What Other Plastic Surgeons Won’t Tell You About 360 Lipo

Monique Ramsey (00:04):
Welcome everyone to the La Jolla Cosmetic podcast. I'm your hostess, Monique Ramsey. So 360 lipo, it's more than just a buzzword, but what makes our surgeon's technique stand out from maybe somebody else's technique? Add that surgeon in question is Dr. Luke Swistun. He's a board certified plastic surgeon, and today I have him here to talk about something very specific, a unique approach that he uses that is three positions. So three positions, 360 lipo. So welcome back Dr. Swistun.

Dr. Swistun (00:39):
Oh, thank you for having me, Monique.

Monique Ramsey (00:41):
So when it comes to 360 liposuction, two positions or three positions?

Dr. Swistun (00:47):
For me it's three positions all the way. I think that's just the best way to get that optimal result, and I can elaborate on that. So obviously everyone knows 360 liposuction has to do with basically liposuctioning the patient's torso all the way around, so the entire back, the entire front, and all the sides, specifically the waist. And that's really the big focus is just getting that waist as narrow as possible. There is ways to do it in two positions. Technically speaking, this is to say after the patient is asleep on the operating table, she can be put on her stomach and then on her back, and that way the surgeon can access the entire front and the entire back. And that's one perfectly acceptable way of doing it. However, in my experience, I find that I get much better results if I actually go to three positions, which means that the patient is on her right side first, then on her left side and then on her back.

(01:41):
And obviously that takes a little bit more time, that takes a little bit more effort. But I think those three positions do allow me to get just a little bit better access to that waste area. And rather than just liposuctioning that area, I can actually sculpt it, which I think makes all the difference in the world as far as the final results. Why do I do it that way? That's how the masters do it. There are some doctors that are very famous for this, Dr. Manta, that G, you may have heard of these, Dr. William or Hall, which I would also classify as one of the masters in this. He does more of this than anything else. Those words literally came from him. I asked him when I was working with him back in Beverly Hills a couple years ago, why do you do it in three positions? And his answer to me was exactly what I just said. That's how the masters do it. It's a little bit of extra effort and time, but it's worth it.

Monique Ramsey (02:30):
And so getting that cinched look, I guess if the patient was on her back or on her tummy, is it just a question of access, like it's hard to reach around and get the perfect shape?

Dr. Swistun (02:43):
Exactly. And that's one way to think about it's if the patient's on their front or on her back, if we're focusing on the sides, the sides are just not in the perfect position to access. They can be reached with a cannula for sure, but they can't be sculpted, in my opinion, in my hands at least. I think if the patient's actually on her side and maybe even what we call a jackknife on the table, which basically means that we actually kind of bend the entire table to expose that side even more into view, then we can really focus on that area and can feel exactly how the skin drapes and exactly what fat there is underneath that extra position on one side really allows me to scope that side of the waist and then we flip the patient to the other side and do the same thing and then we address the entire back through that as well. After that is done, then we flip the patient to her back so that we can access and scope the entire front.

Monique Ramsey (03:37):
So she never has to be on her stomach.

Dr. Swistun (03:39):
Correct. In this particular approach, I think we have very good access to the back as well, just because of that, the way that she's positioned on the side that gives us access to the half of her back that is necessary to focus on each side position.

Monique Ramsey (03:54):
So why don't many doctors do a three position lipo versus why do they stick with a two position?

Dr. Swistun (04:02):
There's obvious benefits of doing a case in a shorter timeframe, which obviously is important to a lot of surgeons. I mean, time is money in the operating room. The longer you take in a case, the more expensive that case becomes. So some patients basically will get sold on the fact that you're getting 360 lipo either way. But again, the two position 360 lipo may be a little bit less expensive, may take a little bit less time in the operating room, but may not deliver quite the same result as taking that extra step and putting the patient in three positions.

Monique Ramsey (04:33):
Okay. I'm going to make an analogy. You may hate it, but I just thought of this in layman's terms. What is it like, okay, if you're vacuuming inside your car, you can get almost everything and let's say we're going down a crevice, you can use the regular thing and try to get in there as good as you can, but if you put on, you take the time to put the little adapter on that's for the crevices and you get down to the crevices, you can reach it better and you're going to get more of a result in your vacuuming of your car. That's the first thing that's coming to my mind. But I don't know if that's right.

