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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 27 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."
Dr. Rapaport often chooses to use VASER technology when treating particularly dense tissues or areas that have previously undergone liposuction. The use of VASER will help to emulsify (or break down) fat before being aspirated with traditional or PAL cannulas.
VASER (vibration amplification of sound energy at resonance) assisted liposuction is the third generation of ultrasound assisted liposuction device. Solid titanium probes deliver pulsed energy into fatty tissue resulting in emulsification of the targeted fat. The probes are relatively small in diameter and contain grooves along the side enabling energy to be emitted down the probe, in addition to, the front face. Energy delivery is resultantly less concentrated. The pulsing nature of the energy delivery reduces heat generation. Overall, these two design advances allow for increased safety and better results than previous ultrasound technologies.
For patients desiring improved contour of their abdominal muscle, Dr. Rapaport harnesses this VASER technology to perform liposculpture. VASER allows for the superficial fat layer to be treated. This is key for performing abdominal etching or detailing of abdominal musculature. Dramatic contour can be achieved by targeting and removing this superficial layer of fat, particularly in patients who are relatively lean to begin with.
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.
Refined by Dr. David P. Rapaport as a multifaceted solution for facial sagging, fat contouring and submental fat buildup, the “Trifecta” is a minimally invasive facelift, which involves three innovative technologies that combine to rejuvenate the face andneck in clients who choose to forgo more invasive surgeries. The Trifecta utilizes FaceTite, AccuTite and Morpheus8, radio frequency-based solutions for stimulating the natural regeneration of collagen while tightening and firming the complexion. It also relies on mini-liposuction to carefully remove unwanted pockets of stubborn fat from beneath the chin and in the lower face. The entire Trifecta procedure typically takes less than 1 hour to perform and is usually performed under local anesthesia.
For those who are hesitant to get liposuction and wish to avoid any scars altogether, CoolSculpting may be a good option for you. CoolSculpting is an FDA-approved, non-surgical treatment designed to help patients reduce fat and remove stubborn love handles and bulges.
Liposuction should not be seen as a weight loss procedure even though fat cells are permanently removed during liposuction. Liposuction is best seen as a procedure that improves one’s fatty proportions. Liposuction addresses fatty bulges but should not be seen as a procedure for overall weight loss, as weight loss requires changes in behavior such as increased exercise and decreased caloric consumption.
Any scarring is extremely small, a small dot about the size of a freckle, which will fade over a few months.
Liposuction results are permanent. The fat cells that are removed will not return. That said, you look better if you maintain your weight.
When performed by an experienced plastic surgeon, liposuction is among the safest of all cosmetic procedures. Scars are very small and downtime is minimal. However, liposuction has the potential of being a truly dangerous procedure when performed by persons without adequate training and experience. Deaths have occurred due to perforation of the abdominal cavity as well as from improperly performed anesthesia. Cosmetically, contour irregularities can also occur. For these reasons, it is important to select an experienced surgeon.
Liposuction is best performed when a patient is not far from their ideal weight. However, it is in most cases best that the patient be a few pounds above their ideal weight when having liposuction. This allows for any minor imperfections in the work to shrink with weight loss rather than grow with weight gain. Obese patients can have liposuction, but their expectations must be realistic in that it will not cure obesity but may improve particularly troublesome spots.
Anesthesia safety is something to be even more careful with when dealing with overweight patients.
Although liposuction is not a weight loss procedure, patients may lose up to 8-10 pounds after liposuction. Furthermore, Liposuction often motivates people to improve their diet and exercise habits and thereby can lead to lasting weight loss. However, lipo should be seen as a body contouring treatment, one which permanently changes your fatty proportions, rather than as a weight loss treatment per se.