Hello. I am a 43 year old male. I have a very specific question about two lipo procedures I had. I will be detailed in my description for accuracy.
A few years ago I had an Aqua-lipo procedure in Florida on my abdomen and love handles. At the time I was 5'10" and about 175-180. Before the procedure, I did REAMS of research and homework to try and ensure things worked out well. My weight was not excessive, except for the abdomen and love handle area. Even if I dieted to the point where I looked nearly gaunt (165), I still had a layer of fat in the abdomen and around the sides.
There were no complications with the procedure.
After healing, I noticed that there seemed to be absolutely no difference in my appearance. I consulted the doctor and he insisted he worked on me until all of the fat in the area between the skin and abdominal wall was removed. He also suggested this may be inter-abdominal fat, but this is not the case as I can tighten my abs and a large amount of fat remains outside of it and I can feel my tight abs underneath. When I say a large amount of fat, I mean a large fistfull. I can Pinch 4-5", maybe 6. Now, when receiving lipo, everybody seems clear that you need to be careful that you should avoid gaining weight as the areas where you have lipo will not grow. However, if I gain weight my abdomen blows right up, no problem.
He agreed to examine me in person.
When he did so, he said that all of the fat in my abdomen was simply skin.
I then went to a dermatologist. I asked him his opinion on the skin on my abdomen. He said skin, almost everywhere, is no more than about a centimeter thick. I asked him if he thought I had grotesquely thick skin. He looked at me like I was nuts and said no, you have abdominal fat and lots of it. (I already knew this. Do you have any idea how silly it feels to pay a dermatologist $120 to confirm for you that you have visible abdominal fat?) So I asked him to write me for a CT scan.
I had the CT scan and the doctor reading the scans also confirmed large areas of abdominal fat. (I have these)
So I went back to the original doc with my findings, and he agreed to redo the procedure. This time he went more slowly, and took his time. I'm quite sure he was attempting to make sure he didn't do this a third time.
After the second procedure..... I looked the same!
I have seen hundreds of other lipo pictures, and in many or most there is a dramatic change in appearance, especially in men. I work out and I have what feels to be a defined abdominal wall. I have seen before pictures of men with ab fat, and after pictures where there is no fat present at all, and the muscles are showing through the skin.
So my question is, what do you think is happening here? Aqua lipo was supposed to do less tissue damage, but does it also not remove fat like it should? There is no mistaking the fact that I have a plainly visible amount of abdominal fat. This is clearly not just skin unless skin can be several inches thick. I'm beginning to think I'm the only thin person in the world that can have two lipo procedures and still be fat afterwards. One of the blog posts here even shows a doctor took out too much fat of someone else and left not enough between the skin and abs, so obviously something is going on with me, my doc, or my procedure.
Thanks for taking the time to read this.
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.
Welcome to our discussion group. Liposuction is not an alternative to losing weight. Lipo will also not tighten loose skin.
When a BMI Body Mass Calculator
comes up with overweight, then the chance the individual will still look overweight after surgery. BMI alone was not enough. Each of my patients also had Body Fat Analysis
before I made a recommendation to using Liposuction for body sculpting.
I have seen patients unhappy after surgery done elsewhere with too much left behind, too little left: skin scarred down to fascia, and variations in between. The question when I was evaluating such conditions was to establish the original problem, what was done, and what currently is going on.
The Anatomy of Stomach Skin Around the Belly Button
I built to demonstrate the nature of loose skin and fat on this central focal point. Removing normal fat, when loose skin is the distorting contour component can make for a more deflated unnatural look. This worsens as adhesions form between skin and underlying fascia when there is no fat left to lubricate the natural movement of structures.
I also evolved a series of Standard Tummy Tuck Stomach Pictures
to critically document loose skin vs fat as contour issues. Tummy Tuck Videos
were even more critical in documenting skin, vs. scar, how tissues moved issues: something I found quite important when documenting a patient coming to see me after having surgery elsewhere and unhappy about the results.
Part of surgical sculpture is judgement. When to operate and on what to operate is part of the art of this specialty. I built tools on How to Pick a Tummy Tuck Surgeon
that can be used to discuss selecting a Liposuction surgeon. A prime feature is critically looking at that specific surgeon and technique. Our How to Evaluate Tummy Tuck Pictures
can be used to evaluate someones liposuction work, which is a component of Tummy Tuck sculpture. Operate on the wrong problem with the wrong tool and failure is a likely outcome. I do not believe a manufacture's hype about their product until I see results showing how the tissues move and the path taken between the before and after (typically not shown). Unless they can match what I was achieving, and I could not find any that did, I rejected their offers to try their products. I used my Bruisiing Swelling and Recovery After Tummy Tuck
documentation which is much more extensive surgery and a measuring point to compare liposuction damaging tissue less claims. Less damaging surgical techniques should be able to demonstrate less bruising, swelling, and discomfort as well as less scarring shown with how tissues move.
A pinch test is often more valuable than a CT scan in assessing what liposuction will help. A CT scan is done on the patient's back, gravity pulls everything back. The equivalent is taking before after pictures of the abdomen with the patient lying down, not normally done and one is comparing apples and oranges for skin issues. CT scans also do not show well when there are scar adhesion issues distorting a bad result. The CT scan is static, and unless I am there in the scanner looking dynamically at the tissue during the scan, comparing it with the clinical exam, I will trust my hands on more than a CT scan in determining if I would have offered further surgery although if a patient already had a CT scan I would put that up on my viewer and use that in conjunction with my clinical exam to better understand the anatomy. You can see me performing a pinch test during this Male Chest Exam for Gynecomastia
You are welcome to post your before surgery pictures and then a standard set now. Show the extra fat by pinch test to see if it is truly fat or just excess skin, but the Standard Views are quite revealing in this factor. How does the result compare to the doctor's before and after surgery photos? How much of the contour was loose skin vs fat between the skin and external structures, where liposuction targets? After removing references to the identifying information on the CT scan, they also can be posted.
Hope this helps,
Michael Bermant, MD
Retired Plastic SurgeonLearn More About Liposuction Body Contouring