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Liposuction will reduce excessively stubborn localised fatty areas where dieting and exercise have failed. These areas are usually genetically determined areas of accumulated fat cells.
Liposuction can also be used in combination with other procedures such as abdominoplasty (tummy tuck) where specific fatty areas can also be contoured. Facelift can also be improved by liposuction by removing fat from under the chin and neck and to enhance the jawline.
- Good health
- The deformity or fatty bulge is localised
- The deformity has not responded to a strict regime of diet, exercise and weight loss
- Good skin tone, with little or no tendency to sagginess
- Generally patients under forty years of age (not absolute)
- Little or no cellulite
- Few or no stretch marks
- Have realistic expectations about result
The best liposuction candidates tend to get the best results. During your consultation your surgeonwill discuss with you the areas of concern and those factors that will influence the
outcome of liposuction surgery. It is important to have realistic expectations as to the
outcome of your surgery.
As with any cosmetic surgery it is important to have clear objectives and realistic
expectations.
Unrealistic Expectations
- Minor deformity to be corrected by major surgical procedure
- Understand that liposuction is not a cure for obesity or a substitute for weight loss
- Wants to have liposuction for themself, not to please someone else
- Don't expect liposuction to change their personal or professional lives dramatically
P lease remember liposuction is not a substitute for weight loss or a cure of obesity. The
following diagrams show suitable areas for liposuction.
A small incision is made in the skin for each area to be treated. A narrow metal tube
(cannula) is inserted through the incision into the fatty area and by working the tube back
and forth, the fat is shaved off in tunnels and evacuated through attached tubing to a suction machine or suction syringe. The suctioned tunnels and spaces are then collapsed by the use
of a compression garment to create the new contour.
Muscle layer.
The fat is shaved off and suctioned into the Cannula.
Tunnels created in fat layer by liposuction cannula
Compression is applied
to collapse tunnels and allow these to heal
T he Tumescent technique (or wet method) involves the injection into the tissues prior to commencing liposuction. A solution of saline, local anaesthetic and vasoconstrictor agents
has been found to increase the amount of fat removed and decrease the amount of post-operative bruising.
This technique uses ultrasonic waves produced by a generator and introduced into the
tissues
by a small incision to disrupt the fat cells (Lipocytes) and release the fat. The free
fat is then removed from the tissues by use of an aspiration cannula in much the same way
as regular liposuction (known as Suction Assisted Liposculpture or SAL). Ultrosonic Assisted Liposculpture (UAL) facilitates removal of fat from areas previously inaccessible by SAL and
by making the procedure less physically strenuous for the surgeon. It allows greater
volumes of fat to be removed than was previously the case. UAL has specific indications
and the relative merits of
the two techniques will be covered in your consultation with your surgeon.
This procedure has been such an advance in surgery because it can alter the body contour significantly with minimal scarring. Generally there are one or two incisions less than 1cm
long
for each area treated. Given time the scars will fade. As far as possible, the tiny skin incisions
are placed in the natural body creases and folds.
The effects of liposuction are permanent. This procedure sculpts away a number of fat cells
from a particular region and the remaining fat cells do not multiply to take their place. Consequently, once the operation has been performed to change the body shape, the
proportions remain the same even if there is weight gain subsequently.
Gaining weight after surgery may adversely affect the result. If you do gain weight, you will
tend to gain it more uniformly, and not just at the former bulges. With weight gain, the
remaining fat cells swell, but no new fat cells are created. With weight loss, those remaining
fat cells shrink.
Cellulite
This uneven skin texture appears to be due to bands of fibrous tissue pulling on the skin so
that fat accumulation is not even. This surface irregularity can not be camouflaged when the overlying skin is thin as is the case in many women. Liposuction alone cannot improve this, although there are additional techniques which are sometimes used with limited success -
please ask your surgeon for additional information. In short, “cellulite” is a name given to
what is nothing more than the normal female appearance of the subcutaneous fat. Cellulite
is not a disease entity in itself.
A number of areas can be treated at the same time. Between two and three litres of
fat can
be aspirated without a need for a blood transfusion. If more than this volume
needs to be aspirated, then the suction of fat is undertaken in two separate procedures.
It is best to avoid transfusion in any cosmetic procedure. A routine blood check is normally undertaken to assess what volume of fat can be removed without transfusion. However,
your surgeon may suggest
that you give your own blood so that this can be given back if
larger volumes of fat are to be aspirated.
