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.
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.
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 Lipsuction
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.
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.
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. |
