Liposuction
Indications
Liposuction removes unwanted fat deposits. It is most ideally
indicated for treating localised fat deposits. Liposuction
is not a treatment for obesity and most believe it is not
a treatment for cellulite.
Anaesthetic
- Small areas: local anaesthesia; large/multiple sites requires
a general anaesthetic.
Technique
Liposuction involves inserting a narrow metal tube into
a fatty area via a small stab incision. Suction from a pump
or syringe is applied to the tube, which is moved backwards
and forwards within the fatty area. The suction removes
fat; largely leaving other structures intact. Following
fat removal the overlying skin retracts to produce the desired
improvement in contour.
There are some variations in the technique used; most surgeons
inject some fluid before liposuction. The amount of fluid
varies and this gives different names to the procedure;
ie “wet”, “superwet” and “tumescent”
- each reflecting increasing amounts amount fluid injected.
The fluid consists of salt water, adrenaline and local anaesthetic
- using fluid reduces the amount of blood loss and has allowed
larger amounts of fat to be safely removed.
Ultrasound assisted liposuction is a newer technique which
may be advantageous in some areas. A special ultrasound
probe is used; the ultrasound energy liquifies fat and this
removed by suction.
Multiple stab incisions may be needed; these are usually
inconspicuous when they heal.
Length
of operation - varies depending upon the
amount of liposuction being performed.
Time
in hospital - Day-case or overnight stay.
Postoperative
discomfort/limitations
Some discomfort follows this operation; simple pain-killers
may be needed. Bruising and swelling are common. Bruising
may take 4 - 6 weeks to disappear. Swelling may take several
months to settle and the full effect of the surgery may
not been seen until this time. The treated area may also
have reduced feeling and may be numb; this may also lasts
for several months.
With the tumescent technique blood-stained fluid will leak
from the incisions for 1 - 2 days.
After liposuction a well-fitting pressure garment is usually
advised. These garments help control swelling and should
be worn for about 2 - 3 weeks.
The amount of fat that can be removed is limited by safety
considerations - less than about 3 litres is generally safe;
however more than 5 litres has significant risks and needs
very careful monitoring of the amount of fluid given to
and removed from a patient - there is a potential for life
threatening complications.
For a good result from liposuction skin needs to have good
elasticity; if this is not the case liposuction leaves skin
which is loose and unsightly. In this situation skin excision
may be recommended.
Time
off work - depends on the area treated;
small areas: one or two days; larger areas: 1 -2 weeks.
Risks
and complications
General anaesthesia is safe; but in a tiny proportion caries
a very small risk.
Serious complications are uncommon; liposuction compares
well to other cosmetic operations. General complications:
bruising and swelling; excessive blood loss; chest and wound
infections, unsatisfactory scarring (keloid or hypertrophic).
Leg vein thrombosis (clot); part of the clot may break off
and gets lodged in the lung (pulmonary embolism).
Specific complications: contour irregularities; dimpling
and depressions; visible waviness and ridging on the surface;
asymmetry; massive areas of skin loss due to an aggressive
wound infection is a potentially disastrous and lethal complication,
which fortunately is rare.
Ultrasound assisted liposuction has some specific complications,
including heat damage to the skin, skin darkening, unpleasant
burning sensations and collection of areas of fluid (seroma)
in the areas treated.
Outcome
5 - 15% of patients who have undergone liposuction will
undergo secondary procedures to correct contour deformities
and to treat further areas.
About three-quarters of patients are entirely satisfied;
but only 5% were completely dissatisfied.
