Liposuction Ontario

What is Liposuction?

Liposuction is a surgical procedure (also referred to as an invasive procedure) that treats fat by surgical removal. Any subcutaneous (below the skin) fat deposit can be reduced or removed. The areas targeted are typically those that are resistant to diet and exercise (tummy, flanks). However, almost any area can be targeted (i.e. chin, arms, ankles etc). The procedure is performed by placing tubes (also known as cannulas) under the skin and into the fat. Next, different types of energy (traditional, power, laser, ultrasound) can then be utilized to break up and remove the fat. While the type of liposuction (traditional, power, laser, ultrasound) is very important it is not the most important factor. The single most important factor is the surgeon performing the liposuction. Why? Because liposuction is as much an art & sculpting as it is surgery. How is that hour glass figure created? How is muscle definition sculpted? By artistically visualizing what needs to be done and then artistically executing and sculpting the result. This ability is solely based on the surgeon performing the liposuction. Experience absolutely matters!

What are the different types of Liposuction? Does it Matter?

The technique of liposuction (as discussed above) was introduced in 1974. Since that time liposuction has significantly changed and evolved for the better. Traditional liposuction involves hooking tubes up to a suction vacuum. This suction vacuum then places your fat cells under suction and removes the fat. Let’s look at each Type of Liposuction and discuss them:

Traditional Liposuction

Traditional liposuction was introduced in 1974 and became increasingly popular in 1982 when surgeons began adopting the technique. The procedure consists of placing a hollow metal tube under the skin and into the fat. The hollow metal tube is hooked up to a vacuum machine. The machine then creates suction and this cause the fat to be forcibly ripped or torn from the surrounding fat cells. In addition, the cannula is then moved back and forth by the surgeon in order to help further tear and dislodge the fat. In many respects, this can be likened to a cheese grater grating the fat and then the fat being sucked away. It isn’t hard to imagine why the recovery from traditional liposuction was significant. And also why traditional liposuction recovery was viewed as a negative experience. In addition, the surgeon would also get tired from physically having to move the liposuction cannula. As the surgeon becomes physically fatigued there is less ability to focus on the artistic result. For these reasons, it is rare that traditional liposuction is performed today.

Power Liposuction (i.e. MicroAire® or PowerX® or TickleLipo®)

Power liposuction involves a motor that moves the hollow metal tube (also known as a cannula) at speeds that are barely visible to eye. The motor causes the cannula to move 3mm 4,000 cycles per minute! That is extremely fast! The powered liposuction cannula significantly reduces the fatigue of the surgeon. Overall, this allows for increased surgical precision in artistically sculpting and contouring the body via liposuction.1 The powered nature also allows for the fat to be removed in a less traumatic (less injury to the body) fashion. Think of it like grapes on a grape vine: Power Liposuction allows for grapes to be plucked while maintaining the grape vines and not injuring the plants. Conversely, traditional liposuction would be similar to simply tearing the grapes with the vines/plants or taking everything in one swoop and ultimately injuring the plant. This is way when Power liposuction is compared to traditional liposuction power liposuction has significantly better patient comfort.2

Laser Liposuction (i.e. SmartLipo®)

The next evolution in Liposuction was to help break up the fat before suction even begins! Prior to placing a hollow tube under the skin, a different round tube is place under the skin and into the fat. In this specific case, the end of this tube has a LASER. The laser emits different light wavelengths (i.e. 1064nm, 1320nm, 1440nm). Ultimately, these specific wavelengths are absorbed and create heat. Thing of it like butter: what happens when you take a stick of butter out of the refrigerator and place it on a pan? What if you put that pan on the stove and turned the stove on? In effect, these wavelengths break up and partially “melt” the fat. This makes the suction removal easier. In addition, the other laser wavelength help to coagulate (or burn) blood vessels to decrease blood loss and decrease bruising. In addition, the coagulation (or burning) causes the tissue (skin) to tighten.
Unfortunately, despite the great marketing name (SmartLipo®) and the ability to say, “LASER”, there are significant concerns with burns (skin burns) that can cause significant injury and ultimately cause major cosmetic issues (i.e a tummy with burns over it). Further, the packed in or difficult to treat fat areas have a limit of how aggressive they can be treated because the risk for burns also increase.

