Liposuction

Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck.

Typical fat deposition sites

The unsightly distribution of body fat is usually due to an inborn tendency to deposit fat in one particular area of the body, most commonly the hips.

During the past decade, liposuction, which is also known as a lipoplasty or suction assisted lipectomy, has benefited from several new refinements.  Today, the tumescent technique is helping plastic surgeons to provide selected patients with more precise results and quicker recovery times.  Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don't respond to traditional weight loss methods. The growth of a benign fat tumour (lipoma) can also become a disfigurement, and in men fatty swellings can develop under their nipples to look like breasts (gynaecomastia).

Are you a good candidate for liposuction?

To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It is important to understand that liposuction can enhance your appearance and self-confidence, but it will not necessarily change your looks to match your ideal or cause people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with me during your consultation. The best candidates for liposuction are normal weight people with firm, elastic skin who have pockets of excess fat in certain areas.

You should be physically healthy, psychologically stable and realistic in your expectations.Your age is not a major consideration, however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin.

Liposuction carriers greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or in those who have recently had surgery near the area to be contoured.  It is important to remember that liposuction is not a treatment for obesity.  The amount of fat that can be removed from a localised area is limited and it may not be possible to slim down an area as much as you may wish.  Further treatments can be carried out on the same area in six months.

Cellulite will not be improved by liposuction.

Planning your surgery

At your initial consultation I will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. I will explain the body contouring method that I consider to 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.

Preparing for your surgery

I will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding vitamins, iron tablets and certain medications. You should avoid aspirin and anti-inflammatory drugs for 2 weeks before the operation.  If liposuction is likely to be extensive, I may advise that you stop the contraceptive pill for a month prior to the operation.  If you develop a cold or infection of any kind, especially a skin infection, the procedure may have to be postponed. Though it is rarely necessary, I may recommend that you have a blood test prior to the operation.

Also, while you are making preparations, arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.

On the day of surgery I will visit you on the ward and will draw on you with a marker pen to identify the areas of fat to be treated.

Anaesthesia

Various types of anaesthesia can be used for liposuction procedures. Together, we will select the type of anaesthesia that provides the most safe and effective level of comfort for your surgery. If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anaesthesia, which numbs only the affected areas. However, the majority of patients prefer a  general anaesthetic, particularly if a large volume of fat is being removed. If this is the case, an anaesthetist will be present to keep you asleep during the procedure.

The operation

The time required to perform liposuction may vary considerably, depending on the size of thearea, the amount of fat being removed, the type of anaesthetic and the technique used.

Liposuction is a procedure in which localised deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube, or cannula, is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed and pulledthrough the fat layer, breaking up the fat cells and sucking them out. The suction action is provided by a vacuum pump or a large syringe. If many sites are being treated, I will then move on to the next area, aiming to keep the incisions as inconspicuous as possible.

Fluid is lost along with the fat and it is crucial that this fluid is replaced during the procedure to prevent shock. For this reason, patients are carefully monitored and receive intravenous fluids during and immediately after surgery. I use the tumescent technique which is a processwhereby a medicated fluid solution is injected into fatty areas before the fat is removed.  Thisis commonly used by plastic surgeons today. The fluid is a mixture of intravenous salt solution, lignocaine (a local anaesthetic) and adrenaline (a drug that constricts blood vessels). This allows the fat to be removed more easily, reduces blood loss and provides anaesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery. All surgery carries some uncertainty and risk

Liposuction technique

Liposuction is normally safe, as long as patients are carefully selected. Although complications are rare, complications can and do occur. Risks increase if a greater number ofareas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid requires a longer operating time than will be required for smaller operations. The combination of these factors can lead to a greater risk of infection, delays in healing, formation of fat clots or blood clots which may migrate to the lungs, excessive fluid loss which can lead to shock or fluid accumulation that must be drained, friction burns or other damage to the skin or nerves, and unfavourable drug reactions. The scars from liposuction are small and are strategically placed to be hidden from view.

However imperfections in the final appearance are not uncommon after liposuction. The skin surface may be irregular, asymmetric or even baggy, especially in the older patient.

Numbness and pigmentation changes may occur. Rarely, a greyish stripe may discolour the skin for several months and is more commonly seen when the ankles have been treated.

Sometimes, additional surgery may be recommended, particularly if the skin is inelastic and becomes loose.  I may recommend that you undergo removal of skin to correct this, either at the same time as the liposuction or as a second procedure.

After your surgery

After surgery, you may experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build up. To control swelling and help your skin better fit its new contours, you may be fittedwith a tightly fitted elastic garment to wear over the treated area for a few weeks.

Pressure garment

I may also prescribe you antibiotics to prevent infection or iron tablets if you become anaemic. Don't expect to look or feel great immediately after your operation. Even though these newer techniques are believed to reduce some post operative discomfort, you may still experience some pain, burning, swelling, bleeding and temporary numbness. The pain can be controlled with medications which I will prescribe before your discharge from hospital.  You may still feel stiff and sore for a few days. It is not unusual to feel a bit anxious or depressed in the days or weeks following surgery. However this feeling will subside as you begin to look and feel better.

Getting back to normal

Healing is a gradual process. I will advise you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs.  You will begin tofeel better after about a week or two and should be back at work within a few days following your surgery. The stitches will dissolve on their own within the first week or 10 days. You should avoid strenuous activity for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more. We will arrange follow-up visits to monitor your progress and to see if any additional procedures are needed. If you have any unusual symptoms between visits, for example heavy bleeding or increase in pain, or any questions about what you can and cannot do, you can contact me through the hospital.

Your new look

You will see a noticeable difference in the shape of your body quite soon after the surgery.

However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final result will be visible. If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wider variety of clothing and feel more at ease with your body. And, by eating a healthy diet and taking regular exercise, you can help to maintain your new shape.

Will it last?

Fat cells are thought not to be regenerated in adult life.  Therefore their removal by liposuction should give you a permanent change in contour and be independent of any changes in your body weight.