My thighs journey to the end of the world

TL;DR
I traveled from New York to Medan to get liposuction from the world’s best surgeon, Dr Arthur Tjandra at Elixir De Vie. I lost fat, and also survived. I document my Odyssey below. The entire video sequence is at the end of this post, for those of you who want to go straight to the before, the bloody OR, and the after.

WARNING: Obviously, this post contains blood and nudity. This is strictly an educational medical documentary. If you are a pervert, or worse, someone offended by breasts, do not continue. I forbid you to press play.

I am a 5″5 cross country runner from Connecticut who has struggled with being bottom-heavy for most of my life. In spite of running 6 miles every morning and being on a strict vegan diet, I have stubborn pockets of fat on my thighs, buttocks, and stomach which do not respond to exercise or starvation. For years I have wanted an Olympically slim figure, and by slim I mean actually skinny, skinny like Svetlana Zakharova and Mo Farah, not Instagram skinny-fat like Gigi Hadid or Kate Upton. Is that too much to implore my chubby Asian genes, I wondered? Yes, it is, a cosmetic surgeon on Fifth Avenue and two endocrinologists in Mount Sinai informed me solemnly.

I did a lot of research on RealSelf and healthgrades about liposuction, but was astonished to find a scarcity of photographed testimonials from slender people who had undergone surgery in America. We are inundated with stylish, heavily edited infomercials from Beverly Hills doctors who claim to target womens’ problem areas, and new technologies like SmartLipo or “4D Vaser” which boast superior results that no mortal surgeon could emulate by hand. One never sees these techniques demonstrated on already thin people with isolated problem areas, only on those who are overweight where any ‘tread marks’ left by the cannula are not visible post op, or where no rigorous sculpting technique is necessary as the patient requires only some mass reduction.

I consulted with several surgeons in the New York area. The surgeon who had done my calves and torso a year previously had only done a moderately decent job, and was unwilling to do anything more. I was informed unequivocally by all but one of them that there was nothing they could do for me, that I did not have enough fat to leave a margin for error during the surgery. They said that it was impossible to remove fat from below the buttock, as this would cause the buttock to collapse. They said that there was a minimum size and level of fat a patient had to be in order for liposuction to have any benefit at all, and that I did not meet that standard.

The last surgeon I met with was a little different. He looked very different in person than on his website photo, and I would not have recognized one from the other. He had had so much work done on his face that he looked virtually ageless, genderless, waxy, pink and inhuman; he had clearly photoshopped his own photo as well as his before-and-afters. Lastly, I was horrified to discover that he was not board certified in America. I painstakingly searched his website as well as the ABS to find his certifications, but the only measurable qualification that he boasted of was being “bi-coastal”. (I was able to verify that he had indeed visited both the East and West coasts of America.) Needless to say, you should always make sure your doctor is board certified, has experience as a cosmetic and not just plastic surgeon, and specializes in liposuction instead of being a boob doctor, nose doctor, or labioplasty doctor. And for obvious reasons, you should not trust a doctor who looks like a Real Housewife! (If you think judging a doctor on appearance sounds unfair, consider this: would you trust a designer with terrible taste? Or an orchestra conductor who was tone deaf? The chances of you coming out of surgery less ridiculous than the ideal of the perfect body in his mind are slim to none.)

What can we do as skinny-fats, neglected in our plight in search of the perfect body, plagued by stubborn pockets of fat, unstudied by the majority of doctors? Well, we can starve ourselves to death, yet still die a few sizes larger than Alessandra Ambrosio, or we can journey to the ends of the earth in search of an elusive genius who can sculpt us by hand. I am not being sarcastic, those are really our only two options. As I was already exercising two hours daily and eating a rabbit diet, I was resigned to the latter option. And since the price of this elusive genius was going up faster than Bitcoin, I decided to do it sooner rather than later. I started by emailing the office coordinator, Jennifer Cotto, who is quick with replies and very knowledgeable about all aspects of the surgery.  Like Siri, she is infinitely patient and helpful, and can answer any question, no matter how dumb. She also speaks impeccable English and sent about 20 emails to prepare me for my upcoming trip.

The flight is not an easy one. Medan is so off the international airline map that if you are traveling from outside of Southeast Asia, it will take you two days and at least two airlines. What is even more maddening is that New York has a direct flight to Hong Kong and then connects Singapore via Cathay Pacific, but then the flight from Singapore to Medan is operated by SilkAir/Garuda which do not align their schedules with international connecting flights. So you will have at least a 6 hour layover in Singapore. With no arrival lounge! The reason Dr Tjandra does not operate in Singapore anymore is because they recently passed a regulation that requires liposuction surgery to be done under general anesthesia. Dr Tjandra does not believe this is necessary, and moreover greatly increases the risk of complication. All surgeries are performed under local anesthesia only. That is the other caveat you should be aware of before reading the rest of this post: don’t bother going if you do not have tolerance for pain. It is not the same as going to LA, going under, and waking up when the operation is done.

