Men and women who come to our Honolulu, Hawaii practice for liposuction each have their own reasons for wanting to enhance their body.Liposuction surgery involves the removal of fatty tissues through small puncture sites as opposed to large incisions to remove the fat “en-bloc” or as a whole piece. Most liposuction procedures involve making a small skin puncture and then utilizing various modalities to loosen the fat prior to suctioning the fat through a small hollow tube or cannula. Liposuction surgery can be performed alone or in conjunction with an open procedure to contour the overlying skin. Care must be taken to minimize injury to the underlying blood supply of the overlying skin when tightening procedures are combined with liposuction.
Liposuction surgery can be performed by a variety of methods and there is no one method which is best for all patients. It is common in most practices that the patient makes various decisions regarding their liposuction surgery. Like everything in life, there are advantages and disadvantages for each option and every patient has different opinions and desires, so you are encouraged to discuss the various options with your plastic surgeon at length to find out which option is best for you. Your plastic surgeon will review a few common options and some of the advantages and disadvantages of each option.
There are a multitude of technologies used for liposuction procedures and some are well established and others are relatively new. Liposuction techniques for body contouring and removal of fat were performed by French surgeons in the 1920’s. A tragic case that resulted in a gangrenous leg of a French ballerina from a procedure performed by Dr. Dujarier in 1926 set back interest in body contouring for decades. Liposuction evolved in the late 1960s from surgeons in Europe using curettage techniques and then introducing suction. These techniques were mostly ignored by traditional surgeons, and even criticized as they often resulted in significant bleeding and pain. Modern liposuction using blunt, hollow cannulas to suction fat was presented at the American Society for Aesthetic Plastic Surgery meeting in Honolulu in 1982 by the French surgeon, Dr. Yves-Gerard Illouz. He described a technique of placing hollow cannulas into the fatty tissues and suctioning out the fat. This procedure was still quite bloody, but was the beginning of a procedure which was embraced and improved upon significantly over the next 3 decades. Many surgeons added new techniques to make the fat removal process less bloody, more predictable, and safer. The introduction of tumescent fluid for anesthesia as well as minimizing blood loss was a tremendous improvement early on in the evolution of liposuction. The use of ultrasonic energy to “loosen up or melt” the fat prior to suctioning it out was another big improvement and led to the VASER technology still used today. Other modalities of “loosening up” the fat prior to suctioning it out and in some cases, not even suctioning the fat out have all been introduced in the past decade. Various lasers and other energy sources have been used with mixed results. Some newer technologies involve using energy sources, ultrasound or other, to “melt the fat” and allow the fat to be resorbed by the body without suctioning, no incisions or scars. These are relatively new procedures and are now being investigated as to how effective they are and how they compare to liposuction using cannulas to remove the fat. Here are some of the current modalities for liposuction surgery.
Tumescent or traditional liposuction utilizes a type of “wetting solution” which usually contains a local anesthetic such as lidocaine and another medication to cause blood vessels to shrink down or constrict in a balanced salt solution. This is usually injected into the areas to be suctioned prior to surgery and allowed some time to take effect prior to suctioning out the excess fatty tissues.
Power assisted liposuction is similar to tumescent liposuction but uses a motorized, (electric or pneumatic) hand piece to move the cannula which is less traumatic to the patient and less strain on the surgeon.
Ultrasound assisted liposuction evolved from the early ultrasonic cannulas which were hollow and had a high complication rate (burns of skin and other soft tissues) to the use of solid ultrasonic cannulas and 2 stage fat removal. A variation of this is the VASER which is an ultrasonic cannula with several grooves which more evenly disperse the energy improving fat disruption and removal. It uses pulses of ultrasonic energy to minimize the risk of injury to the skin or other structures and tends to target fat cells preferentially.
Laser assisted liposuction is a relatively new technology and includes Smartlipo, Slimlipo and other brand names used for marketing. The theory is that the laser will work like ultrasound to disrupt the fat cells and make fat removal more efficient and less traumatic. Some of the drawbacks of this technology is finding a laser wavelength which targets fat cells and so far there are few studies which show any increased effectiveness using laser technology for fat removal.
Liposonix is a new technology which utilizes an external ultrasonic energy source to focus ultrasonic waves on tissues 1-2 cm below the skin surface (similar to the “lithotripter” which is used to break up kidney stones in the kidneys and ureters). By focusing the waves from several sources, the energy doesn’t damage skin and other structures at the point of origin but only at the point where all the waves converge usually 1-2 cm under the skin. There are several companies producing and marketing this type of technology and there have been a few studies which look promising for results. Some questions that remain to be answered are whether you can have precise control over the amount removed in a specific area and essentially sculpt the area like one can with other forms of liposuction. Other questions revolve around the resorption of the fat and if there is a limit that your body can safely resorb at one time. Many toxins are stored in our fatty tissues and can be released with disruption of the fat cells.
Zerona is a laser treatment but not invasive like the previously described laser liposuction. It is something more similar to Liposonix in that it focuses laser energy on the deeper fatty tissues without any incision. The drawbacks are similar to Liposonix in terms of only seeing a small improvement in contour and no control over the amount and exact area to remove the fat. Zerona requires multiple treatments as many as 6. Most surgeons who perform a multitude of techniques will tell their patients that the Liposonix and Zerona treatments do not replace the more traditional forms of invasive liposuction especially in patients who need larger volumes of fat removed or sculpting of a specific area.
After a thorough examination of your anatomy and tissues, your plastic surgeon can recommend which type of procedure may be a better fit for you. Ultimately it will be your decision based on the pros and cons of each procedure. As you can see, it is important to go to a plastic surgeon who has the requisite training and experience to offer a variety of procedures such that the surgery can be tailored to you.
