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Interview with Dr. Yoho About His Surgical Center, Liposuction and Anesthesia

Interviewer: Dr. Yoho is at the New Body Cosmetic Surgery Center in Pasadena. Dr. Yoho, your name has been synonymous with cosmetic surgery and liposuction for a number of years. How long have you been doing liposuction and cosmetic surgery?

Dr. Yoho: My practice has been exclusively cosmetic surgery for more than 12 years and I have performed more than 4,000 cases of liposuction since 1992, and over 6,000 major surgery cases.

Interviewer: Besides being a well-known cosmetic surgeon, you have an additional qualification, don't you?

Dr. Yoho: Yes, I have passed my boards and I am fully qualified to practice emergency medicine. In fact, I took the emergency medicine recertification board a few years ago to assure my patients of a high degree of safety.

Interviewer: Tell me a little bit about your background, Dr. Yoho.

Dr. Yoho: Both my father and mother are physicians. My father is a urological surgeon and my mother, a dermatologist. I knew from a young age that I wanted to be a physician and surgeon. I have been trained in emergency medicine, and have had some training in internal medicine and dermatology. I have passed the board examinations for the American Board of Dermatologic Cosmetic Surgery, the only board tests in existence strictly for beautification surgery.

Interviewer: Tell me about your philosophy of your surgery, Dr. Yoho.

Dr. Yoho: We like to start our cases at 6 to 9 in the morning and have the patients go home between 12 and 2 with a relatively short time interval in the office and a efficient surgery. We do not discharge the patients by wheelchair. We want them walking and they are discharged (with a family member) and we tell them to go straight home because the patients sometimes want to pick up something to eat on the way home.

Interviewer: Dr. Yoho, tell us about your philosophy about anesthesia.

Dr. Yoho: Lots of patients come to us because they hear about our results without using general anesthesia. They do not want general because of their bad experiences in the past. At the same time, they do not want the pain associated with using just local anesthesia. The best compromise is a properly spread local anesthesia coupled with conscious sedation to the patient's needs. Some patients, especially patients who have very small areas, prefer to have very little relaxation medicine. Most, however, want no memory of the procedure. We individualize it for the patient, bearing in mind that the longer cases usually get more sedation. Many of our patients are concerned about nausea and vomiting because, after surgery in the past, they have had a lot of trouble with this. However, less than 1 per cent of our patients have any nausea. We get a lot of compliments about this

Interviewer: How good can you make somebody look, Dr. Yoho?

Dr. Yoho: We do a great job with our cosmetic surgery and are considered international experts in liposuction. Realistically, if you are size 16 full-figured and you come in with the size 6A petite or a swimsuit model's photograph of a size 6, that will not work. What we try to do is have our patients clearly understand what their likely results will be.

Interviewer: What is your personal approach to diet and exercise, Dr. Yoho? This seems relevant since you are in the liposuction field.

Dr. Yoho: Liposuction is the most physical of all surgeries, with the possible exception of some orthopedic surgeries. It requires a physician in tremendous physical condition. I exercise nearly every single day. I run triathlons, and I have placed first in my age group in 2005. I have been an active body-builder since my teens. I climbed El Capitan in Yosemite in in 24 hours in 2005, and only 2 people over 50 years of age have done this, to the best of my knowledge. As I have gotten older, I have been more and more interested with yoga and I credit my flexibility to Bikram and other styles of yoga. These also help me stay in shape. These athletic abilities enable me to perform liposuction efficiently and accurately. We are able to give our patients less medication and the surgeries are safer because they take less time.

Interviewer: Tell us more about your liposuction technique, Dr. Yoho.

Dr. Yoho: With our technique, we must stand the patient up near the end of the case. We stop the procedure and turn the medicine off to do this. Use of general anesthetic doesn't allow this conveniently. We mark the patient with sterile markers during this process because the body takes a completely different shape when lying than standing. Though it is theoretically possible to do the whole case lying down, we find that we are able to achieve a much more precise result by "touching up" the patient right then. Our re-operation rate, in other words, the number of people we take back to surgery later for another procedure, is less than 2% because of this fine-tuning we do during the surgery. Many doctors take a third of their liposuction cases back to surgery later.

Interviewer: Dr. Yoho, tell me about the instruments you use for liposuction.

Dr. Yoho: We choose the cannula or suction tube based on the case. For example, if you are pruning a rose bush, you might only need a little tiny pair of scissors, but if you are working on a big tree, you need something bigger. The myth of "microcannula liposuction" is just that, a myth. If you try to do larger cases with tiny instruments, the patient is subjected to surgery lasting many hours and often has more bruising and a very rough recovery. Sometimes, the case requires a series of cannulas of different sizes.

