Liposuction: Difference between revisions
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'''Liposuction''', also known as '''lipoplasty''' ("fat modeling") or '''suction lipectomy''' ("suction-assisted fat removal") is a [[cosmetic surgery]] operation which removes [[fat]] from many different sites on the human body. Areas affected can range from the [[abdomen]], [[thigh]]s, [[buttock]]s, neck, arms and elsewhere. The fat is usually removed via a [[cannula]] and [[aspirator]]. |
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{{advertisement|May 2006}} |
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{{wikify-date|May 2006}} |
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While [[exercise]] and [[dieting]] may be useful for losing unwanted weight and fat, some fat deposits may not respond to efforts at weight loss. Applying liposuction techniques may be an option in these situations. Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring and not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but the average amount is typically less than 10 [[pound]]s (5 [[kilogram|kg]]). |
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'''Liposuction''', also known as '''lipoplasty''' ("fat modeling") or '''suction lipectomy''' ("suction-assisted fat removal") is a popular operation in [[cosmetic surgery]] which removes [[fat]] from many different sites on the human body, typically the [[abdomen]], [[thigh]]s, [[buttock]]s, neck, arms and elsewhere via a [[cannula]] and [[aspirator]]. |
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While [[exercise]] and [[dieting]] may be useful for ridding oneself of unwanted weight and fat, some fat deposits may not respond to an individual's efforts at weight loss. Applying liposuction techniques may be an option in these situations. Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring and not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but the average amount is typically less than 10 pounds (5 kg). |
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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." |
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." |
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Reports of people removing 50 pounds (25 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 to the amount of tissue removed, the choice of anesthetic, and the patient's overall health. |
Reports of people removing 50 pounds (25 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 to the amount of tissue removed, the choice of anesthetic, and the patient's overall health. |
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==History== |
==History== |
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Before liposuction, if |
Before liposuction, if one desired to have extra fat removed, it had to be done with a surgical knife. Apart from knowing that a great deal of blood would be lost, results were uncertain. |
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Traditional liposuction was first done in 1974, by Dr. Fischer, a gynecologist in Italy. During the 1980s, many U.S. surgeons |
Traditional liposuction was first done in [[1974]], by Dr. Fischer, a [[gynecology|gynecologist]] in [[Italy]]. During the [[1980s]], many [[United States|U.S.]] surgeons experimented with liposuction, developing some variations, and achieving mixed results. |
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In 1985, two U.S. dermatologists developed the tumescent technique, which enhances effectiveness and safety, partly by avoiding the use of general anesthesia. |
In [[1985]], two U.S. [[dermatology|dermatologists]] developed the tumescent technique, which enhances effectiveness and safety, partly by avoiding the use of general anesthesia. |
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In the 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying it. This approach causes less trauma to the body. |
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In the [[1990s]], [[ultrasound]] was introduced to facilitate the fat removal by first liquefying it. This approach causes less trauma to the body. |
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The Vaser System refined the use of ultrasound by using a low energy ultrasound which causes even less trauma to the body and allows the treated areas to be contoured more precisely. It also brings better controlled fluid management, new cannula designs and a grooved probe that more effectively emulsifies the fat, even fibrous fat. All of this enhances the liposuction procedure and leaves neighboring nerves, blood vessels and connective tissue more safely intact. |
The [[Vaser System]] refined the use of ultrasound by using a low energy ultrasound which causes even less trauma to the body and allows the treated areas to be contoured more precisely. It also brings better controlled fluid management, new cannula designs and a grooved probe that more effectively emulsifies the fat, even [[fibrous fat]]. All of this enhances the liposuction procedure and leaves neighboring nerves, blood vessels and connective tissue more safely intact. |
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Since 2000, more variations have been tried. |
Since [[2000]], more variations have been tried. |
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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 clear their pathways through the alternatives and controversies. |
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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. |
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No doubt the future will bring even better ways of performing liposuction. |
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==Popularity== |
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'''LIPOSUCTION IS POPULAR!''' |
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In the U.S., more than 50% of |
In the U.S., more than 50% of the population is overweight. So it shouldn't be surprising that liposuction is now the most often performed surgery in the country. Usually it's done to remove about 10 to 15 pounds of fat. |
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Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The [[American Society of Plastic Surgeons]] defines "large" in this context as being more than 5 liters. |
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Most often, liposuction is performed on: |
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'''CAN ANYBODY GET LIPOSUCTION?''' |
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* The abdomen and thighs in women |
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Not everybody is a good candidate. It isn’t an alternative to dieting or exercising. But if you’re: |
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* The abdomen and flanks in males |
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==Candidacy== |
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* Over 18, |
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Not everybody is a good candidate for liposuction. As stated earlier, it isn't a good alternative to dieting or exercising. To be a good candidate, one must be: |
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* In good general health, and |
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* Over 18 |
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* You’ve tried a diet and exercise regime, and find that the last 10 or 15 pounds insists on remaining in certain pockets on your body, |
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* In good general health |
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then you may be a good candidate. If you have diabetes, any infection, or a heart or circulation problem, you probably wouldn’t be considered for liposuction. |
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* Have tried a diet and exercise regime, and find that the last 10 or 15 pounds insists on remaining in certain pockets on the body |
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[[Diabetes]], any infection, or heart or circulation problems usually nullify ones eligibility for the procedure. |
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Most often, liposuction is done on: |
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In older people, the skin is usually less elastic, so it doesn’t tighten so readily around the new shape. In this case, other procedures can be added to the liposuction, such as a [[tummy tuck]]. |
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* The abdomen and thighs in women and |
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==Approaches== |
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* The abdomen and flanks in males. |
