What Is Liposuction? What Are
The Risks And Benefits Of Liposuction? - Medical News Today -
February 25, 2010 -
Liposuction, also called lipoplasty,
liposculpture suction lipectomy, or lipo is a type of cosmetic surgery
which breaks up and "sucks" fat from various possible parts of the
body, most commonly the abdomen,
thighs, buttocks, neck, chin, upper
and backs of the arms, calves, and back. The fat is removed through a
hollow
instrument - a cannula - which is inserted under the skin. A powerful,
high-pressure vacuum is
applied to the cannula.
It is the
most common cosmetic operation in America and the United Kingdom. Over 400,000
liposuction
procedures are carried out in the USA each
year.
Patients who undergo liposuction generally have a stable body
weight, but would like to remove undesirable
deposits of body fat in
specific parts of the body. It is not an overall weight-loss method - it is not
a
treatment for obesity. Liposuction does not remove cellulite,
dimples or stretch marks. The aim is esthetic -
the patient wishes
to change and enhance the contour of his/her body.
Liposuction
permanently removes fat cells from the body. It can alter the shape of a body.
However, if the
patient does not lead a healthy lifestyle after the
operation there is a risk that the remaining fat cells grow
bigger.
The amount of fat than can be safely removed is limited.
Liposuction has a number of possible risks,
including infection,
numbness and/or scarring. If too much fat is removed there may be lumpiness or
dents in
the skin. Experts say that the surgical risks are linked
to the amount of fat removed.
Some medical conditions may benefit from
liposuction, including:
•Lipomas - benign fatty tumors.
•Gynecomastia -
where fatty breast tissue has developed in men.
•Lipodystrophy syndrome - a
lipid (fat) metabolism disturbance in which there is too much fat in some parts
of the body and partial or total absence of fat in other parts.
Sometimes a side effect of some HIV
medications.
According to
Medilexicon's medical dictionary:
Liposuction is a "Method of removing
unwanted subcutaneous fat using suction cannulae inserted through
short, strategically placed incisions; used in body
contouring."
Short history of liposuction
Liposuction was invented in
1974 by two Italian-American surgeons - Doctors Giorgio and Arpad Fischer.
The roots of liposuction date back to the 1920s. Dr. Dujarier, a French
surgeon performed a fat removal
procedure on a model in 1926 which
tragically resulted in gangrene in one of her legs; consequently, interest
in body contouring receded for several decades.
In the late
1960s Leon Forrester Tcheupdjian, a European surgeon used primitive curettage
techniques to
remove fat - however, results were patchy, there was a
lot of bleeding and morbidity was high.
What we know as 'modern
liposuction' started with a presentation in 1982 by Dr. Yves-Gerard Illouz, a
French surgeon. He started what became known as the 'Illouz Method"
- a technique of suction-assisted
lipolysis (breakdown or
destruction of fats) after infusing fluid into tissues using blunt cannulae and
a high-
vacuum suction. Illouz demonstrated both reproducible good
results and low morbidity. During that decade
several US surgeons
experimented with liposuction, developing some variations from the Illouz
Method, with
mixed results.
In 1985 the tumescent technique
was described by Drs. Jeffrey Alan Klein (USA) and Patrick Lillis (USA),
which added elevated volumes of liquid containing a local anesthetic,
allowing the technique to be carried out
in an office setting under
intravenous sedation, rather than general anesthesia. There were concerns about
the
high volume of fluid and lidocaine toxicity potential with
tumescent techniques, which eventually led to the
concept of lower
volume super wet tumescence.
Near the end of the last century ultrasound
was introduced to assist in the removal of fat, which was initially
liquefied through the application of ultrasonic energy. However, there
was an increase in reported cases of
complications.
In recent
years laser tipped probes - which induce thermal lipolysis - have been
introduced. How beneficial
they are over traditional techniques
still remains to be determined.
Over the last three decades, advancement
in liposuction techniques have meant that a larger number of fat
cells can be removed with less blood loss, risk, discomfort, and
shorter recovery periods. Fat can also be
used today as a natural
filler (autologous fat transfer), where fat is taken from one part of the body,
cleaned,
and then injected into another area of the body - for
example, to enhance the shape of the buttocks or
reduce
wrinkles.
What are the uses of liposuction?
Liposuction is mainly used to
improve how a person looks, rather than providing any physical health
benefits.
