Liposuction Goes High Definition

With Bruce Chau, DO

You may also find that your “love handles” never go away despite how many hours you spend on the treadmill each week, or how many abdominal exercises you do. Your desire to have that healthy, chiseled look is not being met despite your efforts to eat right and exercise often.

One of the alternatives more men are seeking today to get rid of this extra fat is high definition liposuction, according to Dr. Bruce Chau, a board certified plastic surgeon.

“This new approach is unique because it is a marriage of three distinct areas; anatomy, artistry and technology,” says Dr. Chau. “It is a framing, and shaping of the body where in some cases, you do not remove all of the fat.”

A South American physician, Dr. Alfred Hoyas, was a medical illustrator who has reviewed the male anatomy over history. In his studies and illustrations, he noticed that today’s man was more chiseled and “bulkier” than men in the 50’s, 60’s and 70’s.

“He looked at the (male) body over the years, and men haven’t changed all that much for what people desire how the body looks,” says Dr. Chau. “The only thing that changed was the bulk of the muscle. If you look at actor Kirk Douglas in the movie “Spartacus,” he was in great shape, but didn’t have that chiseled look like men today seek.”

As a result, Dr. Hoyas began to utilize “high definition liposculpture” that married the three aforementioned areas together, and gave men a more bulky, athletic, chiseled look than in the past.

“In America, we look to make someone thin, take the fat out, and give curvature,” says Dr. Chau. “But in South America, they look to leave a little fat in the right areas to give a better, more realistic shape.”

By leaving a thin layer of fat over the muscle, it helps frame the muscle and appears to give it more size, explains Dr. Chau. Since men continue to lose muscle mass after the age of 30, this high definition liposculpture approach, takes this into consideration and gives men a more muscular look.

“Look at the six-pack,” says Dr. Chau, referring to most men’s desire for a flat, fit-looking stomach. “With high definition liposculpture, you leave a little fat in the ‘hills’ of the six pack and you suck out as much in the ‘valleys.’ This will give it a more chiseled look.”

Utilizing the Vaser-Assisted Liposuction technology, men can get better results, but Dr. Chau explains that not every male will get the results desired. “We look at body mass index (BMI) and try to determine who will get the best results,” he says. “The ideal candidate will have a BMI around 25. If a patient is higher, we suggest he does more exercising and dieting before getting the surgery.”

If a patient is trying to lose weight by working out, eating right, but can’t seem to get “over the hump,” liposuction can help them lose a few inches that may add motivation to the patient to get to their desired goal.

This approach to liposuction is very applicable to women, too, says Dr. Chau. And, he explains, historically, women are more apt to consider these procedures than men.

There are several reasons men tend to seek out plastic surgery less frequently than women, says Dr. Chau. “Men don’t want to get plastic surgery because they are afraid someone is going to say something about their vanity,” he says. “But this is an imaginary fear.”

Secondly, he says that men are more afraid of pain than women, and don’t want to deal with it – even though the pain can be minimal and is aided with medication.

Finally, Dr. Chau says that men do not want to take time off from work just to get cosmetic surgery. “There is less impetus for men to change their appearance because society accepts them if they are little more round, or older looking. Society is more critical of women’s appearance, so they are more willing to take time off to look better,” says Dr. Chau. “It’s a different psychology.”

Dr. Chau admits there was some initial skepticism about Dr. Hoyas’ approach, but that it has more recently become accepted in many plastic surgery circles. “There were five of us from the U.S. who had hands-on training in South America,” says Dr. Chau. “It was a very difficult training, and I performed surgery on four patients. It was not a weekend course where you just watch a video and look at pictures. You actually did the surgeries.”

Plastic surgery for men became more popular over a decade ago when it was believed that men had to look younger to remain competitive in the workforce. Some believe this still remains true today. And, with our desires to continue to look young and healthier into our later years, we can expect to see more men considering liposuction as one of their alternatives.

Bruce Chau, DO, is board certified by the American Osteopathic Board of Surgery in Plastic and Reconstructive Surgery. He is a graduate of Western University, College of Osteopathic Medicine of the Pacific. He completed his General Surgery Residency at Peninsula Hospital Center, NY, and his Plastic and Reconstructive Surgery Residency at the Plastic Surgery Institute, Mercy Hospital Medical Center. He is in private practice in Southfield, and is program director for plastic surgery residency at Michigan State University.

