Plastic Surgery

Body Contouring: Frequently Asked Questions

Albert E. Cram, M.D., Professor of Surgery
University of Iowa Hospitals and Clinics

First Published: May 2001
Last Revised: May 2001
Peer Review Status: Internally Peer Reviewed

What, if any, insurance company covers this or would they consider such a thing?

Body contouring is not very often covered by the majority of insurance companies. Certainly there are medical indications for breast reduction, and that does change the body contour, so that would be one area where insurance companies might provide coverage. I have never found an insurance company willing to cover liposuction. We do have some patients who have had coverage for belt lipectomy if they required that because of very extensive weight loss.

What is the most common form of body contouring?

The most common form of body contouring is certainly liposuction. Nationwide, that is probably the most commonly performed procedure. It has a limited application, however, since one can only safely remove small to moderate amounts of fat at any given time.

Are there areas of the body on which you would not perform liposuction?

I would not perform liposuction in an area where I thought there was not going to be an improvement in contour following the procedure. There are circumstances where one cannot safely remove enough to achieve the patient's goal. In these cases, I would try to be up front with the patient and explain that I could not accomplish their particular goals safely. There are many areas where there is not much fat and I would not recommend liposuction in those areas.

When would repeat surgeries be indicated?

Belt lipectomy ordinarily would not need to be repeated unless the patient had some very significant change in their weight following the procedure. In that operation, one really goes all the way around the body doing a very extensive tummy tuck up front and doing an extensive lateral thigh and buttocks lift on the sides and on the back. This should result in permanent changes that would not require any repeat procedures. I suppose one could have a situation where patients gain so much weight after the operative procedure that some new surgical procedure might be desirable from the patient's standpoint.

Does liposuction get rid of cellulite such as on the back of the legs?

Liposuction will not fix the appearance that leads people to describe an area of the body as cellulite. If people have an uneven skin appearance prior to liposuction, in general, they will still have an uneven skin appearance following the procedure.

Does bovine collagen promote breast growth?

Not to the best of my knowledge.

Is there any truth that when one has liposuction, the fat shows up in other parts of the body?

The deposition of fat in the body, or the long-term accumulation of fat is dependent on only two things: the number of calories consumed and the number of calories burned. If we suck fat cells out of an area, then those fat cells are gone forever. There are always millions of fat cells left, even after liposuction of an area, and they will have the capacity to store fat. If the patient eats more calories every day than they burn up, those calories will show up as fat some place on the body. Since there are now fewer fat cells in the area of liposuction, it is possible that it may appear that the fat is now showing up in an another area of the body. If, however, the patient maintains a balance between the calories consumed and the number of calories burned by activity each day, there will not be new fat showing up elsewhere after liposuction.

How much weight is taken off during the liposuction procedure? Is it a substantial amount of pounds?

Liposuction is not a good technique for weight loss. Its results are always best when there are only moderate to small contour changes needed to achieve a patient's goal. I have removed as little as two pounds and as much as ten pounds in a liposuction procedure. One must remove only the amount needed to achieve the patient's goal. If one removes too much fat, it is difficult to impossible to fix that situation.

How long does the procedure take? Is it an outpatient procedure?

We almost always do liposuction as an outpatient procedure unless it is being combined with something much more extensive like a belt lipectomy. The procedure may take anywhere from 45 minutes to 3 hours depending on the areas involved and depending on the technique used. In many cases, this can be done under IV sedation and local anesthetic. It is more common in our practice here at the University to do this under a general anesthetic. Almost all of our patients go home the same day.

How does the patient determine what a goal would be for the liposuction?

The patient and the plastic surgeon need to discuss the patient's desires with regard to their body contour. The physician needs to examine the patient carefully and needs to understand exactly what the patient hopes to accomplish in order to advise the patient adequately. In general, patients are fairly specific about the changes that they hope to make with either belt lipectomy or with liposuction or the tummy tuck, for instance. It is the surgeon's job to decide which technique might best meet the patient's goal and to educate the patient regarding those procedures including the risks and potential complications that can arise from this type of surgery. The patient and the surgeon need to come to some understanding and agreement about the goal and how they will attempt to achieve that.

What is an "ultrasonic" liposuction?

Ultrasound can be used in two ways to assist in the removal of fat. We almost always use external ultrasound in our practice. This technique involves placing fluid in the fatty compartment that we intend to operate on. We then use an external ultrasound device to provide ultrasound energy which will partially disrupt some of the fatty cells and which will disperse the fluid throughout the fatty compartments in an even fashion. We then use traditional liposuction cannulas to suck the fat out. In our experience, this has markedly decreased our blood loss from liposuction and it has made our ability to provide a contour even better than techniques that did not use external ultrasound. Many plastic surgeons use internal ultrasound in liposuction. In this case, a special cannula that is able to impart ultrasound energy beneath the skin, directly in the fat compartment, is used. This stronger ultrasound disrupts the fat cells and, in some cases, the cannula then has a port for sucking that fat out and in other cases, the ultrasound cannula is withdrawn and a regular cannula inserted to remove the disrupted fatty cells. This technique also decreases blood loss and can be useful in areas where the tissue is more fibrous.

