AirSculpt - Seattle

From the photos you submitted, it is clear that you do have some skin laxity, but not enough that you would have to worry about having a fold of skin overhanging your waistline after liposuction of any kind, in my opinion.  An individual's skin-tightening response to liposuction of any kind can be difficult to predict.  Some people will get a great response, even without any additional energy based treatment to the skin, such as the laser energy used in a SmartLipo procedure.  Other individuals, will get little to no response to anything we do and it is very difficult to predict.  I do believe that the addition of heat energy to a liposuction procedure will enhance whatever skin-tightening effect you would have had without it.  SmartLipo is one brand among many that can give great skin-tightening results.  In addition to laser energy, the energy sources of mechanical ultrasonic vibration, ultrasound energy, radiofrequency energy, and plasma energy are all currently in use today.  More important than the brand of device is the skill and experience of the surgeon.  In skilled hands, you can expect to get an excellent result without need for skin excision, but you will just have to be willing to accept some degree of persistent skin laxity.  This may manifest as what I call a "frowny-face belly button" or wavy, "crinkly" skin below the belly button.  The only sure way to get rid of those is with skin excision: tummy tuck or even a "mini" tummy tuck, where only the skin from the pubis to about half-way up to the belly button is removed (much faster recovery and can be awake).   I hope this was helpful - best of luck!

Thanks for your question and photos.  I do see what you are referring to and, to me, it appears that you may have a little bit more fat at the jowl of the right cheek.  Another factor is that you may actually be naturally asymmetrical - almost everyone is.  It is very rare that one side is a mirror image of the other; in fact, if you play around with some of the photo editing programs, you can actually cut your face in half and flip around one of the halves and make a new image of yourself with "two left sides" (or two right sides) - most people look really weird like that (except super models).  Assuming that you are not asymmetrical and that this is an asymmetry caused by the surgeon taking a little more fat from one side than the other, then there are several ways to correct this.  If you came to see me at my office, I would recommend InstaLift sutures to give your cheeks and jowls a slight lift, which would make your jawline less "square" looking and, if that is actually a little blob (medical terminology) of fat on the right, I would recommend dissolving it with Kybella.  Some fillers in the midface and cheeks would also give you some more lift and create a more youthful "V" shaped face.

Thank you for your question; it's a bit of a "loaded" one, in that there really is not a definite answer.  Most liposuction cases on appropriate patients result in removal of 1-3 liters of fat.  Of course, the amount will depend upon many variables: the BMI of the patient, the amount of subcutaneous fat (as opposed to visceral fat, which cannot be liposuctioned), present, the total surface area of the body being treated, and the aggressiveness of the surgeon.  "More" does not equal "better."  I tell all my patients that my goal is to get it "just right" the first time; but if I had to make an error, I would rather leave too much fat behind than to take out too much.  One can always take a little more out, but if you're left with unnatural-appearing divots, ruts, and indentations in the treated area, that is nearly impossible to totally "fix" and is not an easy thing to do.  With that said, I cannot tell you if 4 liters is going to be too much.  From your description of yourself as 6' tall and 179, that seems like more than I would expect.  Maybe it was 4 liters of total aspirate? ("Aspirate" means, "all stuff that is sucked out," which includes fat, numbing fluid, and a little blood.)  The fat settles on top of the fluid and blood, because it is lighter and floats on the watery component of the aspirate.  In most cases, the fat portion of the aspirate is approximately double the fluid volume, but this is quite variable from one patient to the next.  In some patients, I will get almost 100% fat and very little fluid (I love it when that happens!), whereas in others, it can be 80% fluid and 20% fat.  The latter can be frustrating for both patients and doctors and has to do with how fibrous or "tightly-held" the fat is.  This is mostly a function of genetics, but I have also found that younger patients, male patients, and more physically-fit patients tend to have more fibrous fat.  The same is true of those who have had previous liposuction of the area being treated, due to scar tissue (just another form of tough collagen fibers that trap the fat).  I would bet that the 4 liters refers to total aspirate, but maybe not.  Time will tell - you will be swollen for several months, so it will not be until the swelling subsides that you will know if you were "overdone."  If you had an experienced surgeon, who does many of these cases, then most likely, you will look great.  Keep us posted with follow up photos, please.

Thanks for the question and photo.  I am sorry you did not get the results you were looking for.  As you point out in your question, your abdomen has many hills and valleys, or "contour irregularities."  This can happen with any liposuction system on the market and occurs for several reasons.  If the results always looked like this (even from 1 month post-operative), then it is likely that the remaining fat layer was not smooth and even to begin with.  If this is something that has become worse in recent months, then it could be from a change in weight since the procedure.  Either weight gain or weight loss can make irregularities worse, because small differences in the thickness of the fat layer become exaggerated with weight gain (or loss), as the fat cells remaining will enlarge.  Therefore, where you have a thicker layer of fat to begin with; with weight gain, it gets even thicker.  Another factor that can compound this is skin laxity, which can result from pregnancy or massive weight loss, or just time, gravity, and genetics.  Skin with stretch marks usually will not contract well, or will contract better in some areas and worse in others.  This can also give the appearance of contour irregularities, even where the fat layer is smooth and even.  One of the advantages of Vaser over other types of liposuction, is that by emulsifying the fat with the Vaser before performing liposuction, the risk of contour irregularities is reduced.

So, how do you get rid of this look?  I have had a lot of experience in revising liposuction messes from other doctors and I will tell you that it is unlikely that this can be 100% "fixed," or smoothed out so that you have none of those hills and valleys, but it can definitely be improved.  You will get different opinions from different surgeons, but here is how I would go about it:  I would basically repeat the abdominal liposuction, only without the suction part - and Vaser is great for this - but with the goal of not removing fat, but liquifying it and maybe removing a small amount sterilely, so that it can be re-injected into the deeper valleys.  I would recommend following that up with something for skin tightening.  In my office, we use Thermi250, but there are other devices that can do this.