Your surgeon will discuss carefully with you the suitability of the procedure for the various
areas
of concern to you. Your surgeon will normally take "before" photos of the areas to be treated
to help judge the final results. Prior to surgery you should not participate in any strenuous
activity or consume alcohol. On the day prior to surgery you should eat a light diet and
increase fluid intake. Showering with antiseptic soap is necessary the evening prior to surgery
and again on the morning of the operation.
If a girdle is considered necessary, we will arrange its purchase for you and will ensure its
delivery to the hospital. Two girdles will be necessary as they must be worn continuously
for up to six weeks after the operation.
Prior to the anaesthetic the areas to be treated will be "marked" with the patient in a
standing position to more accurately locate where the liposuction is to be applied. Occasionally some shaving of the upper pubic hair may be necessary for liposuction to the abdomen.
A careful contour diagram is developed on the areas to be treated as the shape and position
of the troublesome fatty deposits changes when the patient is asleep and lying down.
The operation is performed either under a local anaesthetic (for smaller areas) or
under general anaesthetic in a hospital or day surgery centre. The surgery is performed through
a tiny incision as previously described. The suction cannula is worked evenly
under the skin
over the area to be sculpted. Care is taken to make sure that the suction
is as smooth as possible to avoid uneven contours. The operation can take from 30 minutes
to several hours.
For each area treated the patient has to be specifically positioned and the operative site prepared. Therefore, when multiple areas are treated, it involves a series of procedures and repositionings. The length of time of the operation is therefore proportional to the number of areas treated.
When fat tissue is suctioned from under the skin, it leaves small tunnels and empty pockets.
The purpose of a compressive dressing or girdle is to collapse these spaces to allow healing
to take place.
The area treated with liposuction may be strapped with elastic tape or a girdle will be
applied.
This will minimise bruising and swelling and provide a degree of support for the skin which will
be relatively loose after the operation, particularly when the swelling settles down. The elasticised material of the girdle helps to keep even pressure on the areas treated, minimise bruising and swelling and "even out the skin". This process will help the skin to redistribute itself more evenly and minimises the risk of skin sagging and irregularities.
Bruising and Swelling
Following surgery you may be quite bruised and the areas can be discoloured and even
purple. Your surgeon can show you representative photographs of the healing process and
the time
taken for the result to develop.
There can be swelling of the ankles, particularly if liposuction has been carried out in the abdomen or legs and a girdle is worn. This can be aggravated by hot weather. Minimise
standing if there is swelling of the ankles and elevate your legs on a foot stool when sitting.
The bruising tends to track down the leg or the abdomen and in some cases the patient can experience some swelling of the labia or scrotum.
The bruising usually starts to settle after a week and is usually well faded by two weeks. It
may, however, take six weeks for all the bruising to resolve. When a figure fault is sculpted
away, the fullness in the area is temporarily replaced by swelling which resolves slowly. It is understandable, therefore, that the patient may underestimate the improvement in the first
few weeks and wonder if the operation has been successful.
The fat cells that are suctioned away are gone forever and when the swelling settles the result
will be noticeable particularly in previously tight clothing.
The amount of pain felt varies from individual to individual, depending on one's pain
threshold. Generally, areas treated with liposuction are tender to pressure, but there is
usually no excruciating pain when resting or in bed.
There may be a feeling of stiffness when moving about, but most of the pain subsides after
a few days. It is not a particularly painful operation as the muscles are not disturbed except
when suction is performed on large areas of the abdomen. It is then sometimes painful to sit
up for the first few days. It is our impression that ultra sound assisted liposculpture (UAL) is attended by more pain and discomfort in the postoperative period than is suction assisted lipectomy (SAL). There is no scientific basis for this observation, but it appears to be so. It is
our impression that the results obtained from UAL (where indicated) justify this increased discomfort.
CALL Your surgeon IF YOU EXPERIENCE THE FOLLOWING:
- Excessive pain or bleeding
- Abnormal swelling
- Fever during the first 24 hours following discharge from hospital
- Concerns about your post-operative recovery
The girdle is normally worn continuously for one week. You should then attend your
surgeon's clinic for follow up where his staff will give you specific instructions regarding
further use. The incisions for this operation are usually small and there are not many
sutures to be removed.
