360 Lipo: Snatched, Not Kidnapped

Speaker 1 (00:06):
Welcome to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:15):
Welcome everyone to The La Jolla Cosmetic Podcast. Today, we're going to discuss liposuction and a specific type of liposuction, which I'll get to in a second, but there's so many choices and we need to know what are the differences in the types of lipo out there. According to the urban dictionary, the word snatched means to look good, be perfect on point or fashionable. And it's usually in reference to someone's body. So within the context of 360 lipo, which is what we're talking today about the slang to look snatched is what you'll find on the internet. It's the most common word used to describe the results of this procedure? It doesn't not mean kidnapped like the movie with Goldie Hawn and Amy Schumer snatched, but I'm going to introduce you today to our brilliant guest, Dr. Luke Swistun. Dr. Swistun welcome.

Dr. Luke Swistun (01:10):
Thank you.

Monique Ramsey (01:11):
Here's my first question. Did you know the definition of snatched?

Monique Ramsey (01:15):
All right. Not in the context you described, they knew the definition of snatched in the context of 360 liposuction, which I believe is what we're here to talk about because everybody's asking for it. I didn't learn it until I was asked about it several times. Yeah.

Monique Ramsey (01:30):
So one of your patients said it to you the first time?

Dr. Luke Swistun (01:33):
"Can you snatch my waist?" was the exact line. And then I said, "can I what?" And then she's like, "you know, snatch my waist?" And then, um, we had a conversation about it and it turns out that the thinnest waist we can get her is the result she was looking for. And that was the term she used.

Monique Ramsey (01:48):
Interesting. Well, if you look online, I mean, we found about 17 different brand names for liposuction. I mean, you've got SmartLipo, cool lipo, iLipo, Vaser Lipo, power assisted lipo, laser lipo, slim lipo, lipo lite. Is there anything I've missed?

Dr. Luke Swistun (02:06):
I'm sure there is

Monique Ramsey (02:07):
Lipo sculpt, liposculpture. So today we're really going to talk about 360 lipo. And so let me ask you what is 360 lipo? And what's the goal?

Dr. Luke Swistun (02:19):
My understanding and how I perform 360 lipo is basically a full circle liposuction, and it mostly refers to the torso of the patient. The idea is that you want to optimize the full body contour of any individual acknowledging that each of us is different. And that's what makes it a little bit different from traditional liposuction. It's in the sense that in the past, people would just kind of request a certain area to be addressed. Hey, uh, you know, I have a lot of fat right on my, you know, the front of my tummy. Can you take care of that? And then they would add areas and the idea and this is sort of the respect we should have for the entire human contour, but addressing certain individual areas without paying attention to other individual areas. And to me that never really made sense. Um, you know, coming from a little bit of an artistic background, I think all of these areas are related and really the only way to optimize your result, which is I think what anybody should want to do if they're already going to go in surgery and, you know, deal with the cost of that and then the recovery associated with that, is you really should try to optimize the result.

Dr. Luke Swistun (03:21):
And I think the best way to do that is to address all these areas appropriately. And that's exactly what 360 liposuction does. It's just full circle.

Monique Ramsey (03:31):
As you were saying that it reminded me, I watch a lot of HGTV and you know, these, you see these houses where somebody has done an add on and it looks so ridiculous cause it doesn't go with the rest of the house. You know, if you do an addition on the house, that isn't part of the whole thing that doesn't fit, I guess that would be similar. You know, if you're just addressing one area without really thinking, what are the right proportions?

Dr. Luke Swistun (03:54):
That's right. In the context of that patient it just starts looking unnatural really quickly. And that's the last thing you wanted.

Monique Ramsey (04:02):
Who is the best candidate for this kind of lipo?

Dr. Luke Swistun (04:05):
So typically patients who have fair quality skin and they're a little bit overweight. I mean, we can talk about BMI, which is the specific, the body mass index height to weight ratio. If anybody's familiar with that, normal BMI is 20 to 25, 25 to 29 is considered overweight and 30 to 35 is obese. Anything above 35 is morbidly obese. Somebody who's overweight, BMI of 25 to 30 would be the ideal candidate because that allows us to sort of remove safely the fat that they have that is sort of interfering with their optimal contour and potentially put it elsewhere, which we'll talk about and use it to augment other areas of their body naturally and keep it safe. And that's the other thing is obviously this is a cosmetic procedure. We do not want to introduce the patient to a significant risk for a surgery that they don't technically have to have because it is cosmetic. So there are limits associated with how much surgery we can do at any given time. And the BMI of 25 to 30 gives us the opportunity to be safe because we can still make a very significant difference while keeping the amounts low.

Monique Ramsey (05:09):
You mentioned somebody who has fair skin. I think you said that at the beginning.

Dr. Luke Swistun (05:13):
Good quality skin would be good, yes.

Monique Ramsey (05:15):
Oh, good quality skin. Got it.

