Trish: Great, well I’m here today with Dr Meaghan Heckenberg. And Dr Heckenberg is actually a cosmetic physician who owns Be Sculptured. That’s based in Sydney and we’re gonna talk about liposuction. Dr Heckenberg only does liposculpture and that’s the only procedure that she does.

I’m sure you’ll all agree that repetition is the mother of skills. So definitely we’ll have a chat to Meaghan and if you’re looking at having liposculpture, to get a bit of those love handles done or whatever, maybe you might want to look down this path.

So, thanks for joining us today, Dr Heckenberg.

Dr Meaghan H.: Thank you, Trish. Pleasure.

Trish: Now, I met you at a conference a couple years ago. I heard you talking and everything that you said made so much sense to me because I know that you just do liposculpture. So, I thought, “Great, if anyone is going to have it done, you want to go to someone who pretty much does it all the time, has the patience to do it.” So, tell us a little bit about what you do.

Dr Meaghan H.: All right so, as you very aptly said I’ve chosen out of cosmetic procedures just to do liposculpture. All liposuction I do local anaesthesia, not as my primary procedure but as my only procedure. I think, as you said, by doing the same procedure often you get good skills at doing it. I must admit, the longer I’ve been doing the more I realise it takes time to get it right so I’m happy to dedicate the time to do a liposculpture procedure.

I enjoy it. It’s not for everyone, because it’s quite time consuming. I tend to only operate on one patient a day because sometimes the procedures might take me like 4 to 5 hours to do.

Trish: Right. So you do it under a local anaesthetic. Is that right?

Dr Meaghan H.: That’s correct. So I do give a sedative injection at the beginning of the procedure, just intramuscularly, to make the patient feel nice and floaty and relaxed and then, pretty much it’s all under local anaesthesia. So the patient is awake and able to obey instructions.

So I might say to the patient, can they roll over on this side and that side to get them in the optimal position to do the procedure and they’re able to do that for me. It makes it a much safer procedure than doing it under general anaesthetic, so there’s less operative risk and I must admit I think it gets better results. I’m able to stand the patient up at the end of the procedure to look for symmetry and to look for other areas that may need touching up at the end of the procedure. You don’t have that option when you’re under general anaesthesia.

Trish: It makes sense, but I went to a conference once and they were talking about too much local anaesthetic can not be good for you. You know the old girls that were getting the implants done under … what makes this different?

Dr Meaghan H.: Yeah. The local anaesthetic or the drug called Lignocaine is diluted in large amounts of saline so we actually use litres of saline and sometimes we might put in 4 or 5 litres of saline but into that mixture is the drug Lignocaine. So, Lignocaine is a local anaesthetic drug. In fat, you can use very high doses of Lignocaine compared to putting it into muscle or skin, so we’ve got the opportunity to be able to spread it through the fatty tissue because fat has a lower absorption into the bloodstream compared to the muscles or the skin, so that way we’re able to use large doses of local anaesthetic drug called Lignocaine compared to what you’re saying with the breast augmentation.

So, as long as you keep it under a certain amount which, liposculpture doctors know what that level is. So according to someone’s body weight I’m able to give them a certain amount so we weigh the patient beforehand and I can work out regime of what I can use during that liposculpture procedure.

Trish: So what areas do you do? Can we just run through them, do you mind? I know that we —

Dr Meaghan H.: Yeah, not at all. Basically for a woman I must admit anywhere from the chin or the neck to the ankle. So anywhere where there’s subcutaneous fat, and that means fat that sits underneath the skin. So that could be the neck, chin, the arms, the breasts, the bra area, the abdomen, the hips, the waist, the outer thighs, inner thighs, anterior thighs, knees, calves and ankles. So pretty much anywhere for a woman.

For a man, I must admit probably the only areas that men get is, like, the neck and chin. The breasts or the man boobs, the abdomen and the love handles or the hips. It’s very rare for a man to request their thighs to be done with liposculpture where as that’s a much more common request with women, because of the different shapes that women have.

Trish: Yeah. Right. So say for example, I was coming to have my, what would I want, say I was coming to get my outer thighs done. How long would that procedure take?