What are other methods of body contouring?

The other methods of body contouring involve the removal of skin and fat primarily by direct incision using scalpel, cautery, CO2 lasers have been used, and any form of direct removal. This does leave significant scarring whereas the ultrasound, or liposuction scars, can be very small. There are cases, however, where the skin is not capable of contracting after one has removed fat from an area and in these circumstances, one must remove the skin or be left with a hanging, baggy skin appearance.

What is the range of costs for these procedures?

Costs for these types of asthetic procedures will vary a great deal from one region to another and quite honestly, from one surgeon to another. These are items that are generally not covered by insurance. In most cases, the surgeons will collect the money before performing the procedure. In most cases, the costs are in the area of $1,500 to $15,000 depending on the extent of a procedure and whether it needs to be done in a hospital setting or whether it can be done safely in an office setting. The patients should not be shy about asking about the cost directly when they call a plastic surgeon's office to discuss an appointment.

After the procedure, is there significant bruising and soreness?

The amount of bruising is certainly much less with current techniques of liposuction. There will, almost always, be some visible bruising, however. Pain is a very individual thing. Most of us give narcotic-level pain relief for the first three days following these types of procedures. By the fourth postoperative day, most patients can tolerate their level of discomfort with Tylenol or aspirin if it is safe for them to take aspirin.

What is a good way to find a good plastic surgeon? What certifications should I be looking for?

One way to locate a board certified plastic surgeon is to contact the American Society for Plastic Surgery. The group's office is located in Chicago. I believe that one should look for certification by the American Board of Plastic Surgeons. This board has been in existence since 1937 and requires extensive training in the broad spectrum of plastic surgery. It then requires several years of practice in plastic surgery before taking a written and then an oral examination covering all areas of plastic surgical practice. Most plastic surgeons will then join the American Society of Plastic Surgeons, which has high standards for membership. If one seeks this level of care, one can always check on the surgeon's credentials. If they are members of the American Society of Plastic Surgery and they are Board Certified by the American Board of Plastic Surgery, you can at least be certain they have passed rigorous training and examination in the field of plastic surgery. The number for contacting the ASPS for locating a board certified surgeon is 1-800-635-0635. If you call that number and tell them where you live, the ASPS will send a list of their members who practice near that location.

Is it possible to see before-and-after results at the surgeon's office?

This will depend on the individual surgeon and, of course, his patients. None of us are willing to show new patients pictures of our patients unless we have direct permission from our patients. In many cases, viewing results of other cases can actually be potentially misleading. Every patient is different and the results that you see in before-and-after photographs will usually represent one of the better outcomes for that particular surgeon. No one is going to be anxious to show you a patient who had a complication following a surgical procedure. Complications can occur even in the best of hands. The surgeon should discuss the types of complications that might occur so the patient can evaluate the risks associated with any surgical procedure. There are many websites available that show pre- and postoperative photos for given plastic surgery procedures. They can be helpful for illustrating changes that one might expect but you must remember these will always be good outcomes. That is in the hand of that particular surgeon. They should not be viewed as a guarantee that your own surgical procedure will turn out exactly like the pictures.

Is it possible for men to use liposuction to reduce enlarged breasts?

The short answer is yes. When the male breast is enlarged, there is often a component of very fibrous ductal tissue beneath the nipple and areola. Liposuction usually is not successful in completely removing that tissue. I get many e-mails from patients who have had liposuction only to try and cure their gynecomastia and many patients do experience some recurrence because not all of the ductal tissue was removed. I think the majority of surgeons assess this carefully and use direct excision for the ductal tissue and then use liposuction to achieve the final contour. Certainly that is the technique that I have found most useful. I use liposuction as an adjunct to help with the procedure.

When the procedure is completed and your body has healed, will you be left with stretch marks?

In the case of liposuction, yes. In the case of tummy tuck, those stretch marks that are below the belly button can almost always be removed. If the stretch mark extends well above that level, some of them may be left behind, even in a belt lipectomy. For the most part, we do eliminate a large percentage of the stretch marks with belt lipectomies.

What is the difference between cellulite and fat?

This is a very good question. There are fibrous connections between the muscle that lie beneath the fat and the skin that overlies the fat. Most evidence leads us to believe that as the body's fat expands when one gains weight, these connections can stretch for a short period of time but ultimately remain tethered, and one gets an area of dimpling at the site of that connection between the underlying muscle and the skin. Then, if one loses weight, there may still be tethering as the skin begins to sag and this may produce an even more uneven appearance to the skin. Cellulite is a very difficult problem and one for which we do not feel there is very good treatment at the moment. Certainly, attempting to maintain a proper weight for height and bone structure is an important method of attempting to prevent cellulite formation but, with aging, most of us will develop some areas of so-called cellulite. People have treated this with suction, rollers, and a variety of creams. None of these techniques have shown results that are very convincing to me.

See related Patient Topics Plastic and Cosmetic Surgery, Procedures and Therapies or Surgeries.

See related Provider Topics Procedures and Therapies or Surgeries.

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