I landed in Medan on a Tuesday night. Getting through customs was smooth although I was very nervous, sweating at the thought of being detained in an Indonesian interrogation room. Jennifer had warned me that you should prepare a hotel booking in advance because sometimes the authorities are suspicious of foreign travelers to Medan who say they are going for medical tourism. No one believes you would fly away from Singapore and into Medan for surgery. One of Dr Tjandra’s drivers picked me up and brought me to the clinic. It is quite nondescript and spacious, and does not look like a hospital on the inside. I was received by 3 nurses who unfortunately did not speak English. To my dismay I discovered that Jennifer Cotto does not reside in the clinic; she lives in Malaysia and handles all patient coordination from there. The head nurse, Yusma, is the only English speaker. Unfortunately she was on maternity leave so with great effort I communicated with the other nurses with broken English and hand signals. They gave me the post op care kit and told me that I would meet with Dr Tjandra in the morning. The rooms are simple, but there is decent wi-fi and an en suite bathroom, and most of us bring our own entertainment or books anyway. There are photos all around the house of a clearly accomplished marathon runner and a svelte underwear model; I only realized in the light of morning that they were both Dr Tjandra.

I had nasi lemak given to me in the morning. It can be eaten like a burrito but I recommend bringing your own cutlery. I finally met with Dr T at around 9 AM (3 days after my departure from JFK!) for a pre-op consultation. What can I say about Dr T that isn’t abundantly clear from his surgery videos (which is what he is most famous for on YouTube) and Elixir De Vie blog? He is delightfully vain, funny, precocious and blunt in a way reminiscent of Straits Chinese academics. He is also unabashed in his rightful condemnation of nearly every other cosmetic liposuction surgeon. The fact that there is no regulation on the majority of the cosmetic surgery market, that 90% of photos are doctored, that surgeons do not upload videos because they are impossible to doctor, that they devote considerable resources to mislead patients, and lastly, that modern liposuction techniques have evolved to be more harmful than beneficial, is deplorable indeed, and indicates a dark future for cosmetic surgery. But why would surgeons market suction assisted machines if they did not benefit more patients? Because the companies that make those machines are hundreds of times more profitable, and because it is easier to hold a vacuum cleaner and suck fat out by the liter than to hold a syringe and physically pump out fat by the gram. In fact, the latter is impossible for anyone who is not in Olympic shape, and Dr T is quick to reassure you that he is, and show you the evidence on his arms that he is as muscular as Lance Armstrong.

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Dr Tjandra, preparing for surgery.

The task of syringe liposuction is so taxing and exhausting that he has to run several marathons a year to be able to operate. It is the work of an artist and sculptor rather than a charlatan, it demands a fastidious attention to detail and ox-like stamina. It is also the reason that Dr T performs only one surgery per day.

The main advantages of syringe liposuction are:

  1. Liposuction is a blind surgery–the only truly blind surgery.  Imagine trying to rake a sandbox smooth with your eyes closed. A surgeon cannot see what is going on under the skin, he can only feel it. Vibrations from a machine will interfere with his tactile sensation, which is exacerbated by the machine’s suction amplifying any errors.
  2. For obvious reasons, it is much less traumatic to the body than machine assisted suction. You are more likely to puncture someone’s intestine with a giant cannula than a syringe.
  3. Mistakes can be cleaned up. Aspirating fat with a machine will probably cause unevenness or grooves. Imagine Michaelangelo sculpting David with a concrete drill instead of a chisel.
  4. Smaller incision scars. No stitches necessary.
On the left, the Michelangelo's statue of David using Renaissance era sculpting methods (mallet, chisel, file). On the right, Barría Robinson's Sentados Frente Del Mar statue using post modern sculpting methods.

For about an hour he informed me of all the risks of liposuction, the efforts he takes to minimize them, the post op care to avoid infection, as well as how much pain to expect during surgery. I have had my share of sports injuries and concussions,  and I endured excruciating pain after my last liposuction, so I wasn’t fazed by this. We also discussed what areas of my body I would like done–being a bottom heavy Asian woman, I wanted the saddlebags and love handles fat removed from my waist down, as well as thinner thighs. Dr T was shocked when I told him that I had been turned down by other surgeons. He said there was more than enough fat to pinch, and fat so unseemly he couldn’t understand why another surgeon might refuse.

