Liposuction
What
is liposuction?
Liposuction
- also called lipoplasty or liposculpture
- is the surgical removal of fat tissue
from specific areas of the body. The
basic technique involves making small
incisions in the skin, inserting a
tube through them into a fat deposit,
and using a suction device to remove
fat as the tube is moved through the
desired area.
Who
is a candidate for liposuction?
Candidacy
for liposuction primarily depends
on two criteria that are common to
many cosmetic
procedures: physical condition
and familiarity with the operation.
Honestly assessing each of these will
help the patient to determine if the
procedure is appropriate.
A
prospective liposuction patient should
be of average weight, so that only
a small volume of problem fat in a
specific area needs to be removed.
It is also beneficial to have fairly
elastic skin, which is often not the
case in older patients. Liposuction
can be particularly risky for patients
with diabetes, heart disease, lung
disease, or poor circulatory systems.
Having liposuction in an area that
has recently been operated on can
also cause problems.
The
most important point to understand
about liposuction is that it is intended
to remove fat from problem areas.
It can aesthetically improve one or
more spots on the body of a person
who is in good overall shape. Some
of these areas include:
- The neck and face
- The upper arms
- The breasts or chest
- The back
- The waist or abdomen
- The hips and buttocks
- Parts of the legs, such as the
thighs, backs of the knees, calves,
and ankles
However,
it would be dangerous to employ lipoplasty
as a means of overall weight loss,
and it would be misguided to try to
use it to directly treat cellulite.
It is also important to remember that
the procedure will not necessarily
improve a patient’s self-image.
How
is liposuction performed?
Preparation
for liposuction is important to its
success. Liposuction
takes a significant toll on the body,
especially in terms of fluid loss,
and therefore precautions must be
taken. When meeting with the patient
a few weeks before surgery, the surgeon
usually makes certain recommendations:
namely, to stop smoking and avoid
certain vitamins and medications.
The doctor may also suggest that blood
be drawn ahead of time for use during
the procedure. Finally, a cold or
infection - especially of the skin
- may be cause for postponing the
procedure.
An
overnight hospital stay may or may
not be required for liposuction. Smaller
operations are typically outpatient,
but the surgeon may want the patient
to stay under care for the first night
if more than one area is being operated
on or if a particularly large volume
is being extracted. General anesthesia
is used only in large volume procedures;
regional or local anesthesia is more
common. If fluid injection is used,
the solution may contain the appropriate
anesthetic.
The
general liposuction technique begins
with incisions in the area of the
fat deposit. The liposuction
surgeon will try to make these
as inconspicuous as possible. The
surgeon will then insert a small tube,
called a cannula, deep underneath
the skin. The tube will be connected
to a vacuum source, such as a syringe
or motorized vacuum. The vacuum will
suck the fat out as the surgeon moves
the tube back and forth through the
fat deposit. When the surgeon has
removed the predetermined volume,
the tube is removed and the incisions
stitched up.
Liposuction
technology is constantly improving.
There are several new techniques that
have made liposuction less painful
and more efficient. They also help
the liposuction surgeon to specifically
address the needs of the patient.
These include:
- Fluid
injection - A solution containing
saline, local anesthesia, and drugs
to contract blood vessels is injected
into the area before fat is suctioned
out. The saturation of the fatty
area with this product helps the
fat to be removed, reduces blood
loss, dulls pain, and prevents some
bruising. There are two primary
methods of fluid injection that
are currently used:
-
Tumescent - A large
dose of solution - as much as
three or four times the amount
of fat to be removed - is injected
into the area. The volume to
be suctioned out also increases
three or four times, so tumescent
liposuction takes a long time
to perform. However, the tube
moves easily through the fat,
reducing bruising, swelling
and pain tremendously.
- Superwet
- A smaller amount of fluid,
about equal to the quantity
of fat to be removed, is injected.
While the procedure does take
longer than the standard liposuction
technique, it is significantly
shorter than tumescent liposuction
while still providing some of
the same healing and comfort
benefits. However, superwet
liposuction usually requires
the use of an additional anesthetic
or sedative.
- UAL (ultrasound assisted lipoplasty)
- This technique uses a cannula
with a tip that produces ultrasonic
waves. The waves break up the fat
as the cannula moves through the
area. The fat deposit then becomes
liquefied, almost as if it had been
injected with the fluid solution,
and is much easier to suck out.
Ultrasound assisted liposuction
is particularly noted for its precision,
making it effective in fibrous areas
such as the male chest or the back.
However, it also takes longer than
traditional liposuction.
- Power-assisted lipoplasty
- Ordinarily, the surgeon provides
the back-and-forth motion of the
tube that breaks up the fat. With
power-assisted liposuction, however,
the cannula oscillates under its
own power. The power-assisted movement,
in conjunction with the surgeon’s
movement, has been shown to increase
the effectiveness of the suction
and reduce surgery time.
What
is recovery like?
Liposuction
is likely to have some inconvenient
after effects. They should be manageable
and fairly short in duration. These
may include:
- Pain - Usually only
significant during the first few
days, and the liposuction surgeon
can prescribe medication to help
the patient cope with it.
- Burning
- Swelling - Walking around
during the first few days after
liposuction surgery prevents swelling
and fluid buildup, though strenuous
activity within the first month
is not recommended. Bruising and
swelling usually subside within
a few weeks, though the area may
be slightly swollen for up to six
months.
- Bleeding and fluid drainage
from incisions - This usually
will only persist for a few days,
after which the drainage tube is
almost always removed. The incisions
should be completely healed and
the stitches removed in seven to
ten days.
- Numbness - It may take
several weeks for feeling to return
in some areas.
- Anxiety or depression
- These are normal reactions from
cosmetic surgery. Patients are thought
to be depressed from disappointment
because the area of operation looks
worse (bruising, swelling, etc.)
immediately after surgery.
As
with most surgical procedures, more
serious complications from liposuction
are also possible. These may include:
- Delayed healing
- Accumulation of fluid - This
ordinarily subsides on its own,
but can require surgical removal.
- Infection
- Reactions to drugs
- Fat clots or blood clots - Clotting
is of particular concern because
of the risk of migration to vital
areas such as the lungs or brain.
Should a clot develop, an anticoagulant
will likely be prescribed.
- Dehydration - Even in standard
liposuction, a large amount of fluid
is extracted along with the fat
cells, possibly causing dehydration.
If fluid loss is dramatic, there
is a risk of shock.
- Imperfections in the skin - Liposuction
surgery may cause scars from the
incisions, sagging of skin, or other
unsightly characteristics caused
by inelasticity.
- Burns on the skin
- Damage to the nerves
- Piercing of vital organs
There
are also concerns with the new liposuction
techniques. In fluid injection, the
anesthetic in the solution is typically
lidocaine. This can lead to poisoning
if the concentration is too high.
Fluid injection can also cause fluid
collection in the lungs. Ultrasound
has the potential to heat skin or
muscle tissue along with the fat cells,
causing damage to these tissues. It
also may have long-term effects on
the body that have yet to be discovered.
The
best way to avoid unnecessary complications
is to select a qualified surgeon with
years of training in the area of cosmetic
surgery.
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