Dr. Swistun (05:10):
That's a good analogy because it's all about access. It's like how can I see that area and scope that area the most direct visualization? And frankly, when the patient's on her front or on her back, the sides is where the skin starts draping. The extra skin is just kind of sitting there and collapsing on itself and it's hiding some of that fat that's in there. If a patient's on her side, the skin is taut over the area on liposuctioning, and then I can scope the fat underneath it that much more confidently and reliably and effectively.

Monique Ramsey (05:40):
So I want to bring up from a previous podcast that we did. One of your patients, Gabriela, she did a 360 lipo and a skinny BBL, and I want to play for everybody what she said on our podcast a couple years back.

Gabriela (05:58):
Well, so I told you one of my goals was to have my waist as small as possible. My dream has always been to have a 25 inch waist. So Dr. Swistun, when I think I went to one of my follow-ups and he said, okay, well I can't guarantee that. And so it was so funny, he was just kind of preparing me. It was after my surgery and about a week later I measured my waist and sure enough it was a 25. And so I sent him a picture and he's like, wow, that's amazing. And then a week after that it got even smaller. It was like a 24 and three quarters. I keep shrinking, so that's amazing to me.

Monique Ramsey (06:38):
So how fun was that?

Dr. Swistun (06:40):
It's one of those satisfying results when a patient requests a certain number. Oh, definitely. Can't promise that one. But when you get it and when you even deliver even better than that, then high fives all around.

Monique Ramsey (06:51):
Now I'm assuming Gabriela had the three position 360 lipo.

Dr. Swistun (06:55):
Correct. Again, that's just how I do it. That's just the most confident way of me.

Monique Ramsey (07:01):
And then if you're doing the BBL, so we're going to remove all the fat and do all the sculpting, but then does she end up on her stomach if you were going to do a combo procedure like that?

Dr. Swistun (07:10):
No. In fact, for the same reason actually, when I find that sculpting a buttock augmentation with fat, fat grafting to the buttocks is also done easier from the side because then you can really focus on the right side separately and the left side separately. And as long as you remember your symmetry, you can certainly confirm if you want to put them in under stomach. But I find that you get a little bit better access to sculpting it because whenever you're doing a fat grafting to the buttocks, you're really not just addressing the back of it. You're really addressing the sides and conting into the hip, and you want to blend that buttock with the hip contour as well. And there's no better way to do it than when the patient's on the side.

Monique Ramsey (07:52):
And you think about all of us, if we lay down, things start to shift different directions.

Dr. Swistun (07:58):
Exactly.

Monique Ramsey (07:58):
Than when you're standing up. So it kind of makes perfect sense. And so I want to get into something you said. You were talking about time. So if this procedure or not, if it does, it does take more time because you have to move the body into a third position and you're taking time to really sculpt it from each side, then I'm assuming because operating room time, anesthesia time, those prices are based on time. So I'm assuming that it's a little bit more expensive to have a three position 360 than a two position. So if you're out there and you're comparing prices, it's going to be different, right?

Dr. Swistun (08:40):
Correct. And I think that's the big difference. Yes, there's a lot of patients that are basically thinking they're getting the same thing because they think they're getting a 360 lipo from one surgeon or another surgeon, but the price may be diametrically different. So that key question, I suppose, can be one way to differentiate that.

Monique Ramsey (08:57):
So having people ask as you're comparing, is it going to be two position or three position?

Dr. Swistun (09:03):
Correct.

Monique Ramsey (09:04):
Okay. So anything else that you want to really let the audience know about why you do this and why it's important for patients to think about as they consider reshaping?

Dr. Swistun (09:15):
Well, I guess the first question is like how did I come about? How did I learn this information? You may know I actually trained in Beverly Hills with, I did an aesthetics plastic surgery fellowship in Beverly Hills under Beverly Hills Physicians, which is a very large company in Los Angeles. They have four operating rooms across the entire Los Angeles area and seven or eight other clinics. So they're very well versed in aesthetic plastic surgery. And they have 10 plastic surgeons that work for them across those boards at least they had at the time when I was doing my fellowship. And the blessing for us is that we get to work with all of them and we get to see all of their techniques. And these are very renowned, very famous people in their fields. You've seen a few of them on tv. I'm not going to name names.

