I evaluated a female who was looking to have a body contouring makeover. During the consultation, she stated she wanted to have her abdomen, hips inner and outer thighs shaped. During the examination we identified that her abdomen between the breast bone and the belly button was weakened. After confirming this with a general surgeon we set the expectations, and schedule to repair the hernia while we performed her body contouring.
During the surgery we concurrently perform the abdominal wall reconstruction with a board certified general surgeon, tummy tuck and liposuction procedures
The post-op photo is 3 months out. As you can see, her shape looks great, and most importantly she in very happy with her new and improved look.
To schedule your consultation with Dr. Linder or learn more about body contouring, call our office at 310-275-4513 or fill out our online contact form today.
Revision liposuction has become a very significant part of my practice. Patients come in from throughout the country and in fact, throughout the world, who desire to have revision liposuction in order to improve a previous result.
There are two problems that I see uniformly. One is inadequate liposuctioning in specific designated localized fat deposit areas or over-liposuctioning in areas where suctioning is performed too close to the subdermis leading to indentations and contour deformities of the skin. The first problem of inadequate liposuction is very common, especially with surgeons who are inexperienced or do not have judgment with liposuction. Only board certified plastic and reconstructive surgeons should be performing liposuctioning at any time. The skill of the abdominal wall, the thighs or the lateral breasts requires years of experience and training in both general surgery as well as plastic and reconstructive surgery. Liposuctioning the localized deep fat deposit areas will allow for smoothing and reduced risk of contour deformity.
There are two fat deposit areas
- The superficial fat, referred to as Camper’s fascia
- The deep fat, referred to as Scarpa’s fascia. Only Scarpa’s fascia should be suctioned and only deep portions of the Camper’s fascia should be suctioned in order to prevent skin irregularities and contour deformities.
Patients who present with under-suctioning in areas such as the hips, abdomen, periumbilical, lower and lateral thighs are usually unhappy that they don’t see a significant change in the appearance of their bodies that they were hoping for. When I perform liposuctioning, in our Beverly Hills Surgery Center, of the abdominal area I am very careful to remove fat in the hip and flank areas in order to smooth out the contour of the midriff area. When there is a significant amount of fat in the iliac crest roll or the hip regions, this can be taken care of by and what I refer to as the Linder Bi-Directional Liposuction Technique, removing fat both in a vertical and oblique fashion along the iliac crest roll or hips. This completely changes the boxy appearance into a smoother contour and reduces fat above the jean line. Women who wear low-cut jeans enjoy this result because it reduces that hip bulge above the jeans. Liposuctioning of the lower abdominal and periumbilical area depends upon the amount of skin laxity. If it is not significant and there is good skin tone, then suctioning should be significant and somewhat aggressive in order to smooth this area out. Using an abdominal binder for six weeks will help to allow for skin tightening as well.
Liposuctioning of the thighs requires a significant amount of skill, especially the medial thighs which can end up with loose skin as well as contour deformities greater than the lateral. The reason is the medial fat of the medial thighs is more of a looser fat, a softer fat. The thigh fat along the lateral thigh is a denser, compact fat which usually can be suctioned with less contour problems. Suctioning should only be performed in the deep fat deposit areas in the both the medial and lateral thighs. With revision liposuction there is often a significant amount of scarring internally and this can make it more difficult to smooth out certain areas, as well as more difficult to maintain your plane of direction.
Secondly, over-liposuctioning. Patients who present who have had over-suctioning performed by other surgeons are more difficult to fix in that these areas may require fat grafting or simply feathering of these areas to smooth out the fatty deposits that were left behind in specific areas. It can be very dangerous to perform secondary liposuction on an area where the tissue is less than 1 cm thick in that you can end up with inadequate blood supply and subdermal vascular necrosis which can lead to death of the skin. Therefore, when considering secondary liposuction of areas that are over-suctioned, an experienced Board Certified Plastic Surgeon is a must in order to prevent a catastrophe.
Patients present to my office weekly requiring total mommy makeovers at a much earlier age. This is associated with pregnancy and history of breastfeeding. The case below is a patient who is only 25 years old, who presents with bilateral breast dysphoria, involutional upper pole atrophy, and loss of upper fullness of her breast. She is an excellent candidate for augmentation mammoplasty procedure using a high profile saline implant under the muscle in the dual plane technique in order to obtain upper pole fullness. Her lower abdominal area shows skin laxity with some lipodystrophy at the muffin-top regions.
The patient underwent bilateral augmentation using high profile saline 425 cc Natrelle Allergan implants through the periareolar approach, dual plane and a full abdominoplasty through a tightening of the rectus sheath and liposuctioning of the hips. The frontal view shows slight asymmetry with the right breast slightly smaller than the left and 10 cc more volume was added. It also shows rectus diastasis in the lower abdominal area with the muscles pulled out and a pouching of the lower abdominal region. The side view shows the skin laxity of the abdomen and nicely shows complete flattening of the upper pole of her breast. Her postoperative oblique view shows excellent upper pole fullness with tapering of the implant along the lateral inframammary fold. Her oblique view of the tummy tuck shows nice softening of the hips, well-healed scars around the lower abdominal area and the umbilicus and makes tightening of the rectus sheath in the midline.
