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Ron Shelton M.D.

#317 East 34th Street,
11th Floor, New York, NY 10016. 

Q: I had liposuction on my belly and saddlebags and am very happy, but at one month my scars from where the liposuction rods were entered through the skin are becoming brown and more noticeable. Can this be improved?

A: Post-inflammatory hyperpigmentation is not uncommon at insertion sites from the cannulae being passed back and forth with friction. Some people who have slightly darker skin are more prone to this than others. Those patients may know they’re susceptible to this post inflammatory hyperpigmenation, because they turn brown when they have acne that resolves, a bug bit on their leg, they burn themselves in the kitchen with a grease splatter on their arm, or a curling iron burns their skin, and all these situations develop dark brown skin patches that persist for many months or longer. Hypertrophic scarring is different, in which not pigment, but collagen increases. This manifests itself as raised red itchy or painful scars and is treated differently by massage, corticosteroid injections, V-beam laser and silastic gel dressings. The hyperpigmentation is treated with lightening creams, such as hydroquinone, Lumixyl and Elure and daily use of sunscreen if the skin is in the very slightest bit, exposed to the sun.

Q: I want to fly to my reuninon in California from NY after my liposuction on my abdomen which was six weeks ago. Is this OK?

A: You will probably be fine. It is doubtful, but possible, that you might be slightly more swollen for a day or so after your travel so if you are still wearing a compression garment, you should buy one slightly larger and bring with you on your trip just in case.

Q: My friend is so unhappy after she had facial liposuction. She is too thin and looks sickly and needs to gain weight but she doesn’t want to change her body’s physique. What can she do?

A: If she was overresected and too much fat removed in her face to make her look aesthetically pleasing and proportionate in her face, then fat injections can be done to rejuvenate her appearance. This has been done similarly, for patients who had their cheek (buccal) fat pad removed to accentuate their cheekbones. This had been in vogue then but as these women aged, their faces seem to age more rapidly and their friends who didn’t have the buccal fat pad removed, looked healthier and more youthful.

Q: I think I may need liposuction. No matter how much I exercise, including sit-ups, I can't change the way my tummy makes me look like I'm pregnant. Will the liposuction help?

A: You would need an examination, but it could be that you need an abdominoplasty in addition possibly, to liposuction. The tummy tuck can tighten the muscle that is expanded forward and can remove excess loose skin. Liposuction can only remove the fat that is above the muscle.

Q: Liposuction of the saddlebags was done one week ago but I can’t tell the difference. Should I be concerned?

A: There is probably nothing to be concerned about because it is normal not to see the improvement for many weeks after liposuction because of the swelling. Wear your compression garment and follow up with your surgeon.

Q: I had liposuction of the pubis two weeks ago and it is still swollen. Is this normal?

A: Yes, absolutely. The lower abdomen tends to catch swelling by gravity and allow it to “pool” there. It takes longer for it to clear this area. Below the abdomen is the suprapubic region and the mons pubis, when undergoing liposuction, can swell a great deal and take many weeks to resolve.

Q: I had liposuction of the outer thighs and one week later have very tender bruises. Is this to be expected?

A: Many people bruise, but some things can increase bruising such as taking blood thinners (including but not limited to: alcohol, aspirin, ibuprofen, alleve, Motrin, Advil, fish oil, garlic tablets, ginko, ginseng, and ginger. You should not exercise right after the surgery, and most doctors recommend wearing a compression garment which can minimize bruising. Usually the bruise goes away by three weeks or more.

Q: Is liposuction performed in an office safe?

A: There are many features that affect the safety of liposuction. Liposuction has been an extremely commonly performed surgery and there is a very high safety profile. Aspects that increase risk are long hours of surgery, multiple cosmetic procedures done together, removal of excessive amounts of fat, and the potential of anesthesia complications. Tumescent liposuction has a great safety profile without the need of sedation or general anesthesia. Our practice is accredited as an office based surgical facility by the Joint Commission which is the same agency that accredits hospitals. Offices are only given accreditation status if they follow safety guidelines and perform quality assurance in-office studies.

