Your new look
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.
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.
Women may have liposuction performed under
the chin, on their hips, thighs, and stomach,
and in the under arm and breast area.
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 technique is 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.
Improvement will become apparent after about
six weeks, when most of the swelling has subsided.
After your surgery
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.
As healing progresses, a more proportional
look will emerge.
A slimmer body contour can help you feel
more confident and comfortable.
© Copyright 1994,
American Society of Plastic Surgeons
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