Jacobus A Vlok, MBChB

Your pictures are useful to help give you an idea how best to proceed. In a nutshell: 

The cellulite phenomenon is not permanently curable. Curable might not be the correct term because more ladies present with it than those that don't, therefore it can be seen as a variation of normal. More importantly is to take note that liposuction by wichever technology does not guarantee anything.

You have pockets of fat above your knee caps that are fairly straight forward to remove and that's about it. Your upper thighs responded well to the thigh lift and I do not think further liposculpting by whichever method will add benefit. 

Essentially, in my opinion, based on the photographs it is only your knees (mainly anterior and medial) that require some treatment

The chin is probably the most delicate area that we treat with liposuction and we therefore use low energy settings and thin cannulas. The more fat in the double chin that can be removed, the more significant the change in the person's profile. It can be rather dramatic and satisfying to both patient and clinician. Your age and lifestyle also contribute to a good outcome. Regarding your question about necrosis: This extremely rare phenomenon would occur with extensive burns as caused by over zealous superficial vaser at high energy and/or the liposuction stage is performed too aggressive and too superficial. Simply find a liposuctionist with experience and who had treated many chins and you will be fine. It can be a life changing experience and the result is visible to the patient every day being an exposed part of the human anatomy, the face&neck region.

Observing your age and weight I can imagine you might be best to avoid any treatment, for the time being in any case.

Bodytite alone I would usually not consider for a patient in your profile.

Cryolipo: I do not offer this treatment but I have over the past 18 months treated at least seven patients for complications after cryolipolysis (asymmetry, dents, lumps and bumps). After cryolipo the sub-dermal layer becomes very dense, fibrotic and resistant to vaser and cannulas.  A straight forward process can then become very difficult in  reaching  the desired end point.

I have treated patients in your profile who wanted a bit more definition of the abdomen with vaser and micro cannulas but you also have to take note that we work with what the patients have on offer regarding fat content as well as muscle tone and fitness. It becomes a cost benefit issue especially if the post op change is subtle.

Bodytite as a stand alone treatment is rather rare in our clinic. The areas that are susceptible to Bodytite   (a technology driven by radio frequency) especially when used in conjunction with liposuction are the chin/ neck region, the inner thighs and the lower abdomen.

Recovery is rather quick and depends on the age, gender and anatomical region treated. Compression garments are not an exact science. Duration and extent will be prescribed by the treating clinician.

The picture indicates you might have just too much excessive skin for a 'stand alone' liposuction treatment whether by Vaser or any power assisted method. The principal to treat arms like yours is to be able to help the patient by minimal invasion as we do with liposuction  through tiny incisions and using fine specialist instruments. Obviously surgical skin removal will give the most dramatic result unfortunately with significant scarring. There is always room for a combination of treatments, surgical excision of excess skin with liposuction, simultaneously or in different phases. You might therefore consider the liposuction route initially, and know that if the skin is not retracting to your satisfaction excision of the excessive skin can then be considered.

We have to consider skin tone and the quantity of residual fat in your area of concern, the upper arms, when planning the optimal treatment.

Your options are as follows: (based on the picture)

1. Standard vaser followed by liposuction. 2. Add Bodytite to further improve skin tightening. 3 Surgical removal of excess skin, with or without 1.. The only way to make the final decision is a clinical examination. Increasing muscle tone by isometric exercise is alway a good thing. It is important to see a practitioner who has extensive experience in treating arms because the outcome can sometimes be slightly unpredictable.

Liposuction by Vaser will give some skin tightening but it also depends on skin quality, skin tone, age and gender. Different anatomical regions also react differently. Vaser is simply used to 'loosen' the fat globules by tunnelling and the application of ultrasonic energy in to the subdermal layer. After the vaser stage the fat can be extracted in a more gentle way with less bruising and trauma to the patient, and ensure a quicker recovery. The skin tightening with Vaser can be described as good 'side effect' of the process of lipoaspiration.

We occasionally in selected patients add Bodytite to improve skin tone. 

You have to be aware that previous liposuction (and cryolipolysis) treatment of the area will cause fibrosis and make further treatment difficult if not impossible. 

Vaser liposuction is a technique essentially to remove fat and the trauma to the subdermal layer will give a degree of skin tightening. The more fat is removed the more dramatic the change in appearance

Wearing a band around the head: We advise out patients to wear it for three days, day and night followed by 10 nights. It helps to prevent haematoma and initiates the skin to redrape onto the platysma. 

Fitness toning and healthy living are extremely important in achieving a satisfactory outcome. The removal of fatty tissue based on your anatomical template will reveal what you already have.

In my experience it is best to wait until 6-8 months have passed since the initial vaser liposuction procedure before considering touchup/revision surgery. Your skin appears good and you should therefore be suitable for further surgery. Looking at the photograph I do not see any indication of over resection of adipose tissue which is good, improving your chances for a satisfactory outcome. You will have to find a very experienced liposuctionist to help and the equipment in use is also rather important.