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In older people, the skin is usually less elastic, so it doesn’t tighten so readily around your new shape. In this case, other procedures can be added to the liposuction, such as a tummy tuck. |
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'''HOW DO FAT CELLS WORK?''' |
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Our bodies have many kinds of cells, all with specific jobs to do. For example, nerve cells transmit electrical impulses to brain cells, which interpret them; muscle cells create movement, red blood cells carry oxygen, and so on. The job of fat cells is to store fat. |
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'''Normal amounts of fat''': |
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We need a certain amount of fat in our bodies, and optimal amounts are currently thought to be about 12%-15% for women and 3%-6% for men. This fat is in assorted places all over the body and is needed for our hormonal, immune, and reproductive systems to function properly. |
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There’s also stored fat, which is usually just under the skin. Again, a certain amount of this is good, as it provides some insulation, shock absorption, and an emergency energy reserve. |
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'''Individual amounts of fat''': |
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As we grow through childhood and adolescence, we develop our own ball-park number of fat cells, depending on: |
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* Our diet |
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* Our lifestyle and exercise |
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* Our heredity |
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Once we grow to the point where we’ve set the typical amount of fat in our body, that amount is a default, and we retain that approximate number of fat cells for life. |
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'''Fat cells are expandable''': |
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If we overeat enough, we can create some new fat cells, and this is called hyperplastic obesity. Most often though, we increase the size of the ones we already have (hypertrophic obesity). |
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'''Using stored fat''': |
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The fat stored in fat cells is excess energy in the form of fat. It’s energy that came from the food we ate, and stored in this way, it isn’t energy we can immediately use. But if we consistently increase our amount of exercise relative to our food intake, the fat stored in those cells will start to transform into energy to fuel us through the exercise. This will leave those cells more empty, and therefore smaller, so that we look slimmer. |
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'''Layers of fat''': |
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Most of our fat is subcutaneous, meaning it’s just beneath the skin. There are both superficial and deep layers of subcutaneous fat: |
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* The superficial layers have smaller, dense areas of fat, separated by fibrous walls |
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* The deep layers are less dense and have less well-organized fibrous walls |
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The liposuction surgeon works on the deep layers, where there’s less risk of hurting the skin. |
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For this reason, cellulite isn’t affected by liposuction. Cellulite is related to the fat in the superficial level under the skin, whereas liposuction removes fat from the deeper level. |
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'''As we grow older''': |
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Human bodies age in certain ways that are common to all of us in one combination or another. One way that fat behaves in an older person is to cluster in certain areas, such as the abdomen, buttocks, chin, upper arms, or upper back. Our heredity plays a role in how much this happens and in which specific areas. In men fat can gather in the chest, enlarging the breasts, which is called gynecomastia. |
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So there may come a point where no amount of exercise and dieting will reduce those fat areas, and then liposuction might become an enticing option. |
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'''APROACHES TO LIPOSUCTION''' |
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The basic surgical challenge of any liposuction procedure is: |
The basic surgical challenge of any liposuction procedure is: |
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* To remove the right amount of fat |
* To remove the right amount of fat |
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* Cause the least disturbance of neighboring tissue, such as blood vessels and connective tissue |
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* No disturbance to the person’s fluid balance |
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* The least discomfort to both patient and surgeon |
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As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, painless, and effective. |
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* The least disturbance of neighboring tissue, such as blood vessels and connective tissue, |
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==Techniques== |
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* No disturbance to the person’s fluid balance, and |
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In the basic approach, a small cannula (like a straw) is inserted through a small incision. It's 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. |
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* The least discomfort to both patient and surgeon. |
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This method is seldom used today. Instead, the surgeon will incorporate some of the various improvements that have been made since liposuction's inception. |
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As more and more surgeons have worked with it, many ideas have emerged and techniques have been developed that have brought liposuction closer to being safe, easy, painless, and effective. |
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===Basic liposuction with fluid injection=== |
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'''Basic or standard liposuction''': |
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In the bare bones procedure (so to speak), a small cannula like a straw is inserted through a tiny incision. It’s 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. |
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Today, this basic method is seldom used. Instead, the surgeon will incorporate some of the various improvements that have been made since the early days. |
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'''Basic liposuction with fluid injection''': |
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A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains: |
A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains: |
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* Lidocaine |
* [[Lidocaine]]: as a local anesthetic |
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* [[Epinephrine]]: to contract the blood vessels and thus minimize bleeding |
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* A salt solution: to make it saline, like our body fluids |
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* Epinephrine – to contract the blood vessels and thus minimize bleeding, and |
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* A salt solution – to make it saline, like our body fluids. |
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This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure. |
This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure. |
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===Tumescent liposuction=== |
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This is a major improvement on basic liposuction. Not just a small amount, but 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. Tumescent means swollen. |
This is a major improvement on basic liposuction. Not just a small amount, but 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. "Tumescent" means swollen. |
