Liposuction

Liposuction is the most commonly performed procedure by plastic surgeons in the United States today. It can be performed as an isolated procedure or often in adjunct to another surgical procedure, such as a rhytidectomy (face-lift) or abdominoplasty (tummy tuck).

WHAT IS LIPOSUCTION?

Liposuction is a technique used for "body sculpting." Liposuction is not an alternative to weight loss. The classic "ideal" candidate for liposuction is a patient at or near his/her ideal weight who has isolated areas of fat that cannot be reduced by diet and exercise alone.

IS THERE MORE THAN ONE TYPE OF LIPOSUCTION?

Currently, there are four different liposuction techniques:

1. Conventional liposuction
2. Power-Assisted liposuction
3. Laser liposuction
4. Ultrasonic liposuction
   

In our practice, the first three types of liposuction-conventional, power-assisted and laser liposuction-are performed. The type of liposuction procedure that is chosen depends upon the area to be treated after examination of the patient.

Conventional Liposuction – The patient is generally marked in a standing position to outline the areas where the fat is to be removed. After the patient is prepped and positioned on the operating table, sedation is begun by the anesthesiologist. The surgeon then administers local anesthesia. The type of local anesthesia employed by most surgeons these days is known as tumescent liposuction. The concept of tumescent liposuction is that extremely dilute local anesthesia is injected in larger volumes to aid in a more even dispersion of the medication and in the removal of the fat itself.

A thin metal rod-like instrument known as a cannula is then inserted beneath the skin through 1 or 2 small incisions measuring 5 mm or less in length. The cannula is connected to the liposuction machine through sterile, disposable tubing. The surgeon will pass the cannula through the small incisions to the site to be sculpted. Negative pressure, or suction, in the liposuction machine causes the fat to pass through the cannula and the tubing. The fat is collected in a bottle or canister on top of the liposuction machine. The cannulae that currently are used by surgeons are much narrower in diameter than those that were commonly used when the procedure became popular at the end of the 20th century. The most common size of cannulae used today are 3 and 4 mm in diameter. This permits the surgeon to work on a more superficial plane.

After the surgeon has carefully removed the fat as needed in both superficial and deep planes, the small incisions are then closed with either a single small suture or a steri-strip. Gauze bandages are placed over the site of the injection and the patient is then placed in a compression garment. The garment is changed after 48 hours and then worn for a 3 to 6 week period. The patient is seen back in the surgeon’s office approximately 5 days after the procedure for the first post-operative visit and for removal of the sutures, if necessary.

Power-Assisted Liposuction – The procedure for power-assisted liposuction is generally the same as described for conventional liposuction in the preceding paragraphs. The only difference is that the cannula or surgical instrument used has an oscillating tip that rapidly moves back and forth that aids in the suction of fat in areas where there is more fibrous tissue. These areas include the back, “love handles,” and the male breast. The surgeon will often use a combination of power-assisted and conventional cannulae to achieve the desired aesthetic result. Power assisted liposuction appears to achieve the same stated advantages of ultrasonic liposuction at a lower cost and without the same increase in risk.

Laser Lipolysis – There are three types of devices currently approved by the FDA for laser liposuction. Laser liposuction uses the energy of a laser in an effort to break up the fat less traumatically. The other goal of laser liposuction is to modulate the overlying skin envelope and tighten the skin in order to create a tighter, smoother look. There are many trade names associated with the laser liposuction devices. For example, CoolLipo is associated with a laser liposuction machine which operates at 1320 nm. This is an intriguing wavelength for laser assisted liposuction because there has been much experience with that particular wavelength in treating the skin. The slim-lipo is another laser lipolysis device that operates at 920. This may prove to be a particularly ideal wavelength for laser lipolysis because fat has a peak absorption of light at that wavelength.

Laser liposuction may function as a stand alone procedure or as an aid to conventional liposuction. Theoretically, because the laser light aids in breaking up and liquefying the fatty tissue so that it is easier to remove, there is less trauma to the tissue. In addition, the laser light and heat generated may also aid in hemostasis so that there is less bleeding and bruising. In addition, the laser energy may help in tightening of the skin as well. This procedure is amenable to being performed under a local anesthesia without sedation, may not require wearing a compression garment for a lengthy period of time, and with time may prove to be suitable and less invasive for patients seeking minimal neck lift surgery.

