Fat in belly area

Liposuction: Part 1 of 3


I have hated my belly since I was 20.  Maybe it started before then, but I am certain of that insecure mid-college time period.  Granted I was a bit heavier then (~145 lbs) and have since slimmed down to a consistent 135-138 lbs, but I just want to have on the record that I have been unhappy with this part of my body for 30 years.  I can wax philosophical about the problems of self-loathing, but I am actually working on self-loving and so I want to instead focus on the positive.  (Grin)

Tony Robbins teaches that the reason most people are unhappy is that their notion (or blueprint) of what their life condition should be does not match their reality.  So, the suggestion is to either change your blueprint or take massive action and change the reality (it may work best to do a bit of both).  A few months ago, I decided to take massive action on the belly issue.  I told myself that just because I have had this thing for the last 30 years, I don’t need to have it for another 30 years (and it is unlikely to get better with further aging.)  I am weight stable and feel generally pretty good about myself since I added Pilates and strength training to my decades and decades of running and riding bicycles (often quite vigorously).

The Juice

So today it happened!  Dr. Walter Tom from Sonoma County Laser and Vein did a Smart Lipo (laser assisted liposuction) procedure on my abdomen and flanks.  Since this is something that people are often curious about but afraid to explore, I have decided to make it public and share the journey with anyone who cares to read/look.

The Preparation

1) Consultation visit with Dr. Tom to be evaluated and have your medical history reviewed to make sure that you are a good candidate. What does that mean? As I understand it:

  • Generally well, without chronic or acute conditions that may make healing more difficult or surgical intervention dangerous (uncontrolled hypertension, diabetes, bleeding disorders, etc.)
  • Weight-stable for at least 6-12 months and a BMI of less than 27 (See here for Dr. Tom’s BMI scale and description of a good candidate.)
  • Have realistic expectations!  Perfection is impossible. I told Dr. Tom that if I had a 50% improvement, I would be happy.

2) Scheduling and preparation.

  • Pictures taken and weight measured
  • Pre- and post-operative instructions given, including how to order the post-operative garment(s) – Compression Garment
  • Prescriptions written
  • Payment given ($6,995 for abdomen ($4,995) and flanks ($2000 additional area) done together)

3) The (Super Exciting) Day Of Procedure.

  • Got up early and ran because I would not be able to do that for a couple of weeks.
  • Showered with Dial Anti-Bacterial Soap
  • Took prescribed antibiotics (that I actually started the day before)
  • Brought all my meds with me (things that they would give me if I needed it before/during/after the procedure)
  • Nurse prepped me by checking that I was really me and I understood what we were doing, giving me some of the prescribed medicine, and placing an IV in my arm – just an extreme precautionary measure in case of an emergency.
  • One last examination by Dr. Tom where he marked me and took pictures of the markings and went over my chart again with me.

The Procedure

Please note that everyone’s experience of pain and discomfort is unique to them.  What follows is my experience which should be set in the context of being a doctor who has herself performed hundreds of laser-assisted liposuction cases in my office.  Although I do not do them any longer (for a variety of reasons), and Dr. Tom does things in his way which is not exactly the same as mine, I had a really good idea of what to expect and was absolutely free of nervousness or anxiety.  I was, however, quite hyped up on excitement.  Interestingly, while anxiety tends to accentuate pain, positive anticipation and excitement tend to attenuate pain.

1) I was taken into the procedure room for sterile preparation.  I knew that they would take my watch and phone, but was honestly surprised to be told to strip totally naked.  Whoa!  That sterile prep is chilly! 

2) They (nurse and OR knowledgeable staff) laid me down on the table and draped me with sterile towels and drapes.  They attached monitoring devices (BP cuff, O2 monitor and 3 lead EKG) then Dr. Tom came into the room and we did a final “time out” confirmation of identity and procedure.

3) The procedure starts with making the areas to be treated TOTALLY numb.  There are some slight pinches of needles and brief burning sensation as the numbing medicine is introduced.  Then Dr Tom used an infusion pump with long, blunt catheters to further introduce the tumescent (dilute numbing medicine) solution under my skin and in the fat.  I was totally awake and chattering away throughout this part and all of the rest of the procedure.  (The staff were probably wishing I had taken more Ativan and would just go to sleep already.)  The numbing was really almost perfectly sufficient but the few times that I could feel the actual procedure, Dr. Tom would just pause and add more medicine.  All in all, for both the front and back parts of my procedure (abdomen and flanks), they infused 4 liters = 4 kg = 8.8 lbs of fluid into my subcutaneous tissues.  Hello bloated and swollen!