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It's 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’s easier for the surgeon to make the back and forth movements that break up the fat cells and allow them to be suctioned out. |
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Depending on the size of the area(s) being worked, this procedure takes perhaps |
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. |
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===Stitches=== |
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'''Stitches''' – to stitch or not to stitch is your surgeon’s decision. Since the incisions are tiny, and since the amount of fluid which must drain out is large: |
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To stitch or not to stitch is the surgeons decision. Since the incisions are small, and since the amount of fluid which must drain out is large: |
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* Some surgeons opt to leave the incisions open, the better to clear your body of excess fluid. They find that the unimpeded departure of that fluid allows the little incisions to heal more quickly by themselves. |
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* Some surgeons opt to leave the incisions open, the better to clear your body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly by themselves. |
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* Others stitch them only partially, leaving space for the fluid to drain out |
* Others stitch them only partially, leaving space for the fluid to drain out |
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* Others delay stitching until most of the fluid has drained out, about 1 or 2 days |
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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. |
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* Others delay stitching until most of the fluid has drained out, about 1 or 2 days. |
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===Super-wet liposuction=== |
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* In either case, while the fluid is draining, dressings need to be changed often. |
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In this method, a smaller amount of the fluid is injected, perhaps about the same amount as the volume of fat to be removed. It takes one to three hours, depending on the size of the treated area(s). It may require either: |
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* After 1 or 2 days, sometimes 3, bandaids are sufficient. |
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'''Super-wet liposuction''': |
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In this method, a smaller amount of the fluid is injected, perhaps about the same amount as the volume of fat to be removed. It takes 1 to 3 hours, depending on the size of the treated area(s). It may require either: |
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* IV sedation as well as the local lidocaine, or |
* IV sedation as well as the local lidocaine, or |
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* Complete anesthesia |
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===Ultrasound-assisted liposuction (UAL)=== |
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* Complete anesthesia. |
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Also referred to as ultrasonic liposuction, this is a type of tumescent 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. |
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'''Ultrasound-assisted liposuction (UAL)''': |
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Also referred to as ultrasonic liposuction, this is a type of tumescent 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., it liquefying it, and making it easier to suction out. |
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* UAL is a good choice for working on more fibrous areas, like the upper back, or male breast area |
* UAL is a good choice for working on more fibrous areas, like the upper back, or male breast area |
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* It takes longer to do than traditional liposuction, but not longer than tumescent liposuction |
* It takes longer to do than traditional liposuction, but not longer than tumescent liposuction |
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* There’s slightly less blood loss |
* There’s slightly less blood loss |
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* So far, there appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle |
* So far, there appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle |
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===Power-assisted liposuction (PAL)=== |
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'''What is ultrasound?''': |
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Ultrasound is a kind of energy which is like sound waves, except that we can’t hear it. It’s above our hearing range. (There’s also infrasound, which is similar, but below our hearing range.) |
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In medicine, ultrasound has been used for many years to assist with surgical removal of tissue. |
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'''Power-assisted liposuction (PAL)''': |
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Another variation of UAL, PAL uses a specialized cannula with mechanized movement, so that the surgeon doesn’t need to make manual movements. |
Another variation of UAL, PAL uses a specialized cannula with mechanized movement, so that the surgeon doesn’t need to make manual movements. |
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* The cannula movement is more subtle, which creates less discomfort for the patient |
* The cannula movement is more subtle, which creates less discomfort for the patient |
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* So far, there appears to be less risk of puncturing internal organs, because of the more controlled cannula movement |
* So far, there appears to be less risk of puncturing internal organs, because of the more controlled cannula movement |
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===External ultrasound-assisted liposuction (XUAL or EUAL)=== |
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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. |
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. |
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* Cause less discomfort for the patient, both during the procedure and afterwards |
* Cause less discomfort for the patient, both during the procedure and afterwards |
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* Decrease blood loss |
* Decrease blood loss |
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* Allow better access through scar tissue |
* Allow better access through scar tissue |
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* Treat larger areas |
* Treat larger areas |
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At this time however, |
At this time however, it's not widely used and studies are not conclusive as to its effectiveness. |
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==Candidate preperation== |
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'''REGARDLESS OF WHICH METHOD IS USED''' |
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Before receiving any of the procedures described above: |
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'''Preparing for the procedure''': |
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* No [[anticoagulant]]s should be taken for two weeks before the surgery. |
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* If receiving general anesthesia, and the surgery will be in the morning, fasting from midnight the night before is required. If only local anesthesia will be used, fasting is not required. |
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* Smoking must be avoided for about two months prior to surgery. Smoking interferes with circulation and in the context of surgery, may increase the risk of blood clots. |
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==The procedure== |
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* No anticoagulants should be taken for 2 weeks before your surgery. Anticoagulants are taken to prevent blood clots, and if your doctor has prescribed one for you, such as heparin or warfarin, you may not be a good candidate for liposuction. However, they can be sold over-the-counter too, e.g., aspirin. |
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In all liposuction methods, there are certain things that should be done when having the procedure. |