The girdle is reapplied after the first visit and then worn as much as possible to help the skin "even out" when it is settling for the next five to six weeks. It can be removed to shower after
the first week. You can usually wear normal clothing over this elasticised garment.
This varies with the number of areas treated and the nature of your work. If a single area
is treated, you may be allowed to return to sedentary work within a few days.
However, liposuction of specific areas such as the ankles might need more bed rest and if
your occupation involves a lot of standing, it may be two or three weeks before you can
return to all normal duties.
Again this depends on the areas treated and the type of exercise. However, we encourage immediate mobilisation following surgery as we believe this speeds up the resolution of the postoperative swelling.
Return to exercise will be a gradual process, beginning with slow walks to encourage
circulation and aid healing, progressing to normal activities over a relatively short time.
There are few complications. Like any surgical procedure, there is a small risk attached
to
the anaesthetic.
Specific complications include:-
• Lumpiness
For one week or two following the operation the areas treated may feel a bit lumpy as
the
tissues under the skin are starting to heal. This should be of no concern as it always resolves
by six weeks. Your surgeon may suggest that gentle massage with a body lotion
will help expedite the resolution of the lumpiness and occasionally ultrasound treatment
which gently massages the deeper tissues may be prescribed.
• Skin Laxity, Waviness or Dimpling
If the skin elasticity is not good or if a large volume of fat is removed from one area
there
may be some laxity or waviness of the skin. This is more common in older patients.
• Minor Depressions
Depressions or hollows can occur. These are different to dimpling found with skin laxity. Occasionally small areas can be over treated, but it is possible to reinject fat into these
areas after adequate time has been allowed for settling.
• Numbness
The area treated may feel “numb” when the initial tenderness has settled down. This is
because the fine nerve endings of the skin are temporarily bruised, but the feeling usually
returns to normal within a few weeks.
• Asymmetries
People are rarely symmetrical from side to side. Frequently more fat will need to be
removed
from one side compared with the other. However, a degree of asymmetry can
remain after surgery, even with careful pre-operative planning and marking.
• Infection
Is a rare complication of liposuction. Antiseptic showers prior to surgery along with
operative
and post-operative antibiotics will help to minimise this problem. However, if
redness, increasing tenderness or fever develops report this immediately to your surgeon.
• Skin Loss
Can very rarely occur, but it's more commonly associated with infection. It is also more
likely
to occur where the area suction is quite thin.
• Scarring
The small incisions are hidden as far as possible in the skin creases and fade quickly.
However, areas in the groin and lower limb where it is not possible to “hide” the scars
easily will remain blue-purple in colour and noticeable for many months. These will
eventually fade.
• Pigmentation of the Skin
After the bruising has resolved, slight “staining” or pigmentation of the skin can remain on
rare occasions. The main area affected is the inner thighs but occasionally other areas can
be affected. It takes many months for this to fade but very occasionally it can remain as a permanent problem.
• DVT and PE
Deep vein thrombosis means clotting of blood in the large veins of the leg. This is a very
rare complication of any operation, but is more common after procedures where there is
lengthy immobilisation. Although this is extremely rare, it is important to report related
symptoms to
your surgeon. These include swelling of the leg, tenderness of the calf with
redness and local heat. If this problem is left untreated clots can break off in the large veins
and lodge in the lung (pulmonary embolus – PE).
Please report any suspicious symptoms to your doctor.
Follow up visits allow your surgeon to continue to monitor your progress. "After" photos
may be taken. In some cases, doctor may discuss with you the advisability of a touch up procedure to refine the final result.
The costs of this surgery relate to:
a) surgeon and assistant surgeon
b) anaesthetist
c) hospital
d) ancillary charge (pharmacy, etc)
You must appreciate that the ultimate cost to you will depend on where you choose to go
for
your procedure and what rebates you will receive from your medical fund and Medicare. This in turn depends on whom you may be insured with and what level of insurance you
have chosen. Please advise your surgeon if your insurance has a front- end deductible cost
or "excess". With
all the relevant information, doctor's office should be able to give you a
very close
approximation of what your final costs might be.
Private insurance including Medicare may pay the cost of part of the operation, but not
the cosmetic part. If so, they would also contribute to the anaesthetic and hospital costs.
It is always preferable to arrange all your finance prior to surgery to avoid unnecessary
stress afterwards which will detract from your enjoyment of having achieved your goal.
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