In many cases, the patient would probably achieve the same results, and
sometimes better ones if
they adopted a healthy lifestyle - good
diet, regular exercise and a good night's sleep every night.
Experts say
that liposuction should ideally only be used if the individual did not achieve
the desired results
with a lifestyle change. For example, if some
obstinate areas of fat that are resistant to exercise and diet.
When you
gain weight each fat cell increases in size and volume. Liposuction reduces the
number of fat cells
in isolated areas. How much is removed from a
specific area depends on its appearance and the volume of
fat.
Contour changes resulting from liposuction can be long-lasting, as long as the
patient's weight does not
increase.
Liposuction is only done
in relatively small areas of the human body, and is in no way a treatment for
obesity
or long-term weight loss. It should not be used if the
person wants to get rid of stretch marks, cellulite,
dimpling, or
other skin surface irregularities.
Patients should discuss the pros and
cons of liposuction with their GP (general practitioner, primary care
physician)
before deciding on whether to proceed. If the individual still wants to go
ahead, they should talk
to their surgeon sincerely about why they
want to do it, what they hope to gain out of it personally, and what
their expectations are.
Liposuction should only be done after a
lot of thought. Results are never dramatic; they are subtle.
The
following body areas are commonly targeted for liposuction
treatment:
•Abdomen
•Back
•Buttocks
•Chest
•Inner
knees
•Hips
•Flanks (love-handles)
•Neckline and the area under the
chin (submental)
•Thighs - saddlebags (outer thighs), and inner
thighs
•Upper arms
According to the American Society of Aesthetic Plastic
Surgery, liposuction is performed more commonly
on the thighs and
abdomen of women, and the abdomen and flanks (sides, love-handles) of
men.
Experts say that the best liposuction candidates are those who have
good skin tone and elasticity, where the
skin molds itself into new
contours. People whose skin lacks elasticity may end up with loose-looking skin
in
areas where the procedure was done. The patient needs to be in
good health - people with circulation
(blood flow) problems, such
as coronary artery disease, diabetes, as well as those with weakened immune
systems should not undergo liposuction. Candidates should be over the
age of 18 years. Liposuction is
sometimes used to treat certain
conditions, including:
•Lymphedema - a chronic (long-term) condition in
which excess lymph (fluid) collects in tissues, causing
edema
(swelling). The edema commonly occurs in the arms or legs. The fluid
accumulation occurs faster
than it can be drained away. Liposuction
is sometimes used to reduce swelling, discomfort and pain.
However,
doctors tend only to use liposuction with patients who have severe symptoms.
After the operation
patients have to wear a compression bandage for
several months, sometimes up to a year after the operation.
•Gynecomastia -
sometimes fat accumulates under a man's nipples. Liposuction can remove some of
the fat,
reducing the swelling.
•Lipodystrophy syndrome - fat
accumulates in one part of the body and is lost in another. Liposuction can
improve the patient's appearance by providing a more natural looking
body fat distribution.
•Extreme weight loss after obesity - if a morbidly
obese person has lost at least 40% of his/her BMI (body
mass index)
after perhaps a gastric band or bypass procedure, excess skin and other
abnormalities may
need treatment. Sometimes liposuction is used to
correct abnormalities.
What happens before and during the liposuction
operation?
Before the operation - patients will need to undergo some health
tests to ensure that they are fit for surgery.
The medical team
will ask the patient to:
•Stop taking aspirin and anti-inflammatory drugs
for at least two weeks before the surgery.
•Women - if undergoing an
extensive operation, they may be asked to stop taking the contraceptive pill
for a
specific period before the operation.
•Patients with anemia
- they will be asked to take iron supplements for a specific period before the
operation.
•Consent form - the patient will be asked to sign a
consent form, which confirms that they are fully aware of
the
risks, benefits and possible alternatives to the procedure.
During the
operation
The surgeon will mark out lines on the patient's body, indicating
where treatment will take place. Photos of
the target area, and
sometimes the patient's whole body may be taken; they will be compared to
pictures of
the same areas taken afterwards.
Anesthesia -
the patient will most likely be under a general anesthetic; they are put to
sleep before the
procedure and remain so during it. A liposuction
operation may last from 1 to 4 hours. The doctor may use
an
epidural for treatments on the lower body - the anesthetic is injected the
epidural space surrounding the
dura (fluid-filled sac) around the
spine, partially numbing the abdomen and legs. A local anesthetic may be
used when liposuction is done on very small areas.
