Take liposuction, instance.

Virtually all plastic surgeons consider tumescent liposuction the “gold standard” for removing unsightly, unwanted pockets of fat from the face, neck and body.

(“Tumescent” actually means “a swelling” but in medicine refers to the medication-containing fluids that are first injected into the treatment area.)

It’s not that plastic and cosmetic surgeons are stuck in the mud or resistant to new ideas – quite the contrary.

Any doctor worth his or her salt is always reading medical journals and engaged in continuing medical education, or just CME.

Physicians say that standard, tumescent liposuction, over many years, has shown:

• A long track record of safety
• Acceptance and excellent toleration by patients
• Good aesthetic results
• Ease of use by surgeons

Of 29 patients at Real.Self.com reporting their satisfaction with tumescent liposuction on various parts of the body, 78 percent said it was worth it.

Not scientific by any means, but that sounds like a happy lot, wouldn’t you say?

One of the new kids on the liposuction block, Zerona, is advertised as a low-level laser which does not break the skin to do its slimming work. Instead, the patient makes six, 40-minute doctor visits over two weeks.

The gismo claims to work by using laser energy to burst fat cells, making them release fat which is then said to be removed via the body’s lymphatic system.

Or does it? Is it possible the released fat coats the insides of the veins? Or affects other organs? And because the actual fat cells are punctured — and not removed — will they repair themselves and later cause the same bulges to show again?

We don’t know the answers to those questions until millions of people have experienced the technique.

Patients at RealSelf.com also say total inches lost are reported by before and after measurements of ten areas, including:

• Knees
• Neck
• Arms

Arnold Oppenheim, M.D., a Virginia Beach Dermatologist, read the technical papers about Zerona and pondered: “Will the success look good in six months after treatment? Fat regenerates. How long do these results last?”

The icing on the cake?

Of 24 patients writing reviews on Zerona, a scant 25 percent said the procedure was worth it.

In addition to standard liposuction machines which remove fat by suction, an array of high-tech machines are put being forth to remove unsightly flab.

Nonetheless, most board-certified plastic surgeons agree that the gold standard in surgical fat removal is still the procedure known as “tumescent liposuction.”

But in case you were wondering, here are a few gizmos competing for your attention and fat removal dollar, including:

• SmartLipo

Also known as SlimLipo, LipoSculpt and Cool Lipo, these lasers melt, and not suck, fat. Some surgeons use suction to remove the fat while others let the body absorb the melted fat.

Plastic surgery is evidence-based medicine and so far, no reliable scientific evidence exists that that laser-assisted liposuction can:

• Tighten skin
• Work better than basic liposuction

Downside: The machines cost upwards of $150,000 and drive up patients’ cost for the procedures. Tumescent liposuction does virtually all of what laser liposuction does, making the extra high cost questionable.

• VASER (Vibration Amplification of Sound Energy at Resonance) liposuction. High energy sound waves emulsify fat which is then removed by suction.

Proponents say VASER spares blood vessels and other tissues, resulting in less swelling and bruising.

But not many plastic surgeons use it. If it’s so good, why do most cosmetic surgeons still use tumescent liposuction?

So what is real and what is just hyper marketing?

Our take: the most important choice you can make is the surgeon, him-or-herself!

Various plastic surgeons achieve all type of wonderful results using many types of surgical tools and equipment. Would you hire a carpenter who used an extra fancy hammer? So put your judgment to work studying surgeons’ results!

That’s why plastic surgery before and after pictures are so important and useful.

Also, check and make sure the plastic surgeon you want to use is board certified. (Learn more about plastic surgery board certification.)

• High blood pressure
• Type II diabetes
• High cholesterol readings
• Heart disease

Conditions that go along with an existing health woe are known to plastic surgeons and other doctors as co-morbidities. The conditions listed above are also known as metabolic syndrome.

But what about performing liposuction on a slightly too-fat tummy to improve overall health?

Doctors are still studying it.

Some overseas researchers have found that having liposuction on a fatty tummy is a good thing and reduces the diseases and undesirable health conditions that go along with obesity.

Other researchers have studied groups of slightly overweight patients who have had liposuction and carefully followed their health. Some are good while some are not.

