Dr. Coleman's Comments:

The technique of liposuction has changed very little since it's beginnings in the 1980s. The one true contribution to the art came more than ten years ago when the Tumescent Technique was popularized. This was invented by a dermatologist, and basically involves the use of large amounts of dilute anesthetic and epinephrine instead of small amounts with higher concentrations. In contrast to claims by some doctors, this is not a new development. I have been using the tumescent technique since 1992. The larger amount of fluid distends the tissues and actually improves the accuracy of the liposuction. It also reduces blood loss to a bare minimum and replaces fluids that are normally lost in the operation. Its safety, even with large amounts, led many non-surgically trained physicians to practice this in their offices instead of in an accredited and medicare certified surgical facility.

Although few accidents happened, deaths have occurred due to the lack of training in surgical principals and experience in evaluating and treating fluid balances. Deaths have also occurred because physicians lacked the training to recognize blood losses. This is compounded by office facilities that lack the appropriate monitoring and resuscitation equipment.

When small areas are being treated, the surgery is very safe. When larger amounts are being suctioned, it is best to have doctors who have completed full surgical residency programs and who have privileges in an accredited hospital operating room or surgical facility to do these procedures.

I have completed a full five year residency program in general surgery. I served as Chief Resident in a busy trauma hospital and received extensive training and experience in critical care before I started my additional two years in an accredited nationally acclaimed plastic surgery residency. In 13 years of plastic surgery practice, I have not had one life threatening complication in spite of many major large scale reconstructive procedures.

A Word about Modern Techniques

The 1990s brought in many new products in an effort to improve on the art of liposuction. The most important is ultrasound assisted liposuction. This is added to the regular technique by use of a cannula that vibrates at a high frequency and emulsifies the fat making it easier to remove. This instrument is somewhat bulky and requires a larger incision to fit the tube. There is also a reported instance of burns to the skin from holding it in one place too long, or suctioning too close to the skin.

Another type of ultrasound is given by means of a "wand," which is rubbed over the skin prior to liposuctioning. This has a safer track record.

In spite of these two instruments, there are many specialists who feel that in the long term, they do not really improve the final result with the exception a few special instances. Several photo comparisons have been done by recognized authorities and many could not tell which patients had ultrasound and who did not.

I will continue to follow these trends, but for now, I do not offer ultrasound. It is more expensive to the patient and in my hands, hasn't proven to change my results.

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8715 Village Drive, Ste. 504, San Antonio, TX 78217

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