Liposuction Treatment, also known as lipoplasty ("fat modeling"), liposculpture or suction lipectomy ("suction-assisted fat removal") is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs, buttocks, to the neck, backs of the arms and elsewhere. The fat is usually removed via a cannula (a hollow tube) and aspirator (a suction device).
While exercise and dieting may be useful for losing unwanted weight and fat, some fat deposits may not respond to efforts at weight loss. Liposuction Treatment may be an option in these situations. Liposuction Treatment is not a low-effort alternative to exercise and diet. It is a form of body contouring with significant attendant risks and is not a weight loss method.
There are several factors that limit the amount of fat that can be safely removed in one session. Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over-suctioned". The more fat removed the higher the surgical risk.
Reports of people removing 50 pounds (22.7 kg) of fat are exaggerated. However, the contouring possible with liposuction may cause the appearance of weight loss to be greater than the actual amount of fat removed. The procedure may be performed under general or local ("tumescent") anesthesia. The safety of the technique relates not only to the amount of tissue removed, but to the choice of anesthetic and the patient's overall health.
It is ideal for the patient to be as fit as possible before the procedure and to have given up smoking for several months.
Relatively modern techniques for body contouring and removal of fat date back to French surgeon, Charles Dujarier. A tragic case that resulted in gangrene in the leg of a French model in a procedure performed by Dr. Dujarier in 1926 set back interest in body contouring for decades to follow.
Liposuction Treatment evolved from work in the late 1960s from surgeons in Europe using primitive curetage techniques which were largely ignored, as they achieved irregular results with significant morbidity and bleeding. Modern liposuction Treatment first burst on the scene in a presentation by the French surgeon, Dr Yves-Gerard Illouz, in 1982.
The Illouz Method featured a technique of suction-assisted lipolysis Treatment using blunt cannulas and high-vacuum suction and demonstrated both reproducible good results and low morbidity. During the 1980s, many U.S. surgeons experimented with liposuction, developing some variations, and achieving mixed results.
In 1985, two U.S. dermatologists developed the tumescent technique of Liposuction Treatment, which enhances effectiveness and safety in office-based procedures, partly by avoiding the use of general anesthesia. The patient is instead given twilight anaesthesia in which they remain partly conscious.
In the late 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying it using ultrasonic energy. After a flurry of initial interest, an increase in reported complications tempered the enthusiasm of many practitioners.
Overall, the advantages of 30 years of improvements have been that more fat cells can more easily be removed, with less blood loss, less discomfort, and less risk. A great deal has been written about it as practitioners and advocates wrestle with the alternatives and controversies.
Candidacy For Liposuction Treatment
Not everybody is a good candidate for Liposuction Treatment. As stated earlier, it is not a good alternative to dieting or exercising. To be a good candidate, one must be:
Over 18
In good general health
Have tried a diet and exercise regime, and find that the last 10 or 15 pounds persist in certain pockets on the body. Diabetes, any infection, or heart or circulation problems usually nullify one's eligibility for the procedure.
In older people, the skin is usually less elastic, so it does not tighten so readily around the new shape. In this case, other procedures can be added to the liposuction Treatment, such as an abdominoplasty / tummy tuck.
How can I find the right doctor for me
The FDA cannot recommend physicians to you. However, there are some things that you may consider:
Ask questions. If you decide to take the step to talk to a doctor about liposuction, be sure that you ask questions and understand what happens during the liposuction Treatment and what you can expect. Your physician should also answer any and all questions you have about potential problems with liposuction. Remember that you are purchasing a service when you pay a physician to do a liposuction procedure and you shouldn't feel embarrassed to ask hard questions about the procedure or about the physician's experience in performing liposuction.
Advertising. Be wary of advertisements that say or imply that you will have a perfect appearance after liposuction. Remember that advertisements are meant to sell you a product or service, not to inform you of all the potential problems with that service.
Don't base your decision simply on cost and remember that you don't have to settle for the first doctor or procedure you investigate. The decision you make about liposuction surgery is an important one but not one that you must make right away.
Read. You should learn as much as you can about liposuction Treatment. It is important for you to read the patient information that your doctor provides.
Don't be pressured. Do not feel that because you speak to a physician about this procedure that you must go through with it. Take your time to decide whether liposuction Treatment is right for you and whether you are willing to take the risks of undergoing liposuction for its benefits.
Will I look the way I want after liposuction Treatment
While medical complications are important, the reason that people have liposuction surgery is for cosmetic reasons. The cosmetic effect after liposuction may be very good and many patients report being satisfied. However, it is possible that the cosmetic effect will not be what you expected. In other words, your appearance after liposuction Treatment may not be what you expected or wanted. Some physicians counsel their patients that reasonable expectations are important.
