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Liposuction and Liposculpture

Liposuction is a popular surgical procedure to remove unwanted excess fat. It is one of the commonest cosmetic surgery procedure performed nowadays. Liposuction is not a substitute for dieting and exercise, but it can remove stubborn areas of fat that do not respond to traditional weight loss methods.
Liposuction is particularly well-suited for men and women who are of relatively normal weight or a little overweight, but have isolated pockets of fat that cause certain areas of their body to appear disproportionate. In fact the best results from liposuction are achieved when you have healthy elastic skin with the capacity to shrink. When skin is inelastic as in some older patients or after massive weight loss an additional skin tightening procedure such as tummy tuck, thigh lift, buttock lift or arm lift may be required. Generally eight to ten liters of fat can be reduced by liposuction. The procedure is done under local or general anaesthesia and you may need to be hospitalized for a day.

Am I a Good Candidate for Liposuction?
The best candidates for liposuction are people of relatively normal weight and with elastic skin, who have pockets of excess fat in certain areas. The patient should be physically healthy, and have realistic expectations. They are at or just slightly over their ideal weight, and feel that they can maintain this weight following surgery. Individuals who have lots of loose skin (for instance, after significant weight loss) may be better candidates for ‘body contouring’ surgeries, such as tummy tucks or body lifts, that remove loose skin as well as excess fat. While every patient who goes in for a consultation will be individually assessed to determine if they are healthy enough to undergo surgery, there are some conditions that could indicate that liposuction is right for you: Most importantly, suitable liposuction candidates know that liposuction is not intended as a tool for major weight loss, and want to achieve any of the following aesthetic goals:

  • Attain a figure that is well proportioned.
  • Get rid of fat deposits that are out of proportion with the rest of your body and do not go away with diet and exercise.

Liposuction is beneficial in overweight diabetic patients also wherein excessive weight gain poses a greater demand for insulin and thus deteriorating the physical condition of the patient. In fact, loss of fat or weight by liposuction can tremendously help the diabetics since weight is reduced; insulin requirement and resistance both are decreased.

Anesthesia for liposuction:
Your surgeon will select the type of anesthesia that is most suitable and safe for your surgery. If only small amount of fat and a limited number of body sites are involved, liposuction may be performed under local anesthesia. General anesthesia is a good choice for more extensive procedures. In such cases the anesthetist makes sure you are completely asleep and pain-free during the procedure.

Liposuction Procedure
Dr. Goyal will evaluate your health, determine where your fat deposits lie and assess the condition of your skin and he will explain the body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or “tummy tuck” may more effectively meet your goals; or that a combination of traditional liposuction and UAL would be the best choice for you.

Be frank in discussing your expectations with Dr. Goyal.
The time required to perform liposuction varies considerably, depending on the size of the area treated, the amount of fat being removed, the type of anesthesia used and the liposuction techniques which are selected. A small area, such as the chin/neck, may be treated in less than 30 minutes, while a more extensive procedure might take several hours. Liposuction is performed through small, inconspicuous incisions using negative pressure of nearly minus one atmosphere. During the procedure, a medicated fluid (termed ‘Tumescent solution or wetting solution’) is first injected into the treatment areas. This fluid is a mixture of intravenous salt solution, lidocaine (a local anesthetic), and epinephrine (a drug that constricts blood vessels). This fluid allows for easy removal of fat, reduces blood loss, and assists in pain relief both during and after surgery. Next, a small incision (3-4 mm) is made, and a hollow tube is inserted under the skin. This tube or ‘cannula’ is moved to and fro through the fat layer, breaking up the fat cells and suctioning them out. Once the desired contour is obtained, a compressive garment is placed; this helps to minimize bruising and assists in patient comfort.

Techniques used in liposuction:
While the basic technique of liposuction, as described above, is used in all patients undergoing this procedure, there are a variety of other techniques like Power assisted (PAL), VASER, LASER or Water Jet, however, tumescent liposuction with PAL is the number one surgical procedure worldwide owing to its various advantages namely that it can be performed even under local anesthesia, while minimizing blood loss and prolonged pain control besides providing smoother results, fewer complications (safest of all), and faster recovery that may also be used. Ultrasound-assisted liposuction (UAL), VASER (Vibration Amplification of Sound Energy at Resonance): Intermittent or continuous bursts of ultrasonic energy (sound waves) are transmitted to the tip of the cannula to break up and liquefy fat cells which are then removed by suction. While effective, the ultrasound probe also generates heat, and caution must be used to avoid tissue burns.

Power-assisted Liposuction (PAL):
This technique uses an electric motor to rapidly vibrate the hollow cannula used for suctioning. This vibration breaks up fatty tissue, allowing for a more effective removal of fat in a shorter time. This technique is particularly well-suited for the treatment of body areas where the fat is ‘fibrous’ (tough to suction); these include the upper back and breasts in males. PAL is also useful for the treatment of fatty areas where there is scarring from prior liposuction, and for more extensive liposuction surgeries, as it diminishes operating time and surgeon fatigue.
Recovery:
You can walk and have normal dinner on the same evening and can be discharged very next day. You may need some assistance initially. Compression garments are typically worn for 6-8 weeks after surgery, in order to control swelling and to assist in shaping the body. While pain is usually mild, the patient will experience some discomfort and temporary numbness. These subside with time. Sutures, if used, are removed or dissolve on their own within the first week. It is better to take leave from work for 2-3 days, avoid exertion and heavy work for a week at least.

Results:
There is no inch loss in first 2-3 weeks. The results of liposuction are usually seen after 2-4 months and improvement continuous even later. You should wait for at least 3 months to buy new outfits. The small incisions used for access of the instrument will fade over a number of months usually becoming barely visible. The results of liposuction surgery are technically permanent because the fat cells have been removed. However, your body shape and contours might be affected by weight gain, aging, pregnancy, family genetics, and lifestyle factors. It is crucial to maintain healthy habits and a stable weight to prolong the results from liposuction.


FAQ

What are the risks of liposuction surgery?
As judged by current worldwide experience, liposuction is a safe surgery. Bleeding, infections and reaction to anesthesia are some risks common to all surgeries. Uncommonly there can be skin ulcerations, asymmetry, depression, waviness, prolonged numbness after surgery. Safety of the procedure depends on amount of fat removed, person’s general health, surgeon’s training and experience.

What areas can be treated by liposuction?
The most frequently treated areas are the abdomen and waist, hips, thighs, upper arms, breast and chest areas , knees, calves, ankles, cheeks, jowls and neck. Two or three areas can be safely combined provided it does not exceed the safe limits.

What is the safe upper limit for fat removal by liposuction in one sitting?
ASAPS (American Society of Aesthetic Plastic Surgeons) and several other world authorities recommend fat removal equivalent to 5-8 percent of body weight as upper limit. That means 5 kgs can be safely removed from a 60 kilos person and 8 kilos from a 100 kilos person.
Liposuction of 500 ml or more fat is a major surgical procedure and is safe when done by qualified person in a hospital with good anesthetic and ICU facilities. In absence of the above mentioned, even smaller liposuction can be risky.

Can the surgeon re-use the fat after liposuction?
Yes, this procedure is called fat grafting or fat transfer. Fat Transfer takes your unwanted body fat via liposuction and transfers it to areas of the body where volume is needed. It is the procedure where excess fat is removed from areas such as the abdomen, flanks, hips or thighs and, after special preparation, injected into areas of the body that need filling. The usual indications of fat grafting are: Sunken & hollow appearance around the eye, filling of sunken cheek, to augment smaller breasts, to augment any depressed area of body due to trauma, injections or abscess.