Now, according to a report on liposuction’s effects in the professional journal, Modern Medicine, R.V. Weber, M.D., an assistant professor of plastic and reconstructive surgery at Albert Einstein College of Medicine, is searching the medical literature for more connections between liposuction and metabolic syndrome.

Dr. Weber and his colleagues have already done one study showing that hamsters with metabolic syndrome react favorably to removing belly fat.

But lab animal results don’t necessarily translate to human results.

Other researchers think the connection may be hidden because most liposuction is not used as a means of weight control. Instead, the procedure is used to shape and modify bodies.

That could leaves larger amounts of fat deeper in the body to cause health problems.

But we may see the day in which people routinely have liposuction to improve their general health.

But five Egyptian physicians including a plastic surgeon and a general surgeon recorded all the basic health readings on a group of 60 obese women before performing large volume liposuction of their waists, hips, buttocks, thighs and knees.

The health readings included measurements of:

• Body Mass Index
• Blood pressure
• Blood sugar
• Liver function
• Cholesterol

The surgeons then removed an average of 6300cc’s (about six quarts) of fat and fluid from the patients. Of course, 2700 cc’s of medications were injected into the treatment areas before the procedure because the surgeons used the most popular form, tumescent liposuction.

After surgery, the researchers re-measured the subjects at the six week and four month points; the women ranged in age from 15 to 45.

At both points, the subjects’ weight was an average 30 pounds less.

Medical scientists are just now establishing all the harmful links between obesity and general health. For instance, as weight increases, so do rates of diabetes, high blood pressure and high cholesterol.

When the doctors crunched all the numbers, readings and measurements, they found the subjects were delighted with the removed pockets of fat and their new slimmer appearance.

The physician-researchers also found, among benefits:

• Pulse rate and blood pressure were about the same at four weeks but had significantly decreased at four months.
• Blood glucose (a measurement of blood sugar) had dropped a little at four weeks but really dropped at four months.
• Total cholesterol dropped significantly at the four week point but was going back up at the four month point. (Could eating habits be slipping?)

Overall, the physicians found that large-volume liposuction is safe and can do more than just make you look slimmer. (Read the liposuction study.)

Other plastic surgeons add that people who have large volume liposuction should be:

• In good health
• Willing to make long-term diet and exercise changes
• Choose an experienced surgeon
• Have the procedure at a hospital or certified surgery center in case complications happen during surgery.

That may not be the whole story, according to Indiana plastic surgeon Barry Eppley, M.D., who writes the most excellent blog, Explore Plastic Surgery.

Says Dr. Eppley: “If your weight is stable, the results will be fairly long-term after liposuction.”

That means, if you want to protect your investment in liposuction, you should make permanent changes in your diet and exercise routines.

Yes, liposuction takes out fat cells but some are left behind. And if you shovel in the chow, those few cells will expand and become larger!

So a couch potato lifestyle combined with unmindful eating could undo your plastic surgeon’s good liposuction work.

It’s because some areas of the body – like the stomach and the flanks — are preferred fat storage areas, with men gaining the most in the stomach and women gaining in the buttocks and thighs.

Now, the question of weight gain after liposuction has actually been studied.

Writing in a 2006 issue of Plastic and Reconstructive Surgery, five M.D.s at the University of Texas Southwestern Medical Center asked 209 liposuction patients about the procedure’s long term effects.

Remember, patients must keep their weight stable and make permanent changes in eating and exercise styles.

The study did not say so, but our guess is that half took the doctors’ advice to heart. Here’s what the statistics revealed:

• Weight gain: 43 percent
• Weight gain in the treated area: 65 percent
• Gaining five to 10 pounds within six months of surgery: 56 percent
• Abdomen listed as place where weight returned: 80 percent

So did the respondents – even the ones who stayed on their couches and gained some weight — think they had wasted their time and money?

Not at all! The survey also revealed:

• Patients who were satisfied with their results: 80 percent
• Respondents saying their results were excellent or very good: 53 percent
• Percent who would recommend the procedure to others: 86
• Would have the procedure again: 79.7 percent
• Described their post-op discomfort as mild to moderate: 75 percent
• Discomfort lasting less than seven days: 60 percent

Given the results of that survey, plastic surgeons would do their patients an additional service to give liposuction patients information about diets and exercise plans at the start and suggest they choose one before going ahead with the procedure.