Ultrasonic Liposuction (VASER®)

The newest evolution step in energy assisted liposuction then turned toward SOUND! In this case Ultra-Sound. UltraSound is sounds waves that have a frequency above normal hearing (above roughy 20KHz for the physics buffs). The tube that is first inserted vibrates and creates ultrasound (similar to a SonicCare® Toothbrush…except this is Ultra-Sonic!) these reverberations creates microscopic bubbles that surround fat cells and microscopically dislodge the fat cells. This process is also known as Acoustic Streaming. Overall, the fat is separated not by Avulsion but by Emulsion and this has a significant impact on post-operative recovery and the viability of the fat cells harvested. The process of Acoustic Streaming allows for the precision in the areas of packed-in stubborn fat (flanks/love handles/lower belly); and by the efficient and effective removal of the fat the skin significantly retracts.

Skin Tightening:

Further (and potentially more important), newer ultrasound devices are able to be placed closer to the skin. This causes tightening and firming of the skin; and in some cases this reduces or replaces the need for surgical skin removal.

The main advantages of UltraSonic Liposuction ease of fat removal which reduces surgeon fatigue and increases the precision in body contouring and body sculpting, ease of recovery due to the less traumatic fat separation, decreased pain, decreased bruising, less swelling, and significant skin retraction.

UltraSound and Fat Transfer:
Finally, studies have begun to show that fat transfer with the fat harvested by Ultra-Sound have better fat transfer rates!3 I think this is extremely important to stress. If you are thinking about a fat transfer with the liposuction, studies have shown that UltraSound Fat Harvest produces better results (also known as take-rates) of the transferred fat.

So Which Type of Liposuction is THE BEST?

I believe the most important factor is the surgeon performing the liposuction. The surgeon is essentially the body artists or sculptor that is sculpting your body. In my spare time I paint. Even if I had Michelangelo’s art supplies, and I went head-to-head with Michelangelo… I am going to lose. I think the same can be thought of with the different devices. The devices could be the absolute best…but the surgeon holding and using it also needs to be the best!

OK so let us assume all Liposuction Cosmetic Plastic Surgeons are equal (not the case but we will assume it), then I think a combination of Powered Liposuction (to remove the fat) and an Energy Based (to break up the fat) should be removed. Why? Because the combination creates a very effective and great result by first breaking up the fat (with the Energy Source) and then removing the Fat (with the Powered LIposuction). In my hands, I think UltraSound produces the best results and with the least negatives (i.e. risks of burns or thermal injury that can be seen with LASER). Therefore, I utilize a Combination of Vaser Liposuction and then I perform a second treatment with Power Liposuction (two forms of treatment in 1 surgery). It is this combination that allows me to create some amazing results!

Do I Need to Be Asleep to Get Liposuction?

No. Liposuction may be performed with you completely awake (local only), sedated or sleepy (think multiple margaritas!), or completed asleep or general anesthesia. The number of areas and the amount of liposuction can determine what type anesthesia you can get. For example, there is a limit, based on your weight, of how much local anesthesia (awake lipo) you can receive. Therefore, if you want to do a number of areas (Tummy, Waist, Back, Arms) AND do it awake, then either we need to split the surgeries up into separated days (could be the following day) or utilize a different form of anesthesia that will allow you to get all the areas done at once.

Personally, I think it is a more comfortable experience for you to simply go to sleep and then wake up with it being completed. However, it is completely up to you!

Do I Need to Be Asleep to Get Liposuction & Fat Transfer?

