Liposuction is a body-sculpting procedure to remove fat that is unresponsive to dieting and exercising. This procedure can be applied to nearly any area of the body and is commonly used on multiple areas during an operation. Liposuction results in a slimmer and better proportioned figure. Liposuction is used effectively to reduce love handles, saddlebags, a double-chin, a bulge around the waistline, or other unsightly fatty deposits in order to develop a better shape and create a more beautiful body.
Reasons for Considering Liposuction:
Liposuction is not a replacement for proper exercise and diet. Instead, liposuction is a reduction procedure for stubborn areas where fat accumulates. Used in combination with several areas of the body, liposuction can provide a well proportioned body appearance. Ideal surgical candidates are those already in good physical condition but having stubborn areas that do not respond to diet and exercise.
Q & A
Can liposuction help me lose weight? Liposuction is not recommended as a substitute for weight loss. It is designed to improve the shape or contour of the body in patients who have (ideally) had stable weight for at least a year. Expecting liposuction to compensate for a bad diet and lack of exercise is unrealistic. In a small sub-set of patients who have well-defined areas of fat deposition that do not respond well to weight loss, liposuction can help as a “head-start” by creating greater optimism for achieving a desirable shape after further weight loss. It serves as a “motivator” in this setting, but is still not a substitute for diet an exercise.
What makes someone a good candidate for liposuction? Patients who have a stable baseline weight over a year’s time, and who have fatty bulges in specific areas that stubbornly resist weight loss are the best candidates. Typically, these are individuals who complain of “saddle bags”, or “love handles” that remain despite their being satisfied with their overall body mass and contour. Liposuction works best as a means to refine a good underlying shape or contour in patients who have a stable weight.
What makes someone a bad candidate for liposuction? Individuals seeking liposuction as a means to continue dietary misbehavior, or as a substitute for weight loss by diet and exercise are marginal or poor candidates. Liposuction can be done on these patients, and it can temporarily improve things. In the long run, however, weight is regained and the procedure ultimately makes little difference in overall appearance or self-esteem. Similarly, patients with stretched skin (such as the tummy) frequently request liposuction. If stretching has occurred due to weight gain or pregnancy, liposuction will create even more loosely hanging skin after removal of the supporting fat. Many patients seeking consultation for liposuction of the abdomen actually need an Abdominoplasty. If loose skin is present, liposuction can make the appearance worse!
Can fat come back after liposuction? A short answer to this question is “yes, but the bulges that occur with weight gain arise in areas other than the one that has undergone liposuction. The theory behind liposuction is that we all have a fixed number of fat cells after adolescence. Weight gain occurs as fat cells fill up with stored fat and become physically larger (thus bulges or “paunchiness”). Patients who are morbidly obese (100% above ideal body weight) have fat cells that divide, thus increasing their total number. This is in response to the existing fat cells being too full to store more fat. Liposuction removes the fat cells, thus preventing fat from being stored in these areas with future weight gain. If a patient continues to consume too many calories after having undergone liposuction, fat will be stored in the remaining fat cells outside the area that was operated on. The result is that fatty tissue in other parts of the body will increase in size more significantly than in the liposuctioned area.
Will liposuction improve cellulite? There are many surgeons who feel that liposuction will improve cellulite, and advertise this fact heavily. “Superficial” liposuction was marketed as a specific technique that targets cellulite. Suffice it to say that these “innovations” have proven to be a triumph of marketing rather than results. Cellulite is more that a problem of lumpy fat deposition. Any one who has cellulite can show you that the irregularity disappears if tension is placed on the skin. This is because cellulite is caused by a combination of skin laxity and fat compartmentalization. With age and sun damage, the skin becomes loose and bulges outward from the force of focal fat collections under it. Removing the fat will not take care of the skin laxity problem. In fact, lax skin will tend to look much worse after liposuction since it has a tendency to hang loosely after the supporting fat is removed. In the face of pervasive marketing pressures from surgeons, it is important that assurances from you prospective surgeon pass a test of “common sense” and, above all, honesty.
What happens is I gain weight after liposuction? Will the bulges come back in the same area? As mentioned above, the fat will accumulate in the remaining fat cells regardless of where they are located. Typically, significant weight gain will create bulges in other areas than the one that was liposuctioned. The “take-home point” here is that all fat cells store fat, and bulges are related to the density of the cells in a particular area. The more cells that are available to store fat at a given location, the more likely that area will expand with weight gain when compared with areas having fewer cells.
