December 5, 2024 • 28 mins
In Episode 54 of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and Zoë Schroeder sit down with Dr. Ethan Larson, a plastic surgeon specializing in lipedema care. Together, they delve into the complexities of lipedema, available treatment options, and the transformative role of plastic surgery for lipedema.
What is Lipedema?
Dr. Larson explains that lipedema is a chronic condition that primarily affects women. It manifests as an abnormal accumulation of fat in the legs, arms, and sometimes the abdomen, often triggered by hormonal shifts like puberty or menopause. Unlike normal fat, lipedema fat does not respond to diet or exercise, leaving patients frustrated.
Key Facts About Lipedema:
- Resistant to metabolic breakdown.
- Often accompanied by pain and swelling.
- Can coexist with obesity, which is treatable.
Lipedema Treatment Options
While diet and exercise support overall health, they do little to address lipedema fat. Dr. Larson highlights lymphatic-sparing liposuction as the most effective treatment, designed to:
- Remove abnormal fat while preserving the lymphatic system.
- Improve functionality and reduce pain.
- Enhance cosmetic appearance as a secondary benefit.
The Role of Plastic Surgery for Lipedema
Plastic surgery for lipedema is more than cosmetic; it’s a functional solution that addresses discomfort and mobility challenges. Dr. Larson answers common questions about the procedure:
- Does the fat return? Not in treated areas, but untreated regions may develop new fat pads.
- How much fat can be removed? Up to 8–10 liters per session, depending on individual needs.
- What about risks? Safety measures ensure optimal outcomes while minimizing complications.
Comprehensive Lipedema Care
Effective lipedema treatment often requires a multidisciplinary approach:
- Dietary Adjustments: Anti-inflammatory diets can help manage secondary symptoms.
- Surgical Interventions: Lymphatic-sparing liposuction is the cornerstone of treatment.
- Patient Advocacy: Self-education and persistence are key to navigating insurance challenges.
Addressing Barriers in Lipedema Treatment
Dr. Larson discusses systemic challenges, including:
- Limited awareness among healthcare providers.
- Lack of insurance coverage due to insufficient diagnostic and procedural codes.
- High out-of-pocket costs, with surgeries starting at $12,000 per session.
He stresses the importance of awareness and advocacy to improve access to care.
When to Consider Plastic Surgery for Lipedema
Dr. Larson advises patients to stabilize their weight for at least three months before surgery. For those using GLP-1 medications like Wegovy or Mounjaro, he recommends completing weight loss before planning surgery to ensure long-term success.
Lipedema Support and Resources
Organizations like the Lipedema Foundation are vital for raising awareness and advocating for systemic change. Dr. Larson encourages patients to utilize resources like Lipedema.org to connect with knowledgeable specialists and support networks.
Final Advice for Lipedema Patients
Dr. Larson’s key recommendations:
1. Get Diagnosed: Work with a specialist to confirm your condition.
2. Set Priorities: Identify treatment goals to guide your care plan.
3. Plan Ahead: Ensure long-term weight stability and realistic expectations.
Connect with the Experts
Visit www.larsonplasticsurgery.com or www.poundofcureweightloss.com to learn more
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Larson (00:00):
When people get the diagnosis of lipoedema, they get
sort of a sense of hopelessnessabout their weight overall, and
one thing that I think isimportant for everyone to
understand is that there'slipoedema fat which you can't
lose through diet and exercisebut that's frequently in the
same patient that has maybeobesity and that can be treated.
And so we want to treat theobesity and the lipoedema to get
(00:22):
the patient back to anoptimized lifestyle state.
Obesity and the lipoedema toget the patient back to an
optimized lifestyle state.
Dr. Weiner (00:28):
Welcome to the Pound to Cure Weight Loss podcast.
I want to introduce EthanLarson, a plastic surgeon and a
friend of mine, really highlyskilled.
We're going to talk today aboutlipoedema and body contouring
surgery and Ethan has been onour nutrition program and so, um
, as part of our nutritionprogram, if you sign up, you can
(00:49):
meet with him and talk about,you know, questions you have
about either uh, treating lifeedema or the first steps in body
contouring surgery, and sothat's available on our website
at poundacureweightlosscom.
Slash nutrition, um and uh.
Once you sign up, you'll beable to see the schedule, and it
should be.
She should be scheduled shortlyafter the release of the
(01:10):
podcast.
So welcome, ethan, good to haveyou.
Dr. Larson (01:13):
Thank you very much for having me on.
I appreciate it.
Dr. Weiner (01:16):
So I think the first question that we need to answer
is what is lipoedema.
Dr. Larson (01:22):
So lipoedema is a disease that affects primarily
women and what it represents isfatty tissue that usually starts
in the legs and usually beginsat a period of hormonal shift
whether that be puberty,childbirth, menopause and that
fatty tissue starts to grow.
Unfortunately, it seems to nothave the receptors that normal
(01:46):
fat cells have.
So when it comes time to tryand break that tissue down to
turn it back into energy, thebody can't do it.
The body recognizes thatthere's something wrong with the
cells at that point and alow-grade inflammation starts
and the abnormal fatty tissue,combined with the low-grade
inflammation, over time candevelop fibrosis.
(02:08):
It can develop pain and we seejust generalized swelling of the
legs, not from fluid but froman accumulation of fat that's
very hard to lose.
It can also affect the abdomenand the arms.
Zoe (02:20):
So what do people do to like?
What is it to help that?
Dr. Larson (02:24):
Well there's.
There's not a whole lot ofoptions to help it at this point
.
Diet and exercise can sometimesaffect normal fat.
The weight loss interventionsthat we have now, the new
medications, weight loss surgerythat affects normal fat but it
doesn't really seem to have aprofound effect on lipidema fat.
So even after thoseinterventions that fat is still
(02:47):
there, it's still stuck in thelegs, and so the only way to
really affect it is to remove itsurgically, and we do that with
a special type of liposuctioncalled lymphatic sparing
liposuction, and it's really adebulking procedure.
Zoe (03:03):
I was going to think of it as something like liposuction,
yeah, so what's different Likewhat do you do?
Dr. Weiner (03:08):
different Like, first of all, how's liposuction
work traditionally and what'sdifferent about the liposuction
you do for lipodema.
Dr. Larson (03:16):
Sure.
So traditional liposuction isbasically a hollow rod that's
connected to suction and itrelatively easily removes fat
cells while preserving the bloodsupply, the nerves, the stuff
that keeps the overlying skinalive.
When we do lipedema, that fatis different from normal fat.
Normal fat has more of abuttery consistency.
(03:37):
I say lipedema is more likelike cheese it's.