Dr. Luke Swistun (05:17):
And that has to do with retraction of the skin after we remove the volume from beneath that. So obviously we don't want loose skin after we do the liposuction. Uh, it's important to know that skin grows in response to volume increase, right? So if somebody gains weight, the skin responds by growing and not stretching but growing. So then if somebody gains a significant amount of weight and if we remove all that volume with liposuction, the skin does not necessarily shrink to the same extent. People with good quality skin, which have, you know, maybe people who are younger, people who have thicker skin and people who don't have stretch marks after their pregnancies. Those are the signs that I look for to judge the quality of skin. And they tend to a little bit better because they just tend to shrink wrap themselves in their skin a little bit better after such a procedure. There's obviously other things that we can do to help with the skin tightening afterwards. We can talk about that.

Monique Ramsey (06:10):
Okay, we'll get to that in a minute, I have that on my list. So now you were saying how much surgery can be done safely. So do you say it at this amount of hours or this amount of cc's of fat removed or kind of, where do you draw the line in terms of what's safe and what isn't?

Dr. Luke Swistun (06:28):
So kind of both. And basically we just try to minimize our risks with a procedure like this. So there's actually a legal limit that is associated with this kind of procedure. If anybody looks this up, it's usually quoted as five liters of lipoaspirate, which is not just fat, but the fat and the fluid that we put in there in order to do the surgery at a given session for a patient who is going to go home that day. And that's an important distinction because, you know, if the patient is going to get admitted to the hospital afterwards for monitoring, then we could push that limit a little bit further, technically speaking, but it's all the in terms of safety, once you remove more than five liters from an average person, then we need to monitor their fluid, shifts a little bit more. It gets a little complicated, but the bottom line is they need to be monitored by somebody who knows what they're looking at and looking for in order to balance their fluid appropriately so that they do well.

Dr. Luke Swistun (07:17):
And we know that about five liters, sometimes that can be an issue. And then time is another factor. Of course, there are papers that show that risks increase for a surgery if it takes more than six hours. There is a, you know, it's kind of a little bit of a statistical difference in rate of complications after about six hours of surgery. So I try to keep my surgeries below that if possible, obviously, you know, in emergency situations, you have to do whatever we need to do, but in this case, because it's elective surgery and we want to plan as well as we can. And we want to make it as safe as possible for the patient.

Monique Ramsey (07:51):
Does that ever necessitate with this procedure, doing things in more than one phase or what percentage of the time is it done in one sitting versus two?

Dr. Luke Swistun (08:00):
Absolutely. So occasionally if there is a lot of areas that the patients want to address, let's say they want 360 lipo of their torso, and maybe they want to add the arm liposuction and skin tightening of the arms and thigh liposuction, skin tightening of the thighs and maybe chin liposuction. I'm going to start drawing a line and say like, well, you know, that's going to take us into well beyond the six hour mark that I'd like to be under just to limit your complications. So yeah, let's, let's just focus on the problem the area that bothers you the most. And then let's let you heal for six months and then come back and do the rest.

Monique Ramsey (08:35):
Interesting. Now how much weight could somebody expect to lose with this procedure?

Dr. Luke Swistun (08:41):
So that's an excellent question because a lot of people have misconceptions about this. This is not a weight loss surgery. This is a contouring surgery. So in general, even after a pretty extensive procedure, I'll maybe take off, you know, eight to 10 pounds of pure fat on average, which is not a lot. It is a lot in the sense that it comes from the area that matters the most. So it makes a huge difference because if a patient was to lose 10 pounds on their own, it would come away from their entire body from head to toe. Whereas here I'm really focusing on the abdomen and the flanks. And so that makes a much, much more significant difference aesthetically speaking, but this is not a weight loss surgery nevertheless. If somebody is with a BMI of 35 or more, specifically 35 or more, that would put them in the obese and morbidly obese category, and those are the patients that I actually start having conversation about bariatric surgery.

Dr. Luke Swistun (09:34):
This is not a surgery that I do, but it's a surgery that I'm very familiar with. And that's a very different type of surgery. It involves, you know, stomach stapling, or it involves gastric bypass, but those are surgeries that are designed for morbidly obese people to lose a lot of weight, like 70 pounds, 80 pounds, a hundred pounds, even more. And those are life changing surgeries for these patients. These are surgeries that will extend their lifespan by a lot by decades, they will prevent diseases. They will cure diabetes, they will reduce high blood pressure and they will help them in their lives dramatically. So a lot of times patients who are morbidly obese will come in for liposuction and I'll basically inform them of this. And we will see them after that. You know, when they need some skin removal procedures after they have a massive weight loss, but, but that is the route to go for somebody who is in that category.

Monique Ramsey (10:22):
Yeah. Get the weight off first.

Dr. Luke Swistun (10:24):
Correct.

