Question: I would like to lose 40 pounds. Will liposuction help?

No.  Liposuction is not a diet plan.  Liposuction does remove unwanted fat in certain areas of the body, but it cannot simply remove 10, 20, or 30 pounds.  Diet and exercise are the only real ways to lose that much weight.  Liposuction is a great option for those stubborn areas of unwanted fat that diet and exercise fail.  Liposuction can help to boost this process, but the patient needs to be on a diet and exercise program to fully achieve their goals.

Even after liposuction is performed, patients are advised to maintain a healthy lifestyle to maintain their results. Liposuction can be a very rewarding procedure but those rewards depend on your compliance and commitment to yourself.

Read more about liposuction and view before and after photos.


The Challenges Created by Laser Liposuction by Paul Howard MD

Laser liposuction is the latest of a long line of medical products marketed to physicians and simultaneously to patients leading to a situation where patients are seeking procedures touted by the companies who make the machines.  In fact, a major aspect of the sales pitch to physicians includes a national marketing campaign and the promise of directing patients to the physician through the national marketing campaign.  The marketing assumption is that liposuction is innocuous, everyone is a candidate and laser liposuction is the state-of-the-art for fat reduction.  The sales pitch to physicians does not include a credential check, nor any kind of surgical credential questioning.  In other words, these companies continue to sell a very dangerous surgical implement to almost anyone with the money, without appropriate training and without any previous liposuction experience.  Since many of the purchasers are sold on ridiculously optimistic marketing projections, trying to justify the huge capital expense for  a machine with a less than two year technological window.  It is very easy to understand why there are intense pressures on the physician/owners to relax whatever indications that may exist for laser liposuction.  Unfortunately, many of these physician/owners are not Plastic Surgeons, do not have the depth of knowledge nor experience to loosen the indications for liposuction.  Furthermore, a real surgical procedure that has an implicit set of complications due to the laser technology in the hands of possibly inexperienced operators has led to an astounding array of skin and contour problems that have proven difficult to repair even for the most gifted board certified Plastic Surgeons.  There has become a cottage industry of complicated cases that need the attention of our best surgeons as the inexperienced laser liposuction physicians cannot be expected to find solutions for the difficult problems they have created.

Read more about top plastic surgeon Dr. Paul Howard in Birmingham, Alabama.


Tummy Fat – More Than Just the Middle-Aged Spread

The biology of adipose (fat) tissue has recently become an important topic for research especially as it relates to the aging process and hormonal imbalance.  Much has been made recently of using liposuction as a possible treatment for diabetes mellitus type 2 as well as a proposed treatment for high cholesterol and hyperlipidemia.  Even though the research has been effective there is simply no evidence that reducing body fat by liposuction in any way effects blood sugar, insulin, or blood lipid profiles even though it is shown that a significant reduction in external body fat can be achieved with high volume liposuction procedures.  It only makes sense that there must be hormonally and biologically active adipose tissue in parts of the body not accessible with liposuction.  It remains true that when diet and exercise are used for fat/weight reduction one does get an improvement in overall health as well as overall blood chemistry profile.  To reconcile these facts one only has to know that there is a vast store of biologically active fat located within the abdominal cavity known as visceral fat.  Visceral fat is that adipose tissue located around the abdominal organs such as the liver, pancreas, adrenal glands, and kidneys.  As such it is not available for mechanical removal by liposuction and can only be addressed through diet and exercise.  It has been shown that visceral fat is very sensitive to exercise including weight training.  It’s a little uncertain as to the teleological reasoning for the existence of visceral fat, but it seems clear that there is a genetic component as well as a lift-style component to visceral fat.  Visceral fat has been linked to certain metabolic disturbances and an increased risk for cardiovascular disease, type 2 diabetes, and gall bladder disease.

How do we tell the difference between visceral fat and the subcutaneous fat associated with a “fat stomach” or the middle aged spread?  As a rule, subcutaneous fat can be pinched between the fingers while the visceral fat causes the stomach to be round but cannot be pinched.  In fact, one of the reasons for unhappy liposuction patients is that this distinction between subcutaneous fat which can be liposuctioned and visceral fat which cannot be removed is not made clear to patients pre-operatively.  We do ask all of our liposuction patients to diet and exercise post-operatively so an improvement in abdominal shape should follow as visceral fat will be improved by exercise and diet alone.

