The traditional technique and instruments lead to a number of deaths due to blood loss and other difficulties. Dr. Hall has trained with the individuals who pioneered this technique utilizing finer instruments for more accurate and precise sculpting and administering a local anesthetic, so the patient is awake throughout the procedure. Tumescent Liposuction or “Liposculpture” allows the surgeon to target specific areas with much greater accuracy and control. Risks and recovery time are virtually eliminated and most patients return to their normal routine within 48 hours.
Not everyone is a candidate for this surgery, which is why Dr. Hall emphatically advises individuals to get thorough consultations and second opinions. He explained that many people come to him unhappy with their bodies and seeking his services. Dr. Hall will spend time with each potential client and ascertain his/her physicality, genetic makeup and self-image. He claimed he is more inclined to accept those patients who have been considering the surgery for a longer duration, because they are typically more informed and secure with the decision and not as impulsive. “People who just recently came out of a relationship or divorced or who are unstable I tend to hold off until they put a little more thought and consideration into the decision,” he said.
Sitting in his office, before his first surgery, he explains the human predisposition to fat and why Tumescent Liposuction or “Liposculpture” cannot be used as a remedy for obesity, poor eating habits/lifestyle or as a method for weight loss. “You are born with a predetermined number of fat cells in each area of your body, there is no variation, there is no replication of remaining cells or re-growth of cells or migration of cells to the area,” Hall stated, “so once they are gone – they are gone.” He does not remove all of the fat cells in an area, so there is some possibility for minor weight gain in that area post-surgery, but if there is dramatic weight gain after the procedure, it will most likely be gained elsewhere in the body where the fat cells are most densely populated. For example, if the client has fat removed from the outer and inner thigh area, then it is very possible that he/she might gain weight around the hips, buttocks, abdomen or stomach – if that is where the cells already exist. Typically, Dr. Hall advises his clients to lose roughly five to eight pounds (if the client is slightly heavier), post surgery, so that the most desired result is attained within two to three months. Tumescent Liposuction or “Liposculpture” is very effective; therefore, the need for a redo or second surgery in the same area is rare. Patient satisfaction is high if they follow the instructions and have a healthy lifestyle. With this newer procedure, the result is much smoother with less “buckling” of the skin, which is why redoing an area would be more predominant in the past with traditional Liposuction.
He explained that the most difficult area is the abdomen or “belly” for a few reasons. It is a very vulnerable area and “the doctor must be extremely cautious, because of the underlying abdominal content,” he said. In addition, this is an area that women are very conscious about, so the doctor must be extremely attentive to the area to ensure maximum aesthetic appeal. “The advantage of the Tumescent surgery is having an awake patient when you are doing Liposuction is that the [patient] has muscle tone, Hall explained. He elaborated by stating that the body, when under general anesthesia becomes flaccid and limp. The muscle tissue becomes so relaxed that certain boundaries are not as apparent. The patient is completely unconscious, so asking him/her to flex or lift a certain area would be impossible. With Tumescent LipoScultping, the patient is alert and can respond to the surgeon’s requests. The technique allows for the muscle tissue to react as well, so the surgeon has firm delineation between the fat and other tissue for improved instrument guidance.
When asked about the LipoSuction horror stories and the prospect of patients “bleeding out” on the table or after the surgery, Dr. Hall made the comment, “that’s really not a great risk anymore, because we have a lot of really great physicians here in the Valley.” He continued, “almost all of the plastic surgeons and cosmetic surgeons incorporate at least a modified Tumescent technique for the safety purposes of the Tumescent anesthesia – meaning, they don’t do the whole case under local anesthesia and they still put them out under general, but they administer the Tumescent fluid into the areas they will suction for the vaso-constriction - to close off and shut down the blood vessels in that area to prevent excess bleeding.” He complimented the awareness of physicians in the Phoenix Metropolitan area and stated that, “people could plan on a pretty safe procedure, really anywhere.”
The instruments have changed a lot over the past ten years for sculpting. Dr. Hall practices the micro-canular technique or cross-hatching technique. Instruments are three millimeters or smaller in diameter, which means the incisions are so tiny, that no stitches are necessary. After the post-operational drainage occurs (lasts from one to seven days, depending on the individual) the small openings close on their own leaving virtually no scars. More incisions are made to get to the fat from different points in the area. Traditionally large incisions were made in fewer hidden areas and the surgeons were limited on angle and precision. The result would be less definition, more scars and compromising safety. Now with micro-incision sites and practice of the cross hatching technique, the defects - such as ripples, dimples, lumps, bumps and scar tissue left behind, are dramatically reduced along with revisions and touch-ups.