Monique Ramsey (10:25):
Because then they'll be healthier too. I mean, it's not just about your result, but it's also about the safety. And I think that's really important for patients to know. It made me think about, as you were talking, the gentleman, mostly there's women too, but who have that beer belly is a beer belly, that type of thing that you could address cause that's in the middle of your torso. Is that something you can do with this kind of lipo?

Dr. Luke Swistun (10:48):
It depends. It depends. So in men tend to store their fat and the inside of their abdominal muscles as in like between their intestines. Whereas women tend to store their fat on the outside of the muscles basically, which is what makes them more curvaceous as my eighth grade science teacher put it long ago, but that's sort of the difference. So a lot of times when we have this beer belly, I would try to assess the patient's, uh, you know, the gentleman's abdomen and see how much of that is fat on the outside of the muscles, which is something that I can intervene on or how much of their fat is underneath the muscle around the intestines, which is obviously not something that I can liposuction. The only way to lose that is with weight loss.

Monique Ramsey (11:27):
Ok. Now what areas of the body can be treated with this type of liposuction?

Dr. Luke Swistun (11:32):
So again, 360 lipo pretty much refers to the torso traditionally, but that can be combined with pretty much anywhere else that becomes a problem area. So very frequently I do upper arms and medial thighs as in central thighs and sometimes outer thighs as well. We can liposuction the chin and the jaw area in order to reduce some of the fat in that area. Some patients have a little bit of what we call a Buffalo hump, which has kind of a fullness in the lower neck area. Sometimes they're born with that. Sometimes they sort of acquire that over time. Some times there are certain medications that can cause that, but that's another area that we can treat. Some patients just have large buttocks that they want to reduce. That's unusual, but it can happen. And that's another area

Monique Ramsey (12:16):
They don't know how lucky they are.

Monique Ramsey (12:20):
And then there's another area that's commonly known as the banana roll, which is sort of the area that a little extra roll of fat underneath the buttock crease that some people are bothered by. And then occasionally I've done medial knees as in the central portion of the knees. That actually is pretty effective as well.

Monique Ramsey (12:37):
Now what about people who have cankles, you know, those big, wide cankles? Not something you can do?

Dr. Luke Swistun (12:46):
It depends on the etiology. Again, there's actually one patient that approached me about that. And I was more under the impression that it has something to do with lymphedema. Lymphedema can be treated with liposuction, but what I did is we ended up doing a workup for her to see if there's any specific cause of the lymphedema that we should treat first before we go into liposuction.

Monique Ramsey (13:04):
So it's more that they were having swelling.

Dr. Luke Swistun (13:06):
Correct?

Monique Ramsey (13:06):
Lymphedema is accumulation of fluid, I take it.

Dr. Luke Swistun (13:10):
Correct, swelling there is a little unusual so there may be a reason for it that we need to find first, before we go into a cosmetic procedure to treat it.

Monique Ramsey (13:18):
Now. Well, what about a tummy tuck? Is this ever combined with the tummy tuck or is it ever instead of, or how do you make that determination? Whether they need a tummy tuck or they need lipo or they need both?

Dr. Luke Swistun (13:33):
So excellent question because that's actually the vast majority of patients are sort of in between that realm somewhere. And then those are often the two surgeries that are sought for together because of the things that they address. So the way to think about it is that the tummy tuck really addresses just the front one-third of the abdomen and it really optimizes that area. And for most people that is actually the biggest problem area that they're uncomfortable with, especially after multiple pregnancies, especially after they had a C-section and maybe they have an unfavorable incision that has healed sort of tethered. And then that causes an overhang of the skin, like a little apron. Really the only way to treat that very effectively and give them the best result is with a tummy tuck, because that involves removing the extra skin, also plicating the abdominal muscles, which is a fancy word for just tightening up the muscles like in a corset fashion sort of on the inside at the core, which basically narrows their entire weighs by 10 to 12 centimeters.

Dr. Luke Swistun (14:32):
But it gives them that narrow waist at the core. And in addition to removing the skin and maybe doing a little liposuction on the side that really snatches the waist, but, uh, that may be the most important intervention for some patients who were that sort of problem that is especially with the extra skin and then patients who had weight gain elsewhere may benefit from the 360 liposuction. The 360 liposuction really treats the rest. So basically the other two-thirds I guess, of the torso. So the flanks and the back, and then the upper back, lower back, and you know, related things like that. That's what 360 liposuction is really, really focused on assuming that the skin is not an issue in the front.

Monique Ramsey (15:14):
And could you do it all in one at one time?

Dr. Luke Swistun (15:17):
I typically don't recommend doing it all in one time because it does depend, and I've done it maybe three times and the patient has to be a really good candidate for that.

