Liposuction

There have been and undoubtedly will be written many articles on this theme and therefore I would like to rectify some facts. I will try to set an overview of this topic for a laic public and to contribute to get rid of some myths.

Introduction

Liposuction is not a weight-loss method, i.e. it is not a method for loosing weight. In English there is a suitable term – body contouring. Liposuction is therefore more suitable for people with skin body, when only smaller, localized excesses of fat are removed.

Another condition for successful liposuction is a good skin elasticity that reduces with age though. In general, the age limit to perform liposuction is around 35-40 years. The indication in people above this border is individual.

There are areas that are not at all recommended for liposuction. Those are so-called forbidden areas, such as lower half of buttocks. Some areas are not strictly forbidden, although they are not recommended for liposuction according to anatomical localization, e.g. area of back. Areas that are also not recommended for liposuction are those with skin excess, or with overhang.

Wearing bandage underwear after liposuction is natural. The time to wear it depends on the localization, the amount of removed fat and the skin quality.

Liposuction instruments

There are several types of liposuction techniques depending on used instruments. Today there are available various types of devices. Liposuction cannulas of various shape, length and diameter form a part of every instrumentarium.

Classic liposuction – liposuction is performed only through vacuum pump, to which a cannula is connected with special tube.
Vibration liposuction – the difference from the above mentioned liposuction is that the cannula is connected to a special device that vibrates the cannula so it mainly helps the surgeon physically.
UAL liposuction – UAL simply breaks fat cells
Laser liposuction – laser works similar to UAL

Each above mentioned method has its advantages and disadvantages. The newest modern technique does not have to present always the best solution. The result of the surgery always depends mainly on the surgeon’s skills and experiences with the specific liposuction technique.

Method

Liposuction is performed through so-called dry and wet (tumescent) method.

Dry method – the fatty area that is to be removed is not injected with any solution before the liposuction. That’s why it is logical that the surgery has to be performed under general anesthesia.
Wet method – the area is injected with special solution that helps the fat to be removed more easily.
1. If a local anesthetic is added into the solution, the surgery might be performed as an out-patient procedure, without general anesthesia. It is always necessary to respect possible maximum dosage of local anesthetic (depending on the concentration – the solution) to prevent intoxication of organism. A good guide is expected total amount of the solution with added anesthetic, which should be injected into the fatty area for liposuction.
  Another risk apart from intoxication during large liposuction is a collapse from the loss of bigger amount of liquids. We therefore recommend to perform liposuction as an out-patient procedure only to a certain extent or to separate large liposuction to several out-patient sessions.
2. In larger liposuctions, when we expect larger amounts of fat removed or when we plan to suck more places, or combination of both, we recommend to perform the procedure under general anesthesia through wet technique. It is very simple to watch the patient’s state, to make up the losses of liquids with infusions and to moderate pain. One day stay in hospital with following approximately 2-4 days stay at home is sufficient after the surgery.

Specific area is abdomen where there are relatively strong sensitive nerves coming from the rectus abdominis muscle for innervation of skin of the abdomen. It is essential to be aware that during liposuction under local anesthesia we do not suck only fat but also local anesthetic. The patient can therefore feel strong or uncomfortable pain at the end of the surgery. Moreover we pull on above mentioned nerves through the cannula that cannot be numbed during their passage in the muscles, so the pain might be really very uncomfortable.

Anesthesia

Local = smaller extent, less localizations = out-patient procedure = tumescent liposuction
= greater extent, more localizations = out-patient procedure = more sessions = tumescent liposuction
General = greater extent, more localizations = stay in hospital = dry method
= wet method = tumescent liposuction
= abdomen = stay in hospital = wet method = tumescent liposuction

Conclusion

From experiences that I have gained during my specialization I would like to mention so-called "inflation" of removed fat. Many clients like the fact that several hundreds of milliliters or even few liters of fat were removed. Often they don’t even think about the absurdity of these numbers. Regardless the amount of sucked fat the final effect is obviously more important.

Also one of the oldest rules in plastic surgery is valid, which says that less means often more. It is better to remove the fat twice than to suck too much for the first time. Places with insufficient amount of subcutaneous fat are almost incapable or only partially and imperfectly correctible.

Many clients like the information that during the surgery under local anesthesia the surgeon can have them stand up. He/she can see where it is necessary to continue with liposuction and where not and if everything is symmetric. Such image is very effective. Liposuction can be very well evaluated by touching, when we examine the height of fat layer between two fingers. Through such method we can set symmetry and also we don’t have to be afraid of patient collapsing. Not every patient is able to remain blood circulation on sufficient level of blood pressure.

At the end I recommend to all potential patients for liposuction to trust only experienced, certified plastic surgeons. The consultation can help and it is worth to visit several offices. Even desired liposuction does not have to be the right solution of a problem and another type of procedure can be recommended during the consultation.