Patients may
feel a dull rasping during the procedure as the cannula moves under the skin.
This is normal. If
any acute or different pain is felt the doctor
needs to be told, as the medication or movements may need
modification.
If the patient requires only local anesthesia,
he/she may be asked to stand up during the procedure to ensure
proper fat removal.
One of the following liposuction techniques
may be used:
•Tumescent liposuction - several liters of a saline solution
with a local anesthetic lidocaine and vessel-
constrictor
epinephrine (adrenaline) is pumped subcutaneously (below the skin) in the area
that is to be
suctioned. Epinephrine helps minimize bleeding,
bruising and post-operative swelling. The fat is suctioned
(sucked
out) through small suction tubes (microcannulas). This is the most popular form
of liposuction.
The amount of liquid pumped into the area may be up to
three times the amount of fat to be removed. This
volume of fluids
creates a space between the muscle and the fatty tissue, allowing more
maneuverability for
the cannula.
•Wet liposuction - a small
amount of fluid with less volume than the amount of fat to be removed is
injected
into the target area. The fluid is similar to the one used
in tumescent liposuction and minimizes bleeding and
bruising. The
fluid helps loosen the fat cells. The fat cells are suctioned
out.
•Super-wet liposuction - this technique uses less liquid that tumescent
liposuction; about the same amount of
liquid as fat to be removed.
Otherwise, the technique is very similar to tumescent liposuction. The patient
may need a separate anesthetic.
•Dry liposuction - no fluid is
injected before fat is removed. This method is seldom used today. There is a
higher risk of bruising and bleeding.
•Ultrasound-assisted
liposuction (UAL) , also known as ultrasonic liposuction - the cannula is
energized with
ultrasound. This makes the fat melt away on contact
- the ultrasound vibrations burst the walls of the fat
cells,
emulsifying the fat (liquefying it) and making it easier to suction out. This
method is a good choice for
working on more fibrous areas, such as
the male breast, back, and in areas where liposuction had been
done
before.
UAL is especially useful for stubborn fat accumulations.
However, longer incisions in the skin are needed for
this procedure,
and there is a risk of skin or internal burns. This procedure takes longer than
the others,
because it is often done alongside tumescent
liposuction. It is also more expensive. After ultrasonic
liposuction, it is necessary to perform suction-assisted liposuction to
remove the liquefied fat.
UAL techniques were initially linked with
cases of tissue damage, generally because of over-exposure to
ultrasound energy. A third-generation UAL device - the Vaser Lipo
system - prevents this problem by using
pulsed energy delivery and
a specialized probe that allows surgeons to safely remove excess
fat.
•Power-assisted liposuction (PAS) , also known as Powered liposuction -
uses a specialized cannula with a
mechanized system that rapidly
moves back-and-forth, allowing the surgeon to pull out fat more easily. It is
similar to traditional UAL, but the surgeon does not need to make
so many manual movements, as in other
methods.
This method
may sometimes cause less swelling and pain, and may allow the surgeon to remove
fat with
more precision, especially in smaller areas.
•Laser
Assisted Lipolysis (LAL) , or laser-guided lipo - requires the use of tumescent
fluid. It is a far less
invasive and bloody procedure than the
traditional liposuction method for removing fat. A microcannula is
inserted through a small incision to deliver laser energy and heat into
subcutaneous fat (fat under the skin).
he liposuction cannula - this is a stainless steel tube, which is inserted through an incision in the skin and is
used to suction the fat (suck the fat out).
The liposuction
microcannula - is a very small cannula with an inside diameter of less than 3
mm (some
experts define them with less than 2.2mm
diameter).
The size of the cannula can influence how smooth the skin is
after liposuction. Large cannulae tend to create
irregularities more
commonly than microcannulas. Large cannulae are more frequently used for
total-body
liposuction.
After an area has been prepared for
treatment, a small cut is made (sometimes several, depending on the
size of the area), and a microcannula is inserted into the cut. The
microcannula is attached to a special
vacuum machine. The
microcannula first loosens and then sucks the fat out of the
area.
Draining out excess fluid and blood - after the operation the
surgeon may leave the incisions open so that
fluid can drain from
the body.
