Awake Lipo, Fat Transfer Breast Augmentation & More: Get Off My Lawn Part 5

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis.

Kirstin (00:11):
We're back with more hot takes from Dr. Koehler. Okay. Body surgeries. All right. There's a thing actually, there's lots of shops, clinics that do awake surgeries and awake lipo.

Dr. Koehler (00:28):
Sure. Yeah.

Kirstin (00:29):
So what do you feel about awake lipo?

Dr. Koehler (00:32):
It's fine. I don't personally enjoy doing it, but yeah, it's totally fine.

Kirstin (00:37):
Can you get as good a result if somebody's awake versus if they're asleep?

Dr. Koehler (00:41):
Yeah, potentially. Yeah. So a lot of it is patient dependent. We all know people, I have patients that, I mean, I could probably do it without any anesthesia. They're stoic. They just don't even move. And then I have other people that if they're not completely, I mean if they're even a fraction awake, we can't even touch 'em, it depends on the level of anxiety that people have and their tolerance for sounds and smells and all that kind of stuff.

(01:14):
But to answer your question, I mean, yeah, absolutely you can do liposuction or local. Now it's done differently, and what I mean that by that is that the amount of fluid that we typically inject if we're going to be doing it under just local, is a lot more than what, it's typically three times more than what we would do if we were doing it under general anesthesia. Because you have to, well, it's just done differently, let's just put it that way. But you can totally do it. If a person was doing maybe more than just a few areas, I would say that that might be a little more of a challenge. You got to be patient because you have to get the fluid injected and then you got to wait, got to wait a period of time for that to get numb enough. Whereas when we do liposuction under general anesthesia, we're not relying totally on the numbing medicine in the tumescent that we fill up, like we fill up the fatty area with fluid.

(02:12):
And we do that primarily to make it tight so we can sculpt it and suction the fat off. But we also inject that fluid because there's epinephrine in there and it makes it to where it doesn't bleed. But we don't need it for the pain control when we're under general anesthesia. But when we do it under local, you need to put more fluid in there and you got to wait. And there's nothing more frustrating as a doctor when you're trying to liposuction somebody and they've got one spot that's like you can't get to it. They're like you try to get in every time and then you have to stop and you got to try and numb it again. And it can just be, in those circumstances, it can be frustrating. So again, that's the long answer, but the answer is, I don't like to do it. Can it be done? Yes. Is it safe? Yes, very much so. It's just different.

Kirstin (03:04):
Is the cost savings that somebody would save for the anesthesia, is that worth it, do you feel?

Dr. Koehler (03:10):
I don't know. Let me tell you this. I have people that have to have other things done under general anesthesia, and they have this issue with nausea after surgery. And there's a medicine that I've found to be pretty effective, but that one pill costs a hundred dollars, one pill to help with nausea. And people look at me and go, best money I would ever spend if I don't have to throw up. So the answer, the reason I say that is it, it depends. I mean, for some people saving that money is great because they're not going to be bothered by all of that. But other people, they would gladly pay for general anesthesia to not have to hear it, be awake during it, know what's going on. They just want to have it done and wake up and be done.

Kirstin (03:49):
I'm one of those people.

Dr. Koehler (03:51):
Yeah. So I dunno.

Kirstin (03:53):
I want to get my teeth cleaned under general anesthesia.

Dr. Koehler (03:57):
Sure, you do.

Kirstin (03:59):
Okay. So we like awake lipo. Yeah.

Dr. Koehler (04:03):
Yeah. Not here, but yes, we like it.

Kirstin (04:05):
Yes. Okay. Next thing is, going to Turkey for surgery.

Dr. Koehler (04:11):
Yeah. Well, I will just say this, I'm actually looking at going over to a meeting over there in the summer, but we'll see. Listen, there's great surgeons all over this globe and depends on what the procedure is and who you're going to see. Only comment on that, and I will just say it doesn't matter if you're flying to Turkey or if you live in Alabama and you're flying to, I don't know, Washington state. The point is when you have surgery away from where you live, you either need to be, A willing to fly back to that place or, B be willing to stay at that location for an extended period of time if the surgery that you have has complications. Because nobody is going to want to take care of somebody else's surgical problems. So yes, surgery, certain types of surgery, yeah, cost of living, cost of surgery, cost of a lot of things, healthcare in general. There's places in the country where you can, or in the world I should say, where you can go and get something done, but realize it just depends. Some countries do not have the same standards or regulations. So for us to have an office-based surgery center, we have to have people inspect us and we have to meet certain criteria. And it's a benchmark. Now, I will tell you this, if we didn't have to be accredited, we would still be doing all of those things.

