Procedures | Liposuction
Liposuction is one of the safest and most productive operations in plastic surgery. In properly selected patients, unwanted bulges and prominence can be eliminated by a short operation with almost no scarring. The operation is extremely safe with a relatively rapid recovery. Most patients state that there is very little actual pain, usually described as soreness when moving around for several days after the operation.
- What are the different types of liposuction and which is best for me?
- What is tumescent liposuction?
- What is recovery from liposuction like?
- Will a compression garment be necessary?
- When may I return to work?
- When will I see the results?
- What type of anesthesia is used?
- Is there much blood loss with liposuction?
- Will I get good long-lasting results?
- Will I get fat deposits in other areas?
- Is liposuction safe?
- Is it safe to have liposuction in an office instead of an operating room?
Ironically, the best results from liposuction are in thinner patients. The ideal candidate is slender with an isolated area of fat that is disproportionate to the rest of the body. Correction is accomplished by removing the unwanted fat by gentle suction. Liposuction is not a weight reduction operation. Patients who look to the procedure to obtain significant weight loss will be disappointed.
Liposuction also requires that the skin over the area to be treated will adjust to the decrease in fat volume. Removal of fat changes the volume of tissue between the skin and the underlying muscle. The surface area of the skin must shrink to prevent irregularities of contour. Younger patients (with youthful skin) therefore are the best candidates.
Imagine a balloon and a beach ball both filled with air. If one removes some air from the balloon, the surface remains smooth because the rubber in the balloon shrinks enough to prevent rippling. On the other hand, remove air from the beach ball and all sorts of surface distortions occur. This is because the beach ball's "skin" can only decrease in surface area so much. Additional reductions in volume are accompanied by "gathering up" of redundant surface skin. This results in dimples, wrinkles, or folds.
Obviously, balloon skin is preferred to beach ball skin for the liposuction patient. It is important in the pre-operative assessment to identify those patients whose skin will respond favorably and those who will not. Experience with the management of patients of all skin types allows the surgeon to comfortably predict who is and who is not a good candidate.
Patients may also have prominences produced by situations other than excess fat. After pregnancy, for instance, the abdominal muscles may be stretched forward creating a pot-belly look. This may occur even in women who are quite thin. Liposuction will have little effect on this group of patients. Formal reconstruction of the abdominal musculature in combination with liposuction will generate the best result. Once again, the experienced surgeon will be able to make an accurate assessment.
All types of liposuction involve removal of unwanted fat by aspiration. Variations in technique prepare the fat differently for its ultimate removal. Each of the preparations will be examined separately, but the common denominator is the removal of the final product by negative pressure (suction). The Center for Plastic Surgery offers conventional liposuction, mechanically assisted liposuction, ultrasonically liposuction, and laser-assisted liposuction.
Conventional liposuction-conventional liposuction uses strong negative pressure (suction) to physically remove fat. A canula is inserted through the skin and passed multiple times through the treatment area.
Mechanically assisted liposuction-a technique where conventional liposuction is assisted by rapid mechanical reciprocation generated by an electric motor. In addition to saving the surgeon arm fatigue, the agitation assists in making the fat more available for removal, particulary in places where there is a lot of connective tissue.
Ultrasonically assisted liposuction-ultrasound energy is delivered to break down the fat which is concurrently suctioned using the conventional technique. In addtion to this enhanced fat delivery, ultrasonic energy is converted in thermal damage that may help tighten skin and the connective tissue anchoring the skin to the underlying muscle.
Laser assisted liposuction-laser energy is delivered to the fat by a glass fiber line. A preset amount of energy is deliverd to a given area to break down the fat cells and create thermal injury to help tighten the skin and connective tissue. The laser line is removed and the byproduct of this laser treatment is removed by conventional suction or mechanically assisted liposuction.
Tumescence is not liposuction at all but a preparation of the fat for removal. It is used in almost all cases. The technique involves filling the fat with a dilute solution of lidocaine (an anesthetic) and epinephrine (to reduce bleeding and bruising). It also makes passage of the liposuction cannula (the tube that removes the fat) physically easier for the surgeon.
Liposuction requires only small puncture sites for access, not formal incisions. Therefore, wound management is relatively easy. No significant scars result from the procedure, and there is effectively no incisional pain. Patients complain of soreness over the areas treated, not much pain. Nevertheless, pain medicine is prescribed for the first several days after the operation should the patient need it.
