Trish: Okay, well I’m here today with Dr Soo-Keat Lim, and Dr Lim is actually a cosmetic practitioner, and he works at The Ashbrooke Cosmetic Surgery Clinic, which is located in Military Road at Mosman. So thank you so much for joining us today Dr Lim.
Dr Lim: It’s a pleasure Trish.
Trish: Lovely. So we’re contacting you today, or we’re having a chat with you today about liposuction, and we’ll start off by saying you’re actually involved with the Australian College of Cosmetic Surgery, and you are involved in the lipo training program, the head of it, aren’t you?
Dr Lim: Yes I’m the head of the Australian College of Cosmetic Surgery (ACCS) liposuction training program, and I’ve been the head for the last fifteen years.
Trish: Oh great, and you’ve been doing liposuction for twenty three years, is that right?
Dr Lim: Twenty three altogether, that’s right.
Trish: So you obviously know what you’re doing.
Dr Lim: Yes, I’ve been around, yes.
Trish: So tell us a bit about it, like I know what sort of people liposuction is for, I’ve had liposuction recently myself, but for our listeners that are out there, what is something that you have to be really aware of when you’re going to have liposuction, or you’re planning on seeing someone, what’s something that we need to know.
Dr Lim: Well the very first thing that we all need to know, is liposuction is not about weight reduction. So it is mainly to try and reshape the body, in other words, the body has been out of shape because we’ve either put on fat deposits in different parts of the body, that could be associated with weight gain, or it may not be associated with weight gain. It’ll be just the fact that our bodies are out of shape. Liposuction is really, really the gold standard now in order to try and regain that shape.
Then of course, liposuction is divided into differentiating methods. Now there are two methods, one of course is that you can do it under a general anaesthetic, and the other of course is you do it under a local anaesthetic. Now do it under a local anaesthetic, the method is properly called tumescent liposuction under local anaesthetic. Now even when you do it under local anaesthetic, you can either do it under pretty deep sedation, or under very light sedation. So the gold standard of the whole lot is really tumescent liposuction under local anaesthetic, with light sedation. Purely because this gives you the best results, this also is the safest way to go. Complication rate is very low.
Trish: So if you’re having it as part of another procedure, say for example if you’re having a tummy tuck or whatever, you would have it with your general anaesthetic, wouldn’t you?
Dr Lim: Generally, you can do tummy – if it’s a very big tummy tuck, you probably need to do it under general anaesthetic. So what the surgeon will do then, of course, he will do some liposuction before that, and then do the tummy tuck after that.
Trish: So if you’re having it on its own, you can have it by tumescent, that’s the best way to do it?
Dr Lim: Yes. That’s the best way to do it, and you’d be surprised, you can actually take out quite a lot of fat, and you can reshape quite a lot of the body, even under local anaesthetic. Just to give you an example, the world recommendation is that when we remove fat, we should try and remove not more than five percent of your body weight. Now if you’re a 100 kilogram person, five percent of your body weight you’re looking at five kilogram of fat. Now we’re talking about fat, we’re not talking about water that comes with the fat. In other words when this fat comes out, it floats just above the water, and so it separates. So what we count as the material that we want to count as fat, is dead material, that is floating above the water. Five kilogram is a lot of fat to take out.
Trish: Is there a regulation in Australia as to how much you can actually take out? I know I’ve seen pictures of overseas patients that have had like eight litres of fat taken out, and things like these. But I’m pretty sure we have a regulation here in Australia don’t we?
Dr Lim: Well it’s only recently that a regulation has come in. In other words, this regulation will come into effect from March 1st, in 2017. Liposuction then, if not done in the licensed theatre then we can only take out two and a half kilogram of fat, which is two point five litres of fat, or 2,500 mls of fat.
So that regulation will come in in March next year. Prior to that there was no regulations, so that means that provided the patients condition is well, is good, then you can go on and take out, as you say, up to eight kilograms of fat, but if the condition is not good, then of course you won’t be able to take that much out.
Trish: You hear all these fancy words, so now there’s not only liposuction, but there’s liposculpture, is that something different, or it’s just another word for the same thing?
