African American Fat Removed from Abdomen and Skin Tightening

Question

I am African American and I'm interested in getting fat removed from my upper and lower abdomen. I have had two pregnancies and was left with stretch marks and small pooch. I was told by one physicians that I am a candidate for the Smart Lipo and another told me that the Vaser would be better. I am concerned about skin tightening, so do you find Vaser with Smart Lipo, Vaser with Refirme, or Smart Lipo alone will achieve the  best results?

Steven Teitelbaum, MD · Answer

No one can answer this question without examining you and forcing you to define your expectations.  But this much I can tell you:
All any type of liposuction can guarantee is a removal of fat.  Period.  No method of liposuction has been demonstrated to produce a notable tighening of skin.  In fact, by removing "the stuffing," sometimes the skin looks looser after even the best performed liposuction.  And this problems is particularly an issue with the slightly loose, post-pregnancy stomach, with stretch marks as you describd in yourself.
Between VASER and SmartLipo, it is easy to suggest VASER.  SmartLipo is widely acknowledged as a marketing gimmick, unpublished and not subjected to objective scrutiny. On the other hand, VASER is a bonafide and respected technique,  has been published, and has a following of quite a few very respected plastic surgeons.
If you want to truly see tightening, then you need to be ready to consider some type of a tummy tuck (abdominoplasty.)  That is the only method that will really tighten skin (thought it comes at the expense of a scar.)  Depending upon how loose your skin is, liposuction alone of the abdomen is often disappointing.  And all the laser/radiofrequency newfangled state-of-the-art highly priced "non-invasive" skin tightening procedures are just hocus pocus when it comes to skin tightening.  If you don't believe me, demand that the doctor suggesting the technique show you 1) published articles in legitimate journals and 2) objectively taken photographs of their own work that unequivocally demonstrate the result you seek.
 
Good Luck.  Be sure to avoid the unsubstantiated promises!

Robert L. Kraft, MD, FACS · Answer

Depending on the condition of your abdomen, you could be a viable candidate for liposuction, mini tuck or an abdominoplasty so a personalized consultation would be necessary to provide you with options.   There has not yet been a body of sufficient research on the efficacy of the skin tightening methods you refer to in African American patients so I would regard any representations about their applicability to you with a healthy degree of skepticism at this time.  Thanks for this excellent question!

Peter A. Aldea, MD · Answer

Pregnancy caused PERMANENT stretching of the muscles of the tummy AND of the skin with the maximal stretch in both being in the area of the belly button.
Although Liposuction will remove fat, it cannot and will NEVER APRRECIABLY TIGHTEN SKIN (especiall stretch marks damaged skin). Despite all the bogus glitzy ads out there pushing a variety of devices - none of them will appreciably tighten the skin (this includes Laser Lipo - SmartLipo etc) not tighten the stretched out and split tummy muscles. 
The ONLY way to flatten the tummy, narrow the waist, lift a sagging Mons pubis is to have a properly done FULL Tummy Tuck in which the stretched muscles are "taken in" - plicated (IE "muscle repair") and the damaged excess lower tummy skin is removed.
I suspect you would benefit and do much better with a full tummy tuck than a gimmicky laser or laser lipo procedure.
Good Luck.
Dr. P. Aldea

Steven Wallach, MD · Answer

Loose skin and multiple stretch marks will not improve with Vaser /smartlipo/ etc.. It sounds like you may need a tummy tuck. Go to a qualified plastic surgeon to be evaluated. A tummy tuck will remove many stretch marks below the umbilicus and tighten the abdominal wall.

Christine A. Petti, MD · Answer

Your description of your "belly" is a common scenario for most women after pregnancy.  However, you will need a complete consultation for liposuction versus other surgical options, such as a full abdominoplasty (a "tummy tuck"-involving both the upper and lower abdominal skin/subcutaneous tissue and complete rectus and possible oblique abdominal muscle support/repair) or a "lower" or "mini" abdominoplasty ( a surgical procedure which involves dissection of the lower abdominal skin/subcutaneous tissue, below the belly buttom, and a partial repair of the lower rectus muscles).  These are the main options for you and most women following pregnancy or weight loss-conditions which affect the skin, subcutaneous adipose tissue and the muscles of the abdominal wall.  
Your candidacy will require a complete history, review of your medical health in general, and a complete examination of all anatomical aspects of your abdomen (skin, fat, muscle, surgical scars, check for hernias and abdominal wall tone).  All types of liposuction may be of benefit to you.  Most surgeons have a technique that they feel they are adept at performing and gives the best results to their patients.  
These options can include techniques that involve tumescent liposuction along with forms of energy that are used to help melt and sculpt the fatty tissues for improved and predictable outcomes.  In my practice, over the course of my plastic surgery residency training and private practice in Los Angeles, I have used tradtional liposuction (liposuction with vacuum assisted cannula liposuction alone, ultrasonic liposuction and laser-assisted liposuction (Smartlipo MPX).  
There are other types of laser-assisted liposuction, including VASER.  For the past year, I have used Smartlipo MPX and I have been very satisfied with the outcomes, and have observed improved and predicable body sculpting results, including skin tightening.  Most recently, there have been scientific peer-review published studies by reputable plastic surgeons in the United States, who have had tremendous experience with both liposuction and laser surgery, that have demonstrated skin tightening with Smartlipo MPX using very specific techniques that methodically treat small segments of the skin, heating them to defined temperatures that allow for interaction with dermal collagen -- and -- skin tightening and shrinkage have been documented.  
Another advantage of Smartlipo MPX is that it can be performed under local anesthesia.  I have found this type of  liposuction techinque, ie., Smartlipo MPX, to be very safe and patients can return to their normal life, work and activities of daily living, because only limited amounts of liposuction (1 or 2 anatomic areas-for example, abdomen and hips, or just arms, or arms and neck) can be performed.  This is because the amount of numbing medication-lidocaine- that is given, is based on the patient's kilogram body weight and there is a definite limit to the amount of lidocaine and therefore a limited body surface area that can be "numbed" to permit liposuction.  Blood loss is minimal, both because the amount of liposuction is limited and another benefit of the laser is that is coagulates the blood vessels, so there is much less blood loss, bruising and swelling.   
In my practice, I have never chosen a piece of equipment to assist me with surgery on the basis of marketing, or as a "gimmick".  Each machine or technological advancement that I use has to have a real effect, has to make a difference, and has to be backed by research and development and clinical studies.  I have had extensive experience with laser surgery since 1994, and I am very comfortable with lasers, but they have to produce outcomes, or else they will not be of benefit to me or to my patients.  
Not all surgeons are comfortable with all techniques and especially lasers, so each surgeon must chose what works best for him or her andbe confident with that technique and execute it well to produce the best outcome for their individual patients.  Each surgeon who has experience in liposuction, will be comfortable with their specific technique, so you do not have to base your decision -- on a particular technique.   What is most important is that you base your decision on the surgeon-- his or her  board certification, credentials, experience, knowledge, informed consent, outcomes, concern for safety, "bedside" skills and honesty.  These factors are of utmost importance.  If you find a surgeon with the best credentials, experience, ethics, and technical skills,and concern for your safey and outcome,  you will make a good choice and your outcome should be most predictable and successful.

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