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* If you’ll be having general anesthesia, and your surgery will be in the morning, fast from midnight the night before. If you’ll be just having local anesthesia, you don’t need to fast. |
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* Avoid smoking for about 2 months before your surgery. Smoking interferes with circulation and in the context of surgery, may increase your risk of blood clots. |
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'''The procedure''': |
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In all liposuction methods, there are certain things done when you have your procedure. |
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* You and your surgeon will agree ahead of time on exactly which area(s) will be treated and you’ll have a fair idea of what outcome to expect |
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* 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 |
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* A consent form is signed on the day of surgery |
* A consent form is signed on the day of surgery |
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* An [[antibiotic]] will be given either about an hour beforehand, or afterwards |
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* The targeted areas are marked on the body while the candidate is in a standing position |
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* An antibiotic will be given either about an hour beforehand, or afterwards |
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* Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos |
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* In the operating room, a sterilizing solution such as [[Betadine]], is applied to the relevant areas |
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* The targeted areas are marked on the body while you’re in a standing position |
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* Local anesthetic is injected and the patient may be given a [[sedative]], either orally, or through an IV injection |
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* Photos will be taken of the area to be treated, so you’ll have Before-and-After photos |
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* In the operating room, a sterilizing solution such as Betadine is applied to the relevant areas |
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* Local anesthetic is injected and you may be given a sedative, either orally, or through an IV injection |
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* Incisions are small, about a quarter to a third of an inch |
* Incisions are small, about a quarter to a third of an inch |
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* The patient will probably have an IV fluid line, since they’ll be losing fluid with the fat, and the fluid balance must be kept intact |
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* There’ll be some monitoring devices attached to the body to keep track of the [[blood pressure]], heart rate, and blood oxygen level |
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* The participant will feel only a scraping or rasping sensation from the cannula movement |
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* Usually the participant 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 |
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==Recovery== |
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* You'll probably have an IV fluid line, since you’ll be losing fluid with the fat, and your fluid balance must be kept intact |
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* There’ll be some monitoring devices attached to your body to keep track of your blood pressure, heart rate, and blood oxygen level |
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* You’ll feel only a scraping or rasping sensation from the cannula movement (but if you feel pain, be sure and tell the doctor) |
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* You can get up, walk around, and go home the same day if you had no general anesthesia, although you’ll need someone to drive you |
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'''The recovery period''': |
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* Afterwards, a compression garment or ace bandage will be worn until drainage has stopped, perhaps days, or perhaps for 2 to 4 weeks, depending on your specific case |
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* Bandages will be changed after 1 or 2 days |
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* Drains and sutures will be removed after 5 to 10 days, or whenever the drainage is finished |
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* Any pain is well controlled by a prescription or over-the-counter medication, and may last as long as 2 weeks, depending on your particular procedure |
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* Swelling will subside in anywhere from 2 weeks to 2 months |
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* Bruising will fade after a few days or maybe as long as 2 weeks later |
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* 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 |
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* Bandages will be changed after one or two days |
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* Drains and sutures will be removed after five to ten days, or whenever the drainage is finished |
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* 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 |
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* Swelling will subside in anywhere from two weeks to two months |
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* Bruising will fade after a few days or maybe as long as two weeks later |
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* Numbness may last for several weeks |
* Numbness may last for several weeks |
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* Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on the procedure |
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* 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 |
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===Expediting recovery=== |
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* Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on your particular procedure |
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* The final result will be evident anywhere from 1 to 6 months after surgery, although you’ll see noticeable difference within days or weeks, as swelling subsides |
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'''To enhance your recovery''': |
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The patient should: |
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* Drink enough water to prevent dehydration |
* Drink enough water to prevent dehydration |
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* Avoid alcohol for a couple of days, both before and after surgery |
* Avoid alcohol for a couple of days, both before and after surgery |
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* Avoid using ice packs or heating pads on the treated areas |
* Avoid using ice packs or heating pads on the treated areas |
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* Postpone any submersion in water for at least a week (bathtub, swimming pool, river, etc.) |
* Postpone any submersion in water for at least a week (bathtub, swimming pool, river, etc.) |
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* If any dizziness is experienced, the participant should take it easy. They shoudl stand up slowly, get some help for the shower, remove the compression garment slowly. |
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The suctioned fat cells are permanently gone. However, if the participant doesn't diet and exercise properly, the remaining fat cell neighbors could still enlarge, creating assorted bulges. |
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* If you notice any dizziness, go easy on yourself. Stand up slowly, get some help for the shower, remove the compression garment slowly. |
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==Side effects== |
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Those suctioned fat cells are permanently gone. However, if your diet and exercising are not properly maintained, their remaining neighbors could still enlarge, creating assorted bulges that you probably wouldn’t like. |
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A [[side effect]], as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful. |
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'''SIDE EFFECTS''' |