Dr Lim: Well liposculpture is a word that we’ve been trying to introduce, to more or less differentiate between pure suctioning of fat, and the ability to shape the body. Really the best result is when you can scuplture the body, and that’s why we try to use the word, and want to introduce the word liposculpture. But somehow or other in our practice too, in the last twenty three years, we have found that it’s very difficult for the patient to comprehend that you can actually really shape a persons body that well, and so the word liposuction still remains as the word that everyone comes to us and say “I’d like to have liposuction”. Truly what we’re doing today is we actually sculpturing the body, we’re actually shaping it.
Trish: Yeah, it makes sense. So it’s kind of the same thing.
Dr Lim: Yes, one and the same thing.
Trish: Okay, okay. So do you do fat transfer? Say for example, or lipofilling I think, it’s the same – we hear all these different terms, so fat transfer is like the same as lipofilling?
Dr Lim: Well the term lipofilling just means that you are actually removing fat from one part of the body, and you are filling the deficiency or depression somewhere in another part of the body. So literally, what you are doing, is you are transferring fat from one part of the body to another. So fat transfer is a more common term that we use, and lipofilling is not such an easy term for people to comprehend. So generally now we just say “Look if you like to fill up a depression in another part of the body, we’ll just transfer some fat”, so we call it fat transfer.
Trish: Okay and that can be in the face, or…?
Dr Lim: Oh yes, anywhere, you can take fat from any part of the body where there is fat to be taken out, and that can be processed, and then that can be then transferred into that particular area. But remember, that when you transfer fat from one part of the body to another, not all of the fat cells will survive. It’s a bit like say when you try to transfer a tree from your front yard to the back yard, some of the branches will die and some will not survive. So parts of it will not survive. So when you transfer fat cells from one part of the body to another, maybe 30% of that, easily 40% of that will not survive, and you need maybe a month later or two months later to supplement by another transfer. So very often you need about two or three transfers to get the right result.
Trish: Okay, okay, well that makes sense as well. So you said it’s not, because it’s true, some people think “Oh I’ll have the liposuction, that’ll get rid of all the fat” but I know myself, when I had liposuction, I didn’t lose any weight. My shape was a little bit different, so although people might have thought-well no one said that I’d lost weight, well actually no I gained weight, but people said that I didn’t looked like I had gained weight because I had shaped me in a way that I didn’t sort of have before.
Dr Lim: That’s right, when they look at you and your shape has changed, the immediate response is that you’ve lost some weight. They don’t even know that you had liposuction done, but they know that your shape has changed, so by reference to sort of what we normally know about peoples shape, you must have lost some weight. But actually you haven’t lost any, or much weight at all. If you take fat cells alone, fat cell alone is quite light, it’s a bit like cotton wool, it’s quite light. But when you add water to your cotton wool, then of course there is weight to it, see?
Trish: Right, yes of course, makes it heavier.
Dr Lim: Does that make sense?
Trish: Mm-hmm it does make sense.
Dr Lim: That’s alright.
Trish: Alright, so a rough procedure, like how long will it take? I know that depends on what you’re having done, but just say for example if you wanted a bit of liposuction around your belly and say your thighs or something.
Dr Lim: Yep, so normally, you would do liposuction in terms of an area. So you would do abdomen, which is the front of the abdomen, which is an area, and then very often you’ll find that when you have a tummy problem, in other words, fat building up in the front of your tummy, you also unfortunately also build up fat in your hips, so that’s another area. So very often these two areas are combined together in the same procedure. So you wouldn’t really want to go and do a tummy and then do thighs, and do other parts of the body, all at the same time. You want to do them in a sort of modest parts that will sort of shape together, you see?
Trish: Okay, so for example, if I want to come get my tummy done, so I come get my tummy done first, and then let that settle and then I’d come and get my thighs done.
Dr Lim: And then you can come and get your thighs done after that. Now with the thighs, you can do the outer thighs as one area, in other words, outer thighs of both legs, which means we often refer to as saddle bags, or you can do the outer thighs and inner thighs together. So inner thighs is another area. So we have these two areas done. Then, very often you’ll find out when people have got an inner thigh problem, in other words, the upper part of the inner thigh is where you usually build up fat. And this is where when you stand and bring your legs closer together, the upper part of your legs will touch and squeeze together, and that makes it very uncomfortable. In hot weather, it’s sort of really uncomfortable, because you sweat in the area, and it sticks.