4) At my insistence, we took pictures and videos as we were going along.

Dr. Tom demonstrating that the fat has been removed from the side in his right hand and there is still fat to be sucked out on the other side.

5) After getting the areas numbed up, Dr. Tom used a special mechanical device to break up and liquefy my fat.  It turns out that because I had had an UltraShape series a few years ago (with results that I liked but was not totally thrilled with after a few years), my fat around my belly button was really fibrous and rather tough to break down.  Dr. Tom mentioned that he notices the same thing with people who have had either Mesotherapy or CoolSculpting (so something to think about if you are considering one of the “non-invasive” fat-reducing procedures versus liposuction.)  I could feel the device in my body and the breaking up of septate (fibers between the fat) tissue but it really did not hurt.

6) Next, it was time to get out the vacuum cleaner!  Hah! I loved seeing the fat go from my body through the tube and into the bucket!!  This was, of course, the coolest part because it was the definitive removal of what I really didn’t like and the reason I selected this procedure instead of CoolSculpting.  All of the non-invasive fat digesting/freezing/melting procedures depend on the individual’s body to actually make the change once the fat cells are disrupted.  I like the idea of a skilled surgeon actively doing that work and having its evidence be a canister of fluffy yellow fat! 

Although there were brief moments of discomfort or even sharp pricks of pain while the fat was getting sucked out, any time that it became something that made me flinch at all, Jackie, the nurse, would stop Dr. Tom and he would just add a little more numbing.  There is no value to being stoic in this procedure!  Just complain a little and get the sensation addressed!

7) After sucking the fat out of my belly and my left flank, Dr. Tom used the SmartLipo laser device to tighten the skin where the fat had been removed from beneath it.  For this part of the procedure, we all wore protective glasses and the attention was quite focused – the lights were turned down and music turned off.  Jackie monitored the surface temperature of my skin as well as the total amount of energy being put into each area (4000 Joules).  I’m not sure how long this took because honestly, I was so comfortable that I dozed off several times.  (I hope the staff enjoyed their brief respites from my chatter!)

8) As a last step, Dr. Tom completed the procedure on my right flank with fat sucking followed by skin tightening, again with the Laser and the whole process with glasses, temperatures and energy monitoring.

9) Here is a short video of the three steps: Click Here To View Video

10) Once Dr. Tom was satisfied with the results – it was even, symmetrical and had created a longer, more narrow waist without a muffin top any more, we were done.  The OR techs and nurse cleaned me up and stuffed me (somewhat sausage-like) into a compression garment with stacks of gauze over the incision sites where Dr. Tom had inserted his various instruments (tumescence, suction catheters, laser wands, etc.)  I drained for a few days from these sites as at least some of the numbing liquids comes back out the way it came in.  What remained inside my tissues were slowly absorbed by my body (like a camel).

11) My dear friend was waiting for me in the waiting room when I came out feeling remarkably good (still quite numb).  She went and got the car while Dr. Tom and Jackie escorted me to the curbside and very thoughtfully put down a barrier sheet so that I did not leak onto her car seat.

The Immediate Post-Op Experience

Because I took only Benadryl, Tylenol and 0.5 mg of Ativan (the minimum that Dr. Tom would allow me), I have arrived home feeling quite clear headed.  My sweet friend, Janette, helped me change the soaked gauze out of my compression garment and we both had a good laugh at what I looked like in that thing without undies on (it’s crotch-less and leave it to say that compression pushes all of your parts out to say hello).  Dr. Tom had bequeathed her the power of being the boss of me for 24 hours, so based on her orders (and much better judgment than mine) I did NOT take a picture and send it to my BF.  Here though is a pic of me as a human sausage in the compression garment and abdominal binder plus boy shorts.  (That I even considered taking a picture makes me think that the Ativan did do something.)

I was able to sit down and type out this little missive without trouble right after I got home.  That said, the numbness did wear off and then I could feel a general soreness, like having done a tough ab-day workout.  Totally tolerable.  As planned, I put some Chux down on my bed (already covered with old dark bedspread) and enjoyed an early night’s sleep (totally out of character.)  I had the pain medicine and additional Ativan that Dr. Tom prescribes patients but did not end up taking any of it.