Hi-Def Lipo For Women

With Dr. Bruce Chau, DO

When it comes to a woman’s desire for the “perfect body,” each one may have a different opinion about what that may look like. For those women who work diligently trying to lose weight, but cannot quite work the extra fat from certain parts of their body, high-definition liposuction is available.

In a previous issue, we discussed how men can utilize high-definition to get a more athletic, muscular look. The only thing different with women is that they have such a variability of what they like and do not like, according to Dr. Bruce Chau, a board certified plastic surgeon in Southfield.

“All men want to look athletic, but not all women want to have a six pack,” says Dr. Chau. “The technique is like traditional liposuction, but the goal is not to remove all of the fat, but to remove the fat to accentuate certain parts of the anatomy.”

Unlike traditional liposuction, this technique combines artistry, physiology and technology, says Dr. Chau. “We don’t rely solely on the machine. It is a skill, an operator-dependent skill that you have without just relying on the machine. It is more of an artful skill; it’s artistic control over where you are going to take the fat.”

This new technique combines artistry, anatomy and the Vaser-assisted liposuction technology; making it feasible and attainable for women to get better results. It is not new machinery, it is skilled-dependent. “Not everyone is trained in this technique. You need to have many years of experience to do it,” says Dr. Chau.

“Sometimes people don’t realize it does take a long time, it can’t be done always in a hour or two, it takes time to reshape the body. There is no quick fix.”

Dr. Chau says the recovery time depends on how many areas of the body are done. “With women we want to outline a certain silhouette. We can put a little indentation in the spine, the lower back, above the tailbone. Many women want those little dimples and we can shape that,” says Dr. Chau.

He explains that high-definition liposuction gives the physician the flexibility to shape the athletic female versus the soft, shapely female, versus the more full figured female.

“Women are a little different because they have a lot more options because they want to be thinner, athletic or improve silhouette,” says Dr. Chau.

Once again, Dr. Chau says that high-definition liposculpture is not for everyone. “It takes a very motivated patient. It is for people who exercise but cannot get rid of certain areas of fat,” says Dr. Chau. “They must have a certain body mass index and motivation.”

Liposuction is not for everyone, but women can obtain realistic, desirable results when they prepare appropriately.

Bruce Chau, DO, is board certified by the American Osteopathic Board of Surgery in Plastic and Reconstructive Surgery. He is a graduate of Western University, College of Osteopathic Medicine of the Pacific. He completed his General Surgery Residency at Peninsula Hospital Center, NY, and his Plastic and Reconstructive Surgery Residency at the Plastic Surgery Institute, Mercy Hospital Medical Center. He is in private practice in Southfield, and is program director for plastic surgery residency at Michigan State University.

Reshaping You to Fit Your New Body

A growing epidemic in the United States is morbid obesity.

Be it genetic predisposition, poor eating habits, a sedentary lifestyle or post partum weight gain, the US and the world is realizing the medical costs associated with this epidemic. Already, the statistics are staggering. Forty percent of the population is obese and increasing every year.

For the longest time morbid obesity was treated non-surgically. Weight reduction was usually tied to exercise and calorie controlled diets. Medically, physicians were able to help by correcting imbalances in hormone status such as thyroid, estrogen, and cortisol. Anti-obesity

drugs such as phentarmine have also played a role, but their long term side effects are still questionable and cost is a factor. But as obesity skyrocketed, so has diabetes.

About 15 years ago, a surgical option was developed for the very morbidly obese and was reserved for those in life and death situations. Although complications were relatively high, it was the beginning stages to developing the protocols for surgical weight loss procedures that we are accustomed to today.

Weight loss surgeries today consist of either lap bands or gastric bypass. These procedures have proven very successful in extreme weight loss for the morbidly obese and has been maintained over a longer period of time than

most non-surgical entities. In fact, according to the Agency for Healthcare Research and Quality, bariatric surgeries have increased nine-fold between 1998 and 2004 from 13,386 to 121,055. Complication rates have also decreased due to laparascopic techniques.

While significant weight loss may look successful on the outside, it leaves another side that is largely not talked about – excess and sagging skin.

