Liposuction is a minimally invasive surgical procedure
that employs a vacuum to reshape certain areas of localized
accumulations of fat. A cannula (hollow tube) is attached to a vacuum pump,
inserted through a small incision and used to remove fat to shape an area. The
overlying skin must be elastic enough that
it will retract or shrink to leave an attractive contour. Liposuction
alone is most effective for more minor “figure faults” or localized fat deposits.
While it is a minimally invasive procedure it is a real surgical procedure
with all the potential risks of any surgery.
Traditional liposuction relates to the actual technique of vacuuming
excess fat. However, now a variety of devices have been introduced,
used and many discarded.
In the following discussion we have included
these variations, and have attempted to put these techniques into
OUR APPROACH TO LIPOSUCTION
- Consultation by THE SURGEON provides a complete evaluation, recommendations
and thorough explanation of proposed treatment.
- It is of utmost importance to understand whether you are
a good candidate for liposuction alone or whether you would be better served
by a tummy tuck.
- Liposuction is performed at a surgical hospital or our AAAASF-accredited
office surgical facility, depending on patient's preference, extent of surgery
to be done and other medical considerations. Most liposuction surgeries are
- Liposuction can be performed under either twilight sleep or general
anesthesia– the specific type of anesthesia that is best for you
is determined by your preferences, extent of surgery to be done and medical
considerations. The anesthetic choice is a combined decision made by you,
your surgeon and the anesthesia provider (see Promises and
Pitfalls: Anesthesia »).
- Procedure is reserved for patients within 20% of their
ideal body weight with adequate skin elasticity.
- We typically use a superwet technique (form of tumescent liposuction) where
fluid with local anesthetic and epinephrine (adrenaline) is place into the
tissues to plump them up and prevent bleeding and bruising.
- We use a variety of liposuction techniques. Our primary technique
assisted liposuction which is a variant of traditional liposuction
but incorporates a reticulating cannula that efficiently and effectively
promotes fat removal.
OVERVIEW OF LIPOSUCTION:
Wetting Solutions - Originally, liposuction was done
“dry” - a vacuum was applied to fat that was not prepared in any way. This
led to excessive swelling, bruising and unacceptable blood loss that limited
the amount of fat that could be removed.
In the mid-1980’s a technique
termed tumescent liposuction was described in which a dilute
solution of local anesthetic and epinephrine (adrenaline) is injected into
the area to be liposuctioned. This allowed fat to be suctioned away with a
minimal amount of blood loss, less bruising and swelling. However the downside
was that it required the infiltration of three times as much fluid as what
was anticipated to be removed (fat and fluid). This could be a very large amount
of fluid that tended to distort the area to be suctioned leading to contour
irregularities and cause fluid overloading in patient susceptible to this.
Fluid overloading is potentially life threatening. This technique is
used primarily by dermatologists and other practitioners who do small volume
liposuction often under local anesthesia only.
In response to the downsides of the tumescent technique, variations on this
technique were developed. These were called Wet and Superwet
techniques, where a much smaller amount of fluid, 1:1 and 2:1 respectfully,
(and still containing local anesthetic and epinephrine) were injected into
the area to be suctioned. This decreased or eliminated the distortion of the
tissues so a better contouring could be achieved while still minimizing bleeding
and swelling. Superwet infiltration is generally safer than tumescent liposuction,
due to the lower risk of fluid overload. Yet it is effective enough to
permit liposuction to done comfortably with intravenous sedation (twilight
sleep) in the appropriately selected patient.
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LIPOSUCTION DEVICES -
TRADITIONAL LIPOSCUTION: A hollow
metal tube known as a cannula which has one or more holes at one end and a
vacuum (negative pressure) applied at the other is used to literally vacuum
away fat. The suction is the mechanism for removing the fat. Most other types
of liposuction utilize traditional liposuction to some degree as part of its
POWER-ASSISTED LIPOSUCTION: a device
that moves the cannula in and out over a very short distance (about ¼ inch)
very rapidly. It is a simple variation on traditional liposuction but seems
to be somewhat more efficient and permits liposuction in more fibrous areas
such as the breast, the back and in previously treated areas. It has the advantage
of being less expensive with no added risk and no increase in operation time.
