Liposculpture (Fat Removal)

Introduction
What is Liposuction?
What's the history of Liposuction?
Am I a suitable Candidate?
What is Liposuction with the Tumescent Technique?
What is Ultrasonic Liposuction?
What is Power Assisted Liposuction?
What does the operation involve?
What type of anaesthetic is used?
How long does the surgery take?
Do I need to stay in overnight?
How much fat can you extract?
How much weight will I lose?
Is it Painful?
Will the Fat come back?
What happens immediately after the Operation?
What kind of effects can I expect after Surgery?
What are the scars like?
What can go wrong?
How long before I get back to normal?
Summary

Introduction

Much of our physical appearance is due to heredity and many aspects of the way we look such as, colour of our eyes, height and hair, are out of our control. Many things however, such as our weight can be broadly controlled. It is thus widely accepted that it makes sense to eat a healthy diet and to exercise. Therefore people who are truly concerned about their appearance adhere reasonably well to the various regimens available. However sometimes despite all our best efforts to lose or control the fat, some regions of the body contain stubborn diet and exercise resistant fat. Resistant, localised fat deposits are usually an inherited problem; so don't blame yourself for their presence.

What is Liposuction?

Liposuction is the removal of localised unwanted lumps and bulges of fat by the use of thin straw like metal tubes, called cannulaes. In women and men, these localised fat deposits may be formed virtually anywhere on the body but are more commonly deposited on the abdomen, hips, flanks, inner and outer thighs, knees and chin. In men a condition called gynaecomastia (localised fatty breast enlargement-see below) is commonly encountered.
These cannulaes are placed into the body fat through small incisions. A vacuum is subsequently applied through a hose attached to the cannula and the fat is drawn out of the body. Liposuction is not an alternative to weight loss and exercise, but a means of resculpting the body into a slimmer profile by removing the fat not responsive to the most diligent efforts. It is currently the only available method for removing fat cells in certain areas.

What's the history of Liposuction?

Though liposuction is a relatively new form of cosmetic surgery, it has nevertheless become the most commonly performed cosmetic procedure. Dr. Giorgio Fischer, a gynaecologist in fact, first devised liposuction in 1974 in Rome, Italy. It was taken to Paris by Dr. Illouz a Plastic Surgeon in 1978 and subsequently popularised. Since this time it has undergone a number of refinements, including the development of smaller finer cannulaes, the advent of tumescent liposuction and, newer forms of liposuction including Ultrasonic and Power assisted liposuction.

Am I a suitable Candidate?

Only a consultation will be able to determine if you are an acceptable candidate for a liposuction procedure. A consultation preoperatively accomplishes several objectives. A thorough medical history and appropriate physical examination will be taken to ascertain your health status. If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these.

Determining your suitability will partly be defined by the quality of your skin. In most cases the skin being a dynamic organ, is able to shrink and reaccomodate to the new body contour after liposuction. In the some cases however, patients may have decreased skin elasticity as witnessed by loose, hanging, or crepey skin in the affected area. In these cases liposuction alone will not produce the desired result and you may therefore require some form of skin removal/reduction instead (i.e. tummy tuck) or perhaps in combination with liposuction.
The best patients for liposuction are those individuals who are active and healthy, of average or near average weight (within 12-15% of their ideal weight), and have reasonably good skin tone and elasticity. Age by itself is not a significant factor and in fact patients from age 16 - 65 have benefited from liposuction.

You should also understand that liposuction by itself will not improve the dimpled skin condition known as cellulite.

What is Liposuction with the Tumescent Technique?

The most significant refinement in liposuction over the last decade has probably been the development of the Tumescent Technique, devised by Dr. Klein in the United States. The tumescent technique of liposuction involves the injection of relatively large volumes of a saline solution containing dilute local anaesthesia and adrenaline into the fatty tissues, thus forming a safety cushion on which the cannulas can slide. More importantly, these elements contribute to the loosening of bonds between the fatty cells, thereby facilitating their removal. As a result of the adrenaline there is a decrease in the bleeding from blood vessels thus allowing us to remove larger quantities of fat more safely. Less bleeding also means less bruising. The infiltration of large volumes of dilute anaesthesia also allows the procedure to be performed under local anaesthesia with or without sedation if desired.

What is Ultrasonic Liposuction?

