LIPOSUCTION
Introduction
Liposuction (fat suction) was popularised in the early eighties and completely revolutionised body contour surgery. It was initially designed to resculpture parts of the body, which had unsightly stubborn areas of fat, which did not respond to diet or exercise.
Liposuction can benefit many patients where previous techniques of body contouring were inadequate in achieving the desired result. It can also be combined with other standard procedures thereby producing better and longer lasting results such as in face lifting or abdominoplasty.
This technique is used to reshape or resculpture the following areas of the body:
- Face and neck: In particular, the double chin and fatty neck.
- Limbs: Thighs (riding breeches deformity), knees, calves, ankles, buttocks, fat arms and other abnormal isolated fat deposits.
- Abdomen: Used alone in suitable cases or in conjunction with a tummy-tuck
- Breasts: Abnormal collections of fat in male breasts (gynaecomastia) as well as in the female breast.
- Lipomas: Large isolated collections of fat.
Techniques available:
Traditional technique: this method involves using a blunt metal cannula (surgical tube) to suck out the offending fat using a high negative pressure pump. Over the years variations in technique have appeared. One of the most popular and successful of these has been the use of specially designed syringes to suck out the offending fat thereby eliminating the use of electric suction pumps.
Ultrasonic technique : This technique utilises high frequency ultrasonic energy emitted from a surgical probe. The ultrasonic energy is emitted at a pre set frequency, which ruptures the fat cells, releasing the fat stored inside the cells before it is gently sucked out. The frequency required to rupture the fat cells is not sufficient to cause damage to surrounding tissues such as muscles, bones, tendons and blood vessels.
Nature of operation
The patient is admitted on the morning of the operation. Large areas are best treated using general anaesthesia. Small areas can be treated using local anaesthesia and sedation. Small stab incisions (few millimetres) are made at strategic points on the skin surface for the insertion of the cannula.
Once all the fat is removed the incisions are sutured and a specially designed pressure garment is fitted. The length of stay in clinic is usually no longer than one night.
Postoperative events
Apart from the complications that are common to all surgical operations eg bruising & swelling etc.(See section Factors Common to All Surgical Procedures) , the following are specific to liposuction procedures.
Scars are generally small and wherever possible are placed at sites that are not easily conspicuous. Whereas a permanent mark will always remain it will not as a rule cause the patient any grave concerns.
Rippling and Sagging of the Skin This can occur if either excessive amounts of fat have to be removed from an area or if the skin tone is poor initially. It is impossible to predict accurately how much the skin will tighten up after the operation.
Many patients are of the impression that exercise will tighten (tone up) loose skin in the same way that muscles are enlarged or tightened by pumping iron. Skin does not contain any voluntary muscle so no amount of exercising will increase its tone or tighten it.
Lumpiness and hardness usually occurs for a while after the operation and is part of the normal healing process. The fat is removed in layers in tunnels. These tunnels fill up with blood, which subsequently clots causing hardness. The speed with which the body dissolves and then absorbs the clotted blood will determine how long the hardness lasts.
Ruts, Depressions and Defects can occur as a result of too much fat having been removed from a particular area or site. Although this complication can occur with any operator it is much less common in experienced hands. A further procedure may be required to improve the situation.
Asymmetry It is not possible to promise perfect symmetry after the operation, as the body is asymmetrical to begin with. Where an obvious asymmetry results, further surgery may be necessary to correct it.
Skin Loss Rarely, small patches of skin may die, especially near incision sites, resulting in scar formation. Scar revision will usually improve the situation.
Numbness or other changes in sensation can occur in the treated area due to nerve damage and may take some time to resolve completely. Various sensations have been described by patients such as stiffness, pins and needles, electric shock like sensations and persistent discomfort. These undesirable symptoms generally settle in time.
Blood Transfusion is rarely required. A blood transfusion is only necessary if too much bleeding has occurred into the surrounding tissues usually as a result of trying to remove too much fat.
Further Surgery : On occasions it is possible that insufficient fat has been removed from a particular area or areas. There are many reasons for this. Very often it is not that insufficient fat has been removed but that an excessive amount of scar tissue has been laid down after fat removal thus giving the overall impression of an imperfect result. A further procedure can be performed when the tissues have had sufficient time to heal completely.
Postoperative management
Patients are usually advised to rest for the first twenty-four to forty eight hours. There is usually a degree of stiffness and discomfort. After this time patients are encouraged to become more active.
Most surgeons usually recommend an elastic garment and this should be worn constantly for several weeks. The purpose of the garment is to help mould the reshaped tissue. There is a wide variety of liposuction garments now available for all areas of the body.
Sutures are usually removed after a week. Showering and bathing is permitted as soon as the next day.
Gentle massage of the treated areas should begin at about ten days after the operation and some surgeons advocate ultrasound or other physiotherapy to disperse the bruising and swelling (which can be quite pronounced) more quickly. Moderate exercise can be resumed at about two weeks.
Result
Once removed, the fat should not return. This is because fat cells have been removed from the area and the remaining fat cell number in that area will not have the capacity to absorb sufficient fat in future to restore the previous large volume.
If the calorific intake is still exceeded after the procedure, fat will continue to be deposited in the body but only in those areas that were not operated on. Care must therefore still be executed regarding dietary calorific intake, as liposuction is not a passport to dietary excess.
