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Brian Cox, MD

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Listed in Los Angeles

  • 1044 S. Fair Oaks Ave Suite 101 Pasadena, CA 91105
  • (626) 449-4859

American Board of Plastic Surgery, 2002

Dr. Brian Cox is a board-certified plastic surgeon specializing in cosmetic and reconstructive surgery. Dr. Cox is a trusted source for a wide range of cosmetic and reconstructive surgery procedures such as: breast augmentation, breast reduction and breast reconstruction; tummy tuck and body contouring; facelift; nose and eyelid surgery; laser resurfacing; hair replacement; scar revision; lip enhancement; and Collagen and Botox injections.

Originally from Kansas, Dr. Cox combines his Midwest ethics and values with the highest quality of surgical care. He devotes special attention to educating people on all of their cosmetic options, including surgical and non-surgical techniques, so they are informed and can make the best decisions for their care.

Having trained at some of the most prestigious medical institutions on both the East and West coasts, his diverse training ensures knowledge of national trends. Dr. Cox has trained at Harvard University as an Aesthetic Cosmetic Surgery Fellow, making him part of an elite group of plastic surgeons. Prior to that, he completed plastic surgery training at the University of Tennessee at Memphis, a hub for reconstructive and trauma plastic surgery care. Dr. Cox completed his general surgery training locally at Huntington Memorial Hospital in Pasadena, California.

What is Liposuction?

Liposuction or Lipoplasty is one of the most popular procedures today. This surgical procedure removes unwanted, localized, or disproportioned excess fat from different areas of the body. It is also used to slim the hips and thighs, flatten the abdomen, shape the calves and ankles, and even to get rid of a double chin. It has been adopted by many medical practitioners, even those without formal training in plastic surgery, because of the simplicity of the concept of vacuuming unwanted fat from the body. It is important to note, however, that liposuction is not a substitute for weight loss. You should discuss with your surgeon the proper indications for the procedure, alternatives to the procedure and how to manage potential risks.

Effects of Liposuction

Getting a liposuction will give your body a more slender, sculpted and well-proportioned look.

Candidates for Liposuction

Liposuction can easily improve body contours caused by excess fat. Often, some areas of the body are not as responsive to diet and exercise. Younger patients, because their skin is more elastic, are more likely to get the best results because the skin will smoothly re-contour after the procedure. For older patients however, a skin-tightening procedure (Abdominoplasty or Body Contouring) may be required. Contrary to belief, liposuction cannot correct contours that are irregular for other reasons, such as muscle weakness or hernia, and is not applicable in cases where there is excessive skin laxity (for example, the abdomen after multiple pregnancies) or cellulite. Together with additional procedures, liposuction can correct these deformities with good results. Localized accumulation of excess fatty and breast tissue in teens or adult males, also called gynecomastia or male breast enlargement, can also be treated by liposuction.

The areas that respond well to Liposuction include:

  • Cheeks, jowls, and neck
  • Upper arms
  • Breast or chest areas
  • Back
  • Abdomen and waistline
  • Hips and buttocks
  • Inner and outer thighs
  • Knees, calves and ankles

It is important to remember that liposuction is a body contouring technique, not a method of surgical weight reduction. Although in large-volume liposuction there is usually a noticeable and often dramatic improvement of the body contours, there may be relatively little change in the patient’s weight after surgery, since fat is less dense (lighter in weight) than a comparable volume of water. Liposuction is not effective on diffuse, generalized excess fatty deposits. Your surgeon may advise patients that a medically-supervised weight reduction program is more beneficial in such cases, in order to arrive at or near their ideal goal weight before liposuction is performed. Liposuction works hand-in-hand with a healthy, low-fat diet and a program of regular exercise to restore your shape, or to create the shape you have always dreamed of.

Your Consultation

You will be asked by your surgeon to point out areas that concern you and would like to see improved. Realistic expectations about what can and cannot achieve by the procedure will be addressed by your surgeon. Liposuction is most successful in people with normal body weight, with good skin tone and those who have isolated unwanted fatty deposits.. If weight gain occurs after liposuction, the fat may be deposited in areas that have not been treated. The procedure can be repeated if necessary.

