Why liposuction isn’t always the answer after pregnancy [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. Is there anything else we should throw in there about mommy makeover, tummy tuck, or liposuction?

Dr. O'Brien (00:08):
The only thing I would add about liposuction after pregnancy is that a lot of times the skin just doesn't have the elasticity to draw back without creating some kind of contour abnormalities or waviness or things like that. And so even when folks don't have stretch marks sometimes after pregnancy, they still are not a great candidate for liposuction.

Eva Sheie (00:37):
Is there an easy way to tell if your skin is in good shape or not?

Dr. O'Brien (00:41):
Well, if you have stretch marks, it's probably not going to be in great shape for liposuction alone. You almost always have to have that skin tightened. So if you've made it through pregnancy with no stretch marks and you still have a little pocket of fat that is relatively small, you may be a candidate for liposuction only. But you have to be, as a surgeon, you have to be pretty conservative about who you do liposuction on after pregnancy because there is a much higher risk of having somebody have a skin contour that's a little wavy or may have some dimples or something that we don't love.

Eva Sheie (01:21):
It surprises me every year when the statistics come out and liposuction is always like, number one, number two. And all I can think is it must be combined with so many other things that that's why it's always up there. How often do you see somebody who's like, "I just want lipo." That's all. Does that happen?

Dr. O'Brien (01:39):
It definitely happens. And sometimes they are actually candidates for just having liposuction on one body part or multiple body parts. Everybody would like to have smaller incisions and have little to no scarring. And when you do a tummy tuck, you do have a longer scar. And so most people would rather hear liposuction is the option for them, but the reality is it's oftentimes not, but it is commonly added on to other procedures just to kind of smooth a little of this or a little of that in areas where the skin may be more resilient or in the case of a mommy makeover maybe was never really stretched or particularly stressed out.

Eva Sheie (02:25):
If you don't have a lot of that, are there other things you could do besides liposuction?

Dr. O'Brien (02:30):
There are other non-surgical options. In our office, we utilize CoolSculpting, which does seem to help pretty consistently. You may have to do multiple rounds, but it's a great option that's non-surgical with very little close to no downtime. Most people don't feel like going and exercising right after they're disconnected from the machine, but medically speaking, they could. And so most people are back in action without garments or without recovery very quickly. And the only challenge with non-invasive type procedures like CoolSculpting or in smaller areas, something like Kybella, or that it's your body's reaction to that stimulus or that irritant. And if it doesn't respond enough, then somebody might be underwhelmed by their outcome. If somebody comes in and they've been appropriately told, "This is going to take you two or three rounds, and so we'll just see how you respond to the first one and then go from there." But knowing that they may need multiple treatments, a lot of times people will be very happy with a non-invasive procedure.

(03:44):
And then some people want to know that that fat was removed from their body and was in a canister across the room and they never have to see it again, in which case they may decide for something on something like liposuction.

Eva Sheie (03:58):
It has been said recently that we don't actually want to throw the fat away. We want to do something with it because it's wonderful and useful. Are you using fat anywhere else on the body? Once you take it out, do you put it back somewhere?

Dr. O'Brien (04:12):
Sometimes you can do fat grafting with fat that's been removed. There are varying results in different body parts. It can be injected on other body parts or the breasts. I do a lot of fat grafting on the face because I think you see that benefit very clearly and it's small volumes and it's a great little refresher, lasts longer than things like fillers.

Eva Sheie (04:38):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.