Meet our favorite bad boy of plastic surgery who dubs himself as the “biggest fat sucker” in the industry, plastic surgeon Dr. Robert Ersek. Dr. Ersek has more than a few controversial claims to fame, having performed liposuction on the youngest patient alive, a 12-year old girl who at 5-foot-5 weighed 230 pounds. Dr. Ersek sucked out 35 pounds of fat and fluid from the young girl’s body, who today weighs 153 pounds and calls her surgery a miracle. But there’s more. Dr. Ersek also operates on celebrity look-a-likes who wish to resemble Jennifer Aniston, Demi Moore, Drew Barrymore, Keanu Reeves, and John Travolta. Dr. Ersek also performed auto-liposuction on himself live on TV. But there is more than meets the eye, as Dr. Ersek is not just a headline-grabber who loves the attention and who will do just about any sensational stunt to get press — as other doctors and people often accusing him of being. Dr. Ersek is indisputably a very talented plastic surgeon who has developed many plastic surgery techniques, holds patents (or patent pending) on over 34 medical inventions, and authored numerous papers. Most importantly, Dr. Ersek has a big heart for patients and is in the plastic surgery profession for the right reasons.
Make Me Heal caught up with Dr. Ersek and had a frank one-on-one talk about his various exploits.
Performing Liposuction On A 12-Year Old
Dr. Ersek: Brook Bates was a 12-year-old girl who weighted 230 pounds. She could not run. She could not exercise. She could hardly walk. If she got down on the floor to try and do pushups or other exercises, it was very difficult for her to get back up without rolling over and getting some support from a wall or a piece of furniture. She was severely debilitated by this terrible weight. Further, she had few friends and all of her classmates made fun of her and laughed at her. Her father called and asked me if I would consider liposuction on a 12 year old. I told him, “No. She needed to try diet and exercise.” He said, “She has been doing that since she was three, and it has transient effects but she continues to gain weight.” He said that she had seen me on television talking about liposuction and asked if that would not help her to some extent. I said, “Probably not. She is only 12. She may grow out of this.” He said, “Not likely. She weights 230 pounds.” Her father had been my patient some years ago and so we were friends, and he asked if I would at least just talk to her to maybe motivate her. I said, “Sure, bring her in.”
So mother, father, and Brook came in to see me and explain how difficult it was for her to lose weight and how desperate she was to do something to change her life. She hated to go to school. She was in tears everyday when her mother picked her up. And so I explained to them that it could be possible for us to do a little liposuction, maybe 10 pounds at one time, wait six weeks, and then do 10 pounds again, wait six weeks and do it again. In this way, over a period of time we could probably be responsible for her losing quite a bit of weight by liposuction. But, I did not recommend this as a weight reduction procedure. They thought that that was a wonderful idea and gave her some hope. I referred her to the Way of Life Clinic across the hall where Dr. Walter Parks treats bariatric patients with glycemic index, exercise, tapes and medications when appropriate. She was able to lose a few pounds but it was not possible to give her the medications because they are not approved for a 12 year old. Therefore they came back to see me several times and we had planned to do this over a one, two, or three-year period, a little bit at a time.
One day when dad was not present, Brook and mother explained to me that it was one of her goals for her dad to see her in a dress before he died. He was diagnosed with bladder cancer and he was getting sicker by the day. He was having chemotherapy and was scheduled for a big bladder operation, a bladder bypass operation. They asked if there was any way possible for us to do this more quickly. I explained to them that it would be possible to take a greater amount of fat by liposuction if Brook would donate two units of blood to herself and subsequently we could do a maximum amount of liposuction, wait six weeks or so, and do it again if necessary, and do it again if necessary, as long as her body was able to bounce back before the additional episodes. We also realized that it would be necessary to do a tummy tuck, because she had a large, redundant pannus hanging over her abdomen that would not go away with liposuction. Therefore, we schedule her for surgery, she donated the two units, and we removed about 35 pounds of fat and aspirate at one time. About two months later we did the tummy tuck and removed another 10 pounds. On our scales prior to surgery she weighted 219 pounds. After the liposuction she was down to 190, and at the time of the tummy tuck, she was down to 170. Brook now weights about 155 pounds. She continues to lose weight. She is more motivated for dieting having much less of an appetite, and she is now able to exercise. She can run, jump, dance, use a trampoline, things she could never do before.