After the liposuction operation
•Anesthetic - patients who
underwent a general anesthetic usually spend the night in hospital. Those who
had
a local anesthetic may be able to leave hospital on the same
day. Patients should not drive for at least 24
hours after
receiving an anesthetic.
•Support bandages - the patient will be fitted with
either an elasticated support corset or bandages for the
targeted
area after the operation. They help reduce inflammation and bruising. They
should be worn for
several weeks. It is important to follow the
doctor's advice on keeping the area clean and how to do this.
•Antibiotics -
patients may be given antibiotics immediately after the
operation.
•Painkillers - the doctor will most likely prescribe or recommend
analgesics (painkillers) to relieve pain and
inflammation.
•Stitches - the patient will be given a follow-up
appointment to have the stitches removed. Bruising - there
will be
significant bruising in the targeted area. The amount of bruising is usually
linked to how big the
targeted area was. The bruising may go on for
several weeks; in some cases for as long as six months.
•Numbness - patients
may experience numbness in the area where fat was removed. This should improve
within six to eight weeks.
Results - patients and their doctors
will not be able to fully appreciate the results of liposuction until the
inflammation has gone down, which in some cases may take several months.
Typically, most of the swelling
will have settled after about four
weeks and the area where fat was removed should appear less
bulky.
Patients who maintain their weight can usually expect permanent
results. Those who gain weight after the
procedure may find that
their fat distribution alters. Those who previously had fat accumulating in
their hips
might find that their buttocks become the new problem
area.
If a patient has thought everything through carefully beforehand,
talked to their GP and surgeon about their
aims, motives and
expectation, the surgeon is skilled and well qualified, and there are no
complications, most
patients are pleased with their results.
What
are the risks of liposuction?
Any type of major surgery carries a risk of
bleeding, infection and an adverse reaction to anesthesia. Risk of
complications is usually associated with how large the procedure is, as
well as the surgeons skills and
specific training. The following
risks, unpleasant side effects, or complications are possible:
•Bad bruising
- this is especially the case if patients have been taking anti-inflammatory
medications or
aspirin. Patients with a tendency to bleed are also
at higher risk of bad bruising.
•Inflammation - the swelling in some cases
may take up to six months to settle. Sometimes fluid may
continue
to ooze from the incisions.
•Thrombophlebitis - a blood clot forms in a
vein, causing inflammation of that vein. This may affect
liposuction patients, especially inside the knee and on the inside of
the upper thigh (when these areas have
been treated).
•Contour
irregularities - if the patient has poor skin elasticity, has healed in an
unusual way, or fat removal
has been uneven, the skin may appear
withered, wavy or bumpy. This undesirable result may be permanent.
The cannula may cause damage that makes the skin appear spotted.
Seromas may form under the skin
(temporary pockets of fluid), which
may need to be drained.
•Numbness - the area that was worked on may feel numb
for a while; this is usually only temporary. There
may also be
temporary nerve irritation.
•Infections - although rare, skin infections may
occur after liposuction surgery. Sometimes this needs to be
treated
surgically, with the risk of scarring.
•Internal organ punctures - this is
very rare. If the cannula goes in too deeply one of the internal organs may
be punctured. Further surgery may be required. Internal organ punctures
can be life-threatening.
•Death - anesthesia carries with it a small risk of
death.
•Kidney or heart problems - as fluids are being injected and or
suctioned, the change in the body's fluid
levels may cause kidney
or heart problems.
•Pulmonary embolism - fat gets into the blood vessels and
travels to the lungs, blocking the lungs. This can
be
life-threatening.
•Pulmonary edema - this may be a result of fluid being
injected into the body. Fluid accumulates in the lungs.
•Allergic reaction -
there may be an allergic reaction to medications or material used during
surgery.
•Skin burns - the cannula movement may cause friction burns to the
skin or nerves.
•Lidocaine toxicity - in the super-wet or tumescent methods,
too much saline fluid may be pumped into the
body, or the fluid may
have excessively high concentrations of lidocaine. If lidocaine levels are too
high for
the patient's system he/she may experience lidocaine
poisoning (toxicity) - initially they will experience
tingling and
numbness, then seizures, followed by unconsciousness, and possibly respiratory
or cardiac
arrest.