You have to sort of burrowthrough it.
It needs to be separated.
A lot of times the lipoedemanodules are larger than the
holes in the cannula.
So I have to do a lot of manualbreaking up of the tissue to
make the nuggets of lipoedemasmall enough to remove.
And then I'll also use my handsto actually remove it by
(04:00):
milking the large nuggets out ofthe holes.
And then part of this is wewant people to get a really
satisfying cosmetic result, andthat's challenging when we're
dealing with irregular largelumps of lipidematous tissue.
So a big part of my procedureis smoothing things out at the
end so people get the optimalcosmetic result.
(04:21):
And remember, it's not acosmetic surgery, it's a
functional surgery.
But we want people to look goodwhen we're done.
Zoe (04:27):
Also, so then with lipedema , does it come back after a
certain period of time if theygain weight back, or is it more
so just gone because those fatcells are now removed?
Dr. Larson (04:39):
That's a fantastic question and there's a lot about
lipedema that we don'tunderstand and really recurrent
lipoedema is one of those thingsthe majority of the people that
I treat.
They don't get it back on alarge scale, but if there are
little pockets of lipoedema thatare left behind, I've seen
those grow and make little newlipoedema fat pads.
(05:00):
More commonly, what I see is ifwe treat someone's legs, if
they have lipoedema in theirarms, that may actually start to
grow at an accelerated ratewhen we've removed some of the
lipoedema somewhere else.
So once we start the process,we want to have a plan to see it
through.
Otherwise we can end upworsening other areas?
Dr. Weiner (05:18):
How much fat can you remove in one setting?
You know what are some of therisks of the liposuction.
What are the limitations?
I'm assuming you can't suck outall the fat right?
Dr. Larson (05:30):
That's a fantastic question and I think it's really
variable.
A few years ago I had anopportunity to write the United
States Standard of Care onlipidema with a number of other
experts in the field and thoseof us who do the surgery all
agreed that the nationalstandard, which is about don't
remove more than five liters,falls short of treating the
lipidema patients Because thereis so much tissue that needs to
(05:53):
be removed and because afteryou've operated once it creates
sort of a scar tissue within thetissue, it makes future
operations harder.
The idea is try and treat tocompletion of whatever areas
you're treating at that time.
For people with advanced stagethree lipedema, we might remove
eight 10 liters at a time.
It really depends on how thingsare looking operatively.
(06:15):
Am I getting a lot of bloodback or is it all lipedema?
How healthy is the patient?
How bad is their disease?
How many operations do we haveplanned to treat it?
All that sort of goes into theequation of how much can we
safely remove for eachindividual person.
Dr. Weiner (06:32):
What do you think causes it?
What's the cause of lipoedema?
Dr. Larson (06:35):
You know, we really don't know, since it only
happens in women.
It could be that it's somethingto do with estrogen, because it
is something that is triggeredat these hormonal milestones
frequently.
That could be the case.
One of my own personalobservations is that lipidema
fat is much paler than normalfat.
(06:58):
Normal fat's yellow Lipidema isalmost a white gray color,
which indicates maybe somethingto do with vitamin A storage and
metabolism.
But I mean, there's muchsmarter people than me who are
working on this, you know, as acareer, and we still don't
really know.
Dr. Weiner (07:14):
What's the Lipoedema Foundation?
I see a lot of this.
It seems to me like there'sthis kind of really active group
of people out there trying toaddress this problem.
Do you participate with them?
Dr. Larson (07:28):
Well, not directly.
It's more of an activism fornot only getting the word out
what is this disease?
Because a lot of people don'tknow.
Dr. Weiner (07:37):
Yeah, it's's about five years.
Everybody's been talking aboutit for five years.
I never learned about this inmed school I didn't either.
Dr. Larson (07:44):
I was a lady named karen herbst, who is one of the
pioneers of this, came um andmet with me when I was at the
university and she was at thesame time, and said have you
heard of this?
And I was like, well, I, I cananswer test questions about it,
but I don't know much about it.
And she explained it to me andintroduced me to some people who
are already treating it andsort of got me interested in it.
(08:04):
But you're right, it'ssomething that most of us don't
know much about, most physiciansdon't know a lot about, and so
Lipidema Foundation is workingto spread awareness.
Because there are no ICD-10codes, which are the diagnostic
codes that provide for insurancecoverage that specifically
cover the disease.
There's no CPT codes, which arethe codes that doctors use to
(08:28):
submit for reimbursement frominsurance, that really
adequately cover the magnitudeof work that's involved in
treating this disease.
So until those pieces are inplace, it gets very hard for
these patients, who haveunquestionably a medical
diagnosis, to get appropriatecare and insurance reimbursement
for that care.
Zoe (08:48):
Do you foresee that being something that get those codes
being added soon, now that itdoes seem so widely spread and
more talked about?
Dr. Larson (08:58):
Ideally, yes.
My understanding of the waythat these codes are adopted is
sort of a nebulous and very slowmoving process.
And so getting ICD-10 codescreated I think that's on the
horizon in the next few years.
But then getting CPT codes,which are how the doctors get
(09:21):
reimbursed, and getting themmodulated to where there's real
interest in physicians taking onthese challenges, I think
that's going to be a biggerissue, because my understanding
is the pie is only so big.
So if we're going to be carvingout a little bit more for one
thing, then someone else isgoing to be getting a smaller
piece, and so there's politicsinvolved.
(09:42):
Stay tuned.
Dr. Weiner (09:44):
Is there any insurance coverage for this?
Dr. Larson (09:46):
There is sporadically insurance coverage.
It can be very much an uphillbattle.
The patients have to reallysort of advocate for themselves.
Usually you need to have a fullfunctional capacity examination
by an independent person done.
It'll take lots and lots ofappeals and even with an
authorization there's a chanceon the back end that it gets
(10:07):
denied and the patient getsstuck with a bill.
So it's sort of fraught in aperilous process at the moment
because there's just noguarantees and there's a lot of
liability for the patient there.
Dr. Weiner (10:18):
How much does it cost?
Like how much is it you havesignificant lipidemia.
Let's look at the average.
How much would it cost to get?
Dr. Larson (10:27):
treated.
So I think the patient cost isdepending on how involved their
disease is and how many hoursit's going to take in the
operating room, how many hoursafter the fact it's going to
take to get them fully recovered.
It's somewhere between $12,000and $16,000 per procedure.
That's all in with anesthesia,operating room, garments,
(10:48):
post-operative care.
In my practice other physicianscharge varying amounts.
There's varying specialtiesthat are involved in this.
I've seen dermatologists doingthis.
I've seen obstetrics and gynecinvolved in this.
