Liposuction

Women may have liposuction performed under the chin, on their hips, thighs, and stomach, and in the underarm and breast area.

Suction-assisted lipectomy – also known as liposuction, fat suction, or suction lipectomy – is a technique to remove unwanted fat deposits from specific areas of the body, including the chin, neck, and cheeks; the upper arms and above the breasts; the abdomen, buttocks, hips, and thighs; and the knees, calves, and ankles. Liposuction is not a substitute for weight reduction, but a method of removing localized fat that doesn’t respond to dieting and exercise.  If you’re considering liposuction, this will give you a basic understanding of the procedure – when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your doctor about anything you don’t understand.

The best candidates for liposuction

Liposuction can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for liposuction are of relatively normal weight but have pockets of excess fat in particular areas. You should be physically healthy, psychologically stable, and realistic in your expectations. Most important, having firm, elastic skin will result in a better final contour. (Hanging skin won’t reshape to your body’s new contours, and may require an additional procedure to surgically remove the excess skin. This procedure will leave visible scars.)

Suction lipectomy is not recommended if you’ve had recent surgery on the spot to be sculpted, if you have poor blood circulation in that area, or if you have heart or lung disease. You should also understand that liposuction by itself will not improve the dimpled skin known as cellulite, though some plastic surgeons offer other techniques that may improve this condition.

All surgery carries some uncertainty and risk

Suction-assisted lipectomy is normally safe, as long as patients are carefully selected, the operating facility is properly equipped, and the physician is adequately trained in body contouring as well as general surgery.

Nevertheless, in rare instances, the procedure may cause severe trauma, particularly when multiple or very extensive areas are suctioned at one time. Other infrequent, but possible, complications include fluid accumulation (which must be drained) and injury to the skin. Although serious complications are infrequent, infection or excessive fluid loss can lead to severe illness. You can reduce your risks by choosing a qualified plastic surgeon who has been granted privileges to perform liposuction at an accredited hospital, and by closely following his or her advice.

The scars from liposuction are small and strategically placed to be hidden from view, even in a bikini. However, other cosmetic problems may occur, even if your surgeon is very skilled. They may include rippling or bagginess of the skin over the treated area, and pigmentation changes (such as brown spots) that may become permanent if exposed to the sun. Asymmetry (uneven contour or shape) sometimes requires a second procedure.

Planning your surgery

In your initial consultation, the surgeon will evaluate your health, determine where your fat deposits lie, and carefully assess your skin tone. Your doctor should explain any alternative body-contouring methods that may be appropriate – such as abdominoplasty, or tummy tuck – and discuss the options or the combination of procedures that would be best for you.

Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing the procedure in detail and explaining its risks and limitations. Your surgeon should also explain the anesthesia he or she will use, the type of facility where the surgery will be performed, and the costs involved.

During this consultation, be sure to tell your surgeon about any large weight losses or gains you’ve had at any time. You should also inform your surgeon if you smoke, and if you’re taking any medications, vitamins, or other drugs.

Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for your surgery

If you’re having extensive liposuction, discuss the possibility of having blood drawn ahead of time with your doctor. Your own blood can be used to help replace the blood and other fluids you’ll lose during surgery if your doctor feels this is necessary.

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets, and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your procedure will have to be postponed.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and, if needed, to help you out for a day or two.

Where your surgery will be performed

Suction-assisted lipectomy may be performed in a surgeon’s office-based facility, an outpatient surgery center, or a hospital. It’s usually done on an outpatient basis, for cost containment and convenience. Extensive procedures may require a hospital stay of two or three days.

Types of anesthesia

If your procedure is not too extensive – that is, the amount of fat and fluid removed does not exceed an amount your doctor will define based on your health, body size, and surgical procedure – liposuction can be performed under local anesthesia, which numbs the area, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and will feel minimal discomfort. Some surgeons may instead use an epidural block, similar to the anesthesia used in childbirth.

If your doctor plans to suction a large area, or to treat several sites, you’ll probably have general anesthesia. In that case, you’ll sleep through the operation.

 

The Surgery

Suction-assisted lipectomy usually takes an hour or two, but the time required may vary considerably – from thirty minutes to several hours, depending on the area and amount being suctioned.

