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Liposuction

Liposuction – Liposculpture – Surgical Body Contouring


Liposuction treatmentLiposuction, commonly known as liposculpture, involves removing unwanted pockets of subcutaneous fat. Traditionally liposuction is solely a fat reduction procedure. However, the recent terms liposculpture and body contouring more specifically define newer techniques utilizing energy (eg ultrasound, laser, radiofrequency, highly pressurized water spray) at the same time as the traditional suction to obtain enhanced improvements in skin tightening and body shaping. Overall, fat removal while simultaneously recontouring, creates an aesthetically pleasing improve body. With newer techniques and devices, in some instances cellulite and skin looseness can also be improved, where in the past it was commonly made worse. Nonetheless, those with significant stretch marks, loose skin prior to liposuction can often have worsening of the skin laxity and should avoid overly aggressive liposuction procedures or consider skin removal surgery at the same time. Those with significant cellulite prior to the procedure should have a complimentary targeted treatment for this condition at the same time as the liposuction procedure.

People often think of liposuction as a weight loss procedure, although it is not. Although liposuction selectively removes fat and contours skin, these fat pockets are in persistent localized areas that are unable to be rid with diet and exercise alone. Those who have significant amount of fat from obesity will not benefit from liposuction and will be unhappy with results.  

In more recent years, a condition termed “lipedema” has become better known. In this condition, patients have large amounts of disproportionate fat cells in areas such as the arms, legs, and buttocks with associated symptoms such as pain and swelling. Joint pain and functional impairment (eg difficulty walking or sitting/standing) can begin to affect the person’s quality of life.  In these cases, liposuction or lipocontouring is essential to prevent further worsening of the condition and to rid the patient of the symptoms that cause a significant degree of lifestyle issues. More information can be found at: http://www.curelipedema.org/.

Bothersome fatty deposits are found in areas that are resistant to diet and exercise, such as the face, neck, breast, abdomen, upper arm, hips, thighs, knees, and ankles. The procedure can be performed in multiple areas at a time and your surgeon will follow accepted guidelines regarding safe volumes. Multiple procedures may be necessary for full body contouring.

Those with very athletic builds or those who are thin with small problem areas may benefit from a hi-definition procedure, in which the surgeon uses specialized techniques to remove superficial fat and create etched lines or body contours in areas of musculature.  These specialized procedures require a meticulous and experienced surgeon to create six-pack abs, lift buttocks and breasts, and sculpt arms and shoulder definition. Another term for this type of procedure is 4D hi-definition contouring or 360 degree liposculpture.  

Goals for a liposuction or liposculpture procedure:

  • improvement in body disproportion and shape
  • reduction in fat in the treatment areas
  • improvement in skin quality or tightening in the treatment areas (consider skin removal surgery if starting with a significant amount of loose skin)
  • muscular defining and shaping with a hi-definition procedure
  • reduction of symptoms such as pain or swelling in fatty areas in patients with lipedema
  • improvement in contours, indentations, skin induration or hardness in those with poor previous outcomes (eg revision liposuction)

Final results may not be evident for six months for most procedures and 1-2 years for hi-definition body contouring procedures. During this time, your body balances fluids and the skin and remodels underlying tissues. Final results also depend on proper nutrition and exercise. Some well-trained liposculpture surgeons will use non-invasive devices such as radiofrequency heating or ultrasound to speed the healing process and improve the chances of great outcomes (eg decreasing the risk of complications such as fluid build up, scar tissue, or lumps and bumps).

The liposuction procedure begins by making small incisions in hair bearing areas or natural skin folds to limit scarring. A special tumescent solution (eg fluid with anesthetic medication) is next placed within the fatty areas to be removed. This solution provides numbness to the areas and limits blood loss.  Fat is then carefully removed from the areas of concern using a surgical instrument called a cannula, which is attached with tubing to a suction machine. A cannula is a small blunt-ended instrument with specialized openings at the end to allow for easy removal of fat with limited bruising and swelling.

The time for completion of the procedure depends upon the total amount of fatty tissue removed and the detail of the procedure. Traditional tumescent liposculpture procedures can take a few minutes to a few hours to take place. More detailed hi-definition contouring procedures can take hours to complete, as they require multiple steps to remove fat, tighten skin and create defined etched lines in areas of musculature. At the end of the procedure, the skin openings may be sutured or left open to heal, depending on the size of the openings. The patient is placed in a compression garment that is worn for certain amount of time afterwards.

While recovery is easy, you should expect some initial drainage along with swelling, bruising and discomfort. Your compression garment will minimize the swelling, bruising, discomfort and assist in the retraction of any loose skin.

While some results are noted immediately, your final shape and form will continue to improve as your swelling subsides. You will be encouraged to be up and about the night of your surgery and progressively increase your activities. Usually light work duties may be resumed within three to five days and vigorous exercise within two to four weeks.

Who is a Candidate for Liposuction?

  • Patients desiring fat removal in problem areas such as the facial, neck, torso, breast, arms or legs.
  • Patients looking for a more athletic or contoured body shape.
  • Patients of most ages who are healthy and living an active lifestyle with diet and exercise.
  • Patients who understand that this is not a weight loss procedure.
  • Patients with realistic expectations.

Procedure Description for Liposuction

  • Liposuction can be performed under local or general anesthesia in an approved outpatient facility for larger procedures or in a physicians specialized procedure room for smaller localized areas.
  • The incisions are small and heal with minimal scars.
  • Patients will be placed in a special support (compression) garment at the end of the procedure.

Recuperation and Healing

  • You will be discharged home to the care of a responsible adult, nurse or aftercare facility.
  • You are encouraged to be up and about the first night.
  • Some blood-tinged drainage is expected for usually the first several days.
  • Light household duties may be resumed in several days.
  • Most patients resume standard pre-operative activities with 2 to 4 weeks after their surgery.

Other Options

  • Hi-definition body contouring.
  • Revision liposuction.
  • Lipedema liposuction.
  • Fat grafting along with liposuction to improve body contour such as the breasts and buttock.
  • Energy based devices such as VASER ultrasound, SmartLipo laser, ThermiRF radiofrequency, BodyJet water-assisted.

 

Notes

The specific risks and suitability of this procedure for a given individual can only be fully determined at the time of consultation with your cosmetic surgeon. All surgical procedures have some degree of risk.  Minor complications, which rarely affect the overall cosmetic results, occur occasionally such as swelling, bruising, and skin numbness. Major complications are rare, but include cosmetic irregularities such as lumps and bumps, poor contouring or body shape, indentations, scarring, skin necrosis or skin death, discoloration of the skin, infections, bleeding or hematomas, fluid build up or seromas. Some major complications can be permanent and should be discussed with your surgeon prior to the proposed procedure.

Reviewed by Jason Emer, MD, FAAD, FAACS, www.jasonemermd.com