Liposuction
Introduction
Firm and well-shaped body is considered as a sign of beauty, health and vitality. A lot of people who eat well-balanced diet and have a good health state, suffer from the fat accumulation located in certain areas, they can not get rid of this fat neither by diets nor by regular exercise. As a result a disproportional body appearance is formed. Hormones and genetic predisposition is often a cause of the local fat accumulation.
Liposuction is used for the body shape correction, body shaping. Liposuction helps to improve the appearance of disproportional areas, areas with local fat accumulation but it is not a treatment for obesity or cellulite and it does not substitute regular exercise and proper diet as well.
What is liposuction?
Liposuction is a surgical method which helps to reduce local fat pockets – adipose tissue accumulation. The principle is based on the fat suction with a help of special surgical equipments called cannulas. Liposuction is performed in order to shape the body, not to reduce the weight.
There are several liposuction techniques:
- Traditional liposuction, using various kinds of cannulas. Before the fat suction, an amount of solution is injected into the operating area which helps to reduce the bleeding and loosen the adipose tissue. According to the amount of solution used, we distinguish several types of liposuction - wet, super wet or tumescent.
- Ultrasound–assisted liposuction, ultrasound is used to liquefy adipose tissue before the suction; however compared to the normal liposuction, no significant difference has been proved
- Vibration–assisted liposuction – a vibration device makes the surgery easier, it creates a vibration which moves the tip of the cannula.
- Laser-assisted liposuction – laser is used to liquefy adipose tissue; no significant difference compared to normal liposuction has been proved (Prado A et.al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45.)
Which technique is the best one?
The principle of all techniques is the same – to draw the fat cells, either whole or broken, out of the body by suction, the result of liposuction depends mainly on the skills of the surgeon not on the device that is used.
Where can we remove the fat?
Using liposuction, we can remove the fat anywhere on the body, the most common areas are: abdomen, waist and flanks, hips (area of trochanters) and buttocks, thighs, inner knees, arms, breasts and the thoracic area, back, cheeks, chin and neck, calves and ankles. The fat removal is not suitable for the lower part of buttocks. Also in the areas with the skin excess, the surgical excision of the excess is advisable possibly as a complement to liposuction (e.g. abdominoplasty).
For whom is the liposuction advisable?
Liposuction is advisable for every adult person who is healthy and in relatively good condition, having a firm elastic skin, without overweight. The skin elasticity is one of the important factors which determine the achievement of the surgery. The skin elasticity decreases with age, therefore an individual consideration is necessary for patients aged more than 40 years.
The ideal candidates for liposuction are patients who are relatively slim just with the local fat accumulation. Patients should be healthy, without life threatening illness or health condition, which could affect healing and recovery. Patients should have positive life attitude, clearly defined aims of the surgery and should be well-motivated. Smokers can expect the higher incidence of complications.
Is it appropriate to combine liposuction with other procedures?
Liposuction can be performed individually or as a part of other surgeries e.g. abdominoplasty or the breast reduction. It is necessary to consult such surgery with the surgeon.
How long does the surgery take?
It can take approximately from half an hour up to 5 hours (usually about 1-2 hours), depending on the extent of the surgery and on the used technique.
What we can/can not achieve by liposuction?
With the help of liposuction, we can change the body proportions permanently in the areas where the fat accumulation forms disproportional parts in the relationship to the rest of the body which is in a balance.
With the help of liposuction it is not possible to treat the obesity or substitute proper diet or exercise. Neither the cellutite which is usually located in the area of thighs, hips and buttocks can be treated.
What volume size of fat can be removed?
It is possible to remove relatively large volume of fat within one surgery. However special circumspection and post-operative care is necessary, if more than 5 litres of fat has been removed. Such a liposuction is called “large volume liposuction”. The largest volumes removed in obese patients range over 10 litres. These surgeries are more dangerous and require expensive and complicated post-operative care. Due to the safety and lowering the risk of complications, we usually recommend patients to have most 3-4 litres removed within one surgery. With such a volume there is minimal risk for the blood transfusion need, water and mineral disturbances (patient´s dehydration) and other complications. The rule is that it is always better to repeat the surgery than to remove too much fat. It is very difficult to correct the skin dimples which are the result of the excessive fat removal, on the contrary smaller amount of removed fat is safer. *Choudry UH, Hyza P, Lane J et al.The importance of preoperative haemoglobin evaluation in large volume liposuction: lessons learned from our 15-year experience. Ann Plast Surg. 2008 Sep;61(3):230-4
General or local anaesthesia?