I've seen dermatologists doingthis.
I've seen obstetrics andgynecologists doing this.
I've seen internal medicinedoctors doing this and then a
few of us board-certifiedplastic surgeons also.
Dr. Weiner (11:07):
It seems like your first surgery is your best bet.
We see that a lot with surgery.
I remember when I did mypediatric surgery rotation.
We're talking about a certaincondition and the I remember my
attending surgeon said there'sonly one surgeon in the world
(11:29):
who can do this surgery rightand it's the first surgeon
wisdom yeah, and and I thinkthat you know, is there
something to that with lipidemaas well?
Dr. Larson (11:41):
I think unquestionably, when you're
treating an area of the tissuethat has not been operated on
before, you have a much greaterlikelihood of success.
After any sort of aggressivedebulking procedure which is
really what a lot of lipidemarequires almost a honeycomb of
fat form or sort of honeycomb offibrous tissue forms around the
(12:02):
fat, sort of imprisoning thosefat lobules, and it can be very,
very hard to free those and itbecomes even harder to get a
nice, confluent and smoothresult.
So revision surgeries arealways more challenging.
But frequently in lipedema wedo end up needing to remove some
skin.
So the sequence is usuallydebulk the area, give the skin
(12:25):
time to retract.
If we get satisfactoryretraction we're done.
If not, we might need to dosomething like a thigh lift or
an arm lift, very similar towhat we have to do for people
that have significant weightloss.
Zoe (12:37):
Speaking of skin removal or thigh lifts, arm lifts, those
sorts of things.
Talk to us a little bit aboutyour experience and your
practice, what you're seeingwith patients who have lost a
significant amount of weightMaybe they come to you from our
practice or another bariatricsurgeon and what are some of the
common procedures that you'redoing for the skin removal and
(12:57):
what are some of the commonprocedures that you're doing for
the skin removal.
Dr. Larson (12:59):
I think you know skin removal procedures after
weight loss are incrediblybespoke.
They're really tailored to thepatient, their priorities and
how much resources, time theyhave to spend on healing from
these things.
Frequently in men it's going tobe their overlapping paniculus
(13:21):
or the hanging skin that cansometimes cause hygiene issues
will be the priority and thenwe'll address that.
Doing circumferential liftingis possible.
We get rid of the stomach andthen if there's sagging of the
buttocks redundant tissue therethat's frequently done in a unit
redundant tissue there that'sfrequently done in a unit Then
(13:44):
we can do arms or legs at a necksurgery and then the opposite
limb at another surgery.
Some people will combine it all.
I think safely combining all theprocedures probably requires
more of an operative team,because the time on the table
really becomes an issue and Idon't love to go over five, six
hours at a given operationbecause complications start to
go up.
So, by the same token, whenpeople have had weight loss
(14:06):
they're usually in a catabolicstate where they're used to
breaking down tissue and that'snot super conducive to wound
healing, which requires ananabolic or building up tissue.
And so the more stress you puton that system by doing a bunch
of procedures at once that cancause some significant wound
healing issues.
So I like to break it up intomanageable bits that are easier
(14:27):
to take care of, easier to healfrom, and just sort of come up
with a plan for each personbased on their goals.
In women, breasts are frequentlypart of what loses mass, and so
we have to come up with a planto either lift and augment the
breasts or just lift the breasts, depending on what their volume
goals are.
And then the face is a big partof it.
(14:48):
You know weight loss can agethe face, it can age the breasts
, it can age the buttocks.
And so finding ways to meetpatients', goals with either
restoring volume with fillers wehave a structural biostimulator
, something like Sculptra, whichcan cause your own body to
simulate or synthesize some moretissue to add fullness to your
face.
(15:08):
I can transfer any remainingfat to the face or sometimes we
just need to do a facelift orconsider some implants in order
to get the volume back thatwe've lost.
Dr. Weiner (15:17):
So if someone has lost a lot of weight after
weight loss surgery, what's theright time?
When should they have thesurgery done?
You know, right after theyreached their lowest weight?
Is there a certain amount oftime?
You want to wait?
What if they're about to startGLP-1s and might lose another 20
or 30 pounds?
Should they have the surgerybefore they lose the weight or
(15:38):
after?
Like, how do you work out thetiming of these surgeries?
Dr. Larson (15:49):
Sure, great question .
So for surgery, we like to seethe patient has reached their
nadir or their low weight andthey've maintained it for at
least three months before wetalk about doing the first
surgery.
And I think of it almost likelanding a plane.
You know, we're breaking downtissue, we're breaking down
tissue and then we want to geton the runway, let the body
reset, because we're going tohave to take off again and we're
going to have to build tissueto get you to heal, and so we
don't want that to be jagged, wewant it to be a nice gentle
(16:12):
sleep.
So at least three months morewould probably be better, just
for the patient to be reassuredthat there's not going to be any
weight gain which can alsocompromise the results in the
end.
As far as the GLP-1 medications,that's a little bit trickier,
because we have to decide as ateam what the patient wants to
(16:34):
do in the long term, because weknow that when patients come off
these medications there can besome weight gain.
So the idea would be to decideeither to stay on them for
potentially in perpetuity, andat that point, okay, then this
is going to be your new weight.
Let's do surgery after, again,about a three-month wait period.
If the patient's going to usethem as a stepping stone and
(16:57):
then try and get off and thenmaintain through some other
means, my recommendation is seewhere that takes you Because you
know frequently we're going tosee weight gain and gaining
weight against the scars of thebody contouring procedure can be
painful and you know I've seenliterature reports where there's
actually wounds opening upbecause people gain enough
weight that it strains their oldscars to the breaking point.
(17:19):
So these are areas that we'rereally just sort of feeling our
way through, because it's anewer branch of weight, the way
people lose weight, and peoplefrom all walks of life are
losing significant weight likethis.
So stay tuned.
I haven't really seen any realhard and fast recommendations
from the societies on this yet.
Dr. Weiner (17:39):
I've seen some people are just so happy
Post-plastic surgery, weightbody contouring, the post-weight
loss surgery, body contouringand really thrilled.
I think the majority of peopleare.
But sometimes I see people whoare not happy.
I certainly see people you knowwho maybe go overseas or kind
(17:59):
of seek out some less expensiveoptions.
I think what you know, whatmakes someone most likely to be
happy and satisfied after theirsurgery?
Because I think everybody'salmost everybody who sees you is
going to have a limited budget,right.
My guess is people come in andthey want everything done and
you're like, well, that's a lotof money.
(18:20):
And they're like, well, okay, Igot to spend a little less.
So how do you decide where youshould be spending your money?
How do you get your money'sworth out of plastic surgery?