Dr. Luke Swistun (15:25):
The recovery is just very difficult. It's doable and in the right patient, it can be done. And the patient can't be too large. You know, I'd still like to keep the entire procedure under six hours. And then the recovery becomes difficult, especially, especially if you combine it with a fat transfer to the buttocks, which is a very common thing that we also do in the context of a 360 liposuction. If you think about it, if you have a tummy tuck, you have a lot of surgery in the front of your abdomen, uh, the plication or the corset procedure on the inside is a little uncomfortable at first because all the muscles are tightened up. So those are your core muscles. Every time you get out of bed, every time you move, every time you cough, you feel that.

Dr. Luke Swistun (16:05):
Tummy tuck also has a pretty long incision in the front. So that's another part of the recovery. And you're really kind of hunched over for about a week or two after the surgery, because you know, when everything is swollen everything is very tight and you're walking sort of hunched forward. Now, if we combine that with 360 liposuction. We make the rest of your entire torso also sore,

Monique Ramsey (16:23):
Oh gosh, yeah.

Dr. Luke Swistun (16:25):
Upper, lower back, and flanks. And then if we combine that with fat transfer to the buttocks, then that creates another problem because in order to survive, you need to keep pressure off of that fat for about six weeks. So how do you sleep? Do you sleep on your stomach? Do you sleep on your back? Do you sleep on your side? And it becomes challenging. The answers are there, I've actually had those patients sleep in La-z-boys with pillows underneath their legs and pillows underneath their lower back, floating their buttock while they're still flexed.

Monique Ramsey (16:51):
Oh goodness. It sounds like two surgeries is way better.

Dr. Luke Swistun (16:55):
They need basically a lot of help and a lot of family around for those first couple of weeks. And a lot of people just can't plan for something like that.

Monique Ramsey (17:03):
Yeah. So you would do the tummy tuck first on a patient who needs both or wants both?

Dr. Luke Swistun (17:07):
It depends. It gets a little bit complicated in that it really depends on their goals. I think it's a little bit too long of a discussion to get into. A lot of patients actually, when they first come in, they sort of look for their entire body contour to change. And a lot of times they prefer to look good in clothes and they don't necessarily care about what they look like out of clothes. They're okay with the extra skin hanging in the front, as long as they can hide it, if that makes sense. So a lot of patients will actually request a 360 liposuction and to some extent, the skin will shrink. We know that. Maybe they'll be okay with it. And if not, we always have that avenue of like, okay, well, if you're unhappy with the skin in a year, come back and have a tummy tuck.

Monique Ramsey (17:50):
Oh. And then get the rest of the skin, if there's any.

Dr. Luke Swistun (17:52):
Exactly, exactly. So a lot of people go that way, but there's a small percentage of patients basically come in and they, you know, they're a little bit on the slimmer side and they just had two pregnancies. And their biggest problem is that extra skin on the front. And those are the patients that request that tummy tuck first.

Monique Ramsey (18:07):
So what can we do with the fat once it's removed? It seems like liquid gold. Give us the low down.

Dr. Luke Swistun (18:15):
We can do one of two things. We can either throw it away, in which case we can never use it again. We cannot freeze it or save it for later. That's an important caveat. Or we can use it somewhere, anywhere in the body to augment another area. Fat will survive in the long-term. Not all of it survives. So let's say, you know, the most common place is you know the Brazilian butt lift, which basically involves putting the fat into the buttock area in order to augment the buttocks. And it's usually done with the 360 liposuction it's for good reason, because when we do a 360 liposuction, we have a lot of fat available, which is what we need in order to make a big difference on the buttocks. So that's when we do it. I've done also fat grafting to other areas as well. A very common procedure is also a little bit of fat grafting to the face. We can augment the chin.

Dr. Luke Swistun (19:01):
We can do the... augment the pre jowl sulcus, which is sort of the, the little hollow area right in front of the jowls that can be augmented to smooth out the chin contour. And then the jaw contour. We can graft it to the cheeks and a couple of other areas to the face. Sometimes women want slightly larger hips as well. You know, maybe women who are a little bit more square, so to speak, that's the term that they use and they want to round out their hips a little bit more. That's another area where you can fat graft, that usually blends with the buttocks.

Monique Ramsey (19:31):
And what about the breasts?

Dr. Luke Swistun (19:34):
Absolutely. So that's another common area.

Monique Ramsey (19:37):
So that's safe because it's your own fat, right?

Dr. Luke Swistun (19:40):
Correct.

Monique Ramsey (19:40):
I can't donate any fat to somebody else?

Dr. Luke Swistun (19:43):
This, this, this question comes up all the time. The only person that can donate fat to you is your genetically identical twin. So if you have one of those, then yes, the answer is yes. If you don't then unfortunately not,

Monique Ramsey (19:56):
Okay. I just could be a donor. I I'm happy to do that. Now, what has the technology that you're using in the operating room when you're doing a 360 lipo?

