Liposuction — also known as suction-assisted lipectomy — is a surgical technique to remove unwanted fat deposits from specific areas of the body and face. Liposuction is not a substitute for weight control or exercise, but a method of removing localized fat. Common areas of treatment include:
chin, neck and cheeks
upper arms and folds above the breasts
abdomen, buttocks, hips and thighs
knees, calves and ankles
Liposuction was first performed in Europe in the late 1970s. It has become one of the most commonly performed surgical procedures in the United States. There have been three major advances over the past two decades: Smaller instruments give the surgeon more control. The tumescent technique involves distending the fat with water before removing it. This causes less bleeding and thus less postoperative bruising. The fluid also makes the fat softer and easier to remove thus adding additional control.
In recent years, ultrasound methods and laser-assisted methods have been introduced with mixed reviews. In many instances the disadvantages outweigh the advantages of these technologically sophisticated yet complicated approaches to liposuction.
A good candidate for liposuction is of relatively normal weight with one or more areas of excess fat deposit. The most common areas for liposuction in women are the inner or outer thighs, the knees, the hips, the abdomen, the upper arms, and the chin. In men, the most common areas are the chin, waist and abdomen. Most patients have several different areas which are problematic, and these can usually all be removed simultaneously.
Your skin must be reasonably elastic. This allows the skin to assume the new contour after the fat has been removed. This determination is made before the surgery is performed. Those patients who have experienced very large fluctuations in their body weight are often poor candidates for liposuction. The quality of their skin in most instances is very poor, lacking the necessary elasticity.
Although liposuction can change the shape of your body, if you have cellulite, the surface irregularities will not be changed. Cellulite is caused by connective tissue attachments between the skin and the underlying tissues. Between these attachments is a dense, fibrous form of fat. This more superficial fat is not removed by liposuction. Doing so might impair the circulation to the skin and cause scarring. In order to be a good candidate for liposuction, you must be physically and psychologically healthy and have realistic expectations.
PRIOR TO SURGERY
At your initial consultation, Dr. Glassman will ask you to express your concerns about your appearance. Your medical history will be reviewed and a physical examination will be conducted to determine if a surgical procedure is best for you. If you are a good candidate for surgery, Dr. Glassman will explain what can be done to assist you.
Dr. Glassman may request that you visit your private medical doctor for a check-up and for any necessary lab work and x-rays. Precise preoperative instructions are provided, and all necessary prescriptions are given to you in advance of the surgery. All aspirin, aspirin-containing products, and anti-inflammatory products must be stopped at least ten days before and for ten days after surgery. You will be provided with a complete list of which medications to avoid. Tylenol may be taken during this time. Also, you will be given a list of vitamins and homeopathic preparations to take prior to and after the surgery. This is done to promote healing and limit bruising.
In the vast majority of liposuction cases, general anesthesia is used. However, in some cases, local anesthesia with intravenous sedation may be used. Dr. Glassman and our anesthesiologist will help you make this decision based on what type of anesthesia is best for you.
Liposuction is generally performed as an outpatient in a private facility. It may be combined with other procedures, such as cosmetic facial or breast surgery.
Before anesthesia is given, a detailed “map” of the fat to be removed is drawn on your skin using a special marking pen.
After anesthesia is given, Dr. Glassman will inject a dilute solution of water, saline and local anesthesia to distend the fat (tumescent technique). The solution works on the fat for ten minutes before the suction is begun. No incisions are made. Small puncture sites are made in inconspicuous areas such as the navel or the crease behind the buttocks. A thin hollow tube called a “cannula” is inserted into the fat. The cannula is attached to a clear plastic tubing and connected to a vacuum device. By working the cannula through the fat while suction is applied, Dr. Glassman will remove the unwanted fat and proceeds layer by layer until the desired shape is achieved. No stitches are required because the entry sites are so small. You are then fitted for an elastic garment, awakened and taken to the recovery room.
The time required to perform liposuction varies considerably, depending on the number of areas and the amount of fat to be removed.
THE POSTOPERATIVE PERIOD
The first one to two hours after surgery are spent in the recovery room. When you are fully alert, you will be able to return home in the care of a friend or family member. A private nurse can be provided at your request.
The following morning, the surgical sites are inspected and cleansed in our office. Instructions are given on how to care for the incisions until the stitches are removed in seven days.
A snug elastic garment or body stocking must be worn over the treated area for two weeks. This is done not only to control swelling and bruising, but also to minimize postoperative pain. The pain following liposuction is described by most patients as mild. Some feel as if they had exercised strenuously. Pain medication is prescribed, although this is usually unnecessary after the first day.
Bruising, if present, can persist for a week or more. Swelling, however, may persist longer. The final result may not be evident for six to eight weeks. However, most of the swelling resolves in a matter of two weeks.
You will be encouraged to begin walking short distances within the first several days after surgery. Most patients can return to work or social activities after four to seven days. Strenuous activity such as running, aerobics, weight training, swimming or tennis must be avoided for two weeks after surgery.
RISKS AND COMPLICATIONS
As with any operation, liposuction has minimal risks and potential complications. However, with highly trained doctors and nurses making up the surgical team, complications are extremely rare. Like all surgery, the risk of bleeding, infection, scarring or an anesthetic problem is present.
The most common problem is a contour irregularity which is more likely to be seen in patients with cellulite or poor skin tone. Prolonged bruising and numbness are conditions that invariably improve with time. Rarely, the bruising does not resolve completely and slightly discolored areas may remain. These problems, as well as undercorrection, can usually be corrected easily with a minor revision under local anesthesia. Any remaining excess fat can be suctioned if present. If a depression in the skin is present, fat can be injected into the area to correct the problem.
Liposuction is a highly effective method of giving your body a new contour with minimal, unnoticeable scarring. The results are permanent. Liposuction removes fat cells that will not come back, since no new fat cells are produced after puberty.
If you gain weight after liposuction, the fat will be distributed more uniformly throughout your body. It will not accumulate disproportionately in the former “bulges.”
ADVANTAGES OF LIPOSUCTION
There are no substitutes for eating properly and exercising regularly. However, we have seen many patients who, in spite of a low fat diet and a regular exercise routine, continue to have sites of disproportionate fat accumulation. The medical term for this condition is ‘lipodystrophy’. Lipodystrophy can be corrected with liposuction, the single most significant advance in plastic surgery over the past twenty-five years. Prior to liposuction, body contouring was rarely performed and involved extensive, very visible scars. Now, with liposuction, the following areas can be altered without detection of surgery:
Folds above the breasts
Flanks (love handles)
Thighs- outer, inner, front