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Basics trump 'bells and whistles' in lipoplasty, body contouring


Charles E. Hughes, III M.D
Indianapolis — Cosmetic surgeons use lipoplasty and body contouring to help patients achieve their ideal shape. In an ironic twist, they continually tweak the procedures in an attempt to achieve the ideal technique. But this quest for new and better — whether in cannula tips or suture size — can overshadow that which is truly important, according to Charles E. Hughes, III M.D., chairman of the American Society of Aesthetic Plastic Surgeons' Body Contouring Committee.

"What's new in lipoplasty and body contouring is irrelevant without sufficient observance of what's old," says Dr. Hughes, who is in private practice at the Indianapolis Institute for Plastic Surgery.

"Concentrating on the bells and whistles at the expense of the basics is like having a cutting-edge navigation system in a jalopy," he tells Cosmetic Surgery Times.

Lipoplasty has been the most frequently requested cosmetic surgery in the United States for several years, and body contouring, with its ability to complement lipoplasty or stand alone, can't be far behind.

Patient is shown before (above) and after lipoplasty of the upper arm. Immediately following the removal of 120 cc of fat, multiple passes of ThermaCool were circumferentially applied to tighten the skin of the upper arm. (Photos: Charles E. Hughes III, M.D.
Dr. Hughes points out that most modern-day body contouring emerged from the teachings of Professor Gerand Illouz, M.D., of Paris, who is considered one of the innovators of lipoplasty. Unfortunately, he adds, Dr. Illouz' basic tenets are often forgotten.

"I'm often called upon to consult on sub-optimal lipoplasty or body contouring outcomes. I get pictures from surgeons who say, 'I did this procedure, and I'm not happy with the result and neither is the patient. What should I do now?' And almost invariably, just by looking at the photo, I can identify which of Dr. Illouz' principles had been ignored. We have to remain committed to the basics to get the excellent results possible with today's techniques," he says.

Safety first "Safety first" was Professor Illouz' credo, and Dr. Hughes says it can't be emphasized enough.

"Obviously that's true of any surgical procedure, but unfortunately it's getting lost in all the 'extreme makeover'-type hype," he says.

"As the Body Contouring Committee chair, I see the morbid aspects of this trend. I see the major complications and the deaths, and invariably the vast majority come down to patient selection, or, more specifically, doing a procedure on a patient that is greater than that patient's medical condition would allow," he says. "Sure, the death rate is under 1 percent, but the problem is that for cosmetic surgery, it should be zero."

Treat tissue gently "Your aim should be to simply make tunnels. Once the honeycombs are made, you can allow things to collapse. I've seen liposuction performed on television programs on the Discovery Channel and it looks like a horribly brutal procedure, and it shouldn't be. You really have to be gentle with the tissue, you have to respect the surface areas of the superficial layers," he says.

"In successful lipoplasty, what we're doing is taking advantage of skin retraction, which is something that often in plastic surgery we fight. As plastic surgeons, we have considerable knowledge of how to deal with scar contractures, and here we have the opportunity to take advantage of that because the skin shrinks back to fit the new contour that we've created, as the honeycomb–like spaces collapse," he explains.

Careful patient selection and gentle treatment of tissue contribute to excellent outcomes. Knowing when enough is enough does, too.


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