It may be difficult to have reasonable expectations after reading advertisements and looking at pictures of women and men who have had liposuction. Remember that advertising is made to make you want to purchase a product or service. Advertisements do not usually tell you about problems or shortcomings of the product or service. If you want to know more about advertising ethics, or want to report on false advertising, explore the following websites:
Some cosmetic shortcomings after liposuction Treatment include:
There may be scars at the site where the doctor made the cut to insert the liposuction canula. These scars are usually small and fade with time but in some people, scars may be larger or more prominent.
The liposuction site may have a wavy or bumpy appearance after liposuction Treatment.
Liposuction Treatment results may not be permanent. If you gain weight after liposuction surgery, the fat may return to sites where you had liposuction or to other sites.
Results may be less dramatic than what you were expecting and this can be disappointing.
Approaches To Liposuction Treatment
The basic surgical challenge of any liposuction Treatment is:
To remove the right amount of fat
To cause the least disturbance of neighboring tissue, such as blood vessels and connective tissue
To leave the person’s fluid balance undisturbed
To cause the least discomfort to both patient and surgeon
As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, painless, and effective.
Techniques For Liposuction Treatment
Liposuction techniques can be further categorized by the amount of fluid injection and by the mechanism in which the cannula works.
Dry liposuction Treatment
The dry method Treatment does not use any fluid injection at all. This method is seldom used today.
Wet liposuction reatment
A small amount of fluid, less in volume then the amount of fat to be removed, is injected into the area. It contains:
Lidocaine: as a local anesthetic
Epinephrine: to contract the blood vessels and thus minimize bleeding
A salt solution: to make it saline, like our body fluids
This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure.
Super-wet liposuction Treatment
In this method, the infusate volume is in about the same amount as the volume of fat expected to be removed. This is the preferred technique for high-volume liposuction Treatment by many plastic surgeons as it better balances hemostasis and potential fluid overload (as with the tumescent technique).
It takes one to three hours, depending on the size of the treated area(s). It may require either:
IV sedation as well as the local lidocaine, or
Complete anesthesia
Tumescent Liposuction Treatment
In the tumescent technique, a large amount of fluid is injected into the area, perhaps as much as 3 or 4 times the volume of fat to be removed. It is the same saline fluid as used in basic liposuction, but its increased quantity creates space between the muscle and the fatty tissue, which creates more room for the suction tube (cannula) that the surgeon uses to remove the fat cells.
It is easier for the surgeon to make the back and forth movements that break up the fat cells and allow them to be suctioned out. Depending on the size of the area(s) being worked, this procedure takes perhaps four hours or so, longer than basic liposuction. This is because the fluid must be introduced carefully and about an hour must be allowed for it to percolate and enlarge the area before any work is started.
The high volumes of fluid and local anesthetic required for this technique have limited its use with larger cases.
Mechanism of Liposuction Treatment
Suction-assisted liposuction Treatment (SAL)
Suction-assisted liposuction Treatment is the standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
Ultrasound-assisted Liposuction Treatment
Also referred to as ultrasonic liposuction. A specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat, i.e., liquefying it, and making it easier to suction out.
UAL is a good choice for working on more fibrous areas, like the upper back, or male breast area
It takes longer to do than traditional liposuction Treatment, but not longer than tumescent liposuction
There is slightly less blood loss
So far, there appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle
After ultrasonic liposuction Treatment, it is necessary to perform suction-assisted liposuction to remove the liquidied fat.
Power-assisted Liposuction Treatment (PAL)
PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional UAL.
The cannula movement is more subtle, which creates less discomfort for the patient
So far, there appears to be less risk of puncturing internal organs, because of the more controlled cannula movement.
External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary.
It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially:
Cause less discomfort for the patient, both during the procedure and afterwards
Decrease blood loss
Allow better access through scar tissue
Treat larger areas
At this time however, it is not widely used and studies are not conclusive as to its effectiveness.
Stitches
To stitch or not to stitch is the surgeon's decision. Since the incisions are small, and since the amount of fluid that must drain out is large:
Some surgeons opt to leave the incisions open, the better to clear the patient's body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly by themselves.
Others stitch them only partially, leaving space for the fluid to drain out
Others delay stitching until most of the fluid has drained out, about 1 or 2 days.
In either case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient Treatment.
The procedure
In all liposuction methods, there are certain things that should be done when having the procedure.