Dr. Larson (18:30):
Well, I think it's going to be expectations versus
reality, which is something thatI spend a lot of time with
people on.
When you've had significantweight loss, the quality of the
skin that's going to be leftbehind from any operation is
likely going to be compromised.
What I'm seeing reports of nowis that people that have been on
the GLP-1s for weight losstheir skin, the actual thickness
(18:54):
of the skin, is diminished fromwhat we would expect to see in
patients of sort of an age-matchgroup.
So what we're working againstis a lower quality skin that's
going to be left behind.
We really can't unspill themilk on some of these things,
and so understanding that thereare limitations and that the
surgery has certain goals, butthat we can't just turn back the
(19:15):
clock and make you thin and 21again is a great place to start.
I think looking at before andafters on the internet is
another great way to sort of getan image in your head of what's
possible.
Talk to a plastic surgeon, talkto more than one plastic surgeon
, and get their realisticevaluation of expectations so
that you can get a number ofopinions on what can be done.
(19:39):
As far as going overseas, youknow there's great surgeons all
over the world, but there's alsoterrible ones, and I feel like
in the United States we do apretty good job at weeding out
the terrible ones and othercountries not so much.
The other thing that I see isthat when people go overseas for
their operation, the post-opcare is pretty hit or miss.
(20:01):
I've seen patients getabandoned afterwards, sort of
desperately trying to findsomeone else to take care of
them and that's hard to do whenyou've had surgery somewhere
else and then coming back to theUS and expect a US surgeon to
assume your care when theyweren't part of the original
operation.
So those are some of thechallenges I see and those are
the risks that people take onwhen they go outside the country
(20:22):
.
I mean, there's certainly risksin the USA as well, but I feel
like it may be a little easierto vet people that have a bunch
of you know Google reviews fromyou know other people that
they've treated versus you knowmaybe less transparent things.
Dr. Weiner (20:37):
Yeah, I think, if you, you know, and we do see
this we're in Tucson, soobviously we're not far from the
, from Mexico, and uh, we doquite frequently see people come
from Mexico who've had plasticsurgery down there and now have
a wound complication and youknow, sometimes they'll go to
the emergency room thinking,well, I'll just have you know,
(20:57):
whatever plastic surgeons oncall will take that.
And what I think most peoplewill find is that in most
hospitals there really isn't aplastic surgeon on call and so
you end up getting a generalsurgeon which is kind of, you
know, gallbladder hernia typesurgeon, which again, that's
what I am.
So I certainly have nothingagainst that group of people,
(21:18):
but we're not plastic surgeonswhen it comes to wound care and
comes to cosmetic results andoptimizing it, and you may end
up having, you know, a secondsurgery by a general surgeon,
just kind of the breeding tissue, and it's very likely that
you're not going to get the sameresult that you would get if
you had it done by someone.
Dr. Larson (21:38):
You know Very, very similar.
The first surgeon has the bestshot.
You probably see somethingsimilar.
I know people do medicaltourism for weight loss surgery
as well.
Oh yeah.
Dr. Weiner (21:51):
I don't know for sure.
We see it Like you said.
There's some good surgeons outthere and there's some people
who have some good results andwe certainly have talked to them
and met them.
And then there's also I've seensome kind of crazy stuff,
absolutely, and I just I did anendoscopy last week on a patient
who went to Mexico for hersleeve and I finished the
endoscopy and I was like, didthey actually do a sleeve?
(22:12):
It didn't look like they reallyhad done much of much surgery
at all.
I mean I could they didsomething, but they, yeah, they
didn't take out very muchstomach.
It looked to me like she stillhad about where we normally take
out two thirds of the stomach.
It looked to me like maybe theytook where we normally take out
two-thirds of the stomach.
It looked to me like maybe theytook, maybe they took out a
third of the stomach.
Dr. Larson (22:32):
So and with the sleeve it's really you got to
get the whole thing it'sdefinitely by or be where I you
know I've taken breast implantsout of people's bottoms, that
they've got put in unbeknownstto them.
So there's there's strangethings that can happen when
there's not as much oversight aswe have in the US.
Dr. Weiner (22:52):
They use a breast implant instead of a.
Dr. Larson (22:56):
Breast implants are a lot softer than the buttock
implants are, so they're easierto potentially rupture and cause
problems.
Dr. Weiner (23:04):
Reminds me of the show Botch when you sit on them.
Yeah, they have a bariatricBotch now.
Oh, do they?
I haven't seen it yet.
I got to check it out.
So if you're out there andyou're looking for plastic
surgery in Tucson, looking forlipoedema care, we strongly
recommend Ethan Larson.
We send all of our patientsover Ethan.
(23:26):
If someone out there isthinking about plastic surgery
or care of their lipoedema, youknow what advice can you give
them.
You know I'm just gettingstarted.
I'm thinking like maybe Ishould have the skin contouring
surgery, maybe I'm looking atsome liposuction for my
lipoedema.
What should they be thinking?
What research should they bedoing?
Where should they be looking?
(23:47):
What should they be learningabout?
Dr. Larson (23:49):
So for Lipoedema there's a number of websites.
You can always text my officeand I can give you those, but
Lipoedemaorg is a great place tostart looking into it.
If you haven't received adiagnosis yet, there is a lady
in town.
Her name is Karen Herbst.
She works at the RoxburyInstitute.
She's here in town.
Her name is Karen Herbst.
She works at the RoxburyInstitute.
She's here in Tucson.
She's wonderful.
(24:10):
She can diagnose you Frequentlymore and more.
Family doctors can make thediagnosis, vascular surgeons can
make the diagnosis, bariatricsurgeons can make the diagnosis.
But you'll want to get adiagnosis of lipedema, and if
you are sure that you've got it,then give me a call and we can
talk about what your treatmentoptions are.
One of the things that I seefrequently is that when people
(24:32):
get the diagnosis of lipedema,they get sort of a sense of
hopelessness about their weightoverall, and one thing that I
think is important for everyoneto understand is that there's
lipedema fat which you can'tlose through diet and exercise,
but that's frequently in thesame patient that has maybe
obesity or is significantlyoverweight, and that can be
(24:55):
treated, and so we want to treatthe obesity and the lipidema to
get the patient back to anoptimized lifestyle state,
expand their joy span,potentially extend their
lifespan, and so having ateamwork like ours is going to
be very essential to gettingpeople optimized that have both
(25:18):
of those diseases.
If people are post-weight lossand they're looking for body
contouring surgery, then youwant to be stabilized on your
weight and you'll want to have along-term plan for how you're
going to maintain that weight inplace that is realistic for you
, something that you can reallymaintain in perpetuity.