Make Me Heal: If her overweight situation is due to genetic causes, how effective can this procedure be considering the fact that she has a long time to go through her adolescence period in which many hormonal changes can occur?
Dr. Ersek: Brook’s mother and father are not overweight. Her sister and brother are not obese. But there is little doubt that her metabolic aberration is genetic, that is that it is inherited. Her dad’s mother was quite a bit overweight, but there are not known specific genetic pathway for inheritance of these tendencies. Regardless of the cause of her overweightness, the removal of fat by liposuction is essentially an amputation of that tissue. It is gone forever. If we were to only do liposuction on one leg, for instance, that leg would get a great deal thinner. The other would remain exactly the same. If the patient subsequently gained weight, the untreated weight could gain quite a bit of weight but the treated leg would gain very little because most of the fat tissue is gone. Therefore, liposuction is very effective if done in a large enough area to be complete. Adolescents, of course, do have substantial hormonal changes but they will not affect this. In Brook’s case, she had already started her periods and her epiphyses were closed, indicating that her bones are mature.
Make Me Heal: What are the possible implications for her future body growth and development having the procedure at this young age?
Dr. Ersek: Because Brook was already 5 feet 2 inches with her bones matured, there are no implications for her future body growth and development except that she will not have the fat deposits in her abdomen, arms, legs, flanks, neck, and chin to deposit additional fat.
Make Me Heal: Did you have any ethical dilemmas while considering performing or not performing the operation?
Dr. Ersek: Most plastic surgeons, including myself, would not consider advising liposuction for the average 12 year old. My niece is exactly the same age as Brook, and at the time that we did this surgery, my niece weighed 80 pounds. Brook was 230. I would not consider doing liposuction or any other cosmetic procedure for my niece because she is a normal, healthy 12-year-old child. Brook, however, was something quite different, and after meeting with her family and discussing this matter, I agreed to do this surgery. It is also important to realize that this was done under local anesthesia with Valium and ketamine dissociative sedation so that we consider this to be very safe. Safety, of course, is a relative term. In 30 years of doing about 30,000 procedures with this safe sedation method, all as an outpatient, we have never had mortality or a serious complication. No not once! We have never had a pulmonary embolism, a chipped tooth, malignant hyperthermia, hypothermia, vocal cord paralysis, positive-pressure pneumothorax or a negative-pressure pulmonary edema, or a variety of other problems associated with general anesthesia. Therefore, it is my considered medical opinion, based on a 30-year experience, that this safe sedation is very safe. During the time that we were treating Brook, there were several schoolhouse shootings where 30 children were killed at school. There were several school bus accidents that resulted in other children being killed. So safety is a relative thing. During the time we did the surgery and her one-week each recovery period, she was not at school facing those other dangers. So it was our opinion that this was a safe thing to do for Brook.
Make Me Heal: Can this experience show that a liposuction can be more effective than a gastric bypass to control weight?
Dr. Ersek: This experience shows that liposuction and abdominoplasty can remove a large amount of weight and that this will modulate one’s metabolism so that they can lose additional weight. Gastric bypass and lap band operate in a different way. Both of them absolutely restrict the intake of food, so that the patient is able to only eat a ping pong ball size bolus of food, no matter what he eats, mashed potatoes, string beams, meat, or Jell-O he is limited to a ping pong ball size meal. If they eat more, they vomit. After a few weeks, it gets easier and easier to eat these small amounts because the brain does not like the discomfort of vomiting and thus they get used to eating a small amount. Any one of us could lose substantial amounts of weight if we were to merely restrict out intake for a ping pong ball sized bolus of food. A few years ago it was popular for people to have their jaws wired shut so that they were unable to get their mouth open, so that they were restricted to a liquid diet. This of course decreased the amount of food they could possibly get in in a given period of time, and those people were quite successful in losing weight. Once they lose the weight, often they get used to these smaller amounts of food, and they can go on or years without gaining the weight back. However, all of these programs have their failures. Liposuction, on the other hand, removes fat and it is gone forever. It is an amputation. But in addition, based on recent studies by Sharon Giese and others, the removal of large amounts of fat by liposuction reduces ones appetite, reduces a variety of hormones and apocrines that are secreted by fat, and thus onset appetite is substantially decreased. We had a patient who had gestational diabetes, and so she took her fasting blood sugars every single Monday morning. She was a nurse, so it was easy to do, and she kept a record. She was certain she was going to die of diabetes like her mother did. She was very delicate. Her blood sugars were always between 150 and 200 until we removed 10.6 liters (that is about 25 pounds) of fat by liposuction at which time her blood sugar reverted to normal, 100, and remained there for a couple of years. Perhaps just as important is the fact that she then lost 60 pounds over the next six months. She had always been dieting and exercising but it was never very successful. After large liposuction, she lost an additional 60 pounds essentially on her own. So while gastric bypass and lap band mechanically restricts the amount that one can eat, large liposuction decreases the amount we want to eat.
