Liposuction or
suction assisted lipectomy (SAL) is a procedure that results in
the removal of unwanted fat from specific regions of the body. It is an effective
procedure and the most common cosmetic procedure performed in America. Not
surprisingly, it is affordable, rewarding, and a safe way to lose problem areas
of fat that are unresponsive to diet and exercise. Liposuction may be done alone
or in combination with another cosmetic procedure. Areas commonly treated include
the abdomen, the flanks, the middle and outer thighs and the legs. Other regions
treated by liposuction are: the chin and neck, the arms, the back, the buttocks
and the male breasts. Liposuction improves body contour by removing fatty deposits.
It is not a substitute for weight loss. Patients with good skin elasticity may
expect a pleasing result. If loose or hanging skin exists in areas being treated,
other techniques may be helpful.
Who is a candidate for Liposuction?
The best candidates for liposuction of average weight 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 carries greater risk for individuals with medical problems such as
diabetes, significant heart or lung disease, poor blood circulation, or those who
have recently had surgery near the area to be contoured.
You are probably NOT a good candidate for liposuction surgery if:
You are overweight or obese and trying to lose
weight.
Liposuction is a procedure for shaping the body and is not
recommended for weight loss.
You have a disease or are on medication that affects
wound healing.
These include current infection or past medical history of
bleeding, emboli, thrombophlebitis, edema, or if you are taking medication(s)
that may affect your wound healing or blood clotting (such as aspirin,
nonsteroidal anti-inflammatory agents, warfarin, heparin, or other
anticoagulants) or are taking medication that may interact with the drugs used
during liposuction.
Your skin elasticity is not adequate.
Your
doctor will evaluate the skin at the site where you are considering liposuction
to determine if skin is elastic enough to shrink after liposuction. If it is
not, it will be baggy after liposuction.
Cost is an issue.
Most medical insurance will
not pay for cosmetic liposuction. The cost for liposuction may be
significant. More Liposuction Facts...
How is Liposuction performed?
Liposuction is generally performed in an outpatient surgical facility under a
general anesthetic although an occasional small area may be suctioned under a local
anesthetic with accompanying intravenous sedation. Small incisions are made in
cosmetically convenient skin folds wherever available.
The tumescent liposuction technique is used to minimize bruising, swelling, and post-operative
pain. The tumescent technique utilizes large volumes of saline (physiologic salt
solution) that contains dilute lidocaine (local anesthetic or "numbing" agent) in
combination with epinephrine (adrenaline). Adrenaline temporarily constricts (closes)
the small blood vessels in the fat in order to prevent bleeding. This also helps
prevent post-operative bruising. In addition, dilute sodium bicarbonate (baking soda)
in the solution helps to minimize further the unpleasant stinging otherwise
associated with the lidocaine and epinephrine.
After the tumescent is injected into the area designated to remove fat. A narrow
metal tube that is connected to a plastic hose and then to an aspirator machine,
called a cannula, is passed back and forth through the area of excess fat. When
liposuction is performed, the cannula is passed through the fat to create
"Swiss-cheese-like tunnels." The fat cells are removed from the body. In addition,
the motion of the cannula damages the remaining fat and other fibrous cells. These
remaining damaged cells may take weeks to be absorbed or repaired by the body, a
fact that plagues even some experienced surgeons. Failure to take this second fact
into account has resulted in many cases of "over-suctioning," which causes large
dents or scarred-down portions in the patient's skin. It must be understood that
only the layer of fat between the skin and the underlying muscle (the amount you
can pinch before surgery) can be suctioned.
The tunnels which are created throughout the area of previous fatty excess fill
with blood and body fluids thus creating the bruising and swelling which are seen
after the operation. The bruising usually subsides within one to two weeks. However,
the swelling dissipates anywhere from two weeks to three months depending on the
patient and the area treated. More Liposuction Facts...
What should I expect after surgery?
Depending upon the amount of fat removed and the location of the surgery
(doctor's office, surgical center, hospital), you may leave the doctor's office
soon after the surgery or you may spend the night in the surgical center or hospital.
Ask your doctor how long it will be before you should be able to return to your
normal level of activity or if you will need to miss work after liposuction.
The cuts where the doctor inserted the cannula may be leaky or drain fluids for
several days. In some cases, the doctor may insert a drainage tube to drain fluid
away from the wound.
You will wear special tight garments to keep your skin compressed after the
liposuction procedure. Your doctor will tell you how long to wear these, usually
for weeks. Some doctors provide these garments but others will tell you where to
purchase them before your surgery.
When the anesthesia wears off, you may have some pain. If the pain is extreme,
you should contact your physician. More Liposuction Facts...
What are the risks and concerns about Liposuction?
