Laser Liposuction Questions

Frequently asked questions

What is laser liposuction?
Laser liposuction is a relatively new twist on the traditional liposuction procedure where a laser is used to heat up and denature the fat (cook it literally). This turns the fat into oil and shrinks the tissue holding the fat in place (much like bacon shrinks when you cook it). After the fat has been broken up and turned to oil it is removed by aspirating it out through small strategically placed holes in your skin.
How is it different from regular liposuction?
Traditional liposuction in the past and presently is done in the hospital under general anesthesia. Recovery time is less for tumescent laser liposuction so you can be back at it sooner (work or whatever). Several re*be® patients worked a full day right the day after the procedure. Laser liposuction done under tumescent local anesthesia in an outpatient procedure room is safer having 1000 times fewer problems in some estimations. The holes are smaller using lasers because this liquefies the fat prior to removing it making it come out easier through smaller holes. The cost is less because this is done in the clinic under local anesthesia avoiding charges for the use of the hospital operating room and anesthesia services. There appears to be additional skin tightening when a laser is used making less need to later remove excess skin. Using the laser alone destroys or kills fat cells and the ultimate result may be to remove more fat that with traditional liposuction. Fat cells are really quite large. Traditional liposuction is thought to suck out the fat leaving the cell where it was to deposit more fat. Laser liposuction actually kills these cells by cooking them with the laser heat energy. Cellulite is addressed with laser liposuction but less so with traditional liposuction.
Am I a good candidate for laser liposuction?
Your weight should be stable. Rapidly fluctuating weight is not healthy and makes unpredictable results from laser liposuction. Having one or two problem areas is better than expecting to have your entire body sculptured with laser liposuction. The closer you are to your ideal body weight the better. You should be an adult and have a mature body fat distribution. Teenagers usually do not meet this criterion. The outer thighs can be done on kids as young as 18 but it is best to wait until later to do the other areas. There is an index called BMI or body mass index. As a guideline if your BMI is over 30 you may be able to have only one area done at a time or the procedure may not be a good idea for you at all. You should be in good health. There are a number of medications that could interfere with you having a safe procedure. Part of your consultation for the procedure will be to assess your medical risk for the procedure. More people qualify for in office laser liposuction than will be able to have general anesthetic liposuction. Adjustments in techniques and how much can be done will depend on your health. If your spouse is complaining about your attitude or your behavior or lack of behavior laser liposuction may be just what you need. Several patients have told me their spouse likes their 'behavior change' as much as the new look!
What is Vaser® liposuction?
There are many ways to break up the fat prior to removing it. Vaser® sounds like laser but is not a fat emulsification technique that depends on light. Vaser® is a registered trademark of Sound Surgical Corporation. Vaser® uses high frequency ultrasound to break down the fat prior to removing it from the body. See the re*be® information at Vaser®
What is a cold laser?
There are enormous numbers of lasers in many categories as regulated by the government based on serious concerns about our safety. Low level lasers have been used for pain relief by activating the pain pathways in the body. Recently they have been used to reduce fat without breaking the skin. Effectiveness of this approach is debated but there are those who believe it does work and this includes the FDA. Fat freezing is not the same as a cold laser.
What areas can be treated?
Neck Arms legs thighs outer and inner, neck chin cheeks jowls, breasts back shoulders man boobs, upper stomach, lower stomach. Any area where fat is stored under the skin can be treated with laser liposuction. The most notable area that cannot be treated with laser liposuction is inside the abdomen. This is called visceral fat and is more a problem for men. Fat above the muscle can be treated but that under the muscles of the belly wall cannot be treated safely.
If I gain weight after does my fat go somewhere else?
Sort of but....
Cartoon image showing the distribution of fat cells in a relatively normal person who looks nice.

Normal nice fat.

This stylized diagram shows a pleasant figure with a normal density of fat nicely distributed in the right places. How your fat is distributed and the number of fat cells on your body some scientists believe is pretty constant and set by the time of puberty. As we age the locations on our body that are prone to store fat get to work and store fat for most of us. The fat cells in these areas get bigger. When we diet and exercise the fat cells all over the body lose weight but not all at the same rate. Stubborn areas seem to lose weight slower or not at all. If one side of your body is bigger than the other and you gain weight this will persist and may be more noticeable. If you lose weight the difference may be less noticeable but still remains. It is possible that these differences can actually become more noticeable too with weight loss.
Diagram of heavy person showing larger fat cells.