More recently, newer liposuction instruments have been approved and used. One of latest is the new ultrasonic liposuction device. Since its inception, Ultrasonic liposuction has been changing rapidly and new news comes out every month. Some news is good; unfortunately some news is not so good. Ultrasonic means high pitched sound and this property has already been in use outside the operating room in "shaking things loose" as in the new ultrasonic toothbrushes. The ultrasonic principle is to loosen the fat so that the fat can be vacuumed out of the body faster than it might with other methods. Unfortunately as a result of the high frequency generated by these instruments (20,000Hz), the ultrasonic cannulaes used may overheat and there have been a number of reports of burns to patients. Recently ultrasonic cannulaes have, in inexperienced hands, even perforated patient's kidneys and gallbladders.

Ultrasonic liposuction also results in more seroma formation than other methods. Seromas are collections of fluid, which are made in the tissues as a response to injury. The ultrasonic cannulae presently available are rather bulky and cumbersome and cannot be bent to customise the approach. On the plus side however there have been reports which say that it is better in removing fatty areas which have a high content of dense tissue as well (such as breast tissue in the male chest). Allegedly it is also safer in the removal of very large amounts of fat (20 litres plus!) because of less bleeding.

Finally, sufficient comparisons and follow-ups of more than 3 years are few in number. Thus proper long-term comparison with the already established and accepted methods of liposuction cannot be made as of yet. In light of the aforementioned qualities, side effects, and uncertainties, the Specialist does not therefore offer this form of liposuction to his patients, despite having formally trained in the use of such equipment.

What is Power Assisted Liposuction?

An even newer technique has recently been developed over the last 2 years called Power Assisted Lipoplasty (PAL) using the Micro-Aire power handle. This we feel is the best of both worlds having all the benefits of Ultrasonic Liposuction without however its associated side effects. As a result the Specialist I recommend are pleased to be able to offer this latest technology for the benefit of his patients.

The annuals used to remove the fat in this technique are of a conventional type. The difference lies with the Micro Aired power handle, which allows the cannulae to be mechanically as opposed to manually driven. The results are a vibrating cannulae with a frequency of about 100 times a second(much lower frequency and heat generation than the Ultrasonic device) which progresses through the fatty tissue which much more ease. In doing so, this also allows the surgeon to channel his efforts and concentration into sculpting the treated area much more reliably and efficiently, rather than expending his energy into manually pushing the cannulaes back and forth. This technique can be used to great benefit in all areas of the body. Power assisted Lipoplasty is especially of benefit in male patients who desire reduction of their chest. In these patients, the nature of their firm, dense breasts, makes the improved penetration of the Micro-aire power handle an asset.

Although the Micro-aire power handle is an exciting new development with very promising early but safe results, it would only be fair to say however that ultimately, time alone will only be able to say whether it will become the accepted and established standard of the future.

What does the operation involve?

The following is a description of the classic liposuction method utilising the tumescent technique.

To begin the operation a number of tiny incisions (about 3-4mm) are made in the skin in the areas to be treated. These slit incisions are made, when possible in inconspicuous places. Subsequently the areas are injected with the tumescent solution mentioned previously. The solution is then allowed to diffuse and take effect (about 10-15mins) throughout the target fat. As mentioned the solution will numb the areas as well as reduce bleeding by temporarily closing down the capillaries. The appropriate cannulaes are inserted into the fat, then through backward and forward stroking motions the fat is loosened and drawn off by a strong vacuum pump.

It is at this point that Power Assisted Lipoplasty(PAL) differs from the conventional. The back and forth motions mentioned, are much gentler and smoother because of the mechanical drive mechanism within the power handle. Since the fat is removed by suctioning small "tunnels" through the fat, the skin remains intimately connected to the underlying muscles by multiple attachments called fibrous septa. These can be described as being the body's "Velcro". It is this process and these structures, which assures that the skin will not hang in loose folds after Liposuction. The fat is removed by doing as little damage to the septa, which also contain blood vessels, nerves and lymph vessels. For this fat to be removed without serious damage requires an excellent knowledge of the anatomy, an appreciation of body proportions and of course, surgical and mental stamina.

Throughout this procedure the Specialist is always conscious of leaving a smooth layered thin blanket of fat attached to the underside of the skin, in order to minimise the possibility of any irregularities or rippling of the skin.