Factors like a patient’s physical condition, genetic makeup, diet, exercise, smoking and alcohol habits and skin elasticity can affect the results of the procedure. In addition to the usual consultation, your surgeon will also carefully evaluate your general state of health, any underlying conditions which may compromise your result, and any medications you may be taking. Your surgeon will estimate the amount of fat that should be removed from each area of concern. The surgeon will then select the proper technique and instrumentation necessary in each patient’s case, plus the different options and relative risks and benefits for each procedure to tailor it to receive maximum results.

The Liposuction Procedure

Liposuction is done on an outpatient basis and under light general anesthesia. Discreet incisions, either hidden in the patient’s natural skin fold or in a very inconspicuous place, are positioned adjacent to the areas to be treated. A small (2.5 to 5 millimeter) metal suction tube called a cannula is attached to a surgical vacuum machine or syringe, then inserted through the incisions and directed below the skin into the fatty deposits requiring treatment. Liposuction usually takes over an hour, depending on the number of areas to be treated.

Options and Alternatives:

Tumescent Technique

In this technique, a dilute solution of local anesthetic is infiltrated under pressure into the fatty areas to be liposuctioned, either with or without a sedative. Small, localized areas can be treated with tumescent local anesthesia alone, but the injection of the local anesthetic solution itself may be uncomfortable or painful.

Wet and/or Super-wet Technique

Local anesthesia is used in most cases and involves the use of lesser quantities of dilute solutions of local anesthetic, usually in conjunction with light general anesthesia or intravenous sedation. This will diminish the blood loss associated with liposuction and provide long-lasting pain relief both during and after the procedure. Because the local anesthetic solution is infiltrated after general anesthetic, the injections themselves are painless. This is the usual technique used in cases where liposuction of multiple areas is planned.

In addition to traditional vacuum Liposuction, there are other types of instrumentation which can be useful in certain situations.

Power-Assisted Liposuction (PAL)

This involves the use of a special mechanical hand piece that produces a rapid reciprocating movement of a standard-type cannula tip (similar to a sewing machine). Used in areas of dense or fibrous fat, or in secondary liposuction cases, passage of the cannula is easier, and the fat is simultaneously vacuumed away, as in traditional liposuction.

Ultrasound-Assisted Liposuction (UAL)

This method involves the use of a specialized hand piece and cannula tip connected to an ultra-high-frequency sound wave generator. Vibrations above the range of human hearing (ultrasound) are transmitted to the cannula tip, and fat in the areas of treatment is liquefied and emulsified by bursting of the cell membranes. A separate cannula and low-pressure vacuum are then used to remove the liquefied fat emulsion. This technique is also applied in difficult or secondary cases, but has somewhat greater associated risks.

Autologous Fat Grafting

In this procedure, the excess fat is transferred to an area where you desire increased fullness, such as the lips, other lines in the face, or areas of cellulite dimpling. Many patients ask if this fat can be transferred to the breast; however, fat transfer to the breast is not advisable, because it occasionally can produce small areas of calcification that resemble early signs of breast cancer on mammograms.

Liposuction is not the answer to the laxity of the skin in the treated areas, and in some cases may worsen the appearance of the skin. There are instances where an alternative body contouring surgical procedure may be required, most commonly in combination with liposuction of the involved areas. Abdominoplasty or Lower Body Lift may be required for areas like the abdomen and hip. While the loose skin of the upper arms may require Brachioplasty (arm lift) and the sagging skin of the inner thigh may require thigh lift. A face or neck lift maybe required for a double chin in order to achieve results.

Risks

There are very rare complications after Liposuction but occasionally they may occur. Although permanent problems are quite rare, potential short term complications include bleeding, infection and reactions to the anesthesia. Cosmetically, depressions or wrinkling of the skin, discoloration of the skin, asymmetry when comparing one side to the other, scar tissue, tape burns, and collections of blood (hematoma) or fluid (seroma) under the skin are some of the cosmetic complications that may need additional surgical procedures.

Uncommon complications include loss of sensation or movement in a body area, skin breakdown or loss requiring skin graft or reconstruction, and fat embolism or blood clots in the lower leg veins which may travel to the lungs (pulmonary embolism). Serious infection or shock requiring hospitalization and blood transfusion are very rare. Some bleeding and fluid shift is expected during liposuction. This is the reason why there is a limit to the amount of fat removed. If your surgeon anticipates a large volume of fat will need to be removed (beyond the safe limit of a single operation), they will recommend that the overall operation be divided into multiple stages separated by several weeks or months of recuperation in order to safely accomplish the desired goal without the need for blood transfusion.

