Liposuction

Introduction and Indications:

Liposuction is a technique to remove unwanted deposits of fat from specific areas of the body including under the chin, the upper arms, the trunk, the abdomen, the buttock, the hips and thighs, the knees and occasionally the calves and ankles.

Liposuction is also called lipoplasty or liposculpture by plastic surgeons. This is not a substitute for weight reduction, but a method for removing localised deposits of fatty tissue that do not respond to either diet or exercise. Liposuction may be performed as a primary procedure for body contouring or may be combined with other surgical techniques such as a facelift, an abdominoplasty or thigh-lift. In these combined procedures the idea is that the excess loose skin and supporting structures are also tightened.

The best candidates for liposuction are individuals of relatively normal weight who have excess fat in a particular body area. Having firm elastic skin will result in a better final contour after liposuction.

Hanging skin will not reshape itself to the new contours and may require additional surgical techniques to remove and tighten the excess skin. Body contour irregularity due to structures other than fat cannot be improved by this technique. Liposuction itself will not improve areas of dimpled skin known as cellulite. Liposuction is normally not recommended for individuals with heart or lung disease, poor blood circulation or patients who have recently had surgery near the area to be treated.Techniques:

There are different techniques to remove fat from underneath the skin. Basically, fat cells are broken down either by mechanical force or blasting with a laser or ultrasound energy probe or fat cells are liquefied by water jet.

Suction assisted liposuction (SAL) is performed by using a hollow metal rod known as a cannula that is inserted through a small skin incision and is passed back and forth through the area of fatty deposits. The cannula is attached to a vacuum pump which provides the suction needed to remove the fatty tissue.

Power assisted liposuction (PAL) is an advancement of suction assisted liposuction in which the cannula vibrates back and forth making the liposuction procedure faster and smoother. PAL also reduces tissue trauma, hence it reduces postoperative swelling, pain and bruising.

In Laser assisted liposuction – LAL (commonly known as Smart-lipo) the fat cells are blasted with a very thin laser wire (probe). The liquefied fat is removed from the area by lymphatic and venous circulation and gets metabolised in liver. If the volume of liposuction is large then it is removed by low suction assisted liposuction. It is a very effective treatment technique for small localised area of fat deposits.

Water Jet assisted liposuction (WAL) is another modern technique of removal of localised fat deposits. It also allows infiltration of large volume of diluted local anaesthetics solution with minimal discomfort. Therefore, we can perform your liposuction only under local anaesthesia even without sedation. The water jet (spray) breaks fat cells with minimal trauma. Hence postoperative swelling and bruising are reduced.

In some situations a special cannula may be used that emits ultrasonic energy to breakdown the fatty deposits. This technique is known as ultrasound assisted liposuction (UAL).

Radiofrequency assisted liposuction (RFAL). This is a new technique by which the fat cells are broken by regulated heat energy. The liquefied fat is then removed using either suction or power assisted liposuction, gether suction or power assisted liposuction gtechniques. The effect of thermal treatment to the fatty tissue as well as the structures directly underneath the skin helps the body to tighten its skin – hence the technique is also well known as BODY TITE.

All these modern techniques are designed to reduce tissue trauma hence minimises postoperative discomfort to you We use all the above modern techniques to suit your requirement.

Anaesthesia:

Liposuction may be performed under local or general anaesthesia. Tumescent liposuction techniques involve the infiltration of fluid containing diluted local anaesthetic and adrenalin (to help prevent bleeding) into areas of fatty deposits.

This technique can reduce discomfort at the time of surgery as well as reduce post-operative bruising. We always undertake tumescent liposuction. We prefer to perform your liposuction under local anaesthesia and if required and requested with sedation as a day case procedure. This helps us to encourage you to mobilise and return to your day today activities as early as possible.

Post-operative Care:

Pressure garments and lymphatic massage therapy are essential in the post-operative period to reduce swelling, bruising and pain. They also promote the healing and maturation of the small incision scars.

Life style quality and long term benefit of lipoplasty

Tendency to deposit fat in certain areas of the body is genetically influenced. People have different distributions of excess fat, however fat cannot be deposited if excess food is not eaten and the calories consumed do not exceed the calories needed for energy.

To obtain the best results for liposuction you must balance your activities and exercise level with your calorie intake. You must remember that any surgical result can be quickly undone by a failure to maintain appropriate diet and exercise regimes.

Patients should be physically healthy, psychologically stable and realistic in their expectations. Age is not usually a criterion, but older patients tend to have diminished skin elasticity and may not achieve as good a result as a younger patient.

Liposuction can enhance your appearance and your self-confidence but it may not change your looks to match your idealised concept, nor will it cause people to react differently to you. Before deciding on a liposuction procedure, think carefully about your expectations and discuss them with us fully at your consultation.

The four crucial elements in establishing a healthy, stable appearance are a change in lifestyle, good diet, appropriate exercise with the ‘aid’ of body contouring.

What is cellulite?

Cellulite is a term used to describe a specific look of fat in skin overlying certain areas of the body. As people age almost all develop some areas of cellulite. Cellulite is not a different type of skin but rather a specific look that reflects the architecture of the fat and skin in these areas. It is difficult condition to treat. Liposuction, pressure therapy and lymphatic massage therapy may help to treat cellulite with variable outcome.

What is skin contraction?

When a person loses weight through dieting and exercise the skin will usually contract gradually over the period of weight loss. This is the same as skin contracting after a pregnancy. However skin contraction is not always smooth. Many people who have undergone significant weight loss will often have stretch marks or loose skin. These changes can also occur with liposuction.

Immediately after liposuction the skin overlying the area where fat has been removed is loose but over the next several hours this area will swell significantly and the skin may actually stretch. This swelling slowly disappears over the next few weeks and the skin will usually contract as the swelling resolves.