Depending on the extent of the surgery and the amount of the fat removed we choose either general or local anaesthesia. In general, general anaesthesia provides higher comfort and the painless surgery is guaranteed. It is convenient for the larger volume fat removal. When performing the surgery under the general anaesthesia, at least one-day hospitalization is necessary. On the other hand, local anaesthesia allows us to perform the surgery as an outpatient procedure and it is convenient for small volume liposuction, due to the limited amount of the local anaesthetics which can be applied in the operating field. It is possible to perform the large volume liposuction under local anaesthesia as well, but only within more surgeries (repeated surgery). It is not suitable to perform liposuction of the abdomen under local anaesthesia, because the anaesthesia of deep-located abdominal nerves is not sufficient and so the procedure is more painful.
What is the procedure of the surgery itself like?
Before we start the surgery, the operating field is cleaned and disinfected. Before the fat removal the operating area is infiltrated with a special solution. This solution contains physiological solution, anaesthetics and adrenaline which help to provide the local anaesthesia of the operating field during the surgery and after the surgery as well, it reduces the blood loss and makes the fat suction easier. Afterwards the liposuction cannulas are inserted into the adipose layer under the skin via several small incisions. The adipose tissue in particular area is loosened by moving the cannula to and fro repeatedly. The suction of the fat is provided by the suction device which is connected to the cannula. The alternative method is using the injection syringe with a negative pressure. After the surgery, small approximately 1 cm long incisions are sutured, some incisions are so small so they can be left to heal spontaneously.
What are the scars after the surgery like?
Every surgery requires incisions which leave scars afterwards. After the liposuction, incisions are relatively small, located close to the operated area, in the hidden or just a little noticeable places. The quality of scars (colour, width, thickness) depends on the pattern of your healing. In case the healing process is not ideal it is possible to enhance the healing by the help of balms, creams, injections and special little compressive board etc.
The typical location of scars after the liposuction in particular areas:
- Liposuction of arms: on the lower part of arm, above the elbow or in the armpit and axillary fold
- Liposuction of buttocks: in the area of buttock crease
- Liposuction of neck: under the chin and behind pinnas
- Liposuction of thighs: along the inner thigh, outer thighs and hips
- Liposuction of abdomen: in the area of the bikini line and around the navel
Alternatively, we can make small surgical incisions on different places if necessary. These scars are not visible, usually hidden in the body contours.
What is the post-surgery treatment like?
After the surgery performed under general anaesthesia, it is necessary to be hospitalized for a particular period. The period of hospitalization depends on the extent of the surgery, health status, possibilities of homecare and other factors. Usually 1-2 days of hospitalization are sufficient. Afterwards it is appropriate to keep the rest regime at home. You will be able to resume common daily activities in 1-2 weeks however doing sports or performing bigger physical activities is possible in approximately 4-6 weeks. Sutures are removed usually 5th-14th day after the surgery, it depends on the scar location and on the process of healing. It is necessary to wear compression underwear which is firm in order to keep the tissues in a good contact after the surgery, to enable their healing in the most ideal way. Moreover the elastic underwear provides support during the healing, helps to reduce swelling and haematomas by preventing the liquid accumulation in the operated area. Although the recovery after liposuction is relatively quick, haematomas can remain for 2-3 months. The final result of the surgery is noticeable after the swelling subsides completely.
How to maintain the result that was achieved by liposuction?
It is important to know that despite the fat cells were permanently removed from the particular area, liposuction does not prevent further weight increase. The best way is to maintain the same weight as it was during the surgery. To maintain the result of your surgery, it is important to continue with healthy diet and exercise.
What are possible complications and following surgeries?
Possible complications include: the formation of haematoma and bleeding, irregular body contours, rippling or excessive skin, temporary decreased skin sensitivity, irregular pigmentation, infection in the operated area, blood clots and embolism, fat clots and embolism, temporary liquid accumulation. Moreover during the ultrasound-assisted technique there is a risk of burning by the ultrasound. All surgeries are connected with the risks which follow from anaesthesia. All mentioned risks and the other ones will be discussed with you before the surgery.
If you have any question or comment, do not hesitate to contact us.