Fat cells get big

Gaining weight will cause each of the fat cells to get bigger. After liposuction is done the fat cells will get bigger where you have fat cells. This is not very noticeable or a problem unless you gain quite a bit of weight and have had many areas of liposuction done. If later you lose your weight your shape is expected to be very similar to what you looked like after your liposuction. If your shape is more like a brick you will gain weight in that shape and lose weight in that shape. If you have a female shape you would be expected to gain and lose weight in that shape. Rapidly gaining weight and gaining weight slowly with time and age are very different. The change in your shape is considered permanent and can help you maintain a pleasant shape for a lifetime.
How much does it cost?
The cost of this procedure is variable but based on the number of areas you choose to have done. The cost generally will range from $3200 to $8900 or more depending on how many areas you choose to have done. It is a good idea for many reasons to limit the number of areas to one or two. This limits the amount of time you are in the procedure room and reduces the amount of local anesthesia you will need. The cost is not dependent on the amount of fat you have on your body. It is best to discuss with Dr. Kolegraff the cost at the time of your complimentary consultation. This is expected and is not the time to be shy. Be sure you get the questions you have answered during your consultation. Half of the amount of the procedure is required to hold a spot on the schedule. Making deals with the clinic or doctor is not unusual especially if you are having several things we do at the same time. Make sure this is clear to you and us before we get started.
Does the doctor do the procedure?
Yes. I am not aware of any clinic where the individual doing the procedure is not a doctor. There are a very few clinics in the country that are very busy and a nurse or nurse practitioner may administer your tumescent local anesthesia. At re*be® in Okoboji currently Dr. Kolegraff administers your tumescent anesthesia and does the procedure.
Does it hurt?
No not very much. Of course every patient is different but most people do surprisingly well. The tumescent local anesthesia is very good at numbing up the tissue. Your experience will depend somewhat on the experience of your doctor. Dr. Kolegraff is experienced with tumescent anesthesia and has done thousands of procedures using this technique for varicose veins. When done properly you will feel the initial poke of the same tiny needles we use to inject Botox®. Once the surface of the skin is numb the fat under the skin does not have much sensation and numbs up quickly. You will notice some tugging, pulling and hear the sizzling of the fat as the laser passes through it but most people are comfortable. If you do have discomfort it is easy to give some more local anesthesia which usually fixes the problem quickly.
What kind of anesthesia do you use?
We use tumescent anesthesia with a combination of Lidocaine and epinephrine and sodium bicarbonate to numb your tissue. This is a very dilute local anesthesia in much lower concentrations than your family doctor or dentist might use. By diluting the local anesthesia we can use it to treat a much larger area and volume of tissue than would otherwise be possible. It is this tumescent local anesthesia that makes the procedure much safer than a similar procedure done in the hospital operating room under general anesthesia. Keeping the procedure in well-equipped doctor's offices is safe because of this anesthetic technique. It is estimated to be 1000 times safer than general anesthesia. Reduced anesthesia costs make the procedure more affordable as compared to the alternatives in the hospital. We do not encourage the use of sedatives but if you have had experience to need them in the past for other things we will provide you with some.
Can my friend watch the procedure?
We will on occasion allow friends or family members to watch your procedure but we want you to consider and be aware of our concerns too. Our procedure rooms are state of the art, air filtered and ultra violet light treated clean rooms which were expensive to build. We feel the cost of providing this type of place to do the procedure is well worth the expense especially if it reduces the chances of a serious infection. The more people we bring into the room the more bacteria come into the room. We like to limit the number non medical people observing to one for this reason. If your friend or family member understands sterile technique and is familiar with what goes on in the procedure like this it is better. Someone unfamiliar with anesthesia or surgery can get light-headed and need assistance themselves. This will require an interruption in your procedure as the staff will need to assist them. We already have one patient in the room adding another one is not a good idea. The procedure is pretty 'naked' meaning that you are quite exposed especially the areas we are working on. This can be just as uncomfortable for your friend as it is for you. The procedure is done in phases and there are short interruptions but will get very boring for most friends and family members. If you must have an observer we would recommend they bring a book to read or something to do because watching you have this done may not be as interesting to them as you think. The bottom line is we would like to discourage observers especially non medical people but on occasion will allow one if you and they understand our concerns.