Irregularities in the microscopic blood flow to the remaining fat cells can also result in further areas of fat atrophy. The larger the amount of fat removed the greater the amount of variation and skin irregularities.

As the body heals these irregularities will lessen. This process can be helped by massage, pressure garments and skin conditioning.

What treatment is best for me?

At your initial consultation we will evaluate your general health, identify the areas of fat deposits to be treated and assess the condition of your skin. We will explain fully the body contouring methods that may be most appropriate for you.

For instance it may be that a tummy tuck would be more effective or that a combination of liposuction techniques will achieve good results. It is important that you communicate in an open and honest way what your expectations are from having this procedure.

Be sure to mention any significant weight loss or gain that you have experienced and also remember that no detail in your past medical history is unimportant.

How should I prepare for surgery?

We will give you specific instructions on how to prepare before surgery. In the longer term we can advise you on eating, drinking and smoking and exercise regimes. It is important to get a degree of self-control and discipline before surgery.

It is important to avoid any aspirin or aspirin-containing products for at least two weeks before surgery. If you develop any kind of skin infection your procedure will have to be postponed. Your final result will depend as much on what you do before and after surgery, as what we do in the operating room.

Where will the surgery be performed?

We utilise several private hospitals for the procedure. It is usually performed on a day case basis for cost containment and convenience, but if large volumes of fat are removed then we would advise an overnight hospital stay so that we can closely monitor your progress.

What can I expect immediately after surgery?

You are likely having some fluid drainage from the incisions. You will be fitted with a snug elastic bandage or compression garment to wear over the treated area to help control swelling. You may need to wear this for up to four weeks to help your skin to shrink and fit its new contour. The compression garment can be changed three days after surgery, but a garment must be worn at all times (24 hours) for 2 weeks. After the initial 2 week period the garment must be worn at night for at least 2 additional weeks. The pain can be controlled with medication prescribed by the Hospital prior to your departure.

How long will it take before my new contour is final?

You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after 3 weeks when most of the swelling has subsided.

After 3 months any persistent mild swelling will resolve and the final contour will be apparent. If your expectations are realistic you will be pleased with the results. You may find that your clothes fit more comfortably and you are more at ease with your body image.

By eating a healthy diet and getting regular exercise you can maintain the benefit of liposuction permanently. There are two components of fat contributing to the shape of the abdomen. Liposuction can reduce the fat volume between skin and muscles but will not have any change in the volume of fat inside the peritoneal cavity which could be of significant amount.

Risks of liposuction surgery

Liposuction is one of the most commonly performed surgical procedures in the United Kingdom. Every surgical procedure involves a certain amount of risk but as with any elective surgery procedure it is important to weigh the risks against the potential benefits.

The vast majority of patients undergoing liposuction do not have any complications, however listed below are some descriptions of possible complications.

1. Bleeding

During or after surgery particularly if aspirin or anti-inflammatory medication has been taken seven days prior to surgery.

Using tumescent techniques and being sensible about the amount of fat removed in one treatment, blood transfusions have never been required by our Practice for our liposuction patients.

2. Infection

Infection is unusual after this type of surgery. We give antibiotics during the operation as a prophylaxis.

3. Scarring

Although good wound healing is expected after liposuction, abnormal scars may occur within the skin and deeper tissues. In rare cases abnormal scarring may result which may be unattractive or a different colour from the surrounding skin. In general the scars of liposuction are never a problem as they are so small.

4. Changes in skin sensation

A temporary decrease in skin sensation after liposuction may occur.

5. Skin discoloration/swelling

Skin discoloration (bruising) normally occurs following liposuction. In very rare situations, swelling and skin discoloration may persist for a long period of time. Permanent skin discoloration is rare.

6.Skin contour irregularities

Contour irregularities and depressions in the skin may occur after liposuction. Visible and palpable wrinkling of the skin can also occur. Additional treatments including surgery may be necessary to treat skin contour irregularities following liposuction.

7. Symmetry

It may not be possible to achieve symmetric body appearance from liposuction surgery. Factors such as skin tone, body features, bony prominences and muscle tone may contribute to normal asymmetry.

8. Seroma

Fluid accumulation infrequently occurs in the areas where liposuction has been performed. Additional treatments including aspiration of the fluid may be necessary.

9. Long term affects

Subsequent alterations in body contour may occur as the result of deposition of fat elsewhere, ageing, weight loss or gain, pregnancy or other circumstances.

10. Body fluid imbalance:

There is a possibility that large volumes of fluid containing diluted local anaesthetic and adrenalin that is injected into fatty deposits during surgery may contribute to fluid overload. We are conservative in the amount of fluid that is used as we do not undertake liposuction of large areas in one operative procedure. Your operation will be monitored constantly by the well trained team.

11. Pain

Chronic pain and discomfort following liposuction is rare but does sometimes occur, presumably due to scarring under the skin.

12. Deep vein thrombosis / pulmonary embolism/ fat embolism

This is a rare complication following liposuction. We encourage you to mobilise as early as possible in the early post-operative period.

13. Injury to deeper structures

Cases have been reported where injury to deeper structures such as intestines, lungs, spleen and liver have occurred during liposuction. These are very rare complications have never happened in our Practice.

15. Over and under correction

This is a rare situation. If it is a significant issue, then a revisional procedure is considered.

You should be aware that the larger the amount of fat removed, the more likely that some of the above complications may occur. It may be necessary to perform additional surgery from time to time to improve your results.

This may only be evident after about 6 months after surgery when most of the swelling has resolved. It is important to understand that the scarring underneath the skin should be allowed to mature and soften before any secondary procedure is undertaken.

Usually a minimum of one year is left before undertaking a secondary procedure.

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