the guy's guide to plastic surgery

Plastic surgery is generally considered to be the domain of women, especially with breast implants having become the most popular surgery. All in all, only 15% of patients are men, but that is still quite a lot in terms of absolute numbers. For the record, the most popular procedure for men continues to be liposuction.

One problem I think is that too many of us labor under false notions about plastic surgery. Husbands and boyfriends accompanying their partners for consultation often say something like “I don’t know why she is doing this, I love her just the way she is.” So the first lesson is that she isn’t doing it for you, she has her own personal reasons that don’t really depend on relationships. In fact, having cosmetic surgery in order to improve a relationship is almost always a bad idea.

Another misconception is body contouring surgery vs. diet and exercise. It isn’t an either/or situation, however; there are things that exercise does that cosmetic surgery doesn’t, and vice-versa. Classic examples are doing sit-ups with the expectation that they will tighten abdominal skin, and the idea that specific exercises can affect body fat distribution. Spot-contouring of fat with exercise just doesn’t happen. On the other hand, liposuction isn’t done for weight loss, it is all about reshaping. So thigh exercises may not burn off thigh fat, and crunching the abs won’t result in a 6-pack if the body is genetically programmed to carry extra fat there.

Our typical lipo patient is someone who isn’t overweight but has areas resistant to change. A woman might be a size 4 on the upper half of the body but a different size in the thighs. We see men who are in great shape but have “love handles” or excess abdominal fat. So do continue to hit the gym, and see your plastic surgeon for what you can’t accomplish with exercise and a healthy diet.

Enhanced results with lipo plus Thermage

As usual, the Hot Topics session at this week's meeting of the American Society of Plastic Surgeons served up a number of issues. I had the opportunity to present the data from our studies proving that Thermage given immediately after liposuction enhances skin tightening. The reason that this is important to prove in a scientific way is that skin shrinks all by itself after lipo, so additional shrinkage can only be claimed if it is demonstrated to be greater than what occurs normally. Patients who benefit from this are those who have some looseness to the skin, such that lipo alone would not give a good result, but not so much that they need something like a tummy tuck. This latter part is important because some plastic surgeons are pitching laser lipo as an alternative to tummy tucks. It's a risky proposition because I am already seeing patients who should have had a tummy tuck but chose laser lipo instead, and the results are not pretty.
To be fair, there was some data presented showing enhanced skin shrinkage with smart lipo (though not as much as with lipo-Thermage) and another suggesting that VASER ultrasound helps too. But each of these has its own risks and benefits, so for now my money is on the one designed to tighten skin in the first place.