When consulting for bariatric surgery, the potential for body reconstruction should always be addressed. A lot of physicians and patients assume that once the weight loss is done, the patient will go back to their perceived new looks without any corrective surgery. As a plastic surgeon who performs post-bariatric cosmetic surgeries, almost 95% of patients require some reconstructive work approximately one to two years after their surgery.

A lot of patients don’t realize that with morbid obesity the skin, fascia and underlying tissue support system is strained and damaged to the point that it loses its recoil abilities. Very few people will have their skin go back to normal.

Think about pregnancy and how the abdominal skin does not return 100 percent to its pre-pregnancy state. Now, use this same analogy and put it to skin on the entire body for a much longer period of time. You can realize the extent of the damage to the skin and underlying tissue.

Our skin, breasts, and underlying tissues are soft, pliable and somewhat durable. But our bodies were never made strong enough to handle excessive weight over a long period of time.

So where do we start?

In the face, one usually sees the tell tale signs of aging: redundant skin in the face, neck and eyes; fatty deposits in the neck and eyes; early jowling; thinner skin; exaggerated facial lines (nasal labial folds). These are usually taken care of with brow lifts, eyelifts, face and neck lifts and fillers such as fat, Restylane or Radiesse.

Also common after weight loss is hair loss. This can be taken care of medically or sometimes surgically with micro or macro hair graft transplantation.

The chest and breast area usually does not fair well after extreme weight loss. The breast support system is made of skin, connective tissue and ligaments. Unfortunately, these specific tissues don’t hold up well to excess weight over long periods of time. As the weight loss is complete, the breasts tend to lose a lot of their volume, shape and support. They decrease in size and become ptotic (droopy).

Treatment options may include a breast lift, augmentation or oftentimes both. Thanks to newer techniques in minimally invasive surgery (PEBAM, SPAIR) scarring is left to a minimum while the saline or silicone implants can increase the breast’s volume.

The arms also suffer from redundant skin. The skin in the inner aspect of the arm is the thinnest compared to the outer arm. Some of the redundant skin involves the axilla and upper back area. The excessive skin is usually excised and the upper arm reconstructed to give a more natural look. This is known as a brachioplasty.

Liposuction is also used as an adjuvent in certain areas. The scar heals up somewhat well and is located on the inside of the arm extending into the axilla. If the upper back has redundant skin, an upper body lift is considered to get a more cosmetic appearance.

The areas most people complain about is the abdomen and thighs. In the abdominal area, the skin may be loose and overhanging their beltline, there could be some fatty deposits that are not desirable, and the muscles may be weak and need to be tightened. Also, hernias resulting from the gastric bypass may be present. The best way to take care of the abdominal area is either liposuction, abdominoplasty, or both.

In the thighs, the skin becomes redundant and sags both in the inner and outer areas. The buttocks can also lose their volume and sag. An inner and outer thigh lift is usually done in conjunction with a buttock lift. This can involve liposuction to contour the thighs. The abdominoplasty, inner and outer thigh lift, and buttock lifts are collectively known as a lower body lift. The scars are acceptable and usually hidden in creases or the underwear line.

Liposuction alone is not enough to give the body the contouring that is most pleasing. It is an adjunct only. Surgical scars usually take a year to heal and in about 10 percent of patients, revisions may be necessary. Like all surgeries, the risk of complications is greater in the post bariatric population. A thorough medical clearance is advisable, and peri-operative antibiotics and DVT prophylaxis is given.

The big question is how much of this surgery should be performed at a single setting? There is no right answer. However, scientific studies show that the longer in surgery you are, the more at risk you are to suffer afterwards (pneumnia, DVT, Pulmonary emboli, atelactasis, etc.).

The general rule of thumb is usually six hours. My philosophy is to stage the surgeries over a three month period, doing no more then 6-8 hours at a time. Remember, it’s not how fast you get to the finish line. It is getting there in the safest fashion.

In the end, realistic expectations and safe and effective reconstruction by a board certified plastic surgeon can help you get over the stigma and the resultant excess skin left. Leaving behind, a new you!

Ayoub Sayeg, M.D. is a Board Certified Diplomate, American Board of Plastic Surgery, Cosmetic and Breast Fellowship Trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington, D. C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit from 1998 to 2000.