Liposculpture is more than just fat removal

Liposculpture is more than just fat removal

Liposculpture involves both fat removal and fat remodelling. It requires a specialised approach, says Australia’s chief liposuction cosmetic surgeon Dr Josef Goldbaum.

‘One of the most important aspects of superior liposculpture results is not just removing fat but sculpting it,’ he says. ‘The body is three-dimensional; it has rounded bits, flat bits, crests and curves. Because of this, I believe the best liposculpture results can only be achieved if the patient is able to be responsive and move during the procedure.’

Dr Goldbaum’s approach allows the use of small cannulas, 2, 3 or 4mm in diameter, which he says leaves next to no scarring, removes fat in a gentle manner and allows the use of local instead of general anaesthetic.

‘My technique involves the simplest system: the patient, the doctor and the cannula,’ he says. ‘I don’t use tumescent fluid during the procedure, and I don’t use energy-assisted liposuction techniques; the less unnecessary risk, the better for the patient.’

Dr Goldbaum says there are major advantages to performing liposculpture using local anaesthetic instead of general anaesthetic, the most beneficial of which is that the patient is able to move and respond to the surgeon during the procedure.

‘If the patient is lying down under general anaesthetic, they have no muscle tone, which means there are no reference points to sculpt the body three- dimensionally,’ he says. ‘This can mean uneven removal of fat and, more importantly, a higher risk of penetrating relaxed muscle.’

While the patient is sitting for most of his procedure, they are gently moved into a standing position towards the end to make sure there are no inconsistencies with the fat removal. By using only the cannula without energy assistance, Dr Goldbaum says the fat can be removed intact and atraumatically.

‘The moment you start introducing energy assistance, it changes the equation. I believe there is more risk of things going wrong – it’s the skills that create the results, not the technology,’ he says. ‘I believe that frying the fat cells with laser energy or shrinking them with ultrasound compromises the fat cells – not only to the fat being removed but also the fat which stays in the body,’ he continues. ‘This is why many patients experience fat returning some time after their procedure, because the body is repairing these damaged fat cells.’

Sometimes the problem is too much fat in some places, and not enough in others. In such cases, fat transfer can be an effective adjunct procedure when undergoing liposculpture, particularly for those who are looking for natural-looking volumisation. ‘One of the other reasons I don’t use energy assisted liposuction is to preserve the integrity of the healthy stem cells in the fat if we’re also performing fat transfer,’ he says.

His ultimate aim, Dr Goldbaum explains, is to sculpt the existing fat into a nicer shape, not melt it inconsistently for the sake of removal. ‘We have successfully reduced the size of large stomach aprons, breasts, hips, thighs, abdomen, and even harder to reach areas such as the neck and ankles.’

‘There are sometimes instances where surgery is required,’ he continues. ‘For example, if a woman has more glandular tissue than fat in her breasts, this will need to be removed surgically. However, there are many cases where women undergo a surgical breast reduction when they can simply reduce their breast size with liposuction, which involves two small nicks on either side of the breast instead of obtrusive scarring. Put simply, if there’s fat, I can remove it,’ he says.

Safety first

Dr Goldbaum’s use of local anaesthetic to numb the target areas before surgery means the risks associated with general anaesthetic are eliminated.

‘Liposuction under local anaesthetic carries minimal risks; by not using general anaesthetic we are removing any unnecessary associated complications,’ he explains. ‘With intravenous sedation there is a 1 in 50,000 mortality rate and there is a 1 in 5,000 mortality rate for liposuction under general anaesthetic. No deaths have been reported from liposculpture under local anaesthetic.’

Patients can be assured there will be little sensation in the areas to be sculpted, says Dr Goldbaum. ‘There may be slight discomfort in the form of a slight pinch every now and then, but this usually passes very quickly.’

Dr Goldbaum stresses the importance of patients researching their chosen surgeon before entering into any kind of cosmetic procedure.

‘If you don’t choose the right cosmetic surgeon you may encounter problems such as permanent lumpiness under the skin if the fat isn’t removed in a smooth manner, asymmetric finish on one or both sides of the body, not enough fat or too much fat removed and, in some cases, scarring,’ he explains. ‘These problems are often associated with inexperience, so patients should always ask to see photos of the surgeon’s results beforehand.’

‘Ninety-five percent of my patients are back at work three days after the procedure,’ Dr Goldbaum says. ‘My patients are typically able to shower and walk about the next day, can resume swimming a week or so later, and can usually go back to the gym again after a month. Of course, every patient recovers at a different pace, so patients should pay attention to how they feel before doing any kind of day-to-day activity.’

In Dr Goldbaum’s experience, most patients have found the local anaesthetic to wear off within a few hours after surgery. Patients may experience a change in sensation of their skin, which may take a month or two to come back, but Dr Goldbaum says this is a rare complication.

‘We only infiltrate as much local anaesthetic as needed, no more. It is also removed with the fat during the procedure so any residual anaesthetic is very minimal,’ he explains. ‘This also lessens the likelihood of toxicity after surgery.’

‘My aim is to create the best possible results for each of my patients, helping them achieve more balanced and streamlined proportions. Using advanced techniques, superior three-dimensional body contouring results can be achieved,’ Dr Goldbaum concludes.

Gallery: Liposculpture by Dr Goldbaum