Liposuction
Liposculpture
  Liposuction    
INTRODUCTION:



Although a healthy lifestyle, proper diet, and exercise are the optimal tools to achieve and maintain a healthy, toned, and youthful body, there are certain areas of the body where fat deposits are highly resistant to these modalities.  For these areas, liposuction offers a great alternative to eliminate the amount of fat present, and to contour the remaining tissue to a more desirable shape.  Although a rudimentary type of liposuction was performed as early as 1921, it wasn't until the 1970s when the available technology made it possible to perform liposuction as we know it today.  Liposuction has reached such popularity that it has become the most common cosmetic surgery procedure performed in the United States.

IS LIPOSUCTION FOR YOU?

Liposuction is intended to address problem areas of fat deposition which are resistant to diet and exercise, and to improve the contour or shape of the body. It is not intended as a weight reduction modality. Thus, liposuction is indicated on healthy patients who are within a certain range of their ideal body weight (within 30% is recommended). For obese patients who have undertaken a weight reduction program, liposuction is only indicated after the weight loss is completed, and the weight has stabilized. In these patients, liposuction is done to address localized problem areas.

Since the contour changes after liposuction occur in part, by the natural shrinking of the skin after the excess fat has been suctioned, liposuction results are best noted in younger patients who have optimal skin elasticity. Liposuction has been successfully performed in all areas of the body including face/neck, arms, torso, and legs. Although most of the time liposuction is performed as the sole procedure, there are times when it is combined with other surgical procedures such as a facelift or a tummy tuck in order to optimize the results.

When considering liposuction, the initial consultation with your surgeon is extremely important. A thorough review of your medical history will be performed to elicit conditions which might potentially put you at an increased risk of complications from the procedure. Medical conditions such as high blood pressure, or history of excessive blood clotting should be thoroughly investigated. Smoking has also been identified as increasing the rate of complications. Furthermore, birth control pills, estrogen replacement therapy and smoking might place you at an increased risk of blood clot formation in the lower extremity or lungs, perhaps the most serious complication of this procedure.
 
A thorough physical exam will then be performed where your height, weight, and perhaps your body max index (BMI) will be calculated to ensure you are within a certain safe range of your ideal body weight. It is at this time that you should communicate with your surgeon the areas that you would like treated. The nature of the elasticity of the skin will be assessed, as wells as the topography and contour of the problem areas. Skin irregularities or cellulite in the problem areas for example, might not disappear or perhaps may be worsened with liposuction, especially if the skin elasticity is not optimal. When discussing each specific area to be treated, your surgeon might discuss with your whether liposuction alone will achieve the desired result, or whether other options might be considered in lieu of, or in conjunction with the liposuction. Certain areas of the body respond better to liposuction than others. The area under the chin and the outer thigh for example, usually respond very well whereas liposuction of the inner thigh is known to have a significant patient dissatisfaction rate. In men, liposuction can be utilized to treat the same areas as in women. This modality is also particularly useful in the treatment of excess breast tissue accumulation in men, a condition known as gynecomastia.

UNDERSTANDING THE SURGERY:

Local liposuction of a small area can be performed in an office setting and even with local anesthesia. When the areas to be treated are more extensive however, usually a hospital facility and general anesthesia are required. After the patient is positioned, usually the areas to be treated are injected with a solution which contains saline, local anesthesia and epinephrine (a solution which shrinks the size of the blood vessels in the area). This is done in order to minimize the amount of blood which is suctioned with the fat. This in turn, will not only decrease the chances that a blood transfusion will be necessary after liposuction, but will also minimize the swelling and bruising after the procedure. Some of the terminology utilized to describe this technique of injection of fluid to the areas to be treated include terms such as wet, superwet, and tumescent, and describe different amounts of fluid to be injected to the treatment site. In the tumescent technique for example, large amounts of fluid are injected to the point where the fat compartment becomes taught or firm to the touch. This allows for the liposuction instruments (cannulas) to better glide through the fat during suctioning, and greatly minimizes the amount of blood suctioned along with the fat tissue.

   
The procedure itself involves making small cuts (incisions) strategically placed on the skin at the periphery of the areas to be treated. Through these cuts, the liposuction cannulas are inserted in order to treat the areas in question. Normally, the area to be treated is approached from multiple directions to minimize the rippling or surface irregularities that are sometimes seen with this treatment modality. By utilizing different types and sizes of cannulas the surgeon will not only be able to suction the excess fat deposits, but also mold or shape the fat under the skin (liposculpture) and give that particular area of the body an improved shape and contour. As the technology has improved, newer modalities have emerged that allow for the liposuction process to be done more efficiently. One of these technologies which your surgeon might mention is ultrasound assisted liposuction (UAL). This technique utilizes sound waves to soften or liquefy the fat, thereby making it easier to suction. This technique is particularly useful when liposuction is anticipated in areas of the body where the fat tends to be more fibrous (denser) and thus, more difficult to suction. This is the case in areas such as the back, male breast, and calves.
 
After the areas to be treated are contoured to the surgeon's satisfaction, the small skin incisions are closed with small (usually resorbable) sutures. The surgeon will then usually apply a compression garment to the areas that were treated right in the operating room. This garment is to be worn for a period after the surgery which can last from days to weeks, depending on the area that was treated. This garment helps compress the skin to the underlying tissues. By doing this, it allows the skin to reattach to these tissues in the proper place, and also minimizes free space under the skin where fluid can accumulate in the postoperative period. You might find that this compression garment will give you added support and comfort as you heal in the first few days after the procedure.
 