Dr. Hall feels that one of the biggest advantages to this surgery is having the patient cognitive and awake enough to stand up in front of a mirror and look at the areas before finishing and sending him/her home. When a person is looking at his/her self, it is usually standing before a mirror, while gravity, naturally, is pulling downward. It is from that perspective that he/she is displeased with certain areas of the body before considering the surgery. So getting the patient in that same position allows for better symmetry, and hence, greater satisfaction, overall. “I place and see people in the position that they judge themselves in, which is a tremendous advantage for the physician to be in before letting the work go out the door,” Hall proclaimed. For this reason he has had minimal touch ups in his clinic, because most flaws and potential problems are discovered and eliminated during the scheduled surgery.
Expectations can be a big issue in his position. It’s like going to the hairdresser with a head of fine, limp hair and asking to look like a model with thick wavy hair when you leave. Many clients come in and want the most extreme results when they leave. This Tumescent Liposuction or “Liposculpture” technique is used for sculpting the areas in question, not shaving off layers and pounds of stored fat, erasing cellulite or experiencing dramatic weight loss. Realism as opposed to idealism is the best rule of thumb to apply in this type of scenario. Dr. Hall claimed he asks his patients this question prior to consideration, assuming the candidate met all of the other medical criteria, “If you would be happy with a 50% improvement in any given area, then you are realistic and you are a good candidate for Tumescent Liposuction or “Liposculpture””. He then professed, “of course as a physician I try to achieve upward of 95%, but I need to know their expectations are reasonable and that we will more than likely exceed them.”
After viewing some more examples of his work, we headed back to greet his patient, who graciously allowed us to sit in and watch the procedure. She was awake and shared that she pondered the surgery for some time and weighed the differences between her practical side and the part of her that really wanted to make this commitment to herself. She was a prime candidate for the surgery. She is physically fit, her eating habits are healthy and she works out on a regular basis. The patient does not have a weight problem and feels that the surgery will compliment her image. Dr. Hall confirms that she is the type of case that he most enjoys accepting, because the results will meet the anticipated desire. Dr. Hall’s first step is to sketch a topographic outline on the body to guide him and indicate the targeted areas of entry and removal of fat cells during the procedure and specify incision sites. His patient stands before a mirror as he draws large tear-drops, circles and lines in those designated areas. The patient lies on the table and he then proceeds to administer the localized anesthesia to those locations of the body. Once they are numb, he then inserts the canula to direct the tumescent fluid, which will stop the blood flow to those areas and lower any risks of excess blood loss.
In the Operating Room as Dr. Hall vigorously works on his case (patient), he answers a battery of questions about why he chose Cosmetic Surgery after medical school. It seems intriguing – the idea of changing someone’s physical appearance and his/her overall self image. After working with some of the pioneers in Liposuction and mastering his technique on a few thousand patients of his own, Dr. Hall noticed a consistent result – a high level of satisfaction and overwhelming number of happy faces or cases, as he calls them. “It’s very satisfying taking care of a sick person when you are bringing him/her back to good health, but it is tremendously satisfying also taking someone who might have a low self-esteem or someone who does not feel good,” he said. We all have things that bother us about ourselves, flaws that are intrinsic to our own image,” he continued. “It is amazing to be able to change a person’s life, their whole outlook and perspective on life.” His patient then looks up and adds, “not just from a physical perspective, but from a mental standpoint as well.” Hall then talked about his patient and stated, “people are not going to look at her and say ‘she’s fat, she’s out of shape or she’s grotesque,’ she has a beautiful body and she is a beautiful girl, but in her mind, she feels uncomfortable with these areas, so she is doing it for herself (he gets short of breath as he maneuvers the canula back-and-forth, rigorously in the upper thigh of the patient.)”
It’s a little strange to see and hear them communicating back and forth as this instrument seeks out fat to be removed. We crack a few jokes and talk a lot more about Dr. Hall’s life after his college football career ended due to a knee injury. All the while, his patient interjecting her thoughts and affirming how she came to the conclusion to proceed with her decision, even though it was not the most practical.
“People need to keep in mind that this is something you do for yourself, don’t do it because your boyfriend or mother said that you are gaining weight, think it through and don’t do it on impulse,” he proclaimed. If someone comes in for a consultation and divulges that this has only been a consideration for two days, I will ask them to consider it for awhile longer, just to be sure it is right for the individual,” he concluded.
I have followed Dr. Hall’s patient. She never had stitches and all of her incisions closed within 48 hours. In two weeks the swelling is barely noticed. In one month a handful of days, she is ecstatic with the results. She beams as she shows off her newly refined figure (which was an 8 or 9 to begin with by most people’s standards). There is not a trace of regret. I am really happy with his work. “This has made a big difference in how I feel about myself, even if other people do not notice,” she said. “But, I have noticed people coming up and asking me where I work out, when I have been going to the same place for four years,” she shared with a smile.
It looks like Dr. Hall just satisfied another case and somehow etched a more permanent smile on her face.
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