Fat cells lie beneath the skin throughout the body, but accumulate in greater amounts in certain areas. When we gain or lose weight, we are not adding or subtracting fat cells but rather changing the amount of fat within each cell. It is not surprising, therefore, that many people find that in spite of the weight they lose, they are left with bulges or fat deposits in undesirable places.
Liposuction surgery is a technique that uses a high suction attached to special probes that are passed through tiny punctures made in inconspicuous places around the body. Fat cells are literally suctioned out, allowing the surgeon to shape or contour various parts of the body. The technique used at our Center combines the use of progressive cannulas, ranging from very small to large, with the injection of fluids to minimize the risk of bleeding. We can treat most areas of the body through this approach virtually eliminating noticeable scars.
Liposuction surgery can be performed on almost any area of the body. It has proven particularly effective in the neck, tummy, waist, hips and thighs. In addition, it can be used on the back, arms, buttocks, calves, knees and ankles. As more experience is gained, more areas of the body are becoming suitable for liposuction surgery. For men, liposuction can be used to correct gynecomastia (enlarged breasts), and is frequently used to reduce “love handles” from the waist.
The operation is equally suitable for both men and women. Age itself is not a determining factor although the patient must be in good general health.
Since the procedure removes fat only, and does not remove overlying skin, it is important that the patient have satisfactory skin tension or elasticity. As we age, skin tension lessens. Nevertheless, the procedure has frequently been carried out on older patients with very satisfactory, although not perfect, results. It is often quite surprising how well the skin will contract after this surgery. Cellulite, the cottage cheese appearance some people have, is not improved by the operation although it is generally not worsened.
Liposuction surgery was primarily considered a contouring procedure, and was not specifically intended for the treatment of obesity. It can be useful, however, as an adjunct to diet and physical conditioning in the management of the overweight patient where contour problems play a role. Recent experience has shown that liposuction surgery can be used to remove larger volumes of fat from obese patients. In these cases, it may be necessary to carry out more than one operative procedure.
A major improvement in technique involves the injection of large amounts of fluid into the fatty tissue at the start of the operation. This fluid contains medication designed to limit blood loss and reduce postoperative discomfort. The technique, called the tumescent technique, has allowed safer removal of larger amounts of fat with less postoperative pain and bruising. The decrease in surgical blood loss resulting from this technique has allowed us to safely remove significantly more fat, and has also made the recovery period much easier for patients. An article on tumescent liposuction, written by Dr. Tobin, appeared in the American Journal of Cosmetic Surgery.
* Years ago, when the removal of large volumes of fat was anticipated, patients were asked to “bank” one or two units of their own blood to be replaced during surgery. With the advent of the tumescent technique, autologous transfusion is no longer necessary. Blood replacement is never needed for routine liposuction surgery today.
Liposuction surgery is well suited to an outpatient facility such as our fully licensed and accredited Cosmetic Surgical Center. Patients are able to go home immediately after surgery or after spending a night in one of our residential suites. The operation is usually carried out under general anesthesia, although local anesthesia is an option of selected patients. Pain is usually quite moderate and can easily be controlled with oral medication.
FINE CANNULA SUPERFICIAL TECHNIQUE
We have mentioned the improvements in liposuction surgery resulting from the tumescent. Building on this basis, two innovations have further advanced this remarkable surgical procedure to the point where the name “liposuction” is often replaced by “liposculpture.”
These two modifications are 1) the use of very fine cannulas in place of or in addition to the larger instruments used in the past and 2) the removal of fat immediately beneath the skin. Both of these advances are geared at improving the contour of the skin following liposculpting. Additional advantages derived from the use of fine cannulas are decreased swelling and bruising, less blood loss and quicker recovery.
The cannulas used with the new technique are approximately 1/8th of an inch in diameter as opposed to the older style, which were about 1/2 inch.
Therefore, instead of making an incision, a tiny puncture is used. This allows us to approach the fatty tissue from multiple sites and directions, improving the accuracy of fat removal. Even more important, by sculpting fat immediately beneath the skin, there appears to be better skin shrinkage resulting in smoother postoperative results.
The net result is a smoother post operative result which allows patients with relatively lax skin to now undergo surgery without a high risk of unacceptable skin rippling.
Results do vary from individual to individual, but there is no question that the use of fine cannulas in the superficial plane, combined with tumescent infiltration, represents another step forward in the development of body contouring. While consultation and personal examination is necessary to determine whether you are a candidate for the surgery, these improvements have certainly allowed many more individuals to benefit from the operation with less risk, pain and recovery time than before.
ULTRASONIC TECHNIQUE AND OTHER NEW MODALITIES
Sound waves to lose fat? While it sounds strange, it actually represents one of the newer proposed innovations in cosmetic surgery. Traditional methods of liposuction involve the use of high suction to dislodge fat cells from supporting tissues.
