Liposuction

Liposuction

• What is it?
• Why is it performed and who is it suitable for?
• What are the risks and complications associated with the procedure?
• How are patients prepared for the surgery?
• How is it performed?
• What happens after the surgery?

Liposuction is a cosmetic surgery procedure which involves the removal of excess body fat from under the skin from various parts of the body using a cannula and a suction device. The most common areas that are treated are the abdomen, thighs, buttocks, arms and neck. Liposuction is the most popular cosmetic surgery performed worldwide and is usually done to improve the appearance of distorted body shapes and remove pockets of fat that are difficult to eliminate with diet and exercise. It is also known as body contouring as it can be used to contour the chin, neck, cheeks, ankles, calves, and breasts. It should not be considered as a method of weight loss.

The first liposuction procedures were performed in the early 1980s and were done under general anaesthesia, however they were often associated with serious complications and a high risk of death. New treatments have revolutionised liposuction and it is now considered to be a very safe procedure that can be performed in an office environment with minimal recovery time.

There are a number of liposuction techniques that may be used depending on the site and how much fat is to be removed. They include:

• tumescent liposuction
• wet liposuction
• superwet liposuction
• ultrasound assisted liposuction
• power assisted liposuction
• laser assisted liposuction

Tumescent liposuction is the most common type of liposuction. It involves injecting a large amount of fluid (3-4 times the volume of the fat being removed) made up of a salt solution containing a mix of local anaesthetic and epinephrine into the areas before the fat is removed. The anaesthetic numbs the area and the purpose of the epinephrine is to minimise bruising, swelling and blood loss. Injection of the fluid creates space between the muscle and fatty tissue for the cannula. This form of liposuction usually takes longer than others as the fluid must be injected slowly. However it has the fastest recovery time and least amount of complications.

The super-wet technique is similar to tumescent liposuction except that not as much fluid is used, the amount of fluid injected is about equal to the amount of fat to be removed. This technique takes less time however it usually requires sedation with general anaesthesia.

Ultrasound or ultrasonic-assisted liposuction (UAL) is a fairly recent technique introduced in 1996. It involves exposing fat cells to ultrasonic vibrations which supposedly liquefy fat cells, thereby facilitating aspiration.  This can be done internally through the cannula which transmits ultrasound vibrations under the skin, or by external exposure. This technique may be useful in the removal of fat from dense or fibrous areas of the body such as the upper back or male breast tissue. UAL is often used in conjunction with the tumescent technique or in follow-up procedures. Little benefit is achieved from this procedure and it has been associated with cutaneous burns and higher risk of seroma formation.

Power-assisted liposuction (PAL) is a new technology which utilises a motor-driven, reciprocating cannula attached to a standard aspirator. This reduces the workload on the surgeon as it limits the physical movements that must be made. In addition, it allows the surgeon to remove fat more completely in tight areas where forceful cannula movements are difficult because of physical space constraints. This new technology has been shown to have significant benefits over traditional cannulas.

The newest liposuction technique is Laser-assisted liposuction which works by focusing low energy waves from a laser onto the parts of the body that require treatment. This causes the fat cells to weaken and burst. Like UAL this technique can be used in conjunction to other liposuction procedures. This technique has the advantage of producing much less swelling and bruising and hence a faster recovery time.

obesity. It also does not have any effect on cellulite or stretch marks.

Generally anyone with good health physically and mentally can have the procedure done however a patient must go through extensive counselling prior to undergoing surgery to ensure they are suitable.

An ideal candidate for liposuction would have:

• normal-weight or slightly-overweight with localised pockets of excess fat in certain areas
• generally healthy and doe not have significant medical problems
• elastic skin
• realistic expectations
• is over 18
• age is not a major factor, although older persons with diminished skin elasticity may not have the same results as persons with tighter skin
• has tried diet and exercise
• has a stable weight and has a regular exercise routine
• does not suffer from diabetes, coagulation disorders, cardiovascular disease or any infectious disease
• is not pregnant

These are only a guide; however patients that fill these criteria will have a more optimal result.