Dr. Luke Swistun (20:06):
So you named a bunch that some of them I'm not familiar with. I think some of them are just kind of the same thing with recycled names, but let's start with the technology that we actually use for 360 lipo to communicate with a patient before we ever do surgery and that's the Vectra 3d imaging system. I think I really like that as a communication modality, because what we can do is you can scan a patient in three dimensions and we can have their body on a screen, which we can then manipulate in three dimensions, which I do right in front of them based on my physical exam. So I first examined them. I see where their fat is that I can change. And then we look at the 3d image of them and I just make those changes in three dimensions. And then we have an approximation of what their final result would be.

Dr. Luke Swistun (20:47):
And the other beauty of this modality is that they can have an input as to how much of a change they want. The common area where that becomes important is when we're talking about buttock augmentation or hip augmentation. They like to see, what would I look like if I had a little bit fat added to my hips and it increases their hourglass proportions a little bit more and maybe they like that, or maybe they think that's a little bit more excessive, no, I'd rather not have that. Let's just do the liposuction. Let's just do a little bit of conservative augmentation to the buttocks. But I found that as a great communication tool and that is very new technology and it really gets me and the patient on the same page, as far as the result that we're looking for inside the operating rooms itself.

Dr. Luke Swistun (21:27):
I use power assisted liposuction for all my liposuction, which is basically the MicroAire system that a lot of people are familiar with. And then for the skin tightening, we can use something called Renuvion, which is a fairly new technology. There's a lot of information about that out there right now, but it's a very, in my opinion, one of the safest and most effective technologies to shrink the skin from the inside once the liposuction is done at the same time, you know, during the same surgery in order to try to really tighten up the skin and shrink wrap that patient into their new body.

Monique Ramsey (22:01):
I love that. So how does that work?

Dr. Luke Swistun (22:04):
It's complicated.

Monique Ramsey (22:06):
Well, I don't mean like what are the engineering drawings, but like for the layman how does it work? Does it heat it up to cause contraction, or?

Dr. Luke Swistun (22:17):
It does. The old name for it, which they don't like us to use anymore is J-plasma and the new name is renew again because the company rebranded themselves. But I think the plasma name is actually a little bit more appropriate because of how it works. What it does is it creates a very controlled, very focused beam of very hot helium that affects the collagen and tightens the collagen immediately, and is also very specific for just the collagen. And so it doesn't really affect all the tissues around it, as much as other modalities that are out there. So it's a very targeted and very effective procedure, but it does basically shrink collagen and instantaneously under the skin to tighten it up.

Monique Ramsey (22:53):
More. Well, first of all, you blew my mind now by hearing helium in there. That's just, I didn't expect that, but is it safer than something else? Cause I feel like there is something else out there where it's like a probe and they worried about skin burning and other things?

Dr. Luke Swistun (23:09):
Yeah. So the old modalities that I was trained on before, which I don't really use at this point is something called skin tight and BodyTite. Those are the ones that it's kind of what you're describing. It's a little bit less advanced in the sense that it is just heat and there is a probe on the inside of the skin and there's another probe on the outside of the skin. And the idea is that the skin is heated throughout like full thickness. So it's not, it doesn't really target the collagen, which is the most important part of skin tightening, it targets everything. And that can be a little bit problematic because it takes a very long time to heat that so it extends surgical times and it also less targeted so the result is not as good in my opinion. And then finally it can also affect the blood supply because you're not just heating the collagen, you're also heating the skin, the capillary network underneath that, and everything else in between. And that's not really a problem that I've seen, but what it translates to is that you just can't do as much heat as you would like to, to get the result that you want because you're limited by the blood supply being affected. So you basically stop before you would like to stop. And the result is not as good. Whereas with the Renuvion technology, it really just targets what we want to target and nothing more.

Monique Ramsey (24:20):
That's neat. Now what if somebody is thin and doesn't really need lipo, could they have Renuvion just to tighten an area?

Dr. Luke Swistun (24:28):
Yeah. I mean, there's a wide range of what we consider loose skin versus tight skin versus, you know, their skin that looks good, but feels loose on the torso. And there's the skin that looks great and feels great and really tight and, and, you know, healthy and youthful. It's sort of difficult to explain other than, you know, cause patients ask this a lot. Uh, but the best way I've heard this described and it's, it's a little weird, but the best way I've heard to describe is even for a thin patient who is fairly young, if they have a little bit of fat to remove, if you want to look good naked, go get the Renuvion. As in like, if you want just the tightest skin possible, you want the nicest result possible, just go ahead and do that extra step of Renuvion because it'll just be that much better.

Monique Ramsey (25:11):
Is that something that lasts?

Dr. Luke Swistun (25:15):
Yeah, it is a long lasting result. You know, there's some immediate effects that are seen as much more pronounced in thinner patients, but the whole result does take about six to nine months to manifest itself as the collagen sort of regenerates in this new form, as the scar sort of settles out and everything. And as the swelling goes away from the initial surgery, but once that result is there, then that's sort of the new standard or the new baseline. I should say. Obviously if the patient gains a lot of weight in the future, then the skin will grow in response to that again, and then you lose some of that results. So it's important to keep healthy afterwards.

