Liposuction remains the most commonly performed cosmetic surgical procedure in the United States and one of the most popular procedures performed by New York plastic surgeon Dr. David Rapaport. Dr. Rapaport has performed liposuction in New York City for over 25 years and is considered among the best surgeons the city has to offer.
Liposuction is the gold standard method to produce permanent spot reduction and contour improvement in areas affected by excess fatty deposits. Your fat cells are distributed throughout your body early in life, as determined by your genetics. Fat cells cannot migrate or multiply, and once they are removed, they cannot come back. Therefore, any contour improvement achieved with liposuction is a permanent improvement and will persist, even if a patient gains weight.
This treatment is not, however, an appropriate method for achieving weight loss, although it can, and often does, help motivate patients to improve their diet and exercise patterns post-operatively.
In women, liposuction is most commonly used to treat:
In men, liposuction is often used to treat:
Men are often interested in treating their abdomen, waist and chest.
More often than not, patients choose to have two or more areas treated during one procedure.
New York City plastic surgeon Dr. Rapaport performs all procedures using the tumescent technique. This technique, which is the gold standard according to most experts, involves the injection of a dilute solution of lidocaine as a local anesthetic and epinephrine to control bleeding prior to the actual suctioning of the fatty tissue. The process effectively reduces blood loss, allows for increased fat removal and improved sculpting, and speeds recovery.
The suctioning is carefully performed using a 3 to 3.7-millimeter metallic rod, known as the cannula, inserted via a tiny puncture in the skin. The procedure is generally performed while the patient is comfortably sedated by our board-certified anesthesiologist. (Some patients, especially those treating only one small area opt for pure local anesthesia, usually with some oral sedation.) Patients typically have no memory of the event, and leave the office within 30-60 minutes after the procedure, feeling great! Most patients can return to work within 3 days following their NYC liposuction procedure, and return to the gym within a week.
"By far, the biggest problem I’ve seen with patients who come from elsewhere with suboptimal liposuction is overcorrection."
Manhattan-based surgeon Dr. Rapaport regularly sees patients with irregularities and overcorrection deformities from procedures performed elsewhere, and can often provide significant improvement. During a consultation for liposuction in New York City, Dr. Rapaport will perform a complete evaluation and honestly inform the patient as to what improvement he or she can reasonably expect.
Not uncommonly, fat grafting (transplantation of fat cells from areas of excess to areas of relative deficiency) may be employed to help address overcorrection deformities. Now that real contouring can be achieved non-invasively with CoolSculpting, Dr. Rapaport will also assess to what extent this non-surgical technique can improve contour irregularities caused by prior treatment.
"Most people’s fat is generally soft," says Dr. Rapaport. "Therefore, using these technologies is analogous to a carpenter using power tools when he is trying to carve and shape soft wood."
The claim of these technologies to produce lasting tightening has really never been well established. These technologies can be helpful, and Dr. Rapaport does use them when treating particularly dense tissues, such as the male breast or areas that have undergone liposuction before, and therefore have an increased amount of scar tissue.
Recently, a fairly new technology called BodyTite and FaceTite has been reintroduced in the United States. These devices utilize bipolar radiofrequency technology, which claims to produce tightening in a linear fashion. It does this by having he heating current move from a tiny probe placed beneath the skin, to a send probe on the skin’s surface (therefore the term bipolar). Initial experience with this technology on the face and body, as well as some published results, show that this technology may represent a step forward in our ability to tighten without long scars.
Unlike many facilities that perform the liposuction procedure under general anesthesia, Dr. Rapaport performs virtually all of his liposuctions under IV sedation, also called "twilight" (anesthesia). During this type of anesthesia, the patient has an IV and Dr. Rapaport’s board certified anesthesiologist delivers sedating medications via the IV. The patient is breathing on his or her own, and is responsive to verbal input but typically has no memory of the procedure.
Following the procedure, the patient feels relaxed and comfortable. Dr. Rapaport’s chief anesthesiologist, Dr. John Grillo, is a master of IV sedation, and he has been working with Dr. Rapaport for the past 10 years. This lighter technique virtually eliminates risks associated with general anesthesia, including the risk of blood clots and the risk of airway complications.
"Because liposuction is performed using the tumescent technique, with gentle infiltration of numbing medicine to the treated area, it simply does not require anything more than intravenous sedation,"
Liposuction of limited areas, such as under the chin (submental liposuction), inner knees, or in some patients arms, inner thighs or lower abdomen, may be performed using only local anesthesia.
In such cases, the patient would have no IV at all, and no anesthesiologist present. Instead, the patient would either rely completely on Dr. Rapaport’s injections to numb the area, or could take oral medications to provide relaxation and mild sedation for the procedure. This is, of course, all reviewed with Dr. Rapaport at the time of the individual consultation to plan the procedure in a way that is best suited for the preferences and priorities of each individual patient.
Although liposuction scars are small, on many areas of the body if they are left unsutured, they will heal as circular indented marks, resembling chicken pox scars. On the other hand, if the liposuction scars are sealed shut with sutures, they will not be able to drain and patients will have more swelling and bruising from their procedure.
For this reason, Dr. Rapaport generally places a single suture in each incision to allow it to heal as a fine line, while also allowing the drainage of fluid. Depending on the patient’s skin type, Dr. Rapaport may elect to use dissolvable sutures. If he chooses removable sutures, they will be removed at the first post-operative visit, approximately 1 week following the procedure.
One of the aspects of liposuction that makes it extremely appealing is the fact that scars are truly very small. Depending on the area treated, the scars will range in size from 2-5 mm (a pencil eraser is about 5 mm across). Generally, these liposuction scars are hidden in inconspicuous places. For example, for outer thigh liposuction, scars can be hidden under the buttock crease, rendering them truly invisible making this arguably the best liposuction Manhattan has to offer.
To learn more about some of the best liposuction NYC has to offer, please contact Dr. Rapaport and schedule a consultation.