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* Bruising: can be painful in the short term, and should fade after a few weeks. |
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A side effect, as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful. |
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* Swelling: should subside gradually over a month or two. |
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* 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. |
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* '''Bruising''' – can be painful in the short term, and will fade after a few weeks. |
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* Pain: should be temporary and controlled by either over-the-counter medication, or by a prescription. |
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* Numbness: sometimes persists for a few weeks. |
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* '''Swelling''' – will settle down gradually over a month or two. |
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* Limited mobility: will depend on the exact procedure. |
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There could be various factors limiting movement for a short while, such as: |
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* '''Scars''' – will vary in size depending on your particular procedure, and will fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year. |
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* '''Pain''' – will be temporary and well-controlled by either over-the-counter medication, or by a prescription. |
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* '''Numbness''' – sometimes persists for a few weeks. |
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* '''Limited mobility''' – will depend on your exact procedure. In general it’s a good idea to get up and walk around a little very soon after you arrive home, to promote good circulation. |
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There could be various factors limiting your movement for a short while, such as: |
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* Wearing a compression garment |
* Wearing a compression garment |
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* Keeping the head elevated |
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* Keeping your head elevated |
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* Temporary swelling or pain |
* Temporary swelling or pain |
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The surgeon should advise on how soon the particpant can resume normal activity. |
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==Possible complications== |
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'''POSSIBLE COMPLICATIONS''' |
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As with any surgery, there are certain risks, beyond the temporary and minor side effects. |
As with any surgery, there are certain risks, beyond the temporary and minor side effects. The surgeon may mention them during a consultation. Careful patient selection minimizes their occurrence. Their likelihood is somewhat increased when treated areas are very large or numerous and a large amount of fat is removed. |
||
During the 1990s there were some deaths |
During the [[1990s]] there were some deaths as a result of liposuction, as well as alarmingly high rates of complication. By studying more and educating themselves further, surgeons have reduced complication rates. |
||
A study published in Dermatologic Surgery (July 2004, pp 967-978), found that |
A study published in ''[[Dermatologic Surgery]]'' (July 2004, pp. 967-978), found that: |
||
* “The overall clinical complication rate.[for liposuction] ... was 0.7% (5 of 702)” |
* “The overall clinical complication rate.[for liposuction] ... was 0.7% (5 of 702)” |
||
* The minor complication rate was 0.57% |
* The minor complication rate was 0.57% |
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* The major complication rate was 0.14% with one patient requiring hospitalization |
* The major complication rate was 0.14% with one patient requiring hospitalization |
||
The more serious possible complications include: |
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* '''Allergic reaction to anesthetic''' – most liposuction is done with local anesthetic, so the risks of general anesthesia are avoided. |
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* '''Infection''' – any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula, typically about 1/3 inch wide. |
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Afterwards they may be partially stitched closed, or left open, because the injected fluid must be allowed to drain out. Some surgeons don’t stitch them, but allow the drainage to finish, finding that a more rapid drainage helps the little incisions to heal more quickly. When drainage is finished, bandaids can be used. |
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Before liposuction is done, or after it’s finished, you’ll probably be given an antibiotic, and of course sterile technique is always observed. As a result of the careful pre- and post-surgical care, infection is rare. |
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Early signs of infection are redness, soreness, fever and chills. |
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* '''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. |
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* Allergic reaction to anesthetic: most liposuction is done with local anesthetic, so the risks of general anesthesia are avoided. |
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* Infection: any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula, typically about 1/3 inch wide. |
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* 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. |
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* Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface. |
* Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface. |
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* Skin necrosis (death) is a rare complication, in which the skin falls off in the necrotic area. Bacteria can then invade. |
* Skin necrosis (death) is a rare complication, in which the skin falls off in the necrotic area. Bacteria can then invade. |
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* 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. |
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* 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 the older, the healing may be slower and a bit imperfect. Sometimes a small touch-up procedure can help. |
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* Blood clots or fat clots: if clots form in the treated area, they can get into the circulation system and travel to the lungs (pulmonary embolism). This can interfere seriously with breathing and even sometimes cause death. Or they can travel to the brain, also a serious situation. This is a grave complication, but very rare. |
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* 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. |
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* 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. |
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* 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’s a danger of the body’s fluid balance being disturbed. This could happen afterwards, after the participant has departed. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected. |
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The cosmetic surgeon should give the participant a written list of symptoms to watch for, along with instructions for post-op self-care. |
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* '''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 very rare cases it can be fatal. |
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An experienced cosmetic surgeon is unlikely to puncture any internal organ. |
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==Combined with other procedures== |
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* '''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 if we’re a bit older, our healing may be slower and a bit imperfect. |
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Sometimes a small touch-up procedure can help. |
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In general, it's regarded as less than optimally safe to have other procedures done at the same time as liposuction. But it can be done, and some combinations are: |