To rid themselves of cellulite’s hated, dimpled fat, women (and some men!) have tried enough creams, lotions, tonics and elixirs to float a battleship, herbs by the thousands, and hundreds of supplements “guaranteed” to make the dimpled pockets of fat disappear.

But none ever showed any evidence of effectiveness. Usually, the only reducing taking place was in the wallet.

Plastic surgeons say cellulite is so widely disliked due to its lumpy, dimpled appearance. The condition is caused by bands of fibrous tissue that connect muscles to the skin; otherwise, cellulite fat is the same as other fat.

Treatments have also included:

• Liposuction
• Lower body lift
• Fat injections

Plastic surgeons and dermatologists, writing in the November/December, 2008, issue of Aesthetic Surgery Journal reported a new treatment using laser energy and fat transplantation.

The treatment uses a YAG laser tip inserted under the skin in cellulite areas to stimulate collagen growth and tighten the skin while reducing the pockets of fat.

After that, the doctors took some of the patients own fat and injected it into the treatment area to fill in depressed and dimpled areas. Massage followed to help spread the fat.

Plastic surgeons and dermatologists in New York City and Brazil used the new treatment on 52 women from 18 to 47 who had severe cellulite pockets but no other surgical cellulite treatments.

The patients were followed from 2003 until December, 2006 and asked to rate their final appearance.

Results?  84.6 percent of the patients said the outcome were either good or excellent.

The method has the tongue-twisting name, YAG laser lipolysis and autologous fat transplantation. (Read more about the cellulite treatment.)

Concluded the doctors: “This represents a new treatment…that is proved to be both safe and effective.”

Translation: It may not be widely available until more testing has been done. But look for a sexier name!

What would you call the laser and fat injection treatment for cellulite?

• Face lifts
• Breast augmentation
• Liposuction

The musical comedy, “Skin Deep” (not to be confused with the 1989 movie of the same name starring John Ritter , or the U.S. Magazine, Skin Deep) opened in London, with a Philipino version opening in Quezon City.

Basically, the play is a satire on the culture of narcissism, with a Mephistophelian-like plastic surgeon giving seven characters the choice to look like whomever they want.

In the British version, the sinister surgeon is named Dr. Needlemeir whose famous saying is, “putting right what nature put wrong.”

According to Philipina Mom blogger,  the Philipino version stars a surgeon, Dr.  Beau Batocol, a play on words that gets totally lost in translation.

The clinics in both is the Skin Deep Beauty Sanctuary.

Of course, all this is a sharp departure from the real world of plastic surgery where surgeons are highly trained to spot patients who want too much or needless plastic surgery.

The cultural splash with plastic surgery does not stop with the performing arts.

A popular book, Face Lift Hotel, tells about the adventures, missteps and other off-the-wall moments observed by a registered nurse who ran a Beverly Hills plastic surgery recovery center for 18 years.

Author Maggie Lockridge figures she cared for about 40,000 people after their cosmetic surgical procedures.

The opening anecdote recalls when a lovely, 39-year-old New York City attorney told her husband she was going to L.A. for two weeks but had a face lift instead. While recovering, the attorney meets a high-powered real estate executive who is also recovering from a face lift and becomes enamored of him.

Although post-op patients are not supposed to drink, the duo consume two bottles of wine one evening and really get to “know” each other  — in the biblical sense.

Suddenly, in the middle of the night, Ms. Attorney summons Nurse Lockridge to Mr. Real Estate’s room.

It seems the poor guy broke all his stitches, is bleeding and must make an expensive trip back to the plastic surgeon to re-stitch his incisions.

What are your favorite plays and books about plastic surgery?

Liposuction is done on the arms, the face, the neck, the stomach, the flanks (the “love handles”) the breasts, buttocks and lower body including the “cankle surgery” in a few cases.

Is the world at war with fat?  Actually, we need some fat in our diet and on our bodies for health.
Nonetheless, there are some little-known facts about fat, its removal and your health:

• What liposuction actually does:

Liposuction is the only way to reduce your fat cells. Diet and exercise only shrink them.

• Are you healthier afterwards?

You should reduce the fat around your internal organs, but liposuction doesn’t do that. Otherwise, fat-related health risks remain unchanged.

• What did I do to get fat?

Blame it on the genes you inherited.

• What’s the fattest part of the body?

The brain is about 70 percent fat. Everybody really is a fat head!

