If you're considering
liposuction...
Liposuction is a procedure that can
help sculpt the body by removing unwanted fat from specific
areas, including the abdomen, hips, buttocks, thighs, knees,
upper arms, chin, cheeks and neck. During the past decade,
liposuction, which is also known as "lipoplasty" or
"suction lipectomy," has benefited from several new
refinements. Today, a number of new techniques, including
ultrasound-assisted lipoplasty (UAL), the tumescent technique,
and the super-wet technique, are helping many plastic surgeons
to provide selected patients with more precise results and
quicker recovery times. Although no type of liposuction is a
substitute for dieting and exercise, liposuction can remove
stubborn areas of fat that don't respond to traditional
weight-loss methods.
If you're considering liposuction,
this brochure will give you a basic understanding of the
procedure - when it can help, how it is performed and how you
might look and feel after surgery. It won't answer all of your
questions, since much depends on your individual
circumstances. Please ask your doctor if there is anything
about the procedure you don't understand.
The best candidates for
liposuction
To be a good candidate for
liposuction, you must have realistic expectations about what
the procedure can do for you. It's important to understand
that liposuction can enhance your appearance and 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.
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| Women
may have liposuction performed under the chin, on
their hips, thighs, and stomach, and in the under arm
and breast area. |
The best candidates for liposuction are
normal-weight people with firm, elastic skin who have pockets
of excess fat in certain areas. You should be physically
healthy, psychologically stable and realistic in your
expectations. Your age is not a major consideration; however,
older patients may have diminished skin elasticity and may not
achieve the same results as a younger patient with tighter
skin.
Liposuction carries greater risk for
individuals with medical problems such as diabetes,
significant heart or lung disease, poor blood circulation, or
those who have recently had surgery near the area to be
contoured.
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, if you believe you want
liposuction in the abdominal area, 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. He or she should be equally
frank with you, describing the procedure in detail and
explaining its risks and limitations.
Getting the answers you need
Individuals considering liposuction
often feel a bit overwhelmed by the number of options and
techniques being promoted today. However, your plastic surgeon
can help. In deciding which is the right treatment approach
for you, your doctor will consider effectiveness, safety, cost
and appropriateness for your needs. This is called surgical
judgment, a skill that is developed through surgical
training and experience. Your doctor also uses this judgement
to prevent complications; to handle unexpected occurrences
during surgery; and to treat complications when they occur.
 |
| For
men, common sites include under the chin and around
the waist. Liposuction may also be used in the
reduction of enlarged male breasts, a condition known
as gynecomastia. |
Your surgeon's education and training
have helped to form his or her surgical judgement, so take the
time to do some background checking. Patients are encouraged
to consider a doctor certified by the American Board of
Plastic Surgery ("ABPS"). By choosing a plastic
surgeon who is certified by the ABPS, a patient can be assured
that the doctor has graduated from an accredited medical
school and completed at least five years of additional
residency - usually three years of general surgery (or its
equivalent) and two years of plastic surgery. To be certified
by the ABPS, a doctor must also practice surgery for two years
and pass comprehensive written and oral exams.
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 surgery may have to be postponed.
Though it is rarely necessary, your
doctor may recommend that you have blood drawn ahead of time
in case it is needed during surgery.
Also, while you are making
preparations, be sure to arrange for someone to drive you home
after the procedure and, if needed, to help you at home for a
day or two.
Where your surgery will be
performed
Liposuction may be performed in a
surgeon's office-based facility, in an outpatient surgery
center, or in a hospital. Smaller-volume liposuction is
usually done on an outpatient basis for reasons of cost and
convenience. However, if a large volume of fat will be
removed, or if the liposuction is being performed in
conjunction with other procedures, a stay in a hospital or
overnight nursing facility may be required.
Anesthesia for liposuction
Various types of anesthesia can be
used for liposuction procedures. Together, you and your
surgeon will select the type of anesthesia that provides the
most safe and effective level of comfort for your surgery.