Trish: Oh don’t worry, I know exactly what you’re talking about.
Dr Lim: Very often when you have upper thigh problems, almost always when you look at some ones legs, they will also have pads around the inner part of your knees, so in other words you have these knee pads. So often when we talk about a inner thigh procedure, you will want to do the inner thigh from the groin, the upper part, down to your knees. Otherwise, if you don’t do that, you’ll take away the upper part of your thigh, and that looks very nice, and then after a few years, the pads in the knees, on the inside of both knees, will build up, and that creates a very, very odd sort of shape with the person, you know? A bit skinny at the top and then fat in the knees.
Trish: I got it, got it.
Dr Lim: So it’s very important that when you are seeing the doctor, you must then try to work to try and get the doctor to help you understand whether is it better to do the upper part and knees together? I always say that you should do the two parts together.
Trish: Less recovery?
Dr Lim: It’s very rare that people have got upper thigh, inner thigh problem without any fat in the knees. It’s almost always that you see both together.
Trish: You’re making me look at my knees now. Alright, so how long before for recovery, if you’re having liposuction done, in your way, how long is recovery? So for example, I’m having my inner and outer thighs done in one session.
Dr Lim: Okay, alright, now if you’re doing your outer thighs, inner thighs and knees altogether in one sitting, in one procedure, now if you do it under local anaesthetic, tumescent liposuction under local anaesthetic, with light sedation, you’ll find that by the next day, you’re home after four hours. So the whole procedure will take about four hours, four and a half, depending on how difficult the fat is, and getting it out, and how fussy the doctor is, because very often as you know, the length of time it takes depends on how difficult the fat is to get it off that area. Sometimes there are too many fibrous tissues in the fat, and sometimes there’s not as many, so that determines how long it takes. At the end of the day too, it depends on how fussy and how pedantic the doctor is, because I always say “Look, the more pedantic the doctor is, the better the results you’re going to get” So he’s much careful about the way he likes the shape to be.
Trish: Of course.
Dr Lim: So it’s not something that you walk in and walk out, because I’ve got a golf game to go to or whatever, you know?
Trish: Yep, yep, yep. So with the fibres that you’re talking about, is that like everybody’s different or is it an age thing, like if you’re older?
Dr Lim: Every one is different.
Trish: Okay, so it’s not-
Dr Lim: A lot of it is to do with age things, so the older we get, unfortunately the more fibres you’re going to see in the fat, and the more difficult it is to get the fat out and shape it. That’s why if it’s possible for a person to say get any liposuction done you want to do it as young as you can, as early as you can, and not wait til you’re sort of getting the later part of your life, you see?
So now coming back to your question about how long it takes before you really recover well, completely. Well, if you do it under local anaesthetic, you’ll find that by the next day you should be able to drive a car already. You should be able to get back to work within three days. So that’s how fast it is you know?
Trish: Alright, and so we’ll go back just as an example, if I have my thighs, inner thighs, outer thighs done, do you have to wear a compression garment?
Dr Lim: You have to wear a compression garment. Now that depends on the doctor and the kind of compression garment he gives you, or he or she gives you. In my case, we get our patient to wear them for three weeks, day and night, twenty four hours a day, except when you take it off to have your shower. Otherwise, it’s three weeks.
Trish: That’s pretty good, three weeks. I wore mine for six weeks.
Dr Lim: Yes you can wear it for as long you want, but a minimum would be, I would recommend, three weeks.
Trish: Okay, alright. What about your skin, so for example, you have the liposuction, what about the skin, because the last thing anyone wants is liposuction and then really saggy, baggy skin.
Dr Lim: Correct, yep, I know what you’re saying, yeah. Now that again depends on the skin, the quality of skin before you start your liposuction. Two things, one of course depends on the age of the person, the older a person, the looser the skin will be. But it doesn’t mean that all fifty year olds, all sixty year olds will have the same quality of skin. You find there are some fifty, sixty year old who’ve been so looking out for themselves very well, even though they’ve put on a fair bit of weight, or they have a fair bit of fat deposits, but the skin is still of a good quality, it’s not loose. Then if that’s the case, you can take a reasonable amount of fat out, and still the skin will not become loose.