Because you'll also lose some fluid along with the fat during liposuction, it is normal practise for the anaesthetist to give intravenous fluids to replace those lost in the procedure.

What type of anaesthetic is used?

Liposuction can be performed successfully either with a local anaesthetic alone, local anaesthesia with mild sedation (twilight anaesthesia) or with a General anaesthetic(completely asleep). If you decide to have it done with a local anaesthetic, you will probably feel some vibration and friction during the procedure. You may also occasionally feel a stinging sensation as the cannulae moves closer to the muscle. Obviously if you are put to sleep then you will not be aware of anything.

The decision very much depends on: the number of areas treated, the amount of fat to be removed, any pre-existing medical conditions or unique circumstances and of course the individual patients desires.

Such decisions are best made after a thorough consultation and discussion with the Specialist.

How long does the surgery take?

This depends on the number of areas treated and the amount of fat, which will be removed. Therefore this can be anywhere from 30 minutes to 2 hours.

Do I need to stay in overnight?

This very much depends on the number of areas treated and the amount of fat that is removed. It also depends on the individual’s preference and circumstances. Some people prefer day surgery so that they can recover at home whilst others prefer the reassurance of a hospital environment on the first night following surgery. Certainly when small areas, with less that 1.5 litres of fat are removed, day surgery can comfortably be undertaken. When the amount of fat exceeds this, it may then be preferable to decide on an overnight stay.

The decision for this can be made at the time of the consultation visit.

How much fat can you extract?

It is important to understand that there is a maximum safe limit to the amount of fat that can be extracted during any one operation. This is usually between 2.5 - 3 litres. In some instances therefore you may want to repeat or have more removed at another time. It is usually best to wait at least three months between procedures.

How much weight will I lose?

The answer is very little. In fact in the first few weeks after surgery you may notice a slight increase in weight due to water retention. The reason that you don't lose much weight is because taking out up to 2.5 or even 3 litres of fat (which is the safe maximum limit) is not enough for you to see a significant drop in your weight. This is because fat cells don't actually weigh that much. On the other hand however, depending on the treated area of course, you will notice a significant decrease in girth measurements.

Is it Painful?

There are very few forms of surgery that are completely painless. Discomfort is a euphemism for pain and many doctors use these interchangeably. In the case of liposuction, the degrees of pain vary from patient to patient but this can be controlled by distalgesics, which will be prescribed. The initial pain lasts around 1 week however there may be residual soreness in the treated area, mainly upon palpation, for up to 4-5 weeks. Along with the soreness you may experience some stiffness, which usually abates, as your mobility increases.

Will the Fat come back?

The short answer to this is no. As fat cells have achieved their set number in any given part of the body by puberty, increased caloric intake will not lead to volume gains in the treated site. It is important nonetheless to maintain your weight afterwards by sensible eating and regular exercise. You must understand that if you do take in excess calories after surgery, you will then notice other areas of your body increasing in size. Of course if there is a massive weight gain then new fat cells will also be seen in the previously treated areas.

What happens immediately after the Operation?

After your surgery, depending on which area you've had treated, you will find that a snug elastic compression body stocking or garment will be in place. This must be worn over the treated area to control swelling and bleeding, and to help your skin shrink to fit your new contour. You will need to wear this garment compression continuously for one week (apart from taking it off for a shower) after surgery, then just in the daytime for a few weeks more.

For treatment of the abdominal region however application of a garment very much depends on how comfortable and snug the actual garment feels. The abdominal area is notoriously difficult to apply compression to, due to the lack of any underlying bony support. It certainly needs to be in place however for the first 72 hours. After this time, it depends on the individual. If the garment feels comfortable and you feel it is providing you with support then wear it for 7-10 days, taking it off for showering. If however, it feels as though the garment is digging into your abdomen it may be preferable to loosen it or not wear it. Ill fitting garments may lead to the development of undesired folds in the skin, which subsequently harden and form ridges, and which can last up to 3 months.

What kind of effects can I expect after Surgery?

After the surgery you will notice that you will be draining some fluid from your tiny incisions. This is because there is almost always some fluid build up (usually bloody) that develops in the treated area in the first 24-36 hours postoperatively. Your incision sites therefore will act as "drainage holes" in this instance and are therefore invaluable in reducing overall post operative swelling and bruising.

