Liposuction

How is a liposuction procedure performed?

Liposuction removes fat from your body using suction. In this procedure, small, thin, blunt-tipped tubes (cannula) are inserted through small cuts in the skin. Your plastic surgeon moves these tubes under your skin to target fat deposits and then suction them out. From traditional liposuction procedures to new laser liposuction technologies such as Smart Lipo, there are a variety of techniques that facilitate liposuction:

• Tumescent liposuction describes a “wetting solution” with a local anesthetic, such as lidocaine and another medication in IV fluids, which is injected before surgery, causing blood vessels to shrink down or constrict. This allows liposuction to be performed with the patient under local anesthesia, minimizes blood loss and reduces postsurgical pain and bleeding.
• Suction-assisted liposuction (SAL), the most traditional form of liposuction, draws fat out with a vacuum.
• Power-assisted liposuction (PAL) is traditional SAL with the addition of a tool to increase the motion of the cannula, which speeds up fat removal.
• Ultrasound-assisted liposuction (UAL) transmits energy through a special hand piece that helps to loosen and melt fat, enabling a greater volume of fat to be removed. This is best for larger areas, dense fat and male patients.
• VASER, a variation of UAL, is an ultrasonic cannula with several grooves that evenly disperse the energy, improving fat disruption and removal.
• Laser-assisted liposuction (LAL), such as Smartlipo and Slimlipo, is a relatively new technology. The theory is that the laser will work like ultrasound-assisted lipoplasty to disrupt the fat cells and make fat removal more efficient and less traumatic.

SAFELipo is a procedure that has been developed by an Aesthetic Society member that involves a 3-step process of separation, aspiration and fat equalization.

• Separation – loosens, emulsifies and separates out the unwanted fat cells without generating heat, so essential blood vessels, skin and other tissues are unharmed
• Aspiration – fat cells are gently removed through suction, without damaging supporting structures such as nerves, blood vessels, skin
• Fat Equalization – smooths out the remaining thin fat layer, leaving behind a uniform layer of ‘local fat grafts’ that prevents contour deformities from forming

Originally developed to address the challenges of revision liposuction cases, the process removes a significant amount of fat without increasing chances of contour deformities or skin damage.

1. The surgeon will diagram treatment areas like the hips, abdomen, thighs and flanks.
2. A cannula is inserted through a small incision and fat carried away with suction.
3. Liposuction helps eliminate unsightly bulges by removing localized fat deposits.
4. It is important to maintain a healthy lifestyle with diet and exercise to prolong results.

What are my options?

There are many techniques and new technologies associated with liposuction, as mentioned above under How is liposuction performed? Some traditional liposuction methods such as suction-assisted liposuction (SAL) have been used for some time, while there are ultrasound-assisted and laser technology methods that are relatively new. It is important to know that while some new liposuction techniques can improve your outcome, choosing a procedure based on “what’s new” is never a medically sound decision. Hearing about a brand name procedure such as Smart Lipo or CoolLipo on television, through an advertisement or online does not necessarily mean it is the best procedure for you. Your board-certified plastic surgeon will determine what is best for you based on his or her experience, your body type and your cosmetic goals.

What will my liposuction incisions and scars be like?

• Because liposuction incisions are small, the scars are also small.
• The amount or degree of scarring depends on the surgeon’s technique and your genetic tendencies.
• Most lipoplasty scars fade and are barely perceptible over time. Visible scars are more likely when large liposuction cannulas are used and in patients who have darkly pigmented skin.
• There are two types of marks that can remain on the skin after liposuction. One is a true scar and the other is known as dyschromia, which is a dark (hyperpigmented) or light (hypopigmented) spot on the skin.
• Generally, the incisions are very small and placed in hidden areas. Sometimes, depending on the area, the incisions cannot be hidden.

Select a surgeon you can trust

It’s important to choose your surgeon based on:

• Education, training and certification
• Experience with liposuction surgery
• Your comfort level with him or her

After finding a board-certified plastic surgeon in your area who is experienced in performing liposuction surgery, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for liposuction and clarify what lipoplasty can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered (see related procedures). During the initial consultation, you can expect your surgeon to:

• Ask you to look in a mirror and point out exactly what you would like to see improved.
• Take pictures of you, including 3D photos, especially if the areas to be treated are on your rear side (back, buttocks, or other areas). This will help your surgeon understand your expectations and determine if liposuction can achieve them.
• Evaluate the elasticity of your skin and perform specific measurements to determine skin laxity. The ideal candidate for liposuction surgery has excellent skin tone/tissue elasticity with isolated areas of excess fat.
• Discuss your ideal weight, realistic weight and current weight. He or she may suggest a weight loss program before surgery.
• Ask you about your plans regarding future pregnancies.

You should come to the consultation prepared to discuss your complete medical history. This will include information about:

• Previous surgeries
• Past and present medical conditions, including any history of high blood pressure, thyroid problems or diabetes
• Allergies and current medications

Your treatment plan

Based on your goals, physical characteristics and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your surgery, including the type of procedure of combination of procedures.
• The outcomes that you can anticipate.
• Your financial investment in the procedure.
• Associated risks and complications.
• Options for anesthesia and surgery location.
• What you need to prepare for your surgery.
• What you can expect to experience after surgery.
• Share before-and-after photos of cases similar to yours and answer any questions.