Now just as lap band and gastric bypass have their failures, so too in some of our patients, even though they had an initial loss of weight greater than what we removed, when we have taken large amounts, we often find that in a year or two they also can gain weight. But in the studies reported by Sharon Giese in a group of otherwise healthy but overweight young ladies, she found that removing more than 10 pounds of body fat resulted in all of them losing a substantial amount of weight, and that reduced body weight remained when followed two years later. In addition, circulating insulin decreased and every single patient had a drop in their systolic blood pressure.
Make Me Heal: Should the patients consider other options before undertaking a liposuction in order to address an overweight situation?
Dr. Ersek: Before considering liposuction or abdominoplasty, a patient should do their level best at diet and exercise. There are probably a 1000 diet regimens available on the internet and books are published as fast as they fail, and in general restricting one’s intake to 1200 calories a day or so and avoiding carbohydrates and fatty foods, will reduce a body weight for everyone who is diligent and decreases their portion size. All of us have a different metabolic profile and for some people they seem to be able to eat pasta and anything else, French fries, hamburgers, cake, and anything else they like without restriction and never gain weight. A fine example is Johnny Carson. He sat right next to Ed McMahon for about 20 years on the air. They lived together, ate together, drank together, and Ed McMahon was always struggling with his weight. Johnny Carson never gained a single pound. And all of us know people who swear that they do not eat any more than their partner and one is fat as can be and the other is not. So I advise everyone to do their level best at diet and an organized exercise program before considering liposuction even for figure faults or cosmetic purposes, and especially as a treatment for obesity.
Celebrity and Look-a-like Surgeries
Make Me Heal: What does it really take to shape someone’s body to resemble another person? Is it as complicated as a regular surgery?
Dr. Ersek: Look alike surgery is no more difficult that any other surgery. It is quite common for patients to bring a picture with them to describe the kind of nose or breasts or figure that they wish. We are of course limited to what we start with that will predict, to a great extent, what we will end up with. If a dark, swarthy, large-boned girl with a big nose and sunken cheek bones brings in a picture of Pamela Anderson, we would have to have a long discussion before we would consider operating on her, let alone attempting to change her appearance significantly to look like the someone else that she wishes. On the other hand, usually when patient’s come in with a picture of Demi Moore, John Travolta, Keanu Reeves, Jennifer Aniston, and Drew Barrymore it is usually because someone had told them that they looked like that person, that they already had feature that are similar to that person. We have often done a chin implant and rhinoplasty, liposuction and other procedures to bring people closer to their ideal. A few are Jennifer Aniston look alike and Britney Spears look alike or Keanu Reeves look alike could easily pass for that movie star and are often mistaken for them after the surgery. But most others merely want one feature or another to be altered in a way similar to what they see in a picture of a movie star.
Make Me Heal: Which male celebrities are most requested for look-a-like procedures?
Dr. Ersek:Keanu Reeves and John Travolta and Ricky Martin are our most frequently sought after looks alikes.
Make Me Heal: Which female celebrities are most requested for look-a-like procedures?
Dr. Ersek:Demi Moore, Jennifer Aniston, and Drew Barrymore are the three that are most frequently described in terms of female faces. When it comes to breast surgery, Dolly Pardon is the one that is most usually suggested as what they do not want to look like.
Make Me Heal: Why do you think so many people choose to look like a particular person instead of a better version of themselves?
Dr. Ersek: Most people do not want to look like another person. Even some of those that have brought in a picture of Demi Moore, for instances, or Jennifer Aniston, did not say that they want to look exactly like these movie stars. It is very unusual. There are, of course, some entertainers that make a living by doing impersonations and some of those actually bring the picture in of the star they want to impersonate and do their very best, come as close as possible to that star. They will go to amazing extremes.