Dr Meaghan H.: Okay. Yeah. So probably take about 2 to 3 hours to do. The start of the procedure is where I mark out the areas with a surgical pen, and that pen probably stays on for about a week but it’s important that it stays on during the procedure because that signifies my landmarks, because where I put all the local anaesthetic solution into the tissue it stretches it, so it’s important to have those markings. Then to prepare the tissue, putting the local anaesthetic probably takes about half an hour to do. Also in that mixture is not just the local anaesthetic drug but a drug called adrenaline. Now adrenaline’s a very powerful constrictor of blood vessels so it makes it a virtually bloodless procedure; also keeps the local anaesthetic into the place that I inject it so it doesn’t get absorbed into the bloodstream. This is what we call tumescent analgesia, and that’s how the liposuction under local anaesthetic is done.

So the liposculpture itself then afterward would probably take me maybe a couple of hours to do.

Trish: So basically, because everyone knows about liposuction. So basically liposculpture is like liposuction except it’s not with general anaesthetic… it’s done under the local anaesthetic. Is that kind of right?

Dr Meaghan H.: Yeah. That’s kind of right. It really is truly sculpting because I use very narrow cannulas. I mean, basically I use a 2 or 3 millimetre diameter cannula. 3 millimetres is probably the max that I would use in any area of the body. So you’ve got a more narrow bore cannula. It’s got a blunt end, and it just takes time to get the fat out. It’s actually not the suction that takes the fat away – it’s me moving the cannula back and forth through the fatty tissue. You got to remember the fat is a living cell, it actually has to have a blood supply to survive and also it’s connected to its connective tissue within the body, so to get the fat out it’s not actually the suction that takes the fat, it’s me moving the cannula through to break away the fat cell from its connective tissue, and then the suction just take away the fat cell from its site of destruction. The more narrow the cannula, obviously, the more strokes it requires to get the fat out but you’re left with more even results. Less irregularities for sure.

Trish: Okay, and less bruising?

Dr Meaghan H.: Possibly. I think because we do prepare the tissue very well, because the patient is awake; of course it has to be anaesthetised. So, because of the adrenaline in the solution, that vastly decreases bleeding and bruising afterwards. It is a little bit variable, because sometimes people do bruise a bit, and some people more so than others. Bruising may not come out really for a couple of days The first after the procedure there’s hardly anything and it might take about 2 or 3 for it to come out.

There’s certainly some areas that probably tend to bruise a bit more than others like, I must say, the inner thigh and the knee probably bruises a bit and the lower part of the outer thigh. It’s not to the point where it’s uncomfortable. It looks like a bruise, but it’s uncomfortable for the patient.

Trish: What about recovery time? I’m presuming it’s going to be different to having liposuction under a general anaesthetic.

Dr Meaghan H.: Yeah, well that’s another thing too. Because we are preparing the tissue well, the post operative pain is generally less than under a general anaesthetic and also the bruising; because the tissue is prepared very well. Yeah, the next day afterward everyone feels very well, in fact to the point where they tend to do too much. They feel quite good afterwards.

It’s important to wear compression garments for about 2 weeks after the procedures. Some areas require less time, particularly like the neck or the arms because those areas are above or at the level of the heart so they tend to drain very quickly so the swelling, it doesn’t hang around as much as the more dependent areas of the body. For the thighs or the tummies, we provide compression garments that the patients wear for about 12 to 14 days afterwards. That just helps to reduce the swelling and helps to reduce the bruising afterwards as well.

It’s more feeling of soreness and stiffness. I sometimes equate it to doing a really big work out at the gym where you haven’t used those muscle groups before.

Trish: Have you had it done yourself?

Dr Meaghan H.: I have.

Trish: You didn’t do it yourself?!!

Dr Meaghan H.: I wish. Yes I had it done about 16 years ago. I had my outer thighs, inner thighs and knees done in the one procedure, and I could not believe the change in my body shape. Oh my God, I wish I could have done it sooner. I was so pleased to have had it done, and the results are still there to this day.

We do continue to age, so last year I had a little bit done on my hips, because at that time I was in my late 40’s so you start to get that age related fat deposition in other places of the body. So yeah, I mean look, I’ve had it done twice now.