Written by Christian Nordqvist
Copyright:
Medical News Today
The Risks And Benefits Of Liposuction? - Medical News Today -
February 25, 2010 -
Liposuction, also called lipoplasty,
liposculpture suction lipectomy, or lipo is a type of cosmetic surgery
which breaks up and "sucks" fat from various possible parts of the
body, most commonly the abdomen,
thighs, buttocks, neck, chin, upper
and backs of the arms, calves, and back. The fat is removed through a
hollow
instrument - a cannula - which is inserted under the skin. A powerful,
high-pressure vacuum is
applied to the cannula.
It is the
most common cosmetic operation in America and the United Kingdom. Over 400,000
liposuction
procedures are carried out in the USA each
year.
Patients who undergo liposuction generally have a stable body
weight, but would like to remove undesirable
deposits of body fat in
specific parts of the body. It is not an overall weight-loss method - it is not
a
treatment for obesity. Liposuction does not remove cellulite,
dimples or stretch marks. The aim is esthetic -
the patient wishes
to change and enhance the contour of his/her body.
Liposuction
permanently removes fat cells from the body. It can alter the shape of a body.
However, if the
patient does not lead a healthy lifestyle after the
operation there is a risk that the remaining fat cells grow
bigger.
The amount of fat than can be safely removed is limited.
Liposuction has a number of possible risks,
including infection,
numbness and/or scarring. If too much fat is removed there may be lumpiness or
dents in
the skin. Experts say that the surgical risks are linked
to the amount of fat removed.
Some medical conditions may benefit from
liposuction, including:
•Lipomas - benign fatty tumors.
•Gynecomastia -
where fatty breast tissue has developed in men.
•Lipodystrophy syndrome - a
lipid (fat) metabolism disturbance in which there is too much fat in some parts
of the body and partial or total absence of fat in other parts.
Sometimes a side effect of some HIV
medications.
According to
Medilexicon's medical dictionary:
Liposuction is a "Method of removing
unwanted subcutaneous fat using suction cannulae inserted through
short, strategically placed incisions; used in body
contouring."
Short history of liposuction
Liposuction was invented in
1974 by two Italian-American surgeons - Doctors Giorgio and Arpad Fischer.
The roots of liposuction date back to the 1920s. Dr. Dujarier, a French
surgeon performed a fat removal
procedure on a model in 1926 which
tragically resulted in gangrene in one of her legs; consequently, interest
in body contouring receded for several decades.
In the late
1960s Leon Forrester Tcheupdjian, a European surgeon used primitive curettage
techniques to
remove fat - however, results were patchy, there was a
lot of bleeding and morbidity was high.
What we know as 'modern
liposuction' started with a presentation in 1982 by Dr. Yves-Gerard Illouz, a
French surgeon. He started what became known as the 'Illouz Method"
- a technique of suction-assisted
lipolysis (breakdown or
destruction of fats) after infusing fluid into tissues using blunt cannulae and
a high-
vacuum suction. Illouz demonstrated both reproducible good
results and low morbidity. During that decade
several US surgeons
experimented with liposuction, developing some variations from the Illouz
Method, with
mixed results.
In 1985 the tumescent technique
was described by Drs. Jeffrey Alan Klein (USA) and Patrick Lillis (USA),
which added elevated volumes of liquid containing a local anesthetic,
allowing the technique to be carried out
in an office setting under
intravenous sedation, rather than general anesthesia. There were concerns about
the
high volume of fluid and lidocaine toxicity potential with
tumescent techniques, which eventually led to the
concept of lower
volume super wet tumescence.
Near the end of the last century ultrasound
was introduced to assist in the removal of fat, which was initially
liquefied through the application of ultrasonic energy. However, there
was an increase in reported cases of
complications.
In recent
years laser tipped probes - which induce thermal lipolysis - have been
introduced. How beneficial
they are over traditional techniques
still remains to be determined.
Over the last three decades, advancement
in liposuction techniques have meant that a larger number of fat
cells can be removed with less blood loss, risk, discomfort, and
shorter recovery periods. Fat can also be
used today as a natural
filler (autologous fat transfer), where fat is taken from one part of the body,
cleaned,
and then injected into another area of the body - for
example, to enhance the shape of the buttocks or
reduce
wrinkles.
What are the uses of liposuction?
Liposuction is mainly used to
improve how a person looks, rather than providing any physical health
benefits.
