SUCTION-ASSISTED LIPECTOMY Ultrasonic liposuction
Liposuction, or suction-assisted lipectomy, is a technique to reduce fatty bulges in areas as diverse as the neck, upper arms, above the breast, abdomen, buttocks, hips, thighs, knees, calves and ankles. Liposuction is not a method of weight reduction. It is a contouring technique to reduce localised fatty deposits that do not respond to diet and exercise.
During liposuction, a fine metal tube (cannula) is passed back and forth through the fatty deposit whilst suction is applied to a tube connected to the end of the cannula. Small parcels of fat are removed with each pass, which reduces the amount of fat in the fatty bulge. The area from which the fat was removed forms a small scar.
Over subsequent months these scars shrink which further reduces the prominence of the bulge. Thus the final result of liposuction will not be seen for some months after surgery. The effectiveness of liposuction is greatly enhanced by good skin elasticity. In general skin elasticity deteriorates with age or if the skin has had a severe stretch (for example pregnancy, excessive weight gain, or loss). If skin elasticity is poor and liposuction is performed the skin may not shrink sufficiently and, despite reduction in the size of the bulge, the loose hanging skin maintains the bulge to some extent and the result is not aesthetically pleasing.
Liposuction is commonly performed using a “tumescent” or “super-wet technique” whereby a substantial amount of intra-venous fluid is infiltrated into the area to undergo liposuction. This reduces the bleeding during the procedure and the discomfort after the procedure. As mentioned above, conventional liposuction is done by passing a fine metal tube with suction applied to it back and forth through a fatty bulge.
In some cases and in certain parts of the body, ultrasonic liposuction may be used. After infiltration with the wetting fluid, a metal probe is passed back and forth through the fatty bulge. This metal probe emits ultrasonic energy from its tip. This ultrasonic energy breaks down the walls of the fat cells, releasing the fat that they contain. This is then removed by subsequent conventional liposuction. Ultrasonic liposuction entails more risks than conventional liposuction, and needs larger incisions as the probes are not as fine as most small cannulae. It may however, enhance the shrinkage of skin in certain situations.
Who is best suited for liposuction
The best candidates for liposuction are: Have good skin elasticity ie. young, no loose folds of skin, no history of major weight fluctuations or pregnancies. Near their ideal weight. Have focal deposits of fat rather than generalised fattiness to an entire zone. Have realistic expectations. For liposuction you need to be physically healthy, psychologically stable and realise that liposuction usually gives a modest improvement in body contour.
Remember liposuction is not a treatment for obesity; if you are overweight you will be encouraged to reduce weight prior to surgery. By doing this you increase the chances of getting a good result from your procedure. There is very little that one can do in plastic surgery to reduce weight. Even procedures such as arm lifts, thigh lifts and abdominoplasty, are simply techniques to reduce excess skin and improve tone. They are not effective weight reduction techniques. If you are overweight, at consultation with Dr Scamp, he will explain options to help you lose the weight prior to surgery.
What are the risks of surgery?
Plan to reduce the risks of your surgery by ensuring your surgeon is a fully qualified plastic surgeon. Ensuring that your surgery is done in an adequately equipped day theatre or accredited hospital. Ensuring that you are in the best condition for surgery. A significant number of deaths have been reported in the USA after liposuction.
Almost always these have occurred when liposuction of large amounts have been performed on patients who are significantly above their ideal weight. Frequently these patients have been given large amounts of fluid into each of the zones that were subsequently suctioned. Frequently these patients were sent home on the day of the surgery. Dr Scamp will limit the amount of fluid that is used during your procedure to make it safer. He will also not perform extensive liposuction if such is likely to be dangerous.
If necessary, liposuction can be repeated more than once to achieve the desired result in a staged fashion rather than taking the risk of trying to do too much at once. Despite the above, complications after liposuction are uncommon and rarely serious. Bruising and numbness of the area for weeks to months is to be expected. There will be small scars where the probes were passed into the area, usually two or three for each zone. When ultrasonic liposuction is used, the scars are a little larger, but still less than 1cm in size.
The most common complication after liposuction is skin irregularity, creating a cellulite appearance. This may have been there prior to surgery. It can however, be exaggerated where the skin elasticity is not good and shrinkage of the skin after removal of the fatty bulge does not occur sufficiently. Patchy pigmentation (brown spots) may occur on the skin if sun exposure is allowed soon after surgery.
Irregular bulges may become apparent, particularly where skin elasticity has not been good, and good skin shrinkage has not occurred. Sometimes this will respond to further liposuction. More rarely, infection, serome (accumulation of fluid that needs to be drained), skin loss or even perforation of an internal organ can occur. Fortunately these complications are rare.
Ultrasonic liposuction produces more heat than conventional liposuction. A burn to the skin with loss of part of the skin may result. Again, these complications are rare.
