Liposuction Overview
GENERAL INFORMATION
Liposuction is a powerful technique for reducing unwanted bulges of localized fat. It is a purely elective surgical procedure. It does not improve health or lengthen life. Its value comes from enhanced self-esteem. For those who are striving to improve their bodies and appearance, liposuction can be a dream come true, because it can remove fat that exercise cannot reach. It is for good reason that it is America's most popular and fastest growing plastic surgery procedure.
The surgical instrument used to accomplish liposuction is called a cannula. A cannula is a small-diameter hollow steel tube with a hole near the end. It is connected by sterile plastic tubing to a vacuum pump. Through a 1/2 inch incision near the fat bulge, the cannula is inserted into the fat bulge. As the surgeon moves the cannula back and forth through the fat bulge, the unwanted fat and fat cells are suctioned away. After liposuction, some fat cells remain. You can still add inches in the liposuctioned area if you gain weight overall. It is therefore recommended that you maintain stable body weight after liposuction, to preserve your contour improvement.
The total amount of fat that can be removed during one session is limited to 2000cc, or about 4 pounds. Although this does not sound like much, it can make a big difference if it comes from a localized area. It may help to visualize a 2-liter plastic soda container. If an amount of tissue equal in size to a 2-liter Diet Coke container were removed from one's hips, one can imagine that one's jeans might fit differently afterward. I would hasten to add that it is unusual to reach the 2000cc limit. Most patients achieve their desired contour correction long before the 2000cc limit is reached.
The four reasons for the 2000cc limit are, (1) there is a limit on how much of the body can be infiltrated with local anesthetic before toxic levels are reached (we want to stay well below that), (2) there is a limit on how much blood can be lost before a transfusion is required (we want to stay well below that), (3) the length of time that the average patient can tolerate the procedure under local anesthesia, and (4) the disruption of normal life routines that the average patient can tolerate during the recovery period.
WHAT WILL BE HELPED BY LIPOSUCTION?
Liposuction works best on localized fat bulges: the first places an individual gains weight and the last places he loses it. Typically, this is the outer hip area, although many people have localized accumulation in the inner thighs, tops of buttocks, inner knees or lower abdomen. For some people, the first 5 pounds they gain is along the jaw and neckline. Liposuction is very effective there also.
WHAT WILL NOT BE HELPED BY LIPOSUCTION?
Evenly distributed fat due to being overweight will not be helped by liposuction. Clearly, if the most that can be removed during one session is 4 pounds, it is not an effective treatment for a generalized overweight condition.
Excess or loose skin, typically on the lower abdomen in women, who had had children, does not improve after liposuction. In fact, it may worsen afterward. However, other effective treatments are available. If you need alternative or additional procedures besides liposuction to produce a good result, I will explain that to you during your examination.
Not all contour bulges can be improved by liposuction. For example, the classic "beer belly" of middle-aged men is usually due to fat accumulation around the internal abdominal organs, in association with relaxation of the overlying abdominal muscles. The fat layer beneath the abdominal skin is characteristically thin in such individuals, and liposuction does not correct this problem. Some fat bulges have lots of connective tissue fibers running the fat cells. In this situation, the liposuction tube will not penetrate this area, and this fat will persist after liposuction. Fortunately, this connective tissue fat layer is rarely more than 1/2 " thick and significant improvement can almost always be obtained by removing the looser fat below it. Sometimes a contour prominence is not due to fat, but rather is due to the shape of underlying bones or muscles. Liposuction will not be effective in these situations, either. Liposuction does not improve cellulite. It is an intrinsic feature of the skin and liposuction does not affect it.
GOALS
The goal of liposuction is to reduce localized disproportionate fat bulges. This helps establish a more balanced body contour, which improves appearance both in and out of clothing.
Liposuction Possible Results Please keep in mind that liposuction is not a substitute for dieting or exercise, rather it is done to enhance the body contour that you have gained through dieting and exercise. Please also remember that just as your body is different from someone else's, your results will also be different than someone else's. This is not to say that you will not benefit from liposuction, just perhaps in a different way than your sister or best friend would if she were also having this procedure done. The most important thing to remember is that once you have decided to have liposuction done, the rest is up to you. Liposuction may reshape your body but it cannot reshape your life. The procedure will help you regain self-confidence and esteem but it cannot do it alone--a positive attitude is also essential to make your procedure a success.
Liposuction really works! Over 100,000 people a year are taking advantage of its possibilities, and giving it enthusiastic endorsement. After body contour sculpting by liposuction, you will enjoy the way you look and feel, and all the compliments you will receive. This reinforcement of self-esteem helps maintain the positive, healthy attitude so essential for success in all areas of life.
TEMPORARY CONSEQUENCES OF LIPOSUCTION
A certain amount of bruising and swelling is expected with this procedure. Along with the bruising and swelling, you may feel some soreness and/or numbness in the liposuction-treated area(s). Due to swelling and skin re-shaping, you may notice some lumps and irregularities in the early post-operative period. Although every effort will be made to achieve symmetry on both sides of the body, most people are not perfectly symmetrical before or after liposuction. Therefore, symmetry cannot be guaranteed.