No. Just like liposuction, liposuction and fat transfer (Brazilian Butt Lift or BBL) can be performed with you awake, sedated, or completely asleep. However, in order for me to get the BEST results with the fat transfer, I need to place the fat in areas that you may feel during awake liposuction. So this leaves us with a couple options: 1) Accept that you will not get the best results under awake liposuction & fat transfer or 2) Have you go to sleep for the fat transfer (my preference because in my opinion it provides the best results). Again, it is up to you but I truly believe you will get a better result when you are asleep (general anesthesia).

Liposuction Recovery:

  • What is Normal to Expect after Liposuction?

    Bruising, swelling, and firmness are normal and are expected after liposuction. However, in UltraSounds Liposuction these are all significantly reduced over traditional methods. Bruises take 1 to 2 weeks to resolve or go away. The swelling usually takes longer; the swelling will begin to decrease at 3 weeks after surgery. The process of swelling resolution takes at least a total of 6 weeks for the overall majority of swelling to resolve.  Again, the swelling is significantly less when UltraSound is utilized for the fat removal. The swelling will not prevent you from seeing a result after the surgery. You will be able to see the difference before and after surgery that same day as your liposuction procedure! These results are typically most notable in the waist and flanks. The best part is the results will continue to get better as the swelling continues to go down each week! 

    Firmness is also completely normal and completely expected after liposuction. The firmness is because the fat and surrounding tissues are swollen and inflamed (think angry) from the liposuction.  Think about it like when you sprain an ankle, it gets bruised, swollen, and firm.  It also take at least 6 weeks to 3 months for the ankle to soften. For some people it takes less time and for others it takes more time.  How do we treat it? We elevate the ankle, apply warmth, and wrap the ankle. Therefore, in order to help shorten the firmness and overall recovery time, massage is started at 1 week after surgery (unless a breast surgery has been done at the same time then I wait until at least 2 weeks) to the liposuction areas. The massage softens the skin and tissue.  In my opinion, massage is a KEY step to faster recovery and overall better results.

  • Massage and When to Start:

    I recommend a specific type of massage called Lymphatic Tissue Massage. This is a type of massage designed to promote the decrease of fluid, swelling, and firmness. All of these are things that happen after liposuction. Therefore, the lymphatic massage helps you get to feeling and looking like you quicker. I would also like to point out that UltraSound liposuction typically produces less firmness than traditional liposuction methods because it removes fat in a less traumatic (or injury) fashion.
  • Compressive Garment and How Long to Wear:

    Compressive garments (essentially Medical Grade Spanx) are placed on you immediately after surgery while you are in the operating room. The garments are placed while you are in the operating room for your comfort. Therefore, when you wake up the garments will be on and you do not have to fuss with the garment.  You will keep the garment on for 48 hours straight after surgery.  Then, the garment is worn for 3-6 weeks, at all times, except when showering. The garment helps to decrease the swelling, bruising, and firmness (remember how discussed about how to treat a swollen ankle earlier).  The garment also helps to shape the torso into the hour glass by helping to ensure that the skin and soft tissues “sticks” and forms in the correct locations. Again, think of it like a sprained ankle: How do we treat it? Rest, Elevation, and wrapping!

    Another important factor when thinking about recovery: as we discussed above, different forms of liposuction technology can either increase or decrease your recovery time and in my opinion the UltraSound Liposuction produces the quickest/fastest recovery and the least amount of bruising/swelling/firmness. 

  • How Long Until The Swelling Goes Down?

    The swelling usually takes a full 6 weeks to resolve (or go away); swelling will start to go down after about 3 weeks from surgery. This whole process of swelling resolving or going away will take at least a total of 6 weeks. This is for the majority of swelling to resolve. Ultrasounds liposuction will typically cause less swelling and therefore a quicker recovery from the swelling because there is less tissue injury (or trauma). Tissue swelling does not stop you from being able to see a result on the day of your procedure. You will see a notable difference between your before and after body shape the same day that the liposuction was performed! This difference is most noticeable in your flanks and waist (also know as the hourglass). I think the best part is that the results will only continue to get more noticeable and improve with each week! 
  • How Long Does the Garment Need to Worn?

