Metamorphosis Myths

Navigating laser lipo without getting sucked in

By Nancy Yang

Cold hearted orb that rules the night
Removes the colors from our sight 
Red is gray and yellow white
But we decide which is right
And which is an Illusion?
—From “Late Lament,” by Graeme Edge of the Moody Blues

The female form has remained a source of mystery and wonder since the beginning of humankind. Plato tried to quantify it with his formula for golden proportions, artists considered it a sign of virtue, and legend credits a beautiful woman for launching the Trojan War. In Greek mythology, Pygmalion, the king of Cyprus, was a confirmed bachelor until he sculpted a woman from stone and fell in love with its pleasing proportions. Talk about a hard body.

Welcome to the modern age, where the stuff of legend lives on, blurring the ever-changing line between natural beauty and manmade substitutes. Gyms offer classes in body sculpting, undergarments “spank” away unwanted bulges, jeans enhance the derriere, and practitioners of all shapes and sizes make promises of mythic proportions.

Take liposuction. I’ve always wondered whether vacuuming localized fat cells could affect lasting change, a final victory in the battle of the bulge — a metamorphosis. Can plastic surgeons, like modern-day Pygmalions, create statuesque bodies of golden proportions? Do lasers enhance the procedure? Recently, I had a chance to see for myself.  

I was invited to watch a plastic surgeon from St. Louis, who along with two representatives from a medical equipment company, performed laser-assisted liposuction on a woman in her 30s. She was the perfect candidate. She exercised regularly, was young enough to have good skin elasticity and appeared slender everywhere except around her waist. No one in Columbia was using this particular laser for lipo, so I was — ahem — sucked right in. 

“In general with liposuction there’s some blood loss, but the laser decreases bleeding because it causes the vessels to coagulate,” said the surgeon as he wielded a laser needle that looked like a long magic wand. We were wearing sunglasses to protect against the unlikely event that the laser beam reached someone’s retina. Through the colored lens, I watched the surgeon jab and poke at the patient’s stomach, which had been numbed with local anesthesia. The surgeon brandished another wand-like instrument called a cannula, the workhorse of liposuction, and once again poked and jabbed around the patient’s midsection. 

 “You can feel some of the fat coming out,” he said about 40 minutes into the procedure. Globs of blood-tinged and liquefied fat squirted through a tube, dropping into a clear canister. I watched the patient curl her toes when the jabbing got intense. Over time the contour of her waist seemed to change before my eyes, and the surgeon used a “feathering” technique to create a smooth transition between the treated and non-treated areas. In total, he removed about 400 milliliters of fat in about an hour, and he and the patient seemed delighted with the results. “I was going to stop by Kwik Trip and buy you a six pack,” he quipped. 

The surgeon provided the stats. The bulk of the healing would occur over six weeks, and thanks to the laser technology, the patient could expect tightening of the skin and additional slimming down over a year. She might even drop a pant size, he said, emphasizing that the procedure is no substitute for weight loss. “It’s more about inches and overall contour,” he said. “If a person says they’ve been exercising like crazy, but when they lose weight, it’s all over, or that they want to look like Britney Spears, it’s a red flag.” 

I was looking for a few red flags of my own. Although the surgery might have gone well, and the patient seemed thrilled with the results initially, I wanted to know whether laser technology held any advantages over traditional liposuction. How do the claims of less trauma and blood loss, tighter skin, shorter down time and lower cost hold up? When I got home, I called some local plastic surgeons and physicians. 

“Every week there’s a newfangled gimmick,” said Charles Lin Puckett, professor and chief of Plastic and Reconstructive Surgery at the University of Missouri. “Classic liposuction is still about as effective as you can get. We look at the data. Research says there’s nothing at this moment that has any exciting advantage aside from possibly making the procedure easier for the surgeon.” 

Matt Concannon, a reconstructive and plastic surgeon, took issue with the claim of less blood loss and trauma, describing his traditional outpatient approach this way: “My aspirate is yellow. (Mostly fat with only a little bit of blood.) This is not due to the liposuction machine used, but is a result of the fluid injection into the area.” He said that all types of liposuction, laser assisted or not, employ a standard technique known as tumescent liposuction that involves a local anesthetic and an agent that contracts the small blood vessels. 

In reference to laser’s skin tightening advantages, he explained that skin adjusts to new contours on its own; it shrinks to fit naturally. Finally, the charge that laser lipo costs less because it’s an outpatient procedure is misleading, he said, because traditional procedures are also done this way. “I’ve never felt the urge to be chasing all these new methods because traditional lipo works just fine.”

Concannon referred me to a patient of his who had traditional liposuction about a year ago. She was a fitness instructor who carried weight in her legs and rarely found pants that fit. “It’s not like I hadn’t tried,” she said, explaining that heredity was responsible for what she called saddle bags. The procedure allowed her to look and feel better in her clothes, enhancing her self-confidence from the outside in.  “It’s not about size,” she said, voicing her preference for capri pants over shorts. “It’s all about overall health and well-being.” 

