Q. I have heard a lot about "fat suction" surgery and have many questions about it. How much does it cost? Does it require staying in the hospital? Does it require anesthesia? Is it covered by insurance? How successful is it and what are the pros and cons? Does it work on abdominal fat, the buttocks? What about "fatty tumors"? How can I find a doctor who performs this procedure?
A. Suction lipectomy is a new surgical procedure in which a doctor removes fatty tissue with a suction probe through a small opening in the skin. It is not a treatment for obesity, but is used to remove excess fat in localized areas, including the abdomen, buttocks and thighs. It's also useful for removing large fatty tumors, known as lipomas, which can also be removed in the conventional way by cutting them out.
For most operations, you need to stay in the hospital and have general anesthesia, but some procedures can be done using local anesthesia in in-and-out surgery. Depending on several factors, the cost varies from about $300 to $4,000.
Most medical insurance companies consider this cosmetic surgery and medically unnecessary, so it usually isn't covered. But check with your company to be sure.
Most people are satisfied with the results. The advantages of this technique over other methods of fat removal include the fact that scarring is minimal. Complications include a small risk of damage to nearby nerves or blood vessels, and having some flabby skin over the area where the fat was. This tends to tighten up with time.
Ask your doctor to recommend a plastic surgeon who does this type of surgery, or contact the American Society of Plastic and Reconstructive Surgeons to get the names of three doctors in your area who do. ASPRS will also provide a free brochure explaining the procedure. Call their Physician Referral Service at (312) 856-1834, or write ASPRS, 233 N. Michigan Ave., Suite 1900, Chicago, Ill. 60601.
Q. I'm a 26-year-old male, and for about the past year I've had a problem with impotence. I don't think there's anything physically wrong with me, because I'm able to perform on some occasions, but not others. I think it's due to nervousness -- being self-conscious and wondering what my partner is thinking about me. Lately, it's been a self-fulfilling prophesy. The more I worry about it, the worse it becomes. Do you have any suggestions for me?
A. You're probably right that your problem is more emotional than physical. "Performance anxiety" is the term used to describe your experience, though you may also be suffering from low self-esteem.
In the vast majority of cases, impotence at your age is due to psychologic and emotional factors. When impotence depends on the situation you're in, it's almost always emotional in origin. Another very common cause is the effects of alcohol or drugs that impair sexual function.
It wouldn't do any good to tell you to stop worrying. You've obviously tried that and it hasn't worked. I think you'd benefit from counseling. Ask your doctor to help you with this problem, or for a referral to someone who can. In addition to counseling, an important part of your "cure" will probably be a mutually satisfying relationship with someone you can trust. Note to Readers
Like the rest of the Health section, Consultation is celebrating its first anniversary. I have many people to thank for its existence, and I'd also like to say a few words about how I choose questions to answer.
My first round of thanks goes to you, the readers, for your trust, your challenging questions and your warm support. I appreciate those of you who have taken time to write about your reactions to answers and to share your experiences with me. I got a chuckle, for example, hearing about an old home remedy for ganglions, those fluid-filled swellings that usually appear on the back of the wrist. One reader said that 40 years ago he "treated" one by "banging a big dictionary on it," signing his letter, "Yours for gone ganglions."
I'm indebted to the many health professionals and medical organizations who've helped in my research. I'd also like to thank several institutions for their support: Georgetown University, its Department of Community and Family Medicine, Providence Hospital and the Fort Lincoln Family Medicine Center. And thanks to my wife, Linda, for all her help.
I view Consultation as a health education service, and not as a substitute for medical advice from your physician or other health professional. Space does not permit the depth of discussion that some questions really require. Complex issues deserve the thoughtful and individual attention that only a health professional can give you.
I try to choose questions of general interest, those that highlight an important concern, or those that emphasize principles of good health care. I try to clear up common misunderstandings and put people in touch with resources for further help.
I'm sorry I can't answer all the questions I receive. Some questions are too individual. Others lack a key piece of information. Some describe very difficult, perplexing problems that have baffled other physicians, and undoubtedly baffle me. And some very good questions don't get answered because they've already appeared.
Looking ahead to the coming year, I feel most gratified knowing that some of you have been helped by the advice given here. To the extent that this column brings about better communication between patients and their doctors, I consider it a success.