The way the fat is taken out also will determine how well it contracts. This is where the term we call superficial liposuction comes in. Now if you are able to remove fat and remove it closer to the skin, of course, there needs the skill there to not damage the skin, then by being closer to the skin, by doing more what we call superficial liposuction, you are then able to stimulate the collagen at that level there, to produce some sort of contraction of the skin when it recovers, so you get better results. Now in a younger person, naturally their skin is good, twenty, thirty year old, forty year old, find their skin is usually pretty good, unless you’ve been so much overweight, and you’ve lost twenty or thirty kilos, then of course, it’s very hard for the skin to contract. So for those cases, almost always you’re going to need some surgery to remove the excess skin.
Other than that you don’t need to.
Trish: Okay, so it kind of depends on the quality of the skin, and how much you’ve got depending on how much weight you’ve lost, or how much you get done.
Dr Lim: That’s right, yes yes, correct. Then sometimes of course if somebody says “Look I really don’t want to have any surgery, is there any other way out of it?” Well one way out of it then would be, you just do as much liposuction as possible, because the doctor will be able to tell when he’s removing the fat, he can then see the skin is starting to get a bit loose, then he will stop, and we will then make that as a stage two stage procedure. You take 50% of that for the first stage, leave it for about six months, let the body recover, and then you can go back and extract a little bit more fat, and shape it down again. That way you can get a better skin retraction.
Trish: Okay, so it sounds like you don’t just rock up, go and have your lipo, come home and you’re done, it’s almost like you’ve got to kind of plan it, what do you want, okay let’s do this first and see what it looks like, and then you may need to go in again and kind of sculpt it to suit you as you go along kind of thing.
Dr Lim: Yes you can tell beforehand, more like it can be planned before hand, but generally speaking too, even if you whatever, how old you are, once you’ve had your liposuction done, you should also continue to make sure you don’t put on too much weight, you should look after yourself, exercise well, maintain a good dietary program, because having liposuction done is not a license to go and eat anything and do anything.
Trish: Of course, I think I learned that the hard way. Alright, I reckon I’ve probably asked anything anyone could have possibly want to ask. Is there anything that you think that our listeners might want to know that we haven’t spoke about. Maybe infection?
Dr Lim: Well the one thing that people often ask me, is can I, or can you give me a quotation over the phone, or can you give me a quotation over an email, or whatever. I always say to them, “Look, if you really seriously would like to have liposuction done, you must have a face to face visit.” You must have a sort of a see your doctor, so that he can actually assess your skin, see how difficult it is, or how easy it is to remove the fat, and how, what areas can combine with which area to get the best results. So I don’t support, and I don’t recommend anyone who subscribes to the fact that “Look just give me a call and I’ll give you a quote.” I don’t think that’s a good idea.
Trish: No that’s so true, you need to have that physical examination, without a doubt.
Dr Lim: Oh you need to, yes definitely.
Trish: Now is there anyone that shouldn’t have liposuction? Is it contra-indicated for any particular type of person?
Dr Lim: Yes, yes because of the fact that we do, especially when we do liposuction under local anaesthetic, we use quite a large volume of anaesthetic. So obviously anyone with a heart disease, anyone with a long term anticoagulants, for any sort of bleeding disorders. Anyone with irregular heartbeats, all that. So they should have proper blood test, before they can sort of go ahead. Among the blood tests that we recommend is of course, a check on the bleeding conditions, how your blood coagulates, we check for diabetes, we check for thyroid problems. Check your liver because your liver and your kidneys are going to be the primary organs that’s going to help you discharge the large amount of anaesthetic that we’re going to use, you see? So obviously all of these have got to be done well, so you can’t just simply walk into a doctor and say “look can I have my liposuction tomorrow” and then go ahead and get it done. You must have all these blood tests done.
Trish: Sure, so you want to make sure that anyone that you’re going to see is going to number one, ask you all those questions, and number two, request that you have a blood test before they even …
Dr Lim: Yes, yes, and don’t be afraid to ask questions. It’s important for all patients to sort of ask questions and get the right answers, and if you’re not sure that the answer is something that you can understand, well either you ask again, and if you are not getting the right answers, then I would recommend that you get a second opinion.
