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Liposuction

Liposuction-intervention

Introduced for the first time in the United States in 1982, liposuction also called as lipoplasty or fat modelling or liposculpture, involves usage of a high vacuum device by the surgeon to remove tiny fatty tissue from different areas of the body like legs, buttocks, abdomen, back, face, arms and neck.

Since then, the procedure has become extremely popular due to its effectiveness by enhancing the body contours and proportions while leaving only tiny scars as small as less than an inch. Liposuction is neither a substitute for diet and exercise nor a cure for obesity and is most effective in those with average weight but localized areas of fat that have not responded to diet and exercise.

Mainly used for cosmetic purposes, liposuction can also be used to treat benign fatty tumors, gynecomastia or pseudogynecomastia in men, abnormal fat metabolism (lipodystrophy), excessive sweating in arm pit etc.

Since liposuction involves only fat removal and any skin dimpling or laxity cannot be corrected through this procedure, it is important that one should have a healthy elastic skin with capacity to shrink evenly after surgery. If needed, your plastic surgeon may recommend a skin tightening procedure like abdominoplasty, buttock lift, arm lift or thigh lift that are effective but leave large scars.

Any individual with realistic expectations about the results with average or slightly above average weight, having firm elastic skin and overall good health, but with concentrated pockets of fat, resistant to diet and exercise are good candidates for this procedure. Though age is not a major consideration it is important to remember that older adults may not get same results as younger adults with firm skin and anyone with cellulitis is also not a good candidate.

As an initial step, consult your surgeon and discuss your goals, options, risks versus benefits and costs, any allergies, any prescription medicines and ask any questions you have. Once surgery is decided, any instructions given by the surgeon on dietary guidelines, supplemental drugs, medications and alcohol restrictions should be followed.

How?

Depending on the type of liposuction and amount of fat to be removed, one might get a local or general anesthesia and small cuts made to insert small, thin, blunt tipped cannulas and the fat is suctioned as the doctor moves these cannulas below the skin targeting specific fat deposits. Basic challenge of any liposuction is to remove the right amount of fat with least disturbance to the surrounding tissue (blood vessels and connective tissue) and fluid balance with minimal discomfort to the patient. Different techniques adopted in making this a safer and less painful procedure include:

  • Suction-assisted liposuction (SAL): More standard method of liposuction
     
  • Suction-assisted liposuction (SAL): More standard method of liposuction
     
  • Tumescent liposuction: A saline solution containing local anesthetic, mild pain killer and epinephrine is injected into fatty areas and remove fat more efficiently with less pain and minimal blood loss.
  • ​Water-assisted liposuction (WAL): In this procedure a thin beam of water is used to loosen the fat tissue that is suctioned out using a special cannula. It needs less infiltration solution causing less edema from tumescent fluid.
  • ​Ultrasound-assisted liposuction (UAL): Ultrasound vibrations burst the fat cells and liquefy them before being suctioned out using SAL. Takes longer than traditional liposuction but lesser time than tumescent liposuction but is more efficient in areas with more fibrous tissue (upper back, male breast etc) and has less blood loss and bruising.
     
  • ​Power-assisted liposuction (PAL) is similar to SAL except that it has specialized cannula that makes mechanized movements.
     
  • Laser Assisted liposuction, similar to UAL where the laser administered will melt the fat that is suctioned out with minimal bleeding and bruising.
     
  • Twin-cannula (assisted) liposuction (TCAL or TCL): Potential friction burns are avoided because the cannulas do not get hot and then the spacing effect between outer and inner cannula facilitate superficial or sub-dermal liposuction.

What to expect?

Generally done only by a doctor with special training in liposuction, surgery of skin and management of complications, is an outpatient procedure in a well-equipped clinic or ambulatory surgery center or hospital without any need for overnight hospital stay unless large volumes of fat are removed.

While temporary swelling, bruising, soreness and numbness of treated areas, irritation and minor scarring at incision sites, baggy skin until fully tightened are the most common side effects of the procedure, in rare occasions, the following side effects must be anticipated:

  • Permanent color changes to the skin,
  • Uneven skin surface on treated areas,
  • Nerve and skin damage,
  • Underlying tissue damage from the heat produced during the UAL procedure and sometimes death.

    When done by well trained, board certified surgeons, these risks can be minimized. With large amount of the fat removed, co-morbid health conditions increase the risks that can result in death, warranting a close monitoring overnight after the procedure.

    Some major complications like fat or blood clots, excessive fluid or blood loss, pulmonary edema, infection, toxic reactions to injected materials like lidocaine, puncture to the abdominal organs like spleen can happen very rarely.

    Liposuction is clearly contraindicate din those with major heart problems, blood clotting problems like thrombophilia or during pregnancy.

    To prevent swelling, bruising and pain after the procedure, the area treated is tightly wrapped using elastic bandages, support hose, special girdle or firm fitting garments.

    For at least 3-4 weeks, the compression garments must be used one should expect a lot of bruising and swelling for a week or so. Sometimes fluid draining from incision site can happen for many days and may need antibiotics.

    One can get up and go soon after the surgery and anesthesia recover, but can resume normal activities once they start feeling comfortable. Recovery depends on the treated area size and most of the people can return to work after few days.

    Improvement in body contour is immediately noticeable and may continue for several weeks or months. As the swelling goes away, over time the full effect is visible after several months to almost a year. However, the loose skin might take at least 6 months to tighten in the treated area and also depends on individual’s skin type and age (more elastic in younger age groups).

    Though effective for treating smaller areas, any weight gain after liposuction can result in fatty bulges in same or different areas. The results from liposuction can only be maintained with regular exercise and proper diet.