Introduction To Liposuction
"Liposuction is the surgeon's method of sculpting the body contours."
Liposuction is the most common cosmetic surgical procedure performed in the United States today and works best when treating localized fat deposits. Adipose tissue is surgically removed from specific areas through small skin incisions using a hollow metal tube attached to a vacuum apparatus. You are an ideal candidate for liposuction if you are at or close to your ideal body weight, and you want to improve the contour of your body but you have not been previously successful with traditional diet or exercise. Liposuction can slim the hips, and thighs, can flatten the abdomen and can remove excess fat from the chin and upper arms. Liposuction can also help to create a more shapely contour to the inner knees, calves and ankles. The treated areas will retain their new contour as long as you do not have large weight gains.
There are certain areas of the body, such as the upper arms, abdomen and inner thighs, that may develop loose or hanging skin following liposuction. The degree of skin retraction and tightness depends on the patient’s age, the amount of fat to be removed and the patient’s general skin tone and degree of elasticity. If you are at high risk for loose skin, we may recommend a skin tightening procedure such as a thigh lift, tummy tuck or upper arm lift. If it is equivocal whether the patient will develop skin laxity after liposuction alone, removal of excess or redundant skin can be performed at a later date.
Fat cells play numerous metabolic roles in the body. They serve as an energy source, a storage place, and interact with insulin and hormone synthesis, to name a few. Adult fat cells are thought to be incapable of multiplying. There are a fixed number distributed in a genetically predetermined fashion throughout the body. Regardless of the function, as you gain weight these cells expand. As you lose weight, they contract but the number and distribution remain essentially unchanged. This is why thin people may still complain about localized fatty deposits that don't go away even at their ideal weight. Dieting reduces your weight and overall size, and may show improvement in specific areas. Liposuction reduces the overall number of fat cells, and affects shape and contour.
Liposuction has come a long way since its introduction in the mid 1970’s and modern techniques have made it safer and simpler for both surgeons and patients. It is a safe and effective way to remove unsightly bulges from almost any area to produce an improved shape and contour. This is why liposuction has consistently been the most popular cosmetic surgical procedure in the world for the past several years.
Fat deposits that don't respond to the usual litany of exercise and diet regimens are ideal targets for liposuction. If you are only overweight in certain areas of your body, you would have to lose a larger amount of weight in order to shrink the size of your thighs. The weight will come off everywhere including the breasts and face, and not just where you need it most. Most body parts can be suctioned for better contour and reduced volume, from the face down to the ankles. The most popular areas for women are the abdomen, inner thighs, outer thighs, hips, flanks and knees. Liposuction can even be used to reduce heavy breasts in some women.
Before having liposuction, we will discuss your lifestyle, aerobic shape, and body weight fluctuations. If you have a history of an eating disorder like bulimia, anorexia, binge eating, or have been on prescription weight control medications, we need to know in advance. If you are overweight you may have to undergo these procedures in stages. If you exceed your ideal weight by 50% or more, we may suggest that you lose weight prior to undergoing a liposuction procedure.
Liposuction of multiple areas should not exceed five liters of total fat removed in the outpatient setting and 10 liters in the inpatient setting. When large volume liposuction is performed, it is best to treat "aesthetic units" of the body to maximize the result. For instance, it is possible to combine liposuction of the back, love handle area and abdomen during one session, and the hips, inner and outer thighs and knees during another session.
How We Do It
Advances in liposuction techniques have greatly improved the results you can achieve. The procedure is very straightforward. Tiny incisions of approximately one quarter inch long are made at the sites where fat is to be removed and a wetting solution is infused to provide anesthesia, reduce bleeding and improve fat extraction. This requires careful monitoring to avoid toxicity and must be performed by those experienced with local anesthesia. The surgeon uses various sizes and dimensions of cannulae, hollow, tubular instruments with holes at one end to trap the fat. The cannula is attached to suction tubing through which the excess fat is evacuated.
These instruments come in various shapes, lengths and sizes depending on the thickness and location of the fat. They have highly polished surfaces to slip through the fatty tissues with minimum friction or damage, and are frequently blunt-tipped to prevent cutting through the skin. Cannulae are inserted under the skin moved in a back and forth and criss-cross fashion within the fat, essentially pushing it aside while protecting the vessels and nerves. Fat is suctioned out through one or several holes at the tip, measured, and then the patient is checked for symmetry. The procedure is completed when a safe level of fat removal and the desired contour has been achieved. The patient is then monitored closely to make sure that enough fluid hydration has been received.
The 'wet' techniques, and the superwet technique, referring to the amount of fluids injected, are variations of the tumescent technique. Tumescent anesthesia has had perhaps the most significant impact of all developments in liposuction. Warmed tumescent liquid, a diluted solution containing lidocaine, epinephrine and intravenous fluid, is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and blanched. The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed. The saline softens the fat, the adrenaline decreases the blood loss and bruising, and the anesthesia provides relief from discomfort.
Ultrasound Assisted Liposuction (UAL)
Ultrasonic sound waves, like shock waves, are transmitted into the fatty tissues from the tip of the cannula probe. The fat cells are melted or liquefied and then removed by low-pressure vacuum through a suction tube. Ultrasonic liposuction is often reserved for more difficult areas to contour where the deep fat is thicker, and thus harder to extract; i.e. back rolls, upper abdomen, and flanks. It can be combined with traditional liposuction when both the deeper fat and more superficial fat are being removed. Some physicians use external ultrasound (EUAL) with liposuction in lower frequencies to soften fat deposits from the skin's surface. The literature shows limited effects of this treatment except on the tissues just below the skin surface.