PERMANENT CONSEQUENCES OF LIPOSUCTION
The incisions used to pass the liposuction tube beneath the skin are about 1/2" long, and are placed in natural valleys where they are usually inconspicuous after healing. Some degree of scarring is always a consequence of an incision, however, and must be accepted as a necessary part of the expected final result. I take extra care not to pass the liposuction tube too close to the skin, always trying to maintain 1/2" of fat beneath the skin to provide some soft padding to redistribute the skin evenly. Nonetheless, waviness and surface irregularities in the skin over the liposuction-treated area(s) sometimes become permanent.
Very rarely a bruise will stain the undersurface of the skin, leading to permanent pigmentation of that skin.
Liposuction Timeline
Two Weeks BeforeLiposuction
For two weeks before your procedure, you should not take any ASPIRIN, ADVIL or other ASPIRIN-LIKE COMPOUNDS. One of the side effects of these medications is that they are blood thinner, which increases your risk of post-operative bleeding. This could lead to blood clots requiring a second operation to remove the blood clots.
5 Days Before Liposuction
SMOKING impairs wound healing. If you are smoker, you should plan to stop smoking for five days before your operation and for three weeks afterward.
The day Before On the day before your operation, the operating room secretary will call you and review your pre-operative instructions. She will give you a time at which you should come to the outpatient surgery area. This will be 1 1/2 to 2 hours prior to the anticipated start time of your operation, to allow for processing paperwork and to orient you to the area where you will be before and after your operation. The night before your operation, bathe and wash your hair as usual. It is very important that you take nothing by mouth, liquid or solid, any time after midnight the night before your operation.
The day of Surgery On the day of surgery, you should not wear any make-up or jewelry. You should wear loose clothing that is easy to put on and remove without requiring you to stretch or bend.
You are invited to bring CDs or tapes of music to listen to before and during surgery. You should plan for a driver to bring you and take you home afterward, since you will not be able to drive yourself home. You will also find it helpful to have someone stay with you during the night following your surgery.
At the completion of your procedure, you will be fitted with a tight-fitting compression garment. You will be observed in the recovery room until your sedative has worn off. You can then go home with your driver. You can resume bathing the day after your procedure. You can remove the compression garment for bathing, but should wear it at all other times for 2 full weeks following your procedure.
1-3 Days After Liposuction
After For the first two or three days that you are home, you should expect some discomfort, and should take your pain pills as often as needed to stay comfortable. After the third day, most patients find that they are able to easily control the discomfort by just limiting activity, and no longer require any medication.
8 Days - 2 Weeks After Liposuction
You should expect to be able to resume clerical work, light housework, and sexual relations on about the 8th day after your procedure. You will have some numbness, bruising, swelling and soreness in the treated areas for the first two weeks following the procedure. You can expect to resume full activity, including aerobics, after two weeks.
Please carefully review the contents of this letter, at home without any time pressure. Please write down any questions that occur to you. Call or return to the office for a follow-up consultation at no additional charge, to be sure your questions are answered. Open, thorough communication is a key factor in achieving your desired result.
Sincerely,
John J Seaberg, MD
Liposuction Risks and Complications
COMMON RISKS/COMPLICATIONS
Contour irregularities and depressions are common. They tend to become less prominent over time, but may be persistently visible, especially to the patient and her doctor, who both know to look for them. Swelling of the hips and legs may persist for several months but almost always finally resolves. A certain amount of bruising of skin nerves occurs as a part of the liposuction procedure, and numbness or altered sensation from a bruised skin nerve may sometimes be permanent.
UNCOMMON RISKS/COMPLICATIONS
Shock requiring transfusion has followed liposuction. The newer anesthetic techniques using larger volumes of dilute local anesthetic solution make this problem much less likely than in the early years of liposuction, but it is a reported complication of the procedure, so I have to mention it. I don't think this procedure is worth having a transfusion for, so I limit the amount removed to keep it below the level where you are likely to require a transfusion. You may donate 1 or 2 units of your own blood ahead of time, if you wish. I have never had to transfuse a liposuction patient and I do not recommend that you waste your money to pay for the processing of an autologous blood donation that will not be used.
Sometimes the compression garments are not fully effective at preventing tissue fluid from collecting in the liposuctioned area. If you do get a fluid collection, it is usually just tissue fluid. Occasionally it may be clotted blood. In any case, the fluid is removed with a needle and syringe during an office visit. You may need to return to the office once a week for 2-6 weeks for repeat fluid removal, until your body seals the space and the fluid accumulation stops.
As with any surgical procedure, an infection may follow liposuction, but the infection rate is very low. I personally have never seen an infection follow this procedure.
It is possible the skin over the liposuctioned area may suffer an injury to its circulation, leading to death of that skin. If it should happen, a skin graft might have to be placed on the area of skin loss. I have never seen this happen, either.
It is theoretically possible for fat droplets to get into the circulation during liposuction and travel to the lung, where they could clog the tiny capillaries in the lung and create a fatal condition known as pulmonary embolism. This theoretical possibility has never been proven to occur.
Any and all complications can result in additional surgery, hospitalization, time off from work, and additional expense to you. In addition to the complications listed above, which are peculiar to liposuction, any patient having any kind of surgery incurs a risk of cardiac or respiratory complications leading to prolonged hospitalization or death. The risk is numerically very low, but it is not zero and it is a risk you would not have if you did not have the procedure done.