Drainage of the fluid is possible because, unlike traditional teaching, the Specialist does not use stitches to close the small incisions. As the incisions are very small, these seal off and heal quite quickly on their own and the ensuing scar is no different, if not better, compared to the use of stitches. There is also the obvious advantage in that it negates the need for stitch removal. The down side of this practise is that during the first day or two, your dressings and clothing will usually get soaked quite quickly and therefore you will require regular changes. Thankfully all this usually stops by the end of the first 48 hours after surgery.

Despite wound drainage, you are still likely to experience swelling and bruising to varying degrees. Sometimes this bruising is quite spectacular. Bruising can take up to 3 weeks to disappear although very occasionally a light tinge of yellow can still be seen in the skin up to 2 months following treatment. Tissue swelling, while expected, can last up to 4 weeks. In fact because of this swelling you will probably not notice any change in your size immediately after surgery. It is important to remember that when the abdominal area is treated, the swelling and bruising can migrate downwards to the groin and genital region. In men this would mean substantial swelling, bruising and discomfort of the external genitalia. This usually lasts about 7-10 days, and one may benefit from the use of support underwear instead of boxer shorts, in this instance.

At around 2-3 weeks after surgery, you will discover that the areas treated will feel hard and irregular. This is part of the normal healing response. The body starts to lay down scar tissue (which is hard in nature) in response to surgery in an attempt to "heal" itself. This scar tissue can also block lymph drainage channels temporarily and occasionally cause the skin overlying the treated area to look dimpled or take on an "orange skin" appearance. Thankfully the scar build up ceases and eventually resolves completely, along with its manifestation. However this period of hardening and irregularity can take up to 4 months to resolve.

You will also experience sensory changes in the area treated. This may result in numbness of the skin or alternatively it may feel hypersensitive. Either way this is usually temporary and returns to normal in about 6-8 weeks.

Overall because of these effects, 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.

What are the scars like?

Scars are not a complication but a normal event after any surgery. Thankfully scars in liposuction surgery are tiny. Depending on the area(s) needed to be treated, scars about 3-4 mm in length will form. These are usually placed in natural folds of the skin where possible. Generally about 2-3 incisions are required for any given area.

Thankfully the scars in Liposuction are short and generally heal quite well, gradually fading with time. However it is important to keep in mind that this may take up to two years to complete. If you are of a darker skin type however, then expect your scars to be darkly coloured for a longer period of time (about 3 years). Daily massage of the scars during this time period is advised to expedite and facilitate this process. You must understand however that no responsible surgeon will ever be in a position to predict any scars ultimate appearance.

What can go wrong?

All surgery carries some uncertainty and risk. When liposuction is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Thus complications that can occur include thickened, deeply coloured or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides; prolonged numbness and swelling; haematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections. In extremely rare cases, skin loss resulting in permanent scarring has been reported.

Despite any surgeons best efforts, it is possible that a small number of patients may require a secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape irregularity. This will be determined at the follow up checks.

You can reduce your risks by closely following the Specialists' advice both before and after surgery.

How long before I get back to normal?

The recovery time varies with how many areas are treated and the type of activity the patient intends to resume. It is important to realise that although only tiny incisions are made, liposuction creates a large wound hidden under the skin and therefore as healing is a gradual process, adequate rest in the days after surgery will be required. However you should start walking around as soon as possible to improve the circulation and avoid stagnation of blood, which could lead to the formation of blood clots. Most patients resume light activities within 2-3 days and depending on their work can be back between 5 -7 days. However because of variations in swelling and bruising, sometimes this may be delayed up to 7 -10 days. Exercise is usually recommenced at about 10 -14 days. Don't be depressed however if it takes you longer to resume your full activities. Remember every individual is different and great variations occur.

Summary

Liposuction is the most popular cosmetic surgery procedure in Great Britain and the United States. It is a highly effective technique for giving you a new body contour with minimal scarring. In most instances it improves body image by making you feel better and more comfortable about your body both with and without your clothes.

The results can be permanent, providing you eat sensibly, exercise regularly, and maintain your weight. As long as your expectations are realistic, and understand that the final results may take a few weeks before becoming apparent, you should be happy with your new shape.

If you would like to contact Andie McLean's Clinic for further information, please call
on 01525 40 30 40