Cosmetic Surgery: Promises and Pitfalls™

Liposuction in Dallas

OUR APPROACH:

• Consultation by the surgeon provides a complete evaluation, recommendations by the surgeon and thorough explanation of proposed treatment. 
• Liposuction is performed at the hospital, surgicenter 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 outpatient procedures (see Promises and Pitfalls: Office Surgery).
• Twilight sleep or general anesthesia is used - determined by patient and surgeon discussions and agreement (see Promises and Pitfalls: Office Surgery).
• Procedure is reserved for patients within 30% of their ideal body weight with adequate skin elasticity. 
• A superwet technique is used. 
• Extensive use of the power assisted lipoplasty technology facilitates the surgeon's ability to recontour by fat removal, including areas which have been difficult or impossible using conventional liposuction techniques. 
• Careful attention is given to patient's fluid requirements and other important operative and post-operative management.

OVERVIEW:

Tumescent liposuction refers to a liposuction technique in which a large volume of fluid is injected into the area to be suctioned. This fluid is saline (salt water) containing a dilute solution of adrenalin and local anesthetic. The preparation of the tissues with this solution facilitates the fat removal, reduces bleeding and provides profound local anesthesia, eliminating the need for general anesthesia. Tumescent liposuction requires three times as much fluid being injected as what is aspirated (the fat and fluid removed). Though relatively safe, fluid overloading - which can result in congestive heart failure - has been reported as well as toxic effects of the local anesthesia.

Superwet liposuction is similar to tumescent liposuction but introduces less fluid into the area to be treated: usually a 1:1 proportion of the fluid to inject to the fat/fluid aspirated. This is generally safer than tumescent liposuction due to the lower risk of fluid overload. Yet it is effective enough to permit liposuction with intravenous sedation (twilight sleep).

Ultrasonic liposuction is a relatively new technique, which involves the use of ultrasound high frequency waves to break up the fat prior to its removal. This high tech method of liposuction is presently under investigation and shows promise for removal of male breast tissue and the more fibrous fatty tissue in some areas of the back. It appears to have little, if any, advantage over conventional liposuction in the usual liposuction patient. It does have certain added disadvantages: increased expense and operating time, requires general anesthesia, and increased complications, which include skin burns, fluid accumulation (seromas) and burning pain.

Power-assisted liposuction is similar to ultrasonic liposuction in that it permits liposuction in fibrous areas (such as the breast), in 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, and because it's better for the surgeon it leads to a better result for the patient.

Laser Lipo (Smart Lipo, Cool Lipo, etc.) is relatively new, unproven technology that uses a thin laser wand introduced under the skin to "melt" fat which is then removed with conventional liposuction. The laser has the potential problem of damaging normal tissue while offering little benefit in exchange for this increased risk. This technology is marketed as better than traditional liposuction with the major advantage hyped that it tightens the skin; there is no data to substantiate this claim. Since 'before and after pictures' used in Laser Lipo marketing show negligible results then it may be reasonable to assume that these are the best results. Many of the same photos are seen in multiple contexts: on manufacturer websites, on individual physician websites and in advertisements. We do not offer or recommend Laser Lipo.

 
What's the best liposuction procedure? Who's the best candidate for liposuction in Dallas? Here are some additional points to remember:

• It's important that the patient has realistic expectations. Liposuction will not cure obesity. The procedure is generally recommended for patients of normal weight who have localized fat deposits that have been resistant to exercise and diet. Good candidates for liposuction are the patients who are within 30 percent of their ideal body weight and have adequate skin elasticity to ensure good cosmetic results. 
• It's valuable to thoroughly discuss the procedure. Above, we talked about tumescent and superwet techniques (these both involve monitoring the ratio of injected fluid to the liquid, including fat, removed during liposuction). Proper fluid management is one of the fundamentals of a board-certified plastic surgeon’s training in caring for his/her patients. 
• Some patients (and their doctors) may prefer local anesthesia or epidural anesthesia (with or without conscious sedation); many patients want to sleep throughout the procedure. We believe that general anesthesia should be administered by a board-certified/board-eligible anesthesiologist or a certified registered nurse anesthetist. 
• The value of discussing risks and postoperative care is necessary. 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 surgical sessions. Liposuction is often performed as an outpatient procedure but if more than five liters (5,000 cc’s) of fat and fluid are removed, the patient should have an overnight hospital stay. 
  

See related Websites:

• American Society of Plastic and Reconstructive Surgeons - Liposuction
   
• American Society for Aesthetic Plastic Surgery - Liposuction
   
• ASPS - How to select a surgeon?

 
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