I remember a patient, about twenty years ago, whose sweat smelled so bad that I couldn’t stay in their presence for more than five minutes. It was a pestilential odor reminiscent of vomit. Not daring to tell them directly, I had considered sending them an anonymous letter at one point, which of course I never did. Such a case is rare, but many people struggle with excessive and bothersome sweating.
Over the course of my practice, which spans more than forty years of experience, I have yet to see this unfortunate condition completely disappear. As for the underarms, liposuction can improve a patient’s life by 50 to 75%.
The glands responsible for sweat are partly located in the fat layer, just beneath the dermis. Therefore, it is very easy to reach them with a fine liposuction cannula. In most cases, patients manage this kind of problem with regular antiperspirants, usually based on aluminum salts, but it is a chore to apply this product continuously, and it is complicated to do so at all times of the day, not to mention that excessive use can become irritating, and the underarm has delicate skin where powerful antiperspirants effective on hands and feet cannot always be used.
There is another method recognized as effective for relieving axillary hyperhidrosis, which is Botox injection, the same product used to correct certain facial wrinkles, especially frown lines. But the cost ends up being excessive if it has to be repeated twice a year for the rest of one’s life. For extreme cases, not so long ago, the entire involved area of the underarm was surgically removed, leaving a long and wide scar. Again, liposuction comes to the rescue… in moderation. An iodine solution sprinkled with cornstarch allows for the localization of sweat glands in the underarms. This is the Minor test.
This area is anesthetized as is done for any other site to be liposculpted, and since the glands are on the surface of the fat layer, a fine cannula passed very superficially will dislodge them permanently. It should be noted that to obtain the full benefit of this procedure, one must wait about 6 to 8 months, as the few glands that may have resisted the cannula will gradually be destroyed by the scar fibrosis produced by the healing process.
If, however, a certain percentage of the glands remain, which is likely, the simplest deodorant would have every chance of taking care of it.
This site is the least frequent in my clientele, probably because I am not keen on recommending it. Since the healing process is long and it is rare to achieve skin as smooth and even as for other sites, the appeal for this correction remains lower. Let’s also say that a large calf is very often a function of bones and muscles, much more than fat, and thus the results could be disappointing. Of course, this is predictable before the procedure, through the “pinch test,” and that is why many cases are refused.
The easiest way to assess the amount of fat in the calf is to have the patient kneel with one knee on a bench. This position relaxes the leg and allows for better grasping of the skin between the thumb and index finger to evaluate the thickness of this fold, to determine the real need for liposuction, and to measure the result that can be expected.
Needless to say, fine cannulas, while they have their place in other liposuction sites, are even more necessary for the delicate tissues of the calf, where the diameter should never exceed 3 millimeters.
In any case, I cannot stress enough that the use of fine cannulas is an important factor for success in liposuction. Would you see a woodcarver working on the small details of a sculpture with large tools that tear out big chunks with every stroke? It’s obvious.
At the beginning of liposuction, cannulas the size of a pencil were used, which left unacceptable skin irregularities. Fortunately, that period is over.
Not so long ago, any woman who desired breast reduction had to undergo an inconvenient surgical procedure and could expect scarring, often unsightly, sometimes asymmetrical breasts, areolas with an unnatural appearance because they were too round, partial or total loss of nipple sensitivity, not to mention possible complications such as nipple loss due to skin necrosis, infection, hematoma, and other complications. It is important to know that not all female breasts are suitable for liposuction, but for those that are, it is a great opportunity!
Little to no scarring;
No change to the areola and nipple;
Minimal postoperative pain;
Return to normal activities within a week.
Let’s review some of the inconveniences caused by overly large breasts… let’s be clear here: we are talking about excessively large breasts.
Psychological problems, pain, and discomfort;
Limitation of physical activities;
Intertrigo, which means skin lesions and infections due to moisture under the breasts;
Difficulty dressing and finding suitable clothing;
Issues with bras, including straps digging into the shoulders, among others.
As mentioned earlier, not all breasts are “candidates” for liposuction. The breast must be of moderate volume, as no more than 50% of the fat can be removed from this area.