(25:40):
And once that's all in place,come see me and we can talk
about what your various optionsare.
I would come with a prioritylist.
Most important thing to me isgetting this hanging skin off my
stomach or having my breastsfixed or making my face look
less gaunt, and then we canreally focus on that, because a
lot of times people come in andsay fix everything and we've got
(26:01):
an hour to talk about it.
Well, that's not enough to talkabout everything, so we're
going to have to break it upinto bite-sized pieces and
really get into each individualpart.
So come with a priority list,have a long-term plan to
maintain your weight loss andthen be healthy.
You know surgery takes a lotout of people, so we want to
make sure that your health istotally optimized.
So being physically active andhaving a primary doctor you know
(26:25):
getting regular checkups isgoing to be important also and
having a primary doctor.
Dr. Weiner (26:28):
you know getting regular checkups is going to be
important also.
Love it All right.
A lot of great, a lot of greatwisdom there, ethan.
Thank you so much.
What's your website, ethan?
Or your Instagram?
Dr. Larson (26:37):
It's wwwlarsenplasticsurgerycom is
the website and the Instagram.
There's two.
I have Ethan Larson PlasticSurgeon and L and Larson plastic
surgery, az, but if anyonewants, they can just text my
office and we can send them moreinformation on his stuff.
It's 520-771-0177.
Zoe (26:57):
Thanks so much for joining us.
Dr. Weiner (26:59):
Great Thanks, ethan, good to see you.
My pleasure.
Good to see you guys, thank you.
Dr. Larson (27:03):
Absolutely.
Dr. Weiner (27:03):
Take care.
When people get the diagnosis of lipoedema, they get
sort of a sense of hopelessnessabout their weight overall, and
one thing that I think isimportant for everyone to
understand is that there'slipoedema fat which you can't
lose through diet and exercisebut that's frequently in the
same patient that has maybeobesity and that can be treated.
And so we want to treat theobesity and the lipoedema to get
(00:22):
the patient back to anoptimized lifestyle state.
Obesity and the lipoedema toget the patient back to an
optimized lifestyle state.
Dr. Weiner (00:28):
Welcome to the Pound to Cure Weight Loss podcast.
I want to introduce EthanLarson, a plastic surgeon and a
friend of mine, really highlyskilled.
We're going to talk today aboutlipoedema and body contouring
surgery and Ethan has been onour nutrition program and so, um
, as part of our nutritionprogram, if you sign up, you can
(00:49):
meet with him and talk about,you know, questions you have
about either uh, treating lifeedema or the first steps in body
contouring surgery, and sothat's available on our website
at poundacureweightlosscom.
Slash nutrition, um and uh.
Once you sign up, you'll beable to see the schedule, and it
should be.
She should be scheduled shortlyafter the release of the
(01:10):
podcast.
So welcome, ethan, good to haveyou.
Dr. Larson (01:13):
Thank you very much for having me on.
I appreciate it.
Dr. Weiner (01:16):
So I think the first question that we need to answer
is what is lipoedema.
Dr. Larson (01:22):
So lipoedema is a disease that affects primarily
women and what it represents isfatty tissue that usually starts
in the legs and usually beginsat a period of hormonal shift
whether that be puberty,childbirth, menopause and that
fatty tissue starts to grow.
Unfortunately, it seems to nothave the receptors that normal
(01:46):
fat cells have.
So when it comes time to tryand break that tissue down to
turn it back into energy, thebody can't do it.
The body recognizes thatthere's something wrong with the
cells at that point and alow-grade inflammation starts
and the abnormal fatty tissue,combined with the low-grade
inflammation, over time candevelop fibrosis.
(02:08):
It can develop pain and we seejust generalized swelling of the
legs, not from fluid but froman accumulation of fat that's
very hard to lose.
It can also affect the abdomenand the arms.
Zoe (02:20):
So what do people do to like?
What is it to help that?
Dr. Larson (02:24):
Well there's.
There's not a whole lot ofoptions to help it at this point
.
Diet and exercise can sometimesaffect normal fat.
The weight loss interventionsthat we have now, the new
medications, weight loss surgerythat affects normal fat but it
doesn't really seem to have aprofound effect on lipidema fat.
So even after thoseinterventions that fat is still
(02:47):
there, it's still stuck in thelegs, and so the only way to
really affect it is to remove itsurgically, and we do that with
a special type of liposuctioncalled lymphatic sparing
liposuction, and it's really adebulking procedure.
Zoe (03:03):
I was going to think of it as something like liposuction,
yeah, so what's different Likewhat do you do?
Dr. Weiner (03:08):
different Like, first of all, how's liposuction
work traditionally and what'sdifferent about the liposuction
you do for lipodema.
Dr. Larson (03:16):
Sure.
So traditional liposuction isbasically a hollow rod that's
connected to suction and itrelatively easily removes fat
cells while preserving the bloodsupply, the nerves, the stuff
that keeps the overlying skinalive.
When we do lipedema, that fatis different from normal fat.
Normal fat has more of abuttery consistency.
(03:37):
I say lipedema is more likelike cheese it's.
You have to sort of burrowthrough it.
It needs to be separated.
A lot of times the lipoedemanodules are larger than the
holes in the cannula.
So I have to do a lot of manualbreaking up of the tissue to
make the nuggets of lipoedemasmall enough to remove.
And then I'll also use my handsto actually remove it by
(04:00):
milking the large nuggets out ofthe holes.
And then part of this is wewant people to get a really
satisfying cosmetic result, andthat's challenging when we're
dealing with irregular largelumps of lipidematous tissue.
So a big part of my procedureis smoothing things out at the
end so people get the optimalcosmetic result.
(04:21):
And remember, it's not acosmetic surgery, it's a
functional surgery.
But we want people to look goodwhen we're done.
Zoe (04:27):
Also, so then with lipedema , does it come back after a
certain period of time if theygain weight back, or is it more
so just gone because those fatcells are now removed?
Dr. Larson (04:39):
That's a fantastic question and there's a lot about
lipedema that we don'tunderstand and really recurrent
lipoedema is one of those thingsthe majority of the people that
I treat.
They don't get it back on alarge scale, but if there are
little pockets of lipoedema thatare left behind, I've seen
those grow and make little newlipoedema fat pads.
(05:00):
More commonly, what I see is ifwe treat someone's legs, if
they have lipoedema in theirarms, that may actually start to
grow at an accelerated ratewhen we've removed some of the
lipoedema somewhere else.
So once we start the process,we want to have a plan to see it
through.
Otherwise we can end upworsening other areas?
Dr. Weiner (05:18):
How much fat can you remove in one setting?
You know what are some of therisks of the liposuction.