Monique Ramsey (25:46):
Yeah, I think that's the biggest thing is, don't let your beautiful result go to waste.

Dr. Luke Swistun (25:52):
Hopefully it's a jumpstart for your exercise regimen and everything else, your new

Monique Ramsey (25:55):
Don't let your new waist, your snatched waist, go to waste!

Dr. Luke Swistun (26:00):
You should show them like that.

Monique Ramsey (26:01):
Oh, I know I should. Right. Okay. So how long does the procedure take in general, 360 lipo?

Dr. Luke Swistun (26:09):
It depends on the patient. Again, depends on how much volume we have to remove, but between three to six hours is the timeframe that I'd like to stay with them.

Monique Ramsey (26:17):
Is there a lot of pain afterwards? That's the always the thing that I think a lot of us are worried about, pain, am I going to have...

Dr. Luke Swistun (26:25):
It is quite a recovery, uh, it's different for everyone. So there are patients that I met who basically breeze through right through it. That's not the standard, but they are definitely out there. But in general, I prepare everybody for the worst. So I tell them that, look, it's going to be very uncomfortable for the first couple of weeks. It's going to drain. It's a little bit of a messy procedure of the, the drains that are involved, that you have to sort of maintain and it's uncomfortable and sort of everything is sore and everything hurts. And over time, you know, over two or three weeks, you kind of get back to normal and then can function. Things are still swollen, depending on how much Renuvion was done, you know, that causes more swelling actually. So there are some patients that I've seen where they actually look bigger immediately after the surgery, than when they started and then as the swelling goes away and as the Renuvion takes effect, they shrink and shrink wrap. And it's an amazing, amazing result, but it does take a couple of months sometimes to get there.

Monique Ramsey (27:19):
But I think if people know what to expect, it's a lot easier than if you have no idea.

Dr. Luke Swistun (27:26):
And we have great modalities to control their pain. We, I use Tylenol and ibuprofen for everybody around the clock, which are very safe medications that can be taken for a long time on a regular basis. And those tend to be very, very effective if taken on a regular basis, which is not how most people take Tylenol or ibuprofen. Most people just pop one pill for a headache. If you take them every six hours, they have a dramatically, significantly better effectiveness. And especially if they're taken together because they're synergistic. One works on the brain, the other one works locally to control pain at the inflammation site. But both together are very, very effective. And on top of that, we can still give the patient something stronger, like a narcotic should they need it and they can sort of control how much they take of that. So overall everybody gets through it. It's definitely something that nobody ever regretted six months later and they love their results, but it is not a walk through the park. It is associated with some downtime that the patients should be ready for.

Monique Ramsey (28:21):
Yeah. And I think people have to give themselves permission to have downtime. Yes. You know, we're all so busy all the time and you feel guilty if you're like laying in bed, but your body's busy recovering. And I think you are doing something, you're just, your body's busy. So, you know, finding a really good Netflix. Below Deck or something and start watching.

Dr. Luke Swistun (28:45):
It's a really good investment for the future I would say, also just kind of the whole fat rearrangement. And we can get to that a little bit later.

Monique Ramsey (28:52):
So what happens to this, the shape of your body if you were to gain or lose weight after this procedure?

Dr. Luke Swistun (29:01):
So excellent question. So the way to think about it, and this is a generalization to illustrate the point, but every person basically is born with all the fat cells that they're ever going to have in their lives. And when that person gains weight, each fat cell simply gets bigger. And then when the patient loses weight, each fat cell gets smaller, but they're all there in the same places that we're all familiar with. So what we're doing with 360 liposuction and with fat transfer potentially is rearranging where those fat cells live in your body. So before your procedure, you can gain 20 pounds and you know exactly where that 20 pounds is going to go because everybody sort of knows where it's collecting and those difficult areas to treat. After your procedure, if we let's say, if your problem area was the flanks and we treated the flanks really, really well in the context of the whole 360 liposuction blend everywhere else, then we removed a bunch of fat cells from the flanks.

Dr. Luke Swistun (29:52):
So in the future, if you were to gain weight, you will gain proportionately more weight in other areas and proportionately less weight in the flanks because there's less cells in there now. Now, if we put those cells in the buttocks, then same thing happens. You will gain proportionately more in the buttocks than you used to, and then proportionately less in the waist. So it's kind of a favorable changing of the ratio as you go through life. And there's a lot of plastic surgeons that do this regularly, who are basically of the opinion that everybody just should have their fat rearranged at some point like in their thirties or forties, because that just kind of sets you up for your second half of life in the sense that you can gain a little bit of weight or lose a little.

Monique Ramsey (30:32):
So when you hit menopause and weight is so hard to get off.