    The garment needs to be worn for as long as swelling and firmness are still noticeable. Usually this is 3 to 6 weeks. Everyone is slightly different and some need to wear it longer; however, that is not usually the case. The garment functions by providing constant pressure and decreasing the swelling (fluid) and firmness. The garment also helps to form the skin and get it to “stick” in the right places i.e. the hour glass. You will need to wear the garment at all times except when showering. We will place the garment on you in the operating room. At first, I want you to leave the garment in place for 48 hours. Then, you may take it down, shower, and wash the garment. Afterwards, you need to resume wearing the garments daily at all time except when showering.
  • Do Spanx® Work as the Garment?

    Yes! Spanx® do work. There are advantages and disadvantages to everything. The main negative to Spanx® is that initially after surgery it is more difficult to get the garment on and off. The price of a medical garment is similar (and in some cases less) then Spanx®. The major negative to the medical grade garment is that the garments are not readily available in department stores.

    For all of my patients, I recommend switching to Spanx® or a similar department store compressive garment 2-3 weeks after surgery. Typically, around that time the original compressive garment is loose bc a significant amount of swelling has gone down. Continually, downsizing your compressive garment improves both your healing time (recovery time) and overall results.

  • Does Massage after Liposuction Matter?

    Yes! I believe massage SIGNIFICANTLY shortens recovery time and improves the overall result. There are many different types of liposuction; personally, I feel Lymphatic Massage is the best type of liposuction to get you recovered the quickest and get you the best possible results. What if you want to do your own massage or you have a friend who is a masseuse? As long as the massage is being done on a medium/deep tissue level and in a way to promote lymphatic drainage then that should be fine. When I speak with my patients they are overwhelmingly happy and feel the lymphatic massages were a positive experience both for their results and the mind relaxation after surgery.

  • How Long Will I Need Off Work?

    Everyone is different. Typically from liposuction you will need 1-3 days of work. On rare occasion, you may need longer. However, this is not normal.
  • When Can I Go Back to The Gym/Activity?

    72 hours after liposuction.
  • When Do You See the Final Result from Liposuction?

    Usually, you will be able to see a result at 6 weeks after surgery. However, some firmness may still be present. Therefore, the final results are typically around 3 months after liposuction. However, if this a revision procedure or a second liposuction procedure it can be longer.
  • When Do I need a Tummy Tuck vs Liposuction?

    This is a two part answer because of the new technologies available. Let us start by discussing what the different treatment options do for the body.
    Liposuction- treats fat by removing the fat. Therefore, if your tummy has a lot of external fat then liposuction will be used to remove the fat.
    Tummy Tuck (Abdominoplasty)- treats skin by removing the skin. Treats loose tummy muscles by tightening the tummy muscles (flattening the tummy). Therefore, if your tummy has a significant amount of excess skin, then a tummy tuck will remove the excess skin. Or if your tummy has a round appearance because you have had children then a tummy tuck will tighten those muscles and flatten the tummy.
    UltraSound Liposuction- Ultrasonic liposuction also has the ability to cause skin/soft tissue tightening when the ultrasounds are applied near the skin. This has been a significant game changer. In prior cases when patients had both fat and extra skin we would need to utilize both liposuction and surgical excision (scars) to treat the area. However, now we are able to apply ultrasonic liposuction to help reduce and tighten the excess. Now this is not magic; there is a limit to how much skin can be reduced and tightened; but overall this allows us for another very powerful option!

    Frequently, if you are getting a tummy tuck, I will perform liposuction at the same time. Why? Because almost all tummy tucks benefit from some liposuction. Conversely, with the new Ultrasound Liposuction, all tummy liposuction does not need a tummy tuck.


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