Family doctor

Introduction

As the word implies the procedure involves the removal of unwanted fat by means of suction. It can be used to compliment other procedures or as a procedure in its own right. A variety of new names have been linked to liposuction to describe refinements in technique. 'Liposculpture', 'tumescent liposculpture' and 'superficial liposuction' are such terms. The procedure is primarily designed to contour the body and remove or reshape localised fat deposits, not as a form of weight loss.

Background

Fat composition of the body depends on a number of factors - dietary, genetic, hormonal, exercise. All of these factors determine how much and where fat is deposited in the body. The distribution of that fat plays a large part in our resulting body contour.

Weight gain and loss changes fat cell size preferentially over fat cell number. Liposuction reduces fat cell number. While it doesn't change the fact that you can/lose weight according to the previously mentioned factors, it does mean that it can change the distribution of that fat by reducing fat cell numbers in a certain area. It is very good then for altering body contours e.g. treating areas such as 'saddlebags' on the thighs.

Uses

The most common area in which liposuction is used is the thigh and hip area. Other popular areas include abdomen (tummy), neck and knees. It is frequently employed as an extra to improve the resulting contour in breast, abdominal and neck surgery.

It must be remembered though that body contour is also altered by muscle and skin tone, as well as fat distribution. Liposuction only addresses one of these factors directly. In some individuals in whom these other areas are the major problem, other procedures should also be entertained to achieve a more ideal result e.g. it is not an alternative for facelifts or 'tummy tucks' - these are operations addressing specific problems which liposuction will not remedy alone.

The procedure

The procedure is usually performed under a general anaesthetic (i.e. you are asleep for the procedure). Sometimes it is done under local anaesthetic with sedation (you are made to feel sleepy) and occasionally with local anaesthetic alone (the area of operation alone is 'numbed'). Very small 'stab' cuts are made mainly in hidden areas to allow entry of long, slender instruments. The fat layer is expanded with injection of a fluid mixture which aids fat removal and then the suction apparatus is introduced into the fat layer and the desired amount of fat removed.

Following the procedure

Most people can, and indeed are encouraged, to get up and around as soon as their anaesthetic has worn off. It is advisable that those who have very large volumes of fat removed stay a night in hospital. This is not necessary in most cases however.

A firmly fitting garment is worn around the area which has been liposuctioned. This aids with the 'settling in' of the new shape. It stops fluid and blood from accumulating in the areas where fat has been removed and prevents skin sagging by helping the skin to 'stick back' in place.

The garment is usually worn continuously for two weeks and then 'most of the time' for a further month. Exercise and lifting should be limited during this period.

Possible complications

There are generally few complications in this procedure. Some include:

• Bleeding and fluid collection - at the site of liposuction. The liposuction garment is designed to prevent this. If it occurs it needs to be drained and the garment checked for correct fit.
• Infection - can rarely occur and needs to be dealt with promptly.
• Sensory changes - particularly with large liposuction volumes but tends to be temporary and returns over several weeks to months.
• Irregularities - liposuction can cause some irregularities in the soft tissues at the site of suction. Obviously this is not ideal as the aim is to gain a smooth contour. Irregularities sometimes need to be addressed by a small secondary procedure. Wearing the post-liposuction garment correctly following the procedure helps to avoid this problem.
• Skin Discolouration - may occur, is usually temporary and usually resolves with time.

General comments

Newer methods of liposuction have been introduced in the last 18 months including:

• Ultrasonic liposuction - instead of straight suction removing the fat cells 'ultrasound' is used to break up the cells. It is said to result in 'faster' 'cleaner' removal of fat. While it is good in some areas that traditional liposuction finds difficult e.g. male breast and the back where tissues are thicker, it also runs added complications such as skin burns and a greater risk of seroma.
• External ultrasound assisted liposuction - an ultrasound is massaged over the skin before suction is performed - this is said to result in faster, cleaner removal of fat like that of ultrasonic liposuction without the risk of skin burns. It is thought by most to be less effective than the internal method.
• Oscillating liposuction - a rapidly vibrating liposuction tube is passed into the fat and fat is broken down by mechanical vibration of the probe. It is meant to result in fast, clean removal of fat without the risks of skin burns etc. that can occur with ultrasonic liposuction.

Some advertisements claim to use 'tumescent' liposuction using only local anaesthetic as 'it is safer'. While tumescent liposuction is a commonly used form of liposuction it also swells the tissue with fluid and can make the judgement as to whether appropriate amounts of fat have been removed difficult as the extra fluid can disguise the contour.

It should also be noted that local anaesthetic has its own inherent risks and apart from this, the major risk for most people is not the general anaesthetic itself but rather the fluid problems associated with liposuction. Added to this, most 'local anaesthetic' liposuction is not performed purely under local anesthetic but also using 'sedation' to make one feel sleepy. This is done with prescription-only medications which require special monitoring.

Whatever procedure is used then it is important that you are appropriately 'monitored' during the procedure. In most instances a licensed 'anaesthetist' (a doctor specially trained in giving anaesthetics) needs to be present during the procedure to keep you comfortable and safe.

Summary

In summary, there are many liposuction techniques and each can be shown to produce excellent results by those familiar with each technique. The appropriate choice of procedure, i.e. whether liposuction or a different procedure is best suited to the result you are wanting to achieve, the skill of the liposuctionist and the safety of the procedure, are the most important considerations when thinking of liposuction.