To begin the procedure, the surgeon makes a small incision, just large enough to allow the insertion of a hollow tube called a cannula. The opposite end of the cannula is attached to a machine that creates a strong vacuum. The surgeon manipulates the cannula deep within the fat layers under the skin, breaking up the fat and suctioning it out. Sometimes additional incisions are needed to remove all areas of fat.

If you’ve had local anesthesia, you’ll feel some vibration and friction during the procedure. You may also feel a stinging sensation as the cannula moves closer to the muscle.

You’ll lose fluid along with the fat during liposuction, and it’s crucial that this fluid be replaced to keep your body from going into shock. You’ll be given fluids intravenously, and if needed you may also receive a blood transfusion (usually the blood you’ve donated in advance).

  After your surgery

After surgery, a drainage tube may be inserted beneath your skin for one to three days to remove any fluid build up that occurs. A snug elastic dressing, girdle, or body stocking must be worn over the treated area to control swelling and bleeding, and to help your skin shrink to fit your new contour. You may need to wear this garment continuously for two to three weeks, then just in the day time for a few weeks more, depending on your surgeon’s instructions. Your doctor may also prescribe antibiotics to prevent infection.

Don’t expect to look or feel great right after surgery. You’ll even be heavier for a while, because of the extra fluids you’ve been given. The suctioned areas will be swollen and bruised, and you may feel a burning sensation. The pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days. You may temporarily lose all feeling in the suctioned area; don’t worry – it will return.

It’s not unusual to feel depressed in the days or weeks following surgery. Try to keep in mind that this is normal and will subside as you begin to look and feel better.

Getting back to normal

Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible (to help prevent blood clots from forming in your legs), but to avoid more strenuous activity for two to four weeks. Any stitches will be removed in five to ten days or dissolve, and you should be back at work in 2 – 3 days, or as much as two weeks after your surgery. When you resume activity depends on the extent of your procedure, how you feel and what your doctor recommends.

While most of the swelling and discoloration will be gone a month or two after surgery, some swelling can re main for six months or more. Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.

If you have any unusual symptoms between visits – for example, heavy bleeding or a sudden increase in pain – or any questions about what you can and can’t do, don’t hesitate to call your doctor.

Your new look

Suction-assisted lipectomy is a highly effective technique for giving you a new body contour with very little scarring. The results can be permanent, providing you eat sensibly and exercise regularly. If you do gain weight, you’ll probably gain it more uniformly throughout your body, not just in the former “bulges.”

Most patients are very satisfied with the results of their liposuction – they feel more comfortable in a wide variety of clothes, and more at ease with their bodies. As long as your expectations are realistic, you should be happy with your new shape.

 

 

If you’re considering UAL…

Ultrasound-assisted lipoplasty, commonly known as “UAL,” is a relatively new liposuction technique that uses sound waves to liquefy unwanted fat. Although it is not a substitute for traditional liposuction, UAL can be an effective tool for removing fat from fibrous body areas, such as the male breasts or the back, or for removing larger volumes of fat in a single procedure.

Often, traditional liposuction is performed with UAL to help shape UAL-treated areas or to treat areas of the body not suited for UAL, such as the neck and inner thighs.

If you are considering UAL, the following information will provide an overview of the technique: when it can help, how it is performed and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Ultimately, you and your plastic surgeon will determine whether UAL or traditional liposuction is best suited for you.

Please ask your physician if there is anything about the procedure you don’t understand.

The best candidates for UAL

Liposuction can enhance your appearance and your self confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have UAL or liposuction of any type, think carefully about your expectations and discuss them with your surgeon.

The best candidates for UAL are generally no different than candidates for the traditional liposuction procedure: normal-weight people with firm, elastic skin who have pockets of excess fat in particular areas. UAL candidates should be physically healthy, psychologically stable and realistic in their expectations. Age is usually not a criterion for liposuction, but older patients may have diminished skin elasticity and may not achieve the same results as a younger patient.

All surgery carries some uncertainty and risk

Since it was first described in the medical literature in 1991, UAL has been performed on several thousand patients worldwide. However, long-term effects of ultrasound energy are not known and extensive research and clinical trials are needed to establish fully the safety and efficacy of UAL. So far, clinical investigators have reported good results from the technique.