Dr. Luke Swistun (30:37):
So there's another trend that we noticed where basically as we age, we kind of lose fats from the places where we would like it to be. And we gain fat in the places that we don't like it to be. What this does is basically puts that fat back where it's supposed to be. So that as you age you age a little bit more gracefully, and even though if those 10 or 15 pounds that you gain down the line, they kind of go more to the right places rather than going to your problem areas.

Monique Ramsey (31:00):
Interesting. So are there any non-surgical alternatives that people should be aware of that would really replace what you're doing? Like does CoolSculpting replace this?

Dr. Luke Swistun (31:14):
I think it does for the right patient. I think CoolSculpting is a little bit of a, it's a very different modality. CoolSculpting basically relies on cooling the tissue to the point that the tissue sort of dies and dissolves. And in this case it's basically done through the skin. So it cools the skin, but in order to kill the skin with cooling, you need to freeze it a lot more so that cooling if it goes through the skin and then basically affects the fat immediately underneath. The result is not as pronounced because the area that's affected is a lot thinner. So a lot of times, if somebody is much bigger than they need multiple multiple sessions, and by the time they hit like four or five sessions, then the cost is probably about the same as a 360 lipo. So that may not be worth for a patient who has a lot of weight to lose or, you know, a lot of fat to remove, but for somebody who is very, very thin and just wants a lot of definition, that may be the right patient for that.

Monique Ramsey (32:08):
Yeah. And I've one thing I forgot to ask you, you were talking about recovery time and sort of over time, you're going to have less swelling. And is it three months or six months, or when would you say that patient could see their final result?

Dr. Luke Swistun (32:22):
I would say at least six months you see your final results. Especially if we combine that with a lot of, uh, you know, Renuvion skin tightening. Sometimes even a year. You know, we, we do take photographs of before and afters and I like to take my photographs on a frequent basis pretty much whenever I see the patients. So I have some photos where I have sequences of patients, what they look like a week out, two weeks out, four weeks out, and then maybe three months, six months. And there is a change even between the six month mark and the year mark, there are still subtle changes, certainly between the three-month mark and a six month mark, there are dramatic changes still. So I would say, wait, at least six months before you pass judgment. The other caveat to that is if you were to lose weight after your procedure, because let's say you'd take up, uh, an exercise regimen. Those results are always better. Those are always by far the best before and after results. The patients, you know, they, they don't have that, all that extra fat anymore that they're carrying around. There are a lot more comfortable going to the gym. They're a lot more comfortable putting on the clothes that you work out in that are tighter, and then they are motivated to keep going and get that result and keep that result and maybe even improve on that result. And that's the ideal scenario for any patient after surgery

Monique Ramsey (33:31):
Now, what do you recommend in terms of garments? So they go home and, you know, I know post-op, there's some specific garments, but sort of getting back into life after maybe the drains come out and do you still recommend compression garments?

Dr. Luke Swistun (33:47):
It, different things work for different people. In general. What I tell my patients is that I don't really rely on the garment to shape you after the surgery. It's kind of a modality to help us get through the swelling and get through kind of the discomfort of the initial, you know, all the trains that are there and maybe the gauze that needs to be in place in certain places. But what ultimately shapes you is what I did on the table on the surgical table when the patient was asleep. Plus I would say the massaging afterwards in order to really get a smooth result afterwards, because of the way to think about that part is, there are still some fat cells that are left behind under the skin, and we don't want them to call us in certain areas and scar down and cause bumps. So massaging them out early and often to really redistribute whatever's leftover underneath there and smooth it out and also really control the scar from the very beginning. Scars will form underneath the skin everywhere we liposuction and scars can tether because they contract, that's what scars do, that's their purpose.

Dr. Luke Swistun (34:44):
But if we keep the scars from contracting, from tethering, from affecting the final result, by keeping them soft, by massaging them, that tends to get the best results. So I really advocate massaging, especially lymphatic massages afterwards. And I really obviously want to do a good job when I'm working and during my surgery, the garment itself is just a modality. I know that there are other opinions out there. I know there's a lot of people that really rely on the garment and the, you know, they want the patients to be in the garment. I've seen that sometimes to cause problems. Uh, some garments can be too tight and the patient thinks that they are supposed to be too tight and they can chafe. They can cause skin breakdown. They can even cause little rolls of, uh, you know, where they kind of tighten up and band.

Monique Ramsey (35:24):
Like an indent.

Dr. Luke Swistun (35:24):
Exactly. And then, uh, I I've seen occasionally, a few patients tell me that they've had garments on for a very long time and they actually caused a permanent indentation and kind of makes sense if you're, if that garment constantly dents in that area for several weeks, it's going to scar in there. So, you know, changing garments and shifting them around, but also massaging those areas I think is a lot more important.

Monique Ramsey (35:46):
And the massage I take it, this isn't the kind of massage you enlist your significant other to do for you.

Dr. Luke Swistun (35:52):
Absolutely. You can.

Monique Ramsey (35:55):
Oh you could?