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* '''Blood clots or fat clots''' – If clots form in the treated area, they can get into the circulation system and travel to the lungs (pulmonary embolism). This can interfere seriously with breathing and even sometimes cause death. Or they can travel to the brain, also a serious situation. This is a grave complication, but very rare. |
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===Liposuction with a tummy tuck ([[abdominoplasty]])=== |
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* '''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. |
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The removal of quantities of fat from under the skin leaves the skin loose. If the person’s skin is less elastic than it used to be, it might remain loose and never quite tighten up around the new, slimmer contour. In older people, the muscle can also be somewhat lax and need tightening. So a tummy tuck is a way of addressing this situation. |
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===Liposuction with a hip, thigh or buttock lift=== |
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* '''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. |
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Lidocaine poisoning at first causes tingling and numbness and eventually, seizures followed by unconsciousness and respiratory or cardiac arrest. But of course, it would be treated immediately during a liposuction procedure because patients are closely monitored throughout. So again, this is a very rare complication. |
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For some people, excess fat stubbornly remains in the [[buttocks]], hips and thighs. When the skin is not loose, liposuction alone can remedy the problem. |
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* '''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’s a danger of the body’s fluid balance being disturbed. |
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This could happen afterwards, after you’ve gone home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected. |
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Your cosmetic surgeon will give you a written list of symptoms to watch for, along with instructions for your post-op self-care. |
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'''LIPOSUCTION COMBINED WITH OTHER PROCEDURES''' |
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In general, it’s regarded as less than optimally safe to have other procedures done at the same time as liposuction. But it can be done, and some combinations are: |
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'''Liposuction with a tummy tuck (abdominoplasty)''': |
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The removal of quantities of fat from under the skin leaves the skin loose. If the person’s skin is less elastic than it used to be, it might remain loose and never quite tighten up around the new, slimmer contour. In older people, the muscle can also be somewhat lax and need tightening. |
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So a tummy tuck is a way of addressing this situation. |
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* General anesthesia will be used for both procedures |
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* A long incision is made across the lower belly, from hipbone to hipbone |
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* Another incision detaches the belly button |
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* The abdominal skin is separated from the muscles all the way up to the ribs |
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* The loose muscles are pulled closer together and stitched, to narrow the waistline and firm up the abdominal wall |
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* The skin is replaced and pulled downwards flat over the new muscle position |
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* Excess skin is removed |
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* The navel is replaced in a new position |
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* All incisions are sutured, dressings applied, and a temporary drainage tube inserted |
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'''Liposuction with a hip, thigh or buttock lift''': |
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For some people, excess fat stubbornly remains in the buttocks, hips and thighs. When the skin is not loose, liposuction alone can remedy the problem. |
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But if the skin is loose and hanging in folds, then the liposuction can be combined with a hip, thigh or buttock lift. The skin will be tightened, the excess removed, and the remainder re-positioned over the newly liposuctioned areas. |
But if the skin is loose and hanging in folds, then the liposuction can be combined with a hip, thigh or buttock lift. The skin will be tightened, the excess removed, and the remainder re-positioned over the newly liposuctioned areas. |
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===Liposuction and wrinkle removal=== |
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Tumescent liposuction is often used to slim down the jaw and neck area. In younger people, this produces very good results. In older people, a facelift can often do the job nicely. |
Tumescent liposuction is often used to slim down the jaw and neck area. In younger people, this produces very good results. In older people, a facelift can often do the job nicely. |
||
But if the skin there is becoming too wrinkled or sagging, the best alternative is sometimes a combination of liposuction and laser resurfacing or chemical peel. |
But if the skin there is becoming too wrinkled or sagging, the best alternative is sometimes a combination of liposuction and [[laser resurfacing]] or [[chemical peel]]. |
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==Choosing a surgeon== |
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* A very small cannula is used (less than 1.5 mm) for the liposuction. |
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* A CO2 laser removes wrinkles by tightening the skin. Its depth can be very minutely controlled, to work on more superficial wrinkles, or deeper ones. |
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* A chemical peel is effective for removing uneven pigmentation and fine wrinkles. Chemical peels can also be customized to target deeper levels of the skin and treat deeper defects. |
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* Dermabrasion is a technique that in effect sands the skin, smoothing off the surface irregularities. It uses a diamond-coated disc and requires anesthesia. |
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* Sometimes big vertical folds develop at the throat as we get older. They’re called platysma bands and contain loose muscle and fat as well as skin. Liposuction will help, and at the same time, they can also be tightened through a tiny incision under the chin. The loose muscles are stitched together to give a smoother neck contour. |
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'''CHOOSING A COSMETIC SURGEON''' |
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There is no standardized training specifically required for a surgeon to perform liposuction. Any surgeon can do it, and in view of the increasing demand, many do. |
There is no standardized training specifically required for a surgeon to perform liposuction. Any surgeon can do it, and in view of the increasing demand, many do. |
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| Line 408: | Line 245: | ||
Therefore: |
Therefore: |
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* |
* One should choose a surgeon who belongs to the [[Association of Plastic Surgeons]] (AAPS), at the very least, and preferably some of the other national associations as well such as: |
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**The [[Association of Aesthetic Plastic Surgery]] (ASAPS) |
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* |
**The [[American Society for Dermatologic Surgery]] (ASDS) (in the U.S.) |
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* One should choose a surgeon who's experienced in doing liposuction in the way that he/she proposes it for the candidate. |
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* The facility where it will be done should be certified and accredited by a nationally recognized surgery accreditation body. It should have the ability to handle complications. |
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* The American Society for Dermatologic Surgery (ASDS) |