I have read some reviews that people were offended by bluntly being told that they were fat, but you really don’t want to hear any different from a liposuction doctor. In fact, why would you ever want a plastic surgeon to tell you you look good?! To me that seems an implicit admission that they can afford to be lazy and enjoy a mojito in the OR while doing minimal work on you. I was so relieved to find a surgeon with a sharp eye for the aesthetic that I didn’t care about the length of the trip.  Dr T also said there was a 30% discount for those who gave videographic consent. I was unsure about being on camera and wanted to retain anonymity, but my face would be covered, and  being Asian I am never going to turn down a 30% discount.

For those of you not aware already, Dr T’s specialty is 3D liposuction.  Bodies are 3 dimensional objects and you cannot suction one surface without creating a lopsided shape from a different angle. For most of us, our fat is evenly distributed around problem areas and if you truly want to be skinny, you have to do an entire rotation to sculpt the area.  This is a great contrast to all surgeons in America who charge by the sub-sub-section of the body, in spite of their powerful machines. Of course, with the advent of 4D lipo®™ ©, you should expect no less than 3D lipo plus a time machine to bring you back 10 years. (It’s either that or the inventor is the first to successfully debunk the theory of general relativity.)

kebab
Think of your thigh as a doner kebab stand; would you trust a butcher who only shaved off the ‘saddle bag’ portion?

Because I was the only patient of the day, we were on a flexible time schedule. Dr T said I could make payment, have lunch, and then proceed to the operating room.  This is where the nightmare started. I had alerted all of my credit card companies that I would be making a large payment (roughly 9000 USD) from Indonesia. However, my card was declined. I called the American Express and Visa hotlines to ask them to release payment and turn off Chase Fraud services at least 20 times, and each time they said it was done, that it was more likely a problem with the credit card machine.  We had to call the local bank to send staff to the clinic. They didn’t speak much English, and took maybe 3 hours to resolve the issue by breaking up the payments into smaller ones. The first time the payment went through, the bank said they had not received the money, and so the saga restarted. If you come from a third world country, you will be used to this kind of inefficiency, but at a point so close to surgery, it was incredibly nerve wracking.

The surgery

I was prepped in the afternoon. I took two paracetamol, a course of antibiotic and was painted with iodine. Dr T then drew circles on my body where he would aspirate. This is my favorite part of surgery, like watching an architect design a sailboat out of a tugboat. Three nurses attended and Dr T inserted an IV drip in my hand.  This is my least favorite part of surgery; I am revolted by the thought of a plastic tube jammed in my delicate, tea-pouring hand. But this is where the drugs go in, so I can’t complain.

The rest is foggy. I remember being very cold. I remember being in moderate pain, especially for the inner part of my thigh and the section of my love handles that were so damaged from scar tissue from my previous liposuction. Never get Vaser, laser or smartLipo! Especially in America! They told me afterwards that I kept asking for more sedative, and I remember Dr T’s voice narrating the procedure on camera, but I wasn’t fully present or conscious, so it may as well have been a David Attenborough documentary playing in the background.

Here is what I would advise you if you are nervous: I have found that the fear of pain is almost always worse than the pain itself. If you can withstand something for ten minutes, you can withstand it for two hours. Sedated time moves faster than sober time, and by the end of it I had been drained of two liters of fat, which looks grotesque but is incredibly satisfying:

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Because Dr T injects adrenaline, you won’t bleed very much. The nurses wrapped my legs in bandages and squeezed me into my compression garment. I was able to walk upstairs, call my husband and fall asleep. I was pleasantly surprised by how little residual pain I felt afterwards. Of course, the drugs were still active and this would change the next morning. I threw up several times the first night, unable to keep anything down besides water.

On the second day I had a fever. I was nauseous and felt like I had the flu, falling sleep most of the time and vomiting when I tried to eat. The nurse responsible for my lympathic drainage massage left the bandages off for too long when she left the room, which resulted in my legs becoming terribly swollen and stiff. The massage helped somewhat, but the lack of English of the nurses made communication very difficult. Only one of them was independent of the others or seemed to know what she was doing, and I started to worry that they would have no idea what to do if I fell seriously ill. Luckily Dr T came by every few hours to check on me. He told me I was his weakest patient, but I was too sleepy to be offended. I concluded in my fevered state that he meant I am like the skinniest antelope in the Serengeti, too skinny for the lions to bother chasing.