UAL is normally safe when patients are carefully selected, the operating facility is properly equipped and the physician has completed an appropriate, hands-on UAL training course.

As with traditional liposuction, serious medical complications from UAL are infrequent. However, possible complications include clots that block blood flow, infection, excessive fluid loss that can lead to shock, excessive fluid accumulation that must be drained, skin injury, perforation injury to the skin or other organs and adverse reactions to anesthesia.

One potential complication specifically related to the UAL technique is thermal skin injury or burn caused by the heat from the ultrasound device. Also, temporary collections of fluid beneath the skin surface (seromas) are more common with UAL.

Also, you should be aware that at present, the tube-like instruments or cannulas used to perform UAL are slightly larger than the cannulas used for traditional liposuction. The longer incisions that are needed for UAL require that they be placed carefully in hidden areas. For this reason, some surgeons prefer to use the traditional liposuction technique in areas where an obvious scar may result.

Cosmetic complications from all types of liposuction include: irregularities of the skin’s surface, areas of uneven pigmentation, and asymmetry. Some cosmetic problems can be treated with additional surgery.

Planning your surgery

In your initial consultation, your surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. Your surgeon will explain the body contouring methods that may be most appropriate for you. For example, you may learn that an abdominoplasty or “tummy tuck” may more effectively meet your goals; or that a combination of traditional liposuction and UAL would be the best choice for you.

Be frank in discussing your expectations with your surgeon. Also, be sure to tell your physician about any significant weight losses or gains you have had at any time. You should inform your surgeon if you smoke, and if you’re taking any medications, vitamins or other drugs.

Preparing for your surgery

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your procedure may have to be postponed.

While you are making preparations, be sure to arrange for someone to drive you home after your surgery and, if needed, to help you out for a day or two.

Where your surgery will be performed

UAL may be performed in a surgeon’s office-based facility, an outpatient surgery center, or a hospital. It is usually done on an outpatient basis. If a large volume of fat will be removed, a stay in a hospital or overnight nursing facility may be required.

Anesthesia for UAL

If you are having only a small amount of fat removed, UAL may be performed under local anesthesia combined with a sedative to make you drowsy. You will be awake but relaxed and feel only minimal discomfort. Some surgeons may prefer to use an epidural block, similar to the anesthesia commonly used in childbirth.

General anesthesia may be used if you prefer it, or if your doctor so advises. In that case, you will sleep through the procedure.

The surgery

The time required to perform UAL may vary considerably, depending on the amount of work you are having done. However, UAL generally takes longer than traditional liposuction because of the extra “fat-liquefying” step involved.

To begin the procedure, salt water containing local anesthesia and adrenaline is injected into the area to be treated. Then, a metal cannula connected to an ultrasound generator is inserted beneath the skin through a small incision. The ultrasonic energy causes the walls of the fat cells to break down, allowing the fat to flow out of each cell. The “liquified” fat combines with the injected fluid to create an emulsion, which is removed from the body by vacuum pressure.

If you are awake, you may feel some warmth and vibration during the procedure. You will probably be given some fluid through an IV (intravenous) tube to keep your fluid level balanced. Typically, only a small amount of blood is lost during UAL. However, if your surgeon determines that a blood transfusion may be needed, you can donate your own blood in advance of the procedure.

After your surgery

After surgery, you will likely experience some fluid drainage from the incisions. A drainage tube may be inserted beneath the skin to prevent fluid build-up. To help control swelling, you may be fitted with a snug elastic bandage or compression garment to wear over the treated area. The bandage or garment is typically worn for up to four weeks, to help your skin shrink to fit its new contour.

The side-effects of traditional liposuction surgery — pain, burning, swelling, bleeding and temporary numbness — can be expected from UAL as well. The pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days.

It is normal to feel a bit depressed in the days or weeks following surgery. This feeling will subside as you begin to look and feel better.

Getting back to normal

Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible. You will begin to feel better after about a week and you should be back to work within two weeks following your surgery. Any stitches are usually removed within the first week.

Activity that is more strenuous should be avoided for about three weeks as your body continues to heal. Although most of the bruising and swelling usually disappears within six weeks, some swelling may remain for six months or more.

Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.

Your new look

You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about six weeks, when most of the swelling has subsided.

If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape permanently.