It is a very effective method of body contouring, which has been found to make
the procedure easier for the surgeon; that is its main advantage. Since
it's better for the surgeon it leads to a better result for the patient.
SAFE-LIPO: This is a pretreatment procedure that we have incorporated into our approach to liposuciton. The safe liposuction cannula, which has a flared (widened) tip is use for pretreatment of the areas to be suctioned. The safe-lipo cannula is used with the PAL device without suction. Once the area is pretreated, next the standard cannula is used with suction to remove the fat. This pretreatment facilitates removing the excess fat and producing smother contours.
ULTRASONIC LIPOSUCTION: Involves
the use of ultrasound waves to break up the fat prior to its removal. This
high tech method is effective for treatment in more fibrous areas such as the
male breast tissue and some areas of the back. It may also improve skin shrinkage.
In general though, it appears to have little significant advantage over conventional
liposuction in most areas of liposuction. It does have certain disadvantages:
increased expense and operating time, requires general anesthesia, and increased
complications, which include skin burns, fluid accumulation (seromas) and chronic
burning pain. We have chosen not to use this method of liposuction in most
LASER ASSISTED LIPOSUCTION: Sometimes called Smart
Lipo, Cool Lipo, etc., this method uses a laser wand introduced into the area to be treated
to allegedly "melt" the
fat which is then removed with conventional liposuction. This technology has
been marketed as better than traditional liposuction. The major advantage hyped
is that it tightens the skin. However, there are no good studies to substantiate
this claim. Manufacturers of various laser-assisted liposuction devices have
been very successful in marketing and created a “buzz” regarding this technique.
Often 'before and after pictures' are the primary means of marketing to the
public. Many of the same photos are seen in multiple contexts: on manufacturer
websites, on individual physician websites and in advertisements. We have
no experience with this device but are not impressed with the available studies
regarding this technique. Therefore, we do not offer laser-assisted liposuction.
Cosmetic Surgery: Promises and Pitfalls™
is a contouring procedure and not a weight loss method.
At our practice, the type of anesthesia, the
surgical facility and
type of liposuction used are individualized for each
- Realistic expectations: It's important
the patient has realistic expectations regarding the
results of liposuction.
- Goals: Liposuction is not a treatment
for obesity. The procedure is recommended for patients
of normal weight who have localized fat deposits that
are resistant to diet and exercise.
- Results: Final result
depends on patient selection, surgical technique, etc.,
making selection of a qualified surgeon is critical.
Consider the surgeon's credentials, facility, experience,
reputation, etc. Second opinions are helpful when considering
elective surgery (see Promises
and Pitfalls: Office Surgery ») and (Promises
and Pitfalls: Credentials »).
- Risks: Though a relatively simple
and safe procedure, when properly performed by qualified
surgeons, this is invasive surgery and has certain
- Safety: Because
it is relatively simple in concept and can be done
in any medical office with inexpensive instrumentation,
it may be offered by physicians unqualified as surgeons. Recent
economic pressures have increased the number of minimally
trained physicians doing office liposuction. (see Promises
and Pitfalls: Credentials »)..
- Anesthesia: Anesthesia
for liposuction varies from local only to general
local anesthesia is used due to lack of hospital privileges
of the practitioner, lack of availability of
an anesthesia provider, or simple for economy. Local
anesthesia alone may be a painful experience for the
patient. (see Promises
and Pitfalls: Credentials »)..
- Technology: Many
different methods of liposuction are marketed to
the public with promises of special benefits. Method
used is the decision of the surgeon and should be
discussed in the consultation. Hence, the selection
of a qualified surgeon is of utmost importance.
- Liposuction is serious surgery
and it should only be done when a patient understands
the risks. There is more risk of complications with
multiple procedures and with longer anesthetic time.
Contouring Page »
Promises and Pitfalls Information »