John DeSpain, MD, a dermatologist and medical director of the Skintuition Medical Spa, concurred with the focus of a healthy lifestyle and cautioned about jumping on the laser-lipo bandwagon. “These companies have approached me, and their common pitch is that you can make an awful lot of money,” he said. His practice includes procedures involving the skin for which he has trained extensively. He does not perform liposuction. 

 “Sometimes it’s hard to sort through the hype, which can create a terrible, unethical slant on medical care,” said plastic and reconstructive surgeon Greg Croll during an interview last fall. “It’s like the old snake oil salesmen.” There’s an art to being a physician that involves listening and observation, he said, adding that physicians need to be sensitive to patients who come in with unrealistic expectations.

“It’s hard to stay above the fray,” said Barbara Howard, a cosmetic surgeon who practices in Jefferson City. “Medicines and gadgets don’t always do what they say. It’s often more about the marketing than science.” Howard suggested that baby boomers, who have the money, are of the age and are looking for a quick fix, drive the influx of technologies and procedures. She also let me in on a dirty little secret. Although the FDA approves new technology based on effectiveness and safety, it’s up to the doctor and patients to decide whether it’s up to snuff. (Apparently, the FDA doesn’t require the strict level of testing for medical devices that it does for drugs.) 

“Sometimes the scientific integrity of the data is weak, and the actual reported effectiveness is less than we’d personally deem acceptable,” Howard said. “For example, if you were interested in a skin-tightening laser, would you feel that a 20 percent improvement was enough? It is not the FDA’s job to set a percentage improvement. I believe the inventors just have to show a statistically significant change. This may be a small amount relative to our expectations and desires.”

What Howard and the others are saying is buyer beware. Loopholes exist, in spite of ethical standards and other medical safeguards, and patients need to be savvy consumers, especially with elective surgery. She recommended checking out the following: 

• American Board of Medical Specialists, the umbrella organization for the American Board of Plastic Surgeons. Certification through this organization is the gold standard. If your physician is not certified through this body, you should find out why. 

• Plasticsurgery.org, the Web site for the American Society of Plastic Surgeons. Members have more than six years of surgical training and experience and at least three years in plastic surgery, and the site includes photos, safety information, resources for planning surgery and more.

• Missouri Board of Healing Arts can tell you how long a doctor has been in practice and whether he or she has received disciplinary actions. If you have a complaint about a physician, you can file it here. 

Concannon advised talking with a couple of surgeons to find the best patient-doctor mesh. He suggested gathering as much information about a physician as possible, directing me to a questionnaire on his Web site (see sidebar). “You’re interviewing the doctor as much as they’re interviewing you,” he said.

“There’s increased competition in cosmetic surgery; a lot of non-surgeons are joining in,” said Puckett, who as professor and chief at the University School of Medicine has trained Croll and Concannon. “If it seems too good to be true, it
probably is.” 

Finding the right plastic surgeon for you.

The following is part of a questionnaire available on Dr. Matthew Concannon’s web site:  www.concannon.info, borrowed with permission from www.yestheyrefake.com.  Click on “Q&A” to download the complete questionnaire.

1. What made you decide to become a Cosmetic Plastic Surgeon?

2. How long have you been practicing as a Cosmetic Plastic Surgeon?

3. Are you certified by the American Board of Plastic Surgery?  If so, for how long? 

4. If you are not certified by the ABPS, why not?  Are you Board eligible? 

5. What, if anything, was your medical specialty before you chose to practice Cosmetic Plastic surgery?

6. Have you ever been disciplined by a board or by the state?

7. Have you been involved in any medical malpractice suits? If so, how many?

8. What is your favorite procedure to perform and why?

10. How many of this type of procedure have you performed?

11. How many revisions of your own work, on average, do you perform?

12. Have you or would you be willing to perform this procedure on a loved one or family member?

13. Would there be any reason that I would not be a good candidate for this surgery?

14. What are the complications for this particular procedure?

15. I have heard of patients developing a hematoma, this scares me; what is it, how often does it occur and how is it dealt with?

16. Are there other techniques, newer ones perhaps, that I am not aware of?

17. Do you have a video tape available of the procedure that I may check out?

18. How long do you recommend I take off from work, school, etc. to heal properly?

19. Will there be much pain?

20. What types of medications will I be given and which pain medications do you normally prescribe?

21. I am sensitive to Vicodin and Codeine (it makes some people nauseated), what alternative medications do you offer? (if applicable)

22. Do you perform your surgeries with the patient under General, Light Sleep Sedation or any other? Which do you prefer and why?

23. I have heard that general anesthesia makes the patient sick to their stomach, is this true? What can you do to lessen its effect?

24. Can I view your Before & After photos? Do you have any consecutive collections?

25. May I speak with any of your patients who have had [insert procedure here]? Do you have a patient/referral list so that I may call them?

26. Do you have many repeat patients and referrals?

27. How many of these procedures do you perform on average, annually?

28. Will there be much bruising or swelling?

29. When should I expect to look “normal” again?

30. Will I have scarring? If so, how bad will it be?