Patients are allowed to walk around as soon as they recover from the anesthetic. This must be limited somewhat in patients undergoing suction of the legs to diminish swelling. Absolute bed rest is not required, but attention must be paid to swelling that may result if patients are on their feet for too long.
Patients may be taped in occasional circumstances but usually only a garment is needed to apply gentle pressure to the treated areas.
A compressive garment is not absolutely necessary, but will improve results by allowing the treated tissue to redrape more evenly giving a smoother result. Usually the garments are used in 2 stages. The immediate post-surgicaly garment is worn until the sutures come out (about a week). It is somewhat cumbersome to put on. The the second stage gament replaces the surgical garment. It slips on and off easily and is worn for about 6 weeks.
Most patients return to work in several days, depending upon their job responsibilities. Each patient's restrictions relative to work must be individualized. Athletic activity begins in 1-2 weeks again depending upon the extent of the treatment and the type of exercise the patient wants to do, as well as the amount of swelling. Special exercise apparel may be recommended.
The finished product of liposuction may not be observed for several months. Most of the significant swelling disappears in 4 to 6 weeks. However, an additional 20% or so will require longer to resolve. There is nothing the patient can do except wait. Compressive garments help somewhat but the biological forces at play follow their own time table.
Massage, ultrasound, and other post-operative therapies have their proponents but are probably a waste of time. There is no clear data supporting benefits of such maneuvers. Nevertheless, patients may receive subjective benefits, and for that reason there might be some advantage to them. Conversely, there is no evidence that massage therapy or ultrasonic treatment do any harm.
Depending upon the magnitude of the procedure, liposuction is perfomed sometimes with local anesthesia only, local anesthesia assisted by sedation, or a general anesthetic where the patient is put completely to sleep. Which route is chosen depends on the size of the area to be treated and tolerance of the patient for discomfort. Safety, needless to say, is the premier consideration.
Blood loss is extremely small with even relatively large procedures. Refinements in technique and anesthesia have made blood transfusions unnecessary. Patients are usually not required to donate their own blood as a backup since the likelihood of a transfusion is so small. Bruising is also minimized by the "tumescent' technique.
Blood loss may be further minimized by ultrasonically assisted liposuction or laser assisted liposuction. Several papers have reported remarkably low blood loss in massive fat removal-many thousands of cc's. This translates into less bruising and possibly less swelling.
Liposuction success depends, as mentioned earlier, on several factors: amount of fat removed, the condition of the overlying skin, and the projection of the underlying muscle. In the properly selected patient, liposuction yields spectacular results with effectively no scars. The results are permanent and do not require retreatment.
Liposuction removes not only fat but fat cells as well. It is thought that the number of fat cells in the adult are constant in number. Therefore, when the fat cells are removed from an area, the total number of fat cells that remain will be reduced in number permanently. The remaining fat cells may increase in volume with weight gain, but their capacity is limited. Thus, the results of liposuction are considered permanent.
Bad results do occur but are decidedly uncommon. Dimpling, skin loss, and skin discoloration have been reported but are almost never observed any more because of modifications in technique over the years. Occasionally when the overlying skin does not contract to accommodate the new volume do contour problems result.
It has been suggested that liposuction in one area will increase the propensity for fat accumulation in another area that has not been treated. For instance, if one has suction of the thighs, will there be a tendency to deposit fat in the abdomen or arms if they have not been suctioned? As far as is known, this is not the case. Liposuction is certainly not a method of weight control but it also does not increase the tendency for weight gain in other areas. Patients are still expected to manage their weight properly by diet and exercise.
Liposuction is a very simple and one of the safest operations when perfomed in the hands of experienced and properly trained surgeon. The procedure does require some form of anesthesia which creates the major risk for the operation. It is important that the patient understand the capabilities of the surgeon and the circumstances under which the operation will be performed.
Liposuction should be performed only by certified surgeons who perform the operation more than occasionally. The surgeon should be able to clearly explain the expectations and risks for each patient. There should be photographs of the physician's work to review.
The facility and the anesthesia personnel are just as important. Liposuction should be performed only in a certified facility with anesthesia administered only by licensed personnel. Patients should be thoroughly queried about their health history. They should be comfortable with the surroundings in the operating room and the personnel working there. Patients should also not be hesitant about getting more than one opinion.
Liposuction in an office should be undertaken only for small areas. The surgeon performing the procedure should have privileges in a surgical facility if a problem arises.