(05:43):
So for us, it's not changing anything. It's just a check mark that we have to do. And there's doctors around the world that would probably do the same. If they have their own facility and they do it, they're going to do it to the best that they can do it. And I'm not saying that their facility is not good, but when you don't have a regulating body overseeing it, there's a possibility that things may not be up to par and you could have adverse outcomes because of that. And I'm not saying that, I don't know enough about the surgical facilities in Turkey or anything to really comment on. The only thing I would say is that when you can get cheaper surgery, sometimes outside of the country, but you always have to ask yourself, what if something happens? What happens if you had to be hospitalized? Let's say you got a blood clot after surgery. Are you going to be wanting to be in the hospital in Turkey and have be taken care of in there? Are you going to be life-flighted back over to the United States? How is this going to happen? So those things are rare, but you always have to, at least in the back of your mind, think a little bit of the what if. And yeah, I will not knock any doctors from Turkey because I actually want to go over and visit one to see what he's doing and for some certain procedures. So there's some good surgeons around the world.

Kirstin (06:56):
Okay. Alright. Next thing is rib removal. What's going on with people taking out their ribs?

Dr. Koehler (07:09):
Well, I think Adam did it at first.

Kirstin (07:13):
He was the OG.

Dr. Koehler (07:15):
He was the OG. I mean, so it's a thing. I mean, he's on TikTok now or what? I don't know. I mean.

Kirstin (07:25):
I think females specifically.

Dr. Koehler (07:28):
They don't want his rib?

Kirstin (07:30):
Well, yeah. They're like, Adam, take your rib back.

Dr. Koehler (07:32):
Oh yeah. See, this is what happens. The guy gives and the woman's just giving it back. I mean, I don't know. No, it's off my lawn for me. You know, I think the purpose to be getting a narrower waistline, so the space between where your ribs meet your hip bone, I mean that

Kirstin (07:58):
Show us, lemme see it.

Dr. Koehler (08:00):
I'm not taking my shirt off. But the point is, there's some people that space is not very big, but it's not just the rib. I mean there's all the muscles in that area. So it sometimes just depends on how you're built. But to me, taking ribs out to try to make your waist look a little narrower, I just think is, it's going a little far for me. So I'm going to say pass on that.

Kirstin (08:26):
Get out of here.

Dr. Koehler (08:26):
It's not something that I would do. You'd have a thoracic surgeon or someone do that for you. So, no, pass.

Kirstin (08:32):
Okay. I like this one. Abdominal etching.

Dr. Koehler (08:37):
Yes.

Kirstin (08:40):
HD lipo.

Dr. Koehler (08:41):
Yeah. So, I have mixed feelings about this as wellI n the right person? Absolutely, no question. And so it's referred to as high definition liposuction, and then some people, you'll hear them talk about medium definition liposuction or low definition, medium definition. The point is, is that people who want high definition liposuction, they want to see the whole shadow of all the abs and to see the obliques and all of this. So it's sculpting the fat in a way that it gives this illusion or creation of a person having abdominal muscles. So I think I've shared with you before, but I'll share again. I had a patient that I did this for male patient, and he was fit, very fit, fit guy, but he kind wanted to have more definition. So we did high def lipo on him. He looked great, and he came back for a follow-up, and he got back from a cruise with his brother.

(09:47):
They had a great time. He is like, oh yeah, I looked great. Thank you. Whatever. I just have one concern. He says, Dr. Koehler, like when I push on it, it's kind of soft. I go, yeah, it's fat. I didn't make you muscles. It's just your fat. So the point is, first of all, you need to be reasonable, in my opinion, reasonably fit. Because if you don't have a healthy looking figure that you could actually have that body, then it's not going to look in place. I've got a bit of a beer belly and you're trying to carve abs into it, it it's not going to make sense.

(10:28):
And then the issue that I have is like, okay, let's say you do that and you're like 30. Okay, well now 50 hits and maybe 40 wasn't good to you. Now you're 50 and you've put on a bunch of weight and now you've had these etchings. And it's not something, I don't hear, I don't hear anybody talking about that. like, oh, here's a patient that had abdominal etching and now they put on a bunch of weight. I don't know. I haven't seen anybody personally like that. But it's something you think about because you've got to maintain the result, because you can still put fat on and it can look out of place.

(11:07):
But yes. And then there's something more like medium depth for women. Maybe they don't want to have a six pack, but they'd like to see the outline of their rectus muscles. And I do that very frequently with tummy tucks and things like that to try to create those shadows to give that effect. And I think that's a little bit more doable and not so, somebody puts on weight or loses weight, that's not so obvious. But when you're actually carving abs in, it has to be the right patient. You just have to have a discussion. But it works. Yeah, I'm good with that.

Kirstin (11:42):
All this time, I was just thinking, I was looking fine, but you sculpted me. Is that true?

Dr. Koehler (11:49):
I mean, it was hours and hours.

Kirstin (11:51):
Oh my gosh.

