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General
liposuction information
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liposuction information |
| By Dr. Donn. H. Hickman
 If you are someone who is generally in good
health and has worked hard to get in shape, lost some extra pounds,
but can't seem to shed those troublesome deposits of fat in key
areas no matter how diligent and devoted you are, you may be a good
candidate for liposuction and liposculpture.
What is the difference between liposuction and liposculpture?
Liposuction is the removal of medium to large amounts of contour
fat to reduce the peaks and mounds that portray a heavy and sloppy
appearance. These include areas such as
below the chin, upper arms,
outer breasts, lower abdomen,
flanks, hips and thighs. Liposculpture
is the removal of small to medium amounts of fat in rather normal
to full areas to sharpen features, accentuate the muscles beneath
and create a more cut appearance in the neck, lower cheeks, upper
abdomen, outer buttocks, calves and ankles.
Who are good candidates for these procedures?
These procedures are for anyone who cannot obtain the trim and properly
contoured look with diet and exercise, possess good skin elasticity
and is not looking to lose large volumes of weight. Patients who
exceed their body weight by 30-50% may only be candidates for limited
fat removal because of safety concerns and should undergo these
procedures in stages. Patients who exceed their ideal weight well
over 50% should seek other remedies for weight loss as an initial
step and consult a physician experienced in weight management.
Does the removal of fat tighten the skin as well?
Not exactly. In fact some fat deposits on the body may be unforgiving
to major fat removal and lead to more relaxation of the skin. Many
new methods are being investigated in order to test their effect
on skin contraction and tightening. Ultrasonic liposuction, has
been suggested as a stimulus to skin contraction. Some Cosmetic
Surgeons are recommending the application of laser energy to the
liposuction site. Unfortunately, it is the heat generated by these
modalities that is believed to be the stimulus for the contraction
process. If the heat of ultrasonic and laser energy combined with
the rigors of the suction pressure, is applied too aggressively
near the skin, it can lead to serious skin injury. On the other
hand, the use of the microcannulaes at less than 3.0 mm in diameter,
if applied near the skin in selected areas, can help achieve contraction
as the fat is removed with little risk.
How do I decide whether to have liposuction,
liposculpture, or ultrasonic liposuction?
The surgeon should review his experience with the various methods
and analyze your body type. Some surgeons may advise ultrasonic
liposuction for large volume extractions, especially in tough areas
such as the back, flanks and hips. It was designed principally for
the hard to extract deep fat and to reduce surgeon fatigue. External
ultrasonic energy can be applied and is recommended by some surgeons
before or after the fat is removed by regular liposuction. Ultrasonic
liposuction must ordinarily be combined with traditional liposuction
when deep and surface fat is being removed. This does add to the
operating time and to the cost of the surgery and may offer no advantage
for most surgeons. For gynecomastia (large breasts in the male)
some experts advocate the sole use of ultrasonic liposuction but
it should not be used aggressively near the nipple skin.
Where is the surgery performed?
The surgery can be performed in the hospital, as an inpatient or
outpatient, in an outpatient surgery center, or in an accredited
office surgery center having capability for local, sedation or general
anesthesia.
How is the surgery performed?
The patient is prepared for either local anesthesia, local anesthesia
with sedation, or general anesthesia. Tiny cuts are made at the
sites where fat is to be removed and a wetting solution is infused
to provide some anesthesia, reduce bleeding and improve fat extraction.
If straight local is used, then the wetting solution is delivered
in large volumes with a high concentration of local anesthetic,
to tumesce or creates a glistening tightness to the tissues, so
that the fat can be comfortably removed with minimal discomfort
and practically no blood loss. All the anesthesia is provided in
the wetting solution. This requires careful monitoring of the local
to avoid toxicity and must be performed by those experienced with
local anesthesia. If sedation or general anesthesia is used, then
lesser amounts of local anesthetic are added to the wetting solution
and the solution is applied for its constriction of small blood
vessels and low level of blood loss. General anesthesia does permit
more areas to be treated in one session and may be more cost effective
but one must limit the total volume of fat extracted for the safety
of the patient regardless of anesthesia method. The suction instruments
called cannulaes are inserted under the skin moved in a back and
forth and chriss-cross fashion within the fat (under either hand
syringe pressure, gas reciprocation power, or ultrasonic and/or
suction-assist pressure) and the fat is vacuumed away. The output
of fat is measured in c.c.s, not to exceed 3 to 5 liters in the
majority of patients, the patient is checked for symmetry and the
procedure is completed when a safe level of fat removal for that
patient is achieved. A garment or binder is then placed over the
operative site. Rarely a drain may be placed under the skin where
a lot of fat has been removed. The patient is monitored for a while
to make sure they have received enough fluid hydration and are able
to make clear urine. A responsible adult should accompany the patient
home for large outpatient procedures and stay with the patient for
a while including over night.
How Do I Choose A Liposuction Specialist?
A consultation will help determine whether the patient
is a good candidate for liposuction or liposculpture and whether
the surgery may be safely performed in the office or hospital setting
and under what anesthetic. If the office setting is chosen then
one must check to see if the office is accredited for Outpatient
Surgery and for the level of anesthesia planned. The surgeon should
also have privileges to perform the same surgery at a local hospital,
which indicates some peer review and oversight mechanism for his
Practice of surgery. Further weight loss, stabilization of any medical
conditions and perhaps a surgical contouring operation may be advised
as well, in the planning and patient preparation process. A discussion
of fees is provided and financing can be arranged.
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