Make Me Heal: How do you feel about certain patients who have become addicted to plastic surgery and the idea of perfecting themselves such as Cindy Jackson, who has been referred to as the “Human Barbie”?
Dr. Ersek: Many patients become obsessed with their appearance. This manifests itself in some people by extravagant wardrobes. They will constantly shop for shoes and clothes that they feel set them up to look their very best. Sometimes this becomes transferred to their actual physical appearance and they will have a great deal of plastic surgery performed. I have several of those patients. And when it becomes extreme or it seems unreasonable, I do everything possible to talk them out of that next nip or tuck, often refusing to continue when positive results are not likely. Often this will occur quite innocently when they have gone through life with some defect, such as a hump on the nose or prominent ears, and have that one thing repaired and see the tremendous difference that it makes, not only in their appearance but how others treat them. I recall one lady for whom we did a facelift, brow lift, eyes, and nose who was about 72. She wrote me the nicest love letter afterwards telling me how we had changed her life so dramatically because people now treat her like a human being. She was 72 years old and she said that no one paid any attention to her when she would go to the grocery store, and so forth, people would make change but they would not engage her in conversation and would not look at her. Whereas now they were cheerful and smiling and everyone noticed her. One of the differences is that when someone is older and things are sagging, they look sad. In fact, they look unhappy. And if other people perceive unhappiness in us, they will not want to engage us in conversation or spend much time or attention with us. Whereas, if we have a countenance that is cheerful and a feeling that is happy, we tend to project that and it is the function of the face to look human and to convey emotions. And if the emotion being received by others is one of happiness and joy, they will tend to feel that way in that ones presence. The opposite, of course, is also true. Like dieting, exercise, gambling or weightlifting, things can go to an extreme, and this is true for plastic surgery also. It is a phenomenon called body dysmorphic syndrome where people become completely obsessed with their appearance and go to unreasonable lengths to try and improve it. Those patients are never happy no matter what we do for them. They are easy to diagnose because usually when they come to see us, they have already had five, ten, or twenty different procedures. Often they will forget many of those past procedures when they are discussing their medical history. It is a real tip off that some one could be trouble.
Performing Liposuction On Myself
Make Me Heal: Among your famous feats was your having performed liposcution on youreslf. You’ve been quoted as saying that the reason you performed liposuction on yourself was to take “a sample of my own fat to freeze in case I needed some for a medical procedure in the future.” Was liposuction the only possible way to accomplish this?
Dr. Ersek: The liposuction that I did for myself was not a treatment, it was merely a collection of a sample. I did it myself to demonstrate how safe and simple and easy it is to store one’s stem cells for future use. It would have been possible to store my own bone marrow cells, but that is a very painful and difficult procedure that requires thrusting a trocar through the outer table of the sternum or the hip bone and then sucking out the marrow. It is excruciatingly painful and cannot be relieved by local anesthesia, whereas liposuction merely requires a small injection of local anesthesia, such as Xylocaine, wait a few minutes until the area is numb, and then the cannula can easily dance to and fro, to and fro to remove a few hundred centimeters of subcutaneous fat. This fat is then treated by a laboratory that separates out the stem cells from the fat cells so that they can be stored in liquid nitrogen for a very long period of time. It would also be possible to simply have an abdominoplasty to remove a large amount of skin and fat and use that for the source of stem cells. The liposuction is so safe, so simple, and it just takes a tiny prick to gain access to the subcutaneous fat. It leaves hardly a freckle afterwards.
Make Me Heal: Also was it necessary for the liposuction to be self performed? Would it have been safer for the procedure to be performed by someone else?
Dr. Ersek: It is not necessary or recommended that liposuction be performed with ones self. Circumstances around my doing that were very unusual. On August 26th I was preparing for a symposium at my clinic where 100 plastic surgeons from around the world were coming to see a demonstration liposuction case and a few other cases and have a series of lectures by experts in the field. The patient who was scheduled for liposuction had chosen to store her stem cells on that day, and so the laboratory in California that collects and stores the cells had sent their representative to show my staff how to collect the samples and how to handle them while they are being prepared for storage. And thus, I decided that since they were here, I would store some of my own cells. Someone on my staff said, “Well, would you do your own liposuction?” I said, “Yes, I could do that.” I only thought it would be a demonstration case to show how safe and simple it was. At the time, in the room I had my own associates, Dr. Schaeferle and Dr. Beckham, both Board Certified plastic surgeons, and both very familiar with liposuction. They were right there. In addition, Gerard Illouz, the inventory of liposuction, happened to be there in preparation for the symposium the next day and Matti Pakenen, professor of plastic surgery from Helsinki Finland was also there in the room. So we had plenty of qualified backup ready, willing, and able to help out should there be any untoward event. Of course there was not. It went off without a hitch, and I do not recommend auto suction and I do not recommend anyone do their own liposuction. It is much safer, simpler, and easier to have it done by someone else and to be sedated during the whole procedure.