In many cases, the patient would probably achieve the same results, and
sometimes better ones if
they adopted a healthy lifestyle - good
diet, regular exercise and a good night's sleep every night.
Experts say
that liposuction should ideally only be used if the individual did not achieve
the desired results
with a lifestyle change. For example, if some
obstinate areas of fat that are resistant to exercise and diet.
When you
gain weight each fat cell increases in size and volume. Liposuction reduces the
number of fat cells
in isolated areas. How much is removed from a
specific area depends on its appearance and the volume of
fat.
Contour changes resulting from liposuction can be long-lasting, as long as the
patient's weight does not
increase.
Liposuction is only done
in relatively small areas of the human body, and is in no way a treatment for
obesity
or long-term weight loss. It should not be used if the
person wants to get rid of stretch marks, cellulite,
dimpling, or
other skin surface irregularities.
Patients should discuss the pros and
cons of liposuction with their GP (general practitioner, primary care
physician)
before deciding on whether to proceed. If the individual still wants to go
ahead, they should talk
to their surgeon sincerely about why they
want to do it, what they hope to gain out of it personally, and what
their expectations are.
Liposuction should only be done after a
lot of thought. Results are never dramatic; they are subtle.
The
following body areas are commonly targeted for liposuction
treatment:
•Abdomen
•Back
•Buttocks
•Chest
•Inner
knees
•Hips
•Flanks (love-handles)
•Neckline and the area under the
chin (submental)
•Thighs - saddlebags (outer thighs), and inner
thighs
•Upper arms
According to the American Society of Aesthetic Plastic
Surgery, liposuction is performed more commonly
on the thighs and
abdomen of women, and the abdomen and flanks (sides, love-handles) of
men.
Experts say that the best liposuction candidates are those who have
good skin tone and elasticity, where the
skin molds itself into new
contours. People whose skin lacks elasticity may end up with loose-looking skin
in
areas where the procedure was done. The patient needs to be in
good health - people with circulation
(blood flow) problems, such
as coronary artery disease, diabetes, as well as those with weakened immune
systems should not undergo liposuction. Candidates should be over the
age of 18 years. Liposuction is
sometimes used to treat certain
conditions, including:
•Lymphedema - a chronic (long-term) condition in
which excess lymph (fluid) collects in tissues, causing
edema
(swelling). The edema commonly occurs in the arms or legs. The fluid
accumulation occurs faster
than it can be drained away. Liposuction
is sometimes used to reduce swelling, discomfort and pain.
However,
doctors tend only to use liposuction with patients who have severe symptoms.
After the operation
patients have to wear a compression bandage for
several months, sometimes up to a year after the operation.
•Gynecomastia -
sometimes fat accumulates under a man's nipples. Liposuction can remove some of
the fat,
reducing the swelling.
•Lipodystrophy syndrome - fat
accumulates in one part of the body and is lost in another. Liposuction can
improve the patient's appearance by providing a more natural looking
body fat distribution.
•Extreme weight loss after obesity - if a morbidly
obese person has lost at least 40% of his/her BMI (body
mass index)
after perhaps a gastric band or bypass procedure, excess skin and other
abnormalities may
need treatment. Sometimes liposuction is used to
correct abnormalities.
What happens before and during the liposuction
operation?
Before the operation - patients will need to undergo some health
tests to ensure that they are fit for surgery.
The medical team
will ask the patient to:
•Stop taking aspirin and anti-inflammatory drugs
for at least two weeks before the surgery.
•Women - if undergoing an
extensive operation, they may be asked to stop taking the contraceptive pill
for a
specific period before the operation.
•Patients with anemia
- they will be asked to take iron supplements for a specific period before the
operation.
•Consent form - the patient will be asked to sign a
consent form, which confirms that they are fully aware of
the
risks, benefits and possible alternatives to the procedure.
During the
operation
The surgeon will mark out lines on the patient's body, indicating
where treatment will take place. Photos of
the target area, and
sometimes the patient's whole body may be taken; they will be compared to
pictures of
the same areas taken afterwards.
Anesthesia -
the patient will most likely be under a general anesthetic; they are put to
sleep before the
procedure and remain so during it. A liposuction
operation may last from 1 to 4 hours. The doctor may use
an
epidural for treatments on the lower body - the anesthetic is injected the
epidural space surrounding the
dura (fluid-filled sac) around the
spine, partially numbing the abdomen and legs. A local anesthetic may be
used when liposuction is done on very small areas.
