Your Questions

Q: Dr. Eppley, I have been interested in liposuction for years because I feel my love handles / flanks make me look terrible. I knows I need to lose about 20 lbs but am not motivated because I believe the flanks will never go away. Admittedly even in basic training 20 years ago when I was very lean, but still had flanks. With that said, it has been a dream of mine to remove the ‘love handles’ even if it meant still having a little belly. My hope is that this change would motivate me to lose enough where I am happier with myself. I am 5’ 9″ and 195 lbs and still have decent muscle mass for age 39. With all that being said, how much could I realistically expect to have removed? Thank you for your assistance and honest feedback.

A: The flanks are one area of the body where the most aggressive liposuction can be done in a man or a woman because there is virtually no risk of any skin irregularities. Flank and back skin is fairly thick so it contracts down very well, particularly in men. I could not give an estimate as to how much fat can be removed unless I could see some pictures of the problem areas. Computer imaging can be done to give you a good idea as to what the result would like. Flank or lovehandle liposuction takes about one hour to perform under general anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Please see the photos I have included regarding my interest for a breast lift and abdominal procedure. I am a fit individual in that I work out 5 days a week, and try to keep a balanced diet. Your advice and expertise would be appreciated.

A: Thank you for sending your pictures. From an abdominal standpoint, I agree that liposuction on the abdomen and around the waistline would be beneficial. Certainly no form of an excisional procedure (tummy tuck) is needed. For the breasts, however, that is a different story. As you have also mentioned, a breast lift is needed. There is simply too much skin for the amount of breast tissue you now have. The type of breast lift needed is most likely a blend of what I call a type III (vertical or lollipop lift) or a Type IV (anchor or inverted T lift) These names relate to the degree of lifting they achieve and the type of scar pattern that occurs as a trade-off. I think you could only get by with a Type III lift if you were doing a simultaneous implant for volume enhancement as well.

Both a breast lift and abdominal and flank liposuction can be done at the same time for your trunk makeover.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I would like to find out if I am an appropriate candidate for lipodissolve.  I had a tummy tuck about 7 years ago and do not wish to have another surgical procedure.  I have always had issues with my flanks.

A: While I obviously do not know what your flanks look like, I highly doubt they could be signficantly improved by Lipodissolve injections. That is a fat reduction technique that has largely faded from use due to limited effectiveness. I still use it occasionally for small revisions after liposuction surgery but it is too ineffective and inefficient to treat laregr fat areas. You may consider other non-surgical alternatives such as Exilis radiofrequency treatments which have been shown to be more effective than these old-style fat injections. But whether even this approach is appropriate would depend on the size of your current flanks. I would encourage you  to come in for a free consultation to find out the advantages and disadvantages of both flank liposuction and Exilis treatments to the flanks.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 35 years old and am 5’ 4” and weight 138 lbs. I had my last child one year ago and am back to my prepregnancy weight but can’t get rid of this loose tummy skin and fat. I went to a plastic surgery consultation and, in addition to a tummy tuck, was told that I needed liposuction as well. Do I really need to get liposuction on my love handles with my tummy tuck to get the best result? Since I am going for surgery I want the best result. I'm pretty happy with my general size, I just want to be firmer and smaller around my stomach.

A: It is a common misconception as to how far the effects of a tummy tuck reach. The main effect of a tummy tuck is seen between the hip points, it is essentially a 180 degree procedure of the trunk.. One must remember that waistline reshaping is closer to a 270 or 300 degree procedure. To extend the benefits of a tummy tuck, whose tissue excision and scar stops at the hips, fat removal by liposuction must be done to continue the narrowing benefit around the corner of the hips and into the back. This liposuction effects what most people call the love handles or the flanks. This not only flattens or indents the love handles but also decreases the risk of dogears or fullness at the ends of the tummy tuck incisions. I would estimate that about 2/3s of abdominal reshaping patients in my practice need the combined tummy tuck and flank liposuction procedures for the best result.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am going through a divorce due to domestic violence. I have lost a little over 100 pounds since I left my abusive marriage with our son. I for so many years buried my head into food. Even though I have lost all of this weight I often look in the mirror and cry due to the way I look. I feel empty inside, I want to feel beautiful and content with myself. I want back all of that confidence that he took from me. I have a lot of extra skin from all of the weight I lost. I am only 30 years old but I dress like a 40 or 50 year-old due to my body’s look. I don’t want to feel like I am dying inside anymore, I want to feel alive again, confident, young, and beautiful. These are the goals I want to achieve. Most of all I want to be able to bring my son to a beach in a bikini he is so young I do not want him to miss out on things due to my insecurities, He has suffered so much due to this divorce and domestic Violence. I try to keep a positive outlook on everything. I have attached some pictures so you can see what you have to work with.

A: Thank you for sharing your very personal story and in losing in the weight. This is obviously a transitional period in your life and changing how your body looks would be a complementary component to it. The excess skin and fat represent both physical and emotional baggage. In looking at your pictures, I can see that you would get some good benefit out of the following procedures… a full tummy tuck, liposuction of the lower abdomen (prior to its removal) and flanks with transfer to the buttocks, and a breast lift. Together these would all make a significant improvement in the shape of your body and reverse some of the effects of your prior weight gain.. All those procedures could be done together with the tummy tuck as the foundation procedure which is the one that really involves any significant recovery. Breast lifts are relatively painless and fat injections to the buttocks only as minimal discomfort.

While all four procedures would provide the most benefit in terms of body changes, the most important one is the tummy tuck with flank liposuction. That is the foundational procedure that produces the best benefit out of all the potential body procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m having surgery in a few weeks consisting of a full tummy tuck and liposuction of the, flanks and outer thighs. How much fat did you estimate in inches that can be removed from each of these areas? Particularly with my outer thighs, I was hoping that whatever amount of fat was removed would be visibly noticeable to the eye.

A: While I don’t have the advantage of knowing what your body/thighs look like, there would be little purpose in having the procedure if the change was not noticeable. I never like to use inches as a circumferential measurement outcome for any liposuction-treated area or a tummy tuck because the visible change can be substantial but the circumferential measurement change can be less impressive. This, of course, highly depends on the body type and the size of the original problem. But you have to remember that only one section of the thigh (outer) is being treated not the circumferential thigh so that measurement will never be impressive as the outer profile or silhouette view. For a tummy tuck, only the front half of the body is being treated so the amount of ‘inches’ reduction will depend on the existing size of the frontal abdominal fullness and/or overhang.

While in many patients, inches do come off from a tummy tuck, that can be avery disappointing assessment criteria when looking at outer thigh liposuction…that is rarely an inchess off procedure.

Dr. Barry Eppley

Indianapolis,Indiana