The candidate and the surgeon will agree ahead of time on exactly which area(s) will be treated and both will discuss what outcome to expect
A consent form is signed on the day of surgery
An antibiotic will be given either about an hour beforehand, or afterwards
The targeted areas are marked on the body while the candidate is in a standing position
Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos
In the operating room, a sterilizing solution such as Betadine, is applied to the relevant areas
Local anesthetic is injected and the patient may be given a sedative, either orally, or through an IV injection
Incisions are small, about a quarter to a third of an inch
The patient will probably have an IV fluid line, since they will be losing fluid with the fat, and the fluid balance must be kept intact
There will be some monitoring devices attached to the body to keep track of the blood pressure, heart rate, and blood oxygen level
The patient will feel only a scraping or rasping sensation from the cannula movement
Usually the patient can get up, walk around, and go home the same day if they did not receive general anesthesia, although they’ll need someone else to drive
Recovery From Liposuction Treatment
Afterwards, a compression garment or Ace bandage will be worn until drainage has stopped, perhaps days, or perhaps for two to four weeks, depending on the specific case
Bandages will be changed after one or two days
Drains and sutures will be removed after five to ten days, or whenever the drainage is finished
Any pain is controlled by a prescription or over-the-counter medication, and may last as long as two weeks, depending on the particular procedure
Swelling will subside in anywhere from two weeks to two months
Bruising will fade after a few days or maybe as long as two weeks later
Numbness may last for several weeks
Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on the procedure
The final result will be evident anywhere from one to six months after surgery, although the patient will see noticeable difference within days or weeks, as swelling subsides
Expediting recovery
The patient should:
Drink enough water to prevent dehydration
Avoid alcohol for a couple of days, both before and after surgery
Avoid using ice packs or heating pads on the treated areas
Postpone any submersion in water for at least a week (bathtub, swimming pool, river, etc.)
If any dizziness is experienced, the patient should take it easy: stand up slowly, get some help for the shower, remove the compression garment slowly, etc.
The suctioned fat cells are permanently gone. However, if the patient does not diet and exercise properly, the remaining fat cell neighbors could still enlarge, creating assorted bulges.
Side effects of Liposuction Treatment
A side effect, as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful.
Bruising: can be painful in the short term, and should fade after a few weeks.
Swelling: should subside gradually over a month or two.
Scars: will vary in size depending on the particular procedure, and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.
Pain: should be temporary and controlled by either over-the-counter medication, or by a prescription.
Numbness: sometimes persists for a few weeks.
Limited mobility: will depend on the exact procedure.
There could be various factors limiting movement for a short while, such as:
Wearing a compression garment
Keeping the head elevated
Temporary swelling or pain
The surgeon should advise on how soon the patient can resume normal activity.
Allergic reaction to anesthetic: most liposuction is done with local anesthetic, so the risks of general anesthesia are avoided.
Infection: any time the body is incised or punctured, bacteria can get in and cause an infection.
Damage to the skin: most surgeons work on the deeper levels of fat, so as to avoid wounding the skin any more than they must for the insertion of the cannula.
Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface.
Skin necrosis (death) is a rare complication, in which the skin falls off in the necrotic area. Bacteria can then invade.
Puncture of an internal organ: since the surgeon can't see the cannula, sometimes it damages an internal organ, such as the intestines during abdominal liposuction. Such damage can be corrected surgically, although in rare cases it can be fatal. An experienced cosmetic surgeon is unlikely to puncture any internal organ.
Contour irregularities: sometimes the skin may look bumpy and/or withered, because of uneven fat removal, or poor skin elasticity. We all heal differently, and with older patients the healing may be slower and a bit imperfect. Sometimes a small touch-up procedure can help.
Thromboembolism and fat embolisation: although liposuction Treatment is a low-risk procedure for thromboembolism including pulmonary embolism, the risk can't be ignored.
Burns: sometimes the cannula movement can cause friction burns to skin or nerves. Also, in UAL, the heat from the ultrasound device can cause injury to the skin or deeper tissue.
Lidocaine toxicity: when the super-wet or tumescent methods are used, too much saline fluid may be injected, or the fluid may contain too high a concentration of lidocaine. Then the lidocaine may become too much for that particular person’s system. Lidocaine poisoning at first causes tingling and numbness and eventually seizures, followed by unconsciousness and respiratory or cardiac arrest.
Fluid imbalance: since fat contains a lot of fluid and is removed in liposuction, and since the surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there is a danger of the body’s fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected.
The cosmetic surgeon should give the participant a written list of symptoms to watch for, along with instructions for post-op self-care.
What are the Alternatives to Liposuction Treatment
Liposuction Treatment is usually cosmetic surgery so is not considered medically necessary (there are rare exceptions to this).
Because of this, it is you who will decide whether or not you will undergo Liposuction Treatment.
You may decide that Liposuction Treatment is not right for you.
You may make this decision without consulting a physician or after consulting with a physician. A consultation with a physician does not obligate you to have liposuction if you decide that you do not want to.
Some of the alternatives to liposuction Treatment are:
Change diet to lose some excess body fat.
Exercise.
Accept your body and appearance as it is.
Use clothing or makeup to downplay or emphasize body or facial features.
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