Ultrasonic Liposuction - Ultrasonic liposuction is often used in those areas in which the fat is more difficult to remove. These areas include the male breast (gynecomastia) and the love handle region. Ultrasonic liposuction requires more costly special machines and instruments, has been associated with a higher complication rate than conventional liposuction and special training in their use is required.

WHERE IS THE OPERATION PERFORMED?

The procedure is done on an outpatient basis in our AAAHC (Accreditation Association for Ambulatory Health Care, Inc.) ACCREDITED OFFICE BASED SURGERY FACILITY. 

WHAT TYPE OF ANESTHESIA WILL I RECEIVE?

It is most commonly performed under a local anesthesia with supplementation by intravenous sedation by a board certified anesthesiologist. The type of local anesthesia which is generally administered by the plastic surgeon for liposuction is called tumescent liposuction. Laser lipolysis may be performed under a local anesthesia alone.

WILL I FEEL OR REMEMBER ANYTHING?

If sedation is administered by the anesthesiologist, it is as if the patient is “asleep” and is able to breathe on his or her own without the need for placement of an endotracheal tube. Patients receiving this type of anesthesia have no recollection of the procedure and do not run the same risks as encountered with general anesthesia. Occasionally, for small areas and laser lipolysis, the liposuction can be performed with minimal or no sedation. In those situations, the patient can remain awake and experience little or no discomfort.

WHAT IS MY RECOVERY AND POST-OPERATIVE CARE?

After conventional, power-assisted and ultrasonic liposuction, patients are placed in a gentle compression garment that is worn for three weeks. Patients undergoing laser lipolysis may not be required to wear a garment for the same length of time, if at all. Patients can shower daily after the procedure and often return to work and resume light activities after several days. Full aerobic exercise is restricted for 3 weeks.

WHAT ARE THE COMPLICATIONS ASSOCIATED WITH LIPOSUCTION?

Complications with liposuction are very rare and include irregularities in the contour of the skin and underlying tissue, bleeding, bruising, and scarring. Blistering of the skin and infection are other rare complications of liposuction.

WHAT IS INVOLVED IN THE CONSULTATION? CAN I SEE PHOTOGRAPHS?

All patients require a consultation to:

1. discuss their goals for the operation
2. permit the doctor to take a relevant history and perform a pertinent physical examination
3. learn from the doctor what are:
1. the available procedures and their indications
2. the recommended procedures and why
3. the results
4. the risks and complications
   

In addition, the doctor should discuss, if appropriate:

1. the preoperative testing and preparation required
2. the type of anesthesia
3. where the procedure will be performed
4. the post-operative care required
5. recovery, including:
1. any discomfort expected
2. restriction of activities
3. return to work
   

At that time, that doctor may review appropriate pre- and post-operative photographs of you and how they may or may not be relevant to the results you can reasonably expect after your operation.

WHERE IS THE INCISION FOR LIPOSUCTION MADE?

As noted above, the incisions for liposuction are usually less than 5 mm in length and are generally placed along the periphery of the surgical markings of the area to be suctioned.

HOW MUCH DISCOMFORT WILL I HAVE? WHAT ARE MY POST-OPERATIVE INSTRUCTIONS- shower, exercise, work, etc?

The patient goes home in a gentle compression dressing of gauze and ace bandages. They are able to remove the garment the next morning, shower, and change into a clean compression garment. Drainage of blood tinged fluid through the incision is common the first evening and rarely persists for a longer period of time. Initial discomfort is controlled with oral medication. Patients are generally seen the first and second weeks after the procedure. Light activities can be resumed as tolerated. Most patients are ready to return to work or school quite soon after the procedure- in some cases within 24 hours, but certainly within several days. Full aerobic activities can be resumed in about 3 weeks.

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation and the completion of any required testing. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.