Preparation for liposuction surgery begins after your plastic surgeon examines and talks with you in detail. Not everyone is a good candidate for liposuction surgery; but may be a candidate for one of the other forms of noninvasive liposuction. Regardless of the type of surgery to be performed, hydration is a very important aspect of any surgery and appropriate hydration prior to surgery is critical for safe recovery and optimizing outcome. The plastic surgeon will perform specific measurements to determine the laxity of skin as well as the amount of excess fatty tissue. The ideal candidate for liposuction surgery is a patient who has excellent skin tone or tissue elasticity with an isolated area of excess fat. Often times, plastic surgeons will see patients who are obese and have excess fat throughout their body. These patients are not ideal candidates for liposuction; but may benefit from liposuction of certain areas if these particular areas are the only concern to the patient. Most obese patients are better candidates for weight loss either through an “exercise and lifestyle change” program or through bariatric surgery. These patients may benefit from an open skin tightening procedure following their weight loss. Patients who are otherwise thin but have an isolated area of fat accumulation such as the “saddlebag area” or “love handle area” are excellent candidates for liposuction surgery. In regard to the abdominal area, it is not uncommon for a patient to think they desire a liposuction surgery when, more appropriately, that patient needs an abdominoplasty procedure. It usually takes considerable time to explain to a patient with poor skin tone and separated abdominal muscles (rectus diastases) that removal of the fatty tissues underneath the skin will not improve the contour of their abdomen. The scars for an abdominoplasty surgery can be a considerable deterrent for patients who want to improve the appearance of their abdomen and allowing considerable time for discussion with your plastic surgeon is extremely important. This is one reason you should never rush into surgery without meeting with your plastic surgeon several times before your surgery. In general, liposuction will not improve loose, wrinkly skin. It will also not improve the protruding abdomen which is the result of muscle separation which can occur with pregnancy as well as weight gain. Liposuction can also not remove the fat from within the abdominal cavity and this can only be improved upon with weight loss from decreasing the caloric intake and/or increasing the calories burned from exercise. It is important for the plastic surgeon to review the advantages and disadvantages of each procedure with you , so you can make an informed decision regarding which procedure will improve the areas that you most concerned about.
The immediate recovery will depend upon what type of anesthesia is employed for the surgery and the type of procedure performed. Obviously, the noninvasive liposuction procedures will have a much quicker recovery than the invasive procedures described above. Regardless of whether the procedure was invasive or noninvasive, it is very important for the patient to drink lots of water and adequately hydrate themselves following their procedure. For invasive procedures, a total intravenous anesthesia (TIVA) technique which wears off relatively quickly has minimal side effects such as nausea. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. Most plastic surgeons incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in 3-4 hours and most patients will complain of soreness at this stage. Most patients will have this sensation for a few weeks as the tissue inflammation gradually subsides and they will use pain medication to relieve this. It is very important for the patient to wear the postoperative compression garment as much as possible during the first 3-4 weeks following their procedure. Think of your tissues as a sponge and the swelling fluid is like water in the sponge. The compression garment acts the same as when you squeeze the sponge to keep the fluid from accumulating within the tissues. Although the garment is most effective during the first 3-4 weeks following the surgery, some patients will prefer to wear the garment for 3-4 months following the procedure until all the edema has resolved. There are no other specific restrictions following liposuction surgery aside from no soaking for a week. Patients may shower the following day; but no Jacuzzi, swimming or soaking in the tub for a week. Most plastic surgeons want to see their patients back in the office 5-7 days after their surgery to examine their incisions and evaluate the contour. Some plastic surgeons will use adjunct modalities such as ultrasound or lymphatic drainage massage to expedite the resolution of the edema. For most plastic surgeons, there are no sutures to remove. It is most common to use absorbable sutures which melt on their own within a few months and the outer skin is often times sealed with skin glue which flakes off in a few weeks. One of the potential risks of surgery is infection and this usually manifests itself around 5-7 days after surgery if it occurs. This is usually effectively treated with oral antibiotics if caught early but can be devastating if the infection becomes advanced. The risk of this is less than 1 in a thousand; but is one of the more serious risks of liposuction surgery. Other risks of liposuction surgery include anesthesia problems or adverse reactions, scars, bleeding, hematoma (blood collection), contour irregularities and wrinkling of the skin. Your plastic surgeon will go over all of the potential risks and complications with each patient prior to surgery so that each patient can make an informed decision regarding the risk to benefit ratio for their proposed surgery.
The actual “full” recovery period from liposuction surgery is at least a year and this involves a gradual softening of the tissues and softening of the internal scars which occur around the areas that were suctioned. A significant amount of the recovery occurs within 2-3 months; but it will take the external scar a year to soften/mature and the internal tissues undergo similar softening. Other long term potential complications are related to each patient’s own tissues and the loss of elasticity in those tissues. The amount of sagging which can occur in these tissues is mostly dependent each individual’s genetic makeup. During liposuction procedures, fat cells are destroyed and removed and these cells are essentially gone forever. All of the fat cells are never removed from a specific area as this would result in a severe contour irregularity similar to a patient who has had a bad burn and a skin graft has been placed over a muscle with no fat beneath the skin. The goal of liposuction surgery is to leave a smooth thin layer of fat cells beneath the skin to provide a smooth contour. These fat cells that are left behind have an unlimited potential to grow and will increase in size if the body takes in more calories than it burns. So it is important for liposuction patient’s to remember that the permanent result of the liposuction does depend on their diet and exercise as the body will always store any excess energy/calories consumed in the form of fat.