The
fat layer of skin is located in the subcutaneous
layer of tissue called the hypodermis. The thickness
of the fat layer, which varies greatly from
one person to another, depends on the size and
number of fat cells.
Fat
tends to "settle" in certain regions,
depending on sex. Women gain fat predominantly
in the stomach, hips and thighs, while men tend
to gain fat in the belly and waist. Liposuction
should not be used to treat obesity. It is best
performed in patients close to their ideal weight
who have persistent, localized fat deposits.
A
special liposuction machine and instruments
are used. While the patient is pain-free (local
anesthesia or general anesthesia), small suction
instruments are inserted through the skin into
the fat pockets. The suction instruments are
moved around to break up the fat and suction
it out. Several punctures may be necessary to
treat large areas. Small tubes may be placed
to help drain out fluids and blood during the
first few days. Liposuction may not require
hospitalization, depending on the location and
amount of surgery.
The
area may appear larger than before surgery because
of the swelling. A tight stocking, girdle, or
snug elastic dressing must be worn over the
treated area to reduce swelling and bleeding,
and to help shrink the skin to fit the new contour.
This garment should be worn continuously for
2 to 3 weeks. Patients should expect swelling,
bruising, numbness, and pain that can be managed
with medications. The stitches will be removed
in 5 to 10 days. Some numbness may persist for
weeks. Antibiotics may be prescribed to prevent
infection. Sensations such as numbness or tingling,
as well as pain, may be felt for weeks after
the surgery. Walking is recommended as soon
as possible to help prevent blood clots from
forming in the legs. More strenuous exercise
is restricted for a few weeks after the surgery.
When
healing is complete, the body contour will be
more trim and toned in appearance.
Alternative
names
Fat
removal - suctioning
Definition
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Liposuction
is the removal of excess body fat by suction
with specialized surgical equipment, typically
performed by a plastic surgeon.
Description
Liposuction
has achieved the distinction of being the most
popular cosmetic surgical procedure. By removing
unwanted deposits of excess fat, liposuction
improves body appearance and smoothes irregular
or distorted body shapes. The procedure is sometimes
referred to as body contouring.
Liposuction
may be useful for contouring under the chin,
neck, cheeks, upper arms, breasts, abdomen,
buttocks, hips, thighs, knees, calves, and ankle
areas.
However,
liposuction is a serious surgical procedure
and possibly may involve a painful recovery.
It has the potential for rare but serious or
occasionally fatal complications, so the decision
to have liposuction should be well thought out.
Before
undergoing liposuction certain criteria must
be met:
- An
initial patient consultation. This will include
a history, a thorough physical examination,
and a psychological health examination.
- Your
spouse's presence may be required during the
visit and a second consultation is necessary
to give you time to think over the surgery.
- You
should feel free to express the reasons for
the consult, be free to ask as many questions
as desired, and feel satisfied with the answers
to those questions. A properly informed person
makes a better patient.
- You
must understand fully the pre-operative preparations,
the liposuction procedure, and the precise
post-operative care.
- You
must have realistic expectations. Liposuction
may help to enhance your appearance and also
your self-confidence, but it will probably
not give you your ideal body.
There
are several different liposuction procedures.
- Tumescent
liposuction (fluid injection) is the most
common type of liposuction. It involves injecting
a large amount of medicated solution into
the areas before the fat is removed (sometimes,
up to three times the volume of fat to be
removed). The fluid is a mixture of local
anesthetic (lidocaine), a drug that contracts
the blood vessels (epinephrine), and an intravenous
(IV) salt solution. The lidocaine in the mixture
helps to numb the area during and after surgery,
and may be the only anesthesia needed for
the procedure. The epinephrine in the solution
helps to reduce the loss of blood, reduce
the amount of bruising, and reduce the amount
of swelling that accompanies the surgery.
The IV solution helps to remove the fat more
easily and is suctioned out along with the
fat. This type of liposuction generally takes
longer than other types.
- The
super-wet technique is similar to the tumescent
liposuction stated above. The difference is
that not as much fluid is used during the
surgery--the amount of fluid injected is equal
to the amount of fat to be removed. This technique
takes less time; however it often requires
sedation via an IV, or general anesthesia.
- Ultrasound-assisted
liposuction (UAL) is a fairly new technique,
used in the US since 1996. During this technique
ultrasonic vibrations are used to liquefy
fat cells. After the cells are liquefied,
they can be vacuumed out. UAL can be done
in two ways, external (above the surface of
the skin with a special emitter) or internal
(below the surface of the skin with a small,
heated cannula). This technique may help to
remove fat from dense, fibrous areas of the
body such as the upper back or enlarged male
breast tissue. UAL is often used in combination
with the tumescent technique, in secondary
(follow-up) procedures, or when precision
must be enhanced. In general this procedure
takes longer than the super-wet technique.
Prior
to the day of surgery you may have blood drawn
and be asked to provide a urine sample. This
allows the health care provider to rule out
potential complications. If you are not hospitalized,
you will need a ride home.
A
liposuction machine and specialized instruments
are required for this surgery. The surgical
team first preps the patient's operative site
and administers either local or general anesthesia.
Through a small skin incision, a suction tube
with a sharp end is inserted into the fat pockets
and swept through the area where fat is to be
removed. The dislodged fat is literally "vacuumed"
away through the suction tube. A vacuum pump
or a large syringe provides the suction action.