Patients may
feel a dull rasping during the procedure as the cannula moves under the skin.
This is normal. If
any acute or different pain is felt the doctor
needs to be told, as the medication or movements may need
modification.
If the patient requires only local anesthesia,
he/she may be asked to stand up during the procedure to ensure
proper fat removal.
One of the following liposuction techniques
may be used:
•Tumescent liposuction - several liters of a saline solution
with a local anesthetic lidocaine and vessel-
constrictor
epinephrine (adrenaline) is pumped subcutaneously (below the skin) in the area
that is to be
suctioned. Epinephrine helps minimize bleeding,
bruising and post-operative swelling. The fat is suctioned
(sucked
out) through small suction tubes (microcannulas). This is the most popular form
of liposuction.
The amount of liquid pumped into the area may be up to
three times the amount of fat to be removed. This
volume of fluids
creates a space between the muscle and the fatty tissue, allowing more
maneuverability for
the cannula.
•Wet liposuction - a small
amount of fluid with less volume than the amount of fat to be removed is
injected
into the target area. The fluid is similar to the one used
in tumescent liposuction and minimizes bleeding and
bruising. The
fluid helps loosen the fat cells. The fat cells are suctioned
out.
•Super-wet liposuction - this technique uses less liquid that tumescent
liposuction; about the same amount of
liquid as fat to be removed.
Otherwise, the technique is very similar to tumescent liposuction. The patient
may need a separate anesthetic.
•Dry liposuction - no fluid is
injected before fat is removed. This method is seldom used today. There is a
higher risk of bruising and bleeding.
•Ultrasound-assisted
liposuction (UAL) , also known as ultrasonic liposuction - the cannula is
energized with
ultrasound. This makes the fat melt away on contact
- the ultrasound vibrations burst the walls of the fat
cells,
emulsifying the fat (liquefying it) and making it easier to suction out. This
method is a good choice for
working on more fibrous areas, such as
the male breast, back, and in areas where liposuction had been
done
before.
UAL is especially useful for stubborn fat accumulations.
However, longer incisions in the skin are needed for
this procedure,
and there is a risk of skin or internal burns. This procedure takes longer than
the others,
because it is often done alongside tumescent
liposuction. It is also more expensive. After ultrasonic
liposuction, it is necessary to perform suction-assisted liposuction to
remove the liquefied fat.
UAL techniques were initially linked with
cases of tissue damage, generally because of over-exposure to
ultrasound energy. A third-generation UAL device - the Vaser Lipo
system - prevents this problem by using
pulsed energy delivery and
a specialized probe that allows surgeons to safely remove excess
fat.
•Power-assisted liposuction (PAS) , also known as Powered liposuction -
uses a specialized cannula with a
mechanized system that rapidly
moves back-and-forth, allowing the surgeon to pull out fat more easily. It is
similar to traditional UAL, but the surgeon does not need to make
so many manual movements, as in other
methods.
This method
may sometimes cause less swelling and pain, and may allow the surgeon to remove
fat with
more precision, especially in smaller areas.
•Laser
Assisted Lipolysis (LAL) , or laser-guided lipo - requires the use of tumescent
fluid. It is a far less
invasive and bloody procedure than the
traditional liposuction method for removing fat. A microcannula is
inserted through a small incision to deliver laser energy and heat into
subcutaneous fat (fat under the skin).
he liposuction cannula - this is a stainless steel tube, which is inserted through an incision in the skin and is
used to suction the fat (suck the fat out).
The liposuction
microcannula - is a very small cannula with an inside diameter of less than 3
mm (some
experts define them with less than 2.2mm
diameter).
The size of the cannula can influence how smooth the skin is
after liposuction. Large cannulae tend to create
irregularities more
commonly than microcannulas. Large cannulae are more frequently used for
total-body
liposuction.
After an area has been prepared for
treatment, a small cut is made (sometimes several, depending on the
size of the area), and a microcannula is inserted into the cut. The
microcannula is attached to a special
vacuum machine. The
microcannula first loosens and then sucks the fat out of the
area.
Draining out excess fluid and blood - after the operation the
surgeon may leave the incisions open so that
fluid can drain from
the body.