Trish: Fantastic. I was looking here to try and find some before and after pics but I can’t see, like, they’re not allowed anymore are they?

Dr Meaghan H.: I think so. On the gallery, you’ll see them on the gallery.

Trish: Oh wow, yes I’m here. Fantastic. I’m so impressed. I’ve actually had liposuction under general (anaesthetic), which I’m really really happy with, but yeah it is a bit of a recovery, like, you’ve got to go hospital and what not. So yeah, this is on the cards for something different for sure. Not quite so, intrusive I guess, for want of a better word.

Dr Meaghan H.: Yeah. I was actually seeing a patient yesterday. Before she had come and saw me she had done a lot of research online and liked the fact that it was under local anaesthetic because she said, I’ve watched all these youTube videos of liposuction under general anaesthetic and she’s “oh it looks so aggressive”. You know obviously the patient is asleep and generally anaesthetised.

As I said before, the speed is not important. It’s probably more so the opposite. It’s just taking the time and the size of the cannula. Micro-cannulas give better, smoother results. There’s no doubt about it. If you use a larger bore cannula, there’s obviously more risk of causing irregularities.

Trish: What about time off work. You know, say someone’s coming to have their abdomen and outer thighs done. How long would you be looking at to have off work?

Dr Meaghan H.: Yeah, so. Obviously the day of the procedure. The next day definitely I would say, have the day off. You’re still leaking little bit of the anaesthetic fluid through the incision points. So usually most of it will have stopped leaking by the next day but there might be a bit of ooze throughout the day because it can take about 24 to 36 hours for the leaking of the excess anaesthetic fluid to stop. Then I would say, well you know, if you get a couple of days off.

It really depends on what a person does for work. If it’s a very inactive job they could probably go back to work after 1 or 2 days. If they’re just sitting an office desk or a computer there’s no real need for them to take a lot time off. It’s not like they feel unwell. They actually feel quite okay. As I said it’s just that soreness and stiffness. You don’t want to be doing any marathon runs afterwards for sure.

Trish: Yeah. I’m going to ask you one last question. I had a customer ring me and say I want to have some liposuction done but I’ve been told that you’ll be left with really bad cellulite afterwards. So, what’s your view on that, or how does it work with the liposculpture?

Dr Meaghan H.: Yeah. Cellulite, it may improve. I’m going to promise that it would ever improve. I mean, you decrease the surface area of the fatty tissue so obviously it looks better afterwards but it’s not really a cure for cellulite because cellulite is basically the structure of how the fat sits inside the body, so it’s that connective tissue that holds the fat cell there. You can’t really alter it. It does look better when you reduce the surface area of a certain area that you’re treating. Sometimes we can try to disrupt that connective tissue, but yeah I wouldn’t say there is any treatment that is 100 percent successful in reducing cellulite. It won’t make it worse, in answer to your question, it certainly won’t make it worse. No way.

Trish: Yeah. That’s what I really wanted to hear. The jury seems to, kind of be out on that one and it’s just a matter of someone’s opinion, like some people say yeah does make it worse and some say it doesn’t, but I think you’re right. I think it depends on the size of the needle that you’re using, how long you’re going to take and the whole process really.

Dr Meaghan H.: Yes.

Trish: Yeah. Awesome. I reckon you’ve answered all my questions. I’m going to pop in and see you next time I’m in Sydney.

Dr Meaghan H.: I look forward to it Trish.

Trish: Yeah. Awesome.

Dr Meaghan H.: You probably don’t need any liposuction do you?

Trish: Oh God, all over.

Dr Meaghan H.: Well that’s another thing I wanted to say too. There’s definitely a misconception out there that liposculpture or liposuction is for overweight people. I can get people coming in to see me that are thin and they’ll say I’m probably not going to be a candidate for the procedure, and I stop them and I say, you know what you probably will be because it’s best suited for people of normal weight. You don’t have to do anything to change your lifestyle afterwards because, look, it is a simple equation. If you eat more than what you burn off, you’re going to deposit fat. You can’t destroy energy. It has to be changed from one form to another. So it’s quite simple, that equation.