Dr. Koehler (11:52):
Of sculpting.

Kirstin (11:55):
Well, now I know.

Dr. Koehler (11:56):
Yeah.

Kirstin (11:56):
Okay, now fat transfer to breast.

Dr. Koehler (12:03):
Yeah. So fat transfer to breast is, it's used more often used as an adjunct than a primary procedure. In other words, somebody may be getting breast augmentation, but we'll do fat transfer to maybe enhance the cleavage and other things. And I think that's where it plays a role, adds to the cost of the procedure. But it's sometimes that useful thing. So yes, fat grafting can be useful, but as a primary tool to augment the breasts, I would say that it is not a very good option. Once again, call five offices and ask them, can I get my breasts augmented with fat? And find out how many of those offices tell you. Yes, absolutely. We do it all the time. It's a great procedure. I think what you'll find there may be people that will say, yeah, we'll do fat grafting to your breast. But the reason it's not so popular is because even where we use it often in the buttocks or in the face, you can take fat, transfer it from one area to the other.

(13:08):
But the problem is, is the fat take varies based off of the location that you're putting it in. And also just even individual variability in that person. So I've done fat transfer to some people's butts where we get an incredible take and then we do fat grafting to others that it's like it took, but not nearly as good as that other person. And we didn't do anything different. We took the fat the same way. We did it the same way. So it's like there's some variability there. And the problem with breast augmentation is this, oftentimes we ask people like, well, how big would you like to be? And we go through the process of trying sizers on, and then it's quite a process. And they go, yes, this is what I want to be. Well, okay, let's say we go through that whole process and we found out that, okay, 300 ccs is what that seems to be about the volume that you thought looked good. Well, how much do we put in then? Do we put in 500, expecting 200 to go away? Do we put 300 in and then maybe do it a second time if it doesn't work? Those are the things you don't know. So it's not a hundred percent like, oh, we know that 20% is going to go away, so therefore we will put X amount it.

Kirstin (14:23):
Does it ever not take equally to each breast?

Dr. Koehler (14:27):
I've not seen that happen. I've had that asked before. Same thing with buttocks. It's not like, oh, all the fat took in one cheek and not on the other. I mean, just generally either, it takes the same on both sides, but just the amount is you have to wait and see how much of it'll stay. But yeah, fat grafting also in the breast can potentially cause problems because unlike you're not getting your butt imaged for cancer, but people get their breast image for cancer. And when you put fat in the breast, sometimes you can get calcifications, cyst formation, other things that can appear abnormal on a mammogram or ultrasound. And then that can result in biopsies. And it may be totally benign, and it may just be because of the fat that was transferred there. But again, you're not getting your butt imaged. So you could probably still have calcifications and fat in there, but nobody cares because they're not screening it for cancer. That's the negative part of fat grafting. But it absolutely is used. It's used in breast reconstruction, not as a primary reconstructive method, but it is used to enhance the results of reconstruction and for cosmetic use.

Kirstin (15:41):
So as an augmentation option, we're going to say, get off my lawn.

Dr. Koehler (15:51):
As the only, yes. If it was just like, I want a breast aug and I only want to have my fat in there. And again, the other thing we didn't talk about is you got to have enough fat. Some people, I want breast augmentation with my fat. And you're like, okay, well you have no fat. Where are we going to get this from? But it does remind me of something that was a trend too. I dunno, you maybe want to talk about it, but there was a thing for a while where you'd get your weekend breast augmentation, where you go into the doctor's office and they'd just pump your breast full of IV fluid and get it to the size you want, and then you can go to your event and then of course your body will re-absorb

Kirstin (16:29):
Shut up.

Dr. Koehler (16:29):
Oh yeah, it was a thing.

Kirstin (16:33):
So then you come back on Monday, no boobs anymore.

Dr. Koehler (16:35):
Yeah, you just have 'em for the night. It is just like, oh, I got a wedding to go to. I'm going to pump my boobs full of IV fluid. So maybe the IV fluid place will do that. I don't know. Just like, but it's something. And maybe get a little electrolytes and some zinc in there too.

Kirstin (16:53):
There you go. There you go. It's all around.

Dr. Koehler (16:56):
Yeah. Botox will last longer. Boobs will be bigger.

Kirstin (16:59):
That's right. Man, I think you might be onto something.

Dr. Koehler (17:03):
I think so.

Kirstin (17:05):
Alright. Do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at AlabamatheBeautifulPodcast.com. We'd love to hear from you. Thanks Dr. Koehler.

Dr. Koehler (17:18):
Thanks, Kirstin.

Kirstin (17:19):
Go back to making Alabama Beautiful.

Dr. Koehler (17:21):
I'll try.

Announcer (17:23):
Got a question for Dr. Koehler. Leave us a voicemail at AlabamaTheBeautifulPodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you'd like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.