Interviewer: Dr. Yoho, tell us about time in surgery.

Dr. Yoho: Some doctors spend 3 to even 10 hours on a large liposuction case. That is tough on the patient and tough on the doctor. My approach is to limit the surgical time without compromising the care. We do our surgeries between 6 A.M. and noon, leaving patient recovery for the early afternoon if necessary. That is recovery for the patient and for the doctor because this is a very physical surgery. Our cases, even the large ones, take about an hour.

Interviewer: I understand that you have patients who are medical professionals.

Dr. Yoho: The biggest honor for a physician is to have other physicians come to me as patients. In the last 6 months of 2005, for example, we had 7 physicians as patients. We perform procedures for registered nurses and other healthcare providers every week.

Interviewer: Dr. Yoho, what other procedures do you do and what are you excited about right now?

Dr. Yoho: The breast implant surgery through the belly button is a wonderful procedure. We have had beautiful results and we think that it has been accepted better by our patients because: 1) no scarring on the breasts itself, and 2) the decreased pain during recovery.

Interviewer: What frustrates you, Dr. Yoho, about liposuction today?

Dr. Yoho: I have mentioned the problems with general anesthesia. I think that these cases are not done as well under general. Not only is there a significantly higher risk of problems, such as blood clots to the lungs, but I believe the accuracy of the work isn't as good. We frequently touch up other doctor's patients.

Another frustrating problem that we see is bad abdominoplasty or tummy tuck results. Tummy tucks are frequently performed for people who just need a liposuction, even for young people with a small tummy. We feel that the tummy-tuck is a surgery that is far over-performed. And the tummy-tuck death rate is between 1 in 2000 to 3000 in the medical journals, unacceptably high for a cosmetic surgery operation in my opinion. The liposuction fatality rate, in some studies, is 1 in 50,000 (or even lower).

Interviewer: Dr. Yoho, you have categorized your patients as to body style, tell me a little bit about this.

Dr. Yoho: Whatever your body style is, we have seen it. The body types have to do with ethnic group, diet and exercise, plus weight gain and loss in the past. It also has to do with your smoking: smokers often don't get great results. We have ethnic types on our website and categorized many sets of photos in different groups, so you can find a body just like yours. There's also an article about this in the appendix of the book. Our patients are not all swimsuit models. We have ordinary people of all types with uneven bodies that we work on and you can examine these photos and see the results we have obtained with different body types.

Interviewer: What would you suggest, Dr. Yoho, that the patient do prior to having liposuction?

Dr. Yoho: I stress that any patient should learn everything possible about their procedure. I recommend that you do your research on the web, especially our website, which has comprehensive information about liposuction including our book. Talk to the other patients regarding recovery. If the patients you speak to in a doctor's waiting room or referred by the doctor have had a rough recovery, this is significant negative information about the surgeon's technique. The surgeon should be able to do a good job and still avoid significant post-operative pain (of course there are exceptions depending on the patient). Most of our patients need only Tylenol® for pain control after the first 12 to 24 hours.

Interviewer: Dr. Yoho, what is the "no scalpel tummy-tuck"?

Dr. Yoho: The "no scalpel tummy-tuck" our method of careful liposuction that allows the tummy skin to shrink without cutting and removal of the big wedge from hip to hip, and making a funny new belly button. Skin is more like a rubber band than a paper bag. In other words, if the liposuction is done right, it usually does not have to be cut in a tummy-tuck sort of fashion. It will shrink after liposuction, often yielding a very nice result. If there is a little sagging, this is better trade-off in most cases than having a 2-foot scar from hip-to-hip, such as you would have with a tummy-tuck. Of course there are a few patients who actually need a real tummy tuck and we will tell you who you are in your consultation.

Interviewer: Dr. Yoho, what is your overall satisfaction rate?

Dr. Yoho: We survey our patients after every single procedure and we have an overall satisfaction rate of greater than 95%. Liposuction and the breast augmentations are our most consistent high-satisfaction procedures.

Interviewer: Dr. Yoho, I want to ask a little bit about the complications and problems that can occur with liposuction or other cosmetic surgery

Dr. Yoho: On my website are my articles that you can download about problems with cosmetic surgery, written for both physician medical journals and patients. The journal articles may be a little bit hard to read but I also wrote a chapter about this for my book, and you can download that as well. We take every surgery very seriously and we do everything in our power to make the patient as safe and comfortable as we can, as well as striving for the best results. We have a picture in our office of a person jumping with a parachute and it has the quote on it: "Minor surgery is surgery someone else is having." We take that very seriously and we listen carefully to fears of our patients and try to address them.

Interviewer: What about different areas of the body for liposuction: can you discuss this?