What are the limitations?
I'm assuming you can't suck outall the fat right?
Dr. Larson (05:30):
That's a fantastic question and I think it's really
variable.
A few years ago I had anopportunity to write the United
States Standard of Care onlipidema with a number of other
experts in the field and thoseof us who do the surgery all
agreed that the nationalstandard, which is about don't
remove more than five liters,falls short of treating the
lipidema patients Because thereis so much tissue that needs to
(05:53):
be removed and because afteryou've operated once it creates
sort of a scar tissue within thetissue, it makes future
operations harder.
The idea is try and treat tocompletion of whatever areas
you're treating at that time.
For people with advanced stagethree lipedema, we might remove
eight 10 liters at a time.
It really depends on how thingsare looking operatively.
(06:15):
Am I getting a lot of bloodback or is it all lipedema?
How healthy is the patient?
How bad is their disease?
How many operations do we haveplanned to treat it?
All that sort of goes into theequation of how much can we
safely remove for eachindividual person.
Dr. Weiner (06:32):
What do you think causes it?
What's the cause of lipoedema?
Dr. Larson (06:35):
You know, we really don't know, since it only
happens in women.
It could be that it's somethingto do with estrogen, because it
is something that is triggeredat these hormonal milestones
frequently.
That could be the case.
One of my own personalobservations is that lipidema
fat is much paler than normalfat.
(06:58):
Normal fat's yellow Lipidema isalmost a white gray color,
which indicates maybe somethingto do with vitamin A storage and
metabolism.
But I mean, there's muchsmarter people than me who are
working on this, you know, as acareer, and we still don't
really know.
Dr. Weiner (07:14):
What's the Lipoedema Foundation?
I see a lot of this.
It seems to me like there'sthis kind of really active group
of people out there trying toaddress this problem.
Do you participate with them?
Dr. Larson (07:28):
Well, not directly.
It's more of an activism fornot only getting the word out
what is this disease?
Because a lot of people don'tknow.
Dr. Weiner (07:37):
Yeah, it's's about five years.
Everybody's been talking aboutit for five years.
I never learned about this inmed school I didn't either.
Dr. Larson (07:44):
I was a lady named karen herbst, who is one of the
pioneers of this, came um andmet with me when I was at the
university and she was at thesame time, and said have you
heard of this?
And I was like, well, I, I cananswer test questions about it,
but I don't know much about it.
And she explained it to me andintroduced me to some people who
are already treating it andsort of got me interested in it.
(08:04):
But you're right, it'ssomething that most of us don't
know much about, most physiciansdon't know a lot about, and so
Lipidema Foundation is workingto spread awareness.
Because there are no ICD-10codes, which are the diagnostic
codes that provide for insurancecoverage that specifically
cover the disease.
There's no CPT codes, which arethe codes that doctors use to
(08:28):
submit for reimbursement frominsurance, that really
adequately cover the magnitudeof work that's involved in
treating this disease.
So until those pieces are inplace, it gets very hard for
these patients, who haveunquestionably a medical
diagnosis, to get appropriatecare and insurance reimbursement
for that care.
Zoe (08:48):
Do you foresee that being something that get those codes
being added soon, now that itdoes seem so widely spread and
more talked about?
Dr. Larson (08:58):
Ideally, yes.
My understanding of the waythat these codes are adopted is
sort of a nebulous and very slowmoving process.
And so getting ICD-10 codescreated I think that's on the
horizon in the next few years.
But then getting CPT codes,which are how the doctors get
(09:21):
reimbursed, and getting themmodulated to where there's real
interest in physicians taking onthese challenges, I think
that's going to be a biggerissue, because my understanding
is the pie is only so big.
So if we're going to be carvingout a little bit more for one
thing, then someone else isgoing to be getting a smaller
piece, and so there's politicsinvolved.
(09:42):
Stay tuned.
Dr. Weiner (09:44):
Is there any insurance coverage for this?
Dr. Larson (09:46):
There is sporadically insurance coverage.
It can be very much an uphillbattle.
The patients have to reallysort of advocate for themselves.
Usually you need to have a fullfunctional capacity examination
by an independent person done.
It'll take lots and lots ofappeals and even with an
authorization there's a chanceon the back end that it gets
(10:07):
denied and the patient getsstuck with a bill.
So it's sort of fraught in aperilous process at the moment
because there's just noguarantees and there's a lot of
liability for the patient there.
Dr. Weiner (10:18):
How much does it cost?
Like how much is it you havesignificant lipidemia.
Let's look at the average.
How much would it cost to get?
Dr. Larson (10:27):
treated.
So I think the patient cost isdepending on how involved their
disease is and how many hoursit's going to take in the
operating room, how many hoursafter the fact it's going to
take to get them fully recovered.
It's somewhere between $12,000and $16,000 per procedure.
That's all in with anesthesia,operating room, garments,
(10:48):
post-operative care.
In my practice other physicianscharge varying amounts.
There's varying specialtiesthat are involved in this.
I've seen dermatologists doingthis.
I've seen obstetrics and gynecinvolved in this.
I've seen dermatologists doingthis.
I've seen obstetrics andgynecologists doing this.
I've seen internal medicinedoctors doing this and then a
few of us board-certifiedplastic surgeons also.
Dr. Weiner (11:07):
It seems like your first surgery is your best bet.
We see that a lot with surgery.
I remember when I did mypediatric surgery rotation.
We're talking about a certaincondition and the I remember my
attending surgeon said there'sonly one surgeon in the world
(11:29):
who can do this surgery rightand it's the first surgeon
wisdom yeah, and and I thinkthat you know, is there
something to that with lipidemaas well?
Dr. Larson (11:41):
I think unquestionably, when you're
treating an area of the tissuethat has not been operated on
before, you have a much greaterlikelihood of success.
After any sort of aggressivedebulking procedure which is
really what a lot of lipidemarequires almost a honeycomb of
fat form or sort of honeycomb offibrous tissue forms around the
(12:02):
fat, sort of imprisoning thosefat lobules, and it can be very,
very hard to free those and itbecomes even harder to get a
nice, confluent and smoothresult.
So revision surgeries arealways more challenging.
But frequently in lipedema wedo end up needing to remove some
skin.
So the sequence is usuallydebulk the area, give the skin
(12:25):
time to retract.
If we get satisfactoryretraction we're done.
If not, we might need to dosomething like a thigh lift or
an arm lift, very similar towhat we have to do for people
that have significant weightloss.
Zoe (12:37):
Speaking of skin removal or thigh lifts, arm lifts, those
sorts of things.
