Liposuction

Liposculpture is a technique used to restore or improve facial and body contouring by removing localized fat deposits with small blunt-tipped cannulas connected in a suction device. This procedure can be associated with injections of the removed autologous adipose tissue where needed. It is also named as liposuction, lipoplasty, suction lipectomy or suction-assisted fat removal. Liposculpture is essentially used for body contouring for aesthetic and reconstructive purposes by the removal of fatty deposits with or without re-injection of the removed fat. The technique was described for the treatment of localized fat deposits that may not have responded to efforts of weight loss through exercise and dieting. It is important to stress, however, that liposuction is not a weight-loss method.

Adipose tissue is composed by fat cells organized in lobules. These cells increase in number along childhood and adolescence. The number of cells is constant along adult life. The accumulation of fat occurs by the increase in deposition of the intracellular lipid. Adipose tissue is divided in two layers: the superficial layer and the deep layer. The accumulation of fat occurs in the adipose tissue of the deep layer. Men present with the androgenic pattern when fat deposits will occur in the abdomen and dorsal regions. On the other hand, women present with the gynecoid pattern when fat accumulation occurs in thighs and ankles.

Patients submitting to liposculpture should present with good skin elasticity with no flaccidness or a less elastic skin, as skin in this condition does not tighten so readily around the newly contoured shape. The main indications include fat deposits in the abdomen, fl anks, ankles, thighs, calves, buttocks, back of the arms, neck or elsewhere.

The main indications are; liposuction of gynecomastia, liposuction of the jaw and neck area in the facelift, abdominoplasty with liposuction of the flanks and to reduce ‘dog ears’, liposuction prior to lipoabdominoplasty, liposuction prior to the lifting of the thighs and arms. Liposuction techniques are also indicated for reconstructive purposes.

Materials Used To Perform Liposuction And Surgical Techniques;

Preparation of the adipose tissue is also known as ‘injection of the liposuction fluid’. This determines the amount of fat to be aspirated, the amount of blood loss during the procedure and has a role on some postoperative complications.

Liposuction can be performed using many different techniques and the mechanisms by which the cannulas work are also varied. These are syringe liposuction, suction-assisted liposuction (cannula attached to a vacuum device), power-assisted liposuction, ultrasound-assisted liposuction, laser-assisted liposuction and external ultrasound-assisted liposuction.

Syringe and suction-assisted liposculpture are the most commonly used methods of liposuction. In these techniques localized fat deposits are removed via a small cannula, which is inserted into a previously marked treatment region through a stab incision and attached to a syringe or a vacuum device.

At the time of surgical planning it is important to verify which areas are to be treated. It is possible to treat a number of regions including: Abdomen, waist, back, posterior thoracic region, flanks, culottes, internal region of thighs, knees and legs.

After removal of the desired fat volume, incisions are closed with suture and an adhesive bandage is applied over each incision. At the end of the procedure a compression garment is applied over all of the treated areas. This garment should be used for 30 days to reduce postoperative swelling and distortions, allowing the skin to adhere to its new position.

VASERlipo^® Ultrasonic System;

Ultrasound-assisted liposuction is also named ultrasonic liposuction. In this technique fat is removed via a special cannula linked in an ultrasound device that transmits vibrations to the treatment region. I use VASERlipo^® ultrasonic system in my practice. The area is filled with a medicated solution and fat cells are removed from the body through a gentle suction process after ultrasound energy is given. The vibrations rupture the walls of the fat cells, liquefying the adipose tissue and making it easier to remove. Afterwards, suction-assisted liposuction is performed to remove the liquefied adipose tissue. Nearby tissues are left intact, with less pain and quick recovery.

Renuvion J-Plasma Technology;

I also perform J-plasma Renuvion in liposuction. This is an electrosurgical unit delivering a helium plasma and energy of radiofrequency to contract tissues gently under control. This is a fast, minimally invasive procedure with less risk, faster recovery time with less scars. While enhancing retraction of skin, swelling, discomfort, pain can be seen less than other methods. It can be performed to multiple areas in one prodecure.  Results may be seen as earlier and improves in time. Also complications are less compared to more invasive surgeries.

Other Techniques;

Power-assisted liposuction was developed to reduce both trauma to nerves and vessels, and surgeon fatigue. In this technique a special cannula is connected to a device that produces mechanized movements so that the surgeon does not need to move the cannula manually. This device can be powered electrically or by compressed air. Laser-assisted liposuction works in a similar way to ultrasound assisted liposuction. External ultrasound-assisted liposuction has been described to facilitate fat emulsification, making suction removal easier.

