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Liposuction


Overview

Liposuction has recently become one of the most sought after plastic surgery procedures. It effectively removes fat that cannot be lost by diet or exercise. In addition, the fat cells that are removed are gone forever. Most people have at least some areas of fat on their bodies that just will not to go away no matter how hard they diet and exercise. This is a common complaint. The fact is, both men and women have characteristic fat areas that do not seem to go away. In men, these areas tend to be around the abdomen and the love handles. In women, fat accumulation tends to occur on the hips, flanks, thighs, and, to a lesser extent, abdomen. These are the areas where liposuction works best.

Even though liposuction removes fat, it is best performed on people who are not markedly overweight. The ideal candidates are the people who are within 30 to 40 pounds of their ideal body weight and have localized areas of fat. Liposuction can, and often is, used to treat multiple areas. It is not uncommon to do the abdomen, hips, flanks, and thighs all at one time.

Liposuction works best on people who have skin that is healthy and able to stretch back when the fat is removed. People who have poor skin, which usually includes the elderly, or have a lot of fat to be removed from one area will not receive an outstanding result. They will certainly benefit, but because their skin is incapable of stretching back exactly where it should, it may not resume the ideal contour of the body. In these cases,it is sometimes necessary for some skin to be removed. This is often the case when there is a significant amount of loose skin within the abdomen. Often, liposuction alone is inadequate and an abdominoplasty might be necessary.

Other areas that can benefit from liposuction include: the arms, breasts, calves, knees, and area under the chin. These areas, however, do not respond quite as well as those mentioned above. Liposuction, especially ultrasonic liposuction, may help cellulite somewhat but do not expect dramatic improvements as cellulite remains a difficult problem to treat.

Liposuction is performed by first infiltrating the desired fat to be removed with a special fluid. Then, a small suction cannula is inserted through tiny incisions to remove the fat.

Our plastic surgeons have extensive experience with liposuction and body contouring. Safety is the number one concern. This is why they limit the amount of fat to be removed to 5000 cc's, which is the guideline recommended by the American Board of Plastic Surgery. If more fat needs to be removed, it can be done more safely as a second procedure. Removing greater volume subjects the patient to risks that can not be justified for a cosmetic procedure.

Many people wonder if the fat that is removed during liposuction will return. The answer to this is NO. Fat that is removed is gone forever. The reason for this is that after adolescence, humans lose the ability to make new fat cells. Obviously, the fat cells that remain after liposuction can significantly expand. Fat removal from liposuction is a permanent solution to only the areas operated on. There is a problem, however, when a person who has had liposuction in one area gains a significant amount of weight. This additional weight accumulates in the areas other than where liposuction was performed. This can create contour irregularities. This can be corrected by either weight reduction or liposuction in those areas that have gained fat.

Benefits

The main benefit of liposuction is removal of fat which is resistant to other forms of treatment such as diet and exercising. A two-hour liposuction procedure can do what thousands of hours in the gym and unpleasant dieting could not. It removes areas of fat permanently. Recent research has shown that fat removal via liposuction has certain health advantages as well. These health advantages include improvements in heart disease and diabetes.

Outlined below is a brief review of the benefits of liposuction:

  • Liposuction removes fat that is resistant to exercise and/or dieting.
  • The fat removal is permanent.
  • In women, especially useful for abdomen, hips, flanks, thighs, buttocks, neck, and back.
  • In men, especially useful for abdomen, love handles, back, neck, and chest.
  • It is performed via tiny, hidden incisions.
  • It enables to sculpt thighs with a more desirable contour.
  • it Is easily combined with fat injection for facial rejuvenation.
  • Multiple areas can be liposuctioned.
  • People of all ages are eligible.

Are you a good candidate?

People who make the best candidates for liposuction are those that are within 30 to 40 pounds of their ideal body weight and want to have localized fat removed. Liposuction can remove significant amounts of fat but weight reduction is not the purpose of liposuction. Weight reduction does occur with large volume liposuction removal but, to be safe, our plastic surgeons do this over more than one session because removing too much fat at once can be dangerous.

Brief outline of areas were liposuction is useful.

  • Calves and knees.
  • Inner and outer thighs.
  • Hips and flanks.
  • Buttocks.
  • Love handles.
  • Back and chest.
  • Upper arms.
  • Neck and jowls.

Possible complications

Liposuction in our plastic surgeons' hands rarely has complications but they must be discussed. The most common complications are: inadequate fat removal or contour irregularities. Because our plastic surgeons have extensive experience in liposuction these are uncommon. If they do occur, they addresses this in several ways including external ultrasound, endermology, selective liposuction, etc. Other possible complications include infection and wound healing problems, decreased skin sensation, and fluid or blood collection.

Do's and Don'ts prior to surgery

  • Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within three weeks of surgery. Your plastic surgeon will go over this more thoroughly prior to the procedure.

  • Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help you sleep.

  • Smoking. Do not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. It also affects your airway making the anesthesia much more difficult.

  • Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. It is OK to take medications with a sip of water. Please discuss all medications with your plastic surgeon and the anesthesiologist.

