By Barry J. Cohen, M.D., P.C.
Diplomate, American Board of Plastic Surgery
Suction assisted lipectomy which is also referred as fat suctioning or liposuction, is the most common aesthetic surgery technique performed in the United States. In this technique, unwanted fat deposits are removed from certain areas of the body. The common areas of the body which are amenable to liposuction include the neck, the face, the upper arms, breasts, abdomen, hips, buttocks, thighs, knees, calves and ankles. The common misconception about liposuction is that it is a quick fix weight loss technique. In fact, this is not the case. Approximately 1/3 of all people coming in for consultations for liposuction are turned away as poor candidates for the procedure. Liposuction is meant as a localized fat reduction technique for people with disproportionate areas of fat deposits. It is a wonderful method for removing localized fat that does not respond to diet and exercise to make people proportionate.
Certainly liposuction can improve your appearance and self confidence. The best candidates for liposuction are of relatively normal weight and are not over weight at all. People should be physical and mentally stable and realistic in the expectations. Additionally, having firm skin with good elastic rebound will result in a better final contour. Unfortunately, those people with significant amount of stretch marks or loose skin will require additional surgical procedures to remove excess skin, which will undoubtably leave visible scars. Patients who have significant underlying medical problems such as diabetes or poor blood supply to the extremities are bad candidates for this procedure. Cellulite does not respond to liposuction and despite recent television shows claiming successes in this area, this is not accepted by the mainstream of plastic surgery.
There are risks and complications associated with liposuction. However, with the new tumescent technique, this has become increasingly safe. Specifically, the major risks of liposuction include infection, hemorrhage or bleeding, post operative asymmetries, which could require subsequent touch ups, dimpling of the skin, and fat or blood clots which can travel to your lungs, causing respiratory or breathing problems. The scars from liposuction are present, but are usually quite small and placed strategically to minimize their appearance. They are usually placed in the bikini line or belly button or other inconspicuous areas.
The new technique associated with liposuction is referred to as tumescent liposuction. Specifically, tumescent means distention. We have found, in the last several years, that by injecting large amounts of salt water, also known as saline solution mixed with a blood vessel constricting agent known as adrenaline, blood loss is dramatically lowered. The added benefit of the use of tumescent liposuction is that many limited procedures can be done while the patient is awake by adding Lidocaine or Novocaine solution to the mix. This allows the procedure to be done relatively comfortably while the patient is under only mild sedation.
The post operative period has a modest amount of pain associated with it. The patient cannot exercise for several weeks after surgery. Additionally, most physicians ask that the patients wear some type of girdle or compression garment for a minimum of three to six weeks after the operation. This enhances the outcome of surgery by compressing the tunnels that were created during the operation. In preparations for one’s surgery, a patient may give his or her own blood to help replace blood and other fluid loss during surgery, if the amount of liposuction is substantial. Most patients do not require transfusion with limited amounts of liposuction, especially using the new tumescent technique. Avoidance of aspirin and other products, which make you bleed, is essential prior to surgery. Most liposuction is now done as an outpatient quite successfully. The immediate post operative period is associated with some bruising. However, there are new techniques which can reduce bruising dramatically. All patients who undergo liposuction become firm and lumpy for several weeks after surgery and it takes approximately three to six months to see the final outcome. The rippling we used to see with liposuction several years ago has been substantially reduced by using smaller diameter cannulas or tubes, which are the instruments used to remove the fat. The reduced diameter cannulas associated with tumescent liposuction have dramatically improved the safety and quality of results that we see with liposuction, making it the most common aesthetic procedure performed in the United States. The patient satisfaction from suction assisted lipectomy is enormous, allowing people to feel more comfortably in a wide variety of clothes and at more ease with their body.