Liposuction

|


Liposuction is a surgical technique for contouring the body by removing localized deposits of excess fat.  It was originally used to treat the hips and thighs, areas that are particularly resistant to diet and exercise.  As the technique developed it was applied to many other areas of the body.  Today it is commonly used to treat the neck, breasts, abdomen, back, arms, flanks, hips, thighs, knees, calves, and ankles.  It is effective for both men and women.  It is not intended as a method to achieve generalized weight reduction however.

Liposuction is a safe procedure.  Sporadic reports in the media that have maligned it have invariably involved personnel who either are not medically qualified to perform this surgery, have practiced poor patient selection, have exceeded the recommended safe limit of fat removal, or have combined liposuction with too many other procedures simultaneously.

Fat removal by liposuction is permanent because the body does not manufacture new fat cells after puberty.  Adults become thinner or fatter by altering the amount of fat in each cell.  It is still possible to gain weight after liposuction.  In this case the fat is more evenly distributed throughout the body rather than selectively to the original treatment sites.

Liposuction improves body contour but not skin quality.  Cellulite is a poorly understood superficial dimpling of the skin that is frequently seen in the thighs and buttocks.  It tends to increase with age.  Unfortunately, cellulite is not improved by liposuction. 

Loose skin is characterized by poor elasticity.  It is resistant to improvement except by extensive surgical excision that typically leaves long and often wide scars.  Although liposuction can improve the overall silhouette of the body even in the presence of loose skin, it will not improve skin quality.  There is even the potential that it may make it somewhat worse in the case of very loose skin. 

Results following liposuction are also influenced by age, weight, and body build.  Those who are significantly overweight will not achieve as good a result as those who are close to their ideal weight.  Liposuction will have less overall impact in the presence of wide pelvic bones or short thighs.  In the case of the abdomen, liposuction will not adequately flatten the contour if the problem is due more to loose skin and muscles.

One of the attractive features of liposuction is that very small incisions are needed for each area treated.  These typically measure one-quarter inch in length and frequently can be concealed in natural body creases.  Although the scars are permanent, they are usually quite inconspicuous.

There are three types of liposuction which share many similarities: the tumescent technique, ultrasound assisted liposuction and power assisted liposuction.  The tumescent method involves using high volumes of anesthetic fluid which are injected into each of the areas to be treated at the beginning of the procedure.  This allows more fat to be removed compared to previously used techniques while causing less blood loss at the same time.  Patients are more comfortable after surgery with this technique.  It is now routinely used in all cases.  Ultrasound assisted liposuction (UAL) is a process where sound waves are used to emulsify fat cells instead of removing them by suction alone.  This technique is intended primarily as a supplement to conventional liposuction.  It is more effective in removing fat in certain areas of the body where fibrous tissue makes removal by standard techniques more difficult.  These areas include the abdomen, breasts (men), and the back.  It is also useful to retreat areas in those who have had liposuction before. Power assisted liposuction uses a motorized cannula to extract fat. It has the advantage of decreasing surgeon fatigue and appears to cause less swelling and bruising.  While these different options exist, the final aesthetic outcome of the procedure is determined more by the surgeon’s sculpting abilities than the specific type of liposuction used.    

Liposuction is almost always performed in the office as outpatient surgery.  A private duty nurse is required to provide adequate postoperative monitoring if there are a large number of areas being treated or if another procedure such as a breast procedure, abdominoplasty, or facelift is performed at the same time.  The nurse meets our patients at the office and escorts them home or to the hotel for overnight observation.  They are arranged through our office but charge separately for their services. 

Surgery is usually performed under a complete anesthesia in which there is no awareness.  Other possible options can be discussed with the anesthesiologist prior to surgery.  The anesthesiologist is a board certified physician who is present for the entire procedure.  Surgery time ranges from thirty minutes to three hours depending on the number of areas treated.  The surgery is performed entirely by Dr. Hidalgo.

A support garment is placed at the time of surgery and is worn for two weeks.   It can be removed for bathing.  The small sutures placed at each incision site during surgery dissolve and do not require removal.

After surgery there is soreness in the treated areas that lasts for about 48 hours.  Few patients require any pain medication beyond this time.  Walking is encouraged beginning the day after surgery.  Generalized stiffness lasts for as long as one week.  Return to work is usually possible after one week.  Vigorous exercise involving the treated areas should generally be avoided for three weeks.

Bruising usually lasts for two weeks although complete resolution can take a month.  Occasionally there may be a particular area that takes longer.  Reduced sensation in the treated areas is typical and generally lasts for a few months.  Bleeding, infection, and other problems are possible but very uncommon following liposuction.  Serious complications are extremely rare with this type of surgery. 

While every effort is made to achieve a smooth shape throughout, contour irregularities are sometimes seen after all of the swelling has resolved.  Most defects are subtle and do not require additional treatment.

Copyright © 2007 David A Hidalgo, M.D.


| back to top |