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Liposuction, also known as liposculpture or suction assisted lipectomy, is a technique to remove unwanted fat deposits from the body. The unsightly distribution of body fat is usually due to an inborn tendency to deposit fat in one particular area of the body, most commonly the hips. Other areas include; the neck, arms, tummy, loins, thighs, inner side of the knees and the ankles. Lipolysis is neither a substitute for dieting nor a cure for obesity. Persons with reasonably normal weight and healthy elastic skin with extra localised fat in certain areas, get the best results from this procedure. (Healthy elastic skin has the capacity to shrink after the surgery). Even though Lipolysis can be done on patient's upto 45 or 50 years of age, it is not normally done if the skin is loose in the particular area. One could have loose skin after loosing lot of weight or after the pregnancy in the Abdomen, or one could lose the elasticity of skin due to old age or other reasons. In these patients, in addition to lipolysis, some of the skin is also removed so as to get a satisfactory contour. In these cases liposuction could be coupled with abdominoplasty or body lift in different areas either in the same sitting or as a separate operation.

The total number of fat cells present in a person’s body do not increase with age or when one gains weight. When a person gains weight the size of the fat cells increases as more and more fat is deposited in them. When one loses weight, the fat is mobilised out of the fat cells and so these cells become smaller in size. Fat cells cannot regenerate or multiply. And so, the fat cells that are removed are removed for ever.

 Areas of the body commonly treated

 

THE OPERATION

A small cut about 4 mm to 10mm is made, a few inches away from the area to be suctioned. A cannula is inserted through a this cut. It is attached to a strong vacuum pump by a transparent plastic tube. This cannula is then drawn back and forth within the area of excess fat to loosen and suck out the fat. The process removes tunnels of fat leaving the small blood vessels and nerves intact. The skin will then retract. The cuts are usually made in the skin folds and so, the scars are barely noticeable.. The removed material usually consists of 65% to 85% fat and the remainder would be blood, plasma and serum. It is safe to remove upto 5-8 percent of body fat in one sitting.

There are some minor variants in the techniques. Some surgeons inject the area to be treated with solutions (wet or tumescent technique) others do not. Suction is usually applied with a powerful vacuum machine, but it is some-times perfectly adequate to use a simple syringe for small areas. Power assisted liposuction minimizes surgeons efforts. Ultrasound assisted liposuction is another variant wherein ultrasound is used to break the fat globules which are sucked out through the tube into the vacuum machine.

This procedure is usually carried out under a general anaesthetic and will need 1days of hospital stay after the surgery depending on the area treated.

AFTER THE SURGERY

After the surgery, snug or tight dressings will be applied for 5 days to promote shrinkage of the skin and to minimise swelling. Patient should ambulate as early as possible after the surgery.

You can expect considerable bruising which will be uncomfortable and at times painful. The larger the area treated the greater it will be. The discoloration of this bruising will usually last for about a month, but the lumpiness and swelling of deep bruising can take up to months to disappea. As swelling can take a long time to settle you may not see the full benefit of the operation for 2-3 months. You can expect some numbness in the treated skin which lasts for several months.

You will have small scars 1.0 to 2.0 centimetres long at the sight of insertion of the suction cannulae. There is a small risk in some people that these scars may stay red for a while but they are usually sighted in less obvious areas. If you are having treatment to your legs you may find that your ankles are swollen for a few weeks and if your ankles themselves have been treated, they may stay swollen for a few months

RESULTS

Results depend upon the expectations of the patients and the amount of fat that is suctioned from the given area. Usually, patients with good elastic skin and who come for recontouring a particular area are very happy with the result. Older patients and over weight patients could be unhappy. Perfection and symmetry are not possible in every patient. Also in some patients, all unwanted fat cannot be removed in certain areas in the first sitting. Lipolysis may have to be repeated on these patients. But, a second lipolysis cannot be done until all the swelling is gone from that particular area (i.e. about 4 -6 weeks). On rare occasions, rippled or uneven skin or areas of loose skin could result from these surgeries, which might require further surgeries to correct them..

LIMITATIONS

It is important for you to understand that liposuction is not a treatment for obesity. The amount of fat that can be removed from a localised area is limited by what is safe-maximum of 5-8% of body weight at one sitting. Therefore it may not be possible to slim down an area as much as you might like. Further treatments may be carried out in the same area after six weeks. In certain situations the skin is inelastic and loose. Liposuction in these areas will then tend to leave the skin more loose and it may be recommended that a skin excision be carried out to correct this, either at the same time as the liposuction, or as a second procedure. This is most likely in the abdomen, after pregnancy or weight loss, the buttocks or the neck. Dimples and wrinkles of the skin, sometimes called cellulite will not be improved by liposuction.

RISKS

This operation which is done under general anaesthetic carries with it a small risk of infection and thrombosis of the veins. Heavy bruising can happen particularly in patients who have a tendency to bleed or have been taking aspirin or anti-inflammatory drugs. Serious infection is very rare, but there is sometimes inflammation in the areas that have been treated with perhaps some oozing from the incisions. It normally settles with a course of antibiotics. Thrombophlebitis (which is an inflammation of the veins and not the same as thrombosis) can occur around the inside of the knee and inner part of upper thigh when these areas have been treated. It gradually settles over a period of weeks. The surface contour over the treated areas can sometimes be irregular particularly if a lot of fat has been removed occasionally the skin appears to be tethered to the deep tissues, this is part of the bruising and will settle in time.

Types of Liposuction :

There are various techniques for doing liposuction. Some techniques are no longer considered safe (Dry Technique), and some are recognized as world-wide standards of care (Tumescent Technique).

  • 1. Tumescent Technique - The tumescent technique is a method that provides local anesthesia to large volumes of subcutaneous fat and thus permits bloodless liposuction totally by local anesthesia.
  • 2. Dry Technique - The dry technique derived its name from the fact that it did not use injections of local anesthesia into the fat before liposuction.
  • 3. Wet Technique - The wet technique required the injection of local anesthesia containing epinephrine.
  • 4. Super Wet Technique - The super wet technique requires the injection of a volume of dilute local anesthesia that is less than half the volume used for the tumescent technique.
  • 5. Ultrasonic (UAL) - Ultrasonic Assisted Liposuction (UAL) requires the use of a large volume of tumescent fluid and uses either a metal probe or metal paddle to deliver ultrasonic energy and heat into subcutaneous fat.
  • 6. Vaser Liposuction - Vaser liposuction, also called LipoSelection, is another alternate technology to traditional liposuction. Vaser ultrasonic liposuction is still a process by which fatty deposits are removed from beneath the skin to improve the aesthetics of a particular body part.
  • 7. Power Assisted Techniques (PAL) - PAL devices use power supplied by an electric motor or compressed air to produce either a rapid in-and-out movement or a spinning rotation of an attached liposuction cannula.
  • 8. Laser Liposuction - Laser Liposuction requires the use of tumescent fluid and uses a microcannula inserted through a small incision to deliver laser energy and heat into subcutanteous fat.