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* The surgeon should have privileges in at least one local hospital. This is a back-up in case of any emergency that turns out to be more than the surgeon’s facility can handle. |
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* The anesthesiologist should be equally as qualified and experienced as the performing surgeon. |
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* Choose a surgeon who’s experienced in doing liposuction in the way that he/she proposes it for you. |
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* The surgeon’s support staff in the operating and recovery rooms should be experienced with the procedure. |
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* With a list of possible surgeons, the candidate should set up initial consultations with them. |
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* Check that the facility where it will be done is certified and accredited by a nationally recognized surgery accreditation body. You’ll want to be confident of its ability to handle complications. |
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* The candidate should have a list of questions and should be sure that they understand the answers. If the surgeon seems impatient or unwilling to take time to answer the questions, move on. |
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* The surgeon should be one with whom the candidate feels personally comfortable, as well as confident in their professional qualifications. |
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* Check that the surgeon has privileges in at least one local hospital. This is a back-up in case of any emergency that turns out to be more than the surgeon’s facility can handle. |
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* Make sure that his anesthesiologist is equally qualified and experienced. |
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* Check that all the surgeon’s support staff in the operating and recovery rooms are experienced with the procedure. |
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* When you have a list of possible surgeons, set up initial consultations with them. |
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* Take a list of questions and be sure that you understand the answers. If the surgeon seems impatient or unwilling to take time to answer your questions, move on. |
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* Choose a surgeon with whom you feel personally comfortable, as well as confident of the professional qualifications. You’ll be entrusting your health and appearance to this person, so be sure you feel comfortable in talking to him/her and asking questions as things move along. |
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==External links== |
==External links== |
||
*[http://www.asds.net/Patients/FactSheets/patients-Fact_Sheet-skinny_on_lipo.html The Skinny on Liposuction] |
*[http://www.asds.net/Patients/FactSheets/patients-Fact_Sheet-skinny_on_lipo.html The Skinny on Liposuction] |
||
*[http://health.howstuffworks.com/liposuction.htm How Liposuction Works] |
*[http://health.howstuffworks.com/liposuction.htm How Liposuction Works] from [[howstuffworks]] |
||
*[http://www.the-cosmetic-surgery-directory.com/articles_liposuction.html Liposuction] |
*[http://www.the-cosmetic-surgery-directory.com/articles_liposuction.html Liposuction] from The Cosmetic Surgery Directory |
||
*[http://www.plasticsurgery.org/public_education/procedures/Lipoplasty.cfm Liposuction / Lipoplasty] |
*[http://www.plasticsurgery.org/public_education/procedures/Lipoplasty.cfm Liposuction / Lipoplasty] |
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*[http://www.fda.gov/cdrh/liposuction/ FDA Liposuction Information] |
*[http://www.fda.gov/cdrh/liposuction/ FDA Liposuction Information] |
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[[Category:Medical treatments]] |
[[Category:Medical treatments]] |
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[[Category:Plastic surgery]] |
[[Category:Plastic surgery]] |
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[[de:Fettabsaugung]] |
[[de:Fettabsaugung]] |
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[[ja: |
[[ja:????]] |
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[[es:Liposucción]] |
[[es:Liposucción]] |
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Revision as of 17:49, 9 May 2006
Liposuction, also known as lipoplasty ("fat modeling") or suction lipectomy ("suction-assisted fat removal") is a cosmetic surgery operation which removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs, buttocks, neck, arms and elsewhere. The fat is usually removed via a cannula and aspirator.
While exercise and dieting may be useful for losing unwanted weight and fat, some fat deposits may not respond to efforts at weight loss. Applying liposuction techniques may be an option in these situations. Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring and not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but the average amount is typically less than 10 pounds (5 kg).
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."
Reports of people removing 50 pounds (25 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 to the amount of tissue removed, the choice of anesthetic, and the patient's overall health.
History
Before liposuction, if one desired to have extra fat removed, it had to be done with a surgical knife. Apart from knowing that a great deal of blood would be lost, results were uncertain.
Traditional liposuction was first done in 1974, by Dr. Fischer, a gynecologist in Italy. 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, which enhances effectiveness and safety, partly by avoiding the use of general anesthesia.
In the 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying it. This approach causes less trauma to the body.
The Vaser System refined the use of ultrasound by using a low energy ultrasound which causes even less trauma to the body and allows the treated areas to be contoured more precisely. It also brings better controlled fluid management, new cannula designs and a grooved probe that more effectively emulsifies the fat, even fibrous fat. All of this enhances the liposuction procedure and leaves neighboring nerves, blood vessels and connective tissue more safely intact.
Since 2000, more variations have been tried.
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.
Popularity
In the U.S., more than 50% of the population is overweight. So it shouldn't be surprising that liposuction is now the most often performed surgery in the country. Usually it's done to remove about 10 to 15 pounds of fat.
Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The American Society of Plastic Surgeons defines "large" in this context as being more than 5 liters.
Most often, liposuction is performed on:
- The abdomen and thighs in women
- The abdomen and flanks in males
Candidacy
Not everybody is a good candidate for liposuction. As stated earlier, it isn't 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 insists on remaining in certain pockets on the body
Diabetes, any infection, or heart or circulation problems usually nullify ones eligibility for the procedure.
In older people, the skin is usually less elastic, so it doesn’t tighten so readily around the new shape. In this case, other procedures can be added to the liposuction, such as a tummy tuck.
Approaches
The basic surgical challenge of any liposuction procedure is:
- To remove the right amount of fat
- Cause the least disturbance of neighboring tissue, such as blood vessels and connective tissue
- No disturbance to the person’s fluid balance
- 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
In the basic approach, a small cannula (like a straw) is inserted through a small incision. It's 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.
This method is seldom used today. Instead, the surgeon will incorporate some of the various improvements that have been made since liposuction's inception.
Basic liposuction with fluid injection
A small amount of fluid, less in volume than 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.
Tumescent liposuction
This is a major improvement on basic liposuction. Not just a small amount, but 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. "Tumescent" means swollen.
It's 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’s 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.
Stitches
To stitch or not to stitch is the surgeons decision. Since the incisions are small, and since the amount of fluid which must drain out is large:
- Some surgeons opt to leave the incisions open, the better to clear your 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.