Dr Yoho: Some areas of the body respond better, and like so much of the result, it depends on what you were like before and the area of the body that you are dealing with. Liposuction is not for weight loss. The happiest liposuction patients combine diet and exercise with the procedure to get the best possible result. We can give you a jump-start but the ball bounces into your court after the surgery if you want to change your life.

Interviewer: Dr. Yoho, I understand, you perform many cases of liposuction on male breasts.

Dr. Yoho: The most common liposuction procedures for men are removal of breast tissue and "love handles." We have had up to three or four brothers from the same family who had the same problem: female-appearing breasts, which are fat and sometimes breast glands. In many cases, liposuction alone can treat the problem, but sometimes the tissues must be cut out from a small opening around the nipple (see my journal article about this on the website). Love handle liposuction can change a man's blocky shape to a V-shape that can look great. When a man does some weight and cardiovascular training too, a transformation can occur.

Interviewer: Dr. Yoho, tell us about your 3-dimensional approach to liposuction.

Dr. Yoho: There are a couple of ideas here. First, we do not divide our surgery into "areas." Other physicians typically talk about areas and charge per area. We generally perform 3-dimensional or 360-degree liposuction. Second, there is a limit on the liposuction any given person should have performed at one time and "total body liposuction" can be a great strain on the patient, even if the physician can tolerate it. We'll let you know what is safe and appropriate. Additionally, buttocks rarely need to be liposuctioned. Usually, the hips and the outer thighs can be improved with the liposuction and the buttocks then look good.

Interviewer: Dr. Yoho, tell me about arms.

Dr. Yoho: If your goal is to fit into a suit so your arms match your bottoms, we can do it. If your goal is to wear armless or sleeveless dresses, this may be unrealistic if you have very large arms. I must mention cutting surgery for arm reduction. This is generally very bad news. There is a very long scar and often strange contours with this surgery. Not every patient is a candidate for arm liposuction but we can generally shrink the skin about 75%, even with very large arms. What I want to remind patients is: not every person is a candidate for every procedure. That is when where the consultation and the doctor's expertise comes in.

Interviewer: Dr. Yoho, what about tummy-tucks? Do you liposuction some people after tummy-tucks?

Dr. Yoho: We call it the tummy-tuck tune up. Many patients come to our office with an unnatural look after their tummy-tuck. They may have fat areas remaining or may have a very blocky waist that needs correction. We can improve this with liposuction and have photographs of this on the website.

I just want to remind patients that if you will not show your tummy with a bulge, you certainly will not show a 24-inch scar to anyone. So, everything in life is a trade-off. The trade-off with a tummy-tuck is you may get a little tighter skin on your abdomen but you frequently have a very unnatural-looking belly button and the long scar. With the liposuction, you may have a little bit of loose skin on your abdomen but your risks of the surgery are much less and we can contour your hips and flanks along with your abdomen. We think most patients are happier with our "no scalpel tummy-tuck."

Interviewer: Who do you consider is the best liposuction surgeon?

Dr. Yoho: The patient needs someone who has done many, many different kinds of cases, all kinds of liposuction, all different body types, shapes, sizes, ages, and skin qualities. All these things go into your experience to become a good liposuctionist. Thousands of cases go into a physician's learning curve. We have done about 300-400 cases a year since 1992.

Interviewer: Do you have any feedback about your website and practice?

We get letters from all over the world thanking us for the information that is on our website. We have chosen to put most of my more than 20 scientific publications on line for the public to read. We have had patients from every state and six continents who after research chose me. Many surgeons and registered nurses have asked to observe my procedures in my office.

Interviewer: Dr. Yoho, what is new in liposuction?

Dr. Yoho: Some physicians are still spending 4-6 hours for a liposuction case. Because of my expertise, I can do these cases efficiently and our patient's surgical center stay is usually 3-4 hours including the recovery and time waiting for the procedure. There is a direct relationship to the surgeon's skills with the length of surgery, the length of the recovery, and the time to return to work.

Interviewer: Dr. Yoho, do you have any advice for the patient trying to choose a cosmetic surgeon?

Dr. Yoho: I recommend you judge the doctor by everything available to you in the consultation, the website, and in the office. You can find out a lot more than you think. Do not be intimated by the doctor. Sit in the waiting room and speak with every other patient who comes in for follow-up. Sometimes, they will not want to talk to you but a lot of them are very happy to. If the patients are enthusiastic and have had a reasonably easy recovery, then this may be the doctor for you. You can tell a lot about the physician by the atmosphere and the aesthetics and how you are treated.

Interviewer: Any last words of advice?

Learn as much as you can before you decide. Don't be overly impressed with credentials. Don't try to get everything in one surgery. Use your best judgment and be careful out there, not every doctor is experienced and/or trustworthy.