Patients under 35, including this 25-year-old, do well with high profile saline implants to enhance the upper pole loss of fullness due to involutional atrophy associated with breastfeeding at a young age and full tummy tucks are excellent procedures for patients who no longer desire to have children in the future.
Patients present weekly desiring to have liposculpture of their saddle bags and anteromedial thighs. They also have concerns of cellulite dimpling of the lateral thighs and desire to have these areas smoothed out. It should be realized by the patient that cellulite that is severe cannot be corrected by any form of liposuction. Liposculpturing is to remove the localized deep fat deposits that can be found in the deeper layers of fat. Suctioning close to the skin will actually increase contour deformities and irregularities. Now feathering of areas of contour deformities performed by other surgeons can be done to smooth defects that are large, for example, very large contour concavities.
Fat grafting can also be considered with injection into areas where there is severe deformity; however, there is the risk of calcification of the fat with possible fat atrophy and fat loss or depth. Cellulite or dimpling of the thighs is often hereditary or genetic in nature and is usually uncorrectable with any form of lotions, potions, creams or laser therapy. In fact, some forms of exercising may be helpful in smoothing out and tightening up the muscle which may reduce the obvious appearance of the cellulite; however, the cellulite is very difficult if not impossible to be completely corrected.
About six months ago, I performed a massive tummy tuck and breast lift on a patient with the intent to have a follow-up surgery to complete her full body contouring makeover. After having three children all by c-sections and undergoing significant weight loss, we agreed to reach her goal by having two surgeries. The second surgery entailed liposuction around the abdominal area and inner thighs as well as removal of excess skin (dog ears) that had bunched up from the tummy tuck procedure.
The first photo to the left was taken right before her first surgery. The middle photo was taken right before her second surgery (liposuction). The far right photo was taken three days post-op after her second surgery. The photo below is now four weeks post op. As you can see, her waist and stomach area look great, and she is extremely happy with her new shape.
4 Weeks Post Op
To schedule your consultation with Dr. Linder or learn more about body contouring or breast lift surgery, call our office at 310-275-4513 or fill out our online contact form today.
I evaluated a female who was looking to have a body makeover. During the consultation, she stated she wanted to have her abdomen enhanced, her hips shaped, and a breast augmentation. She explained that after having weight loss, her goal was to get her shape back to where it was in her younger days.
After setting her expectations, we decided to perform an abdominoplasty or tummy tuck along with liposuction of the hips area and a breast augmentation. For the breast augmentation, I placed 425 cc high-profile silicone breast implants and positioned them in a subglandular position. Subglandular means the implant is placed in a pocket behind the breast gland, entirely on top of the pectoralis major muscle.
As you can see, after only eight weeks post op, the abdomen, hips, and breasts look fantastic, and she is very pleased with her recovery.
To schedule a consultation with Dr. Linder or for more information on body contouring, call us at 310-275-4513 or contact us by email.
1. BRA BULGE
Bra buldge is that pesky fat pad that can be found just lateral or outside the outer edge of the pectoralis major muscle. When women wear brassieres, it’s not infrequent that this bra fat that pushes out can be irritating, painful, rashes can form and they can develop dermatitis. This bra bulge can also be unsightly, especially in clothing where this lateral breast region is exposed. On national television Dr. Linder performed a bra bulge procedure, removing this fat using a small triple lumen Mercedes tip cannula to sculp the lateral fat pad resolving the bra bulge. The results can be quite traumatic. This can be performed under either local IV sedation or general anesthesia, depending upon the amount of adiposity. Patients with increased skin laxity at this region may require a skin excision at the same as tumescent liposuction of this bra bulge fat pad. Compressive garments for at least six weeks should be used postoperatively. Sutures remain in for approximately 14 days.
2. MUFFIN TOP
The Muffin Top specifically is associated with the adiposity or lipodystrophy fat pads within the iliac crest roll or hip region and the lower flanks. It can also extend to the lower abdominal or periumbilical region. Dr. Linder performed a muffin top procedure on national television recently. The patient was brought to the operating room, administered general anesthesia, although IV sedation may be used on smaller localized muffin top regions of the hips. The fat is directly lipo sculptured with tumescent technique using a bi-directional technique. Both superficial and deep fat is removed with as 4 mm and a 3 mm triple lumen Mercedes blunt tip cannula. Subsequently, fat is removed directly perpendicular to the pelvic bone in order to smooth out and contour the medial hip region. The results can be absolutely fantastic. Six weeks of compression garments are placed. Patients who have significant fatty tissue around the lower abdomen can be sculpted at the same time leading to a completely sculpted muffin top region.
3. MUFFIN BOTTOM
The Muffin Bottom consists of sculpting three different regions at one time, the infragluteal fold, the medial posterior thigh and the lateral posterior saddlebag region. The muffin bottom can be sculpted using the tumescent technique under either IV sedation or general anesthesia. This was sculpted for a national television program recently and the results are dramatic. Care must be taken to avoid over-sculpting the infragluteal fold to prevent increased skin laxity or contour deformity.