Super-wet liposuction
In this method, a smaller amount of the fluid is injected, perhaps about the same amount as the volume of fat to be removed. 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
Ultrasound-assisted liposuction (UAL)
Also referred to as ultrasonic liposuction, this is a type of tumescent 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, but not longer than tumescent liposuction
- There’s 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
Power-assisted liposuction (PAL)
Another variation of UAL, PAL uses a specialized cannula with mechanized movement, so that the surgeon doesn’t need to make manual movements.
- 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's not widely used and studies are not conclusive as to its effectiveness.
Candidate preperation
Before receiving any of the procedures described above:
- No anticoagulants should be taken for two weeks before the surgery.
- If receiving general anesthesia, and the surgery will be in the morning, fasting from midnight the night before is required. If only local anesthesia will be used, fasting is not required.
- Smoking must be avoided for about two months prior to surgery. Smoking interferes with circulation and in the context of surgery, may increase the risk of blood clots.
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’ll be losing fluid with the fat, and the fluid balance must be kept intact
- There’ll be some monitoring devices attached to the body to keep track of the blood pressure, heart rate, and blood oxygen level
- The participant will feel only a scraping or rasping sensation from the cannula movement
- Usually the participant 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
- 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 participant should take it easy. They shoudl stand up slowly, get some help for the shower, remove the compression garment slowly.
The suctioned fat cells are permanently gone. However, if the participant doesn't diet and exercise properly, the remaining fat cell neighbors could still enlarge, creating assorted bulges.
Side effects
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 particpant can resume normal activity.
Possible complications
As with any surgery, there are certain risks, beyond the temporary and minor side effects. The surgeon may mention them during a consultation. Careful patient selection minimizes their occurrence. Their likelihood is somewhat increased when treated areas are very large or numerous and a large amount of fat is removed.
During the 1990s there were some deaths as a result of liposuction, as well as alarmingly high rates of complication. By studying more and educating themselves further, surgeons have reduced complication rates.
A study published in Dermatologic Surgery (July 2004, pp. 967-978), found that:
- “The overall clinical complication rate.[for liposuction] ... was 0.7% (5 of 702)”
- The minor complication rate was 0.57%
- The major complication rate was 0.14% with one patient requiring hospitalization
The more serious possible complications include:
- 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. During liposuction, multiple small puncture wounds are made for inserting the cannula, typically about 1/3 inch wide.
- 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 the older, the healing may be slower and a bit imperfect. Sometimes a small touch-up procedure can help.
- Blood clots or fat clots: if clots form in the treated area, they can get into the circulation system and travel to the lungs (pulmonary embolism). This can interfere seriously with breathing and even sometimes cause death. Or they can travel to the brain, also a serious situation. This is a grave complication, but very rare.
- 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’s a danger of the body’s fluid balance being disturbed. This could happen afterwards, after the participant has departed. 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.
Combined with other procedures
In general, it's regarded as less than optimally safe to have other procedures done at the same time as liposuction. But it can be done, and some combinations are:
Liposuction with a tummy tuck (abdominoplasty)
The removal of quantities of fat from under the skin leaves the skin loose. If the person’s skin is less elastic than it used to be, it might remain loose and never quite tighten up around the new, slimmer contour. In older people, the muscle can also be somewhat lax and need tightening. So a tummy tuck is a way of addressing this situation.
Liposuction with a hip, thigh or buttock lift
For some people, excess fat stubbornly remains in the buttocks, hips and thighs. When the skin is not loose, liposuction alone can remedy the problem.
But if the skin is loose and hanging in folds, then the liposuction can be combined with a hip, thigh or buttock lift. The skin will be tightened, the excess removed, and the remainder re-positioned over the newly liposuctioned areas.
Liposuction and wrinkle removal
Tumescent liposuction is often used to slim down the jaw and neck area. In younger people, this produces very good results. In older people, a facelift can often do the job nicely.
But if the skin there is becoming too wrinkled or sagging, the best alternative is sometimes a combination of liposuction and laser resurfacing or chemical peel.
Choosing a surgeon
There is no standardized training specifically required for a surgeon to perform liposuction. Any surgeon can do it, and in view of the increasing demand, many do.
Therefore:
- One should choose a surgeon who belongs to the Association of Plastic Surgeons (AAPS), at the very least, and preferably some of the other national associations as well such as:
- The Association of Aesthetic Plastic Surgery (ASAPS)
- The American Society for Dermatologic Surgery (ASDS) (in the U.S.)
- One should choose a surgeon who's experienced in doing liposuction in the way that he/she proposes it for the candidate.
- The facility where it will be done should be certified and accredited by a nationally recognized surgery accreditation body. It should have the ability to handle complications.
- The surgeon should have privileges in at least one local hospital. This is a back-up in case of any emergency that turns out to be more than the surgeon’s facility can handle.
- The anesthesiologist should be equally as qualified and experienced as the performing surgeon.
- The surgeon’s support staff in the operating and recovery rooms should be experienced with the procedure.
- With a list of possible surgeons, the candidate should set up initial consultations with them.
- The candidate should have a list of questions and should be sure that they understand the answers. If the surgeon seems impatient or unwilling to take time to answer the questions, move on.
- The surgeon should be one with whom the candidate feels personally comfortable, as well as confident in their professional qualifications.
External links
- The Skinny on Liposuction
- How Liposuction Works from howstuffworks
- Liposuction from The Cosmetic Surgery Directory
- Liposuction / Lipoplasty
- FDA Liposuction Information
- Liposuction Information from Plastic Surgery Interactive