Recovery

Recovery from Liposuction is relatively easy. After the operation, a patient may feel somewhat stiff and sore, but as soon as the day after surgery should be up and walking around to promote normal circulation. Swelling, possibly to the point where the treated areas appear unchanged or heavier before the surgery, may be expected. There will most likely be bruising about 2 weeks after the procedure, which maybe extensive and may involve untreated areas. The patient is advised to wear a special elastic compression garment to provide pressure on the area and minimize swelling and provide support while healing. These garments, although hot and uncomfortable, will also help in the retraction of the skin. Depending on a patient’s healing time, stitches will be removed within a week.

Patients can go back to work after 3 to 5 days, while more strenuous activities like exercise should be done after 10 to 14 days. Patients are advised to avoid the sun and use generous amounts of sunscreen until all bruising has subsided.

The results will be recognizable immediately after liposuction and will continue to improve once swelling subsides. The unwanted bulges will be gone, giving you a slimmer contour.

Results of liposuction are permanent if combined with a healthy diet, moderate exercise and weight management program. In the event of weight gain following your surgery, you might note a more generalized, even distribution of excess fat, rather than re-accumulation in the previous problem areas where treatment was performed. Your surgeon may recommend another procedure if necessary to further improve the areas of liposuction.

Frequently Asked Questions

Q: How much weight will I lose after Liposuction?

A: In the case of younger patients, their skin has sufficient elasticity and resilience so it can shrink and contract nicely over the areas of fat that have been removed. If the skin has been stretched beyond recovery by years of localized fatty excess, liposuction may need to be combined with another body contouring procedure to remove the excess skin.

Q: What is the maximum volume of fat that can be removed in one operation?

A: Five liters is the maximum safe volume of fat that can be removed during liposuction. The actual safe volume may be greater or less than that amount, depending upon the amount of bleeding observed or other factors such as changes in the patient’s vital signs during the procedure.

Q: Is a blood transfusion required for patients undergoing Liposuction?

A: No. If it is anticipated that there may be a greater risk of blood loss during the procedure (secondary liposuction, large volume liposuction in men), your surgeon may suggest that you donate a unit of your own blood (autologous blood), which can be given to you during the procedure. In general, blood transfusions (even autologous blood) should be discouraged, to avoid the risk of transfusion errors and transmission of blood-borne illnesses.

Q: If I gain weight after Liposuction, will the fat be deposited in other locations?

A: Since the fat deposits your body previously used to store excess fat have been reduced, you may find that fat accumulates in other areas of the body after liposuction. Generally, this tendency of the fat to shift to other areas is minimal, but you should avoid regaining the weight.

Q: How long do I need to wear the elastic compression garment after Liposuction?

A: The elastic compression garment is used to diminish the amount of swelling and bruising in the treated area. It also prevents accumulation of excess fluid (serum or blood) under the skin, and helps to maintain the contour of the treated area. It should be worn continuously, 24 hours a day, 7 days a week (except while showering) for the first 3 to 4 weeks. After that time, it can generally be used for support and comfort during the daytime only, for an additional 3 weeks.

Q: When can I shower or bathe after Liposuction?

A: You may shower after the first office visit / dressing change, generally within 24 to 48 hours after surgery. You must not bathe or immerse the incision sites under water in a bathtub, hot tub, swimming pool, etc. until the incisions are completely healed. The doctor will instruct you when bathing is permitted.

Q: When can I resume driving?

A: Most patients may resume driving after approximately 48 to 72 hours. You should not drive if you are taking narcotic pain medication, sedatives or muscle relaxants.

Q: When can I resume exercise?

A: Patients are encouraged to begin walking immediately after surgery. You may resume more strenuous walking on a treadmill, or mild upper extremity weight training after 7 to 10 days. Most patients resume full, unrestricted exercise after approximately 4 weeks.

Q: When can I return to work or normal social activities?

A: Most patients are able to return to work or resume normal social activities after 3 to 4 days. If your work involves sitting for extended periods, you are encouraged to take frequent breaks to stand and walk, in order to promote circulation and deep breathing. You will need to wear loose-fitting clothing which will hide the presence of your compression garments, as long as necessary.

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