Several skin punctures may be necessary to treat
large areas.
After
the appropriate amount of fat is removed, small
drainage tubes may be inserted into the defatted
areas to remove blood and fluid that accumulate
during the first few days. If significant fluid
or blood is lost during the surgery, the patient
may require fluid replacement (intravenously)
or even a blood transfusion.
After
the surgery, pressure bandages are applied to
keep pressure and stop any bleeding, as well
as help maintain shape. Bandages are kept in
place usually for at least 2 weeks. Your doctor
may call you from time to time to check on your
health status and monitor your healing. A visit
back to the surgeon after 5-7 days is often
recommended. Occasionally liposuction is associated
with weight gain. This is due to the increased
fluid from surgery.
Liposuction
may or may not require hospitalization, depending
on the location and extent of surgery. Liposuction
can be done in an office-based facility, in
a surgery center on an outpatient basis, or
in a hospital. For reasons of cost and convenience,
liposuction of smaller volumes is usually done
as an outpatient. A stay in a hospital may be
required if a larger volume of fat is being
removed, or if you are having other procedures
done at the same time.
Indications
The
following are some of the uses for liposuction:
- Cosmetic
reasons are the most common, including "love
handles", unsightly fat bulges, or an
abnormal chin line.
- To
improve sexual function by reducing abnormally
placed fat deposits on the inner thighs, thus
allowing easier access to the vagina.
- Body
shaping for people who are bothered by fatty
bulges or irregularities that cannot be eliminated
by diet and/or exercise.
However,
liposuction is generally NOT appropriate for
these uses:
- Liposuction
is not a substitute for exercise and diet,
and it is not a cure for generalized obesity.
However, it may be used in sequenced removal
of fat from isolated areas at different points
in time.
- It
is not an effective treatment for cellulite
(the uneven, dimpled appearance of skin over
hips, thighs and buttocks).
- Certain
areas should not have liposuction performed
on them, such as the fat on the sides of the
breasts. This is due to the fact that the
breast is a common site for cancer.
Many
alternatives to liposuction may be considered,
including abdominoplasty (tummy tuck), excision
of lipomas (fatty tumor), reduction mammaplasty
(breast size reduction), or a combination of
plastic surgery approaches.
Risks
Certain
pre-existing conditions should be thoroughly
checked and brought under control before any
surgery, including liposuction:
- History
of heart problems (heart attack)
- High
blood pressure
- Diabetes
- Allergic
reactions to medications
- Pulmonary
problems (shortness of breath, air pockets
in blood stream)
- Allergies
(antibiotics, asthma, surgical prep)
- Smoking,
alcohol, or drug use
There
are also inherent risks associated with receiving
liposuction and these include:
- Shock
(usually from inadequate fluid replacement
during the surgery)
- Fluid
overload -- usually from the procedure
- Infections
(strep, staph)
- Bleeding,
blood clot
- Fat
embolism (tiny globules of fat in the blood
stream that block blood flow to tissue)
- Nerve,
skin, tissue, or organ damage or burns from
the heat or instruments associated with liposuction
- Asymmetry
(uneven fat removal)
- Drug
reactions or overdose from the lidocaine used
in the procedure
- Scarring
(skin surface may be irregular, asymmetric,
or even "baggy," especially in the
older patient)
Finally,
make sure to review and sign any informed consent
(legal) and permission for photographs.
Expectations
after surgery
Most
patients, once correctly informed, are satisfied
with the cosmetic result following their surgery.
Informed patients understand that there are
limitations to what liposuction can accomplish.
If
you are having a large amount of fat removed,
such as having fat removed from your abdomen,
or you are being put to sleep (general anesthesia)
for the procedure, you should expect to be admitted
to the hospital. If you are having a smaller
amount of fat removed, such as from the thighs,
and with the area numbed (local anesthesia)
for the procedure, you may be able to have it
done on an outpatient, same-day basis as long
as the office has the proper equipment and oxygen
on hand, should it be needed.
Convalescence
The
liposuctioned area may appear larger than before
surgery because of swelling. A tight stocking,
girdle, or snug elastic dressing must be worn
over the treated area to reduce swelling and
bleeding, and to help shrink the skin to fit
the new contour. This garment should be worn
continuously for 2 to 3 weeks.
Patients
should expect swelling, bruising, numbness,
and pain that can be managed with medications.
The stitches will be removed in 5 to 10 days.
Antibiotics may be prescribed to prevent infection.
Sensations
such as numbness or tingling, as well as pain,
may be felt for weeks after the surgery. Walking
is recommended as soon after surgery as possible
to help prevent blood clots from forming in
the legs. More strenuous exercise is restricted
for about a month after the surgery.
You
will start to feel better after about a week
or two following liposuction surgery. You may
return to work within a few days of the surgery.
Bruising and swelling is usually subsides within
three weeks; however, several months later you
may still have some residual swelling.
Your
doctor will monitor your progress through follow-up
visits. If you have any questions or problems
between office visits you should call your doctor.
Your new body shape begins to emerge in the
first couple of weeks; however, it isn't until
about 4 to 6 weeks that the improvement becomes
more apparent. By exercising regularly and eating
a healthy diet, you can help to maintain your
new shape.
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