Liposuction is a surgical procedure for removing localised deposits of subcutaneous fat anywhere in the body. This technique uses small incisions and high vacuum to remove fat cells in selected regions and so improving the body contour in these areas. Fat distribution is determined by two factors – heredity and diet. Heredity determines the location and number of individual fat cells which are fixed and unchanging after puberty. Diet can increase or decrease the amount of fat in each cell but will not affect the total number of cells or their distribution. For example, if you have inherited large numbers of fat cells on your thighs and small numbers of fat cells on your chest, you will always have more fat on the thighs than on the chest, and strenuous attempts at weight loss can leave you with a thin upper body and persistently bulky thighs. When considering Liposuction, there are several elements to be considered. The following links provide important information on Liposuction:

• What is Liposuction
• Patient Information before choosing Liposuction
• Risks
• Post Operative Care

What is Liposuction

Liposuction is a surgical procedure for removing localised deposits of subcutaneous fat anywhere in the body. This technique uses small incisions and high vacuum to remove fat cells in selected regions and so improving the body contour in these areas.

The first time fat was ever aspirated was in Paris, in spring of 1977. A French woman had a large lipoma (fatty lump) on her back and she had refused excision, as the long scar would show with a low neckline. Her plastic surgeon friend, Illouz, found he could suck out animal fat, so tried it out on her. It worked! He also discovered that using back and forward movements avoided destruction of large vessels and nerves, leaving good nutrition for the skin. The skin is an elastic tissue that is capable of retraction – the question remained as to how much?

To improve fat removal and reduce blood loss, the tumescent technique for liposuction was developed by Klein in the late 1980s. In this technique, large amounts of fluids (normal saline) containing dilute adrenaline (for vaso-constriction) and a local anaesthetic, lignocaine or naropin (for pain) is used. This improves fat extraction and can also safely remove 4-5 litres. Smaller amounts (eg 500ml) can be removed with local anaesthesia only, sometimes combined with sedation.

Fat distribution is determined by two factors – heredity and diet. Heredity determines the location and number of individual fat cells which are fixed and unchanging after puberty. Diet can increase or decrease the amount of fat in each cell but will not affect the total number of cells or their distribution. For example, if you have inherited large numbers of fat cells on your thighs and small numbers of fat cells on your chest, you will always have more fat on the thighs than on the chest, and strenuous attempts at weight loss can leave you with a thin upper body and persistently bulky thighs.

Patient Information before choosing Liposuction

Patient Selection Criteria for Liposuction, include;

• Good physical and mental health.
• Cardiovascular disease or diabetes can increase complications.
• People with localised pockets of fat will have better results than those with generalised distribution of fat.
• Liposuction is not a substitute for a health diet or generalised weight reduction.
• Good skin elasticity and firmness give the best results. Tight skin is always seen in the very young and is gradually lost as we age. Even through middle age however, we retain some elasticity. The skin envelope always shrinks to adjust to the reduced contour in varying degrees.
• Have realistic expectations – your appearance after liposuction is influenced by general health, condition of skin, age, weight, hormonal and hereditary factors as well as the amount of fat removed. Full improvement is also not seen immediately – changes should be fairly dramatic, but on the day after surgery there will always be residual swelling from tissue trauma and some residual tumescent fluid that will be absorbed with time.
• Have little loose skin and musculature. If loose skin and lax musculature is present eg on the abdomen, additional procedures may be necessary such as an abdominoplasty (tummy tuck) or an inner thigh lift or upper arm tuck, or a total body lift to improve the hip contour and saggy buttocks.
• Do not expect a cure for ‘cellulite’. The word ‘cellulite’ has no precise medical meaning – most people use the term to refer to dimpling and irregularities that occur on the lower abdomen and thighs – it worsens with age and lack of exercise and may be associated with loose skin. Cellulite is due to protein degeneration in the skin and its supporting structures. Liposuction will not cure cellulite but it will remove fat and reduce contour. In mild cases, liposuction may lessen the intensity of cellulite. Severe cases however, require a tummy tuck or thigh lift for permanent improvement.
• Realise that liposuction is permanent. Adults become thinner or fatter by reducing or increasing the amount of fat in each cell. Liposuction removes fat cells and so reduces the ‘thickness’ of the fatty layer. If weight is gained after liposuction, fat is deposited in areas other than those treated. The area treated may increase a little but will not reach the size it was before liposuction.

Risks

All surgery has risks attached. These, and the steps taken to minimise them, will be discussed. 

• Bleeding – rare with the tumescent technique and the compression garment, which is worn immediately post-operatively, day and night for three weeks.
• Infection – rare, treated with antibiotics.
• Skin irregularities, lumpiness or hardness – most improve with post operative massage and may improve with time. Some may remain or require a ‘touch up’.
• Numbness or increased sensitivity to the skin over treated areas may occur and persist for months.
• Scars – should be 4-5mm long – they gradually fade and are usually not noticeable 12 months after surgery.
• Skin bruising – diminished with massage and Lasonil ointment, lasts for 3-6 weeks.
• Excessive liposuction – the goal of liposuction is not to remove the maximum amount of fat but to produce an optimal cosmetic improvement and maximise patient satisfaction.
• Seromas – temporary accumulation of fluid under the skin is not common.
• Allergic or toxic reactions to drugs
• Blood clots – the oral contraceptive pill is stopped one month prior to surgery, as well as any smoking. Aspirin and all anti-inflammatory and herbal medication stopped two weeks prior to surgery to prevent excessive bruising.

Post Operative Care

Post Operative Care for Liposuction, includes;

• Garment compression for three weeks – this helps the drainage of the tumescent fluid, reduces oedema due to tissue trauma and collapses the ‘holes’ created by the liposuction. The garment can be removed to have a shower.
• Wound care – keep incisions clean. Use Betadine liquid to clean and re-apply steri-strips if required or cover with hypafix until completely healed
• Do not apply ice packs or a heat pad to the skin overlying the areas treated by liposuction.
• Do not soak in a bath, Jacuzzi, swimming pool or the ocean for seven days after surgery.
• Massage or laser therapy – one or two sessions of low level laser therapy is recommended after liposuction. There is often a marked improvement in the level of discomfort experienced and a noticeable difference in the amount of post-operative swelling. There are three main physiological reasons for this – an increase in cells is noted – neutrophils, fibroblasts, endothelial cells, keratinocytes and macrophages. Macrophages engulf old and broken down cells. All this helps to speed up tissue repair. Other chemicals are released eg serotonin which aids the resolution of inflammation. (Any tissue trauma causes the process of inflammation) Thirdly, it diminishes the sensation of pain by increasing endorphins (released after any form of exercise) and decreasing bradykinin. It also affects nerve conduction by increasing the nerve conduction latency and decreasing the activity in the C-fibres (pain fibres). As an additional benefit it does not have the side effects of anti-inflammatory drugs which can cause increased bleeding.
• Activities – rest for the first 24 hours. Can resume exercise and physical activity 2-4 days after surgery. After liposuction a healthy eating plan and some form of exercise is highly recommended. Improvement will then continue.
• Anaesthesia – can be either local or general. With tumescent liposuction totally by local anaesthesia, surgeons typically remove no more than 2-3L of supernatant fat at one session. When using general anaesthesia some surgeons remove 5-8L of supernatant fat. The limit of safety however should never be exceeded. Surgeons should strive to obtain the best cosmetic result for the patient, enhancing the contour of various parts of the body, where fatty deposits mostly influenced by hereditary factors, cannot be changed by diet and exercise.