients.

7. Contrast between male breast at left, which has not been treated, and breastat

right, which has been treated, is quite apparent.

8. Deposits of fat at the male waistline, often known as "love handles".

I was fortunate to have the opportunity to train in France with Dr. Illouz and other surgeons who helped to pioneer present-day techniques. Since then, as founder and director of The Liposuction Institute, with headquarters in Chicago, I have myself performed liposuction surgery on literally thousands of patients.

The surgical procedures I do, the pre-operative and post-operative care and follow up that I consider so significant in determining the success of liposuction, the experience of performing liposuction surgery almost daily... all are described in this book exactly as my patients and I have experienced them.

If you live in a different section of the United States, or if you are discussing a possible liposuction with another physician, he or she will advise you, based on your own state of health. The recommendations from your own physician may not agree completely with what I am suggesting. The procedures I describe have worked successfully with many patients. You and the physician of your choice, however, will ultimately have to agree on how your specific case will be managed. As the primary consumer of medical care, you should feel confident that your wishes should be the prevailing views, unless, of course, your medical safety is at stake. In such cases, you should be guided by the specific advice of our own trusted personal physician.

One caution: if your own doctor is not knowledgeable about liposuction, or is reluctant to discuss the surgery, you should find a physician who will talk with you about the operation, and with whom you feel comfortable. Such a person should be experienced enough in liposuction procedure to be able to answer your questions or to refer you to someone who can.

Because I have seen many misinformed patients who had many false beliefs about liposuction surgery, I urge you strongly to discuss the operation with a doctor who has specific training and solid experience rather than a physician who has not personally done the surgery previously.

As in all other kinds of medical procedures, there are many factors to be considered: the best doctor to do the procedure is the one who has had the advantages of the most extensive training and experience.

THOUSANDS OF SUCCESSFUL PROCEDURES
The safety and effectiveness of modern liposuction techniques are solidly based on the experience of many thousands of liposuction procedures that have been performed throughout the world by reputable physicians. As more and more liposuction operations are done by appropriately trained and experienced doctors, the surgery is increasingly successful.

In future chapters of this book, you will learn about the history of liposuction, and more details about this extraordinary surgery.

The full potential of liposuction is still uncharted. There are some who think that the operation may replace or supplement quite a few of the standard operations now in the repertoire of cosmetic surgery. Many physicians are exploring its possibilities. Though liposuction is being done only as a cosmetic procedure right now, there are those, myself included, who think that in the future it might also be applied to those who are obese in the medical sense of the term--and we are actively exploring this possibility. Much has to be learned about the effects of more radical application, however, before we can propose that.

In the meantime, liposuction offers more than enough of a miracle to those who need it, to warrant the attention of a great many men and women. These are the people who long to look better, and consequently to have a better chance for success and happiness in many areas of their lives.

Those who developed and improved the procedure found out that the surgery is possible because of the special nature of fat as a substance, and the way that it is deposited in our bodies. Fat-the fat we can remove with the liposuction procedure-accumulates in pockets located just beneath the skin. The doctor who performs liposuction surgery doesn't need to get near any vital organs. No major blood vessels are involved. And there is virtually no cutting. As you will learn when the operation is discussed in detail in subsequent chapters, the typical liposuction surgery involves only small incisions at most, perhaps less than a quarter of an inch long. As you learn more about liposuction, you will be able to understand clearly how the process is similiar to other types of surgery, and in what ways it is actually quite different.

Liposuction is a safe procedure when it is performed by well-trained, experienced physicians. Because of the way in which fat is deposited in your body, it is usually not going to come back, once it is removed by suction. Liposuction will be a permanent cure for your bulges. But liposuction will not be a permanent "cure" for your total body picture if you believe your diet and exercise routines after surgery do not matter. However, those men and women who take time to learn the principles of good nutrition and calorie counting, who care enough about their hard-earned improved appearance to monitor their weight carefully after the operation, who use psychological and behavioral modification findings to reinforce their commitment to an attractive body, should continue to do well.

The personal program of ongoing care, developed with the advice and monitoring of your doctor, will give you a good foundation for lifelong nutritional and physical patterns of behavior that are healthful and wholesome. Your own participation in and responsibility for your well-being will give you great satisfaction -- perhaps of a kind you have not experienced before. In addition, you will achieve the best results in physical development only by giving it your own best efforts.

Many liposuction patients report that liposuction has made important changes in their lives--in how they feel about their appearance, in how their clothing fits, and how they feel about participating more actively in physical and social aspects of life. In addition, many liposuction patients report that the effects of their follow-up programs, of the development of good exercise and nutrition programs that become a part of their lives, are some of the most important benefits they receive. The total program enhances their attitudes, their confidence, and their actual overall mental and physical health when they commit themselves to working at it.