Dr. Luke Swistun (35:55):
Of course. So, massaging there's different levels of massaging. I think any massage will accomplish a vast majority of what we need to accomplish. There are certainly specialists like lymphatic masseuses that are trained in this that are probably going to do a better job than you yourself will. But some massage is better than none. So what I tell my patient is early and often, as soon as you can get in the shower, lather up in your favorite body wash, and then just use your hands to go over all those areas, especially in the front, because the skin is the thinnest and the front of the abdomen. And that's the least forgiving as far as those lumps and bumps that I talked about. So that area is an easy area for the patient to reach, it's right there in front. So they can massage that. The flanks are a little bit thicker skin, so they're a little bit more forgiving. So they don't bump as much, and the back is very forgiving because that typically is the thickest skin on the body. So you can get your significant other to massage your back and massage your flanks. And then you just really, really focused on the front, you know, go through two or three full songs and your shower just massaging the front, especially early on.

Monique Ramsey (36:57):
And when can you get back into exercise, for the most part, I'm sure it does depend on each patient how much they heal, but in general?

Dr. Luke Swistun (37:05):
Absolutely. I mean, we want the drains out. We want them to heal a little bit. I would say probably like six to eight weeks is when people start feeling comfortable, getting back to the gym, keep in mind that if you get back from the gym a little bit too soon, and the skin has not healed down to the muscle wall yet there's a potential empty space that's there that can fill up with some fluid, especially if you go to the gym and then you raise your blood pressure and your heart rate and you know, that can cause a little bit more fluid build up in that area because of that. So we really want everything ideally to be healed down with no in between spaces, where that fat used to be. So it just takes time. So six to eight weeks is typically a safe estimate.

Monique Ramsey (37:44):
Now we want people to be able to kind of get an idea of what this looks like, before and afters. And we just have a handful of your results right now on our website. And as you're doing more where we're being able to add them, how many times have you done this procedure?

Dr. Luke Swistun (38:01):
It's getting close to a hundred probably right now. This is by far the most common procedure I was doing in Beverly Hills when I was there for a year. And prior to that, I did a lot of it also in Burbank. It is a very common procedure in the Los Angeles area. And certainly in Beverly Hills. A lot of those patients are very private. A lot of those patients have to be also tracked down for additional consents. And that, that is one of the issues that we ran into with regards to me, practicing right here is that in order for us to display results of someone who has been done elsewhere by another, with another practice, we need a separate consent. And those are patients who are kind of like long gone and difficult to reach sometimes. So I think we're missing some of those consents. And for that very reason alone, we, uh, we are not able to show those pictures, but we're building our own library as we speak. I do a lot of these procedures here,

Monique Ramsey (38:49):
And I think it's nice to also have that additional tool of the Vectra 3d imaging, because it's almost like you could see your own before and after, before,

Dr. Luke Swistun (38:58):
Correct with your own input. And I think that's the biggest advantage of the Vectra is that the patient really does have a lot of their own input on their final results.

Monique Ramsey (39:07):
Yeah. Now we publish everything on our website and you can see our prices there. Uh, we're one of the few practices in San Diego and even the country that share this information. So the range published on our website for lipo. 360 lipo is $13,000 to $16,000. And so because of that, it's a long involved procedure. And so financing is really common. So we do have a podcast just about financing. So if you're interested in hearing more about that, you can take a look and then you can look on our website kind of as to, you know, the different ranges. So if somebody wants to come in and have a consultation with Dr. Swistun, are you doing your consultations in person or on zoom?

Dr. Luke Swistun (39:54):
Both. Whatever's convenient for the patient, but I prefer in person, especially for a 360 liposuction, because it does give us the opportunity to do the Vectra analysis together.

Monique Ramsey (40:04):
It seems there's an element of artistry with this procedure, more than maybe any other kind of procedure. Would you agree with that?

Dr. Luke Swistun (40:11):
So rather than focusing on a single problem area, quote unquote 360 lipo treats the entire body as a single continuous aesthetic unit all around. You can't make the front abdomen look its best without the waist looking its best, without the back looking its best. And furthermore, each patient is different and they need different levels of intervention in certain areas. Some are square shaped and they need more effort to carve out the waist while others have a large bra roll and they need help there. But I think ultimately each one of us carries an optimal version of themselves hidden beneath. And it's what 360 lipo is designed to do. It's designed to basically unmask that hidden, optimal contour of themselves.

Monique Ramsey (40:53):
I like that. And we look forward to seeing you all soon and we look forward to talking with you again, Dr. Swistun on our next episode.

Dr. Luke Swistun (41:02):
Thank you again. It was my pleasure. Thanks.

Speaker 1 (41:11):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego freeway in the Ximed building on the Scripps Memorial Hospital campus. To learn more, go to L J C S c.com or follow the team on Instagram at @LJCSC. The La Jolla Cosmetic Podcast is a production of The Axis.