Trish: Yeah that’s true, it’s probably always best to see more than one person, because then you can see what the good things, the bad things and decide who you want to go and feel comfortable when you go.
Dr Lim: Yes that’s why that visit to the doctor is so important. You have a chance to, well not only for the doctor to assess you, but also for you to assess the doctor. To get an idea whether “Does he know what he’s saying, does he sound as if he knows what he’s doing?” It’s important. Unfortunately today, not everyone is really sort of well trained to do the job they claim they can do, and I’m sure you’ve come across that in a lot of your contacts.
Trish: Oh absolutely, absolutely some things are really frightening, when you see things have happened to people, it is. That’s the most important decision, I think, that you’ll make is the choice of practitioner that you choose to go with.
Dr Lim: Yes, yes, yes. So that’s important, and it’s important to also know that the background of the person, how much that kind of work have they done. It doesn’t matter whether the person is a surgeon, non surgeon, or sort of medical whatever practitioner, whatever it is, the important thing is that you must know, has that person been trained in that area of procedure that he’s going to do for you. Just because some one says “I’m a doctor, means I can do anything”
Trish: Yeah, exactly. One last question, I actually had a customer today ask me about, she was looking for some one to do Vaser liposuction. Can you tell us a little bit about Vaser lipo and is that something that you use?
Dr Lim: Oh definitely, yes. I don’t use Vaser liposuction because I’m actually a more traditional sort of practitioner. Now basically using Vaser, Vaser is actually using ultrasound. The purpose of using the Vaser is to break down the fat cells. So when you break it down, then it’s easier for you to suction it out. So at the end of the day, the shaping and everything is to do with the suctioning. How well you move your cannulas to suction the area of the fat, is how the shape is going to end up. The Vaser is used to break the fat cells so that makes it easier for the suction to happen.
Now for traditional people like us, like me, I don’t use the Vaser to break the fat. I actually use another instrument which is called the “mangravet”????. Now it’s an instrument which acts like a cheese grater in a way, so very often we tease the patient, and say “Look I’m going to use a cheese grater on you” because this instrument helps me to break the fat down, but I do it manually. So by doing it manually, then I also break it down, and helps me to suction the fat out well.
So it’s a question of whether the practitioner decides he wants the help of Vaser, or he just wants to do it manually. Now the advantage of doing the manual method, is the opening, the sort of the entry point, is very small. Where as when you use a Vaser, you have to make a bigger cut in the skin, because the instrument to break down the fat through the ultrasound, is pretty big. So that means it’s gonna make a bigger cut, and by making a bigger cut, you need to stitch the cut.
Now when we do it manually, the cut in the skin is very small, it doesn’t need any stitching at all. So that’s why all doctors who do it manually don’t need to stitch the little cuts. Now the other thing about Vaser is of course very important, that the person who uses the Vaser, knows how to use it properly too, because one of the complications of Vaser, is that ultrasound can burn. So if you leave the Vaser in a spot for too long, it’ll burn the skin. So damage can happen, because of that. Where as with a manual method, there is no way you can burn the skin, you see? Of course if you look at making furniture, fine furniture, well all the masters of fine furniture, are all of the ones who use hand tools. They don’t use hazy electrical tools to make their fine furniture. You polish it with your hand, you polish it with your…. You make cuts, and you shape it all with your hand. So that’s why I like to say, “Look when we do it manually, we know exactly where we want to be, we know exactly and you get the right result, all the time”
Dr Lim: So that’s the difference.
Trish: Yeah that makes it really really clear, because I do asked lots of questions about Vaser lipo, I thought it was just being promoted as more of a skin tightener.
Dr Lim: Well it does help in the skin tightening, because, this is where we talked about, remember I said to you a bit earlier about superficial liposuction?
Dr Lim: Now the superficial liposuction is done manually, so in other words you’re going closer to the skin. Now if you’re going to use a Vaser to help you to tighten the skin, you then have to use the Vaser closer to the skin. That’s where the burn comes in, you see?
Trish: Okay, alright, got it.
