Laser Lipo - Surgery Day

Part 1: Selecting the Clinic & Pre-op Appointment

Liposuction History

Dr. Giorgio Fischer, a gynecologist from Rome, Italy, invented the liposuction procedure in 1974. Dr. Illouz, a French plastic surgeon, made the first purely cosmetic use of the procedure four years later. During these early years, lipo was done with thicker tubes using the dry method. That meant that a person was under general anesthetic and they vacuumed out the fat by thrusting and sucking, a rather harsh method.

Dermatologists Dr. Jeffrey Klein and Dr. Patrick Lillis invented the tumescent technique of liposuction in 1985. In this technique "a solution composed of lidocaine (a local anesthetic similar in its numbing effects to novocaine), saline, and epinephrine (a drug that constricts blood vessels and thus reduces bleeding during surgery)" is pumped under the skin. The added fluid in the area makes it easier to maneuver. The patient is awake with this local anesthetic and is able to do this as an out-patient procedure.

In 2006 the technique become even less invasive with the approval for the use of lasers. Now cannulas that were once several mm in size are down the size of a strand of spaghetti. The procedure can be done through small port holes punched into the skin - about the size of a cocktail straw.

The Day is Here

Was I excited? No. Nervous? A little bit, but not too much. My appointment wasn't until 3 p.m. and so I went to work. 

Michelle picked me up at 2 and we headed out to the Physician Skin and Weight's  (PSWC) Roseville surgery center. I had been told the procedure would take about 3-4 hours and Michelle could either go shopping or go to a movie. She opted for shopping and took off.

I was met by Vanessa, a nurse aide who was going to be with me for the afternoon. She had me strip for some more 'before' pictures and more measurements. Then it was time to meet Dr. Menon.

Dr. Shailaja Menon is actually the owner of PSWC. She started the business over seven years ago doing mostly work with skin, things like botox, restalyne, microdermabrasions, etc. Then when laser lipo (also known as SmartLipo) was finally perfected and released in 2006, she immediately trained on it so she could add it to her practice. Since that time laser lipo has become about 90% of their business. There are offices in Folsom and Roseville and she's been able to open a second surgery center in San Jose and is currently looking for a suitable location to add another in the San Joaquin valley. Currently there are six doctors, including herself. An important detail - she's had the procedure done on herself!

They had me take Vicodin and Ativan while I asked her some more questions, like the nature of fat. She explained that we are all born with X number of fat cells in our bodies. You don't get more, they don't regenerate. All fat does is inflate and deflate as needed. Each person is different due to genetics - where the fat sits in the body, their metabolism, hormones - all are factors to how fat appears on us. So I asked her about the size of fat cells on severely overweight people, like 700 lbs. Menon explained that they were probably the size of raisins.

Needle that irrigates with saline/lidocaine mixture

I asked her how much is the most they could take out. After all, I couldn't imagine taking out 100+ pounds of fat from a person. She explained that there is a law and standard that only 5 liters at a time can be removed. She politely explained that this isn't a method for weight loss. What they do is provide body sculpting and contouring. Therefore, they do work closely with clients to discuss realistic outcomes. For instance, some people might ask for something that their body frame just won't pull off. If they are big boned and have a wide skeleton, they'll never have narrow hips - you can't change bone structure. 

She then proceeded to mark my torso with a marker. She indicated where the 7 port holes would be placed. Two would be visible under my chest, but the other 5 would be down at my bikini line. I was the laid on the table to wait. 

The procedure

Punch tool for making port holes
The first part of the procedure was to numb the port hole areas for puncture. I was expecting a harsh needle, like a shot, but was happy that they were more akin to pin pricks. The needle is actually attached to a tube that leads to liters of a saline and lidocaine, which is the numbing agent. Dr. Menon was then able to punch the holes, slightly smaller than a straw.

Next was the injection of the saline. I was inflated like a water balloon with the lidocaine saline solution. This solution numbs up your insides in preparation for the laser and vacuuming. But when you add a couple of liters under your skin that's not used to it, it's stretched very tight. Plus the saline is heavy, so you have the sensation of bricks being loaded on your torso. 

The laser tip comes out of the end of the tube.

Finally it was laser time. The laser itself is on the tip of a thin strand, the size of angel hair pasta. It's super thin. Dr. Menon inserted it into one of the ports and began stroking back and forth with it as the laser blasted the fat cells. I could feel the wand scrape my insides. It didn't hurt except for an occasional jab. I asked her what protected my organs. She explained that it was my abdominal muscles, which are about an inch thick. That after the first couple of strokes, the muscles reflexively tighten up as a self defense mechanism. I was feeling the strokes along the muscles and along the inside of my epidermis (skin). It didn't hurt, I just knew it was happening.

She continued with each section. She had marked 8 sections on me and it took about an hour for that part alone.

NOT a smoothie, some of my fat.
After she was satisfied that she had 'melted' the fat, it was time to suction it out. She switched to the vacuum cannula to once again work each section. This step was a bit more aggressive in the strokes and the jabs, but nothing unbearable.

Interestingly, I was lucid and alert during the whole procedure. The drugs are supposed to be for pain and to calm you down. For some people, they get really loopy. Some people fall asleep. I was alert and paid attention during the whole thing. It wasn't until we were done and I had to stand up that I got a little dizzy.

Finally she was done and Vanessa helped to clean me up. Expect a lot of liquid since there is a lot of the saline solution involved. I used 6 liters of it! This was partly due to my apparent dehydration. Dr. Menon said she could tell I was dehydrated because my body just sucked up the saline.

Vanessa stood me and massaged my body to get some more of the saline to come out of my port holes before dressing me. They aren't able to suck it all out and so it will either drain through the port holes over the next 24 or so hours or it will be reabsorbed into the body and disposed of through your urine.

The port holes were dabbed with antibiotic and then I was taped up with feminine pads over the holes to soak up the drainage. Finally, the compression bandage garment was wrapped and strapped around me. A giant girdle to hold you in tight while your body heals. You are required to wear it 22 hours a day for the first two weeks and then 12 hours a day a month after that. You can also wear Spanx.

Michelle was there to drive me home except that you are required to be with someone for 24 hours just to be sure you don't have any problems. I spent the night over at BFF's house. I took a shower and rebandaged up. Then I took another Vicodin to sleep through the night. It was just a bit uncomfortable with all the padding and the compression garment.

I felt fine the next day. I drove to the first follow-up so that Ranee could check my port holes and to make sure I was wearing the compression garment properly. I was now able to take Tylenol instead for the pain. Basically my holes were itchy and my midsection was just really sore. I was still draining out of the lower holes (gravity), but the upper ones were already closing and healing.

I wore the compression garment and padding through a second night. The next morning I was able to just put small gauze pads on the last three holes that hadn't stopped draining completely and then switch to wearing Spanx. Then I went about my day as normal. I didn't even necessarily need Tylenol anymore. It's just soreness.

What Next

My next follow-up is in a month. By then my swelling should be down and I'll have my first set of after pictures. Perhaps I'll share some body pictures at that time (but that's not a promise). Then I think the final follow-up will be at the 6 month mark. But I should be 'done' any time from 4-6 months, depending on my body. Stay tuned!

Part III: 5 Weeks Out 
Part IV: 4 Months Out
V - Final Appointment

FCC Disclaimer: I was provided a substantial discount on the procedure in exchange for this series of articles.