Moreover, if the breast is too pendulous, the contraction of collagen fibers that occurs during healing will not be sufficient to lift the breast adequately, meaning to an aesthetically acceptable level. Breast liposuction in women requires a very specific and different technique in several aspects compared to other areas. You will understand that symmetry must be absolutely perfect. Additionally, the female breast is a relatively new site for liposuction, as it has only been performed for a few years, whereas the saddlebags have over 30 years of experimentation.
During liposuction, it can generally be said that the edema is completely resolved after six months, which is why if a touch-up is necessary, it is never done before this period. This is even more true for female breasts, as the edema is more significant, and this condition can persist for a good six months, gradually decreasing until the end of this convalescence.
The compressive dressings used after liposuction are of paramount importance here, much more so than for other areas, otherwise bruising could be considerable. A very important point to note is that if pregnancy occurs after breast liposuction, it will be possible to breastfeed as if nothing had happened. After liposuction of any area, it sometimes happens during the first few weeks that small indurations under the skin, the size of marbles, appear and always disappear without leaving a trace. This type of induration can also occur in the breasts, but at that point, patients will be more concerned, as it involves the breast, and one might think of signs of cancer. It is simply necessary to check if the nodule decreases in the following weeks. At that point, it will be clear that it is benign.
Liposuction is the technique of choice to eliminate a double or triple chin, without resorting to the more invasive method of a “face lift.” When I say more invasive, I mean that the “face lift” is a much more invasive procedure than liposuction.
Let’s first compare the two procedures:
Chin liposuction does not leave scars, unlike the “face lift” where cutting is required to remove excess skin. With liposuction, the fat is simply frozen to allow for painless aspiration. For the “face lift,” general anesthesia is usually required, with the potential risks that entails.
Sometimes, the “face lift” gives an appearance of overly stretched, unnatural skin, which is not the case after liposuction, as the skin simply returns to its normal position.
Lastly, the recovery from liposuction is much faster than that of a “face lift” because it does not involve any cuts or sutures.
Unfortunately, liposuction is not always indicated, and if the tissues are simply too loose, liposuction will not help, as it strictly addresses the presence of fat, and the skin will only redrape if the cause of its distension, namely the weight of the fat, is removed.
For women who lack a neck but simply have a long chin, liposuction will correct nature’s mistake and restore a normal neck to these individuals.
“No neck” is an expression meaning that the chin-neck angle is virtually nonexistent, replaced by a straight line running from the chin to the base of the neck. When the patient is older, in addition to the submental region, fat from the jowls will also be aspirated, rejuvenating the jawline.
Around the age of 50 and beyond, one must be cautious about the skin’s reaction in the submental region. Sometimes, instead of a fatty bulge, two or three vertical lines may appear, which may not be a significant improvement for some, but others may prefer it to a double or triple chin. It is important to properly inform the patient to avoid disappointment and to show them “before and after” photos of similar cases.
I repeat, disappointments can not only poison the patient’s life but also that of the surgeon, who needs full concentration to perform flawless work. Therefore, they must do everything possible to avoid such troubles and adopt the old English adage: “In doubt, stay out,” meaning “When in doubt, abstain!”
For this particular region, the size of the cannulas is very important. Personally, I prefer a cannula barely larger than a needle used for blood draws. Therefore, the incision will be tiny and leave no trace. Additionally, a micro cannula allows for very superficial liposuction with excellent skin retraction.
Dr. Luiz Toledo, in his book “Refinements in Facial and Body Contouring,” notes the excellent elasticity of neck skin compared to the face, where elasticity is very poor.
To my knowledge, arm liposuction is only performed on women. It must be said that with the evolution of physical conditioning and the enormous publicity surrounding it, women are much more concerned about their physique. However, no matter how many exercises you do, no matter how hard you try, it may firm and define your muscles, but it will rarely, if ever, melt away certain very unsightly fat deposits trapped in the nets of your genetics. The arms are a very good example of this. Once again, liposuction comes to the rescue of aesthetics and femininity. Imagine, before this ingenious invention, arms were surgically defatted from the elbow to the armpit, leaving an incredible scar ransom, which fortunately no longer has a reason to exist unless the skin and fat are the cause.