Talk to us a little bit aboutyour experience and your
practice, what you're seeingwith patients who have lost a
significant amount of weightMaybe they come to you from our
practice or another bariatricsurgeon and what are some of the
common procedures that you'redoing for the skin removal and
(12:57):
what are some of the commonprocedures that you're doing for
the skin removal.
Dr. Larson (12:59):
I think you know skin removal procedures after
weight loss are incrediblybespoke.
They're really tailored to thepatient, their priorities and
how much resources, time theyhave to spend on healing from
these things.
Frequently in men it's going tobe their overlapping paniculus
(13:21):
or the hanging skin that cansometimes cause hygiene issues
will be the priority and thenwe'll address that.
Doing circumferential liftingis possible.
We get rid of the stomach andthen if there's sagging of the
buttocks redundant tissue therethat's frequently done in a unit
redundant tissue there that'sfrequently done in a unit Then
(13:44):
we can do arms or legs at a necksurgery and then the opposite
limb at another surgery.
Some people will combine it all.
I think safely combining all theprocedures probably requires
more of an operative team,because the time on the table
really becomes an issue and Idon't love to go over five, six
hours at a given operationbecause complications start to
go up.
So, by the same token, whenpeople have had weight loss
(14:06):
they're usually in a catabolicstate where they're used to
breaking down tissue and that'snot super conducive to wound
healing, which requires ananabolic or building up tissue.
And so the more stress you puton that system by doing a bunch
of procedures at once that cancause some significant wound
healing issues.
So I like to break it up intomanageable bits that are easier
(14:27):
to take care of, easier to healfrom, and just sort of come up
with a plan for each personbased on their goals.
In women, breasts are frequentlypart of what loses mass, and so
we have to come up with a planto either lift and augment the
breasts or just lift the breasts, depending on what their volume
goals are.
And then the face is a big partof it.
(14:48):
You know weight loss can agethe face, it can age the breasts
, it can age the buttocks.
And so finding ways to meetpatients', goals with either
restoring volume with fillers wehave a structural biostimulator
, something like Sculptra, whichcan cause your own body to
simulate or synthesize some moretissue to add fullness to your
face.
(15:08):
I can transfer any remainingfat to the face or sometimes we
just need to do a facelift orconsider some implants in order
to get the volume back thatwe've lost.
Dr. Weiner (15:17):
So if someone has lost a lot of weight after
weight loss surgery, what's theright time?
When should they have thesurgery done?
You know, right after theyreached their lowest weight?
Is there a certain amount oftime?
You want to wait?
What if they're about to startGLP-1s and might lose another 20
or 30 pounds?
Should they have the surgerybefore they lose the weight or
(15:38):
after?
Like, how do you work out thetiming of these surgeries?
Dr. Larson (15:49):
Sure, great question .
So for surgery, we like to seethe patient has reached their
nadir or their low weight andthey've maintained it for at
least three months before wetalk about doing the first
surgery.
And I think of it almost likelanding a plane.
You know, we're breaking downtissue, we're breaking down
tissue and then we want to geton the runway, let the body
reset, because we're going tohave to take off again and we're
going to have to build tissueto get you to heal, and so we
don't want that to be jagged, wewant it to be a nice gentle
(16:12):
sleep.
So at least three months morewould probably be better, just
for the patient to be reassuredthat there's not going to be any
weight gain which can alsocompromise the results in the
end.
As far as the GLP-1 medications,that's a little bit trickier,
because we have to decide as ateam what the patient wants to
(16:34):
do in the long term, because weknow that when patients come off
these medications there can besome weight gain.
So the idea would be to decideeither to stay on them for
potentially in perpetuity, andat that point, okay, then this
is going to be your new weight.
Let's do surgery after, again,about a three-month wait period.
If the patient's going to usethem as a stepping stone and
(16:57):
then try and get off and thenmaintain through some other
means, my recommendation is seewhere that takes you Because you
know frequently we're going tosee weight gain and gaining
weight against the scars of thebody contouring procedure can be
painful and you know I've seenliterature reports where there's
actually wounds opening upbecause people gain enough
weight that it strains their oldscars to the breaking point.
(17:19):
So these are areas that we'rereally just sort of feeling our
way through, because it's anewer branch of weight, the way
people lose weight, and peoplefrom all walks of life are
losing significant weight likethis.
So stay tuned.
I haven't really seen any realhard and fast recommendations
from the societies on this yet.
Dr. Weiner (17:39):
I've seen some people are just so happy
Post-plastic surgery, weightbody contouring, the post-weight
loss surgery, body contouringand really thrilled.
I think the majority of peopleare.
But sometimes I see people whoare not happy.
I certainly see people you knowwho maybe go overseas or kind
(17:59):
of seek out some less expensiveoptions.
I think what you know, whatmakes someone most likely to be
happy and satisfied after theirsurgery?
Because I think everybody'salmost everybody who sees you is
going to have a limited budget,right.
My guess is people come in andthey want everything done and
you're like, well, that's a lotof money.
(18:20):
And they're like, well, okay, Igot to spend a little less.
So how do you decide where youshould be spending your money?
How do you get your money'sworth out of plastic surgery?
Dr. Larson (18:30):
Well, I think it's going to be expectations versus
reality, which is something thatI spend a lot of time with
people on.
When you've had significantweight loss, the quality of the
skin that's going to be leftbehind from any operation is
likely going to be compromised.
What I'm seeing reports of nowis that people that have been on
the GLP-1s for weight losstheir skin, the actual thickness
(18:54):
of the skin, is diminished fromwhat we would expect to see in
patients of sort of an age-matchgroup.
So what we're working againstis a lower quality skin that's
going to be left behind.
We really can't unspill themilk on some of these things,
and so understanding that thereare limitations and that the
surgery has certain goals, butthat we can't just turn back the
(19:15):
clock and make you thin and 21again is a great place to start.
I think looking at before andafters on the internet is
another great way to sort of getan image in your head of what's
possible.
Talk to a plastic surgeon, talkto more than one plastic surgeon
, and get their realisticevaluation of expectations so
that you can get a number ofopinions on what can be done.
(19:39):
As far as going overseas, youknow there's great surgeons all
over the world, but there's alsoterrible ones, and I feel like
in the United States we do apretty good job at weeding out
the terrible ones and othercountries not so much.
The other thing that I see isthat when people go overseas for
their operation, the post-opcare is pretty hit or miss.
(20:01):
I've seen patients getabandoned afterwards, sort of
desperately trying to findsomeone else to take care of
them and that's hard to do whenyou've had surgery somewhere
else and then coming back to theUS and expect a US surgeon to
assume your care when theyweren't part of the original
operation.
