Although a healthy lifestyle, proper diet, and exercise are the optimal tools to achieve and maintain a healthy, toned, and youthful body, there are certain areas of the body where fat deposits are highly resistant to these modalities.  For these areas, liposuction offers a great alternative to eliminate the amount of fat present, and to contour the remaining tissue to a more desirable shape.  Although a rudimentary type of liposuction was performed as early as 1921, it wasn’t until the 1970s when the available technology made it possible to perform liposuction as we know it today.  Liposuction has reached such popularity that it has become the most common cosmetic surgery procedure performed in the United States.

IS LIPOSUCTION FOR YOU?

Liposuction is intended to address problem areas of fat deposition which are resistant to diet and exercise, and to improve the contour or shape of the body. It is not intended as a weight reduction modality. Thus, liposuction is indicated on healthy patients who are within a certain range of their ideal body weight (within 30% is recommended). For obese patients who have undertaken a weight reduction program, liposuction is only indicated after the weight loss is completed, and the weight has stabilized. In these patients, liposuction is done to address localized problem areas.

Since the contour changes after liposuction occur in part, by the natural shrinking of the skin after the excess fat has been suctioned, liposuction results are best noted in younger patients who have optimal skin elasticity. Liposuction has been successfully performed in all areas of the body including face/neck, arms, torso, and legs. Although most of the time liposuction is performed as the sole procedure, there are times when it is combined with other surgical procedures such as a facelift or a tummy tuck in order to optimize the results.

 

When considering liposuction, the initial consultation with your surgeon is extremely important. A thorough review of your medical history will be performed to elicit conditions which might potentially put you at an increased risk of complications from the procedure. Medical conditions such as high blood pressure, or history of excessive blood clotting should be thoroughly investigated. Smoking has also been identified as increasing the rate of complications. Furthermore, birth control pills, estrogen replacement therapy and smoking might place you at an increased risk of blood clot formation in the lower extremity or lungs, perhaps the most serious complication of this procedure.

A thorough physical exam will then be performed where your height, weight, and perhaps your body max index (BMI) will be calculated to ensure you are within a certain safe range of your ideal body weight. It is at this time that you should communicate with your surgeon the areas that you would like treated. The nature of the elasticity of the skin will be assessed, as wells as the topography and contour of the problem areas. Skin irregularities or cellulite in the problem areas for example, might not disappear or perhaps may be worsened with liposuction, especially if the skin elasticity is not optimal. When discussing each specific area to be treated, your surgeon might discuss with your whether liposuction alone will achieve the desired result, or whether other options might be considered in lieu of, or in conjunction with the liposuction. Certain areas of the body respond better to liposuction than others. The area under the chin and the outer thigh for example, usually respond very well whereas liposuction of the inner thigh is known to have a significant patient dissatisfaction rate. In men, liposuction can be utilized to treat the same areas as in women. This modality is also particularly useful in the treatment of excess breast tissue accumulation in men, a condition known as gynecomastia.

UNDERSTANDING THE SURGERY:

Local liposuction of a small area can be performed in an office setting and even with local anesthesia. When the areas to be treated are more extensive however, usually a hospital facility and general anesthesia are required. After the patient is positioned, usually the areas to be treated are injected with a solution which contains saline, local anesthesia and epinephrine (a solution which shrinks the size of the blood vessels in the area). This is done in order to minimize the amount of blood which is suctioned with the fat. This in turn, will not only decrease the chances that a blood transfusion will be necessary after liposuction, but will also minimize the swelling and bruising after the procedure. Some of the terminology utilized to describe this technique of injection of fluid to the areas to be treated include terms such as wet, superwet, and tumescent, and describe different amounts of fluid to be injected to the treatment site. In the tumescent technique for example, large amounts of fluid are injected to the point where the fat compartment becomes taught or firm to the touch. This allows for the liposuction instruments (cannulas) to better glide through the fat during suctioning, and greatly minimizes the amount of blood suctioned along with the fat tissue.
 

The procedure itself involves making small cuts (incisions) strategically placed on the skin at the periphery of the areas to be treated. Through these cuts, the liposuction cannulas are inserted in order to treat the areas in question. Normally, the area to be treated is approached from multiple directions to minimize the rippling or surface irregularities that are sometimes seen with this treatment modality. By utilizing different types and sizes of cannulas the surgeon will not only be able to suction the excess fat deposits, but also mold or shape the fat under the skin (liposculpture) and give that particular area of the body an improved shape and contour. As the technology has improved, newer modalities have emerged that allow for the liposuction process to be done more efficiently. One of these technologies which your surgeon might mention is ultrasound assisted liposuction (UAL). This technique utilizes sound waves to soften or liquefy the fat, thereby making it easier to suction. This technique is particularly useful when liposuction is anticipated in areas of the body where the fat tends to be more fibrous (denser) and thus, more difficult to suction. This is the case in areas such as the back, male breast, and calves.

After the areas to be treated are contoured to the surgeon’s satisfaction, the small skin incisions are closed with small (usually resorbable) sutures. The surgeon will then usually apply a compression garment to the areas that were treated right in the operating room. This garment is to be worn for a period after the surgery which can last from days to weeks, depending on the area that was treated. This garment helps compress the skin to the underlying tissues. By doing this, it allows the skin to reattach to these tissues in the proper place, and also minimizes free space under the skin where fluid can accumulate in the postoperative period. You might find that this compression garment will give you added support and comfort as you heal in the first few days after the procedure.

If the liposuction is extensive enough to warrant an overnight stay at the hospital, usually you will be discharged on oral pain medications the next day. Although you might experience some bruising, swelling and numbness in the areas that were treated, the discomfort should not be excessive. You should be able to return to normal daily activities within a couple of days. Your surgeon will ask you to come for a follow-up visit usually within the next week, where he/she will inspect the incisions, surgical sites, and address any concerns you might have. As your body heals and the skin shrinks over the next few days to weeks, the improvement in the areas treated will soon become evident.

THE NEW YOU