Since I wasn’t able to drink enough he put me on a saline drip. I felt almost immediately better. He gave me something for the nausea, which stopped the vomiting also. He noticed I had a higher than normal heart rate, and thoroughly checked my blood tests for possible signs of hyperthyroidism. I continued to sleep for most of the day, periodically waking up for the nurses and Dr T to reprimand me for not eating. You probably won’t have any appetite after surgery, but congee is bland and odorless enough to swallow and it’s easier to force yourself than to argue. I was able to walk, but only if I had paracetamol every few hours. I would compare the pain to running a marathon without any training, an extreme soreness that makes you want to lie down all the time. But it’s bearable, and much less debilitating than the pain from traumatic machine-assisted liposuction.

On day three I was mobile. I could leave the clinic, eat proper food, and drink without feeling sick. The drainage massages hurt less. I continued with paracetamol and antibiotics and went to a nearby hair salon to get my hair washed. My wounds had also closed, so I was allowed to shower. I started making preparations for my flight the next morning, including confirming with Jennifer what time the driver would pick me up. I bid Dr T goodbye and tell him that I will be coming back eventually for more. He dismisses this as absurd. He has no idea.

I informed the nurses that I would be leaving around 6AM so I needed to be able to leave the clinic early. I was so excited to go home that I stayed up for most of the night, but when the car arrived I realized that the nurses had either forgotten or misunderstood completely and the gate was locked, so I couldn’t leave. I had to wake up Dr T to ask them to open it, in panic mode that I would miss my flight. In my bandages, compression garment, and half drugged stupor, I raced out the gate like an asylum escapee.

My flight home was much smoother than the outward leg. My legs were still swollen, but the compression garment helped reduce pain. I slept from the moment I entered the departure lounge until I landed back in New York. I was even able to go to work the next day, albeit on painkillers and walking very slowly. By the end of the week the swelling had gone down and I was able to see most of the results, awed by how much younger my butt looked and finally able to walk without my thighs rubbing.

In conclusion, if you are considering a trip to Medan for the same reasons as me, here is my breakdown of advantages versus disadvantages.

Disadvantages

  1. If you live outside of Singapore, the flight is an arduous one. If you live in Europe or America, it is like a pilgrimage from Los Angeles to Mecca.
  2. You’ll have to deal with the pain during surgery. It is not for the faint of heart.
  3. Indonesia is a third world country, which is why it is difficult to hire English speaking staff or experienced nurses, and if you are used to five star medical hotel nurses, it’s not for you. Still, I wish he had more English speaking or experienced nurses, instead of being the sole runner of the entire clinic.
  4. For those who do not carry thousands of dollars in cash, there is the possibility of credit card machine failure. If I could go back, I would make payment well before traveling to Medan.
  5. It ain’t cheap.  The combined cost of surgery and flights will set you back approximately one Toyota Prius. But here’s the thing. You’re not paying for him to rent out a Fifth Avenue office suite & operation amphitheater. You’re not paying for the five star resort, or the ex Playboy playmate receptionist. Perhaps most importantly, you’re not paying the mortgage on his 100 grand Vaser machine. The amenities comprise the bare minimum required for his clinic to run successfully. All you are paying for is Dr T’s blood, sweat and tears, and skills as a surgeon.

Advantages

  1. You will be the only VIP patient of that day, so all resources are devoted to you.
  2. Dr T is The Last Unicorn, the greatest liposuction surgeon in the world, the Michelangelo in an army of Jeff Koons body contouring doctors. You won’t find anyone else mentally or physically capable of 3D liposuction with nothing but a syringe.
  3. If you are already skinny, there is literally no one else who can (or should) operate on you.
  4. Less pain post-op than a traditional liposuction procedure.
  5. You are awake and thus able to see your body immediately after, or discuss what you want during.
  6. You stay in the same clinic where he resides, so he is able to attend to you at all hours after surgery, should there be any complications.
  7. He doesn’t bullshit you. This is especially meaningful if you come from a country where plastic surgery is ubiquitously and aggressively advertised but effectively unregulated. Unlike most plastic surgeons, he is not motivated by money. Ambition, yes, but ambition in the pursuit of science, which makes him either trustworthy or untrustworthy, depending on whether you are a patient or a competing surgeon. It also means he will turn you away if he doesn’t think he can help you. He doesn’t really want your money. He wants your case to be part of an elaborate, groundbreaking exhibit that cements his place in the annals of medical history. (Okay fine if you don’t want to be part of the exhibit then he does want your money.)

For the complete visual of before, during and after, please see the below! There are 12 videos.  For the full experience I recommend that you watch all of them. Be prepared for graphic visuals. If you faint at the sight of blood, do not watch this standing up. My husband was unable to watch from 2-11. Still, the phrase “from granny butts to bubble butts” is something that amuses him to this day.

Liposuction with Dr. Arthur Tjandra, Elixir De Vie

 

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