Lipo: Dermatologist Vs. Plastic Surgeon

Question

I had a botched vaser lipo plus an unsuccessful corrective with a bleeping family dr. with a fancy laser center. Now what do I do? Someone suggested Dr. Jeff Klein (inventor of the tumescent lipo), but he is a dermatologist. Do I go to a board certified plastic surgeon or a dermatologist for attempted correction? Thanks. Any suggestions appriciated.

Kenneth D. Steinsapir, MD · Answer

If only this impression suggested by the surgeons responding to you question were true.  There is absolutely no data to say that one speciality does better liposuction surgery than another speciality.  In the USA, the specialities of dermatology and plastic surgery account for the vast majority of liposuction performed.
What is undisputed is that general plastic surgeons account for a disproprotionate number of operative deaths related to liposuction.  General plastic surgeons are much more likely than dermatologists to get sued for liposuction malpractice.  This does not mean that general plastic surgeons are less competent than dermatologist in performing liposuction.  However, general plastic surgeons are more likely to perform surgery under general anesthesia than dermatologists and this does appear to increase the risk of death from a liposuction procedure.  The risk may be as high as 10 times as great.
So if all you need is body sculpting, you have a pretty clear choice provided you are a good candidate to have liposuction under local anesthesia.  Dr. Klein would be an excellent choice as would be any of his associates.
However, if your issues are more, such as a weakness in your abdominal wall following pregnancy, a known hernia, history of profound weight loss with hanging skin, then these are conditions that are best addressed by a general plastic surgeon.

Peter D. Geldner, MD · Answer

There are many thing that could constitute a bad result following liposuction.  The solution may be more liposuction, fat transfer, or dermatolipectomies.  The point is to make the most of a bad situation.  Spend time with various doctors.  Understand the options.  A complete solution may be neither quick nor cheap.  Remember the axiom "when all you have is a hammer, all the world looks like a nail"

Armando Soto, MD, FACS · Answer

Hi there-

	I'm sorry you have learned the hard way what I try so very hard to educate my own community about...

	Regardless of the fancy machine they use, the cute name their spa has, or the marketing dollars they spend, there is simply no way that an eye doctor, gynecologist, ER doctor, or family doctor could offer you the safe and effective plastic surgical care that someone who actually spent years training in the discipline could.

	In Orlando, there are several of these types doing this to people... an eye doctor, an ER doctor, a gynecologist, and a urologist (and those are just the ones I am aware of). Between the terrible outcomes (I see patients of the eye doctor all the time, and they usually look like they were attacked by a shark) and the injuries (the ER doctor recently punctured a woman's lung doing liposuction), I cannot believe that women continue to put themselves in these people's hands.

	Better than anyone, you should have learned by now- find a surgeon certified by The American Board of Plastic Surgery.

Ron Shelton, MD · Answer

Tumescent liposuction was in fact invented by Dr. Jeffrey Klein, a dermatologist. This was a significant advance in improving the safety of liposuction. In all likelihood, extremely experienced dermatologic surgeons have performed revisional liposuction on patients that have been operated on by plastic surgeons, and vice-versa. Complications do occur to patients undergoing surgery by doctors with the best reputation, regardless of specialty. Surgery on the skin and subcutaneous tissue falls within the scope of dermatologists and surgeons. It may be very difficult to revise adverse outcomes and regardless of the surgeon you choose, you may not obtain a satisfactory result. It is very hard to comment on what type of repair you need without an examination. If you see a plastic surgeon, then if it does involve a tummy tuck or hernia revision, that they would be the correct specialty and not a dermatologic surgeon. You do need to ensure that whomever you see is extremely experienced in liposuction.

David Hansen, MD · Answer

All specialties do liposuction nowadays but you want to go to someone who you trust, feel comfortable with and has a lot of experience in liposuction.  Dermatologists tend to do most cases under local anesthesia with the micro canulas for the finesse work of sculpting the areas.  Plastic surgeons tend to do most cases under general anesthesia with larger canulas for the debulking work but can also do finesse work as well with the smaller canulas.  
It is true that a dermatologist invented the tumescent liposuction technique and have advanced the liposuction field the most of all the specialties. Dermatologists also tend to get the most required training in liposuctions during their residency of any specialty.  Board certification in Dermatology, General Plastic Surgery, Facial Plastic Surgery, etc., is important since it shows that that doc has met or exceeded the high standards required in that field.
There are a lot of gimmicky lipos out there such as ultrasound, water injected, or various laser techniques and some can be good if the doc has enough experience in that technique but the most important is your relationship with  the doc, his experience, how he answered your questions and the trust or bond you feel since he will be with you all along the way and if any touch ups are needed.

Brent Moelleken, MD · Answer

Correction of botched liposuction involves many possible procedures, including for example a tummy tuck with revisional liposuction for the unevenness and thin semi burned and discolored skin so often seen with laser procedures.
I could not imagine having such corrective surgery by anybody but a board certified plastic surgeon.

Robert L. Kraft, MD, FACS · Answer

Liposuction is a surgical procedure.  It is performed under sedation anesthesia, at minimum and, in NY, non-surgeons do not have privileges to perform such procedures in licensed facilities.  Similarly, surgeons are trained to handle complications of surgery.  I take exception to the notion that plastic surgeons are responsible for more deaths as an indictment of our skills.   We handle major surgeries as opposed to more minimal procedures.  Additionally, the anesthesiologist performs the sedation and I know few anesthesiologists who would administer sedation for a dermatologist.  Board certified plastic surgeons have at least six years of residency training devoted solely to surgery as opposed to internists who hang out a shingle, call themselves experts in cosmetic procedures because they are lucrative and place patients at risk.  Given your situation, you will need someone with expertise in surgical revision and, unfortunately, will require further surgery, pain and expense to address the consequences.

Robert Whitfield, MD · Answer

I don't know what botched means in this instance. If you have photos that would be helpful. Common complications from VASER are burns from end hit on the inside up against the dermis. Typical contour abnormalities created by staying in one area to long are fixed through scar release and fat grafting. I perform fat grafting cases routinely and this is not complicated to fix. I would certainly be happy to give you a better idea if you wish.

Steven Wallach, MD · Answer

There really is no one best doctor to perform lipsuction. You want to go to at least a well qualified dermatologist or plastic surgeon to perform the procedure.

Michelle Copeland, MD, DMD · Answer

It goes without saying that from your surgeon you want brilliance, understanding, resourcefulness, great training, the best hands and eyes in the business, and a calming manner. But you also need him or her to have professional qualifications. No matter whom you pick, your doctor should have the proper certification and experience necessary to perform liposuction. 
You should expect your doctor to be more than just aware of, but positively fluent in, such recent and dramatic advances. Above all, your doctor should be board-certified. Will your doctor be able to handle complications during surgery or the healing process, should any arise? A board-certified plastic surgeon has had years of training in the handling and sculpting of skin tissue and its healing, and may be the doctor best equipped to handle the unexpected. You also want to make sure you're having surgery at an accredited surgical facility with all board-certified anesthesiologists.

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