Liposuction
Also known as lipoplasty (“fat modeling”), lip sculpture suction lipectomy (“suction-assisted fat removal”) or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs and buttocks, to the neck, backs of the arms and elsewhere.
Ultimately, the operating physician and the patient make the decision. In the late 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying the fat using ultrasonic energy. And many of the modern technologies touted to improve liposuction are simply advertising hooks and that the choice of a quality surgeon is the primary determinant of a quality result.
Overall, the advantages of 30 years of improvements have been that more fat cells can more easily be removed, with less blood loss, less discomfort, and less risk. Recent developments suggest that the recovery period can be shortened as well .
In addition, fat can also be used as a natural filler. This is sometimes referred to as “autologous fat transfer” and in general, for these procedures, fat is removed from one area of the patient’s body (for example, the stomach), cleaned, and then re-injected into an area of the body where contouring is desired, for example, to reduce or eliminate wrinkles.To be a good candidate, one must usually be over 18 and in good general health, have an ongoing diet and exercise regimen, and have fatty pockets of tissue available in certain body areas.
Approaches
The basic surgical challenge of any liposuction procedure is:
As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, less uncomfortable, and effective.
Areas of the body where liposuction is performed
Mechanism of liposuction
[Suction-assisted liposuction] (SAL)
Suction-assisted liposuction is the Gold Standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it in a forwards and backwards motion, carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
Ultrasound-assisted liposuction (UAL)
In ultrasound-assisted or ultrasonic liposuction, a specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e., liquefying it) and making it easier to suction out. UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle.
After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat, or to deposit additional fat cells, used in high definition liposuction, to create more volume where it is needed. Third-generation UAL devices address the problem of skin and nerve damages by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.
Power-assisted liposuction (PAL)
PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional SAL.
Twin-cannula (assisted) liposuction (TCAL or TCL)
Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient’s tissue or the surgeon’s joints with each and every forward stroke.
External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary. It was developed because surgeons found that in some cases, the UAL method caused skin necrosis and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells)
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially cause less discomfort for the patient, both during the procedure and afterwards; decrease blood loss; allow better access through scar tissue; and treat larger areas. At this time however, it is not widely used and studies are not conclusive as to its effectiveness .
Water-assisted liposuction (WAL)
WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less immediate edema from the tumescent fluid.
Laser Assisted
A laser is used to melt the fat in the target area, making it easier to remove. This laser is administered through a fibre threaded through a microcannula. The premise is similar to UAL. It is believed that these techniques, such as SmartLipo or SlimLipo, can also reduce bruising and bleeding, as it also cauterizes to a certain extent.
Procedure
In all liposuction methods, there are certain things that should be done when having the procedure:
The candidate and the surgeon will agree ahead of time on exactly which area(s) will be treated and both will discuss what outcome to expect
A consent form is signed on the day of surgery
An antibiotic will be given about an hour beforehand, or afterwards
The targeted areas are marked on the body while the candidate is in a standing position
Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos
In the operating room, a sterilizing solution such as Betadine, is applied to the relevant areas
Local anesthetic is injected and the patient may be given a sedative, either orally, or through an IV injection
Incisions are small, about a quarter to a third of an inch
The patient will probably have an IV fluid line, since they will be losing fluid with the fat, and the fluid balance must be kept intact
There will be some monitoring devices attached to the body to keep track of the blood pressure, heart rate, and blood oxygen level
The patient will feel only a scraping or rasping sensation from the cannula movement
Usually the patient can get up, walk around, and go home the same day if they did not receive general anesthesia, although they would need someone else to drive them.
Recovery
Depending on the extent of the liposuction, patients are generally able to return to work between two days and two weeks. A compression garment which can easily be removed by the patient is worn for two to four weeks, this garment must have elasticity and allow for use of bandages. If non-absorbable sutures are placed, they will be removed after five to ten days
Any pain is controlled by a prescription or over-the-counter medication, and may last as long as two weeks, depending on the particular procedure. Bruising will fade after a few days or maybe as long as two weeks later. Swelling will subside in anywhere from two weeks to two months, while numbness may last for several weeks. Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on the procedure. The final result will be evident anywhere from one to six months after surgery, although the patient will see noticeable difference within days or weeks, as swelling subsides.
The suctioned fat cells are permanently gone. However, if the patient does not maintain a proper diet and exercise regimen, the remaining fat cell neighbors could still enlarge, creating irregularities.
Health benefits
Whether or not liposuction provides the health benefits commonly associated with achieving Weight loss through other means is a matter of debate in scientific circles. Some research groups have shown that liposuction does help to combat certain obesity related metabolic disorders like insulin resistance, while others have demonstrated that liposuction can reduce levels of unhealthy triglycerides in the bloodstream.
Side effects
A side effect, as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful.
There could be various factors limiting movement for a short while, such as:
Also known as lipoplasty (“fat modeling”), lip sculpture suction lipectomy (“suction-assisted fat removal”) or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs and buttocks, to the neck, backs of the arms and elsewhere.
Ultimately, the operating physician and the patient make the decision. In the late 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying the fat using ultrasonic energy. And many of the modern technologies touted to improve liposuction are simply advertising hooks and that the choice of a quality surgeon is the primary determinant of a quality result.
Overall, the advantages of 30 years of improvements have been that more fat cells can more easily be removed, with less blood loss, less discomfort, and less risk. Recent developments suggest that the recovery period can be shortened as well .
In addition, fat can also be used as a natural filler. This is sometimes referred to as “autologous fat transfer” and in general, for these procedures, fat is removed from one area of the patient’s body (for example, the stomach), cleaned, and then re-injected into an area of the body where contouring is desired, for example, to reduce or eliminate wrinkles.To be a good candidate, one must usually be over 18 and in good general health, have an ongoing diet and exercise regimen, and have fatty pockets of tissue available in certain body areas.
