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When I consult with a patient, I am evaluating from a number of different perspectives. I don’t go into my consultation and ask what they would like to treat or what they are here for. Instead I evaluate the entire body from neck down, from all angles and consider the following three factors: disproportion, weight, and laxity.

Disproportion

Is the patient carrying fat disproportionately throughout their body?

Twenty years ago I was featured on The Today Show with the perfect candidate for liposuction: an 18 year old, 110 pound patient—sounds unreasonable, but bear with me. The patient's mother was also on the show, and both mother and daughter shared a genetic disproportion of a thin, bony upper body, with large outer thigh “saddlebags” that were significantly disproportionate to the rest of the body. This is an example of the perfect liposuction patient: regardless of weight fluctuations, the areas of disproportion do not change. These are the areas of fat that are stubborn and do not change regardless of diet or exercise.

David Amron, MD

Weight

Is the patient overweight?

I have never been a fan of BMI (body mass index) measurements as they relate to liposuction, as BMI does not differentiate a body that is disproportionate: you may have a high BMI caused by disproportion, when in fact you’re not overweight. Liposuction is not a weight loss technique and if the patient is significantly overweight, other strategies such as diet, lap band, or bypass surgeries may need to be considered first.

Laxity

Is there laxity in the treatment area?

Patients will grab an area of their body they dislike and wiggle and shake it around, which always leads me to ask what they would call the tissue they are grabbing on to. The first answer is always fat. The second answer is skin—but there is actually something else at play—potential laxity of the skin and underlying muscles. 

As we age, muscles can loosen. A good example is diastasis recti in women after childbirth. This is where the muscles of the abdomen have stretched and separated. A patient with this concern may think she needs liposuction but instead requires an abdominoplasty (tummy tuck surgery) to repair the muscle laxity and excess lax skin.

David Amron, MD

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