Introduction to Liposuction
written by board-certified New York Plastic Surgeon Dr. Howard Bellin
Body contouring has become the major focus of plastic surgery today. Men and women
are more conscious of their bodies than ever before in history. It seems almost
everyone goes to a gym, has a personal trainer or uses exercise equipment at home.
But, after all their efforts to hone themselves into perfect condition fall short
of the mark, they turn to plastic surgery.
Liposuction (also called lipoplasty and suction assisted lipectomy) is the removal
of fat from under the skin by means of a strong suction device. The suction actually
pulls the fat cells out of the body. The skin then shrinks up and the contour
changes accordingly. It may seem like a pretty strange thing to do, but it really
works.
The best thing about the operation is that it is permanent. When you gain weight,
your fat cells enlarge; they do not multiply. (You are born with a fixed number
of fat cells in your body.) When the surgeon removes most of the fat cells in
a particular area, the few that are left can't make new ones, and obviously, the
ones that are gone cannot store fat. Once again, liposuction produces a permanent
change. Some people think that the fat just goes elsewhere in the body, but that
is not true. It is gone forever. However, if you gain weight later on, your body
must find some place to store the fat. That means that some other area of your
body could enlarge, but not the parts that have been treated.
Many areas of the body can be treated. The most common in women are the outer
thighs and the abdomen and hips. Other regions that can be successfully treated
include the neck, the upper arms, the inner thighs, the knees and the ankles.
The calves can rarely be done because there is usually only a little fat there.
The problem with large calves is usually muscular. The buttock area is also usually
not successful because there are fibers that connect the buttock skin to the muscle
that prevent the suction cannula from moving smoothly, although some good results
can occasionally be obtained. In men, the breasts and "love handles"
are the two areas most often done.
Liposuction can be done for almost everyone: very fat people, thin individuals
who just need a moderate change, or anyone in between.
The question is often asked as to whether a liposuction or a tummy tuck is preferable.
That decision is usually but not always easy. If you have extensive stretch marks,
a very bulging abdomen from muscle tears during pregnancy or hanging skin or fat,
then a tummy tuck is for you. If your problem is mostly fat deposits, then you
will need a liposuction. Your doctor will advise you which is preferable when
he performs his examination.
Liposuction Procedure
Here's the way it works: the operation is most often done with the patient completely
asleep, but it can be done with tranquillizers and local anesthesia. A tiny incision
(a bit more than a quarter of an inch) is made near the area to be dealt with.
Then a thin, hollow metal tube (a "cannula") that is connected by a
tube to a high-powered suction pump is inserted. It is run back and forth under
the skin and over the muscle, which is where the fat resides. The fat cells and
the fat that they contain are sucked out into a jar, thus removing them permanently.
As this happens, the skin contracts, just after it does on a woman's stomach after
she has had a baby.
Liposuction Recovery
There is no pain during the surgery, but afterwards when the anesthesia wears
off, you will be sore. However, it is not severe pain. It feels like muscle aches
from too much exercise, because the covering of the underlying muscles have been
irritated. You will probably take some pain pills for a few days, but you should
be able to return to a non-strenuous job with a few days. However, you will be
asked not to do any vigorous exercise for two weeks.
One week after the operation you would return to the office to have the sutures
removed from each incision site, where small scars will soon form.
You will be asked to wear a compression garment after the surgery. It is essentially
made of elastic and is meant to help keep the swelling down the way a corset or
girdle would. Garments are made for different parts of the body.
You will be black and blue in the areas liposuctioned that will last about three
weeks. There will also be some swelling, but it will only be a little bit, certainly
almost never as much as when the fat was present. It takes two to three weeks
for most of the swelling to go away, but it can take two to three months for the
last little bits of the swelling to disappear.
The operation looks easy, thus lots of doctors with other specialties than plastic
surgery think they can do it after just taking a weekend course. But it is a surgical
procedure and there are many nuances to the technique. A lot of experience is
required to do it right.
Liposuction Risks
There are some risks that you need to be aware of. The most important relates
to the shrinking of the skin. If you have good skin tone and a modest amount of
fat is being removed, the skin will shrink perfectly. If there is a great deal
of fat, it may not. And if you have a lot of stretch marks in the area being suctioned,
there may be a problem. Stretch marks are like tears in the skin, and because
of them, much of the elasticity is lost. And the skin of different parts of the
body behaves differently. It is up to your doctor to assess your skin based on
his experience and to advise you of what you can expect. His judgment is key.
This is a very important reason to find someone who has extensive experience in
the area, not someone who has another specialty and does an occasional liposuction.
Infection is a very rare occurrence. Preventative antibiotics are usually given.
But every patient should be advised that infection is a risk.
The real risk, again, is in the appearance of the skin. Irregularities may result
such as waviness, rippling, dimples or depressions. This happens because too much
fat is removed from one area and not from another. The judgment as to whether
the fat removal has been done smoothly is often difficult to make.
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