The complexity of adipose tissue is just now being totally realized including the fact that adult adipose tissue is the body’s largest repository for multi-potent stem cells.

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Will the Fat come back after it is removed?

Plastic Surgery Myth: Once Fat is removed it won’t come back. If it does come back, it will come back in other places.

True but false! Yes, the fat is removed permanently, but liposuction does not alter the human body genetics. Fat can come back if you do not maintain proper diet and exercise. Maintaining your liposuction results is key to a great outcome. The surgeon can remove the fat, but you must also be devoted to keeping it off. If you continue to have a poor diet after liposuction, you can still gain weight, and even gain the weight back where you had liposuction. Again, liposuction does not alter your DNA, it just removes fat cells. Patients need to understand that as we age, our metabolism slows down. The older we get, the harder it is for us to lose those additional inches. That is why liposuction can be so wonderful. But, you must still maintain a healthy diet and exercise program.

Read more about liposuction and top plastic surgeon Dr. Paul Howard in Birmingham, Alabama.

Am I a candidate for Liposuction?

Liposuction is designed for removing unwanted fat and to achieve mild skin tightening.  The ideal candidate is in good health and normal body weight. Liposuction is not a weight loss program, but rather an ideal procedure to contour the body of unwanted areas of fat that diet and exercise fail to address. To see if you are a candidate for liposuction, please refer to our Body Mass Index Chart:

Body Mass Index Chart by Dr. Paul S. Howard


Read more about the benefits of liposuction and view before/after photos.

Revision Liposuction Surgery

Liposuction is the most commonly performed surgical procedure in the world and has been for at least the last 10 years. The methodology has changed since its inception in the 1970’s, but the results achieved have remained good through the years. The use of tumescent fluid was an important change making the procedure available to more patients as an office procedure not requiring general anesthesia. Liposculpture evolved to accommodate a wider variety of patients and their requests. Liposculpture, or superficial liposuction, allowed better body contouring for them without large fat deposits. Ultrasonic and laser have been used more recently to facilitate fat removal with less pain and swelling with the hope that superficial lower wattage lasers could be used beneath the skin to effect skin shrinkage and tightening. As with many extensively marketed technologies, the hype for skin tightening seems over sold and is being shown to be minimal at best.

Billions of dollars have been invested in these new liposuction technologies requiring extensive and exaggerated claims of the benefits of each new liposuction “platform.” As with the pharmaceutical industry, these machines are being marketed directly to the potential patients as well as to the physicians performing liposuction. It is smart marketing to increase the target physician pool of possible purchasers by taking advantage of the gray areas of credentialing and market this expensive, complex, and even dangerous technology to doctors who are untrained but not forbidden to do liposuction. Most manufacturers have catchy names for their products and encourage physicians who buy these machines to “cross market” by using their trademarked name taking advantage of any branding the company may have achieved to cross over to the physician’s practice. It seems very clear that these companies will sell this sophisticated technology to ANY physician who can afford the price.

There are two constraints in the technical evolution of liposuction. The most important with respect to complications is that each successive iteration, while minimally improving results, has increased the complexity and therefore the danger of the procedure. So called “large volume liposuction” evolved due to the tumescent technologies and now is probably the number one cause of plastic surgery fatalities in the world. Performing liposuction more aggressively by attacking the more superficial fat deposits has led to a spate of contour and skin deformities including full thickness skin burns with the laser liposuction. It seems that we see, more recently, complications associated with damage to deeper structures such as fascia, muscle, and even peritoneal penetration. The irony is that as liposuction has progressed to a more complicated procedure, the number of physicians performing liposuction that are NOT plastic surgical trained, or not even surgically trained is exploding. Whereby the least experienced most poorly trained doctors are using the newest, most complicated and most dangerous technologies. To a certain extent, the public is at fault as many seek plastic surgical services through marketing and ad campaigns that are artfully done, impressive, and deceptive. First and foremost, it must be understood that liposuction is a real surgical procedure with real complications and can lead to real disasters. To search out the least of us to perform a potentially dangerous procedure in an office setting is asking for trouble and that seems to be what is occurring. It is no different and makes no common sense to price shop liposuction and not open-heart surgery or brain surgery.