If only a small amount of fat and a
limited number of body sites are involved, liposuction can be
performed under local anesthesia, which numbs only the
affected areas. However, if you prefer, the local is usually
used along with intravenous sedation to keep you more relaxed
during the procedure. Regional anesthesia can be a good choice
for more extensive procedures. One type of regional anesthesia
is the epidural block, the same type of anesthesia commonly
used in childbirth.
However, some patients prefer general
anesthesia, particularly if a large volume of fat is being
removed. If this is the case, a nurse anesthetist or
anesthesiologist will be called in to make sure you are
completely asleep during the procedure.
 |
| Healthy,
normal-weight people with elastic skin and
pockets of excess fat are good candidates for
surgery. |
|
 |
| The
best candidates for liposuction are of normal
weight with localized areas of excess fat -
for example, in the buttocks, hips, and
thighs. |
|
 |
| The
surgeon inserts a cannula through small
incisions in the skin. At the other end of the
tube is a vacuum-pressure unit that suctions
off the fat. |
|
 |
| A
snug compression garment worn after surgery
helps reduce swelling. |
|
The surgery
The time required to perform
liposuction may vary considerably, depending on the size of
the area, the amount of fat being removed, the type of
anesthesia and the technique used.
There are several liposuction
techniques that can be used to improve the ease of the
procedure and to enhance outcome.
Liposuction is a procedure in which
localized deposits of fat are removed to recontour one or more
areas of the body. Through a tiny incision, a narrow tube or
cannula is inserted and used to vacuum the fat layer that lies
deep beneath the skin. The cannula is pushed then pulled
through the fat layer, breaking up the fat cells and
suctioning them out. The suction action is provided by a
vacuum pump or a large syringe, depending on the surgeon's
preference. If many sites are being treated, your surgeon will
then move on to the next area, working to keep the incisions
as inconspicuous as possible.
Fluid is lost along with the fat, and
it's crucial that this fluid be replaced during the procedure
to prevent shock. For this reason, patients need to be
carefully monitored and receive intravenous fluids during and
immediately after surgery.
Technique variations
The basic technique of liposuction,
as described above, is used in all patients undergoing this
procedure. However, as the procedure has been developed and
refined, several variations have been introduced.
Fluid Injection, a technique
in which a medicated solution is injected into fatty areas
before the fat is removed, is commonly used by plastic
surgeons today. The fluid - a mixture of intravenous salt
solution, lidocaine (a local anesthetic) and epinephrine (a
drug that contracts blood vessels) - helps the fat be removed
more easily, reduces blood loss and provides anesthesia during
and after surgery. Fluid injection also helps to reduce the
amount of bruising after surgery.
The amount of fluid that is injected
varies depending on the preference of the surgeon.
Large volumes of fluid - sometimes as
much as three times the amount of fat to be removed - are
injected in the tumescent technique. Tumescent
liposuction, typically performed on patients who need only a
local anesthetic, usually takes significantly longer than
traditional liposuction (sometimes as long as 4 to 5 hours).
However, because the injected fluid contains an adequate
amount of anesthetic, additional anesthesia may not be
necessary. The name of this technique refers to the swollen
and firm or "tumesced" state of the fatty tissues
when they are filled with solution.
The super-wet techniqueis
similar to the tumescent technique, except that lesser amounts
of fluid are used. Usually the amount of fluid injected is
equal to the amount of fat to be removed. This technique often
requires IV sedation or general anesthesia and typically takes
one to two hours of surgery time.
Ultrasound-Assisted Lipoplasty
(UAL). This technique requires the use of a special
cannula that produces ultrasonic energy. As it passes through
the areas of fat, the energy explodes the walls of the fat
cells, liquefying the fat. The fat is then removed with the
traditional liposuction technique.