(09:58):
But bottom line is we get exposed to all these different techniques and we get to make sense out of them and put together what works the best. And I've definitely found that the individuals that do the 360 liposuction in the three positions do get better results. It does take more time, it takes a little bit more effort, but they do get better results in the end, at least in my observation. And this is why I've adapted that, my technique to that, most specifically, I work with Dr. William Rahal for a while. He was actually just finished his training and he was renting, he wasn't actually a part of the fellowship, but he was also working out of that same facility that I was training at. So we got together and talked a little bit. He invited me to the operating room and showed me a few times how he does it.

(10:44):
And he was one of those three position 360 lipo surgeons. And we talked about the logic behind it, which makes all the sense to me in the world. And I asked them literally that question going back to that moment, it's like, why do you do it in three positions rather than two? These other guys do it in two positions. It's like, well, because that's how the masters do it. And that's how you can get that best result. That's how you can get the best access to that waist because ultimately that's what the patients want. That's what they're paying for. And then if you consider everything else, the patient's already going through this entire experience of surgery, they're taking the risk of having surgery, they're taking the time off to recover. They're taking the financial hit on getting that result for themselves. Why would you not optimize the result?

(11:24):
Why would you not take the extra little efforts to make it the best it can be? So that's why basically he says that's how he does it for everybody. And interestingly enough, two years after I finished my training, this is when Covid hit, and I was sort of in the transitional state, this is well before I came to San Diego, he actually reached out to me and said like, Hey, do you want to help me out in the operating room because I have a lot of cases and I could use another pair of hands, and we sort of connected before I kind of trust you with this. So that's how we ended up working together for an entire year. And in that timeframe, he actually taught me a lot more little nuances and tricks of the entire technique. So that's primarily what I was doing when I was with him in Beverly Hills. And I definitely do consider him one of the masters. But we've had the conversations about Dr. Mendieta, Dr. Ghavami, and all these other doctors that do this, and they're famous for this technique as well. And we're definitely on the same page on how to do it. It's just not cutting corners, I think is the best way to put it.

Monique Ramsey (12:25):
And I think you make a great point. And we as patients need to be thinking about that we're going to spend X amount of dollars, we're going to have time off work. We got to recover, our life is going to be disrupted in some way, but that's a good trade off for a wonderful result. But making sure that if you're going to do all that, why not have the very best result you can get?

Dr. Swistun (12:48):
Well, you have to understand that whenever a patient trusts us to take them under general anesthesia, put them through the stress of surgery and recovery, they also trust us that we really optimize the opportunity and give them the best result possible. And that's sort of the mantra that I've been sticking to in my entire career is just optimize this surgical opportunity. The patient's already here, she's already under anesthesia, just take the extra time that you need to take in order to get the best result you can.

Monique Ramsey (13:15):
Well, this is so interesting because I think a lot of people know about 360 Lipo or if they heard about it, and if you haven't heard about it, we'll put in the show notes, some of the podcasts we've done. I know Dr. Swistun has done a 360 lipo podcast with us where we really break down just the entire procedure, not this specific part of it. So we'll put that in the show notes so you can learn more about it. But then we'll also put in the show notes, some links for pictures because I think Dr. Swistun's gallery, and you'll be able to see how beautiful the results can be and how it's just stunning. And you just did a photo shoot with one of your patients, right? So we can maybe link some of that, those photos in our notes as well.

Dr. Swistun (14:01):
So interesting. I used to be a professional photographer before I was a doctor. I had a decided put myself through some college and some of medical school, but I did a lot of freelancing before. One of the things that we do occasionally is we invite a patient back for a personal photo shoot, and I actually do the photo shoot. And in this particular instance, we ended up doing almost 2000 photos of this one patient and focusing on her results, which is my typical professional photo shoot. That's kind of how many photos it takes. And there's a couple that really stand out and we're going to juxtapose those against her befores. She was so happy with the result that she let us sort of showcase these results for anyone.

Monique Ramsey (14:42):
So thank you Dr. Swistun, for helping us understand the difference between two position and three position 360 lipo. Say that five times fast. And like I said, we'll put everything in the show notes, his gallery, his bio. We'll also link to previous podcasts that we've done and we can put Gabriela's podcast in. That's the patient you heard the quote from and some of the newer positions. And I think the patient that you did the photo shoot on that you were mentioning, she's going to come on the podcast in the next couple of weeks, so we'll be able to hear from her as well. So that'll be fun. Thank you again. And so thanks to everybody in the audience for listening. Hit subscribe come every Tuesday. We've got something fun for you to learn about, listen to, hear from patients, hear from doctors, learn about new techniques. We will see you guys all on the next one. Thanks.

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