  • Washing. It is a good idea to wash the surgical area thoroughly the night before and the morning of surgery. Do not forget to wash inside your bellybutton if liposuction is being performed on the abdomen.

  • Arrival. It is best to arrive on time to make sure things run smoothly. Please be sure to have someone else drive you.

  • State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly concerned. Excessive worrying can actually be detrimental and you should discuss this with your doctor prior to surgery so that something can be prescribed to make sure you remain calm.

Anesthesia

The anesthesiologist will discuss with you what type of anesthesia is best for you prior to the procedure. He/she will take into consideration your medical history, the procedure, and your personal wishes.

The type of anesthesia depends on the amount of areas to be liposuctioned. Many doctors routinely do single-area liposuction under local anesthesia. If more areas are involved or you are quite anxious, general anesthesia is best. Your doctor will discuss this with you during your consultation.

After the procedure

The time necessary to perform the procedure depends on the number of areas being liposuctioned. The range is anywhere from 1 to 4 hours.

  • Immediately. Right after the operation you will be nursed for 1 or 2 hours and encouraged to walk around. You will be given as much pain medication as necessary both immediately after the operation and for the next 4 to 5 days. Of course, there will be swelling and bruising but there is surprisingly little pain. You will be wearing a lightly compressive garment to minimize swelling. It is important to wear this at all times except when showering for the first six weeks to make sure your skin redrapes to your newly contoured body. Because a lot of fluid is injected into the tissues being liposuctioned, you will have a significant amount of oozing. You will be asked to drink a lot of fluid to make sure you are not dehydrated. You should continue to drink a lot of fluid for the first 24 hours.

  • That evening. It is recommended that you take it easy. You can eat and drink. You can get up and walk around but not too much as this may increase swelling. You should sit with your legs elevated to encouraged venous return. Take as much pain medication as necessary and try to go to sleep early. You will be given medication to help keep the swelling down as well as to prevent infection.

  • First 48 hours. The next day, you can remove the compressive garment and shower. The shower water should be cool. While you are showering have someone wash and dry the garment as it will have dried blood and fluid on it. Put the garment on so that there are no creases bunching up and pinching your skin. The importance of wearing this compressive garment for 6 weeks cannot be overstated.

  • First week. Your first postoperative visit will be 1 week after the procedure. Your plastic surgeon will make sure everything is healing properly.

  • Beyond. It will take 4 to 6 weeks for the majority of the swelling to go down. Complete resolution of the swelling will take six months. Skin redraping takes quite a while as the skin needs time to contract to its new body contour. The final result will not be seen until at least 6 months when all the swelling is down and skin contraction is complete.

Recovery time

Time off work is highly dependent on how large of an area is liposuctioned. If a single area is liposuctioned then it may be possible to return to work the very next day. As more areas are liposuctioned the amount of bruising and swelling increases and, therefore, the recovery time increases. If several areas are liposuctioned, it will take about 3 weeks for the majority of swelling and bruising to resolve. Some people with sedentary jobs go back to work after 4 days. If your job, however, requires strenuous activity then it may take up to 2 to 3 weeks to return to work.


Consultation

We have outlined below what you can expect from your liposuction consultation. Read carefully, as there are many suggestions that will save you time, clear up questions, and help you convey to your plastic surgeon what you want to accomplish.


Health History

All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used but also applies to local anesthesia. Liposuctions can be done under either general or local anesthesia. The type of anesthesia depends on how many areas are being liposuctioned and the discomfort tolerance of the patient. Single areas such as abdomen or lateral thighs can be done under a type of local called tumescent anesthesia. Tumescent anesthesia is a local anesthesia mixed with saline and then injected into the subcutaneous fat. This effectively numbs the area. Multiple areas and sensitive areas such as the medial thigh are often done under general anesthesia. Each plastic surgeon has his/her own strategy regarding the type of anesthesia used.

Prior to meeting with the plastic surgeon you will be given a health history questionnaire to fill out in the waiting area. There are five areas of your health you will be asked about. Be sure to answer it with detail so that your surgery and anesthesia can be optimized for you.

  • General Health

General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are: high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.

What will the plastic surgeon do if I have medical problems?

In short, he/she will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.

If you have a health problem or are over 50 years of age you can often save yourself time by getting a letter from your private physician prior to your cosmetic consultation stating what the health problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.

If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating you are able to tolerate surgery.

Be sure to let your plastic surgeon know if you have ever had a blood clot.

  • Past Surgical History

On your questionnaire you will be asked about previous surgeries. Be sure to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries especially if you do not like the result and are interested in revision.

  • Medications

Be sure to list all medications you take including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin containing products at least 10 days before surgery. Tylenol is a good alternative. Here is a partial list of aspirin containing products and other products to be avoided prior to surgery.

  • Allergies to Medications

Information about medications that cause allergies is very important so that these medications can be avoided. Of particular importance is the reaction you had, especially if you had trouble breathing. Be sure to include this information! Nausea is not an allergy but it is important to mention as well.