The second constant with liposuction technical evolution is that the newer, most complicated, and advanced technology leads to the most challenging and even devastating problems. It appears that the least of us, while utilizing complex technology for marketing gain, are causing the most horrific post-operative complications. The benefits of the newest laser technologies are small, but the new laser liposuction makes it more difficult to determine the depth and “feel” experienced plastic surgeons use in contouring fat pockets. This loss of “feel” leads the inexperienced to laser either too deep damaging muscle or too superficial burning and scarring the overlying skin.

For many years, revision liposuction entailed a second liposuction procedure to improve contour and to harvest fat to be grafted to depressed areas where too much fat was removed. In most cases, contours could be drastically improved with this rather supple complication of fat harvesting and grafting. As the technologies advanced so did the number and severity of the complications. Muscle and fascia damage caused complex contour and physical problems whereas skin damage will test even the most experienced and talented plastic usrgeons, not a description of the new practitioner. In a patient who cost-shopped their liposuction (or any other cosmetic plastic surgery), the cost to repair these deformities usually exceeds the cost of the original mishap. There is no applicable insurance for secondary liposuction procedures and, as a rule, the most experienced plastic surgeons should be sought after for the complex problems.

Unfortunately, there are no guarantees that board certified plastic surgeons will not have complications, but it is clear that one’s odds are improved by choosing the best trained surgeon who practices the skills taught as a resident in the field of plastic surgery. All other certifications are short-cuts to proper training and proper plastic surgical training leads to better results, patient care, and as a whole, better surgical decisions.

Dr. Paul Howard is a leader in revision liposuction procedures having treated numerous patients who fell victim to swift marketing, very low prices, and deceptive board certification credentials.

A Primer on Liposuction by Paul Howard, MD

The development of tumescent liposuction about 30 years ago was driven by our patients who asked for a method to reduce body fat without the scars associated with the usual tummy tuck procedures.  Our primary focus is the safe removal of isolated pockets of fat to improve body contours.  While the goal (fat removal) has always been the same, the methods of anesthesia for liposuction have changed through the years making the procedure more “patient friendly,” yet achieving the same contour results.  Most of the technological advances are intended to make the fat removal easier and, even more importantly, an attempt is being made to tighten loose skin and improve the appearance of cellulite utilizing the latest surgical laser technology. Most plastic surgeons believe that the skin tightening effects have not been as impressive as the manufacturers claim.  Each manufacturer slightly alters the laser platform so their product can be claimed as “unique” while there is no discoverable clinical difference in the final result.  Laser assisted liposuction is marketed under any number of trademarked names including Smartlipo, Vaser, Slim Lipo, Cool Touch, etc.  The marketing department of the manufacturer uses the trade names to market these laser liposuction platforms directly to the patients.  The laser can be purchased by ANY practitioner, even those with no laser or surgical training.  Regardless of the laser manufacturer, the practitioner is told that the patient referrals will be generated through their web marketing and the practitioner is allowed to use the trademarked name (Smartlipo) in their practice marketing efforts.

This marketing strategy is similar in design to the pharmaceutical companies who advertise their drugs directly to the public and offer the names of certain physicians who prescribe their products.  All of these marketing schemes are evidently legal, but in the laser liposuction example, the machines are sold to any doctor with the money, training is offered but not required, marketing and patients are guaranteed without checking the doctor’s credentials.  The red elephant in the room is that laser liposuction is inherently more dangerous than standard tumescent liposuction techniques and in many instances is performed by non-plastic surgeons who are damaging their patients because of a lack of basic education and the need to market the trademarked product that they own rather than choosing the proper technique for each individual patient.

Many of these doctors ask you to ignore their training and credentials and emphasize their marketing skills.  In the final analysis, patient education is not advanced with unclear or even false advertising and many people have suffered as a result.

Dr. Paul Howard is a top plastic surgeon in Birmingham, Alabama. Read more about Dr. Howard’s liposuction procedures and view before/after photos.