UAL has been shown to improve the
ease and effectiveness of liposuction in fibrous areas of the
body, such as the upper back or the enlarged male breast. It
is also commonly used in secondary procedures, when enhanced
precision is needed. In general, UAL takes longer to perform
than traditional liposuction.
All surgery carries some
uncertainty and risk
Liposuction is normally safe, as long
as patients are carefully selected, the operating facility is
properly equipped and the physician is adequately trained.
As a minimum, your surgeon should
have basic (core) accredited surgical training with special
training in body contouring. Also, even though many
body-contouring procedures are performed outside the hospital
setting, be certain that your surgeon has been granted
privileges to perform liposuction at an accredited hospital.
Your doctor must have advanced
surgical skills to perform procedures that involve the removal
of a large amount of fat (more than 5 liters or 5,000 ccs);
ask your doctor about his or her other patients who have had
similar procedures and what their results were. Also, more
extensive liposuction procedures require attentive after-care.
Find out how your surgeon plans to monitor your condition
closely after the procedure.
However, it's important to keep in
mind that even though a well-trained surgeon and a
state-of-the art facility can improve your chance of having a
good result, there are no guarantees. Though they are rare,
complications can and do occur. Risks increase if a greater
number of areas are treated at the same time, or if the
operative sites are larger in size. Removal of a large amount
of fat and fluid may require longer operating times than may
be required for smaller operations.
The combination of these factors can
create greater hazards for infection; delays in healing; the
formation of fat clots or blood clots, which may migrate to
the lungs and cause death; excessive fluid loss, which can
lead to shock or fluid accumulation that must be drained;
friction burns or other damage to the skin or nerves or
perforation injury to the vital organs; and unfavorable drug
reactions.
There are also points to consider
with the newer techniques. For example, in UAL, the heat from
the ultrasound device used to liquefy the fat cells may cause
injury to the skin or deeper tissues. Also, you should be
aware that even though UAL has been performed successfully on
several thousand people worldwide, the long-term effects of
ultrasound energy on the body are not yet known.
In the tumescent and super-wet
techniques, the anesthetic fluid that is injected may cause
lidocaine toxicity (if the solution's lidocaine content is too
high), or the collection of fluid in the lungs (if too much
fluid is administered).
The scars from liposuction are small
and strategically placed to be hidden from view. However,
imperfections in the final appearance are not uncommon after
lipoplasty. The skin surface may be irregular, asymmetric or
even "baggy," especially in the older patient.
Numbness and pigmentation changes may occur. Sometimes,
additional surgery may be recommended.
After your surgery
 |
| Improvement
will become apparent after about six weeks, when most
of the swelling has subsided. |
After surgery, you will likely
experience some fluid drainage from the incisions.
Occasionally, a small drainage tube may be inserted beneath
the skin for a couple of days to prevent fluid build-up. To
control swelling and to help your skin better fit its new
contours, you may be fitted with a snug elastic garment to
wear over the treated area for a few weeks. Your doctor may
also prescribe antibiotics to prevent infection.
Don't expect to look or feel great
right after surgery. Even though the newer techniques are
believed to reduce some post-operative discomforts, you may
still experience some pain, burning, swelling, bleeding and
temporary numbness. 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 anxious or
depressed in the days or weeks following surgery. However,
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 to reduce swelling and to help prevent blood clots
from forming in your legs. You will begin to feel better after
about a week or two and you should be back at work within a
few days following your surgery. The stitches are removed or
dissolve on their own within the first week to 10 days.
Activity that is more strenuous
should be avoided for about a month as your body continues to
heal. Although most of the bruising and swelling usually
disappears within three 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.
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, call your doctor.
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 four to
six weeks, when most of the swelling has subsided. After about
three months, any persistent mild swelling usually disappears
and the final contour will be visible.
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.
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| As
healing progresses, a more proportional look
will emerge. |
|
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| A
slimmer body contour can help you feel more
confident and comfortable. |
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