Liposuction is also suitable for the treatment of other conditions such as breast reduction in men, gynecomastia, removal of lipomas and angiolipoma, hematoma evacuation and improving hyperhidrosis of axillae.

seromas

infections

skin burns, particularly in the use of UAL devices

Skin necrosis- superficial liposuction, overzealous subdermal fat thinning, liposuction in areas of prior incision scars, and UAL can result in partial-thickness and full-thickness skin necrosis

necrotizing fasciitis

cerebrovascular accident or transient ischemic attack

pulmonary thromboembolism

pulmonary fat embolism

bleeding, especially if large amounts of fat are removed

Shock if not enough fluid is replaced during the surgery

Fluid overload

transfusion complication

deep vein thrombosis

Drug toxicity, the patient can react to the anaesthetic or epinephrine

toxic shock syndrome

Nerve damage

thoracic and abdominal cavity perforation

aortic perforation

acute renal failure

Overall revision or re-operative rates range from 5-15%. Rates of serious or fatal complications are in the range of 0.02% to 0.3% and are predominantly attributed to pulmonary embolus, fat embolus, abdominal perforation, anesthesia.

What happens after the surgery?

Following surgery compression garments are applied to the areas that have been treated to reduce swelling and support the skin as it readjusts to the new contour. These usually need to be left on for 2-3 weeks. There is likely to be swelling, bruising, pain and numbness for a few weeks after surgery. Pain medication can be prescribed as well as antibiotics to prevent infection.

Patients can return to work and resume their normal activities within a few days after the procedure. Strenuous excercise should be avoided however walking soon after surgery is advised to prevent blood clots. It may take up to 3-6 months to see the final result of the surgery as swelling subsides and skin contraction occurs. The final outcome generally depends on age, skin elasticity, volume of fat removed and the area it is removed from, with the best results are generally seen in younger patients of normal weight and who have had a small volume of fat removed. Maintaining a healthy lifestyle with regular excersise all aid in improving the final outcome.

More information

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss. 

Reference

1. Coleman WP, Glogau RG, Klein JA, Moy RL, Narins RS, Chuang T, Farmer ER, Lewis CW, Lowery BJ and the Guidelines/Outcomes Committee. Guidelines of care for liposuction. American Academy of Cosmetic Surgery.
2. Flynn TC, Coleman WP, field LM, Klein JA and Hanke CW. History of liposuction. Dermatol Surg.; 2000; 26(6); p. 515-520.
3. http://www.plasticsurgery.org.au/procedures/liposuction.html
4. Sattler G. Advances in liposuction and fat Transfer. Dermatology Nursing; Apr 2005; 17(2); p. 133-139.
5. Jayashree V and Mysore V. Microcannular tumescent liposuction
   Indian Journal of Dermatology. 2007; 73 (6); p. 377-383.
6. Guidelines for Liposuction Surgery. 2006. The American Academy of Cosmetic Surgery.
   Available from: http://www.cosmeticsurgery.org/Media/2006 Liposuction Guidelines.pdf
7. Katz BE, Bruck MC, Felnsfield L and Prew KE. Power liposuction: a report on complications. Dermatol Surg; 2003; 29; p. 925–927.
8. Prado A, Andrades P, Danilla S, Leniz P, Castillo P and Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plastic Reconstructive Surgery. 2006; 118(4); p. 1032-1045.
9. Matarasso A and Hutchinson OHZ. Liposuction. JAMA. 2001; 285(3); p. 266-268.
10. Flynn TC and Narins S. Preoperative evaluation of the liposuction patient. Dermatologic Clinics. 1999; 17(4); p.729-734.
11. Cowles RA. Liposuction. Updated 5/3/2007 http://www.nlm.nih.gov/medlineplus/ency/article/002985.htm updated 5/3/07

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Article Dates:

Modified: 2/2/2011

Created: 26/3/2008

Liposuction