• How many Americans are overweight?

Sixty-six percent of Americans are overweight or obese. As of 2007, California was the only state not getting fatter. (But don’t move here thinking you’ll automatically get thinner. The state is too crowded already!)

• What did I do to get fat?

If you regularly eat dinner or breakfast in restaurants, the risk of obesity is doubled.

• What location on the body is fat the most unhealthy?

Belly fat is associated with type II diabetes and heart disease.

• Why should I lose weight?

A cosmetic plastic surgery firm in England, Surgicare, surveyed their past lap band patients and found:

• Seventy-one percent reporting an increase in their intimate relations
• Ninety percent said they could move and get around better
• 86 percent said they had massively improved self-esteem.

(Read more about the lap band patient survey.)

What kind of fat would you like to lose? Belly, arm, leg or cankle?

Cosmetic plastic surgery procedures that influence changes in diet and exercise often include:

• Liposuction

Plastic surgeons say liposuction is not a means of weight control. But once the bothersome pockets of fat are gone, many decide to devote more time to exercise.

A University study shows why: 209 people who had liposuction between 1999 and 2003 were studied. Later, 43 percent gained around five and 10 pounds. Among this group, only 10 percent increased their exercise level while 22 percent consumed a better diet.

But of the 57 percent who gained no weight, 35 percent said they exercised more while 50 percent ate better foods.

• Buttocks augmentation

When a man or woman’s derriere is made more round and shapely, these patients also take up exercise to maintain the new look. Many are rewarded because they can again wear – and look good in — stylish clothing.

• Tummy tuck

These patients also look good again in clothing and are rewarded during beach season and at poolside.

• Lap band procedure

After the procedure, patients experience what doctors know as massive weight loss, or MSL, for short. Studies reveal these patients experience a much better love life and take up sports and other activities they once had to give up.

• Body Shaping

After losing massive amounts of weight – like 100, 150 or more pounds – the patient is usually left with stretched skin hanging from their bodies and limbs. The hanging skin makes it difficult to move and creates health problems due to sheets of skin rubbing together.

But after body shaping, the loose skin is no longer in the way, the skin problems go away and they also can again take up activities like jogging, roller blading or bike riding.

Clothing is also much easier to find.

What activities do you think best keep you in shape after surgery?

For 2008, about 10.2 million invasive and non-invasive procedures were performed.

Now, the American Society of Aesthetic Plastic Surgery (ASAPS) has crunched their own numbers (with a plus or minus error rate of 3.21 percent) to reveal that breast enhancement leads the list of invasive plastic surgeries while Botox is king of the non-surgical procedures.

Here are the top invasive procedures for both men and women in 2008 and the numbers performed:

1. Breast enhancement: 355,671
2. Liposuction:341,144
3. Eyelid surgery: 195,104
4. Rhinoplasty:152,434
5. Tummy tuck: 147,382

About 2.4 million people received Botox injections last year. The non invasive procedures included:

1. Botox Injections: 2,400,000
2. Laser hair removal: 1,280,964
3. Hyaluronic acid injections (Restylane, Juvederm, etc) 1,262,848
4. Chemical peel: 591,808
5. Laser skin resurfacing: 570,880

Other interesting trends include the percentage of women plastic surgery patients (92) versus male patients (8 percent). Racial and ethnic minorities accounted for 20 percent of all cosmetic procedures with Hispanics having eight percent; African-Americans, six percent; Asians, four percent and other non-Caucasians, two percent.

Where patients had surgery also made the list, including:

• In surgeons’ offices: 53 percent
• In freestanding surgical centers: 26 percent
• In hospitals: 19 percent

Based on a survey of fees charged, experts figure Americans ponied up some $12 billion overall. Surgery accounted for $7.2 billion while $4.6 billion was consumed by nonsurgical procedures.

In addition to breast augmentation, the leading surgical procedures for women were:

• Liposuction
• Eyelid surgery
• Tummy tuck
• Breast reduction

The nonsurgical procedures were the same as the very first list above.

One final statistic shows where more patients want to go with rejuvenation surgery.

Since 1997, surgical procedures for women have increased by 104 percent. But non-surgical procedures for the ladies have increased 233 percent.

Since 1997, men have seen a decrease in rejuvenation surgery of 15 percent while their nonsurgical procedures have increased 239 percent.