How do I plan my surgery?
At your initial consultation, Dr Scamp will assess you and advise you whether he thinks you are a good candidate for liposuction. Weight loss is recommended prior to surgery; it is done to enhance the standard of the final result. If multiple areas are to undergo liposuction, Doctor Scamp may recommend that you do this in more than one operation, a month or two apart. Dr Scamp will also advise if he feels liposuction will not achieve the best result for you. For example after childbearing the skin of the abdomen has often lost its tone and the area may not respond well to liposuction. A much better result may be achieved by means of abdominoplasty and Dr Scamp will inform you if this is the case. Dr Scamp will take your medical history and ask you if you smoke or take any medication. Do not hesitate to ask any questions at consultation that do not appear to have been covered by your discussion. You will also be given information to read on the surgery and an idea of the costs in your case.
Preparation for surgery
As mentioned above, weight loss prior to surgery may be advised. Dr Scamp does not use blood transfusions for liposuction. If extensive areas are planned for liposuction, it will generally be recommended that you undergo a number of operations a month or two apart so that the blood loss and fluid infiltration at each episode is not significant enough to be dangerous or require a transfusion. Diet and exercise prior to surgery will not only improve your chances of a good result but will also enhance your fitness for the operation.
If you are planning to have your surgery performed as a day patient, ensure that there is someone to drive you home and stay with you for the next night until you feel capable of taking care of yourself.
Where will my operation be performed?
Your liposuction procedure may be performed in an accredited day theatre (Pindara Day Procedure Centre) or with a stay of one or more nights in a private hospital. In general the decision is yours to make, but extensive areas of liposuction are not recommended to be done as a day patient.
What sort of anaesthetic will I have?
Whilst liposuction can be performed under local anaesthesia, most people find it much more comfortable and less traumatic to be asleep for the procedure. Day surgery is still possible with this approach. Once you are asleep, local anaesthetic is infiltrated into the areas to be treated. This makes them numb when you wake up and therefore your discomfort after surgery is reduced.
What is done at the surgery?
The duration of surgery depends upon the extent of the correction required. It may take from as little as 30 minutes to several hours. At each site to undergo liposuction one or more incisions will be made to allow passage of the cannula or ultrasonic probe. This instrument is then passed back and forth with negative pressure applied to a tube on the end of the cannula. Parcels of fat are loosened and dislodged and removed by this action. By removing some fat, the bulge will tend to decrease in size. Subsequent contraction of the scars within the fatty bulge leads to further correction. By infiltrating with fluid into each area prior to liposuction, bleeding is reduced.
After the operation
After your surgery is completed the small incisions are closed and dressed and a special garment is applied to apply pressure. This encourages the skin to shrink and stick down to fit your new shape. You will be measured for this garment prior to surgery. You will need to wear the pressure garment constantly for 6 weeks or more after surgery. Liposuction is therefore best planned for cooler times of the year.
The garments are somewhat foundation underwear and can become uncomfortable in hot weather. Expect to be bruised and swollen after surgery. As the weeks go by the bruising and swelling will abate and your discomfort will also improve markedly. You will be given medication to take if you are uncomfortable. You may feel a bit “down” after surgery but this tends to improve as the bruising and swelling disappears.
When will I return to normal activity?
You may start gentle exercise (walking) within a few days after surgery. Be guided by how you feel. Heavy physical activity is not recommended for two to four weeks. The sutures used in your small incisions are absorbable. Do not be surprised however if fluid leaks from these incision sites during the first few days. In some ways this is desirable, as it tends to decrease the amount of bruising you get.
Depending upon your occupation, your general health and the extent of your surgery, you may be able to return to work within the next day or two. Again, be guided by how you feel. Most of your swelling and discolouration will be gone by four weeks after surgery. However, you will not see the final result of the liposuction procedure for three to six months after surgery. This is due to the slow resolution of some of the swelling and the delayed scar contracture effect from the parcels of fat that have been removed. In the postoperative period, massage may be used to decrease your swelling and ease your discomfort.
This will be arranged for you after surgery. Of course contact the surgery at any time if you feel there is some untoward event occurring or you need some explanation or reassurance.
The new you
Liposuction can produce a modest improvement in body contour with minimal scarring. The best results are achieved with young elastic skin and smaller amounts of correction. However, it may give benefits at almost any age if your expectations are not excessive. The fat cells removed with liposuction are gone and can not reform. However your residual fat cells are more than capable of increasing in size if you overeat. Liposuction will not make it impossible for you to gain weight. You may not however reform the initial bulges that you had; rather you will get a more diffuse increase in size if you gain weight.
Like most operations, liposuction is not perfect. It has limitations and you must be realistic in your expectations. Write down any questions you have and ask Dr Scamp when you see him.