Why did we accept procedures that left such poor results and such unfortunate scars? It’s because there were “fatty” disgraces that were so unacceptable, for example, in the saddlebags, abdomen, or arms, that in desperation, patients were willing to make all kinds of compromises: long and ugly scars, never being able to show themselves naked again. Then came liposuction, which made scarless solutions possible.
With age and genetics playing a role, the accumulation of fat on the back of the arms can become so unpleasant for some, their body image so disturbed, that they desperately seek a solution.
In fact, if the arms are out of proportion with the rest of the body, clothing becomes very limited and undressing is hardly pleasant. Some patients have so much fat in this area that their clothes need to be two to three sizes larger just so the sleeves can fit. Fortunately, liposuction offers a solution, and even if the skin is sometimes damaged in this area, it will retract quite well.
And often, the results are such that these patients will wear short-sleeved or sleeveless shirts for the first time. I even liposculpted the arms of a lady who couldn’t fit into her wedding dress. Can you imagine the responsibility I inherited? The wedding was eight weeks later.
The skin on the arms is thin and reminds me of the inner thigh. The fat there is also devoid of fibers and very easy to extract, hence the need for great caution by the surgeon and the importance of mini cannulas. In works dealing with arm liposuction, it is often said that the skin is of poor quality, but thanks to superficial liposuction, this has less impact.
Some patients have perfectly normal arms when they are in a natural position along the body, arms that fit very well into clothes of their size, but which present a “pendulous” appearance when they place them perpendicularly and flap the triceps with the opposite hand in a gesture of disdain.
It is important to explain to these patients that the arm placed perpendicular to the body is an unnatural position that never occurs; liposuction may be of no help, especially when it is the skin and not the fat that causes this pendulous appearance.
When arm liposuction is indicated, it applies to two-thirds of the arm, that is, the posterior and lateral arm. The anterior portion where the biceps is located is usually free of fat, unless there is significant obesity in this area, which could then justify liposuction of the entire circumference of the arm, which is very rare.
Some patients who have been mortified all their lives by large arms will try to influence the surgeon to remove fat excessively. This would result in skinny arms on a corpulent body. An experienced surgeon will avoid falling into this trap and will explain to the patient the disappointment they are avoiding by their justified refusal.
Before the advent of liposuction, pseudogynecomastia (the scientific term for male breasts) was treated surgically with very mixed, if not poor, results, especially concerning the areola and nipple, which would retract inward in a very unsightly manner. Liposuction provides excellent results here, leaving no trace, as the incision is made along the areolar line. This demarcation between the white skin and the brownish areola will completely mask any minor scar that might remain.
What a complex it is for a man to have breasts; one must see and hear it to believe it. Some have confessed to me that they have never worn a swimsuit, never exposed their chest in public, and felt embarrassed even in front of their wives and children. And what results! Liposuction removes this excess fat, restoring a completely natural chest to the man.
Sometimes, a “female-like” breast exists only on one side, which is almost worse. Here again, liposuction comes to the rescue, restoring beautiful symmetry. Unlike the buttocks or the anterior thigh, where at least 50% of the fat must be left, here we can proceed freely and remove as much as possible to maximize a natural masculine chest appearance.
If you recall, we mentioned that the fat on the inner thigh was like jelly due to the absence of fibers. Well, it’s the complete opposite for the male breast, which is rather fibrous and responds with a “crunch crunch” to the cannula’s penetration. Moreover, this region is highly vascularized and bleeds more easily.
To overcome this, we must perform hyper-tumescence to create a “hydrodilation” of these resistant tissues, making them easier to aspirate.
Additionally, even male breasts contain mammary or glandular tissue located just behind the nipple. Upon palpation, one can distinguish this tissue, which is harder than fat. With the liposuction cannula, we can partially break up and aspirate this firm and fibrous tissue, but we cannot expect its complete disappearance. Sometimes the breast will not become absolutely flat, but enough to make a noticeable difference. In any case, in medicine, we cannot and should not offer absolute guarantees, nor especially false hopes.
