Patients are incredibly concerned as they shold be with natural appearing results.  I have been asked recently about whether not patients would be able to have liposuction.  There are several factors I take into consideration when evaluating whether not a patint is an appropriate candidate or liposuction.  First I address if the patient has had changes in their  weight over the past several months that could unfortunately compromise the result.  I want patient to be at their current weight over the past 6 months and sometimes over the past year in a patient who has had surgical weight loss.  i would like the patient to have a BMI of less than 30 normally.  If these factors are within reason then we will delve into what area or areas they are interested in improving.  Liposuction doesn't remove all the fat in any given area.  I prefer patients to have a greater than 2 to 3cm pinch in any given area they desire liposuction.  Typical areas to have liposuction are the abdomen, flaks, hip roll, inner and outer thighs.  These can be done in conjunction with other procedures but I am not an advocate of large amounts of liposuction on the legs and thighs as well as excision procedures like tummy tucks.  There is an increased risk of DVT with combination procedures of the legs and abdomen.  I typically with confine the liposuction to the lower back, abdomen, flanks with the addition of a tummy tuck.  I feel the extremities can be dealt with in another session.  Also I would prefer that all patients after abdominal rejuvenation whether tummy tuck with or without liposuction feel very comfortable with walking in order to help prevent blood clot development in the veins of their legs.  It would make sense that patients would be less inclined to get up and move around if they have had liposuction of their abdomen, flanks and a tummy tuck as well as liposuction of the thighs and lower legs.  Liposuction is always associated with a certain amount of swelling.  The more swelling that develops the more difficulty the patient will have with pain control after surgery.  As soon as the procedure is finished and the wounds are closed my patient's are placed into the appropriate garments to help decrease swelling.  Swelling typically peaks at 48 to 72 hours after a procedure.  With the compression provided by the garment the patient will help limit their swelling.  This in essence will allow them to move around with less discomfort.  In addition pain medications are more effective when there is less swelling at the operative site.  These are some of the considerations for patients before and after their procedure.  Liposuction is a great technique to both improve those difficult areas of the abdomen, back, flanks, inner and outer thighs as well as a great sculpting tool in thinner patients.

Diep flap surgery in the past was limited by a patient tissues.  I am speaking directly to those patients seeking reconstruction with their own tissues who do not want implants under any circumstances.  In many instances patients who were deemed to thin or those on the other hand who were felt to be to obese were denied the opportunity for this type of breast reconstruction.  Several thoughts have changed regarding DIEP flap surgery and breast reconstruction.  Since the introduction of the bipedicled DIEP flap, double stack DIEP, stacked DIEP flap more women who are relatively thin have been given the opportunity to have breast reconstruction surgery using their own tissue in the form of the DIEP flap.   This is particularly advantageous in situations where patients are having skin sparing mastectomy surgery.  This allows for the most complete breast reconstruction result where the mastectomy or breast skin has been saved by the breast surgeon and the plastic surgeon has the opportunity then to perform breast reconstruction surgery either with the abdominal tissue like a DIEP flap for optimal reconstructive outcomes.

Read an interesting Article in Scientific American, "The Naked Truth", on a flight home recently.  It distills down the pressure the environment posed for the early humans to adapt to the sweltering tropical climates in Africa.  We continue to evolve but the skin seems to be a constant battle.  Bare skin keeps cool but I am constantly asked by patients about laser hair removal.  In breast reconstruction where one breast is in the natural position, slightly drooping, I have to lift it, augment it or both.  If someone is concerned with the appearance of the facial tissues.  Many times unnatural appearances can be created if just the skin envelope is adjusted without any change in the position of the underlying tissues of the cheek and jowls.  It is part of the process of evaluation in  an office consultation to come up with a plan that will fit a given patient in terms of their expectations and the ability to reach expectations with their own tissues.