If the liposuction is extensive enough to warrant an overnight stay at the hospital, usually you will be discharged on oral pain medications the next day. Although you might experience some bruising, swelling and numbness in the areas that were treated, the discomfort should not be excessive. You should be able to return to normal daily activities within a couple of days. Your surgeon will ask you to come for a follow-up visit usually within the next week, where he/she will inspect the incisions, surgical sites, and address any concerns you might have. As your body heals and the skin shrinks over the next few days to weeks, the improvement in the areas treated will soon become evident.

As with any surgical procedure, there are certain potential risks that can occur. It is important that you understand those risks and discuss them with your surgeon until all your questions are answered to your satisfaction. Some of the risks involved include the following:

Asymmetry: When liposuction is performed on areas on both sides of the body, part of the goal of the surgery is to end up with symmetrical results. At times however, this goal is difficult to achieve as these areas might not be entirely symmetrical to begin with, or the fat deposits might be different in amounts or density from side to side.

Clots (Thrombus) on legs/lungs: One of the more serious complications of liposuction is when blood clots develop in the legs or the lungs. There are certain medical conditions such as lupus or medications such as birth control pills that might predispose the patient to this. Also at increased risks are obese patients or patients who remain immobile for extended periods of time, as in long surgical procedures. In order to minimize this complication, your surgeon will attempt to modify or eliminate all possible risk factors. There are also certain modalities that can be utilized during the surgery, such as leg compression devices or the injection of a blood thinner like heparin, that have been shown to reduce this risk as well.

Infection: The risk of infection with liposuction is extremely low. If infection does occur, it is usually a superficial infection around the site of the incisions. If a deeper infection does occur, further surgery might be necessary to treat it.

Changes in skin sensation: As with any type of surgery, liposuction may disrupt the nerves that supply sensation to the skin. This can result in areas of skin that feel numb or at times, loose all sensation. This condition is usually temporary and sensation returns to normal within a few weeks to months. There is the possibility that the changes in sensibility might remain permanently, but this is seen rarely.

Skin discoloration: Initially after the procedure, bruising may be present. There is also the potential however for changes in the pigmentation of the skin. These changes are usually temporary as well, and permanent discoloration is also rare.

Skin contour irregularities: Although surgeons take great care to avoid this condition, contour irregularities, dimpling, and wrinkling of the skin can be seen after liposuction. This has to do with a combination of the fat removal from under the skin, and the skin shrinking that occurs after the procedure. Usually, these contour irregularities are very subtle if they happen at all. When they persist for extended periods of time, or are very noticeable, further intervention in the form of liposuction or surgery may be necessary to correct them.

Seroma/hematoma formation: Through the process of liposuction, a void or space is created where the fat was suctioned, between the skin and the deeper tissues. This is the space where blood (hematoma) or fluid (seroma) can accumulate. In order to prevent this, your surgeon will take all steps to minimize bleeding during the operation. Pressure garments also help in preventing the accumulation of fluid. If a seroma or hematoma does occur and it is small, your own body might gradually resorb it without further intervention. Sometimes if large however, intervention via aspiration with a needle or open drainage might be necessary to removed this collection of fluid or blood.

WHAT TO EXPECT AFTER THE SURGERY:


For any significant liposuction, your surgeon might keep you in the hospital overnight. This is to allow you ample time to recover from your anesthesia, and to make sure all body fluids removed by the liposuction process are replaced. The day following your surgery however, you will be able to go home. Your surgeon will most likely ask you to keep your compression garment on at all times. If drains are utilized for the procedure, you might be asked to keep them for the first few days and instructions will be given to you by your surgeon or nurses on their care at home. You will be encouraged to be as active as possible and you should be able to return to normal daily activities within a couple of days.

You can anticipate some swelling, bruising and numbness at the surgical site. There might be some soreness as well, which is usually easily controlled with mild to moderate pain medication. Bruising and swelling will be greatest within the first couple of weeks and will then begin to dissipate. Several days after the surgery, your surgeon will ask you to come into the office where the treatment areas and incisions will be inspected, and sutures may be removed. Your surgeon at that time will give you detailed instructions on the use of the pressure garment, level of activity, and further follow-up appointments.

With time, the swelling and numbness will resolve. This will be further enhanced as your level of activity progressively increases. The incisions will heal to the point where they will become almost imperceptible. This process will take several weeks to months and it is important to be patient while your body heals.

THE NEW YOU




As opposed to other procedures in plastic surgery where the final changes become evident almost immediately, liposuction is the type of procedure where the initial changes are followed by continued improvement over time, as the residual tissue swelling diminishes over the course of weeks to months. Your initial result will be enhanced with time as you feel increasingly better and more confident with your new body shape. Furthermore, this might lead to a more active lifestyle which will reap further benefits in creating a more youthful, toned, and healthier you.
 
The information provided above is for educational purposes only.  Individual results may vary.  A personal consultation with your plastic surgeon is the best way to gain information about your particular complaint, and about potential treatment options to address the same.

 

 
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