After the liposuction operation
•Anesthetic - patients who
underwent a general anesthetic usually spend the night in hospital. Those who
had
a local anesthetic may be able to leave hospital on the same
day. Patients should not drive for at least 24
hours after
receiving an anesthetic.
•Support bandages - the patient will be fitted with
either an elasticated support corset or bandages for the
targeted
area after the operation. They help reduce inflammation and bruising. They
should be worn for
several weeks. It is important to follow the
doctor's advice on keeping the area clean and how to do this.
•Antibiotics -
patients may be given antibiotics immediately after the
operation.
•Painkillers - the doctor will most likely prescribe or recommend
analgesics (painkillers) to relieve pain and
inflammation.
•Stitches - the patient will be given a follow-up
appointment to have the stitches removed. Bruising - there
will be
significant bruising in the targeted area. The amount of bruising is usually
linked to how big the
targeted area was. The bruising may go on for
several weeks; in some cases for as long as six months.
•Numbness - patients
may experience numbness in the area where fat was removed. This should improve
within six to eight weeks.
Results - patients and their doctors
will not be able to fully appreciate the results of liposuction until the
inflammation has gone down, which in some cases may take several months.
Typically, most of the swelling
will have settled after about four
weeks and the area where fat was removed should appear less
bulky.
Patients who maintain their weight can usually expect permanent
results. Those who gain weight after the
procedure may find that
their fat distribution alters. Those who previously had fat accumulating in
their hips
might find that their buttocks become the new problem
area.
If a patient has thought everything through carefully beforehand,
talked to their GP and surgeon about their
aims, motives and
expectation, the surgeon is skilled and well qualified, and there are no
complications, most
patients are pleased with their results.
What
are the risks of liposuction?
Any type of major surgery carries a risk of
bleeding, infection and an adverse reaction to anesthesia. Risk of
complications is usually associated with how large the procedure is, as
well as the surgeons skills and
specific training. The following
risks, unpleasant side effects, or complications are possible:
•Bad bruising
- this is especially the case if patients have been taking anti-inflammatory
medications or
aspirin. Patients with a tendency to bleed are also
at higher risk of bad bruising.
•Inflammation - the swelling in some cases
may take up to six months to settle. Sometimes fluid may
continue
to ooze from the incisions.
•Thrombophlebitis - a blood clot forms in a
vein, causing inflammation of that vein. This may affect
liposuction patients, especially inside the knee and on the inside of
the upper thigh (when these areas have
been treated).
•Contour
irregularities - if the patient has poor skin elasticity, has healed in an
unusual way, or fat removal
has been uneven, the skin may appear
withered, wavy or bumpy. This undesirable result may be permanent.
The cannula may cause damage that makes the skin appear spotted.
Seromas may form under the skin
(temporary pockets of fluid), which
may need to be drained.
•Numbness - the area that was worked on may feel numb
for a while; this is usually only temporary. There
may also be
temporary nerve irritation.
•Infections - although rare, skin infections may
occur after liposuction surgery. Sometimes this needs to be
treated
surgically, with the risk of scarring.
•Internal organ punctures - this is
very rare. If the cannula goes in too deeply one of the internal organs may
be punctured. Further surgery may be required. Internal organ punctures
can be life-threatening.
•Death - anesthesia carries with it a small risk of
death.
•Kidney or heart problems - as fluids are being injected and or
suctioned, the change in the body's fluid
levels may cause kidney
or heart problems.
•Pulmonary embolism - fat gets into the blood vessels and
travels to the lungs, blocking the lungs. This can
be
life-threatening.
•Pulmonary edema - this may be a result of fluid being
injected into the body. Fluid accumulates in the lungs.
•Allergic reaction -
there may be an allergic reaction to medications or material used during
surgery.
•Skin burns - the cannula movement may cause friction burns to the
skin or nerves.
•Lidocaine toxicity - in the super-wet or tumescent methods,
too much saline fluid may be pumped into the
body, or the fluid may
have excessively high concentrations of lidocaine. If lidocaine levels are too
high for
the patient's system he/she may experience lidocaine
poisoning (toxicity) - initially they will experience
tingling and
numbness, then seizures, followed by unconsciousness, and possibly respiratory
or cardiac
arrest.
Written by Christian Nordqvist
Copyright:
Medical News Today