Questions to ask your aesthetic plastic surgeon

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation:

• Am I a good candidate for liposuction?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for the procedure I am undergoing?
• Will my scars be visible? Where will my scars be located?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my surgery?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

How do I prepare for a liposuction procedure?

Your surgeon will provide you with preoperative instructions, answer any questions you may have, take a medical detailed medical history and perform a physical exam to determine your fitness for surgery. In advance of your procedure, your surgeon will ask you to:

• Stop smoking before undergoing surgery to better promote healing.
• Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
• If your surgeon recommends weight benchmarks or lifestyle changes, do your best to achieve them to ensure the best results and minimize the chance of complications.

Liposuction surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and stay with you at least the first night following surgery. If you are undergoing a large volume of liposuction, you may be asked to stay in the surgical facility overnight. What can I expect on the day of liposuction surgery? Your liposuction surgery may be performed in an accredited hospital, free-standing ambulatory facility or office-based surgical suite. Most lipoplasty procedures take ninety minutes or less to complete but may take longer depending on how much fat is removed and the number of liposuction sites. If multiple sites on both sides of the body are suctioned, the procedure could take over three hours.

• You will receive medications to make you as comfortable as possible during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing liposuction, although general anesthesia is sometimes desirable.
• For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
• Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• After surgery, you will be taken into a recovery area where you will continue to be closely monitored. You will most likely be wearing a compression garment to help “shrink” the skin. Many patients state that the area feels sore, as if they underwent a vigorous workout.
• You will probably be permitted to go home after a short observation period unless you and your plastic surgery have made other plans for your immediate post-operative recovery.

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your post-surgical care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Any potential signs of complications

  Immediately after your liposuction surgery The incisions where the doctor inserted the cannula may be leaky or drain fluids for several days. In some cases, the doctor may insert a drainage tube to drain fluid away from the wound. You will wear special tight garments to keep your skin compressed. Your doctor will tell you how long to wear these, usually for weeks. Some doctors provide these garments but others will tell you where to purchase them before your surgery. When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact your physician. You will also have some redness and swelling after the surgery. In some cases, the swelling will remain for weeks or even months. Contact your surgeon to find out if your pain, redness and swelling is normal or a sign of a problem. Recovery time frame after liposuction It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, taking an antibiotic, if prescribed, and the level of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals. The first two weeks

• The first few days after surgery, you should rest quietly. Elevate the affected body part if possible. Remember, you must not take aspirin or certain anti-inflammatory medications. You will most likely wear a postsurgical garment; if it is too tight, notify your surgeon.
• The first 48 hours after surgery, you will experience varying degrees of swelling and bruising. The swelling is maximal at 48 hours after surgery and mostly disappears within two to three weeks, but there may be slight residual swelling for up to four months. Bruising is normal and typically disappears within seven to ten days.
• Sutures, if placed, are usually removed seven to ten days after liposuction.
• Do not smoke after your liposuction surgery to prevent coughing and bleeding. Do not drink alcohol for five days after surgery or while you are taking pain medication.
• Avoid straining, bending over and lifting during the early post-operative period. In many cases, you will be able to resume most of your normal activities within ten days or less.
• Discomfort after liposuction is generally limited to soreness rather than pain. Pain medications are prescribed to lessen any discomfort during the first few days.
• Patients usually return to work within a few days following a liposuction procedure.

Weeks two to six

• It is important to ambulate (walk) as soon as possible after liposuction to discourage swelling and prevent blood clots in the legs. However, avoid strenuous exercise for four to six weeks because it can trigger unnecessary fluid retention in the treated areas.
• You should wait a minimum of six weeks before exposure to sun and heat, including sunbathing, because of the possibility of swelling.
• You will wear a compression garment over the treated areas for four to six weeks to control swelling and promote skin contraction.

Long-term recovery Since the healing process is gradual, you should expect to wait at least several months to get an accurate picture of the results of your surgery. The small incisions used for access will fade over a number of months, usually becoming barely visible. For six to nine months, you may experience a fluctuating return of ten to 15 percent swelling with exercise or excessive activity. It is important to see your doctor as scheduled. Follow-up visits will continue for several weeks and then after several months at prescribed intervals.

The results of liposuction surgery are technically permanent because fat cells have been removed. However, your body shape and contours might be affected by weight gain, aging, pregnancy, family genes and lifestyle factors. It is crucial to maintain healthy habits and a stable weight to maintain liposuction results. Following liposuction, if you continue to eat excess calories, fat will no longer be stored in the cells that have been removed, but will be stored in other body areas. There is no way to predict where your body will store new fat. What’s more, your surgeon will not remove all of the fat cells from your target area, so you could still increase the size of remaining fat cells in that area. The basic message: keep your weight stable for a long lasting result. Maintain a relationship with your aesthetic plastic surgeon For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in the treated area. Do not hesitate to contact your surgeon when you have any questions or concerns.

The cost of liposuction varies from doctor to doctor and from one geographic area to another. Because liposuction is an elective cosmetic surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable. These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to surgery. Choose your surgeon based on quality, training and experience—not cost. See why ASAPS members are widely recognized for upholding the highest standards in the area of aesthetic plastic surgery by viewing their basic credentials, training and certifications.

Fortunately, significant complications from liposuction surgery are infrequent. Your specific risks will be discussed during your consultation. All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

Other risks specific to liposuction are outlined below:

• Indentations
• Contour irregularities

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your liposuction surgery.

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