Accuracy in Liposuction
written by board-certified New York Plastic Surgeon Dr. Howard Bellin
I feel that there are many ways to achieve the same result, and different surgeons
will recommend different methods based on their experience. This is true of
every plastic surgery procedure, not just liposuction. I wish to
present a method of liposuction that I believe is superior to other
techniques for most of the prospective patients who want liposuction.
It is one that I developed myself and have used for over fifteen years. As you
have probably read, most practitioners do liposuction under total anesthesia. But doing
it that way can often be inaccurate, despite the skill of the surgeon. Doing
the surgery with a patient lying asleep on an operating table cannot achieve
the accuracy that I can with my technique. The problem is that while a patient
is lying asleep on an operating table, the fatty areas fall away, blending into
the rest of the body, making the decisions necessary for an accurate removal
of fat very difficult.
Accuracy is important, because if too much fat is removed from an area, it
will create deformities such as waviness, rippling, depressions or dimpling
of the skin. If that occurs, the problem is most likely to be permanent,
or at best require a second operation for correction of the defect. Typically, fat injections are used post-operatively to fill in the deformed
areas, but many doctors believe that the injected fat eventually dissolves,
leaving the distortion visible. (I think survival of the fat depends on the
technique used.) On the other hand, if not enough fat is removed, the operation
must be done over.
For this reason, I developed a highly accurate method of doing liposuction
under local anesthesia so that the patient can stand up several times during
the procedure and be evaluated. Obviously, one cannot stand up under general
anesthesia. When fat is removed, the skin contracts immediately, thus I can
make judgments as to how much more to remove and whether the area looks smooth.
The method works as follows: first I give you intravenous tranquilizers for
sedation so that you are not completely aware of what is happening, but you
are perfectly safe. Then local anesthesia is put into the areas to be operated
upon. Next, a period of about one half hour is allowed to pass for the anesthetic
to become fully effective and to let the tranquilizers wear off, so you are
awake enough to stand up for evaluation when necessary.
Then I make a small incision near the first of the areas to be treated and
the liposuction is begun. About half of the removal is carried out and then
I will ask you to get up so I can evaluate you. I can determine precisely how
much fat has been removed, from what areas and how much more I need to do; as
previously noted, the skin shrinks immediately so that I can make accurate judgments.
You will then be asked to lie down once again so I can remove a bit more fat.
Areas requiring more reduction are outlined with a temporary skin marker and
you will lie down again for more suctioning. This process is repeated several
times--stand up for evaluation, lie down for more suction. I take out little
bits at a time, very carefully, until it looks perfect. In this way there is
very little risk that too much fat will be removed or that some will be left
behind.
Sometimes the last little bit of fine-tuning is actually done with the patient
standing up. This is true body sculpting! All the areas being treated are done
in the same manner. At the end of the operation, you will be given a mirror
to see the outcome of the surgery. Long before there is any swelling, both you
and I can see the precise final result. You could even comment if you see some
little bit more that you think needs removal; but this rarely happens as my
nurse and I have a very good eye. Remember that I do not distort the tissue
by inflating it with fluid. I can see exactly what is happening.
I then take pictures with a digital camera while you are standing up. When
you come back to the office a week later and want to know how much swelling
there is, I show you the picture so that you feel at ease about the ultimate
success of the operation during the post-operative period. You do not worry
in the ensuing weeks that I did not get enough out. What you see is what you
will get.
Since I am using local anesthesia that contains epinephrine to constrict blood
vessels, just as with the tumescent technique, there is very little bleeding
and there is a delay of many hours before soreness sets in.
I have had almost universal success with this method and it is perfectly safe.
I have done about 1500 liposuctions in my career and have had to re-operate
on only three patients for minor corrections.
Once again, this is an original and unique method of liposuction--true, precision,
body sculpting.
|