Results;

Patients with localized fat deposits (not obese) observe excellent longterm results with a significant improvement in body contour. It is important to stress that liposuction is not an alternative to exercise and diet. Patients should thereafter control their weight to guarantee the best surgical results.

Complications;

Complications of liposuction can be minimized by correct selection of the technique to be used, proper preoperative planning regarding the site and volume of fat to be removed, and attention to the principles of the surgical technique.

Systemic complications:

Pulmonary embolism,

The most common serious complication of liposuction technique is pulmonary embolism as a result of blood flow decrease to the lower extremity, trauma and hypercoagulability. The two former factors occur during liposculpture because of the patient’s position during surgery and the duration of the procedure. Hypercoagulability can also occur in patients who present with this condition or when patients are on medications such as birth control pills. Prevention can be achieved with the use of compressive stockings, compressive devices for the lower limbs and low-molecular-weight heparin.

Fat embolism,

It has been reported that clinical fat embolism can occur frequently in liposuction

Abdominal perforation,

This usually occurs during liposuction but the abdominal wall can also be perforated during fluid infiltration. As the cannula is moved back and forth, the risk of visceral perforation should always be considered.

Lidocaine toxicity,

Lidocaine toxicity occurs when the serum level of this medication is above. A relevant fact is that lidocaine, when injected into the subcutaneous tissue, has a serum peak of 6–8 hours after the injection. High serum levels of lidocaine can lead to seizures, coma and cardiac arrest.

Infection,

Localized infection is not rare in patients who have undergone liposuction, especially in those who return to daily activities prematurely. The main concern in these cases is that skin retraction and subcutaneous atrophy may occur.

Toxic shock syndrome,

It is a life-threatening complication and is the result of a toxin produced by Staphylococcus aureus. The initial symptoms and signs are non-specific, such as high temperature, diarrhea and vomiting. When hypotension, cutaneous rash and oliguria occur, diagnosis of this syndrome should be considered.

Other systemic complications,

Excessive bleeding, local irregularities, persistent edema, induration, and fat necrosos, vasculopathy, hyperpigmentation, third space fluids shifts and hemorrhage.

Local complications,

Local complications are more frequent than the systemic ones and some of them could be avoided or the effects minimized.

Edema, ecchymosis and seroma,

Edema, ecchymosis and seroma at the aspirated areas are common events and can occur in almost every surgical procedure. The effects usually disappear 2–3 weeks after surgery. Although rare, prolonged edema and induration can last for up to 1 year. Manual lymphatic drainage ( massage) and the use of a compressive dressing are adjuvant postoperative care procedures that can minimize edema and pain.

Liponecrosis and pseudocysts,

Liponecrosis and pseudocyst formation are complications that can occur when the volume of fat injected into one site exceeds. These complications can be avoided with the injection of a small amount of fat graft through multiple tunnels.

Depressions or irregularities,

Depressions or irregularities in the liposuctioned area may also occur after any treatment. These deformities can be treated with fat injection. These complications can occur when patients have excess skin and also if aggressive superficial liposuction is carried out.

Safe Limits;

It is known that if a large volume of fat is injected into one area there is a greater possibility of fat necrosis and fat-graft reabsorption and oily cysts may form. Also, calcification may occur with time. The risks associated with the procedure increase when a large volume of fat is aspirated. Larger volume removal should be performed by a well-trained team.

Aftercare;

The patient is monitored for 24 h after the operation, during which time he or she should move about as much as possible (1 h lying down, 20 min walking up and down in the room so that the fluid drains.

1st postoperative day the entire dressing is changed and a compression girdle is fitted before counteracts swelling and pain and to help adapt the skin to the changed contours of the body. This compression girdle also encourages the skin to tighten and should be worn for at least 4 weeks after the operation.

Two weeks after the operation the skin can be treated with moisturizing body lotion, massaged gently on a daily basis into the areas of skin treated.

Physical exertion, sport, and exposure to direct sunlight are permitted after 4 weeks.

We recommend training in the gym after liposuction. Ultimate body goal can normally only be achieved by liposuction in combination with strenuous physical training, not by liposuction alone.

With the help of liposuction, fat cells are permanently removed. Since the fat cells do not grow back, liposuction treatment produces a permanent effect.

The results of the operation are dependent on the patient’s general health, the condition of the skin, the patient’s age and weight, and the hormonal content of the body, among other things.

In particular, significant weight gain caused by nutrition will result in the layer of adipose tissue increasing again even in the treated area, as the remaining fat cells will fill out.

Occasionally, wavelike unevenness or dimples become visible on the surface of the skin, but these usually reduce again within 6 months.

Manual lymphatic drainage massage is recommended for a month, twice weekly in the post-op period.