Make Me Heal: What type of anesthesia was used in this type of procedure? Are different types of anesthesia used in different liposuction procedures? In other plastic surgery procedures are patients typically anesthetized completely?
Dr Ersek:The anesthesia used to do my own liposuction was purely local. I merely injected the area with Xylocaine with epinephrine. In a few minutes, it is completely numb. The epinephrine causes the blood vessels to shrink down so there is very little bleeding. Other plastic surgeons use a variety of different methods for anesthesia. The most profound and most complicated is general anesthesia. The least profound is a so-called tumescent technique, where they merely infiltrate large amounts of local anesthesia and fluid to balloon up the tissue, render it numb before liposuction. What I do is between these two extremes. I believe that general anesthesia carries with it the complications of deep vein thrombosis and subsequent pulmonary embolism, malignant hyperthermia, hypothermia, chipped teeth, vocal cord injuries, arrhythmias all of which can be avoided by avoiding those profound anesthetic agents and intubation. The method we use is safe sedation. It includes tranquilizing the patient with Valium and then giving them a very small mini dose of ketamine. The usual recommended dose of ketamine is around 300 mg. We give 75 mg. It causes the patient to be completely asleep for about 15 minutes, but during this time, just as in sleep, their reflexes remain intact. So some mucous accumulates in their throat, they will just swallow it or they will cough. The tone remains in their muscles, so that the deep veins within the leg muscles do not become stagnant, do not become clotted, and do not cause a deep vein thrombosis that can then break lose to case a pulmonary or brain embolism, all of which occur with general anesthesia. In addition, since we do not have to intubate anybody since they breath on their own, we avoid the problems of a tube down you windpipe. Of course we monitor everybody for their oxygen saturation, their heart rate, their blood pressure. But in 30 years with more than 30,000 procedures completed, we have never had a deep vein thrombosis, a pulmonary embolism, malignant hyperthermia, hypothermia, chipped teeth, vocal cord injuries, or arrhythmias and I do not anticipate we ever will. Because the mechanism of action is so different. Other plastic surgeons have a different opinion based on their experience. But anyone who has used this safe sedation method will then develop a great respect for general anesthesia, a great respect, and they will use it sparingly. We use this method for doing all cosmetic surgery procedures in our clinic and those include, from head to toe, hair transplants, brow lift, eyes, nose, facelift, breast reduction breast enlargement, liposuction from head to toe, labia reduction, and everything else.
Make Me Heal: Have you undergone any other plastic surgery procedures?
Dr. Ersek:I personally have had a facelift, brow lift, eyes and nose done under this kind of anesthesia. They were done by one of my colleagues, Dick Mladick in Virginia Beach, Virginia, and I do not recommend anyone do any procedures on themselves.
Dr. Robert Ersek is an internationally acclaimed surgeon. Recognized by his profession, he has published more than 100 articles and delivered lectures around the world. Dr. Ersek’s publications range from reconstructive surgical methods to skin grafting and technical reports on the suction-assisted lipectomy process. Dr. Ersek has developed and invented unique procedures for many surgical techniques. He is dedicated to the highest standards in the medical profession. He is a highly sought after speaker and educator on plastic surgery.
Among his many activities, Dr. Ersek is a Clinical Assistant Professor of Plastic Surgery at Southwest Texas State University and an Instructor at the University of Texas. He is certified by the American Board of Plastic and Reconstructive Surgery and a member of the American Medical Association and the Texas Medical Association. He is affiliated with every major hospital in the Austin area.
Dr. Ersek is active in many civic organizations including the Austin Symphony and Ballet Austin. He is a member of Austin Smiles, visiting remote countries to provide plastic surgery for the poor.
Tags: celebrity, plastic, surgery