Approaches
The basic surgical challenge of any liposuction procedure is:
- To extract the right amount of fat
- To cause the least disturbance of neighboring tissue, such as blood vessels and connective tissue
- To leave the person’s fluid balance undisturbed
- To cause the least discomfort to the patient
As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, less uncomfortable, and effective.
Areas of the body where liposuction is performed
- Abdomen
- Breasts
- Hips
- Outer thighs (saddlebags)
- Flanks (love handles)
- Back
- Inner thighs
- Inner knees
- Upper arms
- Segmental (chin),(gullet)
- Gynecomastia (male breast tissue)
Mechanism of liposuction
[Suction-assisted liposuction] (SAL)
Suction-assisted liposuction is the Gold Standard method of liposuction. In this approach, a small cannula (like a straw) is inserted through a small incision. It is attached to a vacuum device. The surgeon pushes and pulls it in a forwards and backwards motion, carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
Ultrasound-assisted liposuction (UAL)
In ultrasound-assisted or ultrasonic liposuction, a specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e., liquefying it) and making it easier to suction out. UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction, but not longer than tumescent liposuction. There is slightly less blood loss. There appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle.
After ultrasonic liposuction, it is necessary to perform suction-assisted liposuction to remove the liquified fat, or to deposit additional fat cells, used in high definition liposuction, to create more volume where it is needed. Third-generation UAL devices address the problem of skin and nerve damages by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.
Power-assisted liposuction (PAL)
PAL uses a specialized cannula with mechanized movement, so that the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional SAL.
Twin-cannula (assisted) liposuction (TCAL or TCL)
Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient’s tissue or the surgeon’s joints with each and every forward stroke.
External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary. It was developed because surgeons found that in some cases, the UAL method caused skin necrosis and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells)
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially cause less discomfort for the patient, both during the procedure and afterwards; decrease blood loss; allow better access through scar tissue; and treat larger areas. At this time however, it is not widely used and studies are not conclusive as to its effectiveness .
Water-assisted liposuction (WAL)
WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. WAL requires less infiltration solution and produces less immediate edema from the tumescent fluid.
Laser Assisted
A laser is used to melt the fat in the target area, making it easier to remove. This laser is administered through a fibre threaded through a microcannula. The premise is similar to UAL. It is believed that these techniques, such as SmartLipo or SlimLipo, can also reduce bruising and bleeding, as it also cauterizes to a certain extent.
Procedure
In all liposuction methods, there are certain things that should be done when having the procedure:
The candidate and the surgeon will agree ahead of time on exactly which area(s) will be treated and both will discuss what outcome to expect
A consent form is signed on the day of surgery
An antibiotic will be given about an hour beforehand, or afterwards
The targeted areas are marked on the body while the candidate is in a standing position
Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos
In the operating room, a sterilizing solution such as Betadine, is applied to the relevant areas
Local anesthetic is injected and the patient may be given a sedative, either orally, or through an IV injection
Incisions are small, about a quarter to a third of an inch
The patient will probably have an IV fluid line, since they will be losing fluid with the fat, and the fluid balance must be kept intact
There will be some monitoring devices attached to the body to keep track of the blood pressure, heart rate, and blood oxygen level
The patient will feel only a scraping or rasping sensation from the cannula movement
Usually the patient can get up, walk around, and go home the same day if they did not receive general anesthesia, although they would need someone else to drive them.
Recovery
Depending on the extent of the liposuction, patients are generally able to return to work between two days and two weeks. A compression garment which can easily be removed by the patient is worn for two to four weeks, this garment must have elasticity and allow for use of bandages. If non-absorbable sutures are placed, they will be removed after five to ten days
Any pain is controlled by a prescription or over-the-counter medication, and may last as long as two weeks, depending on the particular procedure. Bruising will fade after a few days or maybe as long as two weeks later. Swelling will subside in anywhere from two weeks to two months, while numbness may last for several weeks. Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on the procedure. The final result will be evident anywhere from one to six months after surgery, although the patient will see noticeable difference within days or weeks, as swelling subsides.
The suctioned fat cells are permanently gone. However, if the patient does not maintain a proper diet and exercise regimen, the remaining fat cell neighbors could still enlarge, creating irregularities.
Health benefits
Whether or not liposuction provides the health benefits commonly associated with achieving Weight loss through other means is a matter of debate in scientific circles. Some research groups have shown that liposuction does help to combat certain obesity related metabolic disorders like insulin resistance, while others have demonstrated that liposuction can reduce levels of unhealthy triglycerides in the bloodstream.
Side effects
A side effect, as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful.
- Bruising: can be painful in the short term, and should fade after a few weeks.
- Swelling: should subside gradually over a month or two.
- Scars: will vary in size depending on the particular procedure, and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.
- Pain: should be temporary and controlled by either over-the-counter medication, or by a prescription.
- Numbness: sometimes persists for a few weeks.
- Post-operative weight gain
- Limited mobility: will depend on the exact procedure.
There could be various factors limiting movement for a short while, such as:
- Wearing a compression garment
- Keeping the head elevated
- Temporary swelling or pain
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ReplyDeleteDr. Ashish Ahuja is a Senior Consultant Laproscopic Bariatric Surgeon and Associate Professor in Department of Surgery, Dayanand Medical College and Hospital, Ludhiana. First Surgeon to start Laproscopic Bariatric Surgery in his hospital which is one of the most premier institutes of Northern India.
ReplyDeleteliposuction in ludhiana