A ^Retired Plastic Surgeon's Notebook

Seattle Plastic surgeon shows why belly fat cannot be treated with liposuction (with a little help from Oprah and Dr. Oz).

This, folks, is belly fat. It is inside the abdomen, deep to the abdominal muscles. It cannot be removed with liposuction or tummy tuck (abdominoplasty). Losing weight will make it shrink.

I saw a patient a couple of years ago who was requesting abdominal liposuction.  I did my usual body contouring evaluation and had the unenviable task of informing him that he was a really lousy candidate for liposuction or an abdominoplasty (tummy tuck).  His abdominal girth was caused by belly fat a.k.a. intrabdominal fat a.k.a. visceral fat a.k.a. beer belly fat.   The way I could determine this was to have him lay down on the exam table.  His belly did not flatten out.  See photo on the right.

The omentum from a deceased obese person vs. the omentum from a deceased slender person.

Belly fat collects in the mesentary, which is the structure that carries blood vessels to the abdominal organs, and the omentum, which is an apron like structure that hangs off the stomach.   In an obese person, they are very, very thick.  In a lean person, the mesentary and omentum are very thin and translucent.   Here is Dr. Oz holding the omentum of a fat person and Oprah holding the omentum of lean person.  There is NO WAY a fat omentum can be sucked down to a thin omentum.  The only way to reduce an omentum is to lose weight.  I referred the patient to Dr. Richard Lindquist at Swedish Medical Center Weight Loss Services.

I asked him to follow-up with me but I haven’t heard from him.  And he never went to Dr. Lindquist.  I hope he did not find a surgeon ignorant or desperate enough to do surgery on him.  If he did, my guess is that he is sorely disappointed with his result.

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon discusses the importance of “translation of pull” in body lifting after massive weight loss.

Try this at home! If you get a lot of lift and smoothing of the skin by pulling, you will likely do well with a body lift.

I have seen quite a few massive weight loss patients interested in body lifts in the past several weeks.  The fall and winter months are the best time to have this type of surgery and these patients are wanting to sort out their options so they can take advantage of cool and dismal months and  be fully recovered by the time spring rolls around again.

Body lift is a really big procedure and should only be considered if the patient has a really good chance of getting a lot of improvement.  The requirments for this procedure include excellent health,  a stable and healthy weight, a good support system, the ability to take enough time off of work for healing, and good translation of pull. Translation of pull refers to how much the skin reacts to traction.

Many massive weight loss patients are like this lady where the skin can be yanked up almost like a pair of panty hose.  In this case, she is likely to have great result.

Some patients, however, either because of residual fat or thick and tethered skin, hardy budge with this manuver.  Sometimes additional weight loss helps but sometimes it does not.  Those patients with lousy translation of pull will not see much improvement with a body lift.  And a body lift would be a very, very long run for a very, very short slide for these patients.

Thanks for reading!  Dr. Lisa Lynn Sowder