So those are some of thechallenges I see and those are
the risks that people take onwhen they go outside the country
(20:22):
.
I mean, there's certainly risksin the USA as well, but I feel
like it may be a little easierto vet people that have a bunch
of you know Google reviews fromyou know other people that
they've treated versus you knowmaybe less transparent things.
Dr. Weiner (20:37):
Yeah, I think, if you, you know, and we do see
this we're in Tucson, soobviously we're not far from the
, from Mexico, and uh, we doquite frequently see people come
from Mexico who've had plasticsurgery down there and now have
a wound complication and youknow, sometimes they'll go to
the emergency room thinking,well, I'll just have you know,
(20:57):
whatever plastic surgeons oncall will take that.
And what I think most peoplewill find is that in most
hospitals there really isn't aplastic surgeon on call and so
you end up getting a generalsurgeon which is kind of, you
know, gallbladder hernia typesurgeon, which again, that's
what I am.
So I certainly have nothingagainst that group of people,
(21:18):
but we're not plastic surgeonswhen it comes to wound care and
comes to cosmetic results andoptimizing it, and you may end
up having, you know, a secondsurgery by a general surgeon,
just kind of the breeding tissue, and it's very likely that
you're not going to get the sameresult that you would get if
you had it done by someone.
Dr. Larson (21:38):
You know Very, very similar.
The first surgeon has the bestshot.
You probably see somethingsimilar.
I know people do medicaltourism for weight loss surgery
as well.
Oh yeah.
Dr. Weiner (21:51):
I don't know for sure.
We see it Like you said.
There's some good surgeons outthere and there's some people
who have some good results andwe certainly have talked to them
and met them.
And then there's also I've seensome kind of crazy stuff,
absolutely, and I just I did anendoscopy last week on a patient
who went to Mexico for hersleeve and I finished the
endoscopy and I was like, didthey actually do a sleeve?
(22:12):
It didn't look like they reallyhad done much of much surgery
at all.
I mean I could they didsomething, but they, yeah, they
didn't take out very muchstomach.
It looked to me like she stillhad about where we normally take
out two thirds of the stomach.
It looked to me like maybe theytook where we normally take out
two-thirds of the stomach.
It looked to me like maybe theytook, maybe they took out a
third of the stomach.
Dr. Larson (22:32):
So and with the sleeve it's really you got to
get the whole thing it'sdefinitely by or be where I you
know I've taken breast implantsout of people's bottoms, that
they've got put in unbeknownstto them.
So there's there's strangethings that can happen when
there's not as much oversight aswe have in the US.
Dr. Weiner (22:52):
They use a breast implant instead of a.
Dr. Larson (22:56):
Breast implants are a lot softer than the buttock
implants are, so they're easierto potentially rupture and cause
problems.
Dr. Weiner (23:04):
Reminds me of the show Botch when you sit on them.
Yeah, they have a bariatricBotch now.
Oh, do they?
I haven't seen it yet.
I got to check it out.
So if you're out there andyou're looking for plastic
surgery in Tucson, looking forlipoedema care, we strongly
recommend Ethan Larson.
We send all of our patientsover Ethan.
(23:26):
If someone out there isthinking about plastic surgery
or care of their lipoedema, youknow what advice can you give
them.
You know I'm just gettingstarted.
I'm thinking like maybe Ishould have the skin contouring
surgery, maybe I'm looking atsome liposuction for my
lipoedema.
What should they be thinking?
What research should they bedoing?
Where should they be looking?
(23:47):
What should they be learningabout?
Dr. Larson (23:49):
So for Lipoedema there's a number of websites.
You can always text my officeand I can give you those, but
Lipoedemaorg is a great place tostart looking into it.
If you haven't received adiagnosis yet, there is a lady
in town.
Her name is Karen Herbst.
She works at the RoxburyInstitute.
She's here in town.
Her name is Karen Herbst.
She works at the RoxburyInstitute.
She's here in Tucson.
She's wonderful.
(24:10):
She can diagnose you Frequentlymore and more.
Family doctors can make thediagnosis, vascular surgeons can
make the diagnosis, bariatricsurgeons can make the diagnosis.
But you'll want to get adiagnosis of lipedema, and if
you are sure that you've got it,then give me a call and we can
talk about what your treatmentoptions are.
One of the things that I seefrequently is that when people
(24:32):
get the diagnosis of lipedema,they get sort of a sense of
hopelessness about their weightoverall, and one thing that I
think is important for everyoneto understand is that there's
lipedema fat which you can'tlose through diet and exercise,
but that's frequently in thesame patient that has maybe
obesity or is significantlyoverweight, and that can be
(24:55):
treated, and so we want to treatthe obesity and the lipidema to
get the patient back to anoptimized lifestyle state,
expand their joy span,potentially extend their
lifespan, and so having ateamwork like ours is going to
be very essential to gettingpeople optimized that have both
(25:18):
of those diseases.
If people are post-weight lossand they're looking for body
contouring surgery, then youwant to be stabilized on your
weight and you'll want to have along-term plan for how you're
going to maintain that weight inplace that is realistic for you
, something that you can reallymaintain in perpetuity.
(25:40):
And once that's all in place,come see me and we can talk
about what your various optionsare.
I would come with a prioritylist.
Most important thing to me isgetting this hanging skin off my
stomach or having my breastsfixed or making my face look
less gaunt, and then we canreally focus on that, because a
lot of times people come in andsay fix everything and we've got
(26:01):
an hour to talk about it.
Well, that's not enough to talkabout everything, so we're
going to have to break it upinto bite-sized pieces and
really get into each individualpart.
So come with a priority list,have a long-term plan to
maintain your weight loss andthen be healthy.
You know surgery takes a lotout of people, so we want to
make sure that your health istotally optimized.
So being physically active andhaving a primary doctor you know
(26:25):
getting regular checkups isgoing to be important also and
having a primary doctor.
Dr. Weiner (26:28):
you know getting regular checkups is going to be
important also.
Love it All right.
A lot of great, a lot of greatwisdom there, ethan.
Thank you so much.
What's your website, ethan?
Or your Instagram?
Dr. Larson (26:37):
It's wwwlarsenplasticsurgerycom is
the website and the Instagram.
There's two.
I have Ethan Larson PlasticSurgeon and L and Larson plastic
surgery, az, but if anyonewants, they can just text my
office and we can send them moreinformation on his stuff.
It's 520-771-0177.
Zoe (26:57):
Thanks so much for joining us.
Dr. Weiner (26:59):
Great Thanks, ethan, good to see you.
My pleasure.
Good to see you guys, thank you.
Dr. Larson (27:03):
Absolutely.
Dr. Weiner (27:03):
Take care.
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