Although many patients have very satisfactory results, as with any operation,
certain problems may occur and it is important that you be aware of the risks
involved. The most common concern with liposuction is a patient who is unhappy with
their results. Unhappy patients generally have unrealistic expectations prior to
undergoing liposuction. Careful and accurate communication between you and your
surgeon should minimize unrealistic expectations. The following information should
provide you with enough information to help you make an informed decision about
having liposuction. Detailed information about specific complications is presented
in the following pages entitled:
- Excessive Liposuction
- Common & Minor Complications
- Rare & Severe Complications
- Drugs That Increase Bleeding
- Risks of Local Anesthesia
- Risks of General Anesthesia
- Risks of Ultrasonic Liposuction
More Liposuction Facts...
Excessive Liposuction
The three types of excessive surgery include 1) removal of an excessive volume
of fat by liposuction on a single day, 2) liposuction of an excessive number of
body areas on the same day, 3) combinations of liposuction and other unrelated
surgical procedures which involves excessive surgical trauma and prolonged exposure
to general anesthesia. More Liposuction Facts...
Common & Minor Complications
Common & minor complications are conditions that do not threaten a patient's
life, normal body functions or the ability to work. These include superficial
irregularities of the skin, seromas, hematomas, focal skin necrosis, allergic
reactions to drugs, visible or disfiguring scars, discoloration of the skin,
fainting during or after surgery, temporary bruising, numbness or nerve injury,
and temporary adverse drug reactions. Most of these complications can be considered
minor, however some may become quite serious. Post-liposuction fainting the next
morning at home, especially after urinating is not rare. This can be serious if
the patient falls and experiences a head or neck injury. More Liposuction Facts...
Rare & Severe Complications
Rare & severe complications associated with liposuction include problems
with anesthesia, blood clots in the leg or lung, injury to the abdominal organs,
excessive intravenous fluids, excessive blood loss, excessive loss of body heat
(hypothermia), infections, allergic drug reactions, aspiration pneumonia
(most likely under general anesthesia),heart attack, cardiac arrest and potentially
fatal cardiac arrhythmias, permanent nerve damage. More Liposuction Facts...
Risks of Local Anesthesia
Lidocaine is the safest of local anesthetics available for liposuction. At higher
concentrations, patients might experience some toxicity. Blood concentrations of
lidocaine in excess of 12 milligrams/liter can produce serious cardiac toxicity.
The maximum recommended dosage of lidocaine for tumescent liposuction is 50 mg/kg
(50 milligrams/kilogram of patient weight). The most extraordinary aspect of the
tumescent technique is its unprecedented safety record when used as directed. Most
liposuction surgeons know that it can be dangerous to give a patient a dosage of
tumescent lidocaine that exceeds 50 mg/kg. All liposuction-related deaths have
been associated with either the use of general anesthesia, or IV sedation, or
lidocaine doses in far in excess of 75 mg/kg. The tumescent technique is dangerous
in the hands of surgeons or anesthesiologists who have not had specific training
in the technique. There has never been a reported death associated with tumescent
liposuction totally by local anesthesia. More Liposuction Facts...
Risks of General Anesthesia
General anesthesia for liposuction can be considered safe when 1) the general
anesthesia is administered by a board certified anesthesiologist, 2) liposuction is
not performed with other unrelated surgical procedures, and 3) there is no excessive
liposuction. The most dangerous aspects of general anesthesia are respiratory
depression and impairment of protective airway reflexes. The risks of general
anesthesia include human error, unsuspected inherited hypersensitivity to anesthetic
drugs, accidental overdose of anesthesia, any undetected airway disconnection or
airway blockage. General anesthesia, which increases the risk of vomiting and
impairs protective airway reflexes, can cause aspiration of stomach contents.
Because general anesthesia impairs the ability to breathe, when a complication does
occur it can lead to disaster.
Drugs That Increase Bleeding if taken by a patient soon before having
liposuction, can cause liposuction complications such a hematoma (a large collection
of blood trapped beneath the skin), excessive bleeding that might require
hospitalization. Among the more common drugs that can interfere with normal clotting
of blood are aspirin, ibuprofen (Motrin, Advil), and warfarin (Coumadin). Even
vitamin E, red wine, and some herbal remedies can cause prolonged bleeding.
Results vary among patients but the majority of patients are happy and enjoy the
improved quality of life. This information is provided to acquaint you with the
risks as well as the benefits associated with this procedure. Of course, it is not
possible to advise you of every conceivable complication and other problems can
occur which are unexpected. It should be noted that the complications associated
with this procedure are frequently related to the amount of fat removed from the
patient and the patient's age. More Liposuction Facts...
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Disclaimer:
This information is intended only as an introduction to this procedure.
This information should not be used to determine whether you will
have the procedure performed nor does it guarantee results of your
elective surgery. Further details regarding surgical standards and
procedures should be discussed with your physician
By OnlineSurgery Staff
Updated: May 18, 2007
Cosmetic/Plastic Surgery