If someone’s of normal weight and they’re exercising well and they just can’t budge a certain little area or, you know, like on their love handles or hips or muffin top or they’re born a certain shape and their parents have got a similar shape or their mother does then they’re the perfect candidate for liposculpture because I can just, basically, sculpt their body and give them a more aesthetically pleasing shape and remove that unwanted fat. So definitely it is a procedure for thin people.

Trish: Yeah. If you’ve just got that localised little bit of fat that you just can’t get rid of, I mean, perfect way to get rid of it.

Dr Meaghan H.: Yeah. I mean, for overweight people; you can’t be obese, I mean, it’s not a procedure for that. For obesity, what those patients need is bariatric surgery or gastric banding or getting some sort of operation to stop them eating so much. If you’re slightly overweight, liposculpture can certainly be a bit of a kick start to a better living and eating and exercise programme but it’s certainly not an answer for weight reduction. It’s more about shaping the body.

Trish: Yeah. Absolutely, and just actually one last question.

So, is there any skin tightening with liposculpture at all or not really?

Dr Meaghan H.: Yes. Definitely. There are lots of gimmicky things out there, everyone thinks that they need to have laser or some sort of heat trauma to the skin to give skin retraction. If you remove the fat, the subcutaneous fat from underneath the skin, that skin will shrink. So there’s skin tightening as we do liposculpture and I actually see it happening as I’m doing it. I see the skin shrinking to the new shape, and particularly using the micro-cannulas, you can get relatively close to the skin with that without causing the irregularities so that will improve skin retraction.

If you’re getting a large bore cannula, as I said, that only be used in the deeper tissue and that certainly can’t be used close to the skin because that’s when it will start to cause irregularities. The micro cannulas that we use, it’s good because you can get close to the skin, that can even improve skin retraction. Once again, it’s time taken to do the procedure properly and the skill of the doctor. They’re the two ingredients that you need.

Trish: Do you guys do anything else at the clinic there?

Dr Meaghan H.: Yes. I’m under a banner also of Crows Nest Cosmetic and Vein Clinic even though my company’s called Be Sculptured which is purely liposculpture. But we do the wrinkle reducing injections and also the fillers, dermal fillers, laser, varicose vein treatments, intravenous sclerotherapy, intravenous laser. We’ve got 2 other practitioners.

Once again, they do the same thing. So, we have our nurse practitioner does all of the wrinkle reducing injections and the fillers and the lasers and then another doctor, Dr Owen Roberts, he’s a phlebologist, so he specialises in vein treatments.

Trish: Okay. Great. So veins, cosmetic fillers and treatments and laser, and you do the liposculpture.

Dr Meaghan H.: That’s right, yes.

Trish: Great. So you’re a bit of a one stop shop.

Dr Meaghan H.: Yeah. All these things, as you know, it’s all … with facial treatments it’s all a bit of maintenance. Some of my patients would like to know other treatments that are available so they end up seeing Jill, our nurse practitioner and likewise she’ll see people that she can’t, for instance might have fat on the neck, and no amount of wrinkle reducing injections will reduce the sagginess or the thickness of the neck skin so liposculpture is often something that she will refer to me; for some of her clients.

Trish: Yeah. Of course. One client … maybe you have a client come to you that might need something else that’s in the clinic and it’s perfect. It’s all there like veins or whatever, because it’s someone struggling to find someone for veins.

Dr Meaghan H.: Exactly.

Trish: Awesome. Well thank you so much for taking the time today.

Dr Meaghan H.: Thank you Trish, thank you very much for having me.

Trish: Lovely. So if you guys are looking for somewhere to have your liposculpture done, definitely check out, I like to call you Doctor Meaghan. You can have a click on the bottom of this podcast or drop us an email at info@plasticsurgeryhelp.com.au or contact Be Sculptured direct and they’re at Crows Nest.

So thank you very much.

Dr Meaghan H.: Thank you very much Trish. Lovely speaking to you.

Trish: Okay. Bye.

Dr Meaghan H.: Thank you.

This interview was completed by Trish from the Plastic Surgery Hub. View original article here.