AirSculpt - Seattle

A: From the photos you submitted, it is clear that you do have some skin laxity, but not enough that you would have to worry about having a fold of skin overhanging your waistline after liposuction of any kind, in my opinion.  An individual's skin-tightening response to liposuction of any kind can be difficult to predict.  Some people will get a great response, even without any additional energy based treatment to the skin, such as the laser energy used in a SmartLipo procedure.  Other individuals, will get little to no response to anything we do and it is very difficult to predict.  I do believe that the addition of heat energy to a liposuction procedure will enhance whatever skin-tightening effect you would have had without it.  SmartLipo is one brand among many that can give great skin-tightening results.  In addition to laser energy, the energy sources of mechanical ultrasonic vibration, ultrasound energy, radiofrequency energy, and plasma energy are all currently in use today.  More important than the brand of device is the skill and experience of the surgeon.  In skilled hands, you can expect to get an excellent result without need for skin excision, but you will just have to be willing to accept some degree of persistent skin laxity.  This may manifest as what I call a "frowny-face belly button" or wavy, "crinkly" skin below the belly button.  The only sure way to get rid of those is with skin excision: tummy tuck or even a "mini" tummy tuck, where only the skin from the pubis to about half-way up to the belly button is removed (much faster recovery and can be awake).   I hope this was helpful - best of luck!

A: Thanks for your question and photos.  I do see what you are referring to and, to me, it appears that you may have a little bit more fat at the jowl of the right cheek.  Another factor is that you may actually be naturally asymmetrical - almost everyone is.  It is very rare that one side is a mirror image of the other; in fact, if you play around with some of the photo editing programs, you can actually cut your face in half and flip around one of the halves and make a new image of yourself with "two left sides" (or two right sides) - most people look really weird like that (except super models).  Assuming that you are not asymmetrical and that this is an asymmetry caused by the surgeon taking a little more fat from one side than the other, then there are several ways to correct this.  If you came to see me at my office, I would recommend InstaLift sutures to give your cheeks and jowls a slight lift, which would make your jawline less "square" looking and, if that is actually a little blob (medical terminology) of fat on the right, I would recommend dissolving it with Kybella.  Some fillers in the midface and cheeks would also give you some more lift and create a more youthful "V" shaped face.

A: Thanks for the question and photo.  I am sorry you did not get the results you were looking for.  As you point out in your question, your abdomen has many hills and valleys, or "contour irregularities."  This can happen with any liposuction system on the market and occurs for several reasons.  If the results always looked like this (even from 1 month post-operative), then it is likely that the remaining fat layer was not smooth and even to begin with.  If this is something that has become worse in recent months, then it could be from a change in weight since the procedure.  Either weight gain or weight loss can make irregularities worse, because small differences in the thickness of the fat layer become exaggerated with weight gain (or loss), as the fat cells remaining will enlarge.  Therefore, where you have a thicker layer of fat to begin with; with weight gain, it gets even thicker.  Another factor that can compound this is skin laxity, which can result from pregnancy or massive weight loss, or just time, gravity, and genetics.  Skin with stretch marks usually will not contract well, or will contract better in some areas and worse in others.  This can also give the appearance of contour irregularities, even where the fat layer is smooth and even.  One of the advantages of Vaser over other types of liposuction, is that by emulsifying the fat with the Vaser before performing liposuction, the risk of contour irregularities is reduced.

So, how do you get rid of this look?  I have had a lot of experience in revising liposuction messes from other doctors and I will tell you that it is unlikely that this can be 100% "fixed," or smoothed out so that you have none of those hills and valleys, but it can definitely be improved.  You will get different opinions from different surgeons, but here is how I would go about it:  I would basically repeat the abdominal liposuction, only without the suction part - and Vaser is great for this - but with the goal of not removing fat, but liquifying it and maybe removing a small amount sterilely, so that it can be re-injected into the deeper valleys.  I would recommend following that up with something for skin tightening.  In my office, we use Thermi250, but there are other devices that can do this.