Ultrasound energy is applied through a special probe containing a transducer with a quartz crystal that vibrates at a frequency of about 20,000 Hz. A byproduct of ultrasound is heat that creates a possible risk of burning tissue. This complication has been noted in some of the early cases of ultrasonic liposculpture. Some equipment combines the ultrasound with a constant irrigation to prevent heat build-up and surgeons who use this equipment report that burns have not occurred. Our experience so far has not seen this complication.
Another disadvantage is the fact that fat extraction with ultrasound is much slower than conventional techniques. This has led to the development of techniques of mixed liposculpture, where ultrasound is combined with traditional methods of liposuction to achieve the benefits of both.
TOO MUCH HYPE?
Our extensive experience with the technique has convinced us that there is no advantage over conventional techniques. Since the procedure only adds to the expense of the surgery, we no longer utilize it. The same is true of some of the other new methods of liposuction utilizing laser, vibration and temperature. To date, there is no convincing evidence that these procedures produce results superior to conventional technique. In addition, the high pressure sales techniques have led to these machines being used by practitioners who lack adequate knowledge and experience in liposuction surgery. Unfortunately, we have seen many problems in patients who have fallen victim to these marketing efforts.
LIPOSUCTION WITH CRESCENT MINI ABDOMINOPLASTY
Not infrequently, we have combined abdominal liposuction with a mini abdominoplasty with very good results. This operation is useful when the abdominal skin has too much laxity for liposuction alone. While it does require an external transverse low abdominal incision, the surgery is much less extensive than a full abdominoplasty. Consequently, the surgical risk is much lower. The length of the incision varies according to the amount of skin to be removed. This procedure is often well suited to patients who are not ideal candidates for traditional abdominoplasty, either because of underlying health problems or because of obesity, which can significantly increase risks following full abdominoplasty. Relatively large amounts of fat can be removed from the abdomen when combining these procedures – far more than liposuction alone would allow. Recovery from this operation is not significantly longer than from liposuction alone.
Excess fat in the neck and chin area responds nicely to liposuction. If the skin is firm, a good result is to be expected. In certain selected cases, liposuction is also useful in the treatment of excess fat in the cheeks and jowls. When skin is lax, however, fat removal alone may not provide and adequate solution. Face or neck lifting may be required. When facial liposuction is carried out by itself, it can be done under local anesthesia in many cases.
WHAT IS THE RECOVERY PERIOD?
Surprisingly, the recovery period is very rapid. The first 24 hours are accompanied by a very profuse drainage of the fluid that was injected during surgery. While quite a nuisance, it usually stops by the day after surgery. Patients are generally able to resume light activity the day after surgery and full normal activity within a week or so. An elastic garment is worn for several weeks to help avoid contour irregularity, but it does not interfere with activity. Movement, in moderation, actually tends to lessen the tightness and stiffness that are a part of the early recovery period. While recovery is relatively brief, patients should not expect to see the results of surgery until swelling resolves. This period varies but usually requires three to six months. Do not get discouraged if you don’t see results quickly. This is quite normal.
WHAT ARE THE RISKS?
Any surgical procedure carries certain risks. Fortunately, serious complications are very uncommon. While there have been reported cases of death, organ or vessel perforation, skin loss or severe scarring, we have not seen any of these major complications in our experience with the operation over a period exceeding 15 years. A slight dimpling or waviness may occur after surgery, especially in patients with poor skin elasticity. When it does occur, this tends to diminish with time, and rarely is of significant magnitude. This problem can be minimized by faithful use of elastic garments for a few weeks following surgery. The operated area is frequently numb for some time after surgery, but normal sensation eventually returns. Occasional long-standing soreness may occur. Infection can occur but is rare.
Patients must be aware that results vary from individual to individual and no specific result can be assured prior to surgery. The amount of fat that can be removed is not predictable. In some cases, less than ideal amounts are subject to extraction because of potential bleeding or simply the nature of the tissues. We always try to remove as much as possible, but our primary concern is the safety of our patients.
Liposuction surgery has brought a new dimension to body contouring surgery, providing an opportunity for corrections that were not feasible only a few years ago. It is certainly one of the most exciting advancements in cosmetic surgery.
For years, surgeons have been re-injecting fat harvested through liposuction. It has been used as a filler throughout the face and body. Currently this procedure has been highly touted. Our experience has not been nearly as good as is commonly reported. The main problem is that much of the fat that is re-injected atrophies over time. Surgeons who highly recommend the procedure are quick to advise that multiple procedures are often necessary to obtain the desirable result.
Recently there has been considerable interest in re-injecting fat into the buttocks. This is commonly known as the “Brazilian Butt Lift” We have done quite a few of these procedures in patients who are undergoing liposuction. Since the fat would be discarded if we did not re-inject it, we feel the procedure is reasonable so long as patients understand that much if not all of the fat may eventually be absorbed. The initial results are generally quite favorable, but we have not had enough long term follow up to make any reasonable prediction as to how much of the fat will remain.
We have also found fat re-injection to be useful when injected into the back of the hand to rejuvenate aging hands.
* For additional information on liposuction surgery reprints of articles on tumescent liposuction surgery written by Dr. Tobin are available.