How is liposuction done? Small incisions are made in the skin to gain access to the fatty areas. These incisions are usually about ½ inch long or less. Specially designed hollow metal tubes are inserted through these incisions and passed through the subcutaneous tissues to reach the area of excessive fatty deposition. Typically, the incisions (ports) are placed to allow approaching the fatty area from more than one angle to help assure a more even removal of the fat. The ports can be placed at a significant distance from the fatty area to insure they are hidden in natural skin creases or areas that are covered with clothing. High suction is placed on the hollow tube, and fat cells are suctioned out of the area by passing the tube back-and-forth many times.
What are the risks of liposuction? As with any surgery, there is the potential for bleeding and infection. If bleeding causes significant bruising, the pigment from the blood can stain the skin permanently. This is a rare problem and is called “hemosiderin staining”. The biggest source of complaints after liposuction is unevenness of the result, or asymmetry of one side of the body when compared to the other. Usually, the differences are minimal, but they may require additional surgery to correct. Areas of significant depressions can be caused by over-aggressive removal of fat, and these can be very challenging to correct. Scars are seldom a source of dissatisfaction for patients, since they are small and typically well hidden. The scars resulting from Ultrasonic liposuction tend to be slightly larger and more conspicuous, but rarely need revision if they are allowed sufficient time to remodel and settle. Fluid collections termed seromas can occur as straw-colored fluid weeps into the cavity formed after fat is removed. These may need to be aspirated multiple times in the clinic with a needle before they resolve completely.
What is tumescent liposuction? In the past, patients were encouraged to donate their own blood for transfusion (autologous blood donation) prior to undergoing liposuction, due to the amount of blood loss associated with the procedure. Tumescent liposuction was developed as a means to decrease blood loss, and reduce pain experienced during the surgery. The technique involves injecting large amounts of solution containing dilute local anesthetic (similar to that used by a dentist when anesthetizing a tooth), and a potent vaso-constrictive medication called epinephrine (also known as adrenaline). The epinephrine causes blood vessels in the skin and fat to contract, thus decreasing the tendency for bleeding. The technique has been proven to be safe and effective. Significant blood loss is very rare since tumescent liposuction has become widely employed. Decreased blood loss has also decreased bruising from the procedure and improved post-operative recovery.
Is Ultrasonic liposuction better than more traditional techniques? Ultrasonic liposucton has been available for many years, but has not become the dominant means of fat removal that was initially envisioned. This technique passes a special rod into the tissue that vibrates at ultrasonic frequencies (typically 20kHZ or greater) and emulsifies the fatty tissue. Traditional liposuction is then done to remove the debris and emulsified fat. In fibrous tissue that binds the fat or makes it difficult to remove, ultrasonic emulsification helps increase the volume that can be resected. It is especially useful in male breasts and in fatty deposits on the flank. Typically, ultrasound is now used for secondary (re-do) liposuction or for treating areas that are resistant to standard liposuction. It requires significantly more operating time to perform, and can increase the potential for complications such as fluid collections or prolonged swelling.
What is large-volume liposuction? The American Society of Plastic Surgeons defines large-volume liposuction as removal of more than 5 liters of fat during a procedure. Establishing this standard was in response to greater and greater volumes of fat being removed in an out-patient setting. Large-volume procedures involve a bigger stress-reaction to surgery and larger changes in the distribution of fluid in the body. It is recommended that patients undergoing large-volume procedures undergo overnight observation in the hospital following their operation. The distinction is one of volume removal alone, and is not related to how the procedure is performed.
Will I have to wear a compression garment afterwards? Compression garments are almost universally recommended during the post-operative recovery. When compression is begun after surgery is highly variable between different surgeons. Some put the garment on their patients in the operating room, while others wait a day or more until the initial swelling has improved. Most surgeons recommend continuing compression for a month after the procedure. This can depend on the area liposuctioned, and the extent of the procedure.
Can I have Liposuction at the same time as a Gynecologic operation such as a tubal ligation or laparoscopy? For operations that do not involve body areas that would predispose to infection, liposuction can be done safely. Operations such as tubal ligation or laparoscopy are good examples.
Why would I want to combine these types of operations? The answer consists of two parts: 1. Cost savings 2. Combined recovery times. Cost savings are realized by having insurance plans cover the initial start of the operation in the operating room, the initial anesthesia, and your hospital room. Of course, this depends on whether or not the gynecologic operation is covered by your insurance. Adding a cosmetic procedure to one covered by insurance allows lower charges for the total cosmetic procedure “package”. If you are having gynecologic surgery for medically indicated reasons, there is usually a recovery time involved that includes time off of work. By having your cosmetic operation at the same time as you gynecologic procedure, you can recover from both at the same time!
Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org
To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469