Q: My friend is having liposuction for her tummy. I’m trying to convince her to just keep working out but she won’t listen. Is she making a mistake?

A: Many women and men have inherited a tendency to gain weight in a certain location, whether the hips, outer thighs, lower abdomen, despite exercise and diet! They can try do do 1,000 sit-ups a day and that tummy won’t flatten. The fat cells there are under a different hormonal influence. Liposuction removes a significant amount of those fat cells and the body can obtain the desired shape. Diet and exercise continues to maintain good health and shape.

Q: It’s been four weeks since SmartLipo and I have a lot of bumps on my belly. Can I have these injected with steroid to reduce the swelling?

A: You need to see your surgeon to evaluate your condition. You may have swelling that is concentrated in some areas or you may have residual fat. It is too early, though, to consider revising your lumps. If you were instructed to wear compression garments, then continue to do so. Your surgeon will probably tell you to wait several weeks or months and return for followup examination. Endermologie and Velashape lymphatic massage may help but your surgeon must approve of this.

Q: I had liposuction one month ago and still see some irregularities. My surgeon recommended deep tissue massage. Why?

A: Swelling is normal after liposuction and deep tissue massage can help reduce this temporarily. It can be done with Endermologie or Velashape and other devices. Usually it resolves spontaneously without help, and compression garments help, but these deep tissue massages expedite the resolution. External ultrasound and other techniques have been used also.

Q: How long after abdominal liposuction do patients have to wait before having sexual intercourse?

A: After a couple of days there isn’t much of a concern with increasing bruising, but you’ll have to ask your surgeon based on the amount of liposuction, was there much bleeding (usually, not much), was this a second surgery in the same area working in scar tissue which might make it more sore? These are some of the variables the surgeon will contemplate when answering your question. The openings through which the liposuction cannulae are passed for the liposuction could theoretically get infected if there is much friction or if the incisions get soiled so these need to be healed well, or at least protected, before you traumatize these areas.

Q: I never had a good shape, somewhat overweight and cellulite. I had liposuction done by a well-known liposuction surgeon and a lot of fat is gone and I’m slimmer in clothes that used to be tight, but I have more cellulite now. Why? Can it be corrected?

A: Liposuction irregularities can be similar in appearance to cellulite, so you may be seeing a side effect of the surgery. Indents can be filled with fat injections and lumps or areas of fat that weren’t reduced well enough with the liposuction can be treated by performing meticulous liposuction on spot areas with tiny cannulae.

Q: Can a man get a good result from neck liposuction?

A: Yes. Men can get as a good a result from neck liposuction as women provided they are a good candidate. Some men don't obtain a sharp angle of neck because their "Adam's Apple" is very forward. Other men may have more fat below the level of the neck muscle, called the platysma, and if this is more in volume than the fat above the muscle, then liposuction (which is usually not done below the muscle unless surgery opens up the layer for direct visualization which is needed because of the risk of bleeding deep to the muscle) won't provide a good result. When men have the correct anatomy, and the knowledgeable surgeon accepts those who are good candidates, then the results can be excellent.

Q: If I’m going to have liposuction on my belly, can I ask the doctor to only make one incision so I have less scarring?

A: One insertion site would not allow the surgeon to provide you with the best result. Liposuction should reduce the fat in different directions so that the volume is brought down evenly rather than tunneling the cannula from one point and fanning it out in different directions which would create greater removal in the concentric areas closest to the insertion site, and reduce the coverage as the distance increases because of untreated fat in between the "spokes of the wheel". When you look at a wheel closest to the center, the spokes look closer together, but as you look at the end of the spokes near the tire, there is more space in between. The spokes are less dense there, and similarly, in liposuction it would be hard to evenly treat all areas with one insertion site.

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