Do I have to have my pictures on the internet?
No. re*be® is a busy medical clinic and we would love to be able to use your photos to demonstrate what we have done for you to others. If you do not want your photos used they will not be. If you give us permission to use your pictures on the website and later change your mind we will remove them at the next opportunity. If you give us permission to use your photographs and they make it into our billboards or our print material removing them is more difficult and takes longer.
Who will know I had it done?
Anyone who pays attention to your figure should notice the change. re*be® is a busy medical clinic and of course we are bound by the HIPAA Privacy Policy. Every effort will be made to maintain your privacy for any procedure you have done at re*be®. The only people in the procedure room will be those taking care of you.f We train doctors and nurses regularly at re*be® and have had a larger number of doctors and nurses through the clinic this year. If there is a medical professional who is our guess we will get your permission before they are present during your procedure.
What can go wrong?
The worst complication is death but is very rare and almost never related to the tumescent anesthesia. Interestingly the experience and background of the doctor doing the procedure plays a role. Credentials and Board certifications are difficult for your doctor to get but do not seem to correlate with safety as much as those of us with Credentials and board certifications would hope. Death from liposuction has been reported from the laser poking through the muscles and hurting the intestine inside the belly. This has been reported when non surgeons are just beginning to learn to do the procedure. Small lumps in your skin that do not resolve after 3-6 months may need to be touched up. There are places in this country where the doctor even a non surgeon has taken a weekend course bought a machine and started doing liposuction. Bleeding after the procedure can occur but so far not been a problem for us. The epinephrine constricts the blood vessels and the laser seems to close them up making both bleeding and blood loss from the procedure much less than traditional liposuction. You can get fat. Laser liposuction does not prevent you from getting fat. If you don't take care of yourself with diet and exercise you can and will gain weight.
Does this work for cellulite?
We have seen some real improvement in the appearance of cellulite doing laser liposuction at re*be®. It appears that breaking up the connective tissue between the fat lobules will cause improvement to the surface of the skin resulting in improvement in the cellulite appearance.
What can I expect after the procedure??
You will be tired the evening of the procedure. This occurs because of the adrenaline you release and the epinephrine we give you as well as the disruption in your routine. You will drain from the small holes in your skin for 24 to 48 hours usually. You will be sore. The skin over the treated areas will be somewhat numb to very numb. This can last many months but generally gets better with time. It may never be absolutely normal but real problems with numbness are rare. There will be scabs around the port sites that resolve in a week or two. As you heal the treated area will become uneven. This occurs because of fluid shifts and We have seen some real improvement in the appearance of cellulite doing laser liposuction at re*be. It appears that breaking up the connective tissue between the fat lobules will cause improvement to the surface of the skin resulting in improvement in the cellulite appearance.
What are all the circles for?
The distribution of fat on your body looks very different when standing and when lying down. The marks placed on your skin just prior to the procedure are used to guide the fat removal process. They work much like the lines on a trail map to show how far the fat sticks out and to show how much fat is present and needs to be removed. The circles also serve to show where there are asymmetrical areas of your body meaning that a bigger circle on one side shows that there is more fat to be removed in that location. The marks come off with alcohol although they do stay longer than most people want them to.
Have you treated excessive sweating with laser liposuction (hyperhidrosis)?
Yes. Excessive sweating is treated in a very similar manner with laser liposuction techniques. We have successfully treated excessive sweating or hyperhidrosis with laser ablation. Insurance does not yet cover this but the results are good and we anticipate they will with continued success using lasers. Botox® is used with insurance coverage at re*be® for excessive sweating when the appropriate criteria are met.

Check this website frequently as there is always something new going on at re*be®.

ProLipo brochure rebe®

Liposuction Thigh

The re*be® Clinic has been extensively remodeled and purchased state of the art new equipment to be able to offer laser liposuction. This procedure is now done under tumescent anesthesia. Dr. Kolegraff has performed many thousands of tumescent anesthesia cases for the varicose vein part of his practice. This gives re*be® a huge experience to draw from for our latest offering Laser liposuction. Dr. Kolegraff and his wife Jill have trained with Dr. Roger Hogue M.D. in Maple Grove M.N., a true pioneer in laser liposuction. They have traveled to Los Angeles to train with Dr. Jeffery Klein M.D. one of the founders of the procedure and have trained with Dr. Mark Saltzman M.D. in Louisville KY.
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