4. SADDLEBAG PROCEDURE
Saddlebags are that localized fat deposits in the outer thigh region which cannot be removed through diet and exercise. These are resistant genetic fat pads which can only be removed through direct surgical liposculpture. Dr. Linder performs a double layer criss-cross technique using a deep 4 mm cannula and a superficial 3 mm cannula to remove the fat in the lateral thigh region in a criss-cross perpendicular manner. Meticulous and precise sculpting of the lateral thigh as well as removing some of the anteromedial inner thigh and iliac crest roll or hip thigh fat can completely contour the thigh, removing the saddlebags and proportionating the lower third of the body with the midriff and upper portions of a woman’s anatomy. This was performed recently on national television with the following pre- and postoperative results. Liposuctioning of different areas of the body follow similar patterns with respect to technique. I use tumescent fluid in all these regions in order to
- 1) contour the fat, hydrating the fat cells, reducing the contour deformity and skin irregularity;
- 2) reduce bruising and bleeding by using the epinephrine to vasoconstrict the blood vessels;
- 3) to use Lidocaine in order to reduce pain by allowing for numbness.
I was presented with a 23-year-old male who was looking to reduce the size of his chest and stomach area. During the consultation, we discuss the amount of glandular tissues behind the nipple areolar complex and his fatty tissue extending along the chest wall. His other concern was the lower abdominal area that was bothersome to him.
After setting the expectation, we performed the procedure called gynecomastia surgery to the chest area. The patient has excellent skin tone in the abdominal area, allowing us to liposuction the fatty area and smoothing and contouring his mid-section.
The patient to the left is now four weeks post op and is healing nicely. He is extremely happy with his results.
If you would like more information regarding male plastic surgery or want to set up a consultation today, call us at 310-275-4517 or fill out our online contact form.
The patient since his surgery has had to follow up appointments and as you can see by the post op photos below his results are excellent.
4 Month Post Op
7 Months Post Op
The female patient presented was requesting to address her outer thighs, inner thighs, hips, and inner knees. During her consultation, she discussed the chafing and touching of her inner thighs and the fat deposits on the lateral thighs and the muffin top or hip area. All of these areas are difficult for many women to remove through diet and exercise and, therefore, elect for liposuction surgery
To address the knees, a small stab incision was made in the medial knee area (inner knee), and a small fat pad was suctioned out smoothly and evenly without skin laxity. Along with the medial knees, we also sculpted the fat deposits of the body, medial and lateral thighs, and the hips concurrently.
After six weeks of wearing postoperative compressive garments, the patient is recovering well, and, as you can see, she is looking great.
We perform abdominoplasty and tummy tuck procedures weekly in our Beverly Hills Surgery Center as our patients undergoing complete mommy makeover reconstruction, including augmentation, breast enhancement, mastopexy, body lipo contouring and abdominoplasty. The perfect tummy tuck requires multiple steps during the surgical procedure. The first step includes the incision site being made near the inferior position above the suprapubic hairline. This should be placed low enough that the patient will be able to wear postoperatively the clothing and fashion that the scar will be well hidden. The dissection should be carried out carefully meticulously above the fascia of the external oblique muscle midline rectus sheath up to the subcostal ribs maintaining a cuff of fat with the umbilicus to maintains its blood supply, preventing avascular necrosis; however, death of the umbilicus or belly button. The photographs displayed here show a clean dissection anatomically of the entire abdominal wall. Notice the midline rectus fascia and notice the sutures of the O-Ethibond in the midline rectus sheath. This patient is 42 years old and status post deliveries. Notice the external oblique muscle laterally. It’s tight and does not require further tightening sutures. Midline plication has been performed both supraumbilical and infraumbilically from two fingerbreadths below the subxiphoid point to the umbilicus and once again below to the suprapubic region. Plication of the muscle sheath is absolutely essential for a firm and tight appearance to the lower abdominal wall.
The next photograph shows specifically patient in a V-Y configuration, also referred to as the semi-Fowler position with redundant dermoglandular tissue retracted inferiorly, carefully marked and incised as well as allow for the removal of the redundant skin and fatty tissue. After closure of the wound, tumescent liposculpturing the bilateral iliac crest hip region with tumescent liposculpture technique is performed and the reposition of belly button and umbilicus. This ends the final step, which should be done in an oval-like fashion, which will allow for a more natural appearance to the umbilicus rather than round. We used two 10 mm JP drains in order to remove serous fluid as well as small amount of blood as well as tumescent liposuction fluid from the abdominal wall which is furthermore also allows scarring back down in the abdominal tissue to the muscle fascia. Patients are placed with abdominal binders for up to six weeks. Antibiotics were seven days, pain control with Norco. It is important to understand the specific anatomy and the specific pathological diagnosis and physiological sex of pregnancy and significant weight fluctuation on the abdominal wall. The tightening of the abdominal muscle is essential for retraining optimal results and intraoperative photos are taken prior to abdominal wall closure. It should be discussed with your plastic surgeon prior to the operation.