By Michael Huntly M.D.,F,A,C,S.
Beach weather is just around the corner and it is time to think about getting in shape. Liposuction may be the answer.
Liposuction, or lipoplasty, was first developed in France during the 1970s.The technique rapidly gained popularity and is now the most commonly performed cosmetic procedure. In principle, liposuction involves suctioning fat from under the skin through small incisions strategically placed to allow access with minimal scarring .The procedure requires hollow tubes of various lengths and diameters with various tip designs .These tubes are hand held by the surgeon and attached to a vacuum pump producing approximately one atmosphere of negative pressure. The surgeon guides the tube [or cannula] back and forth through the treated area, vacuuming out fat globules. After treatment, the appearance of the fat layer is similar to Swiss cheese, with a honey comb effect where the fat has been removed. Early cannulas were large, up to one centimeter in diameter. These cannulas rapidly removed fat, but made it difficult to achieve a smooth result. With today’s smaller cannulas and better tip designs, fat can still be removed effectively with contour irregularities less likely to occur. Ideally a layer of undisturbed fat should be left directly under the skin to achieve a smooth result .Most areas are treated from more than one direction, creating a crisscross pattern, promoting a smooth result.
A key addition to treatment is the use of pressure garments to compress the treated area after the liposuction procedure. Compression controls post operative swelling and helps remodel the fat layer during the six week healing period following surgery .I recommend using the garment 24/7 for three weeks then twelve hours per day for the second three weeks. Afterwards slimming garments or body formers available from department stores can be used as necessary.
The following major changes in liposuction technique have evolved over the past two decades.
- Tumescent liposuction
- Ultrasound-assisted liposuction
- Mechanical-assisted and Laser-assisted liposuction
Tumescent liposuction is arguably the most important of these changes. Prior to the invention of this technique, 40% of fluid suctioned from the body was blood, so blood loss was a significant limitation of the procedure. More than two liters of tissue removal could require a blood transfusion.
Tumescent liposuction involves pre-treating the area to be suctioned by injecting a salt solution containing a local anesthetic and adrenalin, a drug that constricts small blood vessels in the fat layer, reducing bleeding and bruising. Typically, surgeons inject or pump a fairly large volume of this solution into the fat layer and allow several minutes for the medication to take effect, usually evident by blanching of the skin over the treated area .Liposuction then proceeds, which removes a comparable amount of fat containing fluid .The fluid removed after tumescent liposuction contains much less blood and more fat, than prior techniques. Typically the fluid will consist of 50%-80% fat. Essentially, a volume exchange occurs during which a volume of clear fluid is injected and a similar quantity of fat- containing fluid is removed. So, overall, tumescent liposuction allows more fat removal without significant blood loss, which in turn allows more fat to be removed. Furthermore, the local anesthetic in the injected fluid, dramatically diminishes pain when the patient awakens from general anesthesia.
Initially, the patient will not see a dramatic change in shape because the fluid exchange that has occurred is approximately equal-that is the injected volume is similar to the volume of fluid removed during surgery. It is important to realize that, as in any surgery, liposuction is an injury and swelling is the body’s natural response to injury of any sort. Of course the injured areas take time to fully recover. The new body contour will emerge in four to ten weeks, as swelling decreases with the help of compression garments. Patients can resume normal exercise three to four weeks after the procedure. Importantly, patients must guard against overeating during the recovery phase, as they are less active and so may be likely to gain weight. Also, tissues retain fluid during the healing phase, much like sponges retain fluid. Lymphatic massage and ultrasound treatments can help to free and remove this retained fluid. I also recommend a low salt diet with plenty of water intake to help reduce swelling, and let’s not forget the importance of the compression garments. Patients should avoid hot baths and sunbathing during the healing phase because these activities encourage additional swelling.
Ultrasound and laser assisted liposuction are newer techniques which incorporate an energy source into the cannula. Either ultrasonic or laser energy is applied to the fat directly disrupting the fat cells and releasing fat, which is then sucked out. These techniques can make fat removal physically easier for the surgeon but they are more difficult to control. Removing too much fat can result in depressions and irregular contours. Energy applied to the under surface of the skin can result in burns with significant scarring. The margin for error is small and in my opinion, because of these issues the benefits do not outweigh the risks.
Mechanical assisted liposuction employs either an electric or air driven motor to drive the suction cannula tip. The tip of the cannula oscillates in and out, a centimeter or so depending on the instrument design. It increases the efficiency of fat removal and greatly decreases surgeon fatigue on bigger cases. The surgeon can concentrate on contouring whilst the cannula does most of the work. It is particulary useful on secondary cases where scar tissue makes fat removal more difficult. Personally I have found this technique extremely useful for patients requiring a larger volume of fat removal.