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.
Men'sy 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. Men'sy 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 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.
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.
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.
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.
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.
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 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.
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 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.
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.
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.
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.
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.
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.
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.
Men'sy 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
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.
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 is usually has a thick dermis
and responds favorably.
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.
|