Dr Lim: So you can tighten both ways, either manually or with a Vaser. So it doesn’t mean Vaser is the only thing they can use to tighten. But where Vaser helps, it definitely helps, is definitely in the male, in the back, because the fat in the back of the male is very very tough. Now manually you can still do it and soften it up, but it leaves a fair bit of muscle to get to the point where you can soften it up.
So that being said, for the doctor, you’d be raising a bit more sweat.
Trish: Yeah, well I’ve actually seen-go on sorry.
Dr Lim: You’ve seen them go in a bit harder in the back. Now with the Vaser, the Vaser helps you to break it down a bit faster, with the male back. But other than that, in the other parts of the body, I really don’t see any advantage. The end result is really the suctioning. That’s why I sort of never seen any work done through a Vaser, which is going to end up looking any better than anyone who does it well under manual situation.
Trish: Got it. Well you know what I’ve watched, just recently, well a few months ago, I watched my first surgical procedure, and that involved liposuction, I tell you, you guys work, it’s like a work out.
Dr Lim: Yes, it is.
Trish: So it keeps you fit.
Dr Lim: Yeah but actually even though it looks as if it’s the person is really doing a great workout there, but truly if it is done well and correctly, it’s more you can see the movements moving fast, but it’s not really against great pressure. You shouldn’t, no one should use great pressure, because if you’re using great pressure, you cannot get fine results. As you know, if I ask you to press a pencil down on the paper very hard, you can never get a fine drawing, all the fine drawings always done with the lightest of hand, isn’t it?
Trish: That’s so true. It’s the most delicate strokes. No I know what you mean, I can visualize it, can visualise it in my mind.
Dr Lim: Yeah, all the strokes has got to be delicate. It might be fast, but it’s still delicate, right? Where it’s just that when you’re doing drawing, you might be able to move fast but it’s still very light, you know? You’re drawing across the paper very lightly, you see? But if you were to force yourself on the paper and do it very very hard, you’re never going to get a very neat picture done.
Trish: No totally, oh that’s great, that’s been really really helpful. Now before we go I know that you do lots of other procedures, so I thought just very quickly, so you do facial treatments as well? Injectables?
Dr Lim: Yes, we do injectables, and do the liquid face lift, with injectables. Yes, definitely, and then of course what we call the neuro modulators now – neuro toxins, like Botox, xeomin, and dysport, and all these other things, yes we do that. I do PRP as well, so one of these days we can talk about that and we can talk about liquid face lift as well because I teach that as well.
Trish: Oh fantastic, that’d be great, well I’ll look forward to our next chat, so thank you so much for being with us today.
Dr Lim: Thank you very much Trish.
Trish: No worries.
Dr Lim: Hopefully we’ll get a chance to talk again on any other aspects of liposuction, particularly we can concentrate on certain areas – what areas can be done, we do breast reduction, we do chin, we do whatever it is we can talk about each individual procedure then, because today we are concentrating on a general aspect of liposuction.
Trish: Yeah, well good to know anyway, you can get your chin done, you can get where else?
Dr Lim: Yeah you can breast reduce.
Trish: Yeah breast reduction.
Dr Lim: You can get your back done, hips, lower legs, you know what we call cankles? Nowadays the young people call them cankles instead of ankles?
Trish: Cankles. Yep there’s an answer for everything isn’t there?
Dr Lim: Yes, and of course arms can be done also very well these days.
Trish: That’s true, I didn’t even think to even bring that up, but of course only because I’m thinking of what I would want.
Dr Lim: Oh it’s a lot to talk about, it’s a lot to talk about, I’m sure we’ll get back and we’ll concentrate on area at a time, and then, because each area has it’s own peculiar aspects to talk about.
Trish: That’s true, that’s true too. Alright, well if you’re new listeners out there, if you’re looking for The Ashbrooke Cosmetic Surgery Clinic, they’re actually based on Military Road in Mosman, so pop down and they’d love to hear from you. You can Google them, or you can call them.
Dr Lim: That’s right, and I’m also in Parramatta as well.
Trish: Oh okay, Parramatta as well, good to know.
Dr Lim: Yes, yes so they can Google it and find us.
Trish: And if not you can always drop us an email to firstname.lastname@example.org, so thank you so much Dr Lim.
Dr Lim: Thank you very much Trish.
Trish: Lovely, thank you bye!
Dr Lim: Bye.