  • Smoking, Drinking, and Drug Uses

These there will certainly affect your surgery and MUST be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift smoking must be stopped at least 2-3 weeks before and after surgery. Otherwise, the results could be disastrous leading to non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction smoking will hurt the overall result but this may or may not be noticeable. In this case smoking cessation is strongly advised but is not mandatory.


What Do You Want To Change?

It is important that you have a clear idea of what you want changed when you go for a consultation. The least favorite thing a plastic surgeon wants to hear is: What do you think I need done.

Look in a mirror and identify what bothers you. Be specific. It may be helpful to look back at younger pictures to see if that problem always existed or if it is part of aging. Bring the picture as it may be helpful.

Physical Exam

The key to the liposuction exam is to determine exactly what is causing the problem. Some problems can be treated with liposuction while other require removal of excess skin. Sometimes a combination of the two is best. This section will help you decide what is best for you.


  • What areas do NOT respond well to liposuction?

This web site is designed to educate you so that your plastic surgery experience achieves yours goals. Part of our responsibility is to make sure that your goals are realistic. With this in mind we will first outline which patients are not good candidates for liposuction.

Not all areas respond well to liposuction. Most people feel that if they have a fatty area it can just be sucked away and the problem will be solved. This is not the case. There are other issues that must be considered.

  • Redundant Skin

Redundant skin usually is best treated with removal. This is especially true with medial thigh, and arms, and often abdomen. If liposuction is done in these cases then a poor result is likely. When the fat is removed, the loose skin becomes even looser often with waviness because the skin does not have the ability to recoil. This elastic skin contraction is extremely important and is elaborated on throughout this section.

  • Poor Quality Skin

The entire basis of liposuction depends of skin contraction. Poor quality skin does not have this ability. Poor quality skin is identified by stretch marks, cellulite, scars, age, and a certain thin dermis feel that only your plastic surgeon can determine.

  • Stretch Marks

Stretch marks show that the skin does not have much elastin, which is necessary for the skin to contract. Therefore, after the skin has been stretched (i.e. pregnancy or weight gain) it cannot recoil back. The skin essentially forms scars that are represented by stretch marks. These scars have no capacity to contract.

  • Cellulite

Unfortunately, cellulite also responds poorly to liposuction. Ironically, this is why some women want liposuction in the first place. Cellulite is skin that has fat in the subcutaneous areas separated by fibrous septa. These septa break the fat into compartments. Sometimes, when this fat is removed the cellulite can become more prominent. Currently, there are no good answers to this problem but certainly muscle tone and proper diet help.

  • Scars

Scar tissue is devoid of elastin. It has NO ability to contract. Areas with scars are often best revised. Since a scar is already there a good plastic surgeon can perform a scar revision that will result in a less conspicuous scar. As a bonus, a skin and fat removal can be done at the same time, thus, creating a win-win situation.

  • Aged Skin

Notice how the title is Aged Skin and not a specific age. This is because different people's skin age differently. Amazingly, even skin on different areas of the same person age differently! The bottom line is that the older the patient is, the more likely is he/she to benefit from skin excision than liposuction. The good news is that older skin forms thinner, less visible scars than younger skin.

  • Thin Dermis Areas

Once again, skin contraction depends on elastin within the dermis. Areas that have a thin dermis do not have much elastin. Areas that are notorious for thin dermis are the medial thigh, and the inner arms. Pinch these areas and feel for yourself. This is why a medial thigh lift or arm lift is usually a better choice. An exception to this is the young patient with thick, elastic skin in these areas.

  • Beer Belly

This is almost exclusively a male concern. The problem is that this fat is NOT subcutaneous fat that is amenable to liposuction. This fat is under the muscle within the abdomen itself. It is hard, therefore, pinching it is difficult. Because it is intra-abdominal it is not accessible to liposuction and can only be lost by diet and exercise.

  • Markedly Overweight

Liposuction is not meant to be a weight loss procedure. In fact, most plastic surgeons will limit the amount of fat removed so that patient safety is maintained. Many will not exceed 5000 cc's (11 lbs. ) in one operation. The fact is, massive liposuction often leads to skin waviness as well as skin sag. Skin excision is often a better way to go.


What Makes a Good Candidate For Liposuction?

Basically, anyone who is not a bad candidate as outlined above is a good candidate. Below are some common examples of the patient who is likely to obtain a good result from liposuction

  • Localized fat deposit

The ideal candidate is one who is at, or just slightly above, his/her ideal body weight but has one fatty area that just will not go away. With women this is often the lateral thigh(saddlebags) or the abdomen. With men, this is usually the flanks (love handles) and abdomen.

  • Lateral Thighs

Fat within the lateral thigh area is easily liposuctioned AND the skin in this area has a thick dermis that allows it to contract well.

  • Abdomen

Abdomen is usually has a thick dermis and responds favorably.

  • Flanks

This areas usually have a more fibrous fat but still respond favorably.

  • Knees, calves, medial thighs, back, arms, and neck

These areas are highly variable and must be considered individually. Good results are possible if good quality skin is present.


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